Ligaments of the Costovertebral Joints including Biomechanics, Innervations, and Clinical Applications: A Comprehensive Review with Application to Approaches to the Thoracic Spine

Abstract

Few studies have examined the costovertebral joint and its ligaments in detail. Therefore, the following review was performed to better elucidate their anatomy, function and involvement in pathology. Standard search engines were used to find studies concerning the costovertebral joints and ligaments. These often-overlooked ligaments of the body serve important functions in maintaining appropriate alignment between the ribs and spine. With an increasing interest in minimally invasive approaches to the thoracic spine and an improved understanding of the function and innervation of these ligaments, surgeons and clinicians should have a good working knowledge of these structures.

Traumatic costovertebral joint dislocation

“…For this joint to dislocate either concomitant rib fractures have to occur or ligamentous injury. The majority of posterior rib fractures occur at the rib neck due to the strong costovertebral ligamentous attachment to the rib head and tubercle, 4 this kind of stress fracture is also well described as a rowers and swimmers injury. 7 8 The costovertebral ligaments are innervated by the lateral branch of the thoracic dorsal rami of C8 and Th1-Th11, and some studies suggest that these ligaments add a protective mechanism against traction and compression of the nerves by maintaining proper positioning of the nerves in the intervertebral foramen.…”

“…Furthermore, the first rib also has no superior costotransverse ligament. 4 Because of its position at the top of the rib cage and the lack of stabilising ligaments, the first rib is more prone to fracture or dislocation, just as the 10th, 11th and 12th. 5 Due to its close relation to the spinal cord thorough assessment and imaging to rule out neurological damage is strongly advised when treating a patient with a costovertebral dislocation.…”

Opinion Piece: Patient-Specific Implants May Be the Next Big Thing in Spinal Surgery

“…The characteristic customisability of PSIs may lend them particularly suited to spinal surgery, given the inherently complex anatomy of the spine, consisting of 33 vertebrae with up to seven joints at each vertebral level [22][23][24], as well as the often complex distortion produced by common pathologies, including degeneration, malignancy and deformity [11]. While, in this setting, PSIs are intuitively more likely to be superior tools in comparison to OTS generic options, the customisability of PSIs also provides spinal surgeons with new avenues of combating some of the key challenges they routinely face.…”

Resection arthroplasty for isolated costotransverse joint osteoarthritis: A case report and literature review

“…[ 3 , 7 ] Further, it may compromise the intercostal nerve roots. [ 6 ] However, the CTJ is unique in that it includes the articulation of the tubercle of the rib with the transverse process of the corresponding thoracic vertebra, and isolated osteoarthritis (IOA) of the CVJs is rare. [ 7 ]…”