Structural thoracic kyphosis can be a painful spine condition that warrants back surgery if conservative interventions such as braces and physical therapy fail to improve symptoms. Patients will usually have analgesics and anti-inflammatory medications prescribed for use prior to surgery as well as padded back supports (orthoses) to manage pain by controlling movement. Back surgery for thoracic kyphosis may be considered necessary once the patient’s age, severity of back curvature, rate of progression of the abnormality and likely growth (in children) is taken into account.
Surgeries may involve techniques that remove bone (an osteotomy) and correct problems with the spinal discs, nerves, muscles, ligaments and the lamina. More than a 70 degree curve is usually a trigger for back surgery for kyphosis in the thoracic spine.
Removing Bone to Correct Spinal Curves
The severity of the curve and its location will determine the type of spine surgery required. Osteotomies usually involve a wedge shape being excised from the bones in order to realign the spine. A pedicle subtraction is one such osteotomy and is where parts of the vertebrae are removed at the front and back to correct posture. The Smith-Peterson osteotomy for thoracic kyphosis is a procedure to remove part of the back of the spine and is frequently performed in tandem with a discectomy and instrumented spinal fusion to stabilize the spinal column. Those with existing spinal hardware will normally have to have these rods, screws and metal plates removed before their latest surgery.
Types of Thoracic Kyphosis Surgery
Aggressive surgery such as facetectomy (removal of the facet joint) and cantilever corrections can be the preferred option for patients with flexible kyphosis. Where the spinal deformity is long and smooth it may help to perform multiple osteotomies to produce a more subtle change throughout that section of spine.
Osteoporosis and Spinal Curvature
Unfortunately, a major cause of thoracic kyphosis in adults can hinder the success of surgery for the condition. Osteoporosis, the loss of bone mineral density can make back surgery difficult due to the increased risk of fracture. Osteoporosis can also make it more problematic to use hardware as this requires fixing to the fragile bones, and patients with osteoporosis tend to have more bone pain before and after surgery unless their condition is well managed.
Spinal Fusion for Thoracic Kyphosis
Spinal fusion can restore lost stability to the spinal column by using a bone graft and medical hardware to affix the graft and hold the spine in place while the bone fuses. In cases of thoracic kyphosis this may involve removal of bone from one area of the spine in order to correct alignment. Surgeries may be done from the front of the spine through the chest cavity (a thoracotomy) and posteriorly, or using both approaches where severe deformity exists. Most surgeries used to require both anterior and posterior approaches but refinements of spine surgery techniques now allow surgeons to perform many surgeries using minimally invasive methods from a posterior approach.
After Thoracic Kyphosis Surgery
After back surgery for thoracic kyphosis it is important to heed medical advice to improve the likely success of the procedure and aid healing. Patients will usually have follow-up appointments scheduled in order to monitor for any further changes in spinal curvature. It is common to have physical therapy in order to support recovery by strengthening the spine, improving mobility and flexibility and to boost general health and confidence after the procedure. Pain relief medications are usually delivered intravenously and controlled by the patient immediately after thoracic kyphosis surgery and then followed by oral pain medications after discharge from the hospital. Risks of surgery, such as deep vein thrombosis, anxiety, post-traumatic stress disorder (PTSD) and depression and nerve adhesion through scarring can all be reduced by following advice to get up and about quickly after back surgery for thoracic kyphosis.