Anatomy of thoracic vertebra

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1. ANATOMY OF THORACOLUMBER SPINE AND VERTEBRAL COLUMN APPROACHES TO THORACOLUMBER SPINE PRESENTER : DR. SANDEEP TRIPATHI MODERATOR : PROF R. NANDAKUMAR

2. ANATOMY OF THORACIC VERTEBRA 12 thoracic vertebra Typical thoracic are 2-9

3. CHARACTERISTIC FEATURES Vertebral body is  heart shaped . Presence of  demi-facets  on the sides of each vertebral body – these articulate with the heads of the ribs.

4. Presence of  costal facets  on the transverse processes – these articulate with the tubercles of the ribs. They are present on T1-T10 only. The   spinous processes  are long

5. SUPERIOR AND INFERIOR COSTAL FACETS  The superior facet articulates with the head of the adjacent rib, and the inferior facet articulates with the head of the rib below T2- T9 is a typical vertebra these facets are  demi-facets .

6. ATYPICAL VERTEBRAE T1  – Superior facet is not a demifacet , as this is the only vertebrae to articulate with the 1 st  rib. T10  – A single pair of whole facets is present which articulate with the 10 th  rib. These facets are located across both the vertebral body and the pedicle . T11  and  T12  – Each have a single pair of entire costal facets, which are located on the pedicles.

7. LIGAMENTS

8. UNIQUE TO THORACIC SPINE Radiate ligament of head of rib  – from the head of the rib to the bodies of the two vertebrae and intervertebral disc. Costotransverse ligament  – Connects the neck of the rib and the transverse process Lateral costotransverse ligament  – from the transverse process to the tubercle of the rib. Superior costotransverse ligament  – Passes from the upper border of the neck of the rib to the transverse process of the vertebra superior to it.

9. LUMBER VERTEBRA L1 TO L5 BODY SIZE INCREASE the L5 vertebra has the heaviest body, smallest spinous process, and thickest transverse process .

10. APPROACH TO THORACIC SPINE ANTERIOR (TRANSTHORACIC) APPROACH TO THE THORACIC SPINE Posterolateral ( Costotransversectomy ) Approach to the Thoracic Spine Posterior Approach to the Thoracic and Lumbar Spines

11. ANTERIOR (TRANSTHORACIC) APPROACH Effective in Treatment of infections, such as tuberculosis of the thoracic vertebral bodies 20 Fusion of the vertebral bodies Resection of the vertebral bodies for tumor and reconstruction with bone grafting Correction of scoliosis (Dwyer instrumentation technique and rods) Correction of kyphosis Anterior spinal cord decompression Biopsy

12. POSITION On the side Move arm above his head Approach from right side

13. LANDMARKS Inferior angle of the scapula Spinous process Inframammary crease Incision

14. superficial incision Latismus Dorsi division Serratus anterior- elevate scapula Rhomboids? Bleeding Resect ribs

15. Cut the periosteum on the upper border of the rib.

16. Deep Dissection Deflate lungs Retract anteriorly Identify oesophagus Incise pleura

17. Retract the oesophagus IC vessels that cross the field need to be ligated Cord ishemia

18. Posterolateral ( Costotransversectomy ) Approach to the Thoracic Spine Indication Abscess drainage Vertebral body biopsy Partial verterbral body resection Limited anterior spinal fusion Ant. Lateral decompression of the spinal cord

19. Position Prone Bolsters Drape widely

20. Incision Curvilinear lateral to spinous process Center over thIncisione involved rib

21. No true internervous plane Trapezius is cut

22. Cut onto the posterior aspect of the rib to be resected Incise the periosteum over the rib

23. Separate muscles from the rib using subperiosteal resection

24. Divide rib 8 cm from the midline Cut muscle attachment and costotransverse ligaments

25. Enter the retropleural space by blunt dissection and digital palpation Safe in disease only

26. DANGERS Nerves- Dura intercostal vessels Lungs- pneumo thorax

27. POSTERIOR APPROACH TO THE THORACIC AND LUMBAR SPINE Indications Scoliosis Posterior spine fusion Removal of tumour of the posterior aspect of the vertebra Open biopsy Stabilization of fractures vertebrae

28. POSITION Prone Bolsters Landmarks – gluteal cleft, C7 T1

29. INCISION Midline straight Internervous plane- midline paraspinal muscles it is truly internervous ; the nerves do not cross the midline

30. The paraspinal muscles are innervated segmentally by the posterior primary rami of the individual nerve roots in the thoracic and lumbar spines.

31. SUPERFICIAL SURGICAL DISSECTION Palpate the individual spinous processes dissect down to the middle of the spinous processes and move the muscle origins to either side of the surface

32. DEEP SURGICAL DISSECTION Remove the paraspinal remove the short rotators from the base of the spinous processes to the leading edges of the laminae

33. DANGERS The posterior primary rami emerge posteriorly from between the transverse processes, close to the facet joints. Because of the significant overlap of innervation in the paraspinal muscles Segmental vessels

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