Article Figures & Data
Figures
- Figure 1
(A) Preoperative computerized tomography (CT) shows a severe thoracolumbar kyphosis due to wedge deformity causing posterior canal stenosis and a Cobb angle of 73° at the T11 to 12 apex. (B and C) Anteroposterior and lateral intraoperative fluoroscopy images showing posterolateral instrumented fusion with a left-sided approach lateral interbody device at T11 to T12 with integrated fixation. (D) Postoperative follow-up CT at 2 years with nearly 40° correction. No hardware issues were noted.
- Figure 2
Schematic of an articulating rod using a commercially available 3-dimensional software used to create the device.
- Figure 3
Illustration of placed articulating rod. (A) With the articulating rod in place within the pedicle screw tulip and all set caps finally tightened, downward pressure utilizing heavy rod holders allows for distraction of the disc space immediately inferior to the central pivot point. This allows for increased space to introduce an expandable lateral interbody device safely. (B) The cranial set caps are then loosened. When downward pressure is applied now, it allows for compression. With the sequential expansion of the interbody device with a continued downward force vector, the construct and spine can be placed in mild extension. Intraoperative neuromonitoring during these maneuvers is critical.
Supplementary Materials
- Supplemental Video 1.The mechanism of action for the articulating rod is seen after midline exposure, posterolateral pedicle screw fixation, and posterior element release are completed. Downward vector causes the articulating rod to pivot on its central lever proportional to the force applied. The exposed spinal cord can be seen adjacent to the central pivot.
- Supplemental Video 2.This sequence demonstrates the technique to induce distraction in order to safely introduce the lateral interbody device into the collapsed space. The set caps are tightened at all points, fixing the articulating rod to the pedicle screws. Rod holders are used to apply downward force, which opens the disc space (see Figure 2A) so that the lateral interbody device can be introduced. Intraoperative C-arm fluoroscopy confirms adequate placement, and the interbody device is expanded in the lateral plane.
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