Idiopathic Scoliosis: Surgical Compression and Closure

Compression

Once the rod has been seated and all the plugs inserted into the screws, compression between the screws is performed. Compression of the construct must be performed.

Rack and Pinion
The Compressor is inserted through one of the portal sites with the portal removed. Once in the thoracic cavity, it can be manipulated by holding the ball shaped attachment with the compressor holder. The rack and pinion compressor fits over two screw heads on the rod and can be compressed by turning the Compressor Driver clockwise and compressing the two screws together (Fig. 28). Compression is started at the inferior end of the construct with the most inferior screw’s plug fully tightened. Once satisfactory compression has been performed on a level the superior plug is fully tightened using the Plug Driver through the Plug Introduction Guide. Compression is sequentially performed superiorly until all levels have been compressed. After all levels are compressed each plug is torqued to 75 in/lbs. with the Torque-Limiting Wrench. The construct is complete at this point.

Figure 28

Closure
A # 20 French chest tube is placed through the inferior portal and the incisions closed. A/P and lateral x-rays are obtained and the patient transferred to the recovery room.

Post-Operative Regiment
Chest tube is left in until drainage is less than 100 cc’s/8hrs. Patients can be ambulated post-operative day one and are discharged the day after the chest tube is removed. Patients are seen back in one, three, six, and then 12-month intervals with x-rays.

Patients should be braced for 3 months.