Name:
Posterior Spinal Fusion and Instrumentation for Adolescent Idiopathic Scoliosis
Description:
Posterior Spinal Fusion and Instrumentation for Adolescent Idiopathic Scoliosis
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Duration:
T00H06M12S
Embed URL:
https://stream.cadmore.media/player/1b34b3ff-e34a-41bb-9c3d-1c1dee685a36
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/1b34b3ff-e34a-41bb-9c3d-1c1dee685a36/5_ Posterior Spinal Fusion and Instrumentation for Adolescen.mov?sv=2019-02-02&sr=c&sig=AX7ihN2Ujengk%2Bf6atdVndj6zC4DUr7arcW3h2BeyHw%3D&st=2024-11-24T03%3A14%3A44Z&se=2024-11-24T05%3A19%3A44Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
ROGER WIDMANN: My name is Roger Widmann. I'm Chief of Pediatric Orthopedics at the Hospital for Special Surgery. Surgery is needed for a small minority of adolescent patients with scoliosis. The main indication for surgery in this group of patients is curved progression past 50 degrees. Curves that progress past 50 degrees tend to progress at variable rates up to one degree per year in adulthood.
ROGER WIDMANN: These large progressive curves may result in increasing truncal imbalance, chest wall asymmetry and complaints of back pain, secondary to degenerative or arthritic changes in the spine. This child, initially presented at age 12 with a 35 degree right thoracic curve and a strong family history of scoliosis. Her mother had a spinal fusion at Hospital for Special Surgery 30 years prior for a 70 degree scoliotic deformity.
ROGER WIDMANN: Bracing was attempted in this child for two years, but despite bracing, this curve continued to progress. After appropriate discussion of risks and benefits of spinal fusion surgery, and consideration of the natural history of scoliosis and the significant risk of ongoing curve progression, the family elected to proceed with surgery. At the time of surgery, the patient was 15 years of age and she had completed growth.
ROGER WIDMANN: Her right thoracic curve measured 58 degrees and her left lumbar curve measured 45 degrees. Her bending x-rays demonstrated that the lumbar curve was extremely flexible and smaller than the thoracic curve. In addition, on forward bending examination, the lumbar prominence was smaller than the thoracic prominence. As such, selective fusion of the thoracic spine was an excellent option to correct and prevent further progression of the patient's scoliosis while maintaining all of her lumbar spine range of motion.
ROGER WIDMANN: The patient was taken to the operating room and after anesthesia was induced, the patient was positioned face down on a spinal operating room table with appropriate padding. A straight incision is made in the midline of the thoracic spine from top to bottom. The incision is carried down through the skin to the midline fascia. An electric cautery is used to incise the fascia and the cartilage overlying the spinous prostheses at every level.
ROGER WIDMANN: The spine exposure is then performed out to the tips of the spinous prosetheses and an intraoperative x-ray is obtained to verify the fusion levels. The spine dissection is then carried out distally to the proposed fusion level, T11 in this case, with care to prevent damage to the unfused areas of the spine. After exposure, the spine is complete. The joints linking each vertebra are exposed using an osteotome and a mallet, and the pristine joint cartilage is visualized.
ROGER WIDMANN: A rotating burr is used to remove the white joint cartilage in order to prepare the bone for fusion. The spinous prostheses are removed to supply bone graft material and transverse prostheses are de-corticated as well to supply bone graft and assist with fusion. At this point, pedicle screw fixation is obtained at every level.
ROGER WIDMANN: A burr is used to initially mark the screw starting points and a probe is used to develop the screw track. A special probe with an electro conductive tip and a visual and audible signal may also be used to verify that the probe remains within the bone and out of the soft tissues and spinal canal. A ball tip probe is used to feel the contours of the screw track, and the screw is inserted carefully into the bone, through the pedicle and into the vertebral body.
ROGER WIDMANN: The same process is carefully repeated at each level. Live x-ray is used to verify screw positioning. The identical process is then performed for screw insertion on the opposite side of the spine. A rod template is used to obtain a measurement of the proposed customized rod length and the 6 millimeter rod is cut, contoured and then positioned on the concave side of the spine.
ROGER WIDMANN: The rod is provisionally fixed at the top and at the bottom of the construct with specialized set screws, and the rod is rotated into appropriate sagittal alignment. The spine is then gradually reduced to the rod, working toward the apex of the deformity. The bottom of the spine is maintained in neutral rotation with a single level de-rotation device. An apical rotation device is then applied to the 6 pedicle screws at the apex of the curve in order to prepare to de-rotate the spine in order to decrease the rib and chest wall prominence.
ROGER WIDMANN: The spine is slowly de-rotated at the apex of the deformity while applying counter rotation at the bottom of the construct. All of the set screws are loose except for those at the very top and very bottom of the spine. The set screws are all provisionally tightened after de-rotation is complete. The de-rotation devices are removed and distraction across the apex of the concave rod aids in correction of the scoliosis.
ROGER WIDMANN: Coronal plane bending provides the finishing touches on correction of the scoliosis deformity. The right sided rod is then measured, cut and contoured, and the rod is inserted and fixed in place with set screws. Compression on the convex rod assists in leveling the vertebra at every level. Additional live x-ray confirms correction of the deformity as well as anatomic placement of all of the spinal implants.
ROGER WIDMANN: The set screws are sheared off at every level, locking in the correction and the spine is then de-corticated with a burr and bone graft is applied to the back of the spine in order to facilitate bony healing and fusion. The standing X-rays at six weeks after surgery demonstrate excellent correction of both curves without the need for fusion of the lumbar spine.
