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Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
There are two types of joint between the ribs and the vertebrae in the thoracic region: the costovertebral and costotransverse joints. The costovertebral joint is between the head of the rib and the vertebral body. The radiate ligament crosses this joint. The ligament is so-named because it fans out from the head of the rib to its insertions on the vertebral body. The costotransverse joint is between the tubercle of the rib and the transverse process of the vertebra. There are lateral and superior costotransverse ligaments at this joint. The lateral costotransverse ligament passes from the rib tubercle to the transverse process it articulates with. The superior costotransverse ligament passes from the superior border of the rib to the transverse process of the vertebra above.
One-stage posterior approach for treating multilevel noncontiguous thoracic and lumbar spinal tuberculosis
Published in Postgraduate Medicine, 2019
Rui-song Chen, Xin Liao, Mo-liang Xiong, Feng-rong Chen, Bo-wen Wang, Jian-ming Huang, Xiao-lin Chen, Gang-hui Yin, Hao-yuan Liu, Da-di Jin
The patient was placed in a prone position, and general anesthesia was administered after intubation. Two linear midline skin incisions were performed. Extra-periosteal dissection was performed. The posterior elements including the lamina, facet joints, and transverse processes were exposed. At debridement, the exposed area extended to the costotransverse joint (in the thoracic spine) according to the preoperative imaging. A pedicle screw was placed according to the decompression level. Moreover, the upper part of the vertebral body was not damaged in the instrumentation system. A temporary pre-bent lever was then stabilized on the slightly affected side to avoid spinal cord injury during decompression and local debridement. The obviously infected side was chosen. A partial or complete laminectomy was performed on the more severely affected side of the lesion. The superior and inferior articular processes of the vertebrae were partially resected to expose the intervertebral space. We eliminated pus and necrotic tissue using pressurized lavage with a soft catheter inserted deep into the lesion. We cut off 1.0–1.5 cm of the ribs next to the thoracic vertebra. If needed, the focal thoracic nerve root is sacrificed for adequate exposure. It should be noted that the spinal cord was not stretched or separated. Autologous bone or allograft was implanted in the bone defect, as appropriate. The local deposition was treated with 1.0 g of streptomycin and 0.2 g of isoniazid; the area was drained; and the incision was sutured after surgery. The collected material was sent for culture and histopathologic examination. Blood transfusions were administered to patients who lost more than 800 ml of blood during surgery.