Vertebral Derotation in Adolescent Idiopathic Scoliosis
Section snippets
Surgical Technique
We position our scoliosis patients prone on a Jackson table. A midline incision is made over the levels to be fused and meticulous exposure of the posterior elements is performed out to the tips of the transverse processes. The inferior articular facets at each thoracic level are osteotomized with a narrow osteotome to increase the flexibility of the spine and expose the superior articular facet. Exposing the superior articular facet allows for thorough removal of the cartilaginous surface to
Conclusion
With the initial introduction of the revolutionary CD instrumentation 25 years ago, the quest for optimal 3-dimensional scoliosis correction continues. The combination of periapical thoracic pedicle screws undergoing a bilateral apical vertebral derotation technique using modern instrument sets is the next evolution in the CD philosophy. DVR devices provide not only optimal periapical vertebral manipulation but also marked correlative correction of thoracic and lumbar rib prominences without
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Cited by (34)
Improving effects of vertebral column manipulator on lower instrumented vertebrate tilt and lumbar mobility of lenke 5C patients for follow-up of minimum 2 years
2021, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :Direct vertebral rotation and simple rod derotation (SRD) are the two mainstream options in the correction surgeries on AIS patients at present. As one of the most prevailing vertebral rotation instruments, vertebral column manipulator (VCM) has been designed and proved to achieve more periapical screw capture, control and stress dispersion when compared with SRD [14]. Theoretically, VCM is more effective in alleviating the asymmetric biomechanical stress on involving disks through multi-segmental derotation.
Morphology and growth of the pediatric lumbar vertebrae
2021, Spine JournalCitation Excerpt :The popularity of this treatment can be attributed to improvements in curve correction, reduction in loss of correction, and greater kyphosis correction compared to pedicle hook-based and hybrid techniques [80–84]. The number and position of pedicle screws used in a spine fusion are left to the preference and experience of the surgeon who often relies on freehand placement techniques and although the incidence of pedicel screw-related complications in scoliosis is low, the occurrence of medial screw violations into the spinal canal range from 15% to 50% with a paralysis or permanent neurologic deficit rate of 0.3% to 1.4% [84–87]. Detailed pediatric lumbar geometry data like those provided here could be used to improve the design of spinal fusion devices and to help determine appropriate sizing and insertion angles for pedicle screws.
Strength of Thoracic Spine under Simulated Direct Vertebral Rotation: A Biomechanical Study
2016, Spine DeformityCitation Excerpt :For example, using direct vertebral rotation (DVR) [3,4], axial torsion is applied directly to the spine through a device with large lever arms attached bilaterally to pedicle screws at multiple levels along the length of the deformity. With such techniques, torques purportedly in excess of 100 Nm have been applied to the thoracic spine intraoperatively [3], and satisfactory curve corrections have been reported. Notwithstanding studies that have reported satisfactory curvature corrections and low complication rates using DVR [4-8], others have reported intraoperative complications with DVR and other rotational correction maneuvers [9-12].
Surgical management of adolescent idiopathic scoliosis
2015, Seminars in Spine SurgeryCitation Excerpt :The rod is then rotated into the distal screws and locked in place when appropriate sagittal alignment of the rod is achieved. The apex of the contoured rod is then engaged into the pedicle screw heads utilizing a periapical rocker-blocker or similar reduction tool.37,41 The screws are then distracted on the concavity to increase kyphosis.
Mechanical behavior of a novel non-fusion scoliosis correction device
2013, Journal of the Mechanical Behavior of Biomedical Materials