Name of the Procedure:

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (e.g., herniated intervertebral disc), single segment; thoracic

Summary

This surgical procedure involves accessing the thoracic spine through the pedicles (the bony projections on the vertebrae) to relieve pressure on the spinal cord, cauda equina, and/or nerve roots caused by conditions such as herniated intervertebral discs.

Purpose

The procedure addresses spinal conditions that cause compression of the spinal cord or nerve roots, resulting in pain, weakness, or other neurological symptoms. The goal is to alleviate these symptoms by removing the source of compression, thereby improving patient mobility and quality of life.

Indications

• Persistent thoracic spine pain unresponsive to conservative treatments
• Neurological deficits such as numbness, tingling, or weakness in the limbs
• Imaging studies showing herniated intervertebral discs or spinal stenosis
• Myelopathy (spinal cord dysfunction) or radiculopathy (nerve root pain)

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments, such as stopping blood thinners, may be required.
• Preoperative imaging studies like MRI or CT scans to plan the surgery.
• Blood tests and a thorough medical evaluation to ensure fitness for surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made over the affected area of the thoracic spine.
3. Surgical instruments are used to access the spine through the pedicles.
4. The surgeon removes bone, disc material, or other structures compressing the spinal cord and/or nerve roots.
5. Instruments like a surgical microscope or endoscope may be used for precision.
6. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists
• Post-operative care team

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Nerve damage leading to persistent pain or weakness
• Spinal fluid leak
• Reaction to anesthesia
• Blood clots or deep vein thrombosis (DVT)

Benefits

• Relief from chronic pain and neurological symptoms
• Improved mobility and function
• Enhanced quality of life
• Reduced risk of further neurological damage

Recovery

• Initial hospital stay of a few days for monitoring
• Pain management with medications
• Physical therapy to aid recovery
• Avoidance of heavy lifting and strenuous activities for several weeks
• Follow-up appointments to monitor healing and progress

Alternatives

• Conservative treatments like physical therapy, medications, and epidural injections
• Minimally invasive spine surgery
• Anterior approach spinal decompression
• The choice of treatment depends on the patient's specific condition, severity of symptoms, and overall health.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Postoperatively, some pain and discomfort are expected, which can be managed with medication. Monitoring for complications will be conducted, and physical therapy will be a key part of the recovery process.