Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 66. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Idiopathic Scoliosis Chapter 23 643 Figure 7. Technique of posterior scoliosis correction The technique of posterior scoliosis correction is exemplified using the Universal Spine System. a b Pedicle screws are inserted in the target vertebra and a rod is first inserted on the concave side of the curve and connected to the screws c d Insertion of the convex rod and levering it to the lower screws allows the concave apex screw to be narrowed to the rod achieving a good correction. A posterior fusion is added. shorter fusion lengths and better vertebral derotation compared to posterior procedures. The fusion usually incorporates all segments between upper and lower end vertebrae 10 112 128 209 218 . The spine is exposed by a thoracotomy lumbo-tomy or a thoraco-lumbotomy depending on the anatomical location of the curve. The intervertebral discs are completely removed at the levels selected for fusion. Correction in the coronal sagittal and axial planes is achieved by proper placement of the screws into the vertebral bodies and connection to a pre-bent single or double rod Fig. 8 Case Introduction . The disc space can be filled with bone . resected rib to enhance interbody fusion. These approaches are obviously technically more demanding than a posterior approach and are restricted to the mid thoracic to upper lumbar levels. The morbidity caused by a thoracotomy is not negligible but can be kept very low in experienced hands. Recently thoracoscopic procedures have been introduced which are even more demanding 134 152 177 178 181 206 232 . Newton et al. 152 153 reported on comparable results after thoracoscopic correction of thoracic curves compared with open techniques. Similar findings were reported by Grewal et al. 75 even though they reported a higher intraoperative blood loss in the thoracoscopic group. During the first year the thoracoscopic approach was found to cause fewer declines in the vital capacity compared to the open anterior approach. The rod needs to
