During which type of surgery is the anterior vasculature of the spine at greatest risk?

The anterior vasculature of the spine is at greatest risk during anterior surgery in the thoracic spine due to the nature of the surgical approach in this area. When performing anterior thoracic spine surgery, the surgeon accesses the spine from the front of the body, often necessitating retraction or manipulation of the major blood vessels, such as the aorta and the vena cava. This close proximity to vital vascular structures significantly increases the risk of vascular injury or compromise during the procedure.

Additionally, the thoracic spine region is confined by the rib cage, which includes critical vascular structures that can be inadvertently damaged during dissection or surgical manipulation. The anterior approach, while beneficial for various spinal conditions, inherently carries a higher risk for the anterior vasculature compared to other surgical approaches where these vessels are less directly involved. Understanding the anatomy and risk factors associated with different surgical approaches helps in minimizing potential complications during neurophysiological intraoperative monitoring.