What is Thoracic Corpectomy?
Thoracic corpectomy is a surgical procedure performed to relieve pressure on a nerve at the thoracic region (upper and middle back) by removing the source of the compression.
Thoracic Spine Anatomy
The thoracic spine is the central part of the spine. The spine consists of 33 vertebral bones stacked one on top of the other with cushioning discs lying between each vertebrae. It is divided into 7 cervical vertebrae (neck), 12 thoracic vertebrae (mid back), 5 lumbar vertebrae (lower back), 5 sacral bones, and 4 coccyx bones. The sacral and the coccyx bones are fused and do not provide any movement in the spine. The spine plays a key role in the smooth movement, stability, and protection of the delicate spinal cord, and giving symmetry and support to the body.
Indications for Thoracic Corpectomy
Thoracic corpectomy is indicated for conditions such as degenerative disc disease, spinal stenosis, bone spurs, tumor, fracture and infection leading to spinal compression, which causes pain, weakness, and numbness in various parts of the body.
The objective of thoracic corpectomy is to stabilize the spine post injury or trauma, remove infected bone material or tumor, and relieve pressure on the spinal cord and nerves.
Preparation for Thoracic Corpectomy
A preoperative assessment will be made before thoracic corpectomy to check your overall health and to make sure you are ready for the surgery. Make sure to inform your doctor about any medications or supplements that you may be taking, especially medications that can thin your blood such as aspirin. Your doctor may recommend stopping these meds temporarily before your surgery. Make sure to inform your doctor about any allergy to medications or latex. If you are a smoker, inform your doctor as nicotine prevents bone fusion needed for long-term spinal stability. Your doctor may provide you with options to help quit smoking. Your doctor will also discuss the need to avoid food and drink past midnight the night prior to your surgery.
Procedure for Thoracic Corpectomy
Thoracic corpectomy is carried out under general anesthesia. You will lie on your side during the procedure. An oblique incision is made. Important organs are moved aside to protect them during the surgery. The surgery involves two stages - decompression and fusion. To decompress the nerve, the presence of bone spurs, tumors, or fractures causing the compression are removed. This is followed by fusion, where deformed or diseased vertebrae are removed along with the intervertebral discs, and the adjacent vertebrae are then fused. A bone graft is placed in this region to provide stability and a metal plate with screws may be used to provide added support. The procedure typically takes 3-4 hours to complete.
Postoperative Care for Thoracic Corpectomy
Post surgery, most patients will have immediate relief from severe back pain, while some symptoms may take some time to improve. You will require some time to recover ranging from 3-7 days. You will be prescribed pain medications to keep you comfortable. A brace may sometimes be necessary depending on the condition of the spine and the extent of bone removal. You will be encouraged to increase your physical activities as tolerated and to refrain from strenuous activities. Your doctor will schedule follow-up appointments 4-6 weeks post surgery to monitor your progress, and based on the bone healing, a customized physiotherapy program will be designed as part of your recovery plan. The time required to return to normal routine activities varies considerably from one individual to another depending on their physical condition.
Risks and Complications of Thoracic Corpectomy
As with any surgical procedure, thoracic corpectomy involves potential risks and complications that may include:
- Damage to nerves
- Persistent pain
- Anaesthetic complications
- Broken hardware
- Implant migration
- Thrombophlebitis or deep venous thrombosis
- Spinal cord injury
- Sexual dysfunction