Costotransversectomy

Abstract

The costotransversectomy is a thoracic spine approach that can be made in one of two positions: prone1,2 or in the lateral decubitus position tilted anteriorly 20 degrees.3 Either of two skin incisions, midline or paraspinous, and one of three fascial incisions, midline, longitudinal paraspinous or transverse paraspinous, can be used. The pathology determines the exact approach. For biopsy and exposure of an intervertebral disc or vertebral body, position the patient prone, make a midline incision, and retract the paraspinous muscle mass laterally (Fig. 44.1). A transverse incision in the paraspinous fascia and muscle may be necessaiy. For decompression after Harrington rod insertion, a long midline incision allows adequate lateral retraction to expose the costotransverse joint. Resect the transverse process, resect the pedicle, and decompress the spinal canal.4Adequate interbody fusion can be most difficult with the prone position, midline incision approach. Optimum exposure for resection of an entire vertebral body and two intervertebral discs followed by a strut graft is through a semilateral decubitus position, a paraspinous skin incision, and a paraspinous fascial incision.3