Managing disorders of the cervicothoracic junction.

A wide range of pathologic conditions occur at the cervicothoracic junction. These conditions are usually the result of trauma, neoplastic processes, infection, prior surgery, or degenerative changes. Instability in this region of the spine is difficult to manage, particularly because of the complex biomechanics involved and the challenging surgical approaches required for treatment. Traditional radiologic evaluation of the cervicothoracic junction is often inadequate; as a result, the standard 3-view cervical spine series should be augmented with swimmer's or oblique views. Surgical treatment, designed to increase stability and allow early mobilization and rehabilitation, often requires internal fixation devices; lateral-mass or pedicle screws are increasingly being used to avoid complications associated with devices occupying the spinal canal. Although posterior surgical approaches to the cervicothoracic junction are relatively straightforward, anterior approaches require mastery in traversing the various bony and soft-tissue structures.