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Open access

Short segment rib resection to mitigate risk of pleural violation during retropleural lateral thoracic interbody fusion

Bo Li, Gregory A. Kuzmik, Saman Shabani, Nitin Agarwal, Alysha Jamieson, Thomas Wozny, Simon Ammanuel, Praveen V. Mummaneni, and Dean Chou

It can be difficult to avoid violating the pleura during the retropleural approach to the thoracolumbar spine. In this video, the authors resect a short segment of rib to allow more room for pleural dissection during a minimally invasive (MIS) lateral retropleural approach. After a lateral MIS skin incision, the rib is dissected and removed, clearly identifying the retropleural space. The curvature of the rib can then be followed, decreasing the risk of pleural violation. The pleura can then be mobilized ventrally until the spine is accessed. Managing the diaphragm is also illustrated by separating the fibers without a traditional cut through the muscle.

The video can be found here: https://stream.cadmore.media/r10.3171/2022.3.FOCVID21138

Open access

Use of an exoscope for enhanced visualization of a Schwab grade 5 osteotomy to correct kyphotic deformity

Alma Rechav Ben-Natan, Nitin Agarwal, Saman Shabani, Jason Chung, Vivian Le, Dean Chou, and Praveen V. Mummaneni

The development of the 3D exoscope has advanced intraoperative visualization by providing access to visual corridors that were previously difficult to obtain or maintain with traditional operating microscopes. Favorable ergonomics, maneuverability, and increased potential for instruction provide utility in a large range of procedures. Here, the authors demonstrate the exoscope system in a patient with progressive thoracolumbar junctional kyphosis with bony retropulsion of a T12–L1 fracture requiring a Schwab grade 5 osteotomy and fusion. The utilization of the exoscope provides visual access to the ventrolateral dura for the entire surgical team (surgeons, learners, and scrub nurse).

The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21190

Open access

Navigated transoral odontoidectomy to treat congenital basilar invagination after failed posterior reduction and fusion

Wanru Duan, Dean Chou, Fengzeng Jian, and Zan Chen

Transoral odontoidectomy is a traditional technique to treat congenital basilar invagination (BI) associated with atlantoaxial dislocation (AAD). Although posterior surgery has been a trend to treat most cases, there are still cases that need to be treated through a transoral approach. In addition, intraoperative modern image-guided navigation systems help identify any remnants of the dens and decrease the risk of vertebral artery injury. For symptomatic cases with a history of previous posterior fusion and severe osteoporosis, transoral odontoidectomy is preferred over a posterior-only approach. Our video demonstrates the surgical technique for transoral revision odontoidectomy to treat congenital basilar invagination associated with atlantoaxial dislocation after previous posterior craniovertebral junction surgery.

The video can be found here: https://youtu.be/vzcAW8oLcZY

Open access

Posterior intra-articular distraction with cage placement to treat congenital atlantoaxial dislocation associated with basilar invagination

Wanru Duan, Dean Chou, Fengzeng Jian, and Zan Chen

Congenital atlantoaxial dislocation (AAD) associated with basilar invagination (BI) is a complex congenital malalignment at the craniovertebral junction. The olisthesis, atlantoaxial facet joint arthropathy, and the contraction of the anterior soft tissue make the treatment challenging. Our video demonstrates the surgical technique for posterior intra-articular distraction with cage placement to treat congenital atlantoaxial dislocation associated with basilar invagination.

The video can be found here: https://youtu.be/7EQqW96HhN8

Open access

Closure of L3 pedicle subtraction osteotomy via an open-bottom hinged table in 3D video

Chih-Chang Chang, Praveen V. Mummaneni, Joshua Rivera, Rory Mayer, and Dean Chou

Iatrogenic flat back deformity generally can be treated with a pedicle subtraction osteotomy (PSO) (Chan et al., 2018; Lu and Chou, 2007). One of the difficulties with PSO is that a controlled closure can sometimes be problematic in that there may be translation of the spine, manual pushing of the spine, and significant stress on the pedicle screws, which may risk loosening. The authors present a video of their surgical technique for PSO closed by passive closure using an open-bottom hinged table. This allows the osteotomy to be closed without any force on the screws and without significant manual forces on the spinal column.

The video can be found here: https://youtu.be/pUECEjKdmSk.

Open access

Navigated oblique lumbar interbody fusion for adult spinal deformity

Chih-Chang Chang, Joshua Rivera, Brenton Pennicooke, Dean Chou, and Praveen V. Mummaneni

Adult spinal deformity (ASD) is an increasing disease entity as the population ages. An emerging minimally invasive surgery (MIS) option for the treatment of ASD is the oblique lumbar interbody fusion (OLIF), which allows indirect foraminal decompression of stenosis as well as segmental deformity correction (DiGiorgio et al., 2017). The authors utilize computer-assisted navigation with OLIF to reduce radiation exposure and improve time efficiency. The authors present a video of navigated oblique lumbar interbody fusion at L3–5 followed by open posterior screw-rod fixation.

The video can be found here: https://youtu.be/zKDT7PhMYf8.