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Thoracic Discectomy Surgery

What does “Thoracic Discectomy” mean?

Here is the meaning of each word:

  1. Thoracic: the area of the spine located in the mid-back
  2. Discectomy: surgical procedure where a piece of the disc is removed

Altogether, “Thoracic Discectomy” means to remove a piece of a herniated disc from the mid-back.

What is a Thoracic Discectomy?

A Thoracic Discectomy is a surgical procedure usually done for a disc herniation in the mid-back. Disc herniations in this part of the spine are not as common as they are in the neck (cervical spine) and low-back (lumbar spine). Less than 5% of all disc herniations occur in the mid-back (thoracic spine).

Why is a Thoracic Discectomy done?

A Thoracic Discectomy is done for a disc herniation in the mid-back which is either pushing (compressing) a spinal nerve or the spinal cord. The spinal canal in the mid-back is smaller than in the low back. A disc herniation can therefore put pressure on the spinal cord itself.

What is the difference between an Endoscopic Thoracic Discectomy, a Percutanous Thoracic Discectomy and a regular Thoracic Discectomy?

    1. An Endoscopic Thoracic Discectomy is performed with a small endoscope through a small metal tube placed through the skin and into the disc.
    2. A Percutaneous Thoracic Discectomy is done through a needle  with a small instrument. It may not be able to remove very much disc material.
    3. A regular Thoracic Discectomy is an open surgery with a larger incision.

Are there different ways to perform a Thoracic Discectomy?

Here are the different approaches for Thoracic Discectomies. The specific approach chosen may depend on the location of the disc herniation and the surgeon’s preference.

1. Posterior Approach (from the back)

In this approach, the disc is targeted from the back of the spine. Once the muscles are pushed to the side, a small piece of the back of the vertebra (lamina) is removed (laminotomy). The disc herniation is then taken out from an area behind the spinal cord and spinal nerve. This approach may be difficult to do if the disc herniation is putting a lot of pressure on the spinal cord. This may mean that the spinal cord has to be moved to the side in order to remove the disc herniation. Moving the spinal cord can sometimes lead to a spinal cord injury.

2. Anterior Approach (actually done from the side, i.e. lateral)

This approach is done through the chest. A cut (incision) is made between the ribs and the lung is intentionally collapsed (deflated). The disc is then seen from the side (lateral). A portion or the entire disc is then removed. Sometimes a fusion of the vertebrae has to be done to provide stability for the spine.

This approach is sometimes chosen to avoid placing any pressure on the spinal cord during the surgery. Since the surgery approaches the disc from the side, the spinal cord is not traumatized since it is located behind (posterior) to the disc itself.

How is a Thoracic Discectomy done?

Here are the steps of performing a Thoracic Discectomy:

1. Posterior Thoracic Discectomy

  1. This surgery is done in an Operating Room.
  2. An intravenous catheter (IV) is placed before surgery and antibiotics are given.
  3. In the Operating Room, the patient is initially place on the back (supine) and a General Anesthetic is given.
  4. The patient is then carefully placed on the stomach (prone).
  5. The mid-back (thoracic spine) is cleaned with a sterile surgical solution and sterile sheets (drapes) are placed around the surgical site.
  6. The surgeon makes a cut (incision) over the spine.
  7. The tissue and muscles under the skin are freed up and moved to the side.
  8. The lamina bone on the back of the spine is seen and a portion removed.
  9. The spinal nerve or spinal cord is now seen.
  10. The disc herniation behind the spinal nerve or spinal cord is located and removed.
  11. The tissue and skin are closed with stitches (sutures).
  12. A bandage (dressing) is placed on the surgical site.
  13. The patient is turned on the back (supine) and awoken from Anesthesia.
  14. The patient is brought to the Recovery Room.

2. Anterior Thoracic Discectomy

  1. This surgery is performed in an Operating Room.
  2. An intravenous catheter (IV) is placed and antibiotics are given before surgery.
  3. The patient is brought to the Operating Room and initially placed on the back (supine).
  4. A General Anesthetic is given. The Anesthesia Provider places a specific breathing tube (double lumen tube) in the windpipe which will allow him/her to breathe into one lung at a time.
  5. The patient is carefully placed on the side.
  6. The chest area is cleaned with a sterile surgical solution and sterile sheets (drapes) are placed around the surgical area.
  7. The surgeon makes a cut (incision) between the ribs. Sometimes a portion of the rib is removed.
  8. A cut is then made into the outer lining of the lung cavity (pleura).
  9. The Anesthesia Provider deflates the lung on the side of the surgery.
  10. The surgeon gently pushes the lung out of the way to see the spine.
  11. An X-Ray machine is used to identify the correct disc.
  12. A portion or the entire disc is now removed.
  13. Sometimes the spine will need to be fused at this point. In that case, screws, and a plate or rod will be attached to the vertebrae above and below the removed disc. A piece of bone or bone substitute will be placed into the empty disc space.
  14. The lung is inflated again and the chest is closed. A tube is left in place in the chest cavity to get rid of any residual air.
  15. The chest, tissue and skin are closed.
  16. A bandage is placed over the surgical site.
  17. The patient is placed on the back again and awoken from Anesthesia.
  18. The patient is then brought to the Recovery Room.

How long does it take to perform a Thoracic Discectomy?

A Thoracic Discectomy may take 2-4 hours or more to complete.

What is the recovery from a Thoracic Discectomy like?

Here are some of the steps during a recovery from this type of surgery:

  1. The patient is admitted to the hospital for at least an overnight stay. For Anterior Thoracic Discectomies, the stay is usually longer, i.e. 2-3 days.
  2. After discharge, activity restrictions will be given.
  3. The wound will heal in 2-4 weeks.
  4. The surgeon will typically evaluate the patient again within several weeks.
  5. If a fusion was performed, the bone from the fusion may take 6 months to 1 year to form a solid fusion.

What kind of benefit can patients gain from a Thoracic Discectomy?

A Thoracic Discectomy will remove pressure on the spinal nerve or spinal cord. The symptoms often improve over weeks and months following the surgery.

Depending on how long a nerve or the spinal cord was compressed and the severity of the compression, some symptoms may remain.