The thoracic spine is the middle region of the back and is made up of twelve vertebrae, T1 through T12. Injuries to the thoracic spine are less common that other regions, like cervical and lumbar, because the thoracic region has the added protection of the rib cage. However, the thoracic spine is the main support system involved in activities like twisting and bending so condition like a herniated disc or spinal stenosis can still occur.
Thoracic spine surgery can be an effective treatment for mid-back pain, but should only be considered if conservative and non-operative treatments have failed to provide relief.
Experiencing or suffering from an injury or condition to the thoracic spine and conventional pain relief options like pain medication, NSAIDS, steroid injections and rest have not alleviated the pain, thoracic spine surgery may be the most appropriate thoracic spine treatment option.
Conditions potentially requiring thoracic spine surgery can include:
- degenerative disc disease
- herniated disc
- compression fractures
A herniated disc occurs when the intervertebral disc’s outer fibers (the annulus) are damaged and the soft inner material of the nucleus pulposus ruptures out of its normal space. If the annulus tears near the spinal canal, the nucleus pulposus material can push into the spinal canal. In the thoracic area, there is very little extra space around the spinal cord. When a herniated disc occurs in the thoracic spine it can be extremely serious. In some cases, the first sign of the herniated disc is paralysis below the waist. Luckily, herniated discs in the thoracic area are not nearly as common as in the lumbar spine.
Thoracic Spine Surgery:
1). Laminotomy and Discectomy
The traditional way of treating the herniated disc with surgery is to perform a laminotomy and discectomy. Laminotomy involves making and opening in the lamina and discectomy involves removing the protruding disc.
Surgery for thoracic disc herniation is much more complicated than surgery for a cervical or lumbar herniation. The bones that make the thoracic region more stable and less prone to disc herniation—the ribs and sternum—also make it more difficult to access the region. The thoracic cavity also contains vital organs such as the heart and the lungs.
Because of these obstacles, thoracic discectomy carries an increased risk for complications such as pulmonary issues and irreversible spinal cord injury.
This procedure is performed through an incision down the center of the back over the area of the herniated disc. Once the incision is made through the skin, the muscles are moved to the side to see the back of the vertebrae. X-rays during surgery may be required to make sure that the correct vertebra is chosen. A small opening is made between the two vertebrae where the disc is ruptured. This allows to see into the spinal canal. The term laminotomy (make an opening in the lamina) comes from the fact that usually a small amount of the bone of the lamina must be removed. This is to make room to see into the spinal canal and to allow room to work.
Once this is done, the nerve roots are moved out of the way to see the intervertebral disc. The disc material that has ruptured into the spinal canal is then located and removed. This removes any pressure and irritation on the nerves of the spine. Using small instruments that fit inside the disc itself, nucleus pulposus material inside the disc is removed as much as possible. This is done to prevent any remaining disc material to herniate again after the operation.
After the procedure is complete, the muscles of the back are returned to their normal position around the spine. The skin incision is repaired with sutures or metal staples.
With improvements have been made in the tools available, minimally invasive approach requiring much smaller incision is used for performing a laminotomy and discectomy. The advantage of this procedure over the traditional approach is that there is less damage to the normal parts of the spine during the operation. It generally results in a shorter hospital stay, less blood loss and post-operative pain, and fewer complications.
To be able to see through the smaller incision, an operating microscope is used. A small incision (as small as two inches) is made in the back just above the area where the disc is herniated. Once the muscles are moved aside and the vertebra can be seen, a microscope is used to finish the operation. The rest of the operation is performed exactly like the more traditional approach.