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Thoracic Osteotomy and Fusion

What does “Thoracic Osteotomy and Fusion” mean?

Here is the meaning of each word:

  1. Thoracic: area of the spine located in the mid-back
  2. Osteotomy: to remove a portion of bone
  3. Fusion: to mend bones together

Altogether, “Thoracic Osteotomy and Fusion” means to remove a portion of vertebrae in the mid-back and then mending them together.

What is a Thoracic Osteotomy and Fusion?

Thoracic Osteotomies and Fusions are done to help with an abnormal spine curvature in the mid-back. A piece or pieces of the vertebra is/are removed to help change the curvature. The vertebrae are then fused together with titanium screws and rods. The surgery is usually done from the side of the spine through the chest.

Why is a Thoracic Osteotomy and Fusion done?                                         

A Thoracic Osteotomy and Fusion is usually done for a Kyphosis of the mid-back.

A Kyphosis is an abnormal forward curvature. Usually our spine has a natural forward curvature in the midback. However, in the case of a thoracic kyphosis, the mid-back is tilted forward far more than is normal. This can cause problems standing upright and shrinks the overall height of the patient.

The organs in the chest such as the heart and lungs can be affected by this condition.

How is a Thoracic Osteotomy and Fusion done?

There are variations of how this surgery is approached. Here are some of the steps of one of the techniques:

  1. An intravenous catheter (IV) is placed and antibiotics are given.
  2. The patient is taken to the Operating Room and initially placed on the back (supine).
  3. A General Anesthetic is given. The Anesthesia Provider places a specialized breathing tube (double lumen tube) into the windpipe. This tube can be used to inflate or deflate one lung at a time.
  4.  The patient is carefully placed on the side.
  5. The chest area is cleaned with a sterile surgical solution. Plastic sheets (drapes) are placed around the surgical site.
  6. The surgeon makes a cut (incision) between the ribs. Often part of a rib is removed.
  7. The lining of the lung cavity (pleura) is opened and the lung deflated by the Anesthesia Provider.
  8. The lung is gently pulled aside until the spine can be seen.
  9. An X-Ray machine is used to find the correct vertebra.
  10. Specialized instruments are used to remove part of the vertebra and possibly adjacent discs. The idea is to make the vertebrae taller in the front than in the back. That can be done by either removing a portion of the back part of the vertebral body in the front, or some of the bone from the back part of the spine (lamina, pedicle, facet joint).
  11. The lung is re-inflated and a tube placed into the chest cavity (chest tube).
  12. The chest cavity, tissue and skin are closed.
  13. The patient is carefully placed on the stomach.
  14. The skin in the mid-back (thoracic spine) is now cleaned with a sterile surgical solution. Plastic sheets (drapes) are used to keep the surgical area sterile.
  15. A cut (incision) is made in the middle of the spine.
  16. The tissue and muscles are moved to the sides.
  17. The pedicles of the vertebra to be fused are found with an X-Ray machine.
  18. Small titanium screws are placed through the pedicle into each vertebral body. This is done on each side of the vertebra.
  19. Titanium rods are attached to the screws.
  20. Bone or bone-substitute material is placed next to the screws and rods.
  21. The tissue and skin are closed.
  22. The patient is turned on the back (supine) and awoken from Anesthesia.
  23. The patient is then taken to the Recovery Area.

How long does a Thoracic Osteotomy and Fusion take to complete?

The length of this surgery can vary. Here are some of the variables:

  1. The degree of the abnormal curvature (kyphosis) the surgery is trying to correct.
  2. The length of the abnormal curvature (kyphosis). The longer the curvature, the longer the surgery takes.
  3. The type of Osteotomy chosen. Some types of this surgery remove bone from multiple parts of the vertebra, which takes longer.

Overall, this surgery can take about 4-12 hours or more to complete.

What is the recovery like from a Thoracic Osteotomy and Fusion?

Here are some of the steps for the recovery from a Thoracic Osteotomy and Fusion:

  1. The patient is admitted to the hospital often for 3-5 days or more.
  2. A number of X-Rays are taken during the hospital stay.
  3. The tube left in the chest cavity to remove excess air (chest tube) is typically removed after several days.
  4. Often Physical Therapist help with the initial recovery from surgery.
  5. A firm brace is often used for months after surgery.
  6. The patient will have activity restrictions such as lifting, bending, etc. for weeks to months after surgery.
  7. The wound will take 4-6 weeks to heal.
  8. The surgeon will usually reevaluate the patient in the office within a week after discharge from the hospital.
  9. The Fusion part of the surgery can take 6 months to a year to complete itself.

What type of benefit can patients gain from a Thoracic Osteotomy and Fusion?

Here are some potential benefits from a Thoracic Osteotomy and Fusion:

  1. The correction of the curvature can improve spine pain.
  2. The correction of the curvature allows patient to stand and walk straighter.
  3. The correction of the curvature can help with the function of the chest organs such as the heart and lungs.
  4. Patients can regain some of the lost body height.