Thoracic spine surgery treats the mid back, the twelve vertebrae behind the ribcage. It is rarely needed. Most upper back pain settles with physiotherapy and time. Surgery is reserved for cord compression, unstable fracture, tumour, infection, or weakness that is getting worse. Dr. M. Abdur Rehman, consultant neurosurgeon, assesses these cases at Mujahid Hospital, Faisalabad.
Is thoracic spine surgery safe, or will I be paralysed?
This is the first question almost every family asks, and it deserves a straight answer. The spinal cord runs through the thoracic spine and there is little spare room around it. That is exactly why surgery here is taken seriously and why it is not offered casually. It is also why the operation is done under a microscope, with the patient's nerve signals monitored during surgery where that facility is available.
The honest position is this. Any operation near the spinal cord carries a risk of weakness, numbness or bladder trouble, and no surgeon can promise you a zero. But in most cases where thoracic surgery is recommended, the cord is already being squeezed and the weakness is already moving in the wrong direction. Waiting is not a neutral choice. Nerve that has been compressed for months recovers less than nerve that has been compressed for weeks.
Ask your surgeon to name the specific risks of your operation, in your own language, and to say what he expects the surgery to achieve. If the answer stays vague, ask again before you sign anything.
Do I really need surgery for my mid back pain?
Most likely not. Pain between the shoulder blades is usually muscular, postural or arthritic. The ribcage holds the thoracic vertebrae in place, so disc problems here are far less common than in the neck or lower back. The majority of people who come in with mid back pain leave with physiotherapy, posture correction, medicines and a review date, not a surgery date.
Surgery is not a treatment for pain alone in the thoracic spine. It is a treatment for something pressing on the spinal cord, a spine that is structurally unstable, an infection, or a tumour. If nobody has shown you a scan that explains your pain, be cautious about agreeing to an operation.
If you have been told you need upper back surgery and you are not sure, take your films and get a second opinion. Nothing is lost by asking.
What mid back problems actually need an operation?
A small number of conditions genuinely need surgery here. A thoracic disc or bone spur pressing on the spinal cord, causing heavy legs, unsteady walking, or numbness climbing up from the feet. An unstable fracture after a road accident or a fall, where the bone can no longer hold the spine safely. A collapsing osteoporotic vertebra in an older patient whose pain will not settle, or whose back wall has pushed into the canal.
TB of the spine is common in Punjab, but even then the main treatment is anti-TB medicine taken for many months. Surgery is the exception, used when weakness is getting worse, when the spine is collapsing, or when a biopsy is needed to confirm the diagnosis. Tumours and other infections make up the rest.
The common thread is not how bad the pain feels. It is pressure on the cord, loss of stability, or a diagnosis that needs tissue to confirm it.
What tests do I need before surgery is even discussed?
An MRI of the thoracic spine is the test that answers most questions. It shows the cord, the discs, infection and tumour, which a plain X-ray cannot. Where infection or tumour is suspected, the MRI is done with contrast.
A CT scan is added when the bone itself matters, for example in a fracture or when planning screws. Standing X-rays show alignment. Blood tests are done when infection or TB is possible, and a biopsy may be needed before any treatment is chosen.
Bring your films with you, not only the report. Old scans matter too, because comparing images taken six months apart often tells more than a single new picture.
What does thoracic spine surgery involve?
It depends entirely on the problem. The aim of most thoracic operations is one of two things: take pressure off the spinal cord, or make an unstable segment stable again. Often both are done in the same sitting.
Taking pressure off may mean removing bone from the back of the spine, or reaching a disc from the side of the chest, because the spinal cord cannot simply be moved aside the way a nerve root in the lower back can. Making the spine stable usually means screws and rods across the affected levels, so the bone can heal in a safe position.
For a painful osteoporotic collapse that will not settle, a smaller procedure injecting bone cement into the vertebra is sometimes used instead of open surgery. Your surgeon should tell you which of these applies to you and why.
What does thoracic spine surgery cost in Faisalabad?
There is no single figure, and anyone who gives you one over the phone is guessing. Cost depends on the diagnosis, how many levels are involved, whether implants are used and which ones, how long you stay, and whether you need an ICU bed.
Ask for an itemised written quote in PKR before you commit to anything. It should list the surgeon's fee, anaesthesia, theatre charges, implants, hospital stay, and the tests still outstanding. Ask what is not included, because that is where families get caught out. If you have a government employee card, insurance, or access to zakat or hospital welfare support, raise it at the same time.
Do not sell land or borrow money against a verbal estimate. Get it on paper first.
What is recovery like after upper back surgery?
Most patients are helped out of bed within a day or two, because lying still is bad for the lungs and the legs. Walking short distances early is part of the treatment, not a test of toughness. A brace is used in some fracture and fusion cases.
Pain from the wound settles over a few weeks. If nerves were already damaged before surgery, numbness and weakness recover slowly and sometimes not completely. The first goal of the operation is usually to stop things getting worse. Improvement, where it comes, comes over months.
Expect restrictions on bending, lifting and long journeys for a period your surgeon will specify. Physiotherapy once the spine has healed matters as much as the operation itself.
How do I arrange a consultation at Mujahid Hospital, Faisalabad?
Dr. M. Abdur Rehman is a consultant neurosurgeon at Mujahid Hospital, Faisalabad. Request an appointment through the contact form or phone number on this site, and the staff will tell you when he is seeing patients and what to bring.
If you are travelling from Jhang, Sargodha, Toba Tek Singh, Chiniot or elsewhere in Punjab, send the MRI report ahead if you can, and bring the films with you on the day. Come with the family member who will be part of the decision. Bring a list of your medicines, and say if you are diabetic, on blood thinners, or already on TB treatment.
If your symptoms are getting worse quickly, or you have leg weakness, numbness between the legs, or trouble passing urine, do not wait for an appointment. Go to a hospital emergency department the same day.
Questions patients ask about this
Can you get a slip disc in the mid back?
Yes, but it is much less common than in the neck or lower back. The ribcage locks the thoracic vertebrae in place, so discs here move and tear less. When a thoracic disc does press on the cord, it can cause a band of pain around the ribs, heavy legs, or unsteady walking. That pattern needs an MRI.
Should I try malish or a hakeem first for upper back pain?
Malish and hakeem treatment are usually harmless for simple muscular mid back pain, and many people feel better after them. The danger is pressing, pulling or twisting a back that has a fracture, an infection, or a tumour in it. If you have fever, night pain, weight loss, or weakness in your legs, get an MRI before anyone touches your spine.
Is an X-ray enough, or do I have to get an MRI?
An X-ray shows bone alignment and can pick up a collapsed vertebra, so it is a reasonable first film. It cannot show the spinal cord, a disc, an early infection, or a tumour. If your symptoms include leg weakness, numbness, or a tight band around the chest, an MRI is the test that answers the question.
How long will I be in hospital after thoracic spine surgery?
It depends on what is done. A decompression at a single level is a shorter stay than a fusion for an unstable fracture or spinal TB. Expect several days in hospital for most thoracic operations, then weeks of restricted activity at home. Your surgeon will give you a realistic timeline for your own case before you consent.
Should I bring my family, and can I take a second opinion?
Yes. Bring whoever makes decisions with you, and bring your MRI films and CD, not only the report. Most families want to hear the same explanation twice before agreeing to an operation on the spine. If you want a second opinion, take your films and get one. A genuine surgical indication will still be there next week.
Ask about your own scan. Send your MRI or X-ray on WhatsApp and get a straight answer on whether surgery is needed at all.
Dr. M. Abdur Rehman is a consultant neurosurgeon in Faisalabad. Send your scan on WhatsApp and ask what it actually shows.
Two clinics in Faisalabad, each with its own timing. Mujahid Hospital, Madina Town, Susan Road, Faisalabad: 4:00 PM to 7:00 PM. IDC, 563-B, Satiana Road, Faisalabad: 8:00 PM to 9:00 PM. Message before travelling to check availability on the day.
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