Anterior Thoracic Decompression and Fusion
This procedure is performed to take pressure off the anterior or front aspect of the spinal cord in the thoracic spine. Usually disc herniation, tumor, infected abscess, or fracture fragments are pressing on the spinal cord compromising spinal cord function.
Adequate decompression cannot be performed in the back side of the spinal cord as spinal cord cannot be retracted or manipulated as the offending agent is directly in front of the spinal cord.
Resection of a rib is necessary to enter the chest cavity. Occasionally patient can develop pain in the area of the rib resection so called post thoracotomy pain which can persist and that can be usually treated with a procedure called intercostals nerve block or ablation.
Chest tubes are required to drain the chest cavity after the surgery and they are usually removed several days after the surgery if there is less than 50 cc to 100cc of drainage in 24 hour interval.
Instrumentation such as screws and rods and plates may be used in addition to bone graft or cages to stabilize the spine. Additional posterior surgery using pedicle screws and rods may be necessary to further stabilize the spine.
Potential complications of the procedure includes risk of neurological injury including paralysis, wound infection, lung injury, accumulation of lymph fluid called chyle in the chest cavity, hardware failure, failure of fusion to occur, and thoracotomy pain as mentioned above. The surgery is performed in conjunction with a general surgeon.