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Surgical Approaches for Various Pathologies
Levels
Disc Herniation
Approaches
Central, centrolateral
Central, centrolateral
Centrolateral, lateral
Central, centrolateral, lateral
Central, centrolateral, lateral
Centrolateral, lateral
Central, centrolateral, lateral
Lateral
Transsternal
Medial clavisectomy
Costoransversectomy
Transthoracic
Thoracoscopy
Lateral
Costoransversectomy
Tranpedicular
CALCIFIED DISC
T1 to T4
Central, centrolateral
Central, centrolateral
Lateral
T4 to T12
Central, centrolateral, lateral
Lateral
Lateral, centrolateral
Transsternal
Medial clavisectomy
Costoransversectomy
Transthoracic
Lateral
Costoransversectomy
SOFT DISC
T1 to T4
From Mirkovic S: Thoracic disc herniation herniations. In Garfin S R, Vaccaro AR, eds: Orthopaedic
knowledge undate: spine, Rosemont III, 1997. American Academy of Orthopaedic Surgeons, pp 87-96.
Thoracic Pedicle
• Larger superior-inferior dimensions than transverse
widths create oval shape.
• Average height is 8 to 15 mm; average width is 3 to
10mm
• Diameter is less than 5mm in 35%of pedicles.
• Transverse plane angulation at T4 is around 15 degrees
medially; it becomes more parallel to sagittal plane T5 to
T12, path may be diverged.
• Entry point is 7 to 8 mm medial to lateral edge of
superior facet and 3 to 4 mm superior to midline of
transverse process of T1 and T2. Between T3 and T12,
point lies 5mm medial to lateral edge of superior facet
and 5mm superior to midline of transverse process.
Pedicle Screw Placement
•
•
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Stereotactic guidance
Fluoroscopically guided
Manual technique
CT Scan
How Accurately Do Novice Surgeons Place
Thoracic Pedicle Screws
with the Free Hand Technique?
surgeons placing thoracic pedicle screws in
cadavers were able to significantly improve by the
fourth cadaver practice
Ryan K. Bergeson, et al. Spine Vol 33(15), 2008.
Reliability of Three-dimensional Fluoroscopy
for Detecting Pedicle Screw Violations
in the Thoracic and Lumbar Spine
real-time intraoperative imaging, 3-D
fluoroscopy may enhance the safety of
thoracic transpedicular instrumentation.
Neurosurgery 2004;Vol.54(5), pp 1138–1143
Michael Y. Wang, M.D. et al.
Risks
•
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Vascular injury
Spinal cord injury
Malposition
Pulmonary injury