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Thoracic (dorsal) spineMinimally invasive surgery

Posterior thoracic fusion

Posterior thoracic fusion is surgery that stabilises the dorsal spine from the back using pedicle screws and rods. It is considered when a fracture, deformity, tumour or instability threatens the spinal cord or seriously limits daily life. Many patients reach this option after trauma, an osteoporotic compression fracture or progressive pain that does not respond to conservative care. Others present with adult scoliosis, spondylitis or tumour lesions that need posterior reinforcement. This guide explains when it is indicated, how it is performed and what to expect during recovery, so that you can make a calm, informed decision with a team experienced in spine surgery.

Spine neurosurgeon in Alicante and Benidorm
More than 20 years of experience in Neurosurgery (since 2003)
Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm
Posterior thoracic fusion illustration with pedicle screws and rods along the dorsal spine.

What is posterior thoracic fusion?

Posterior thoracic fusion is a surgery that stably joins one or several levels of the dorsal spine (T1 to T12) through a posterior approach. We place pedicle screws in the vertebral bodies and connect them with metal rods. Bone graft is then added so the segment can fuse over time.

Unlike cervicothoracic fusion, which focuses on the junction between the lower cervical and upper thoracic spine, this technique addresses the pure thoracic spine. The proximity of the spinal cord, pleura and great vessels demands careful planning and, when needed, intraoperative navigation and neuromonitoring. If you want to discuss your case, you can request an assessment with Dr. Ben Ghezala.

Symptoms and warning signs

Patients who may benefit from posterior thoracic fusion typically report:

Localised or band-like mid-back pain that worsens with load or movement
Pain radiating to the chest or abdomen along a nerve root
Leg weakness, balance issues or gait disturbance
Numbness or tingling in the trunk or lower limbs
Visible deformity, progressive kyphosis or a feeling of collapse after a fall
Warning signs: sudden loss of strength, bowel or bladder changes or intractable pain that need urgent assessment

When is this procedure indicated?

Unstable thoracic fractures, traumatic or osteoporotic, with neurological compromise or deformity
Progressive dorsal deformity: adult scoliosis, post-traumatic or degenerative kyphosis
Primary or metastatic vertebral tumours requiring decompression and posterior reinforcement
Post-traumatic or post-infectious instability (spondylodiscitis) with pain or neurological risk
Thoracic stenosis or cord compression that needs segmental stabilisation after decompression
Failure or loosening of previous instrumentation requiring revision

How is the procedure performed?

1.Preoperative preparation

We carry out a full clinical assessment, review the MRI and CT, assess bone density when osteoporosis is suspected and plan the levels to be instrumented. Fasting rules, anticoagulant adjustments and antibiotic prophylaxis are tailored to thoracic surgery in our centres in Alicante and Benidorm.

2.During the procedure

The patient is placed prone under general anaesthesia. We use a posterior approach centred on the levels to be treated. Pedicle screws are inserted in each vertebra under fluoroscopy and, when the case calls for it, neuronavigation, given the proximity of the pleura, aorta and spinal cord.

Intraoperative neurophysiological monitoring tracks the cord and nerve roots throughout. When needed, we decompress the spinal cord by removing lamina or compressing bone. The screws are then connected with two rods, the deformity is corrected if appropriate and bone graft is added to promote fusion.

3.Immediate postoperative period

Patients spend several hours in recovery and, in many cases, one night under close neurological observation. We start multimodal analgesia and progressive mobilisation the following day, supported by physiotherapy. Hospital stay typically ranges from 3 to 7 days depending on the number of fused levels and the underlying cause.

Recovery after posterior thoracic fusion

Recovery is gradual. Assisted walking usually starts the day after surgery and light activities resume within a few weeks. Office work is typically possible between 6 and 12 weeks. Physical jobs need longer and are always assessed case by case.

Bony fusion takes several months to consolidate, so heavy axial loads, abrupt twisting and impact sports are avoided early on. Specific rehabilitation, postural hygiene and scheduled imaging follow-up shape the outcome. Fever, worsening pain or new neurological symptoms warrant prompt review.

Risks and possible complications

Every surgery carries general risks such as infection, bleeding, thrombosis or anaesthesia-related complications.

Specific risks of posterior thoracic fusion include misplacement of a pedicle screw, with possible nerve root irritation or injury to the spinal cord, vessels or pleura. Cerebrospinal fluid leak, pneumothorax (uncommon), non-union (pseudarthrosis), loosening of the hardware or accelerated degeneration of adjacent levels may also occur. Individual planning, fluoroscopy, navigation when appropriate and neurophysiological monitoring help reduce these risks.

Frequently asked questions

It depends on the number of levels and the cause. A 2-3 level stabilisation for fracture usually takes 2 to 4 hours. Wide deformity corrections can extend several hours more.
There is no pain during surgery because it is performed under general anaesthesia. Afterwards, back pain is controlled with multimodal analgesia and decreases over the first few days.
Not always. When the instrumentation is firm and the bone quality is good, no brace is required. In osteoporotic fractures or selected cases, a temporary orthosis is used for some weeks.
Office work usually resumes between 6 and 12 weeks. For physical jobs or those involving load, the timeline extends depending on the number of fused levels and radiological progress.
Walking and physiotherapy start early. Impact sports or heavy lifting are reintroduced gradually once fusion progresses, typically between 4 and 9 months depending on the case.
In most cases the screws and rods stay in place permanently because the fusion depends on them. They are only removed if they cause confirmed discomfort, infection or loosening.

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Do these symptoms sound familiar?

If you recognise yourself in some of these symptoms and your pain is starting to limit your daily life, we can review your case in a personalised consultation. Dr. Ben Ghezala will assess your clinical history and imaging studies to help you decide the best treatment option for you.

Request a consultation with Dr. Ben Ghezala