الفهرس 
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Abstract
Different surgical approaches has been developed to approach the cervicothoracic junction of spine; these including anterior, posterior, anterolateral and posterolateral approaches. The aim of this systematic review was to compare between them regarding achieving surgical goals, indicating pathologies, outcomes and complications.
A literature search was conducted in March 2017 revealed 146 related studies, and after screening and then applying the inclusion and exclusion criteria, they were filtered to 19 case series studies. Patients of those case series were grouped according to approaches, and comparisons were done between patients of anterior and posterior groups only as they contained the majority of patients in contrast to other groups, which they had statistically insignificant minorities.
Surgical goals were found to be achieved in most patients but detailed data were unavailable to do thorough analysis. Patients were then stratified according to age, and pathologies within the two groups to compare outcomes and complications.
Clinical outcome in generally showed that the majority of patients (72%) operated with anterior approach had improved postoperatively, while patients operated via posterior approaches showed close chances (46% and 50%) between improving and staying with the same neurological status as preoperative. Attempting to compare postoperative neurological outcomes according to pathologies yielded tendency for improvement in traumatic, infection and degenerative subgroups of anterior approaches patients. And in posterior approaches group patients tended to show unchanged neurological function postoperatively in both traumatic and neoplastic subgroups, while much of the infection subgroup patients improved postoperatively.
Complications were different between anterior and posterior groups. In anterior group 2 prominent complications were recurrent laryngeal nerve palsy (11%) and instrumentation failure (10%). While in posterior approaches the most frequent were prolonged ICU stay (28%), lung infection (12%) and tracheostomy (10%).
In conclusion, the anterior and posterior approaches showed similar success rates of achieving surgical goals. Complications are different between them, and
Summary
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this is because different structures are encountered in different approaches, as well as the nature of pathology indicating that surgery can contribute to initial neurological deficit rendering it permanent and decreasing neurological function. The choice of surgical approach should be based on careful study of each patient’s condition with regards to pathology, anatomy and technique of surgery; one of the most important determining factors is the surgeon’s capabilities and contrasting hand skills. There is no evidence that there is an absolute approach that is safer than the other or a more suitable approach for all CTJ diseases