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The Free Hand Anatomical Procedure for Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis

February 10, 2018

Contributors: Molly Ann Day, ATC, MD; Luca Labianca, MD; Stuart L Weinstein, MD; Pawin Gajaseni, MD; Pawin Gajaseni, MD

Posterior spine fusion with instrumentation is the standard of care for the surgical management of scoliosis. In current instrumentation systems, additional anchors are used to connect the rod and the spine, resulting in better correction and decreased likelihood of implant failure. The use of segmental pedicle screw constructs or hybrid constructs with pedicle screws, hooks, and wires is increasing. In addition, new devices, such as the O-arm, navigated surgery, CT, and intraoperative fluoroscopy are helpful tools commonly used by surgeons. Placement of the screws in the correct position is the most challenging aspect of posterior spine fusion. Fluoroscopy is the tool most commonly used before and after screw insertion to determine if the screw is well placed in the pedicle. Fluoroscopy is a useful tool but is time consuming and increases exposure to radiation. Safe screw positioning may be difficult in the thoracic spine because of unique neurologic and vascular anatomy and the position of the pedicles. Four areas are available for screw placement: lumbar, low thoracic, middle thoracic, and proximal thoracic. The second challenge is to achieve an almost complete correction and a straight spine. The freehand technique has gained popularity, and some studies have confirmed the validity of this approach. This video demonstrates freehand screw placement. Anatomic landmarks are shown during live surgery and in models. The video describes the osteotomy the senior author has used for 35 years.

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