Thoracic discectomy is an operation to remove a herniated disc in the thoracic (mid-back) spine that is compressing the spinal cord. Thoracic disc herniations are uncommon but can cause serious spinal cord compression.
The approach depends on the location and size of the herniation. Options include a costotransversectomy (through the back, removing part of a rib and transverse process), a transthoracic approach (through the chest), or a thoracoscopic approach (keyhole through the chest). The disc is removed from in front of the spinal cord to avoid manipulating the cord. The operation takes two to three hours.
Surgery is recommended for symptomatic thoracic disc herniations causing myelopathy (spinal cord compression), progressive neurological deficit, or severe radiculopathy not responding to non-operative treatment.
Many thoracic disc herniations are asymptomatic and found incidentally on MRI. If symptoms are mild and stable, observation with regular monitoring may be appropriate. Pain management and physiotherapy for mild radiculopathy.
MRI and CT for planning. Pulmonary function tests if transthoracic approach. This is a specialised procedure.
Prevention of progressive spinal cord damage. Neurological improvement is possible but depends on the duration and severity of cord compression.
Chest wall or back pain from the surgical approach.
Rib or chest wall pain from nerve irritation during the approach.
The thoracic spinal cord is vulnerable and has limited space. Risk of worsening neurological function.
Dural tear. More common than in lumbar surgery due to limited space.
Air leak around the lung with transthoracic approaches. Usually managed with a chest drain.
Wound or spinal infection.
Chronic chest wall pain from nerve damage.
General anaesthesia. One-lung ventilation may be needed for transthoracic approaches. Neuromonitoring is essential.
Hospital stay two to five days. If a chest drain is needed, it is usually removed within one to two days. Walking encouraged early. Return to desk work at four to six weeks. Avoid heavy lifting for three months.
Reviews at two weeks, six weeks, and three months with imaging.
The thoracic spinal cord fills more of the spinal canal than in the lumbar spine, leaving less room for surgical manoeuvre. The disc must be removed from in front of the cord, requiring specialised approaches.