Name of the Procedure:

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

Summary

A procedure to relieve pressure on the spinal cord or nerve roots by accessing the spine through an incision near the ribs. It is commonly used to treat thoracic spinal problems like herniated discs.

Purpose

The procedure addresses conditions such as herniated discs in the thoracic spine that cause pain, weakness, or neurological deficits. The goal is to alleviate pain, restore function, and prevent further neurological impairment.

Indications

• Chronic thoracic back pain unresponsive to conservative treatments.
• Neurological symptoms such as numbness, tingling, or weakness in the limbs.
• Diagnosed herniated thoracic disc with compression on spinal cord or nerve roots.
• Spinal stenosis or other thoracic spine degenerative conditions.

Preparation

• Fasting for at least 8 hours prior to the procedure.
• Discontinuation of certain medications (e.g., blood thinners) as advised by the doctor.
• Preoperative imaging studies like MRI or CT scans to assess the affected segments.
• Physical examination and laboratory tests to evaluate overall health.

Procedure Description

1. The patient is positioned on their side or prone and administered general anesthesia.
2. An incision is made near the ribs (costovertebral junction) to access the thoracic spine.
3. Muscles and tissues are carefully retracted to expose the vertebrae.
4. Surgical instruments are used to remove part of the herniated disc or bony structures compressing the spinal cord or nerve roots.
5. The site is checked for adequate decompression, and the incision is closed with sutures.

Duration

Approximately 2 to 4 hours.

Setting

Typically performed in a hospital operating room.

Personnel

• Orthopedic or neurosurgeon.
• Anesthesiologist.
• Surgical nurses.
• Operating room technicians.

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Nerve damage leading to paralysis or loss of function.
• Spinal fluid leakage.
• Respiratory complications due to the proximity to the lungs.
• Blood clots or deep vein thrombosis (DVT).

Benefits

• Relief from pain and neurological symptoms.
• Improved function and quality of life.
• Prevention of further neurological damage.

Recovery

• Hospital stay of 1-3 days post-surgery.
• Pain management with medications.
• Gradual return to daily activities over several weeks.
• Physical therapy to aid in recovery.
• Regular follow-up appointments to monitor progress and detect any complications.

Alternatives

• Conservative treatments such as physical therapy, medications, and epidural steroid injections.
• Minimally invasive procedures like endoscopic discectomy.
• Other surgical options like spinal fusion or laminectomy.
• Pros and cons should be discussed with a healthcare provider.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not experience any sensations. Postoperatively, pain at the incision site and discomfort from muscle retraction is common, managed with pain medications. Gradual improvement in symptoms can be expected, with specific instructions on activity restrictions and rehabilitation exercises provided to ensure optimal recovery.