Thoracic spine – posterolateral approach

* 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

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