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1Introduction

The cervico-thoracic junction

The cervico-thoracic junction has a specific biomechanical behavior. 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 shear forces. Usually a long construct (2-3 levels above and 2-3 below the tumor) 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.