What is Thoracic Corpectomy?
Thoracic = having to do with the thoracic spine (the spine in the upper/middle back)
Corpectomy = removal of the vertebral body (a solid section of bone at the front of the spine) and its adjoining discs
A thoracic corpectomy removes damaged vertebrae (bones of the spine) and intervertebral discs (the “cushions” between vertebrae) in the thoracic spine (spine in the upper or middle back).
Thoracic corpectomy is usually performed for patients with trauma, tumor, infection, or degenerative disease in the thoracic spine. These conditions can compress (put pressure on) the spinal cord and the nerves that exit the spine. Compression can irritate and injure these tissues. In the spinal cord, compression can cause permanent damage.
When is This Procedure Required?
A thoracic corpectomy may be required to stabilize the spine after a trauma, to remove infected bone material or tumor, or to relieve pressure on the spinal cord and nerves.
Surgery that relieves pressure on the spinal cord and nerves is called decompression surgery. Decompression surgery is warranted when compression puts the spinal cord at risk of permanent damage, or when nonoperative measures do not relieve symptoms of compression of the nerves that exit the spine. Compression of a nerve that exits the thoracic spine may cause pain, weakness, numbness or tingling on either side of the back or chest, or down the front of one arm (i.e., bicep to wrist).
How is This Procedure Performed?
This procedure is performed under general anesthesia, which means the patient is unconscious and can not feel pain during the procedure.
During the procedure, the surgeon first makes an incision in the skin. Then, the surgeon exposes the bones of the spinal column and removes the damaged vertebrae and surrounding discs. This is the decompression portion of the procedure, which relieves the pressure on the spinal cord and nerves.
Next, the surgeon will typically perform a spinal fusion to ensure stability of the spinal column. During a spinal fusion, the surgeon implants a bone graft (transplant) that will fuse, or grow together with, bone in the area. The graft may come from a segment of the patient’s own bone removed during surgery, or from a bone bank. The surgeon may implant one solid piece of bone, called a strut graft, or may use an artificial (manufactured) implant called a cage. The end plates of a cage are porous, like a kitchen strainer. The cage is packed with bone graft, which can fuse with vertebral bone through the porous end plates.
To keep the spine stable while the bone fuses, hardware like plates, screws, rods and wires may be implanted. This procedure is referred to as fixation. Fixation is often an effective short-term solution for spinal stability. An external back brace may also be used when the thoracic spine has undergone extensive bone removal or reconstruction.
Long-term stability can be achieved with good bone fusion.
The incision is then closed in layers and dressed with a gauze bandage.
Some surgeries are always performed with a particular surgical approach (way of reaching the necessary area). In thoracic corpectomies, however, neurosurgeons have a few approaches from which they can choose. Certain problems–such as spinal cord compression or disc disease–tend to need the surgeon’s attentions at the anterior (front) portion of the spine. But simply exposing the anterior portion is not always satisfactory: fusion must often be performed at the posterior (rear) of the spine. Organs such as the heart, lungs, and liver are also located in the thoracic region and must be considered when planning the surgical approach.
Experienced neurosurgeons, like those at the Spine Hospital at the Neurological Institute of New York, weigh the type, location, and extent of the problem in the thoracic spine and choose from approaches that include the following:
- thoracotomy: Sometimes called a transpleural thoracotomy, this approach uses a route that passes through the lung space. It provides good access to the anterior (front) portion of the thoracic spine. It normally requires a chest drain after surgery, which allows fluid around the lungs to drain to the outside of the body. Dr. Sheng-fu (Larry) Lo is especially experienced with this approach.
- retropleural thoracotomy: This approach offers the shortest direct route to the anterior (front) portion of the thoracic spine. It does not involve opening the cavity around the lungs, though a chest drain is still normally left in place. It is particularly useful for the surgical treatment of disc disease in the thoracic spine. Drs. Paul C. McCormick, Michael G. Kaiser, Peter D. Angevine and Sheng-fu (Larry) Lo are especially experienced with this approach, and have written about it extensively.
- lateral extracavitary or transpedicular approaches: These approaches expose both the side and the rear of the thoracic spine. They are of great benefit when a combination of decompression (which usually takes place from the side or front of the spinal column) and stabilization (which usually takes place from the back) is required. They are used in cases of tumor, trauma, infection and degenerative disease. Drs. Paul C. McCormick, Michael G. Kaiser, Peter D. Angevine and Sheng-fu (Larry) Lo are also especially experienced with these approaches, and have written extensively about them as well.
How Should I Prepare for This Procedure?
Make sure to tell your doctor about any medications that you’re taking, including over the counter medication and supplements, especially medications that can thin your blood such as aspirin. Your doctor may recommend you stop taking these medications before your procedure. To make it easier, write all of your medications down before the day of surgery.
Be sure to tell your doctor if you have an allergy to any medications, food, latex (some surgical gloves are made of latex).
Talk with your neurosurgeon if you use any tobacco products. Nicotine inhibits the bony fusion required for long-term spinal stability. Your neurosurgeon can provide resources to help you quit using tobacco products before your surgery.
On the day of the procedure, remove any nail polish or acrylic nails. If staying overnight, bring items that may be needed, such as a toothbrush, toothpaste, and dentures. On the day of surgery, do not wear makeup and remove all jewelry.
What Should I Expect After the Procedure?
How long will I stay in the hospital?
The length of the hospital stay varies by case. Some patients may be discharged in as little as 3 days, but the typical range is 5-7 days.
Will I need to take any special medications?
The surgeon will typically prescribe oral pain medications to be taken at home.
Will I need to wear a brace?
A brace is sometimes necessary depending on the extent of bone removal and condition of the spine.
When can I resume exercise?
Patients are encouraged to increase their activities as they are able to tolerate but refrain from strenuous exercise until cleared by the surgeon.
Will I need rehabilitation or physical therapy?
The surgeon will schedule a follow up visit, typically 4-6 weeks after surgery. At the follow up visit, the surgeon will take X-rays to monitor your bones and and see how they are healing. At this time, depending on the state of bone healing, patients may begin physical therapy.
Will I have any long-term limitations due to thoracic corpectomy?
There are no long-term limitations due to this procedure.