A posterior parasagittal approach to thoracic paravertebral neural structures with curved cannulae

Abstract

The clinical value of percutaneous diagnostic and therapeutic interventions in modern spine care has increased in proportion to growing knowledge regarding specific sites and structures responsible for chronic spinal pain. Although the information gained from noninvasive technologies continues to improve, correlation of morphologic abnormalities with clinical symptoms can often only be achieved with target-specific analgesic or provocative testing. Cervical and lumbar percutaneous techniques abound, but relatively little has been published on target-specific approaches to the thoracic paravertebral structures. The anatomic juxtaposition of vital viscera, limited access due to bony structures, and the small volume of the thoracic paravertebral space have likely limited widespread accession of structures specifically involved in thoracic nociception. This report reviews the relevant regional anatomy of the thoracic paravertebral region and basic neurophysiologic principles and rationale for targeting paravertebral structures and outlines a new method of accessing thoracic paravertebral neural structures with curved cannulae and real-time fluoroscopic guidance. Clinical applications and indications are also discussed. This method has permitted the performance of more than 1,000 thoracic percutaneous paravertebral procedures of varying levels of complexity to be performed by the author without a single case of clinically evident or documented pneumothorax. Copyright © 2001 by W.B. Saunders Company