Scoliosis Surgery

Mark Wilms, CSTST Program Director

Anthem CollegeAurora, Colorado

Scoliosis

An abnormal side to side curvature of the spine.

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Develops in the thoracic spine The thoracolumbar area of the spine Only in the lumbar spine

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Causes

Congenital Developmental Degenerative Idiopathic (most common)

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The most common forms of Scoliosis:

Congenital Neuromuscular Degenerative Idiopathic

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Congenital

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Cerebral Palsy Muscular Dystrophy

Neuromuscular

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Degenerative

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Idiopathic

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Idiopathic Scoliosis

Infantile scoliosis birth to 3 years

Juvenile Scoliosis 3 to 9 years

Adolescent scoliosis10 to 18 years

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Facts

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Scoliosis testing

Physicians exam X-ray

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Treatment is based on

two factors;

Skeletal maturity Degree of curvature

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Treatment

Observation Back Braces Surgery

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Observation

Curvature of the spine

Cobb angle measurement

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Braces

Milwaukee brace Charleston brace TLSO brace

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Bracing results(worn for 18 months, 23 hours a day)

Before After

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Surgery

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Two General Approaches:

Posterior approach Anterior approach

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Posterior Surgical Approach

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OSI spine table

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Room Preparation

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Positioning

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Hooks, Wire, Screws, and Rods

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Instrumentation

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Hooks

• Each hook site is prepared using a hook finder or elevator.

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Implants are applied to the spine to correct the deformity.

Hooks are placed in the thoracic spine and screws are generally used in the lumbar spine.

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Rod Contouring

The rod is contoured to the desired correction Additional contouring is done with in situ benders

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Rod insertion

Set screws are inserted into each hook or screw Each screw is hand tightened

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Rod rotation

The deformity is corrected using the appropriate method.

Compression and distraction may be applied to gain additional correction.

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Bone grafting and crosslink plating

Bone grafting is completed. Cross links are measured for

and applied to the construct.

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Final tightening and closure

A counter torque and break off driver are used to torque and break off the plugs.

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Completed Posterior Spinal Fusion

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Anterior Surgical Approach

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Disc removal Screw & rod placement

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Endoscopic Anterior Approach

Also known as a thoracoscopic approach

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Endoscopic Instrumentation

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Endoscopic Anterior – Posterior Spinal Fusion

A combination of both procedures previously discussed.

An endoscopic anterior approach done first. Disc is removed in the most severe part of the curve to facilitate posterior fusion.

Posterior approach is then done to correct deformity with instrumentation and fusion.

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Image guidance

Helps in the accuracy of the placement of screws.

Reduces potential nerve, spinal cord, and major vascular damage.

No exposure to ionizing radiation in surgery.

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Image Guidance

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Scoliosis surgery using the image guidance system

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Image guidance instrumentation

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Image Guidance instrumentation

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Image guidance & spine instrumentation

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Other equipment needed for Spinal Fusion:

EEG monitor Intra-operative X-Ray

holder Mayfield Table (if

preferred)

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Complications of Spinal Surgery

Blindness Brachial Palsy Nerve Damage Paralysis Infection Allergy to metal Blood Loss Blood Transfusion Reactions

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Spine Team survival tips:

Think Plan Organize Position Padding Warmth Documentation

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As in all surgical procedures, Teamwork is a must in Spine Surgery!

Thank You!

Questions?