just as we would in a primary surgery, to obtain the necessary exposure.
[Music]
With the self-retaining retractors in place, we are now preparing to place our pins in
the vertebrae above and below the disc. This is a critical step in revision disc surgery.
Here, we are placing the lower pin,
followed by the upper pin. Next, we will insert the distraction device.
[Music]
Now, we proceed with the first maneuver to safely and efficiently remove the disc.
This involves distraction with the pins, which allows us to remove the core first.
The core of the disc consists of plastic, specifically polyethylene,
and this is removed first. With the core out, we are left with the two endplates,
which will now be removed. You'll see in a moment how we use a thin osteotome
to lift the endplates without damaging the vertebral endplate. Preserving the
vertebral endplate is crucial for a successful revision disc replacement.
Here, we are removing some fibrous tissue, which will be sent to pathology for examination.
Now, we use a maneuver to detach the old endplate.
Gently pushing it toward the middle of the disc space allows it to come
out smoothly. We will repeat this process for the upper endplate.
You’ll see here that just a slight tap is enough to loosen
and remove the old endplate.
Now that the disc space is empty, we inspect the vertebral endplates to ensure they are
intact. In this case, they are. We also take a culture sample to send to pathology.
Any residual fibrous or scar tissue is carefully removed to create a fresh,
clean surface for the new disc. This is done delicately using curettes and pituitary forceps.
Once the preparation is complete, we irrigate the area with sterile saline.
[Music]
If additional decompression is needed to relieve pressure on the spinal cord or nerve roots,
this is the stage where we would perform that. However, in this case, no residual
nerve impingement was present, so it was simply a matter of exchanging the old disc for the new one.
One of the hallmarks of disc replacement is parallel distraction. Here, I release the
distraction and use an intervertebral spreader to do the work while the pins act as retainers
rather than distractors. The distraction maneuver is performed using the intervertebral spreader.
Now, we have an ideal space for placing the new disc.
At this point, we use a trial implant to ensure
correct positioning and size. We then confirm this with an X-ray.
[Music]
As you can see in the X-ray, the old disc is on the right,
and the trial for the new disc is on the left.
This particular disc requires a keel to be cut, so we will use a short keel.
This is performed under X-ray guidance as well.
Now,
we remove the keel cutter. With the proper disc size selected and the endplate prepared,
we irrigate the area once more and prepare for final disc placement.
Here, we are positioning the final disc implant. It is gently tapped into place,
and an X-ray is used to confirm the positioning.
[Music]
You can see the disc being placed. After removing all instrumentation, we take a final X-ray.
[Music]
This is the final positioning of the disc,
as seen in both views. We are very pleased with the outcome.
As you can see, there was minimal blood loss, and the technique, while meticulous, is
not overly extensive. The procedure is performed through a small incision,
and in most cases, the patient will go home the next day.
Thanks for watching. This is Scott Blumenthal from the Center
for Disc Replacement at Texas Back Institute.
[Music]
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