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Thoracic Vertebrectomy and Fusion Surgery

What does “Thoracic Vertebrectomy” mean?

Here is the meaning of each word:

  1. Thoracic: the part of the spine located in the mid-back
  2. Vertebrectomy: to remove most of or the whole vertebra
  3. Corpectomy: to remove most of or the whole body of the vertebra

Altogether, “Thoracic Vertebrectomy” means removing a portion or the entire vertebrae from the mid-back.

What is a Thoracic Vertebrectomy?

A Thoracic Vertebrectomy is a surgery done through the chest area which removes a portion or all of the body of the vertebra and then puts bone and metal in its place for stability.

Why is a Thoracic Vertebrectomy done?

A Thoracic Vertebrectomy is usually done for these reasons:

  1. Complicated Fracture of the Vertebra
  2. Bone Cancer of the Vertebra
  3. Infection of the Vertebra

In either situation, the affected vertebra is weakened and at risk for collapse. The surgery replaces the weakened vertebra with a metal cage and bone which strengthens it.

How is a Thoracic Vertebrectomy done?

Here are some of the steps of how this surgery is done:

  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 or all of the vertebra and adjacent discs.
  11. A metal cage is filled with bone or bone substitute and placed into the area where bone from the vertebra was removed. It is secured to the vertebrae above and below.
  12. Sometimes a metal plate and screws can be placed over the metal care to secure the area. This would be done from the side of the spine.
  13. The lung is re-inflated and a tube placed into the chest cavity (chest tube).
  14. The chest cavity, tissue and skin are closed.
  15. The patient is carefully placed on the stomach.
  16. Sometimes the metal cage and bone have to be supported by placing metal hardware in the back of the spine.
  17. The skin in the mid-back (thoracic spine) is cleaned with a sterile surgical solution. Plastic sheets (drapes) are used to keep the surgical area sterile.
  18. A cut (incision) is made in the middle of the spine.
  19. The tissue and muscles are moved to the sides.
  20. The pedicles of the vertebra to be fused are found with an X-Ray machine.
  21. Small titanium screws are placed through the pedicle into each vertebral body. This is done on each side of the vertebra.
  22. Titanium rods are attached to the screws.
  23. Bone or bone-substitute material is place next to the screws and rods.
  24. The tissue and skin are closed.
  25. The patient is turned on the back (supine) and awoken from Anesthesia.
  26. The patient is then taken to the Recovery Area.

How long does it take to complete a Thoracic Vertebrectomy?

A Thoracic Vertebrectomy can take 3-6 hours or more of surgery to complete.

What is the recovery like from a Thoracic Vertebrectomy?

Here are some of the steps for the recovery from a Thoracic Vertebrectomy:

  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 weeks to 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.

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

This depends on the reason for the surgery.

  1. If the surgery is done for a bone infection, the benefit is that the surgery is part of the treatment of the infection. Also, the spine can now be stable without fear of collapse of the vertebra.
  2. If the surgery is done for spine cancer, the benefit is that the spine is now stable, and cannot collapse in the segment where the surgery took place. Due to that, the patient can be more active once recovered from the surgery.