Mayo Clinic pediatric orthopedic surgeons A. Noelle Larson, M.D., and Todd A. Milbrandt, M.D., demonstrate anterior vertebral body tethering on patients with scoliosis.
So if we have now prepped and draped the patient, Typically we're looking for flexible curve pattern and we try to achieve approximately 50% correction in our operatively, both from the tension ing and from the position of the patient on the table. Our first step is Thio Obtain access to the right Hemi thorax and Dr Potter, we'll take us through this. It's important that this arm is prepped and draped out of the way because you'll see the horoscope will come pretty close to the arm. Um, in addition, we've prepped in the spine is processes because we'll place a navigated stealth reference frame on the spine. This process and that will help us navigate the position of the screws. We placed them later in the case. Okay, so the landmark for Earth arkus copy is the tip of the scapula there. And then the 12th rib, which is down here. We try to stay interior to the lotus Imus muscle, or at least not divide it so more towards the escalatory triangle. So we use ah, selective intubation. So our lung should not be ventilated on this side. So we use Ah, that's approach and then our lower port will be somewhere about there will double check that on the inside. Once we have Thor Cas Coptic visualization. The pleura is opened using the harmonic scalpel, and each segmental artery and vein is identified and coagulated using the harmonic scalpel, finding the landmark on the anterior chest wall using the camera and then a port is then placed through the chest to obtain access to each of these vertebra levels. The navigated pointer is placed into the chest so that the screw starting point can be identified. A navigated all is then placed on the vertebral body and then inserted, followed by the bone tap itself. Once this has been placed, a feeler is used to ensure that by cortical purchase has been obtained. A staple is then placed into the vertebral body using a mallet. This allows for extra fixation. In the vertebral body itself, another tap is placed to make room for the screw. You can see the hydroxy appetite coded component of the screw. The tether is then placed from superior to inferior. Using the ports. It is locked at the top using the port and a set screw. These levels are then 10 chinned Using an external tension. Er you can see the tension being applied across the vertebral bodies. A such grew is then placed with pressure on the wall. End result is a corrected spine post operatively. The patient is given a chest tube but has no restrictions on range of motion. In hospital time is approximately three days. Final postoperative radiographs can be compared to the preoperative radiographs showing significant correction of the scoliosis.
