Background Information:

What are the other Names for the Procedure?

• Thoracic (Open) Microscopic Discectomy
• Microdiscectomy of Thoracic Disc
• Posterior Thoracic Discectomy

What is the Microthoracic Discectomy surgical procedure?

• Microthoracic Discectomy (MTD) is an advanced surgical procedure used to treat individuals with Thoracic Disc Herniation
• Microthoracic Discectomy (MTD) is a minimally invasive surgical procedure that uses a specialized surgical instrument that has an attached microscope to see the area of operation. During the procedure, the part of herniated disc that is damaged is removed
• This procedure uses a much smaller incision on the skin and does minimal damage to the tissues surrounding the herniated disc
• Minimally invasive procedure results in much few complications and rapid recovery to normal health
• The outcomes of this minimally invasive procedure is better than the traditional technique of open surgical approach

What part of the Body does the Procedure involve?

Microthoracic Discectomy (MTD) involves the thoracic vertebrae and the surrounding regions. It also involves the damaged discs between the two thoracic vertebrae.

Why is the Microthoracic Discectomy surgical procedure Performed?

Microthoracic Discectomy (MTD) is performed to remove the damaged and herniated disc in between the thoracic vertebrae of the backbone.

What are some Alternative Choices for the Procedure?

An alternative method to repair a herniated disc is to use traditional open surgical method. This method is still performed widely.

What are the Recent Advances in the Procedure?

Microthoracic Discectomy (MTD) is the most advanced surgical treatment for a Herniated Disc currently being performed.

What is the Cost of performing the Microthoracic Discectomy surgical procedure?

The cost of Microthoracic Discectomy (MTD) procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Microthoracic Discectomy (MTD) and on what needs to be done.
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required.

What are some helpful Resources?

http://okspineortho.com/thoracic-discectomy

http://www.spinecenter.com/content/text/chiuCV/thoracic.pdf

http://www.londonspineclinic.co.uk/thoracic_discectomy.htm

http://www.californiaspineinstitutemedctr.com/brochures/thoracic.php

Prior to Microthoracic Discectomy surgical procedure:

How is the Microthoracic Discectomy surgical procedure Performed?

Microthoracic Discectomy (MTD) is performed by making a small incision on the skin of the back in the vicinity to the herniated disc. After going through the soft tissue under the skin, a portion of the vertebral bone is removed. This removal of the part of vertebral bone gives the surgeon access to the herniated disc. Using an instrument called a nerve retractor spinal nerves are carefully moved away from the herniated disc. Once all the nerves are cleared, the herniated disc is removed in small pieces using a microdissector.

Where is the Procedure Performed?

Microthoracic Discectomy (MTD) is usually performed in an out-patient surgery center facility or a hospital and normally the person can go home once the procedure is completed. The preferred facility to perform a Microthoracic Discectomy (MTD) is a hospital that has experienced trained staff.

Who Performs the Procedure?

The procedure is performed by any of these medical personnel, with assistance from an anesthesiologist:

• A spinal surgeon experienced to perform a Microthoracic Discectomy (MTD)
• A neurosurgeon
• An orthopedic surgeon

How long will the Procedure take?

Microthoracic Discectomy (MTD) usually takes about 1-2 hours

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking, to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken.
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed.
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure.
• It is advised to quit smoking and the use of any nicotine based products, at least 7 days before the surgery
• Prior to the surgical procedure, an individual will also sign a consent and additional form educating the surgeon on your prior medical history, such as allergies, medicines/vitamins, bleeding history, reaction to anesthesia, and complete surgical history
• Medications current being taken, such as prescription medication, over-the-counter medications, and herbal or dietary supplements will also be discuss with your physician.  Individuals may be advised to continue or stop certain medications the day of the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for the Microthoracic Discectomy (MTD) procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Microthoracic Discectomy surgical procedure?

Several tests may be necessary prior to the procedure, such as a Blood Test, Electrocardiogram, and Chest X-ray leading up to the day of the surgery.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Microthoracic Discectomy (MTD)?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Microthoracic Discectomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia or spinal anesthesia is administered prior to the procedure.

How much Blood will you lose, during the Procedure?

Since Microthoracic Discectomy (MTD) is minimally invasive, there is little or no blood loss involved.

What are the possible Risks and Complications during the Microthoracic Discectomy surgical procedure?

There are general factors that increase the risk of getting complications during the procedure, which include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Nerve damage
• Infection
• Bleeding
• Spinal fluid leakage
• Complications due to a Microthoracic Discectomy (MTD) procedures are rare

What Post-Operative Care is needed at the Healthcare Facility after the Microthoracic Discectomy surgical procedure?

After the surgical procedure, patients will be sent to an area of the hospital called postoperative recovery area or PACU. A patient’s blood pressure, heart rate, and respiration cycle will be closely monitored. Any additional pain associated with the procedure will also be treated. Since Microthoracic Discectomy (MTD) is a minimally invasive surgical procedure, a high percentage of patients are discharged from the healthcare facility on a outpatient basis, and are release the same day as the surgery was performed. However, some patient may be released from the healthcare facility 1-2 days after surgery.

After the Microthoracic Discectomy surgical procedure:

What are the possible Risks and Complications after the Microthoracic Discectomy surgical procedure?

The possible risks and complications that may arise after a Microthoracic Discectomy (MTD) are:

• Infection in the surgical wound
• Thrombophlebitis, which is inflammation of a vein associated with a blood clot
• Continuous pain
• Spinal fluid leakage
• Reoccurrence of disc herniation
• Loss of bowel/bladder function 

What is the Prognosis after the Surgery?

• A complete recovery from this procedure is usually excellent
• The majority of individuals experience pain relief and improved range of motion after the procedure.
• Pain relief is noted to decrease quickly in a high percentage of patients, allowing a return to normal functionality.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain around the surgical wound
• Bleeding or Drainage
• Signs of an infection

What Post-Operative Care is needed at Home after the Microthoracic Discectomy surgical procedure?

At home, the following post-operative care is recommended, after a Microthoracic Discectomy (MTD) procedure:

• Avoid strenuous activity, such as lifting any objects over 5 pounds
• Avoid bending at the waist
• Avoid prolonged sitting
• Keep the incision site bandaged
• Wash the incision site with soap and bandage it again
• A physicians advises patients to slowly resume regular/daily activities as soon as possible, which aids in faster recovery
• Avoid strenuous activities between 4-6 weeks

How long does it normally take to fully recover, from the Procedure?

Individuals may begin light activities about 2-3 days after the procedure. Usually, it takes about 4-6 weeks to completely recover from the effects of the Microthoracic Discectomy (MTD) procedure and allow an individual to start participating in more rigorous work or physical activities.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision.
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued.
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time.

Who will you receive a Bill from, after the Procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)
• A spinal surgeon

The patient is advised to inquire and confirm the type of billing, before the Microthoracic Discectomy (MTD) procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA