Name of the Procedure:

Osteotomy of the spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (e.g., pedicle/vertebral body subtraction); thoracic

• Common Name(s): Thoracic Spinal Osteotomy, Thoracic Vertebral Subtraction Osteotomy (VSO)

Summary

A thoracic spinal osteotomy is a surgical procedure where a portion of a thoracic vertebra is cut and removed to correct spinal deformities, like kyphosis (hunchback) or lordosis (swayback), by realigning the spine.

Purpose

This procedure addresses severe spinal deformities, spinal malalignment, or significant curves that cannot be corrected by less invasive methods. The primary goal is to improve spinal alignment, relieve pain, and enhance the patient's overall functionality and quality of life.

Indications

• Severe kyphosis or lordosis
• Rigid spinal deformities
• Previous spinal surgeries with residual deformities
• Severe spinal instability or imbalance

Preparation

• Fasting for 8-12 hours before the surgery
• Medication adjustments as directed by the physician
• Pre-operative imaging studies like X-rays, CT scans, or MRIs
• Blood tests and medical clearance

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Surgical Approach: The patient is positioned prone (on their stomach). The surgeon makes an incision in the back, over the thoracic spine.
3. Exposure: Muscles and soft tissues are retracted to expose the vertebrae.
4. Osteotomy: A segment of the vertebra is carefully cut and removed.
5. Realignment: The spine is realigned, correcting the deformity.
6. Stabilization: Metal rods, screws, or other instruments are implanted to stabilize the spine.
7. Closure: The incision is closed with sutures or staples.

Duration

3 to 6 hours, depending on the complexity of the case.

Setting

Hospital operating room (OR)

Personnel

• Orthopedic surgeon or neurosurgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

• Infection
• Blood loss
• Nerve damage or spinal cord injury
• Failure to achieve the desired alignment
• Hardware complications (e.g., broken screws or rods)

Benefits

• Improved spinal alignment and posture
• Reduced pain
• Enhanced functional mobility
• Improved overall quality of life

Recovery

• Hospital stay of 3-7 days
• Pain management with prescribed medications
• Physical therapy starting a few weeks post-surgery
• Avoid heavy lifting or strenuous activities for several months
• Follow-up appointments for monitoring and imaging

Alternatives

• Bracing (for less severe cases)
• Physical therapy and exercise programs
• Less invasive spinal treatments such as vertebroplasty or kyphoplasty
• Pros and Cons: Non-surgical options often have fewer risks but may not be as effective for severe deformities.

Patient Experience

• During the Procedure: The patient will be under general anesthesia and will not feel pain.
• Post-Procedure: Initial pain and discomfort are managed with medications. The patient may experience some pain and limited mobility during the recovery phase, which improves with time and rehabilitation.