thoracic fusion

Dr. Corenman, I’m going to copy paste here my recent operative post. I thought you might like to see how it was performed here in Ohio.

PREOPERATIVE DIAGNOSES:
1. Thoracic pseudoarthrosis.
2. Hardware failure.
3. Back pain.
4. Kyphosis.

POSTOPERATIVE DIAGNOSES:
1. Thoracic pseudoarthrosis.
2. Hardware failure.
3. Back pain.
4. Kyphosis.

PROCEDURES PERFORMED:
1. Placement of bilateral pedicle screws with DePuy Expedium screws
from T4 to T8.
2. Posterolateral fusion from T4 to T11 with autograft and allograft.

INDICATIONS: The patient is a 67-year-old female who presents after a
T10 to S1 instrumentation and fusion at an outside institution. She
presented with increasing thoracic back pain. She was found to have
some loosening of her T10 screws indicating a T10-T11 pseudoarthrosis.
She did have some subtle kyphosis at that level. Given the
pseudoarthrosis, extension of her fusion with posterolateral fusion from
T4 to T11 is indicated.

DESCRIPTION OF PROCEDURE: The patient was intubated and placed under
general endotracheal anesthesia. She was positioned in the prone
position. All pressure points were appropriately padded. Fluoroscopy
was used to localize the incision. Skin was marked, then prepped and
draped in sterile fashion. Antibiotics were given prior to incision.
Midline incision was made with a #10 scalpel. Monopolar cautery was
used to expose the T4 to T9 lamina in subperiosteal fashion out to the
transverse processes. Dissection was carried up and over the T10 and T9
screws out to the transverse processes. The ends of the rods were
exposed and end-to-end connectors were attached. Attention was directed
to the T8 pedicles. High-speed drill was used to create a starting
point and gearshift was used to access the pedicle. Ball-tip feeler
ensures no cortical breaches. An undersized tap was used followed again
by the ball-tip feeler and placement of bilateral pedicle screws at T8.
DePuy Expedium screws were used. Pedicle screws were also placed
bilaterally from T7 to T4. AP and lateral fluoroscopy ensured adequate
placement of all instrumentation. Screws were all stimulated and found
to stimulate above threshold. Rods were then measured and cut and
placed in the end-to-end connector and the screw heads. Set screws were
placed at all levels. Torque, counter-torque was used to final tighten
all set screws and the end-to-end connector. At this point, the wound
was copiously irrigated with 3 L of sterile saline with vancomycin.
High-speed drill was used to decorticate the exposed transverse
processes as well as lamina from T4 to T9 and a large kit of BMP along
with 60 cc of cortical cancellous chips, and the autograft from the
decortication was placed in the posterolateral gutters and along the
lamina from T4 to oT9 to achieve posterolateral fusion with autograft
and allograft from T4 to T9. Two hubless channel drains were placed
prior to closure. Powder vancomycin was applied to the incision prior
to closure. Fascia closed with 0 Vicryl in interrupted fashion. Dermis
was closed with 2-0 Vicryl in interrupted fashion. Skin was closed with
staples. A Prevena incisional wound VAC was applied to the incision.
The patient tolerated the procedure well with no acute complications.
Estimated blood loss was 300 cc. Following the procedure, patient was
brought to postop anesthesia care unit in stable condition. All needle
and sponge counts were correct. I was present for the entire procedure.