THORACIC SPINE DECOMPRESSION

How Chronic Thoracic Spine Pain Impacts Daily Life

Living with chronic thoracic spine pain can drastically alter your daily routine, affecting both physical and emotional well-being. Here’s how this condition can impact your everyday life:

Restricted Mobility:
Simple activities like bending over to tie your shoes or lifting light objects can become daunting tasks. This added difficulty can lead to frustration and a reliance on others for help.

Work Limitations:
Pain can make it challenging to maintain focus and productivity at work. You might find it difficult to sit for extended periods or perform jobs that require physical exertion.

Social and Recreational Activities:
Enjoying hobbies or social gatherings may feel impossible, impacting your social relationships and overall satisfaction with life. Physical pain can make participating in sports or even taking leisurely walks less enjoyable.

Emotional and Mental Health:
Persistent pain often leads to stress, anxiety, and depression. The constant discomfort can wear down your mental resilience, making everything feel like a chore.

Who is a Candidate for Spinal Decompression Surgery?

Spinal decompression surgery is typically considered for individuals who meet the following criteria:

• Chronic Leg or Foot Pain: Those experiencing significant pain, weakness, or numbness in their leg or foot.
• Predominant Leg Pain: Patients suffering from leg pain that overshadows any back pain they might have.
• Limited Improvement with Conservative Treatments: Individuals who have not seen substantial improvement despite physical therapy or medication.
• Mobility Issues: People face difficulty walking or standing, which adversely affects their quality of life.
• Diagnostic Confirmations: Those with MRI, CT, or myelogram results showing spinal stenosis in the central canal or lateral recess.

If these symptoms and conditions resonate with your experiences, it may be time to discuss spinal decompression surgery with your healthcare provider.

How to Decide Whether to Undergo Decompression Surgery for Spinal Stenosis

Deciding whether to undergo decompression surgery for spinal stenosis is a significant and personal choice. Here’s a comprehensive guide to help you make an informed decision:

Evaluate Severity and Symptoms

The first step is to assess the severity of your symptoms. Surgery is typically elective, meaning it’s not an emergency procedure except in rare cases like cauda equina syndrome or rapidly worsening neurological deficits.

Consider Non-Surgical Options

Before opting for surgery, consider other treatments:

• Physical Therapy: Exercises and stretches can alleviate pain and improve mobility.
• Medications: Pain relievers and anti-inflammatory drugs can help manage symptoms.
• Epidural Injections: These can provide temporary relief from pain.

Understand the Goal of Surgery

Decompression surgery aims to relieve pressure on the spinal cord or nerves. It’s important to note that the procedure does not cure spinal stenosis or arthritis but can reduce some of the discomfort associated with these conditions.

Risks and Benefits

Weigh the risks and benefits:

• Benefits: Potential pain relief and improved function.
• Risks: As with any surgery, there are potential complications such as infection, blood clots, or nerve damage. Additionally, symptoms may recur over time due to the ongoing degenerative nature of spinal stenosis.

Consult Multiple Specialists

Get opinions from more than one medical professional. Different specialists may offer varying perspectives and treatment options, giving you a broader understanding of what’s available.

Personal Lifestyle and Preferences

Consider your lifestyle and how the symptoms impact your daily activities:

• Activity Level: If pain and immobility significantly hinder your quality of life, surgery may be more justifiable.
• Recovery Time: Be prepared for the recovery process, which may involve physical therapy and temporary limitations on daily activities.

Financial Considerations

Surgery can be expensive and may not be fully covered by insurance. Evaluate your financial situation and insurance coverage to ensure you’re prepared for the costs involved.

Informed Decision

Finally, make sure you’re fully informed:

• Research: Read credible sources and patient testimonials.
• Ask Questions: Don’t hesitate to ask your doctors about success rates, recovery times, and alternative treatments.

By thoroughly evaluating these factors, you’ll be better equipped to make a decision that’s right for your health and lifestyle.

Preparing for Spinal Decompression Surgery

Upon arrival at the office, you will sign consent forms and provide detailed medical history. This information includes allergies, current medications and supplements, past surgeries, bleeding history, and any previous reactions to anesthesia.

Undergoing Presurgical Tests

A series of tests may be necessary several days before surgery. Common tests include blood tests, electrocardiograms (ECG), and chest X-rays. Consulting with your primary care physician about halting specific medications is also essential for clearance.

Medication Guidelines

• Continue: Follow your surgeon’s recommendations for medications that should be maintained.
• Stop: Cease taking all non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, as well as blood-thinning medications such as aspirin and Plavix, seven days before surgery.
• Lifestyle Adjustments: Avoid nicotine and alcohol one week before and two weeks after surgery to minimize bleeding and aid in recovery.

Skin Preparation

You might need to wash your skin with an antibacterial soap before surgery to reduce the risk of infection. Make sure to avoid contact with your eyes, ears, nose, and genital areas when using these soaps.

Fasting Before Surgery

No food or drink should be consumed after midnight on the night before your surgery.

Hospital Admission and Anesthesia

On the morning of the procedure, you will be admitted to the hospital. An intravenous (IV) line will be placed in your arm to prepare you for anesthesia. An anesthesiologist will then discuss the anesthesia’s effects and potential risks with you.
By following these detailed steps, you ensure your body is optimally prepared for spinal decompression surgery, setting the stage for a successful procedure and smoother recovery.

Treating Thoracic Spine Decompression Conditions 

Spine doctors only recommend it when non-surgical treatments do not help. This surgery aims to improve symptoms such as numbness and persistent pain in the leg. This pain comes from the pressure on the nerves in the spine.

Surgeons often use lumbar (spine) decompression surgery to treat:

• Spinal Stenosis – In this condition, there is a narrowing of a part of the spinal column. And this puts pressure on the nerves inside.
• A Slipped Disc And Sciatica – In this case, a damaged spinal disc presses down on an underlying nerve.
• Spinal Injuries – Fracture or the swelling of tissue
• Metastatic Spinal Cord Compression – In this condition, cancer in one part of the body spreads into the spine and puts pressure on the spinal cord or nerves.

Factors Influencing the Success of Spinal Decompression Surgery

When discussing the success of spinal decompression surgery, it’s crucial to consider several key factors that can impact outcomes.

Type of Surgery

Different surgical methods can yield varying success rates. For instance:

• Decompressive Laminectomy: This procedure often alleviates leg pain in about 70% of patients, leading to notable improvements in daily function and a significant reduction in discomfort. However, relief from back pain is not guaranteed, and there’s a chance that some older adults may require additional treatments. Also, symptoms might resurface over time.
• Decompressive Laminotomy: Generally more effective for both back and leg pain, with success rates of around 72% for back pain relief and 86% for leg pain relief. Furthermore, it can enhance walking ability in approximately 88% of patients.
• Endoscopic Laminotomy: Offers advantages such as reduced blood loss, shorter hospital stays, and less need for postoperative pain medication compared to open laminotomy.

Patient Involvement

The patient’s role in their recovery cannot be overstated:

• Attitude and Motivation: Maintaining a positive outlook and being diligent with physical therapy exercises are vital for a successful recovery.
• Weight Management: Keeping a healthy weight appropriate for your height can significantly alleviate pain and improve surgical outcomes.
• Lifestyle Adjustments: It is essential to adopt correct posture and lifting techniques to prevent re-injury. Patients should be realistic and understand that while relief is possible, they may always need to manage their back health proactively.

Long-term Considerations

Patients should be mindful that:

• Recurrence of Symptoms: There is a possibility that symptoms may return after a few years, necessitating close monitoring and possibly further medical intervention.

Understanding these factors can help set realistic expectations and improve the success rates of spinal decompression surgery. By proactively managing their recovery, patients can maximize the benefits of their surgical procedures.

Effectiveness of Thoracic Spine Decompression Surgery

Like any surgical procedure, thoracic spine decompression has both risks and potential benefits. Risks may include infection, bleeding, damage to nerves or surrounding structures, or complications related to anesthesia. The potential benefits, however, include relief from symptoms, improved spinal stability, and enhanced overall functionality. Your spine doctor will thoroughly discuss the specific risks and benefits based on your individual health and the nature of your thoracic spine condition.

Potential Complications of Spine Surgery

Anesthesia Complications

The vast majority of surgical procedures require some type of anesthesia to ensure you do not feel or are aware of the procedure. A very small number of patients may experience problems with general anesthesia, such as reactions to the drugs used or issues arising from other medical conditions. Be sure to discuss these complications with your anesthesiologist.

Thrombophlebitis

Deep Venous Thrombosis (DVT) occurs when blood clots form inside the veins of the legs. The risk of developing DVT is much higher following surgery involving the pelvis or lower extremities. If a portion of the blood clot breaks free, it may travel to the lungs and cause a pulmonary embolism, which can be fatal if large enough.

Lung Problems

Post-surgery, particularly if general anesthesia is used, the lungs may not function as well as normal. Collapsed lung areas cannot move oxygen into the blood or remove fluids, creating an environment ripe for bacterial growth and potential pneumonia.

Infection

Any surgical procedure carries a risk of infection. Infections can be superficial, affecting only the skin incision, or deeper, involving areas around the spinal cord and vertebrae. Symptoms include redness, heat, swelling, and increased pain. Deep infections may require additional operations to drain the infection.

Hardware Fracture

In many spinal operations, metal screws, plates, and rods are used to hold the vertebrae in alignment. Sometimes, before the surgery is completely healed, the hardware can break or move from its correct position, necessitating a second operation.

Implant Migration

Implant migration refers to the movement of surgical implants from their initial placement. This may require a second surgery to replace the displaced implant.

Spinal Cord Injury

Operating on the spine carries a risk of spinal cord injury, which can result in paralysis in areas depending on the affected spinal nerves.

Persistent Pain

Some spinal operations may not fully alleviate pain. Persistent pain is a common complication, even if the surgery is technically successful.

Sexual Dysfunction

The spinal cord and nerves are essential for bodily functions, sensation, and sexual activity. Damage to these nerves can lead to sexual dysfunction.

Transitional Syndrome

Over time, segments adjacent to a surgical fusion may experience increased wear and tear, causing pain. This condition is known as transitional syndrome.

Pseudoarthrosis

Pseudoarthrosis occurs when there is a failure of bone fusion post-surgery. It may require more surgery to encourage bone healing, possibly involving additional bone grafts, hardware replacement, or electrical stimulation.

By understanding these potential complications, you can have a more informed discussion with your spine doctor about the risks and benefits of your thoracic spine decompression surgery.

Like any surgical procedure, thoracic spine decompression has both risks and potential benefits. Risks may include infection, bleeding, damage to nerves or surrounding structures, or complications related to anesthesia. The potential benefits, however, include relief from symptoms, improved spinal stability, and enhanced overall functionality.

Nerve Damage or Persistent Pain

Any operation on the spine comes with the risk of damaging the nerves or spinal cord. Damage can cause numbness or even paralysis. The most common cause of persistent pain is nerve damage from stenosis. Some bone spurs may permanently damage a nerve, making it unresponsive to decompressive surgery. In these cases, spinal cord stimulation or other treatments may provide relief. Be sure to go into surgery with realistic expectations about your pain. Discuss your expectations with your doctor to better understand potential outcomes and management strategies.

The Common Techniques For Thoracic Spine Decompression

Thoracic spine decompression is a generic term that denotes different surgical procedures that help relieve pressure off the spinal cord or spinal nerves. These surgical procedures aim to increase the space within the spinal canal or neural foramen. It is the place where the spinal nerve roots leave the spinal canal.

• Full Laminectomy: In this procedure, doctors remove the entire lamina, a part of the thickened ligaments, and enlarged facet joints to relieve pressure.
• Partial Laminotomy: During this method, surgeons only remove a section of the lamina and ligament.
• Foraminotomy: A foraminotomy helps increase the space where the spinal nerve roots leave your spinal canal to reduce compression.
• Laminoplasty: Laminoplasty is a surgical method that helps improve conditions such as cervical spinal stenosis. This procedure increases the space within the spinal canal and thus; helps relieve the pressure off the spinal canal. In this process, experts create a hinge on one side of the vertebrae and cut a part of the vertebrae on the other side.

It creates swinging vertebrae. And the parts or vertebrae are fixed in place by using small wedges. These spacers are then settled with the help of tiny plates and then set with screws. It expands the space of the spinal canal and relieves the pressure off the spinal cord.

Performing Surgeries 

Surgeons perform these surgeries under general anesthesia. They make an incision in the middle of your back to split and move the muscles overlying the vertebrae to the side. This exposes the lamina of the vertebra, the bone that forms the back of the spinal canal and creates a protective roof on the back of the spinal cord.

Then they remove the entire bony lamina and ligament (laminectomy). In some cases, experts only create a small opening removing the bone of the lamina above and below the spinal nerves to relieve compression (laminotomy). Next, they retract the protective sac of the spinal cord and the nerve root to eliminate the bone spurs and the thickened ligament.

Step 1: Preparation

You will lie on your back on the operative table and be given anesthesia. Once asleep, you will be rolled over onto your stomach with your chest and sides supported by pillows. The area where the incision will be made is cleansed and prepped. If a fusion is planned and you have decided to use your own bone, the hip area will be prepped to obtain a bone graft. If you’ve decided to use donor bone, a hip incision is not necessary.

Step 2: Incision

A skin incision is made down the middle of your back over the appropriate vertebrae. The length of the incision depends on how many laminectomies are to be performed. The strong back muscles are split down the middle and moved to either side exposing the lamina of each vertebra.

Step 3: Laminectomy or Laminotomy

Once the bone is exposed, an X-ray is taken to verify the correct vertebra.

• Laminectomy: The surgeon removes the entire bony lamina and ligament using a drill or bone-biting tools. The thickened ligamentum flavum that connects the laminae of the vertebra below with the vertebra above is removed. This is repeated for each affected vertebrae.
• Laminotomy: In some cases, experts only create a small opening by removing the bone of the lamina above and below the spinal nerves. It helps in relieving compression. Laminotomy can be done on one side (unilateral) or both sides (bilateral) and on multiple vertebrae levels.

Step 4: Decompress the Spinal Cord

Once the lamina and ligamentum flavum are removed, the protective covering of the spinal cord (dura mater) becomes visible. Surgeons gently retract the protective sac of the spinal cord and the nerve root to eliminate bone spurs and thickened ligament.

Step 5: Decompress the Spinal Nerve

To decompress the spinal nerve, the facet joints, which are directly over the nerve roots, may be undercut (trimmed) to give the nerve roots more room. This procedure, called a foraminotomy, enlarges the neural foramen, where the spinal nerves exit the spinal canal (Fig. 6). If a herniated disc is causing compression, the surgeon will perform a discectomy, removing the part of the disc that is pressing on the nerve.

A foraminotomy removes the bone narrowing the nerve root canals. The enlarged facet joints are trimmed to relieve pressure on the spinal nerves. Use of a minimally invasive tube retractor causes less disruption to the back muscles.

Then surgeons trim the facet joints to create more space for the nerve roots. If the reason for compression is a slipped disc, the surgeon will perform a discectomy, removing a part of the slipped disc.

However, sometimes spinal decompression may require a combination of these surgical procedures. For example, this surgery makes the spine quite unstable. And to deal with this, experts perform another surgery, spinal fusion, to stabilize the spine. Spinal fusion involves rods, bone grafts, plates, or screws to join two separate vertebrae in the spine.

In cases where spinal fusion is necessary, it is often performed simultaneously with a laminectomy to help stabilize the treated sections of the spine. The fusion process uses a combination of bone graft, screws, and rods to connect two separate vertebrae into one unified piece of bone. This procedure prevents spinal stenosis from recurring and helps eliminate pain from an unstable spine, providing both immediate and long-term relief. Fusing the joint not only stabilizes the spine but also ensures that the benefits of the initial surgery are maintained, offering patients a better quality of life post-operation.

Step 6: Fusion (If Necessary)

However, sometimes spinal decompression may require a combination of these surgical procedures. For example, this surgery makes the spine quite unstable. If you have spinal instability or have laminectomies to multiple vertebrae, a fusion may be performed. Fusion involves rods, bone grafts, plates, or screws to join two separate vertebrae in the spine. The back muscles are laid over the bone graft to hold it in place.

Step 7: Closure

The muscle and skin incisions are sewn together with sutures or staples. This concludes the surgical procedure, ensuring everything is securely in place for recovery.

Understanding Pseudoarthrosis in the Context of Spine Surgery Risks

What is Pseudoarthrosis?

Pseudoarthrosis, derived from “pseudo” (false) and “arthrosis” (joint), denotes a false joint. This term often arises in the context of bone fractures or surgical fusions that fail to heal correctly. Essentially, it signifies that there remains undesirable motion between two bones that should be solidly fused.

Pseudoarthrosis in Spine Surgery

In spine surgery, pseudoarthrosis can be a troubling outcome. When vertebrae intended to fuse do not properly join together, it results in persistent and potentially escalating pain. This condition also puts undue stress on the surgical hardware, such as screws and rods, used to stabilize the spine.

Consequences of Non-Fusion

• Increased Pain: The lack of fusion often amplifies pain due to continued movement between the bones.
• Hardware Stress: Metal components employed to stabilize the failed fusion might break under stress, worsening the situation.
• Further Surgery: Correcting pseudoarthrosis typically necessitates additional surgical interventions. This could involve:
  • Adding more bone graft material.
  • Replacing or reinforcing the metal hardware.
  • Introducing an electrical stimulator to enhance bone healing.

Key Takeaways

• Pseudoarthrosis refers to an unsuccessful bone healing or fusion, causing persistent movement and pain.
• In spine surgery, it leads to both medical complications and the need for further operations, highlighting the importance of proper initial surgical technique and post-operative care.

Treatment Options for Pseudoarthrosis After Spine Surgery

If pseudoarthrosis occurs following spine surgery, additional treatment is typically necessary to encourage bone healing. Here are common approaches your surgeon might consider:

• Bone Grafting: Adding more bone graft material can stimulate the bone healing process. This may involve using bone from your own body, donor bone, or synthetic substitutes.
• Hardware Revision: Sometimes, replacing or augmenting the metal hardware, such as screws or rods, can provide better stability to the fusion site, facilitating proper bone union.
• Electrical Stimulation: An electrical bone growth stimulator might be applied to the affected area. These devices use electrical currents to promote bone growth and fusion.

Each of these treatments aims to create a more favorable environment for the bones to heal properly and achieve a successful spinal fusion.

Happens After Spinal Decompression Surgery

The recovery process after thoracic spine decompression surgery varies depending on the complexity of the procedure and individual factors. Initially, there will be a period of restricted activity, and physical therapy may be recommended to enhance strength and mobility gradually. Pain management strategies will also be implemented. Full recovery can take several weeks to months, and your spine doctor will provide a personalized postoperative care plan, including follow-up appointments to monitor progress and address any concerns.

Here’s what you can generally expect during your recovery:

Immediate Postoperative Period

• Recovery Area: You’ll awaken in the postoperative recovery area where your blood pressure, heart rate, and respiration will be closely monitored. Pain management will be a priority.
• Transition: Once you’re fully awake, you’ll be moved to a regular room. Here, you’ll start to increase your activity level, such as sitting in a chair and walking. If a spinal fusion was performed, you may need to wear a brace.

Hospital Discharge

• Duration: Typically, you’ll be discharged from the hospital within 1 to 2 days.
• Home Assistance: It’s crucial to have someone at home to assist you for the first 24 to 48 hours post-discharge.

Postoperative Restrictions

To ensure a smooth recovery, your doctor will advise you to:

• Avoid bending or twisting your back.
• Refrain from lifting anything heavier than 5 pounds.
• Avoid strenuous activities, including yard work, housework, and sex.
• Don’t drive for the first 2-3 days or while taking pain medicines or muscle relaxers. You can drive once your pain is well controlled.
• Avoid alcohol as it thins the blood and increases the risk of bleeding. Also, don’t mix alcohol with pain medications.

Activity Guidelines

• Icing: Ice your incision 3-4 times daily for 15-20 minutes to reduce pain and swelling.
• Movement: Don’t sit or lie in one position longer than an hour unless you’re sleeping. Stiffness can lead to more pain.
• Walking: Get up and walk for 5-10 minutes every 3-4 hours. Gradually increase your walking duration as you’re able.

Incision Care

• Dermabond Skin Glue: If your incision is covered with Dermabond skin glue, you may shower the day after surgery. Gently wash the area with soap and water daily. Avoid rubbing or picking at the glue and pat the area dry.
• Staples, Steri-Strips, or Stitches: If you have these types of closures, you can shower 2 days after surgery. Gently wash the area with soap and water daily and pat dry.
• Dressing Changes: If there is drainage, cover the incision with a dry gauze dressing. If drainage soaks through two or more dressings in a day, call your doctor’s office.
• Hygiene: Do not soak the incision in a bath or pool. Avoid applying lotion or ointment on the incision. Dress in clean clothes after each shower and sleep with clean bed linens. No pets in the bed until your incision heals.

Medications

• Pain Management: Take pain medication as directed by your surgeon. Reduce the amount and frequency as your pain subsides. If you don’t need the pain medication, don’t take it.
• Constipation Relief: Narcotics can cause constipation. Drink plenty of water and eat high-fiber foods. Over-the-counter options like Colace, Senokot, Dulcolax, and Miralax can help.

When to Call Your Doctor

Contact your doctor if you experience:

• Fever over 101.5°F (unrelieved by Tylenol).
• Persistent nausea or vomiting.
• Signs of incision infection.
• Rash or itching at the incision (potential allergy to Dermabond skin glue).
• Swelling and tenderness in the calf of one leg.
• New onset of tingling, numbness, or weakness in the arms or legs.
• Dizziness, confusion, nausea, or excessive sleepiness.

By following these guidelines and maintaining open communication with your healthcare team, you can help ensure a smoother and more effective recovery.

Recovery

Depending on the complexity of the surgery and your mobility level before the operation, you will be well enough to leave the hospital within 1 to 4 days after having surgery.

Most people can walk without any help just a day after the operation. However, you should avoid more strenuous activities for about six weeks. You can return to work after 4 to 6 weeks, even though you may have to stay off from your job for a longer time if your job involves lifting heavy objects or driving for long periods.

Activities To Avoid

• Avoid bending or twisting your back in repeated motion.
• Do not lift more than 5-10 pounds.
• If you attempt to pick something up and it causes an ache in the back muscles, you better not lift it.
• Keep things close to your body if you carry or lift anything. Also, if you bend, remember to use your knees instead of your back.
• Because of your recent surgery, avoid driving for at least two weeks. Even after two weeks, do not drive if you are still taking prescription pain medications or muscle relaxers. It is because these medications make you drowsy. And once you feel easy with driving, make sure you can look over your shoulders without experiencing any pain.
• Avoid vacuuming, weight lifting, sweeping/mopping, laundry, running/jogging, wave runner, shoveling/raking, riding a lawn mower, or anything that might irritate your back during the healing period.

Follow these activity restrictions until your follow-up appointment in the fourth-sixth week.

When To Call a Doctor 

Contact the doctors if you have any of the following signs and symptoms:

• Numbness or tingling in your feet or legs
• Increasing swelling and redness around the incision with or without any soreness
• The edges of the incision are coming apart.
• Yellow/green and/or bad-smelling drainage from the incision.
• Fever over 101 F.
• Sudden bruising around the incision
• Increasing pain.
• Numbness or tingling in the hands or fingers on any one side.
• Weakness of your arm, hand, or leg

The Surgeons at the Southwest Scoliosis and Spine Institute

There are risks and complications associated with spinal decompression, such as nerve or tissue damage and allergic reaction to anesthesia, infection, bleeding, and blood clots. However, as long as you have our spine doctors and surgeons at the Southwest Scoliosis and Spine Institute to help you out, you can stay completely worry-free. Finally, our team with offices in Dallas, Plano, and Frisco, Texas takes complete care of patients throughout the healing procedure.

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Footnote:

WebMD: Spinal Decompression Therapy