1. Scoliosis Surgery Mark Wilms, CST ST Program Director Anthem College Aurora, Colorado

2. Scoliosis An abnormal side to side curvature of the spine.

3. Scoliosis Develops in the thoracic spine The thoracolumbar area of the spine Only in the lumbar spine

4. Scoliosis Causes Congenital Developmental Degenerative Idiopathic (most common)

5. Scoliosis The most common forms of Scoliosis: Congenital Neuromuscular Degenerative Idiopathic

6. Scoliosis Congenital

7. Scoliosis Cerebral Palsy Muscular Dystrophy Neuromuscular

8. Scoliosis Degenerative

9. Scoliosis Idiopathic

10. Scoliosis Idiopathic Scoliosis Infantile scoliosis birth to 3 years Juvenile Scoliosis 3 to 9 years Adolescent scoliosis 10 to 18 years

11. Scoliosis Facts

12. Scoliosis Scoliosis testing Physicians exam X-ray

13. Scoliosis Treatment is based on two factors; Skeletal maturity Degree of curvature

14. Scoliosis Treatment Observation Back Braces Surgery

15. Scoliosis Observation Curvature of the spine  Cobb angle measurement

16. Scoliosis Braces Milwaukee brace Charleston brace TLSO brace

17. Scoliosis Bracing results (worn for 18 months, 23 hours a day) Before After

18. Scoliosis Surgery

19. Scoliosis Two General Approaches: Posterior approach Anterior approach

20. Scoliosis Posterior Surgical Approach

21. Scoliosis OSI spine table

22. Scoliosis Room Preparation

23. Scoliosis Positioning

24. Scoliosis Hooks, Wire, Screws, and Rods

25. Scoliosis Instrumentation

26. Scoliosis Hooks Each hook site is prepared using a hook finder or elevator.

27. Scoliosis Implants are applied to the spine to correct the deformity. Hooks are placed in the thoracic spine and screws are generally used in the lumbar spine.

28. Scoliosis Rod Contouring The rod is contoured to the desired correction Additional contouring is done with in situ benders

29. Scoliosis Rod insertion Set screws are inserted into each hook or screw Each screw is hand tightened

30. Scoliosis Rod rotation The deformity is corrected using the appropriate method. Compression and distraction may be applied to gain additional correction.

31. Scoliosis Bone grafting and crosslink plating Bone grafting is completed. Cross links are measured for and applied to the construct.

32. Scoliosis Final tightening and closure A counter torque and break off driver are used to torque and break off the plugs.

33. Scoliosis Completed Posterior Spinal Fusion

34. Scoliosis Anterior Surgical Approach

35. Scoliosis Disc removal Screw & rod placement

36. Scoliosis Endoscopic Anterior Approach Also known as a thoracoscopic approach

37. Scoliosis Endoscopic Instrumentation

38. Scoliosis Endoscopic Anterior – Posterior Spinal Fusion A combination of both procedures previously discussed. An endoscopic anterior approach done first. Disc is removed in the most severe part of the curve to facilitate posterior fusion. Posterior approach is then done to correct deformity with instrumentation and fusion.

39. Scoliosis Image guidance Helps in the accuracy of the placement of screws. Reduces potential nerve, spinal cord, and major vascular damage. No exposure to ionizing radiation in surgery.

40. Scoliosis Image Guidance

41. Scoliosis Scoliosis surgery using the image guidance system

42. Scoliosis Image guidance instrumentation

43. Scoliosis Image Guidance instrumentation

44. Scoliosis Image guidance & spine instrumentation

45. Scoliosis Other equipment needed for Spinal Fusion: EEG monitor Intra-operative X-Ray holder Mayfield Table (if preferred)

46. Scoliosis Complications of Spinal Surgery  Blindness  Brachial Palsy  Nerve Damage  Paralysis  Infection  Allergy to metal  Blood Loss  Blood Transfusion Reactions

47. Scoliosis Spine Team survival tips: Think Plan Organize Position Padding Warmth Documentation

48. Scoliosis As in all surgical procedures, Teamwork is a must in Spine Surgery!

49. Thank You! Questions?