Uninstrumented anterior corpectomy with structural bone grafting for ventral reconstruction at the cervicothoracic junction: A technical case series

Background: Ventral reconstruction at the cervicothoracic junction (CTJ) is technically demanding due to the depth of the operative field and the frequent need for manubrial or sternal extension to achieve adequate exposure. Although anterior plating is commonly recommended, instrumentation at C7–T1 is often difficult, and the role of uninstrumented structural grafting in this region remains poorly defined. This study evaluates the feasibility, radiological, and clinical outcomes of anterior corpectomy with uninstrumented autologous structural grafting at the CTJ. Materials and Methods: This retrospective observational series included patients with traumatic CTJ injuries who underwent anterior corpectomy with uninstrumented structural autograft reconstruction with/without posterior stabilization at a tertiary neurosurgical center by a single surgeon between 2012 and 2023. Demographic, radiological, surgical, and functional data were collected. Patients were followed clinically and radiologically at 6 months postoperatively and annually thereafter. Fusion was assessed using computed tomography and dynamic radiographs. Results: Seven patients (mean age 45.6 years; range 10–73), all with traumatic CTJ injuries, were included. Pathologies comprised C7–T1 spondyloptosis ( n = 2), high-grade C6–7/C7–T1 listhesis or fracture-dislocation ( n = 5). Corpectomy levels comprised four two-level corpectomies, two single-level corpectomies, and one three-level corpectomy. No patient required manubriotomy or sternotomy. Posterior stabilization was performed in six patients. Clinical follow-up was available in four patients (mean 34.8 months; range 15–129), with two demonstrating improvement in Nurick grade and two remaining neurologically stable. Radiological follow-up confirmed solid fusion in all evaluated cases. Two patients developed transient postoperative hoarseness; no other complications were observed. Conclusion: Uninstrumented structural grafting following anterior corpectomy at the CTJ is a feasible and safe ventral reconstruction strategy when combined with appropriate posterior stabilization. This technique achieves reliable fusion and avoids the need for manubriotomy or sternotomy in selected traumatic CTJ injuries.