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described an anterior cervical approach with a median sternotomy to access the cervicothoracic junction. In 1960, Hodgson et al. 7 described the high anterior transthoracic approach, which allowed for access to the upper thoracic segments but had limited to no exposure of the lower cervical spine ( Fig. 5 , Approach 5). Sundaresan and colleagues 20 repopularized the low anterior cervical approach, incorporating an additional resection of the medial third of the clavicle for increased exposure ( Fig. 5 , Approach 2). This approach was followed by several different