Dr. Pedro Roldán Ramos
Neurosurgeon · Spine, functional and brain surgery
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Spinal pathology
Thoracic spine surgery
Surgical treatment of thoracic vertebral pathology: thoracic disc herniations, vertebral tumours (primary and metastatic), thoracolumbar fractures and deformities (kyphosis, scoliosis).
What is it?
Thoracic spine surgery
Thoracic spine surgery treats pathologies of the 12 thoracic vertebrae, a zone with complex anatomy due to its relationship with the rib cage, aorta, lungs and spinal cord. Thoracic disc herniations are uncommon (<1% of all herniations) but technically complex. Vertebral tumours (mainly metastases) and osteoporotic fractures are the most common reasons for surgery in this region.
<1%
of disc herniations are thoracic
70%
of vertebral metastases are located in the thoracic spine
80%
pain improvement after kyphoplasty for osteoporotic fractures
Symptoms
When to see a neurosurgeon?
Symptoms vary according to cause:
- Mechanical or referred dorsal pain in a thoracic band pattern
- Intercostal radicular pain (well localised in the affected dermatome)
- Leg weakness or gait disturbance (thoracic myelopathy)
- Sensory disturbance below the level of the lesion
- Bladder or bowel dysfunction in significant spinal cord compression
- Intense focal pain following trauma (fracture)
- Progressive visible deformity (hump) in kyphosis or scoliosis
Urgent attention: Rapid onset of paraparesis or loss of sensation in the legs requires urgent MRI: it may indicate acute spinal cord compression syndrome.
Surgical treatments
Techniques we use in thoracic spine surgery
Vertebroplasty
What it involves: injection of cement into the fractured vertebra.
- Rapid pain relief
- Percutaneous procedure
Indications: osteoporotic fractures.
Kyphoplasty
What it involves: insertion of a balloon to restore vertebral height before cement injection.
- Deformity correction
- Pain reduction
Indications: compression fractures.
MIS thoracic laminectomy
What it involves: decompression of the spinal canal via a minimally invasive approach.
- Less tissue disruption
- Faster recovery
Indications: thoracic stenosis, spinal cord compression.
Thoracic endoscopic surgery
What it involves: percutaneous approach to treat disc or compressive pathology.
- Less tissue damage
Indications: selected thoracic herniations.
Percutaneous thoracic fusion
What it involves: stabilisation using screws placed in a minimally invasive fashion.
- Less blood loss
- Faster recovery
Indications: fractures, instability.
Robotic thoracic surgery (Alaya)
What it involves: robotic assistance for instrumentation placement.
- High precision
- Enhanced safety
Indications: tumours, deformities, complex surgery.
Our protocol
How we approach each case
The workup includes a complete thoracic MRI, CT scan for bony study and, when indicated, bone scintigraphy or PET-CT in suspected tumour. In vertebral metastases we apply the SINS (Spine Instability Neoplastic Score) and the Tokuhashi scale for the surgical decision. Fractures are evaluated using the TLICS classification. The approach is chosen according to the location of pathology (central, paramedian, lateral) and patient condition. In metastases with life expectancy >3 months and neurological deficit, surgery improves function and quality of life.
Perioperative protocol
How we organise each case
-
1 · Preoperative workup
Thoracic MRI with and without contrast, CT for bony study, bone densitometry for osteoporotic fractures, full oncological workup for metastases.
-
2 · Surgery
Open or minimally invasive techniques according to lesion. For metastases, NOMS algorithm (Neurologic, Oncologic, Mechanical, Systemic). ALAYA robotic assistance for thoracic pedicle screws.
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3 · Immediate postoperative period
Early mobilisation. After vertebroplasty, discharge within 24h. After major procedures, progressive rehabilitation.
-
4 · Discharge and follow-up
Discharge 1-7 days depending on procedure. Radiographic follow-up at 6 weeks and coordination with oncology where appropriate.
Team
Neurosurgeons who treat this condition
Dr. Jorge Torales
Neurosurgeon · Skull base and spinal endoscopy
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Dr. Abel Ferrés Pijoan
Neurosurgeon · Spine, neuro-oncology and skull base
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Dr. Jhon A. Hoyos Castro
Neurosurgeon · Spine, peripheral nerve and skull base
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Dr. María Elena Filadoro
Neurosurgeon · Functional, epilepsy and spine
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Dr. M. Noelia Sosa Echeverría
Neurosurgeon · Functional and stereotaxy
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Dr. Giulia Guizzardi
Neurosurgeon · Minimally invasive and skull base
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Outcomes
Prognosis and recovery
Surgery for thoracic disc herniation achieves resolution of radicular pain in 75-85% and neurological improvement in the majority of patients operated for progressive thoracic myelopathy. Kyphoplasty for osteoporotic fracture relieves pain in 80% of patients within the first 48 hours. In vertebral metastases with spinal cord compression, early surgery combined with radiotherapy preserves the ability to walk in 70% of patients operated before losing ambulation.
Frequently asked questions
Answers to your questions
Is thoracic disc herniation common?
No. Thoracic disc herniations represent less than 1% of all vertebral disc herniations because the thoracic spine is stabilised by the rib cage. When they occur they can be technically more complex as the spinal cord is in direct contact with the disc.
How are thoracic herniations operated on?
Several approaches exist: transthoracic (thoracotomy), costotransversectomy, lateral extracavitary approach, or thoracic endoscopic approach. The choice depends on disc location (central, paramedian or lateral) and the surgeon's preference.
What vertebral tumours are treated in the thoracic spine?
Both primary tumours (rare) and vertebral metastases (most commonly from lung, breast and prostate cancer). Treatment combines surgery (stabilisation, decompression, en-bloc resection where viable) with oncology, radiotherapy and systemic treatments.
When is surgery indicated for a thoracolumbar fracture?
Surgery is indicated for unstable fractures (compromise of all 3 Denis columns, kyphotic angulation >30°, wedging >50%) or in the presence of neurological deficit. Fixation can be percutaneous (minimally invasive) or open depending on the need for decompression.
What are kyphoplasty and vertebroplasty?
They are percutaneous techniques to treat painful osteoporotic vertebral fractures. Bone cement is injected into the vertebral body through a needle to stabilise it and relieve pain. Kyphoplasty adds the use of a balloon that restores some vertebral height before injecting the cement.
References
What clinical guidelines say
"Decompressive surgery combined with radiotherapy is superior to radiotherapy alone in vertebral metastases with spinal cord compression in patients with a reasonable life expectancy."
"Vertebroplasty and kyphoplasty techniques are effective in relieving pain from osteoporotic fractures refractory to medical treatment."
Bibliography
Scientific references consulted
Studies and clinical guidelines on which we base our approach to this condition.
- Laufer I. et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013. View publication
- Klazen CAH. et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (VERTOS II). Lancet. 2010. View publication
- Vaccaro AR. et al. AOSpine Thoracolumbar Spine Injury Classification System. Eur Spine J. 2013. View publication
- Patchell RA. et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer. Lancet. 2005. View publication
- Fehlings MG. et al. Spinal cord injury evaluation and management guidelines (AOSpine). Global Spine J. 2017. View publication
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Surgical technology
Robot-assisted surgery with ALAYA
We use the ALAYA Robotic Assistant (Cyber Surgery) for the precise placement of pedicle screws in spinal fusion surgery, both open and minimally invasive.
ALAYA guides the trajectory of the surgical instruments through a patented kinematic tracking system that requires no optical navigation cameras: it avoids the classic line-of-sight problems and takes up less space in theatre. The patient's position is monitored in real time by a bone reference clamp attached directly to the tracking device, which improves the overall accuracy of the procedure.
What do we use it for?
- Pedicle screw placement in the posterior thoracic and sacro-lumbar spine.
- Spinal fusion surgery, both open and minimally invasive.
- Intraoperative 3D planning using preoperative or intraoperative 2D/3D CT.
- Implant-brand independence: compatible with any commercially available cannulated screw.
A real benefit for the patient: a reduction in mean hospital stay from 9.4 to 6.8 days documented with robotic assistance in spinal fusion, together with lower intraoperative radiation exposure for both patient and team.
↑
Greater accuracy
Significantly more accurate pedicle screw placement than with conventional technique.
↓
Minimally invasive
Less tissue damage, lower risk of infection and faster postoperative recovery.
⏱
Shorter operating time
An intuitive workflow and fast set-up that shorten the length of the procedure.
☢
Lower radiation
The system minimises the number of image acquisitions needed during surgery.
Patient reviews
What our patients say
High-grade glioma
"I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well."
Cervical disc herniation
"For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away."
International patient
"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."
Request information
Thoracic spine consultation
Send us your thoracic MRI and CT scan if you have one. Thoracic herniations and pathologies in this region are technically complex · we will advise you on the best approach.