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- The ligaments connecting the ribs to the thoracic vertebrae.
- Three common surgical approaches - the anterior (trans-thoracic) approach, posterolateral (costotransversectomy) approach, and posterior approach. Each approach is described in terms of indications, patient positioning, incision details, and important anatomic structures to identify and retract.
- Considerations for each approach like potential complications and the structures at risk of injury.
To describe the structure of the thorax, cutaneous innervations of thorax (concept of the myotomes and dermatomes) and of bony framework that forms part of the thorax, and how it is adapted to their functions
To define the thorax, rib cage and thoracic wall.
To describe the structures that form the boundary of the rib cage i.e ribs, sternum, vertebrae.
To outline the clinical importance of the structures that form the rib cage.
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3. • 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. 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.
7.
8.
9. • T1 – Superior facet is not a demifacet, as this
is the only vertebrae to articulate with the
1st rib.
• T10 – A single pair of whole facets is present
which articulate with the 10th 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.
10.
11.
12.
13. • 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.
•
14. • L1 TO L5 BODY SIZE INCREASE
• the L5 vertebra has the heaviest body,
smallest spinous process, and thickest
transverse process.
15.
16.
17.
18. • ANTERIOR (TRANSTHORACIC)
APPROACH TO THE THORACIC SPINE
• Posterolateral
(Costotransversectomy) Approach to
the Thoracic Spine
• Posterior Approach to the Thoracic
and Lumbar Spines
19. • Effective in
• Treatment of infections, such as tuberculosis of the
thoracic vertebral bodies20
• 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
20. • On the side
• Move arm above
his head
• Approach from right
side
21. • Inferior angle of the
scapula
• Spinous process
• Inframammary crease
• Incision
37. • Midline straight
• Internervous plane-
midline paraspinal
muscles
• it is truly
internervous; the
nerves do not cross
the midline
38. • The paraspinal muscles are innervated
segmentally by the posterior primary rami
of the individual nerve roots in the thoracic
and lumbar spines.
39.
40. • 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
41. • Remove the paraspinal
• remove the short rotators from the base of the spinous
processes to the leading edges of the laminae
42.
43. • 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
