Name of the Procedure:

Osteotomy of Spine, Posterior or Posterolateral Approach, 1 Vertebral Segment; Thoracic

Summary

An osteotomy of the spine is a surgical procedure where a section of the spine (thoracic vertebra) is cut and realigned to correct deformities, alleviate pain, or improve function. This procedure uses a posterior or posterolateral approach, meaning the surgery is performed from the back or side of the spine.

Purpose

This procedure addresses spinal deformities like kyphosis, scoliosis, or significant spinal curvature that causes pain or functional limitations. The goal is to realign the spine, reduce pain, and improve the patient's posture and mobility.

Indications

• Severe spinal curvature (scoliosis or kyphosis) unresponsive to conservative treatments
• Chronic back pain due to spinal deformity
• Neurological symptoms caused by spinal deformity
• Progressive spinal deformities

Preparation

• Patients may need to fast for several hours before the procedure.
• A thorough physical examination and medical history are required.
• Imaging tests like X-rays, MRIs, or CT scans to plan the surgery.
• Adjustments to medications, particularly blood thinners and diabetes medications, as advised by the doctor.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgical team makes an incision in the posterior (back) or posterolateral (side-back) of the spine.
3. The muscles and tissues are carefully moved aside to expose the targeted thoracic vertebra.
4. The surgeon cuts a section of the vertebra and realigns it to correct the deformity.
5. Metal rods, screws, or plates may be used to stabilize the spine.
6. The incision is closed with sutures or staples, and a dressing is applied.

Duration

The procedure typically takes 3 to 6 hours, depending on the complexity.

Setting

This surgery is performed in a hospital operating room with specialized spinal surgery equipment.

Personnel

• Orthopedic or neurosurgeon specializing in spinal surgery
• Anesthesiologist
• Surgical nurses
• Surgical technologists
• Radiologic technologists (if real-time imaging is used)

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve injury, leading to numbness or weakness
• Spinal cord injury
• Hardware failure or misplacement
• Blood clots
• Respiratory complications

Benefits

• Correction of spinal deformity
• Reduction in pain
• Improved posture
• Enhanced mobility and function
• Improved quality of life, often noticeable within weeks to months after surgery

Recovery

• Initial hospital stay of 3 to 7 days, depending on individual recovery
• Pain management with medications
• Physical therapy starting soon after the procedure to aid recovery
• Restrictions on heavy lifting or strenuous activity for several months
• Follow-up appointments for monitoring healing and spinal alignment

Alternatives

• Bracing (non-surgical)
• Physical therapy
• Pain management injections
• Spinal fusion (a different type of surgery)
• Each alternative has its own pros and cons, often depending on the severity of the condition and patient-specific factors.

Patient Experience

During the procedure:

• The patient will be under general anesthesia and will not feel anything.

After the procedure:

• Expect significant initial pain, managed with medication.
• Some discomfort or restricted movement as the spine heals.
• Gradual return to daily activities with guidance from a healthcare provider.
• Regular physical therapy sessions to regain strength and mobility.

Pain management and comfort measures include medications, specialized beds, and supportive care from the medical team.