• Hong-Ming Xu, Fei Hu, Xiang-Yang Wang, and Song-Lin Tong.
• Department of Orthopaedic Surgery, Affiliated Cixi Hospital, Wenzhou Medical University, Cixi, Ningbo, People's Republic of China.
• World Neurosurg. 2019 Apr 1; 124: e793e798e793-e798.

ObjectiveWe sought to identify the morphological features of the relationship between the manubrium and vertebrae of the cervicothoracic junction for use in guidelines for the selection of the appropriate surgical approach.MethodsWe performed a review of 222 midsagittal section magnetic resonance imaging scans. The surgeons' view line was parallel to the inferior caudal vertebral endplate. Morphometric measurement of the manubrium and the cervicothoracic junction's vertebral body included the distance from the highest point of the manubrium to the surgeons' view line and the angle between that line to the horizontal line.ResultsA significant difference was found with regard to the distance between the groups (P < 0.001). A significant difference between males and females was also identified. The lowest level above the manubrium was the T1. Between the groups, the angles were significantly different (P ≤ 0.01). Males had a larger angle than females with respect to groups C6, C7, T1 (P < 0.001), and T2 (P = 0.007). In terms of both the distance and the angle, no significant difference was found according to age (P > 0.05).ConclusionOur results have provided insight into the anatomy of the manubrium and vertebrae of the cervicothoracic junction. Furthermore, our results have shown that, for most people, the T1 forms the boundary of the manubriotomy. We found that both the distance and angle differed significantly according to sex. A better understanding of the radiological anatomy of the surgeons' view line will help in the preoperative assessment of patients and in indicating an appropriate surgical approach.Copyright © 2019 Elsevier Inc. All rights reserved.

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