In this report, we discuss two cases of upper thoracic myelopathy, treated successfully with anterior decompression and fusion utilizing sternum manubrium splitting approach. When considering surgical approach to lesions around the spinal canal, lesions existing in the anterior of spinal canal can basically be treated more effectively from the anterior approach. This is especially true at the thoracic level, because of physiological kyposis of the thoracic spine. Since the conventional anterior approach is difficult for the upper thoracic spine, this approach proves very useful for the treatment of intracanal lesions at the upper thoracic level localized at the anterior of the spinal canal.
