A posterior thoracic removal
of a herniated disc is an operation performed to decompress
either a nerve or the spinal cord within the thoracic area.
Thoracic discs account for only 0.5% of all herniated
discs, due to the rigidity of the thoracic spine and rib cage.
These can be linked to a history of trauma in only 25% of
cases. We focus here on the posterior (from the back)
approach. The patient is brought to the operating
room, and put to sleep. Then, once asleep and on a ventilator
(breathing apparatus), the patient is carefully turned into
the prone position (face down). Care is taken to ensure
that all "bony" areas are well protected, to prevent
pressure sores. The surgeon will now incise the skin
overlying the appropriate level of the herniated disc, and
push the muscle away from the spine. Retractors hold
the muscle aside, and the surgeon then removes a portion of
the lamina (roof of the spinal cord). Depending on where
the nerve or spinal cord compression is, part of the joint
connecting two adjacent vertebral body levels may also be
removed. Often, spinal cord monitoring may be used
during the case, depending upon the degree of spinal cord
compression and the judgement of the surgeon. After
the decompression has been accomplished, closure of the muscle
layer, deep fascia (deep fibrous tissue) and skin is performed.
Posterior thoracic discectomy
is performed much less frequently than lumbar or cervical
discectomies. Risks can be broken down into two
categories, 1) those related to the operative site, and 2)
those related to the risks of anesthesia.
to the operative site:
Exposure: The patient is placed in the
prone position (face down). In this position, there
can be pressure sores, pressure injuries to nerves, and
injury to the eyes as a result of pressure to them.
During surgical dissection, injury to muscle surrounding
the spine can occur.
Root injuries: If
there is any injury to the spinal cord in the thoracic area,
this could result in paralysis of the lower extremities,
as well as loss of bowel, bladder and sexual function.
There may be a spinal fluid leak, which could occur
after a tear of the covering of the spinal cord or nerve
roots. There is a small chance of causing
instability with the discectomy.
include general difficulties, such as bleeding, infection,
stroke, paralysis, coma and death. Incisions on the
back generally heal well, but the incision site could
be tender, or may heal in an unpleasant manner, with scarring.
There is also the possibility that the surgery may not relieve
the symptoms for which the procedure was performed.
The problem for which the surgery was performed may recur,
requiring additional surgery in the future. In addition,
although every attempt is made to protect all areas of the
body from pressure on nerves, skin and bones, injuries to
these areas can occur, particularly with prolonged cases.
clots in the legs, heart attacks, reaction to the anesthetic,
reaction to blood transfusion, if given.
There shall be no bending,
twisting, or heavy lifting for several weeks after surgery.
Physical therapy may or may not be implicated. Your
doctor will gradually ease your work restrictions, depending
on your progress.
Remember to keep the wound
dry and clean. Notify your surgeon of any drainage
or temperatures greater than 101 Fahrenheit.
The goal of this surgery was
to relieve the pressure on the nerves and/or spinal cord
in your back. The healing process may be a long one,
depending on whether nerve root or spinal cord damage was
involved. Some continuuing back pain is
not unusual during the first few days and weeks following
surgery. Hurt does not necessarily mean harm.
The following is a list of suggestions that should help
speed your recovery and give you every possible chance for
the best results from your surgery.
- Immediately upon discharge,
contact our office and set up an appointment for staple
removal if one has not already been set up.
- Take it easy until seen
by the physician. This does not mean bed rest, but
athletic activities during this period are definitely
not recommended. Please give your incision a chance
to heal. Avoid bending.
- If your surgeon has prescribed
for you a brace or corset, make sure to wear it when you
are out of bed. It will help to support your spine
while your own bone is healing.
- Lift nothing heavier than
a half gallon of milk until seen by your doctor.
- Avoid sitting for periods
of time longer than 45 minutes. It is OK to sit
in a lounge chair which is laid back, for as long as you
- No jogging or running.
- After you get home, you
may begin walking up to one mile per day.
- You may walk up or down
steps as often as you like. Please take them smoothly
- No driving until OK with
your physician. Do not ride further than 50
miles at a time. This applies during the first month
- You may shower after you
go home unless otherwise instructed. Cover the incision
with plastic wrap before the shower and remove it afterward.
Change dressing immediately. Tub baths are not advisable.
You may shower without covering the incision one week
after the staples are out. Follow instructions concerning
care of tapestrips, stitches or staples. Your surgeon
or his nurse clinician will explain the techniques used
in the closure of your incision.
- Sexual activities are permitted.
- If you notice swelling,
redness or opening of the incision, or if there is any
clear fluid draining from it, please contact your surgeon
immediately! If you develop a fever, stiff neck
or chills, contact the office immediately. Take
your temperature at 4:00 PM daily until the clips are
removed. Call in greater than 101 degrees Fahrenheit.
- If you have any questions,
call our office, and for after hours emergencies, call
the medical society.
- Take your medications prescribed
on discharge, as directed.
- It takes 6 - 18 months for
a nerve to heal. During that time you may experience
numbness, tingling, fleeting pain, or creepy/crawly sensations.
- If there has been spinal
cord damage due to long term spinal cord compression,
it may take 1-2 years for an improvement, and often, improvement
will be very limited, if it does occur at all.
- If you have had a fusion,
make sure you don't smoke, as this decreases the likelihood
of a successful fusion.