Pelvic instrumentation for neuromuscular scoliosis has been part of neuromuscular scoliosis surgery since the era of the Luque Galveston construct. Unit Rod(Medtronic Sofamor-Danek, Nashville, TN) instrumentation brou...Pelvic instrumentation for neuromuscular scoliosis has been part of neuromuscular scoliosis surgery since the era of the Luque Galveston construct. Unit Rod(Medtronic Sofamor-Danek, Nashville, TN) instrumentation brought with it the concept of cantilever correction by placing the implants in the pelvis and then gradually bringing the rod to the spine by sequentially tightening the sublaminar wires, with the goal of creating a level pelvis over a straight spine. More recently surgeons have utilized pedicle screw constructs in which the corrective strategies have varied. Challenges with pelvic fixation using iliac screws linked to the spinal rod have led to the development of the S2-alariliac technique(S2 AI) in which the spinal rod connects to the pelvic screw. The screw is placed in the S2 ala, crosses the sacro-iliac joint and into the ilium through a large column of supra-acetabular bone. This column is the same area used for anterior inferior iliac spine external fixation frames used in trauma surgery. S2 AI screw placement can be technically difficult and can require experienced radiology technologists to provide the appropriate views. Additionally, although the technique was originally described being placed via freehand technique with intra-operative flouroscopy, the freehand technique suffers from the anatomic anomalies present in the pelvis in neuromuscular scoliosis. As such, we prefer to place them using intra-operative navigation for all pediatric spinal deformity cases. Below in detail we report our intra-operative technique and an illustrative case example.展开更多
Arthrodesis of the sacroiliac joint（SIJ） for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluor...Arthrodesis of the sacroiliac joint（SIJ） for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement;however,image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement.In the following cases,we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm^（？）multidimensional surgical imaging with StealthStation^（？）navigation（Medtronic,Inc.Minneapolis,MN）.Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site.O-arm^（？） integrated with StealthStation^（？） allowed immediate autoregistration.The skin incision was planned with an image-guidance probe.An image-guided awl,drill and tap were utilized to choose a starting point and trajectory.Threaded titanium cage（s） packed with autograft and/or allograft were then placed.O-arm^（？） image-guidance allowed for implant placement in the SIJ with a small skin incision.However,we could not track the cage depth position with our current system,and in one patient,the SIJ cage had to be revised secondary to the anterior breach of sacrum.展开更多
文摘Pelvic instrumentation for neuromuscular scoliosis has been part of neuromuscular scoliosis surgery since the era of the Luque Galveston construct. Unit Rod(Medtronic Sofamor-Danek, Nashville, TN) instrumentation brought with it the concept of cantilever correction by placing the implants in the pelvis and then gradually bringing the rod to the spine by sequentially tightening the sublaminar wires, with the goal of creating a level pelvis over a straight spine. More recently surgeons have utilized pedicle screw constructs in which the corrective strategies have varied. Challenges with pelvic fixation using iliac screws linked to the spinal rod have led to the development of the S2-alariliac technique(S2 AI) in which the spinal rod connects to the pelvic screw. The screw is placed in the S2 ala, crosses the sacro-iliac joint and into the ilium through a large column of supra-acetabular bone. This column is the same area used for anterior inferior iliac spine external fixation frames used in trauma surgery. S2 AI screw placement can be technically difficult and can require experienced radiology technologists to provide the appropriate views. Additionally, although the technique was originally described being placed via freehand technique with intra-operative flouroscopy, the freehand technique suffers from the anatomic anomalies present in the pelvis in neuromuscular scoliosis. As such, we prefer to place them using intra-operative navigation for all pediatric spinal deformity cases. Below in detail we report our intra-operative technique and an illustrative case example.
文摘Arthrodesis of the sacroiliac joint（SIJ） for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement;however,image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement.In the following cases,we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm^（？）multidimensional surgical imaging with StealthStation^（？）navigation（Medtronic,Inc.Minneapolis,MN）.Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site.O-arm^（？） integrated with StealthStation^（？） allowed immediate autoregistration.The skin incision was planned with an image-guidance probe.An image-guided awl,drill and tap were utilized to choose a starting point and trajectory.Threaded titanium cage（s） packed with autograft and/or allograft were then placed.O-arm^（？） image-guidance allowed for implant placement in the SIJ with a small skin incision.However,we could not track the cage depth position with our current system,and in one patient,the SIJ cage had to be revised secondary to the anterior breach of sacrum.
