Anterior Approach to the Cervicothoracic Junction Without Sternotomy
Bibliographic record
Abstract
In Brief Study Design. Description of a new anterior approach to the cervicothoracic junction and retrospective study of results. Objective. To propose a less invasive anterior approach and report the preliminary results of this technique. Summary of Background Data. Different partial sternotomies with or without associated clavicular resection have been proposed but expose patients to the risk of pseudarthrosis. A less invasive technique should reduce the morbidity of this surgery. Methods. From 2000 to 2004, 37 patients were operated between T1 and T4. Whenever possible, access was limited to a left standard cervical approach anterior to the carotid sheath extended caudally. If necessary, partial manubrial resection preserving the sternoclavicular joints was performed to extend the exposure. In the majority of cases, metastatic spinal cord compression was involved. Results. The average duration of surgery was 114 minutes; the average blood loss was 760 mL. For access to the vertebral body of T2, a standard anterior cervical approach alone was always sufficient. For exposure of T3 and T4, median manubrial resection was performed in roughly 1 case out of 2. This was used in every case for T5. There were 4 severe and 3 mild complications. Conclusion. This approach provides satisfactory access to the anterior aspect of the spine down to T5 while preserving the sternoclavicular joints. Thirty-seven patients had surgery of the cervicothoracic junction between T1 and T4 through an anterior approach. The technique was as minimally invasive as possible by performing a standard anterior cervical approach anterior to the carotid sheath completed, if necessary, by an isolated manubrial resection. This access provides satisfactory exposure of the anterior aspect of the spine with relatively low morbidity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".