Pedicle screw fixation (T1, T2, and T3).

The indications for thoracic pedicle screw fixation have expanded over the past decade. Thoracic pedicle screws are now being used in the treatment of degenerative, traumatic, neoplastic, congenital, and developmental disorders. The pedicles of T1, T2, and T3 are typically large and ovoid in shape and amenable to pedicle screw fixation in most instances. The placement of thoracic pedicle screws requires knowledge of the topographic and deep bony anatomy of the thoracic spine as well as an appreciation of the surrounding visceral structures at risk. With strict adherence to the surgical techniques of insertion, thoracic pedicle screw fixation is a safe and effective method of stabilization. It offers several advantages over other forms of fixation, especially in the upper thoracic spine where the options are limited.