Fig. 6.

Approach to the paravertebral space. (A) Reconstructed computed tomography of the thoracic spine showing potential needle trajectory in sagittal plane, (B) gross dissection of paraspinal area in coronal plane. Item 1 shows place of initial contact with transverse process (TP). Item 2 shows that a cephalad approach after walking off the TP would result in close anatomic proximity to the neurovascular bundle (NVB). Item 3 shows that a caudal approach after walking off the TP results in a protective angle away from NVB. Item 4 suggests that a medial redirection of the needle risks neuraxial violation. Item 5 suggests that a lateral redirection of the needle risks pleural violation.