Idiopathic Scoliosis: Rod Measurement and Placement

Surgical Technique for Anterior Thoracoscopic Correction of Idiopathic Scoliosis: Chapter 6

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Rod Measurement and Placement

The rod length is determined with the Eclipse Rod Measurer. The fixed ball at the end of the measuring device is placed into the saddle of the inferior screw. The ball at the end of the cable is then guided through all of the screws with a pituitary to the superior most screw and inserted into the saddle (Fig. 21). The wire is then pulled tight and a reading is taken from the scale (Fig. 22). The scale is in centimeters.

thoracoscopic correction scoliosis cable guided through screws with a pituitary to superior most screw and inserted into the saddle figure 21 picetti thoracoscopic correction scoliosis wire pulled tight reading taken from scale in centimeters figure 22 picetti
Figure 21 Figure 22

The 4.5mm rod is then cut to length and inserted into the chest cavity through the inferior most port. The rod has a slight flexibility and is not bent prior to insertion. With the anterior compression, kyphosis is obtained in the thoracic spine. Do not cut rod longer than measured since the total distance between the screws will be reduced with compression. The rod is manipulated into the inferior screw with the Rod Holder (Fig. 23). The end of the rod should be flush with the saddle of the screw. This is done to prevent the rod from protruding and irritating or puncturing the diaphragm. Once the rod is in place, the portal is removed and the Plug Introduction Guide is placed over the screw to guide the plug and hold the rod into position (Fig. 24). The Obturator can be placed in the tube to assist in the insertion through the incision.

thoracoscopic correction scoliosis rod manipulated into the inferior screw with the rod holder figure 23 picetti thoracoscopic correction scoliosis plug introduction guide placed over screw to guide plug and hold rod into position figure 24 picetti
Figure 23 Figure 24

The plug is loaded onto the Plug-Inserter (Fig. 25). The plug must be inserted with the flat side with the laser etching up. Once the plug is placed on the driver turn the sleeve clockwise to engage the plug with the sleeve. The Plug Inserter is then placed through the Plug Introduction Guide and inserted into the screw. The plug should not be placed without using the Introduction Guide and the Plug Inserter. One turn counter clockwise before advancing the plug will assist in ensuring proper threading. Once the plug has been correctly started, hold the locking sleeve to prevent any further rotation. This will disengage the plug from the inserter as the plug is inserted into the screw (Fig. 26). Remove the driver and Introduction Guide and torque the screw with the Torque Limiting Wrench. This is the only plug that is tightened completely at this time.

thoracoscopic correction scoliosis plug-inserter figure 25 picetti thoracoscopic correction scoliosis locking sleeve to prevent further rotation disengage the plug from inserter as plug inserted into the screw figure 26 picetti thoracoscopic correction scoliosis rod sequentially reduced into remaining screws using rod pushers figure 27 picetti
Figure 25 Figure 26 Figure 27

The rod is then sequentially reduced into the remaining screws using the Rod Pushers (Fig. 27). The Rod Pushers should be placed on the rod several screws above the screw that the rod is being reduced into. This will assist in rod reduction. The plugs are applied through the Plug Introduction Guide as described above. These plugs should not be fully tightened at this time in order to allow for compression

Updated on: 03/14/16
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Idiopathic Scoliosis: Surgical Compression and Closure
Edward C. Benzel, MD
Dr. Picetti has presented a comprehensive treatise on the surgical technique for anterior thoracoscopic correction of idiopathic scoliosis. For the consumer and patient who desire to be informed, this is a worthwhile and valuable document to carefully scrutinize. The reader is cautioned to not extrapolate the information provided by Dr. Picetti to all clinical situations. In particular, many surgeons may utilize modifications of the strategies outlined by Dr. Picetti or may in fact use significantly different approaches. All may be appropriate. Dr. Picetti’s meticulous and well-prepared monograph should be used as a guideline. It is emphasized, however, that it is not the only way of ‘skinning the cat’.

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