Transaxillary Approach to the Upper Dorsal Spine

Abstract

For female patients, and for males of slender build, the transaxillary transthoracic approach is an alternative to the posterior parascapular approach to the upper dorsal spine. The highest dorsal vertebra reached through this approach is the body of T1, although the C7–T1 interspace is often accessible at the extreme apex of the thoracic inlet. The most significant advantage of this approach is that no major muscle groups are sectioned during the procedure, and there is rapid functional recovery of shoulder girdle mobility. The principal disadvantage of the approach is its limited exposure compared with that obtained by complete mobilization of the scapula. The approach is not indicated in obese individuals or in males of substantial muscular build with hypertrophic pectoralis major and latissimus dorsi muscles. The approach described here is from the right side, although the left-side approach is commonly used.