Thoracic Procedures

Thoracic fusions

  • Thoracic fusion surgery is performed to treat a variety of spinal conditions affecting the mid-back (thoracic spine), including spinal deformities (such as scoliosis or kyphosis), trauma, tumors, infections, or degenerative instability. It may also be indicated for patients with progressive neurologic symptoms due to spinal cord compression or spinal column instability that cannot be managed non-operatively. Common symptoms include mid-back pain, numbness or weakness in the legs, gait imbalance, or deformity-related postural changes.

  • Thoracic fusion involves stabilizing one or more vertebrae in the thoracic spine by permanently connecting them with screws, rods, and bone graft. This prevents abnormal motion and allows the bones to heal together (fuse) over time. The procedure can be performed through a posterior (back) approach, an anterior (front or lateral thoracotomy/thoracoscopy) approach, or a combined approach, depending on the pathology and surgical goals.

    In many cases, decompression of the spinal cord or nerves is also performed by removing bone or soft tissue structures compressing neural elements. Fusion is achieved using bone graft from the patient (autograft), donor tissue (allograft), or synthetic materials.

  • Thoracic fusion is a major spine surgery and carries inherent risks, which may include:

    • Infection

    • Bleeding (especially with anterior or tumor-related cases)

    • Nerve or spinal cord injury (may result in numbness, weakness, or paralysis)

    • Pulmonary complications (due to proximity to the lungs)

    • Dural tear or cerebrospinal fluid leak

    • Nonunion (failure of fusion)

    • Implant failure or hardware-related issues

    • Persistent pain or stiffness

    • Adjacent segment degeneration over time

    Your surgeon will review risks based on your condition, approach, and overall health.

  • Hospital stay typically ranges from 3 to 7 days, depending on the complexity of surgery and recovery progress. Pain control, pulmonary support (incentive spirometry), and early mobilization are key aspects of early recovery. Activity is gradually increased with the guidance of physical therapy. A brace may be used in some cases, particularly when long fusions are performed or if there are concerns about bone quality. Return to normal activities varies, but most patients are restricted from bending, lifting, and twisting for 2–3 months. Follow-up imaging monitors bone healing and fusion status. Full recovery may take several months, with progressive return to activity over time.

 

Thoracic disc herniations

  • Thoracic disc herniations are rare but can cause significant symptoms when they compress the spinal cord. Surgery is typically recommended for patients experiencing myelopathy (spinal cord dysfunction), including leg weakness, numbness, balance issues, or bowel/bladder changes, as well as intractable axial back pain or radicular pain unresponsive to non-surgical treatment. Indications also include progressive neurologic decline or radiographic evidence of severe cord compression.

  • Surgical treatment for symptomatic thoracic disc herniation often involves a posterior laminectomy and spinal fusion. Through an incision along the back, part of the vertebral bone (lamina) and surrounding ligament is removed to decompress the spinal cord. If the herniation is central or calcified, additional bone work or partial facetectomy may be necessary.

    To stabilize the spine after decompression—and to reduce the risk of post-operative instability—a fusion is performed using screws, rods, and bone graft. In select cases (e.g., large central or calcified herniations), a lateral or transthoracic approach may be considered to allow safer access to the disc.

  • Thoracic spine surgery is technically complex due to the proximity of the spinal cord, and risks include:

    • Spinal cord injury (may result in weakness, paralysis, or sensory loss)

    • Dural tear or spinal fluid leak

    • Infection

    • Bleeding or hematoma

    • Nonunion (failure of fusion)

    • Implant-related complications

    • Persistent or recurrent symptoms

    • Pulmonary complications if a thoracotomy is required (e.g., pneumothorax, atelectasis)

    In experienced hands, the procedure is generally safe, with precautions taken to monitor the spinal cord and protect nearby structures.

  • Hospital stay typically lasts 2 to 5 days, depending on the extent of surgery and neurological recovery. Patients are mobilized early with the help of physical therapy. Postoperative discomfort in the back and ribs (if a lateral approach is used) is common but manageable with medication. Activity restrictions include no lifting, bending, or twisting for 6 to 12 weeks, depending on the fusion extent. A brace may be prescribed to support healing. Follow-up imaging monitors fusion, and physical therapy may be initiated once healing is stable.