Surgical approaches to the thoracic spine.

When surgery for thoracic spine lesions is being considered, surgical indications should be strongly influenced by the presence of myelopathy; evidence of instability, particularly kyphosis; and the general medical and, particularly, the pulmonary health status of the patient. Numerous surgical options are available and should be utilized by considering the location, resectability, and the relationship of the lesion to the spinal cord blood supply. Options in stabilization technique and bone grafting permit adequate stabilization in most patients. As with instability syndromes in the cervical spine, if the surgeon is unsure regarding the adequacy of a limited stabilization technique, it should be supplemented with additional stabilization before further spinal cord damage occurs.