Dynamic Positioning of Scoliotic Patients During Spine Instrumentation Surgery

Duke, Kajsa; Aubin, Carl‐Éric; Dansereau, J.; Koller, Annick

doi:10.1097/bsd.0b013e3181753afd

Cited by 8 publications

(3 citation statements)

References 22 publications

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“…In recent years, positioning objectives for spinal surgeries have evolved to include intra-operative modulation of the patient's vertebral column geometry [1,2]. Thus far, the primary focus has been on the modulation of lumbar lordosis due to positioning of the lower limbs [3][4][5] and as a consequence many surgical frames now allow flexion or extension of patients' hips.…”

Section: Introductionmentioning

confidence: 99%

The impact of intra-operative sternum vertical displacement on the sagittal curves of the spine

et al. 2009

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Patient positioning is an important step in spinal surgeries. Many surgical frames allow for lumbar lordosis modulation due to lower limb displacement, however, they do not include a feature which can modulate thoracic kyphosis. A sternum vertical displacer (SVD) prototype has been developed which can increase a subject's thoracic kyphosis relative to the neutral prone position on a surgical frame. The kyphosis increase is obtained by lifting the subject's torso off the thoracic cushions with a dedicated sternum cushion that can be displaced vertically. The objective of this study was to evaluate the impact of SVD utilization on the sagittal curves of the spine. Experimental testing was performed on six healthy volunteers. Lateral radiographs were taken in the neutral and sternum raised positions and then analyzed in order to compare the values of sagittal curves. The displacement of volunteers and surgical frame components between positions was recorded using an optoelectronic device. Finally, interface pressures between the volunteers and surgical frame cushions were recorded using a force sensing array. Average results show that passing from the neutral to sternum raised positions caused an increase of 53% in thoracic kyphosis and 24% in lumbar lordosis; both statistically significant. Sensors showed that the sternum was raised a total of 8 cm and that interface pressures were considerably higher in the raised position. The SVD provides a novel way of increasing a patient's thoracic kyphosis intra-operatively which can be used to improve access to posterior vertebral elements and improve sagittal balance. It is recommended that its use should be limited in time due to the increase in interface pressures observed.

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Section: Introductionmentioning

confidence: 99%

The impact of intra-operative sternum vertical displacement on the sagittal curves of the spine

et al. 2009

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“…The small inaccuracy of the 3D reconstruction technique could introduce a slight misplacement of the implants with respect to the vertebrae, thus leading to an increase of the F I-V especially when using monoaxial screws. 17 Also, intraoperative spontaneous correction is generally obtained because of the positioning of the patient on the surgical table and the effect of anesthesia 35 and one could anticipate that the force levels during the surgery would be lower than the one obtained in the simulations.…”

Section: Implant Type and Densitymentioning

confidence: 99%

Biomechanical Analysis of Vertebral Derotation Techniques for the Surgical Correction of Thoracic Scoliosis

Martino

Aubin²,

Wang³

et al. 2013

Spine

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“…It allows for a safe and effective longitudinal elongation of the spine but requires a dedicated device, must be done several weeks before the procedure and has an uncertain impact on post-operative results [6]. An alternate method to achieve further Cobb reduction through patient positioning has been proposed by Duke et al [7] and involves the application of lateral forces (up to 150 N) to the trunk at the curve apex using adjustable thoracic cushions. Experimental evaluation of this method on 12 patients showed significant increases in spine height and decreases in both rib and trunk torsional deformity.…”

Section: Introductionmentioning

confidence: 99%

Assessment of two novel surgical positions for the reduction of scoliotic deformities: lateral leg displacement and hip torsion

2011

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Cobb angles and apical vertebral rotations (AVR) are two of the main scoliosis deformity parameters which spinal instrumentation and fusion techniques aim to reduce. Despite this importance, current surgical positioning techniques do not allow the reduction of these parameters. Two new surgical frame accessory prototypes have been developed: (1) a lateral leg displacer (LLD) allows lateral bending of a patient's legs up to 75° in either direction and (2) a pelvic torsion device (PTD) which allows transverse plane twisting of a patient's pelvis at 30° in either direction while raising the thoracic cushion, opposite to the raised side of the pelvis, by 5 cm. The objective of this study was to evaluate the ability of the LLD and PTD to reduce Cobb angles and AVR. Experimental testing was performed pre-operatively on 12 surgical scoliosis patients prone on an experimental surgical frame. Postero-anterior radiographs of their spines were taken in the neutral prone position on a surgical frame, and then again for 6 with their legs bent towards the convexity of their lowest structural curve, 4 with their pelvis raised on the convex side of their lowest structural curve and one each in opposite LLD and PTD intended use. Use of the LLD allowed for an average supplementary reduction of 16° (39%) for Cobb angle and 9° (33%) for AVR in the lowest structural curve. Use of the PTD allowed for an average supplementary reduction of 9° (19%) for Cobb angle and 17° (48%) for AVR in the lowest structural curve. Both devices were most efficient on thoraco-lumbar/lumbar curves. Opposite of intended use resulted in an increase in both Cobb angle and AVR. The LLD and PTD provide interesting novel methods to reduce Cobb angles and AVR through surgical positioning which can be used to facilitate instrumentation procedures by offering an improved intra-operative geometry of the spine.

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Dynamic Positioning of Scoliotic Patients During Spine Instrumentation Surgery

Cited by 8 publications

References 22 publications

The impact of intra-operative sternum vertical displacement on the sagittal curves of the spine

The impact of intra-operative sternum vertical displacement on the sagittal curves of the spine

Biomechanical Analysis of Vertebral Derotation Techniques for the Surgical Correction of Thoracic Scoliosis

Assessment of two novel surgical positions for the reduction of scoliotic deformities: lateral leg displacement and hip torsion

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