Deformity Correction Through the Use of Reduction Towers: 2-Dimensional Operative Video.

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2020-08

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Abstract

Spinal deformity management can be difficult. The decision for surgery, approach, number of levels, and surgical technique all present challenges. Even when other issues are managed appropriately the process of how to correct the deformity needs special consideration. Numerous techniques have been studied including vertebra-to-rod, rod de-rotation, 3-rod-techniques, and cantilever maneuvers. While cantilever is the preferred technique when treating sagittal plane deformity, scoliosis often requires a combination of techniques due to the complexity of deformity in coronal and transverse planes. This video illustrates an adult scoliosis correction using sequential reduction towers and de-rotation techniques. Using this method the step of hook holders is eliminated and tension is distributed evenly across the rod using sequential reduction of the reduction towers across the length of the rod. This has led to a very efficient correction of our deformity as well as a powerful de-rotation tool. We routinely use this technique for flexible and rigid deformities, which is assessed pre-op with a computed tomography. The patient is a 67-yr-old female with prior lumbar decompressions and worsening back pain with radiculopathy. No significant sagittal malalignment is present but pelvic tilt is elevated and a coronal deformity exists. pelvic incidence measures 59°, LL50°, PT28° and lumbar scoliosis shows a coronal Cobb angle of 50.8°. Briefly, surgery involved transpedicular instrumentation from T10-S1 with bilateral iliac screw fixation. To achieve mobility posterior column osteotomies were performed at T12-L1, L1-2, L2-3, L3-4, L4-5, and L5-S1 levels. TLIF was performed at L4-5, L5-S1 for fusion. Postoperative scoliosis X-rays demonstrated improved sagittal and coronal alignment with PI59°, LL59°, PT22°, and coronal Cobb angle of 12°.

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10.1093/ons/opz356

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Buchholz, Avery L, Thomas J Buell, Mark E Shaffrey, Regis W Haid and Christopher I Shaffrey (2020). Deformity Correction Through the Use of Reduction Towers: 2-Dimensional Operative Video. Operative neurosurgery (Hagerstown, Md.), 19(2). pp. E157–E158. 10.1093/ons/opz356 Retrieved from https://hdl.handle.net/10161/21321.

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Shaffrey

Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.


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