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Anatomy of the thoracic paravertebral space: 3D micro-CT findings and their clinical implications for nerve blockade

Authors
 Tae-Hyeon Cho  ;  Shin Hyung Kim  ;  Jehoon O  ;  Hyun-Jin Kwon  ;  Ki Wook Kim  ;  Hun-Mu Yang 
Citation
 REGIONAL ANESTHESIA AND PAIN MEDICINE, Vol.46(8) : 699-703, 2021-08 
Journal Title
REGIONAL ANESTHESIA AND PAIN MEDICINE
ISSN
 1098-7339 
Issue Date
2021-08
MeSH
Cadaver ; Humans ; Nerve Block* ; Paraspinal Muscles ; Thoracic Vertebrae / diagnostic imaging ; Ultrasonography, Interventional* ; X-Ray Microtomography
Keywords
nerve block ; pain management ; regional anesthesia
Abstract
Background: A precise anatomical understanding of the thoracic paravertebral space (TPVS) is essential to understanding how an injection outside this space can result in paravertebral spread. Therefore, we aimed to clarify the three-dimensional (3D) structures of the TPVS and adjacent tissues using micro-CT, and investigate the potential routes for nerve blockade in this area.

Methods: Eleven embalmed cadavers were used in this study. Micro-CT images of the TPVS were acquired after phosphotungstic acid preparation at the mid-thoracic region. The TPVS was examined meticulously based on its 3D topography.

Results: Micro-CT images clearly showed the serial topography of the TPVS and its adjacent spaces. First, the TPVS was a very narrow space with the posterior intercostal vessels very close to the pleura. Second, the superior costotransverse ligament (SCTL) incompletely formed the posterior wall of the TPVS between the internal intercostal membrane and vertebral body. Third, the retro-SCTL space broadly communicated with the TPVS via slits, costotransverse space, intervertebral foramen, and erector spinae compartment. Fourth, the costotransverse space was intersegmentally connected to the adjacent retro-SCTL space.

Conclusions: A non-destructive, multi-sectional approach using 3D micro-CT more comprehensively demonstrated the real topography of the intricate TPVS than previous cadaver studies. The posterior boundary and connectivity of the TPVS provides an anatomical rationale for the notion that paravertebral spread can be achieved with an injection outside this space.
Full Text
https://rapm.bmj.com/content/46/8/699.long
DOI
10.1136/rapm-2021-102588
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anatomy (해부학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Hyun-Jin(권현진) ORCID logo https://orcid.org/0000-0001-7752-6172
Kim, Kiwook(김기욱)
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Yang, Hun Mu(양헌무) ORCID logo https://orcid.org/0000-0003-1954-0114
O, Jehoon(오제훈) ORCID logo https://orcid.org/0000-0003-4351-3183
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184448
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