The anteromedial approach is an extension of the Smith–Robinson approach. It is medial to the sternocleidomastoid muscle and medial to the carotid sheath. This method allows exposure from C1 to T2 [1] and can be combined with an osteotomy of the sternoclavicular joint to allow a greater exposure at T2. The thoracic duct must be avoided with the left anteromedial approach. The recurrent laryngeal nerve should be identified with the right-side approach. The inferior thyroid artery and vein may need ligation, and the apex of the lung must be avoided.

The anterolateral approach to the cervicothoracic junction is an extension of the Hodgson approach [2] combined with the Nanson supraclavicular approach [3], in which the sternocleidomastoid is removed from the clavicle. The spine is approached from the right side, lateral to the carotid sheath and vessels. With the carotid sheath and internal jugular vein retracted medially, the anterior scalene muscle may be divided and the phrenic nerve retracted for greater exposure.