Name:
Use of an exoscope for enhanced visualization of a Schwab grade 5 osteotomy to correct kyphotic deformity
Description:
Use of an exoscope for enhanced visualization of a Schwab grade 5 osteotomy to correct kyphotic deformity
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/db0caa47-6533-490a-a2cf-ab1c707b861d/videoscrubberimages/Scrubber_219.jpg
Duration:
T00H07M14S
Embed URL:
https://stream.cadmore.media/player/db0caa47-6533-490a-a2cf-ab1c707b861d
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/db0caa47-6533-490a-a2cf-ab1c707b861d/21-190.mp4?sv=2019-02-02&sr=c&sig=s%2BAGarezbScseU7ubc32nBj%2FxG666TKE1rzm%2Bnh%2F2q8%3D&st=2024-05-05T08%3A07%3A41Z&se=2024-05-05T10%3A12%3A41Z&sp=r
Upload Date:
2021-11-30T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER 1: The following is a presentation regarding the use of the exoscope to visualize a Schwab grade 5 osteotomy. In a Schwab grade 5 osteotomy, the entire vertebra body is removed followed by removal of the superior and inferior discs. This allows for 40-degree correction of kyphosis. A titanium cage may be used as a pivot point to correct the kyphosis.
SPEAKER 1: This patient's clinical history is the following. He is an octogenarian male. He presented with a few months of progressive back pain from T12– L1 fracture and kyphosis. He was initially treated at an outside hospital with vetrebroplasty. Subsequently, a CT and MRI demonstrates severe progressive thoracolumbar kyphosis with bony retropulsion of the T12–L1 fracture as well as some of the cement.
SPEAKER 1: The clinical and laboratory findings suggest he now has an infected vetrebroplasty. On physical exam, the patient was severely limited by back pain and was unable to ambulate more than 30 feet. Preoperative x-ray, MRI, and CT scan demonstrated a focal kyphotic deformity at T12–L1 with canal compromise. In addition, it's likely the vetrebroplasty is infected based on contrast-enhanced images.
SPEAKER 1: The patient was position prone with arms in the Superman position on a Jackson table. Preoperative neuromonitoring baseline was obtained and the miniature pressure was maintained throughout surgery at 90 to perfuse his spinal cord. Following exposure, pedicle screws were placed above and below the kyphotic deformity utilizing stereotactic navigation. Subsequently, an on block laminectomy was performed at T12–L1.
SPEAKER 1: Additional temporary pedicle screws were placed at the fracture level using navigation. This was done to temporarily assist with screw rod kyphosis correction.
SPEAKER 1: Further decompression of the spinal canal was done using a transpedicular approach at T12. An osteotome was utilized to perform a complete facetectomy bilaterally at T11, T12, L1, and L2 in order to fully decompress the exiting nerve roots and correct the kyphosis. A combination of interbody shavers and pituitary rongeurs were used to perform the Schwab grade 5 osteotomy, also known as a vertebral column resection or a posterior based corpectomy.
SPEAKER 1: In order to achieve better visual access to the areas ventral to the thecal sac, the exoscope was utilized. This allowed for efficient removal of the bony elements and vetrebroplasty cement ventral to the thecal sac. The surgeon, the assistant surgeon, and the scrub nurse could all see what was happening during the operation by watching the operation on the exoscope. The corpectomy at T12 was completed followed by the removal of the adjacent discs at T11–12 and T12–L1, and also removal of migrated pieces of vetrebroplasty cement into the ventral thecal sac area.
SPEAKER 1: An L-shaped tamp was then used to ensure no cement or bone was adherant to the ventral surface of the thecal sac. During a Schwab grade 5 osteotomy visualization of the ventral surface of the dura is typically a limiting factor in both speed and safety.
SPEAKER 1: The exoscope allows access to visual corridors of the ventral dura that were previously difficult for the surgeon, the assistant surgeon, and the scrub nurse to all see simultaneously. An expandable cage trial was used to size the appropriate size expandable cage.
SPEAKER 1: Next, titanium rods were contoured, placed, and subsequently reduced. The expandable cage was placed into the corpectomy site. Subsequently, a screw on rod compression was done to reduce the kyphosis using the cages of ventral pivot point.
SPEAKER 1: Appropriate placement of the cage was verified with fluoroscopy. The second rod and across link were placed.
SPEAKER 1: Extracompartmental bone graft was added around the cage in the corpectomy site. The ventral surface of the thecal sac was assessed with the woodsen to ensure that there was adequate decompression.
SPEAKER 1: These final x-rays and CT demonstrate the postoperative correction and the final construct spanning from T10 to L3 along with a T12 Schwab grade 5 osteotomy with the osteotomy site filled by an expandable cage.