Thoracic decompression and fusion is an operation to relieve pressure on the spinal cord in the thoracic (mid-back) spine and stabilise the affected levels with screws, rods, and bone graft. It is performed for thoracic stenosis, fractures, tumours, or deformity.
A midline incision is made over the thoracic spine. Pedicle screws are placed into the vertebrae above and below the affected levels. The spinal canal is decompressed by removing the lamina and any compressive pathology. Rods are connected to the screws to stabilise the spine. Bone graft is placed to promote fusion. The operation takes two to four hours.
Surgery is recommended for thoracic myelopathy (spinal cord compression causing leg weakness and balance problems), thoracic fractures with instability or neurological compromise, thoracic spinal tumours, and kyphotic deformity with cord compression.
Observation for mild or stable conditions, bracing for fractures, and radiotherapy for certain tumours. Progressive myelopathy generally requires surgery.
MRI and CT for planning. Pulmonary function tests in patients with kyphosis. This is a major procedure requiring thorough preparation.
Prevention of neurological deterioration. Some patients improve, but recovery of established spinal cord damage is variable.
Significant for several weeks. The thoracic spine has extensive muscle coverage.
More than lumbar surgery. Transfusion may be needed.
The fused segment is rigid.
The thoracic spinal cord has limited tolerance for manipulation. Risk approximately 1-2%.
Wound or deep infection.
Thoracic pedicle screws are technically demanding.
Failure of fusion.
Chest infection or respiratory compromise, particularly in patients with pre-existing lung disease or kyphosis.
New kyphosis above the fusion.
General anaesthesia with neuromonitoring (motor and sensory evoked potentials). Positioned prone.
Hospital stay three to seven days. Walking encouraged from day one. Brace may be worn for six to twelve weeks. Return to desk work at six to eight weeks. Avoid heavy lifting for three to six months. Full recovery six to twelve months.
X-rays at six weeks, three months, and six months. CT scan to assess fusion if needed.
The thoracic spinal cord is less tolerant of compression and manipulation than the lumbar nerve roots. Neuromonitoring is used throughout surgery to reduce the risk of cord injury.