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PRESENTER : DR. SANDEEP TRIPATHI
MODERATOR : PROF R. NANDAKUMAR
•12 thoracic vertebra
• Typical thoracic are 2-9
• Vertebral body is heart shaped.
• Presence of demi-facets on the sides
of each vertebral body – these
articulate with the heads of the ribs.
• 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
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.
Anatomy of thoracic vertebra
Anatomy of thoracic vertebra
Anatomy of thoracic vertebra
• 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.
Anatomy of thoracic vertebra
Anatomy of thoracic vertebra
Anatomy of thoracic vertebra
• 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.
•
• L1 TO L5 BODY SIZE INCREASE
• the L5 vertebra has the heaviest body,
smallest spinous process, and thickest
transverse process.
Anatomy of thoracic vertebra
Anatomy of thoracic vertebra
Anatomy of thoracic vertebra
• ANTERIOR (TRANSTHORACIC)
APPROACH TO THE THORACIC SPINE
• Posterolateral
(Costotransversectomy) Approach to
the Thoracic Spine
• Posterior Approach to the Thoracic
and Lumbar Spines
• 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
• On the side
• Move arm above
his head
• Approach from right
side
• Inferior angle of the
scapula
• Spinous process
• Inframammary crease
• Incision
• Latismus Dorsi
division
• Serratus anterior-
elevate scapula
• Rhomboids?
• Bleeding
• Resect ribs
• Cut the periosteum
on the upper border
of the rib.
• Deflate lungs
• Retract anteriorly
• Identify oesophagus
• Incise pleura
• Retract the
oesophagus
• IC vessels that cross
the field need to be
ligated
• Cord ishemia
• Indication
•Abscess drainage
•Vertebral body biopsy
•Partial verterbral body resection
•Limited anterior spinal fusion
•Ant. Lateral decompression of the spinal
cord
• Prone
• Bolsters
• Drape widely
• Curvilinear lateral
to spinous process
• Center over
thIncisione involved
rib
• No true internervous
plane
• Trapezius is cut
• Cut onto the posterior
aspect of the rib to be
resected
• Incise the periosteum
over the rib
• Separate muscles
from the rib using
subperiosteal
resection
• Divide rib 8 cm from
the midline
• Cut muscle
attachment and
costotransverse
ligaments
• Enter the retropleural
space by blunt
dissection and digital
palpation
• Safe in disease only
• Nerves- Dura
• intercostal vessels
• Lungs- pneumo thorax
• Indications
•Scoliosis
•Posterior spine fusion
•Removal of tumour of the posterior
aspect of the vertebra
•Open biopsy
•Stabilization of fractures vertebrae
• Prone
• Bolsters
• Landmarks – gluteal
cleft, C7 T1
• Midline straight
• Internervous plane-
midline paraspinal
muscles
• it is truly
internervous; the
nerves do not cross
the midline
• The paraspinal muscles are innervated
segmentally by the posterior primary rami
of the individual nerve roots in the thoracic
and lumbar spines.
Anatomy of thoracic vertebra
• 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
• Remove the paraspinal
• remove the short rotators from the base of the spinous
processes to the leading edges of the laminae
Anatomy of thoracic vertebra
• 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
Anatomy of thoracic vertebra

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Anatomy of thoracic vertebra

  • 1. PRESENTER : DR. SANDEEP TRIPATHI MODERATOR : PROF R. NANDAKUMAR
  • 2. •12 thoracic vertebra • Typical thoracic are 2-9
  • 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.
  • 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.
  • 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.
  • 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
  • 22. • Latismus Dorsi division • Serratus anterior- elevate scapula • Rhomboids? • Bleeding • Resect ribs
  • 23. • Cut the periosteum on the upper border of the rib.
  • 24. • Deflate lungs • Retract anteriorly • Identify oesophagus • Incise pleura
  • 25. • Retract the oesophagus • IC vessels that cross the field need to be ligated • Cord ishemia
  • 26. • Indication •Abscess drainage •Vertebral body biopsy •Partial verterbral body resection •Limited anterior spinal fusion •Ant. Lateral decompression of the spinal cord
  • 28. • Curvilinear lateral to spinous process • Center over thIncisione involved rib
  • 29. • No true internervous plane • Trapezius is cut
  • 30. • Cut onto the posterior aspect of the rib to be resected • Incise the periosteum over the rib
  • 31. • Separate muscles from the rib using subperiosteal resection
  • 32. • Divide rib 8 cm from the midline • Cut muscle attachment and costotransverse ligaments
  • 33. • Enter the retropleural space by blunt dissection and digital palpation • Safe in disease only
  • 34. • Nerves- Dura • intercostal vessels • Lungs- pneumo thorax
  • 35. • Indications •Scoliosis •Posterior spine fusion •Removal of tumour of the posterior aspect of the vertebra •Open biopsy •Stabilization of fractures vertebrae
  • 36. • Prone • Bolsters • Landmarks – gluteal cleft, C7 T1
  • 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.
  • 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
  • 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