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Fig. 15 Pre-operative thick maximum intensity projection CT of patient with severe progressive
scoliosis, rendering of 3D templating results developed with the spine surgery planning tools, the
physical model printed from the plan, and the inter-op, post-operative radiographs
adjacent to the congenital hemivertebrae could be safely instrumented with pedicle
screws. The model in Fig.
14
illustrated correct starting point location and trajectory
for pedicle screw placement, permitting safe instrumentation of the very small and
abnormal spine. Surgery was performed without complication and an excellent
clinical and radiographic outcome was achieved, as displayed in Fig.
14
. As with
Case 1, the viability of hemivertebrae resection was con
rmed with CT; however,
the software was unable to model this process. In addition, the surgeon planned for
the placement of 4 additional screws located more distal from the hemivertebrae;
however, it was determined intra-operatively that this was unnecessary.
Case Study 3: An 11 year old male presented with severe progressive scoliosis
measuring 100
s Deformity, developmental delay, and
several congenital vertebral abnormalities which can be seen in Fig.
15
(upper-left).
The severe curve magnitude and congenital vertebral abnormalities warranted CT
imaging to better understand the complex vertebral anatomy, especially pertaining
to pedicle morphology. Three dimensional templating displayed in Fig.
15
(upper-
right) con
°
associated with Sprengel
'
rmed that vertebral anatomy at most levels would safely accommodate
pedicle screw
cation of those vertebrae where pedicle
screws could not be placed. Adding screw templates to the 3-D model permitted
identi
fixation, and allowed identi
and could not be included in the
instrumentation construct. The three dimensional model in Fig.
15
(lower-left) was
used in the operating room and used as a reference for pedicle starting point and
trajectory during the operation. Surgery was performed safely in an ef
cation of pedicles which were
“
out of line
”
cient manner
with an excellent clinical and radiographic outcome, shown in Fig.
15
(lower-right).
A total of 37 screws were planned for the surgery; however, the patient only
required 26 screws to be placed, based on the pre-surgical plan and intra-operative
assessment of the outcome.
Additional Cases: Four additional pediatric patients, all of which presented
similarly complex deformities, have been operated on using the same planning
methodology. One of the four presented severe thoracolumbar kyphotic deformity
