00626 Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic approach; utilizing 1 lung ventilation

Name of the Procedure:

Anterior Transthoracic Approach with One Lung Ventilation (OLV) for Thoracic Spine and Cord Surgery

Summary

This surgical procedure involves accessing the thoracic spine and spinal cord through the chest (anterior transthoracic approach) while ventilating only one lung to provide the surgeon with better visibility and space to operate.

Purpose

This procedure is used to address various spinal conditions, such as thoracic spine tumors, deformities, or injuries. The goal is to correct or remove the problematic area, relieve pain, and improve spinal function.

Indications

• Thoracic spine tumors
• Spinal deformities (e.g., scoliosis)
• Spinal cord injuries
• Persistent pain or neurological symptoms not relieved by conservative treatments
• Patients in need of spine stabilization

Preparation

• Fasting: Patients are typically required to fast for 8 hours before surgery.
• Medication Adjustments: Certain medications, like blood thinners, may need to be paused under medical advice.
• Preoperative Tests: These may include blood tests, chest X-rays, and pulmonary function tests.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Positioning: The patient is positioned on their side.
3. Incision: An incision is made in the chest to access the thoracic spine.
4. One-Lung Ventilation (OLV): A double-lumen endotracheal tube is used to collapse one lung for better access to the spine.
5. Surgical Access: The surgeon carefully navigates around vital structures to reach the thoracic spine.
6. Spinal Correction/Removal: The problematic spine segment is corrected, stabilized, or removed.
7. Closure: The incision is closed, and the patient is monitored as they recover from anesthesia.

Duration

The procedure typically lasts between 4 to 6 hours, depending on complexity.

Setting

The procedure is performed in a hospital operating room equipped for thoracic surgery.

Personnel

• Surgeon: Specialized in spine or thoracic surgery.
• Anesthesiologist: Manages anesthesia and one-lung ventilation.
• Surgical Nurses: Assist with the procedure.
• Respiratory Therapist: Assists with maintaining one-lung ventilation.

Risks and Complications

• Common Risks: Infection, bleeding, pain at the incision site.
• Rare Risks: Pneumothorax (collapsed lung), damage to nearby organs or blood vessels, spinal cord injury, prolonged lung issues.
• Management: Risks are managed with antibiotics, careful monitoring, and appropriate surgical techniques.

Benefits

• Improved Function: Correction of spine deformities or removal of tumors.
• Pain Relief: Decreased pain levels.
• Enhanced Quality of Life: Better spinal stability and overall function.

Recovery

• Post-Procedure Care: Hospital stay for a few days, pain management, physical therapy.
• Recovery Time: Full recovery may take several weeks to months.
• Restrictions: Limited physical activity, follow-up visits for monitoring.

Alternatives

• Conservative Treatments: Physical therapy, medications, or spinal injections.
• Minimally Invasive Surgery: If appropriate, less invasive options may be considered.
• Pros and Cons: Alternatives may have shorter recovery times but may not be suitable for all conditions.

Patient Experience

Patients may feel groggy and sore immediately post-surgery. Pain management is provided through medications and comfort measures. Gradual improvement in symptoms is expected as they engage in prescribed rehabilitation.