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VIDEO: Open instrumentation, posterior approach used for thoracolumbar open wedge osteotomy
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In this video from the Open Operating Theatre, Nils Hansen-Algenstaedt, MD, of OrthoCentrum Hamburg in Hamburg, Germany, discusses how open spinal instrumentation is used with a posterior-only approach to perform open wedge osteotomy in the thoracolumbar spine in a 54-year-old female patient with kyphotic deformity.
With the patient in the prone position, the skin incision is made, the paravertebral muscles are retracted for posterior release and facetectomy, and instrumentation is extended to L2 due to an intraoperative fracture. Surgeons placed monoaxial pedicle screws at T12, L1 and L2. Surgeons modified the originally planned bone-to-bone osteotomy to an open wedge osteotomy and removed the disc.
They carried out a facetectomy and osteotomy of the bone in intervertebral disc space. The segmental height was restored, and coronal alignment achieved by placing a transforaminal lumbar interbody fusion cage on the left side. Longitudinal rods were fixed on the right from caudal to cranial for deformity correction. Segmental compression and distraction were performed to complete coronal correction. Screws are tightened, then autologous bone and bone substitute was placed for posterior spinal fusion from T12 to L2.
This video is a teaching tool to help surgeons prepare for surgery or they can use it as a refresher on the surgical technique and indications for this surgery.