Disposable instrumentation for lumbar pedicle screw and rod constructs
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OPEN OPERATING THEATRE (OOT)
Disposable instrumentation for lumbar pedicle screw and rod constructs Antonio Faundez • Wendy Thompson J.-C. Le Huec
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Springer-Verlag Berlin Heidelberg 2013
Keywords Lumbar fusion Disposable instrumentation Cost efficiency
Learning targets •
New solutions for cost efficiency in spine surgery
Introduction The number of spinal surgeries has been steadily increasing these last years due to a constant ageing of the population. In the USA, the rate of instrumented fusion has tremendously increased since 1996 and cost-effectiveness has become a major concern [1, 2]. There is thus a need to improve cost-effectiveness at all stages of the therapeutic process of spinal instrumented fusion.
Electronic supplementary material The online version of this article (doi:10.1007/s00586-013-3115-8) contains supplementary material, which is available to authorized users. A. Faundez (&) Service de Chirurgie Orthope´dique et Traumatologie de l’Appareil Moteur, Geneva University Hospital, Geneva, Switzerland e-mail: [email protected] W. Thompson J.-C. Le Huec Universite´ Bordeaux Se´galen, Unite´ Ortho-Rachis 2, Poˆle Chirurgie, CHU Pellegrin, Bordeaux, France
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Case description The patient is a 52-year-old man who has followed a more than 6-month non-surgical treatment without success. The MRI shows a two-level disc degeneration at L3–L4 and L4–L5, with central disc herniation at this former level (Fig. 1a, b). As a last resort, he agreed to undergo a posterolateral and interbody fusion L3–L5. As in all of our patients, a detailed sagittal balance parameters analysis on a low-dose full spine X-ray was performed to respect patient’s spinopelvic balance (Fig. 2). Surgical procedure The patient underwent a two-level classic posterolateral lumbar fusion under general anaesthesia. We used a high technology instrumentation and implants, delivered in several fully traceable sterile kits: two kits each containing a couple of pre-loaded pedicle screws, one kit of two sterile rods, one set of sterile implantation instrumentation. The preloaded pedicle screws were implanted using a standard transpedicular technique. We performed a classic transforaminal interbody fusion using a PEEK cage filled with allograft. Special care was taken to insert the interbody fusion cage the most anteriorly possible, to be able to gain the most possible segmental lordosis (cantilever technique) [3]. Posterolateral bone decortication and fusion was carried out with a mix of locally harvested autograft, allograft and demineralised bone matrix. The rod’s shape was adapted to fit the patient’s lordosis as determined preoperatively by sagittal balance analysis [4, 5]. Watch surgery online
Eur Spine J (2013) 22:2904–2906
2905 Fig. 2 Preoperative low radiation dose full spine X-ray of the patient. Before any surgical treatment, it is mandatory to analyze spino-pelvic parameters to adapt our therapeutic strategy to each individual
Fig. 1 Preoperative MRI of the lumbar spine of the treated patient. A two level disc d
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