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Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis.

Sarwahi V, Amaral T, Wendolowski S, Gecelter R, Gambassi M, Plakas C, Liao B, Kalantre S, Katyal C - Biomed Res Int (2015)

Bottom Line: However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients.We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis.Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Orthopedics, Cohen Children's Medical Center, New Hyde Park, NY 11040, USA.

ABSTRACT
Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

No MeSH data available.


Related in: MedlinePlus

Rods have been inserted on both of the sides and correction has been obtained. Notice that the midline osteoligamentous structures have been preserved.
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fig6: Rods have been inserted on both of the sides and correction has been obtained. Notice that the midline osteoligamentous structures have been preserved.

Mentions: Complete exposure of the transverse process is usually not needed to identify the entry point but can be carried out if desired. Sacral screw insertion is carried out in a free hand manner but can also be done under fluoroscopy for a tricortical approach. Pelvic fixation can be carried out similarly. The PSIS serves as an attachment for multifidus and thus the dissection plane leads to the entry point. We prefer to place pelvic screws under intermittent fluoroscopy to direct the screw towards dense bone superior to the sciatic notch. Two rods, cut to appropriate length, are contoured in the normal sagittal plane and are inserted caudad to cephalad. We start with the concave rod first. A rod translation or rod derotation maneuver can be carried out to seat the rod compression and distraction as needed can also be carried out. In situ rod contouring can also be carried out but is not our preference. Direct vertebral rotation maneuver is then carried out off the concave-side screws (Figures 5 and 6).


Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis.

Sarwahi V, Amaral T, Wendolowski S, Gecelter R, Gambassi M, Plakas C, Liao B, Kalantre S, Katyal C - Biomed Res Int (2015)

Rods have been inserted on both of the sides and correction has been obtained. Notice that the midline osteoligamentous structures have been preserved.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663285&req=5

fig6: Rods have been inserted on both of the sides and correction has been obtained. Notice that the midline osteoligamentous structures have been preserved.
Mentions: Complete exposure of the transverse process is usually not needed to identify the entry point but can be carried out if desired. Sacral screw insertion is carried out in a free hand manner but can also be done under fluoroscopy for a tricortical approach. Pelvic fixation can be carried out similarly. The PSIS serves as an attachment for multifidus and thus the dissection plane leads to the entry point. We prefer to place pelvic screws under intermittent fluoroscopy to direct the screw towards dense bone superior to the sciatic notch. Two rods, cut to appropriate length, are contoured in the normal sagittal plane and are inserted caudad to cephalad. We start with the concave rod first. A rod translation or rod derotation maneuver can be carried out to seat the rod compression and distraction as needed can also be carried out. In situ rod contouring can also be carried out but is not our preference. Direct vertebral rotation maneuver is then carried out off the concave-side screws (Figures 5 and 6).

Bottom Line: However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients.We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis.Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Orthopedics, Cohen Children's Medical Center, New Hyde Park, NY 11040, USA.

ABSTRACT
Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

No MeSH data available.


Related in: MedlinePlus