OrthoNet

Thoracic spine - posterolateral approach
Costotransversectomy

* position - prone with bolsters positioned long.

* incision - curved linear incison about 8 cm lat. to appropriate spinous process

* no internervous plane

* dissection
- incise subcut. fat & fascia in line with skin incision
- cut thru trapezius in line with fibers close to transverse processes
- cut down to post. aspect of rib to be resected
- separate all muscle attachments from rib subperiosteally
- dissect lat. along sup. border of rib & med. along inf. border
- divide rib about 6-8 cm from midline
- detach any remaining muscle & twist rib’s med. end to complete resection
- remove muscle from TP
- remove TP at jxn with lamina & pedicle
- enter retropleural space by digital palpation
- remove parietal pleura from vert. body

* dangers
- dura - if dissection is extensive around vert. body & central canal entered
- intercostal art. - safe with subperiosteal dissection
- pleura - initially use blunt dissection