Research Article Mini Transsternal Approach to the Anterior High Thoracic Spine (T1–T4 Vertebrae) Christian Brogna, 1 Bhaskar Thakur, 1 Leslie Fiengo, 2 Sandra Maria Tsoti, 3 Alessandro Landi, 4 Giulio Anichini, 4 Francesco Vergani, 1 and Irfan Malik 1 1 Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK 2 Department of Vascular Surgery, King’s College Hospital NHS Foundation Trust, London, UK 3 Faculty of Medicine, Imperial College London, London, UK 4 Department of Neurosurgery, “Sapienza” University of Rome, Rome, Italy Correspondence should be addressed to Christian Brogna; christian.brogna@gmail.com Received 27 October 2015; Accepted 14 March 2016 Academic Editor: William B. Rodgers Copyright © 2016 Christian Brogna et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. Te anterior high thoracic spine is one of the most complex segments to be accessed surgically due to anatomical constraints and transitional characteristics. We describe in detail the mini transsternal approach to metastatic, infective, traumatic, and degenerative pathologies of T1 to T4 vertebral bodies. We analyse our surgical series, indications, and outcomes. Methods. Over a 5-year period 18 consecutive patients with thoracic myelopathy due to metastatic, infective, traumatic, and degenerative pathologies with T1 to T4 vertebral bodies involvement received a mini transsternal approach with intraoperative monitoring. Frankel scoring system was used to grade the neurological status. Results. Mean follow-up was 40 months. 78% patients improved in Frankel grade afer surgery and 22% patients remained unchanged. Average operation time was 210 minutes. Tere were no intraoperative complications. One patient developed postoperative pneumonia successfully treated with antibiotics. Conclusion. Te mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions afecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca. Tis approach overcomes the anatomical constraints of this region and provides adequate room for optimal reconstruction and preservation of spinal alignment in the cervicothoracic transition zone with good functional patient outcomes. 1. Introduction Neoplastic lesions, infectious processes, disc herniations, traumatic fractures, and severe kyphotic deformities can occur in the anterior upper thoracic spine [1–9]. Historically, anterior access to the cervicothoracic junction down to T4 vertebrae has been hampered by anatomical constraints, namely, the supra-aortic trunks, and the transition from cervical lordosis to thoracic kyphosis [8–15]. Adequate and early visualisation of the anterior thecal sac and the need to avoid postoperative kyphotic deformities and instability are paramount [8, 9, 14–18]. We describe our experience with the mini transsternal approach, in a wide range of diseases involving the anterior upper thoracic spine. Tis approach provides excellent direct access to the upper thoracic vertebral bodies, optimising both the neurological outcome and the preservation of spinal alignment in the cervicothoracic transition zone. 2. Materials and Methods 2.1. Patient Population. Between January 2010 and January 2015, 18 patients with various pathological entities involving the anterior upper thoracic spine from T1 to T4 received a mini transsternal approach by the most senior author I. Malik (Table 1). All patients presented with thoracic myelopathy, and the average time to diagnosis was 5 months (1–9 months). Neurological status was graded according to Frankel scoring system. Preoperative neuroimaging included MRI spine and Hindawi Publishing Corporation BioMed Research International Volume 2016, Article ID 4854217, 9 pages http://dx.doi.org/10.1155/2016/4854217