VIDEO: MIS revision of de novo scoliosis, stenosis following open spinal instrumentation

In this video from Open Operating Theatre, Nils Hansen-Algenstaedt MD, department of spine surgery, OrthoCentrum, Hamburg, Germany, discusses how to perform minimally invasive revision of de novo scoliosis and stenosis after open spinal instrumentation.

The surgery was performed with the patient placed in prone position. The trajectory of the previously placed pedicle screws was found with spinal needles placed under fluoroscopic control and after exposure surgeons removed implants. For the second procedure, surgeons began with facet joint decompression in segment L3-4 with a Smith Petersen osteotomy. Significant mobilization is achieved and complete decompression is achieved with a cross over decompression. The Dural tube is mobilized medially, disc is excised and end plates cleaned. Coronal alignment is achieved with the placement of cages and then correct implant positioning is achieved. Segmental height is restored with bone-disc-bone osteotomy and with a T-lift cage inserted. Reduction screws are placed and with the completion of unilateral instrumentation, a longitudinal rod is placed craniocortically to achieve coronal and sagittal correction. Fusion graft mass is added for posterior fusion from T11-S1 and performed contralaterally. A 3-D scan in performed to confirm correct implant placement.

This video is a teaching tool to help surgeons prepare for surgery or they can use it as refresher on the surgical technique and indications for this surgery.