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Intervention
Because of his general health, the patient was not deemed fit for a major reconstructive
procedure. Prolonged bedrest was also preferably avoided. In view of this he
was offered percutaneous pedicle screw fusion via the MAST (Minimal Access Spinal
Technology) technique using the Sextant® apparatus (Medtronic-Sofamor Danek,
Memphis, TN).
The patient is shown below (Figure 3) positioned in preparation for the surgery:
Figure 3
Using the sextant apparatus the T11 and then the L1 pedicles were sequentially
cannulated with 5.5 x 45 mm screws. 4 screws were placed with 2 rods. The procedure
was performed through a total of six 2 cm incisions. The Intraoperative imaging
is shown below in Figure 4:
Figure 4
The incisions at the end of the case are shown as below in Figure 5:
Figure 5
There were no problems intraoperatively and no appreciable blood loss. The
patient was transferred to the ward uneventfully. Total operating time was 75
minutes.
Postoperative CT scanning showed the position of the pedicle screws:
L1 (Figure 6):
Figure 6
T12 (Figure 7):
Figure 7
The patient was mobilized in TLSO with no adverse surgical complications.
Postoperative CT scanning and x-rays 1 week after surgery are shown below in Figures 8a and 8b:
Figure 8a
Figure 8b
Four weeks after surgery he was transferred to the rehabilitation service with
no complications as a result of the stabilization. It would be envisioned that
the instrumentation would be removed 12 months after surgery.
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