Costotransversectomy

Since the end of the nineteenth century, the wide dissemination of Pott's disease has ignited debates about which should be the ideal route to perform ventrolateral decompression of the dorsal rachis in case of paraplegia due to spinal cord compression in tuberculosis spondylitis. It was immediately clear that the optimal approach should be the one minimizing the surgical manipulation on both neural and extra-neural structures while optimizing the exposure and surgical maneuverability on the target area. The first attempt was reported by Victor Auguste Menard in 1894, who described, for the first time, a completely different route from traditional laminectomy, called costotransversectomy. The technique was conceived to drain tubercular paravertebral abscesses causing paraplegia without manipulating the spinal cord ¹⁾.

In the past, this was often used to drain tuberculous spine abscess.

Biopsy of VB or pedicle, limited unilateral decompression of spinal cord from tumor or bone fragments, or sympathectomy. Can be used at ≈ any T-spine level. Limitations: difficult to visualize the anterior canal to access midline anterior pathology.

Involves resection of the transverse process and at least ≈ 4–5 cm of the posterior rib. A serious risk of this approach is interruption of a significant radicular artery which may compromise spinal cord blood supply

There is also a risk of pneumothorax, which is less grave.

Costotransversectomy for thoracic disc herniation.