In his latest installment to the Total Spine series of instructional videos, Dr. Paul McCormick describes retropleural thoracotomy, a surgical technique used to treat complex spinal conditions of the thoracic and lumbar spine. “Retropleural thoracotomy is an important...
|What is a Thoracic Laminectomy?|
Thoracic = having to do with the spine in the upper and mid-back
A laminectomy the removal of the lamina, a part of the spine that forms a bony “roof” over the spinal canal. This common procedure gives a neurosurgeon access to the spinal canal and relieves pressure on the spinal cord or nerve roots.
When performed in the thoracic spine (upper and mid-back), the procedure is known as a thoracic laminectomy. For information about laminectomy in the neck, see our page on cervical laminectomy. For information about laminectomy in the low back, see our page on lumbar laminectomy.
|When is this Procedure Performed?|
Certain tumors can occur inside the spinal canal–for example, nerve sheath tumors, meningiomas, astrocytomas, ependymomas and hemangioblastomas. A surgeon performs a laminectomy as part of a microsurgical tumor removal to access and remove these tumors.
Spinal stenosis is a narrowing of the spinal canal that has many possible causes. A thoracic laminectomy can help treat stenosis caused by a narrowing at the back of the spinal canal (as opposed to the front or the sides).
|How is this Procedure Performed?|
A thoracic laminectomy is performed under general anesthesia.
An incision is made over the spine at the level of the surgery. The skin and muscles are opened and the bones at the back of the spine are revealed. The surgeon then removes the lamina.
Compression of the spinal cord is relieved when the lamina is removed. The surgeon may also relieve pressure on the spinal nerves with a procedure called a foraminotomy. In this procedure, the surgeon enlarges the foramina, or the small holes through which nerves exit the spinal canal. The surgeon may also remove some bone from a spinal joint called a facet joint. The facet joint is sometimes involved in nerve compression.
If the laminectomy is being performed a part of a tumor removal, the surgeon proceeds with the rest of the operation to remove the tumor.
After a laminectomy, the “roof” of the spinal canal can be left open; the lamina does not need to be replaced by a plate or bone graft. However, in cases where the spine is already weakened and/or bone removal is extensive, the surgeon may perform a spinal fusion to ensure the spinal column is strong and stable. During a spinal fusion, the surgeon inserts a bone graft that joins two or more vertebrae together into a single unit. The surgeon may also use instruments such as a metal plate and screws to hold the bones in place until they heal.
Finally, working layer by layer, the surgeon closes the incision using absorbable sutures that can be dissolved by the body.
|How Should I Prepare for this Procedure?|
Make sure to tell your doctor about any medications that you’re taking, including over the counter medication and supplements, especially medications that can thin your blood such as aspirin. Your doctor may recommend you stop taking these medications before your procedure. To make it easier, write all of your medications down before the day of surgery.
Be sure to tell your doctor if you have an allergy to any medications, food, or latex (some surgical gloves are made of latex).
On the day of surgery, remove any nail polish or acrylic nails, do not wear makeup and remove all jewelry. If staying overnight, bring items that may be needed, such as a toothbrush, toothpaste, and dentures.
|What Should I Expect After the Procedure?|
Post-surgical pain is usually controlled with intravenous pain medication for the first day, followed by oral pain medication. On average, patients are discharged from the hospital two to three days following surgery. Most patients are encouraged to walk as soon as possible, often on the day of surgery.
The surgeon will schedule a follow up visit, typically 4-6 weeks after surgery.
Will I need to wear a brace?
When can I resume exercise?
Will I need rehabilitation or physical therapy?
Will I have any long-term limitations due to thoracic laminectomy?
|Preparing for Your Appointment|
Drs. Paul C. McCormick, Michael G. Kaiser, Peter D. Angevine, Alfred T. Ogden, Christopher E. Mandigo, Patrick C. Reid and Richard C. E. Anderson (Pediatric) are experts in thoracic laminectomy.
Helpful Surgery Overviews
Dr. McCormick will choose the treatment method specific to each patient and situation. Some of the condition’s treatment options may be listed below.
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