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.
- regional anesthesia
- pain management
- nerve block
Data availability statement
Data are available upon reasonable request. Deidentified data will be made available upon reasonable written request submitted to the corresponding author.
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T-HC and SHK are co-first authors.
Correction notice This article has been corrected since it published Online First. The corresponding author's ORCID ID has been corrected.
Contributors T-HC and SHK (these authors contributed equally to this work): dissection, experiment, validation, formal analysis, writing and editing of the original manuscript. JO: data curation, three-dimensional (3D) images analysis and figure illustrations. H-JK: dissection, experiment, and 3D images analysis. KWK: experiment, data curation, and formal analysis. H-MY: project administration, conceptualization, design, supervision, formal analysis, and critical revision of the manuscript for intellectual content. All authors read and gave final approval of the version to be published.
Funding This work was supported by the National Research Foundation of Korea grant funded by the Korea government (MSIT) (No. 2020R1F1A1058123). No other external funding or competing interests declared.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.