A new approach to the lower cervical-thoracic spine with dislocation of the sterno-clavicular joint: FAMA (Fast Anterior Medium Approach)

Purpose To evaluate the Fast Anterior Medium Approach (FAMA) as an alternative to traditional anterior cervico-thoracic approaches, enhancing access to the C7-T1-T2 and T2-T4 junctions while minimizing postoperative morbidity. The cervico-thoracic junction is one of the most challenging regions to access surgically due to its deep location and proximity to critical neurovascular structures. Conventional approaches, including postero-lateral thoracotomy and transmanubrial techniques, are associated with high morbidity. The FAMA technique was designed to provide enhanced exposure while reducing surgical trauma. Methods A cadaveric study was performed to understand how FAMA approach could find application in spine surgery in order to obtain wider access to the cervico-thoracic spine with lower post-operative morbidity compared to the surgical procedure with sternotomy. This approach involves controlled dislocation of the sterno-clavicular joint to extend anterior access without requiring sternotomy. Results The approach allowed excellent exposure of the thoracic apex, enabling safe spinal stabilization procedures with minimal disruption to surrounding structures. No major neurovascular injuries occurred. Conclusion The FAMA approach represents a viable alternative to conventional cervico-thoracic surgical techniques, offering improved visualization and accessibility while preserving anatomical integrity. This technique has the potential to reduce morbidity and improve patient recovery. Larger-scale studies are required to validate these findings.