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  • cindy2836
    Participant
    Post count: 22

    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.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    A typical report for an extension of the thoracic fusion to T4. How did you do post-operatively?

    Dr. Corenman

    cindy2836
    Participant
    Post count: 22

    I am doing excellent! The radiating rib pain is gone. My only real soreness was my front side and I think the positioning table caused some deep bruising on my chest and back of my arm tops. I’m very glad I had the surgery!!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Excellent

    Dr. Corenman

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