The incision may be in the flank, or side of the body, but sometimes the surgeon must work from the front and the back to have the best view of the area and to place the instrumentation properly. Often what is called a cage will be inserted in the place of the removed vertebra. There may be bone grafts as well. If there are bone grafts, the surgeon will also likely use a substance that encourages bone to grow. This is helpful in a successful fusion of the spine. You want the vertebrae above and below the affected area to all grow together vertically, or fuse. This way the spine will be stable. If the vertebrae can slide from front to back, the spinal cord is not protected.
The surgery often requires several days in the hospital, possibly up to a week. If there have been pain and neurological symptoms prior to surgery, when you wake up these symptoms may be gone or lessened a great deal, depending on how long there has been pressure on the nerves and spinal cord. Usually the pain you wake up with is surgical pain rather than the previous pain from the mass. You will be encouraged to get up and moving as soon as possible, with a lot of walking on flat surfaces.
Spine surgeons differ in post-op instructions, but generally you will not be allowed to lift or bend for weeks, instructed to avoid stairs initially, and some surgeons may not want you to sit for extended periods. You may or may not have to wear a brace. You will be encouraged to walk on flat surfaces, and will have follow-up appointments with serial X-rays to be sure the instruments remain in the proper position and the vertebrae are fusing as they should. You will likely go to physical therapy after a recovery period of a couple of months.
While symptomatic thoracic hemangiomas are not common, spinal fusions are done every day. There are minimally invasive techniques that can sometimes be used, and the recovery is much faster and easier than you may be expecting if you know people who had this surgery even five or ten years ago.