Applied Macro-, Micro-, and Sonoanatomy of the Thoracic Paravertebral Space

The thoracic paravertebral space (TPVS) is a wedge-shaped space of which the anterior boundary is the parietal pleura of the lung. The superior costotransverse ligament (SCTL) and the internal intercostal membrane (IIM) form the posterior boundary, while the posterolateral aspect of the vertebra, the intervertebral disc, and the intervertebral foramen form the medial border. Superior and inferior the boundaries are the heads and necks of the ribs. The TPVS contains spinal nerve roots, the posterior rami of the thoracic nerves, the anterior rami, which comprises the intercostal nerves, the gray and white rami communicantes to the sympathetic chain and the sympathetic chain itself, the spinal rami from the aorta, and an intervertebral veins that form a vascular plexus. The TPVS communicates superiorly and inferiorly with the adjacent TPVS above and below, medially with the spinal epidural space, and laterally with the intercostal space. The macro- and microanatomy and sonoanatomy (static and dynamic) of these spaces and its nerve roots and relationships to other structures are discussed in this chapter.

Keywords: Acute pain medicine, Anterior rami, Gray rami communicantes, Intercostal nerves, Intercostal space, Internal intercostal membrane, Intervertebral artery, Intervertebral disc, Intervertebral foramen, Intervertebral vein, Macroanatomy, Microanatomy, Parietal pleura, Posterior rami, Regional anesthesia, Sonoanatomy, Spinal epidural, Spinal nerve roots, Superior costotransverse ligament, Sympathetic chain, Thoracic paravertebral block, Thoracic paravertebral space, White rami communicantes.