1. Surgical Approaches for Various Pathologies LevelsDisc HerniationApproaches SOFT DISC T1 to T4Central, centrolateralTranssternal Central, centrolateralMedial clavisectomy Centrolateral, lateralCostoransversectomy Central, centrolateral, lateralTransthoracic Central, centrolateral, lateralThoracoscopy Centrolateral, lateralLateral Central, centrolateral, lateralCostoransversectomy LateralTranpedicular CALCIFIED DISC T1 to T4Central, centrolateralTranssternal Central, centrolateralMedial clavisectomy LateralCostoransversectomy T4 to T12Central, centrolateral, lateralTransthoracic Lateral Lateral, centrolateralCostoransversectomy From Mirkovic S: Thoracic disc herniation herniations. In Garfin S R, Vaccaro AR, eds: Orthopaedic knowledge undate: spine, Rosemont III, 1997. American Academy of Orthopaedic Surgeons, pp 87-96.

2. Thoracic Pedicle Larger superior-inferior dimensions than transverse widths create oval shape. Average height is 8 to 15 mm; average width is 3 to 10mm Diameter is less than 5mm in 35%of pedicles. Transverse plane angulation at T4 is around 15 degrees medially; it becomes more parallel to sagittal plane T5 to T12, path may be diverged. Entry point is 7 to 8 mm medial to lateral edge of superior facet and 3 to 4 mm superior to midline of transverse process of T1 and T2. Between T3 and T12, point lies 5mm medial to lateral edge of superior facet and 5mm superior to midline of transverse process.

3. Pedicle Screw Placement Stereotactic guidance Fluoroscopically guided Manual technique CT Scan

4. How Accurately Do Novice Surgeons Place Thoracic Pedicle Screws with the Free Hand Technique? Ryan K. Bergeson, et al. Spine Vol 33(15), 2008.  surgeons placing thoracic pedicle screws in cadavers were able to significantly improve by the fourth cadaver practice

5. Reliability of Three-dimensional Fluoroscopy for Detecting Pedicle Screw Violations in the Thoracic and Lumbar Spine real-time intraoperative imaging, 3-D fluoroscopy may enhance the safety of thoracic transpedicular instrumentation. Neurosurgery 2004;Vol.54(5), pp 1138–1143 Michael Y. Wang, M.D. et al.

6. Risks Vascular injury Spinal cord injury Malposition Pulmonary injury