The natural curvature of the spine provides the skeleton strength and stability. The curves act like a coiled spring to distribute the mechanical stress as the body moves. As discs age, they lose their water content and begin to degenerate. The annulus fibrosis (outer ring), may also be damaged through general wear and tear or by injury in which the nucleus, under extreme pressure, bulges out through the annulus fibrosis ring.
Like other discs in the spine, the thoracic discs are vulnerable to injury when the person practices poor posture. Sensible exercises, designed to strengthen the upper back, help to improve posture and prevent injury. Maintaining a healthy lifestyle with good nutrition is key, as well as preventing accidents. The spine, designed for flexibility, will perform best if cared for properly.
The standard open surgical approaches to the thoracic spine usually involve creating a large opening in the chest wall. Dr. John Regan pioneered the use of endoscopic instruments with cameras and cutting tips to access the spine. Video Assisted Thoracic Surgery (VATS), is a minimally invasive (keyhole) surgical procedure. It allows the surgeon to directly examine the chest cavity without a big incision. Three or four small incisions will be made to allow the surgeon to use the special instruments (video camera and endoscope) needed for this operation. A very small video camera is used to project pictures of the chest cavity onto a screen during the procedure.
VATS avoids the extensive damage to the chest wall. Specific tools and implant systems permit the spine surgeon to remove thoracic discs, biopsy vertebral masses/tumors, release scoliotic curves, bone graft disc spaces and even to instrument the spine working through these small (1-2 inch) puncture incisions.
A discectomy is a surgical procedure in which part or all of an intervertebral disc is removed from the spine. This is commonly done when a disc is herniated (slipped disc) and is causing symptoms of pain and nerve irritation or injury. In the thoracic area, discectomies are usually done through an incision on the side of the ribcage. A small window is created in the bone overlying the disc herniation. The nerve root is gently retracted to expose the disc herniation. The disc material is then removed using special instruments which snip it away.
Fusion is a surgically created solid bone bridge between two or more adjacent (usually freely mobile) bones. In the spine, this procedure is used to create a stability between vertebrae. In order to achieve a fusion, bone must grow across the desired area in a gradual and solid fashion. A number of techniques can increase the chance of this to occur. The basic principle is to place bone tissue (bone graft) into the area of desired fusion, ensure sufficient immobility across that area (brace, cast, spinal instrumentation) and then wait for the fusion to take place (6-9 months or more).
For spine operations to be successful, solid healing of bone across the spine must be achieved. Dr. Regan's private practice makes use of metal devices, also called instrumentation (screws, rods, plates, cables, wires) that can help correct a deformed spine and will also increase the probability of obtaining a solid spinal fusion.
Spinal instrumentation can be placed in the front or in the back portion of the spine. The devices are usually made of metal, commonly stainless steel or titanium. In order to place this instrumentation into the spine, the spine is at first exposed by making a skin incision, and then gently clearing the muscles, ligaments and other soft tissues from the levels of the vertebrae to be fused. Specific tools are used to carefully prepare the bone in such a way to obtain good seating of the implants (screw, rod, wire, cable or other). When these devices are in the proper position, a rod or plate is positioned to link the implants together. Screws are inserted into the pedicles, which are part of the arch of the vertebra. This essentially forms a rigid scaffolding to hold the spine in the desired position. The bone graft which has been placed into the area of fusion gradually solidifies over several months. The spinal instrumentation is gradually covered by scar tissue and sometimes bone which the body lays down. uters, software and tracking technology.
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