The cervico thoracic junction has a specific biomechanical behaviour. This is due to the sudden change from the extremely flexible cervical spine, to the more rigid thoracic spine.
The thoracic spine has a shorter elastic zone due to:
- The rigid rib cage
- The coronal orientation of the facet joints
- The overlapping of the spinous processes.
Biomechanically the cervico thoracic junction is vulnerable to kyphosis and sheer forces. Usually a long construct (2-3 levels above and 2-3 below the dislocation) is necessary to achieve adequate stability. That is why the anterior alone constructs at this level are not recommended because of high failure risks.
The anterior approaches might be difficult because of complex anatomy involving numerous essential anatomical structures at this level.