Idiopathic Scoliosis: Graft Harvest for Fusion

Surgical Technique for Anterior Thoracoscopic Correction of Idiopathic Scoliosis: Chapter 4

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Graft Harvest

Once all of the discs have been removed, the portals are removed and rib graft is harvested. An Army/Navy is utilized to stabilize the rib. The portal is retracted anteriorly as far as possible. The rib is then dissected subperiosteally. Dissection is then carried posteriorly as far as the portal can be retracted. Utilizing the endoscopic rib cutter, two vertical cuts are made through the superior aspect of the rib. The incisions are perpendicular to the rib and extend halfway across the rib. An osteotome is then used to connect the two previous incisions while using the retractor to support the rib. The rib section is removed and morsilized. Three to four other rib sections are removed in similar fashion until enough bone graft has been obtained. (Fig. 10 and photo 8A & 8B). This technique will produce an adequate amount of graft and preserves the integrity of the rib, thus protecting the intercostal nerve and decreasing post-operative pain.

thoracoscopic correction scoliosis rib sections removed photo 8a picetti thoracoscopic correction scoliosis rib sections removed photo 8b picetti thoracoscopic correction scoliosis lateral drawing portals figure 2 picetti
Photo 8A Photo 8B Figure 10

If the patient has a large chest wall deformity, thorascopic thoracoplasties can be performed and the rib sections can be utilized for graft. One should not remove the rib heads at this time, since they will function as landmarks for screw placement.

Updated on: 03/14/16
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Idiopathic Scoliosis: Surgical Screw Placement
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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