At which level should a thoracotomy be performed for a transthoracic disc resection

A chest radiograph can be used to determine the slope of the ribs in the thoracic spine. Usually, a thoracotomy is performed one or two levels above the target disc space. This strategy allows a parallel approach to the disc space, thus permitting the use of a microscope if desired. Alternatively, a minithoracotomy can be performed to attempt to decrease approach-related morbidity. The posterior portion of the rib leading to the target disc space is removed (e.g. remove the posterior portion of the ninth rib to access a T8-T9 disc herniation).

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