Transthoracic Decompression

What is Transthoracic Decompression?

Most mid-back (thoracic) disc herniations press on the spinal cord from the front. That is what makes them hard to treat. Coming in from the back means working around the cord to reach something sitting in front of it, and the thoracic cord has very little room to spare.

A transthoracic approach goes the other way. The spine is reached from the side of the chest, between the ribs, so the surgeon faces the front of the spinal canal directly and can remove the disc or bone spur without moving the spinal cord to get to it.

Dr. Melamed developed a navigation-assisted, minimally invasive version of this approach. Intraoperative navigation, the same technology he uses in biportal endoscopic surgery, confirms the exact level and guides the instruments, and the work is done through small incisions rather than a large open chest incision. It is a specialized operation, and it is not the same thing as a routine minimally invasive back procedure.

Am I a candidate for Transthoracic Decompression?

This approach is considered for thoracic disc herniations, calcified discs, and bone spurs that compress the spinal cord or a thoracic nerve root, confirmed on MRI and often CT. Symptoms that point toward cord compression include leg weakness or stiffness, trouble with balance and walking, numbness below the chest, and in more advanced cases changes in bladder or bowel control. Compression of a thoracic nerve can also cause band-like pain around the chest or abdomen that is sometimes mistaken for a digestive or kidney problem.

Pain alone, without signs of cord compression, is usually treated conservatively first. Dr. Melamed reviews your imaging and examination to decide whether surgery is needed and which approach fits the location of the compression.

How does Transthoracic Decompression work?

The operation is done under general anesthesia with you lying on your side. Navigation imaging is used to identify the correct level, which is a real concern in the mid-back, where vertebrae look alike on X-ray.

Working through small incisions between the ribs, Dr. Melamed reaches the side of the spine and removes the part of the disc or bone spur that is pressing on the spinal cord or nerve. The cord itself is not retracted. If removing the compression would leave the segment unstable, a limited stabilization may be added in the same operation. He will tell you before surgery whether that is likely in your case.

What is recovery like?

Because the approach passes through the chest wall, a short hospital stay is usual, and some patients need a temporary chest drain. Walking starts early. Recovery is guided by Dr. Melamed's narcotic-sparing plan, and he will map out a realistic timeline based on the level treated, your symptoms before surgery, and whether stabilization was needed.

What are the benefits of Transthoracic Decompression?

• ✓Reaches compression in front of the spinal cord directly
• ✓Removes the disc or spur without moving the cord aside
• ✓Navigation confirms the correct thoracic level
• ✓Small incisions instead of an open chest incision
• ✓A technique Dr. Melamed developed

What conditions does Transthoracic Decompression treat?

• Thoracic disc herniation pressing on the spinal cord
• Calcified thoracic discs
• Thoracic myelopathy from compression in front of the cord
• Thoracic nerve compression causing band-like chest or abdominal pain