Hello, my name is Tyler Koski. I'm a neurologic surgeon and the director of the neurological spine
surgery program here at Northwestern Medicine. Today we'll be treating a patient with a complex
spinal deformity related to Parkinson's disease. So please join me inside the OR.
Our patient today has a kyphosis which is a bending forward posture it's related to
Parkinson's disease in this instance in a phenomenon called camptocormia essentially he
cannot stand up straight which is quite disabling for people what we're doing today is the start of
a two-step process of standing him back upright via a fairly complex spinal fusion operation
our patient is in the supine position or face up because we're actually going through his abdomen
today the benefit of going through the front is that we don't have the nerves in the waist
i can put a much larger spacer in through the front than i can through the back
we'll bring him back secondarily to do a operation from his back that involves a much
bigger surgery with screws and rods reconstructing his spine to allow him to stand up straight again
Dr. Rodriguez and the vascular team have opened up the patient's abdomen to expose the spine
they've protected the blood vessels and gotten all the organs safely out of the way so i can
do my part which is to take out some of his lumbar discs and i'll build that height up by adding some
spacers in there and a few screws to stabilize that so today we're working on the lumbar spine
where there are five lumbar segments with discs in between them the bones get numbers and the
discs have to share so i'm removing the l45 disc which is in between the l4 bone and the l5 bone
the discs are generally like shock absorbers and cushions and allow motion in the spine
but when they get really degenerative and collapse they can be painful and in this case they're not
supporting the spine enough to stand upright so this is the device we're going to place this is
a relatively small sized cage it's made out of a material called peak stands for polyether ether
ketone it's a biocompatible plastic and has a metal front where we'll put some screws through
once we get in there so it's going to go in like this into the disc space okay mallet please
good so it goes in with a little bit of force but that's because we want it to
be nice and tight in there because it is not supposed to move around put a hand on the top
i'm going to place two spacers today to really stabilize the disc space at the bottom of his
spine where we'll put the screws and rods in his back which will hold him in position and
really gives him a very nice solid foundation to build this entire new alignment that we're going
to build for him okay so that implant is done so when people cannot stand up straight we call it a
sagittal plane imbalance it is extremely disabling so they can't go very far without some type of
assistive device they get significant back pain in the fatigue really quickly so it's difficult
but when somebody starts to collapse over as much as this we actually start to compress some of the
abdominal organs and he was having problems with eating because he get full after just a few bites
of food because his stomach was so compressed so that was a big problem that we're going to correct
by giving all of his organs more normal room as well we just took an x-ray the implants that we
placed looked great this little dot you see back here is the back of where that spacer i put in
it's made of a plastic so it's radiolucent so they put a little marker so i can tell that it's in
safe position and then the you can see the metal plate that was on the front and then the screws
we put into the bones to hold that in position so the overall alignment change it went from
shaped like this to now shaped like this so since the x-rays look good we've confirmed everything
is in position now we can call the vascular team back in to start the closure process
once they close him up he'll go off to recovery for the next two days then he'll come back down
for the next stage of the surgery which will be the much more extensive posterior approach
from the back from all the way between his shoulder blades all the way down to the bottom
of his spine to really build him that new stable aligned spine what do you see on monday yeah