What it is
Decompression of the thoracic spinal cord, by whichever approach reaches the compression most safely — from behind, from the side through the chest wall, or from in front. Stabilization is added where removing bone leaves the segment unstable.
Who it is for
Thoracic disc herniations causing cord compression, thoracic stenosis from ossified ligament, and tumor or infection compressing the cord. The threshold for operating is higher than in the neck or lower back, and the planning is more detailed.
How it works
The approach is chosen from the imaging. Compression behind the cord is reached through a posterior approach. A calcified disc in front is typically reached from the side, through a costotransversectomy or a lateral extracavitary or transthoracic route, so the cord is never retracted. Intraoperative neuromonitoring is used throughout. Instrumentation is added where stability requires it.
Recovery
Usually two to four nights, longer where the chest has been entered. Early mobilization with therapy. Recovery of neurological function, where it was impaired, continues over months and depends heavily on how long the cord was compressed before surgery.
Risks and alternatives
Spinal cord injury, which is uncommon but the reason for the care taken; injury to the lung or pleura in transthoracic approaches; infection; bleeding; CSF leak; and incomplete decompression. Alternatives depend on the cause and include radiotherapy for tumor, antibiotics for infection, and observation where the examination is normal.