Who is a candidate?
Thoracic decompression is considered for spinal cord compression in the mid-back (from a herniated or calcified thoracic disc, stenosis, tumor, infection, or fracture), particularly when there are myelopathic signs such as leg weakness, changes in walking, or a sensory level around the trunk. Because thoracic disc herniations are frequently found incidentally without symptoms, the examination governs the decision.
Urgent
New weakness in both legs, a band of numbness around the trunk, or any change in bowel or bladder control is assessed urgently.
How the procedure works
The route is chosen to reach the compression without retracting the cord. A transpedicular or costotransversectomy approach comes from behind and to the side, removing part of the pedicle or rib head to see around the cord. A lateral approach enters through the chest wall. An anterior approach reaches the front of the spine directly. Where a calcified disc is adherent to the cord, it is separated with particular care. Instrumentation is added when enough structure has been removed to require it.
Recovery
Recovery depends heavily on the approach and on the neurological starting point. Walking is resumed as soon as it is safe. Where the chest cavity has been entered, a chest drain may be needed briefly. Neurological recovery after thoracic cord decompression is gradual and varies; the operation frequently aims to stop deterioration as much as to reverse it.
Benefits and alternatives
The benefit is relief of pressure on a part of the cord where the canal is narrow and the blood supply is comparatively vulnerable. Alternatives include continued observation where symptoms are mild and stable, physical therapy and pain management for non-myelopathic pain, and radiation or systemic therapy where the cause is tumor.
Risks
Risks include infection, bleeding, injury to the spinal cord with weakness or paralysis, a tear in the lining around the cord, lung or chest complications with anterior and lateral approaches, hardware problems, and failure of the bone to fuse where fusion is performed. The thoracic spine carries a higher neurological risk profile than other regions, and that is discussed frankly.