The transmanubrial approach first reported by Grunenwald in 1997 is well-known for superior sulcus lung malignancies involving the thoracic inlet. Because an anterior approach to levels below Th2 is difficult without removing the manubrium, we used the transmanubrial approach for anterior cervicothoracic corpectomy and fusion (C7–Th3) in a patient with bilateral lower extremity paralysis due to ossification of the posterior longitudinal ligament in the cervicothoracic spine. To ensure more working space in the deep surgical field, which was hindered by a prior cardiac operation with median sternotomy and a goiter protruding into the upper mediastinal region, the right brachiocephalic vein was temporarily divided and subsequently reconstructed using bovine pericardium.