Navigated posterior scoliosis correction for adolescent idiopathic scoliosis using Medtronic Solera system
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Posterior scoliosis correction is the most common surgical procedure used for adolescent idiopathic scoliosis. It can be performed using hooks, sublaminar wires, and pedicle screw contracts. This feature demonstrates the use of a pedicle screw construct with screw insertion using 3D navigation and partial correction of a large deformity to improve standing alignment. I discuss the indications for surgical intervention in idiopathic scoliosis and a technique to allow posterior release and mobilisation of the spine to achieve correction of severe deformity. I also discuss the peri-operative considerations and imaging required.
The magnitude of scoliosis can vary from minimal curves of 10 degrees to very large curves of over 100 degrees. Curves of less than 40-50 degrees are often managed non-operatively since they are unlikely to cause functional problems as the patient becomes older. However, larger curves may cause back pain, sagittal or coronal imbalance, shoulder imbalance, and cosmetic concern which may effect mental health. Very large curves can also cause restrictive lung pathology (>90 degrees) and rarely cardiac problems (>110 degrees). Some patients may be asymptomatic whilst others may have shortness of breath in addition to the above features. Also, larger curves are more likely to progress over the course of many years.
Having trained with freehand insertion and fluoroscopic-guided pedicle screw insertion, I now utilise navigation guidance for pedicle screw insertion in complex spinal conditions. There are a large number of implants available for spine deformity correction and the requirements and benefits of some are discussed. In this feature, I use Medtronic Solera implants which can be navigated after obtaining 3D fluoroscopic images using Medtronic O-arm. Solera allows the choice of multi-axial screws, fixed angle screws, sagittal alignment screws, and uniplanar screws. It also has the choice of titanium, titanium alloy, or cobalt chrome rods with 5.5 or 6.0mm diameter. It comes with reduction towers that provide a very powerful correction tool for scoliosis. During navigated spine surgery, there is the risk of error in navigated imaging; this feature helps demonstrate techniques for reducing this error by limiting movement of the spine during pedicle drilling and screw insertion.
A technique for anterior release of a scoliotic deformity via thoracotomy is detailed on https://www.orthoracle.com/library/anterior-release-of-scoliosis-access-by-thoracotomy/ and correction of kyphoscoliosis at https://www.orthoracle.com/library/congenital-kyphoscoliosis-correction-hemivertebra-excision-deformity-correction-and-posterior-instrumented-fusion/
Author:Mr Stephen Morris FRCS(Tr & Orth)
Institution: The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK