Table 4.

Review of the larger series reported with the transmanubrial approach along with complications and outcomes

Author and year	Number of cases	Complications	Outcomes	Levels fused	Remarks
Xiao (2007)[15]	28	11 patients had bradycardia and hypotension, 3 had recurrent laryngeal nerve paresis	Improvement in pain and neurological symptoms in all	C7–T4	On the right side, its easier approach than left due to thoracic duct
Liu et al. (2009)[16]	11	1 patient had recurrent laryngeal nerve palsy, 1 patient had chyle leak	Improvement in incomplete cord injury and radiculopathy	C6–T2	Adequate access to upper cervical region
Falavigna et al. (2009)[17]	14	Hematoma - 1 Dysphonia - 1	Improvement in all patients	C7–T4	C7 corpectomy and C7–T1 intervertebral disc herniation, a transcervical approach without the manubriotomy was indicated; when a T1 and/or T2 corpectomy was necessary, the transmanubrial approach usually was necessary in order to provide a good working space to perform a corpectomy and reconstruction
Jiang et al. (2010)[18]	16	1 patient hoarseness of voice	8 patients had neurological improvement	C7–T4	It leads to better visulaisation
Zengming et al. (2010)[19]	54	-	Improvement in radiculopathy and myelopathy	C7–T4	Adequate access to spine and immediate stability
Park et al. (2015)[20]	13	Chylothorax - 1 Hoarseness of voice - 2	Improvement in VAS and Frenkel	C7–T3	The transmanubrial approach for CTJ lesions can achieve favorable clinical outcomes by providing direct decompression of lesion and effective reconstruction
Mihir et al. (2006)[21]	28	Left recurrent laryngeal nerve palsy 2 cases	Improvement in neurological deficits	C7–T4	Safe approach for stabilization of anterior spine

VAS – Visual analog scale; CTJ – Cervicothoracic junction