Thoracotomy Approach

Abstract

Use the standard thoracotomy approach for safe exposure of vertebral levels T2-L2. Proper rib selection depends on the pathology for most cases, especially those involving a strut graft. The rib to resect for a certain vertebral level is chosen by one of two methods:

• 1. When the pathology dictates a direct anterior approach to the vertebral column, that is, kyphotic TB abscess, choose the rib directly horizontal to the vertebral level at the midaxillary line in an anteroposterior (AP) chest X-ray. The rib removed must be cephalad to the lesion to give adequate proximal exposure while working down the lesion. ¹

• 2. When direct access to the spinal canal is needed at one disc, that is, a thoracic disc excision, resect the rib that leads to that disc, that is, 9th rib to the T8-T9 disc.