Chapters Transcript Video Scoliosis Correction Surgery for Patient Life Quality Charles Reitman, M.D., discusses functionality-focused approach to spinal surgery in adults. Really our primary goal is not to do surgery pretty much anytime somebody walks in the office, you know some things have clear indication, some things you can try to manage and work with and some things just flat don't need surgery. You know this is somebody who had this deformity and just didn't have surgery when she was you know 13 or 14 or 15 I think her curve was somewhere in the 50 range. Her main curve was in the thoracic spine. And then she had a reasonably large compensatory curve in the lower you know historical lumbar spine but it was very mobile. And so we didn't address that curve. We just address the curve that was stiff and then you know the mobile spine should accommodate back to that. So if we were to address her whole curve, you know it would be T. Four to L. Four or something like that. But again we can spare the lower lumbar spine and I think you know help with long term. So I've seen her back and you can see you know how she has the compensatory lower curve and you know that her spine overall is much straighter. But you know if we had an instrument in more levels, maybe cosmetically you didn't straighten everything straight as an arrow, you know functionally they're much better off for that. She had a lot of rotation in her curve and um you know somewhat imbalanced regionally. So even though her overall, you know alignment top to bottom if you just looked at her head and looked at her pelvis. It was um looked you know pretty well lined up, you know within that area the curve, it was fairly marked and you know a lot of rotation or twisting. So our goals were you know, just to improve your alignment, balance her spine and um you know minimize the number of levels, refused to mitigate you know, adjacent segment problems and and really help her keep you know, maintain her function. The left side is the correction side. So we put out what we would call a high density of implants on that side. Um Pretty much try and get usually screws into the medical screws into the um vertebra at each level. And if you have like segmental fixation like that with high density you can really influence the curb correction. And then on the opposite side we just put in a much lower density of implants just to kind of help hold I think with modern day what what modern day implants have done really is to allow you to fuse fewer levels. So that's good the more levels you can spare and still correct the deformity and maintain it. You know, the better they'll be long term. And I think you know in general from my point of view, the more levels you can spare below. So in the lumbar spine, the much better off you are probably the less likely you are to develop adjacent segment problems. So um you know you can imagine if you fuse the spine that's gonna play stress on other areas of the spine and the lower you go you know towards the tailbone or sacrum. The more localized stress and the more you're gonna affect mechanics. If you can limit you know most of the fusion to just the ribcage area thoracic spine that really has a lot less influence on the overall mechanics of the spine. We do have a navigation system. Takes some sort of a C. T. Scan during surgery. So three dimensional study the machine than records and then the tools you use during surgery um are you know navigated or tracked. So you can watch on a screen and see where your trajectory is. You have to know how to do open surgery in order to be a good surgeon with navigation. And then the navigation just helps ensure you know especially in those where you have a really tight tolerance that you're in the right direction. I think you know it also in deformity because things are twisted and aimed in odd directions. It's just more challenging anyway than you know just a straight spine. So it does. I think it allows you to instrument it more safely. You have an idea of what the spine should look like just based on normal anatomy and so generally you bend the rod to the position you want the spine to be, not to the position. She's in part of the surgery is doing fast detect amis or basically partially removing all the joints. So you loosen everything up. Um I do that with an osteo to more like a chisel. But some people use other ultrasonic type cutting devices or other devices but you need to loosen up all the joints. So essentially you tear down the spine and then rebuild it again. But because it's loose and mobile and especially in younger patients you can get it to move to the rod and get it straighter. You know it went from plus or minus 50 whatever it was to probably you know the 10 15 degree range. So that's you know it's not perfectly straight but it's good you can still see a little rotational deformity as well. You know that that worked well. And then the last part is just the actual fusion process because in the end the implants just there to hold the position like an internal brace. But you need to get all of those bones essentially to grow together cause screws won't hold up for 80 years. You know in a 20 year old. So all that bone needs to grow together. So we prepare the bone by essentially injuring the bone um or dick or decaying as the fancy term we use with either the osteo Tums or birds so that it provides a surface for new bone growth and then we recycle her bone from all of the decor decayed stuff we do and we use the telegraph phone as well to supplement that or expand that. What M. U. S. C. Is unique for is really the complex deformity so hers I would not consider complex you know um And some of the certainly some of the pediatric cases can get much more complex especially those that are due to um congenital, more congenital problems or neuro muscular problems. And then in the adult you know people have had prior surgery have had prior decompression need revision, de compressions along with you know procedures like osteo Tommy's which are really you know cutting out wedges out of fused areas and reshaping the spine totally doing front and back surgery surgery from the side and the back there. Big surgeries. You know you need good anesthesia team, you need a good ICU team and you're good blood bank. There are a lot of you know components that go into those. So I think the more complex the deformity and the problem becomes. I think the more M. U. S. C. Stands out as a center of excellence Published December 21, 2022 Created by
