E-Case report
Spondylolisthesis
T12-iliac in situ fixationAlexandre Delmotte, MD
![](data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAA2YAAAEJAQAAAADXkwn1AAAAAnRSTlMAAHaTzTgAAAAySURBVHja7cEBAQAAAIIg/69uSEABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAPBtx3gABXqRhawAAAABJRU5ErkJggg==)
![premiere-page](https://neo-medical.com/wp-content/uploads/2023/05/premiere-page-1.jpg)
Pre OP
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
Clinical Case – Spondylolisthesis
T12-iliac in situ fixation
Neo ADVISE™
Dr. Alexandre Delmotte
Neurosurgeon
Spine department
Clinique de la Sauvegarde
Lyon, France
![logo](https://neo-medical.com/wp-content/uploads/2023/05/logo-1-300x142.png)
![Rectangle-13](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-13.png)
![photo](https://neo-medical.com/wp-content/uploads/2023/05/photo-1-261x300.png)
![Rectangle-11](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-11.png)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
Planned Surgery:
- General Anestesia
- Posterior fixation T12 – Iliac
- Open surgery, midline
- Neo ADVISE™ application to be used
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
Pre OP CT sagittal
![PROP marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/05/PROP.png)
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Intra OP
![ligne](https://neo-medical.com/wp-content/uploads/2021/02/ligne-e1613577992934.png)
Posterior fixation with Neo Pedicle Screw System™
Totally 16 pedicle screws to be placed over the 8 vertebral levels T12 – Iliac
![PROP1](https://neo-medical.com/wp-content/uploads/2023/05/PROP1.png)
OR table prepared & Incision midline
![PROP2](https://neo-medical.com/wp-content/uploads/2023/05/PROP2-1.png)
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b.png)
![PROP](https://neo-medical.com/wp-content/uploads/2023/05/PROP.png)
Pedicle preparation and pedicle markers are placed
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
![PROP3](https://neo-medical.com/wp-content/uploads/2023/05/PROP3.png)
K-wire placement and removal of the pedicle markers
![PROP4](https://neo-medical.com/wp-content/uploads/2023/05/PROP4.png)
Pedicle screw placement
Full tightening – ½ turn reverse
![PROP5](https://neo-medical.com/wp-content/uploads/2023/05/PROP5.png)
Polyaxiality check
![ligne](https://neo-medical.com/wp-content/uploads/2021/01/ligne.png)
![intra-op](https://neo-medical.com/wp-content/uploads/2023/05/intra-op-2.png)
![INTROP1](https://neo-medical.com/wp-content/uploads/2023/05/INTROP1.png)
All pedicle screws placed in all levels, including the iliac screws (T12-iliac)
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Preparing to use the Neo ADVISE™
![INTROP2](https://neo-medical.com/wp-content/uploads/2023/05/INTROP2.png)
![INTROP3](https://neo-medical.com/wp-content/uploads/2023/05/INTROP3.png)
Change the lighting conditions to increase the contrast and avoid reflections (turn of the OP field lights)
Cleaning the guide towers. Note the use of a fabric to cover the left side whenADVISE™ is used at the right side
![ligne](https://neo-medical.com/wp-content/uploads/2021/01/ligne.png)
![INTRAOP](https://neo-medical.com/wp-content/uploads/2023/05/INTRAOP-1.png)
Scanning the right side and bending the rod using the visualization provided at the iPad screen
Note that the iliac screw guide is scanned from the same side
![INTRAOP.1png](https://neo-medical.com/wp-content/uploads/2023/05/INTRAOP.1png.png)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
![INTRAP](https://neo-medical.com/wp-content/uploads/2023/05/INTRAP.png)
Rod insertion
OP field light is turned on again
![INTRAP1](https://neo-medical.com/wp-content/uploads/2023/05/INTRAP1.png)
Checking the seating of the rod into the pedicle screw heads
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b.png)
![INTROP](https://neo-medical.com/wp-content/uploads/2023/05/INTROP-1.png)
Set screw placement using the torque limiter
![INTROP1](https://neo-medical.com/wp-content/uploads/2023/05/INTROP1-1.png)
Rod prefixation and hold transfer
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
Radiographs showing that two of the set screws are not fully seated into the screw head
![intra-op-delmotte](https://neo-medical.com/wp-content/uploads/2023/05/intra-op-delmotte.jpg)
![intra-op-delmotte-2](https://neo-medical.com/wp-content/uploads/2023/05/intra-op-delmotte-2.jpg)
![introp2](https://neo-medical.com/wp-content/uploads/2023/05/introp2-1.png)
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b.png)
![INTROP](https://neo-medical.com/wp-content/uploads/2023/05/INTROP-3.png)
![INTROP1](https://neo-medical.com/wp-content/uploads/2023/05/INTROP1-3.png)
Final tightening of the fully seated set screws only, and guide towerremoval (1-2)
Further tightening of the previously not fully seated set screws (3) and check before final tightening (4)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
![INTRAP](https://neo-medical.com/wp-content/uploads/2023/05/INTRAP-1.png)
![INTRAP1](https://neo-medical.com/wp-content/uploads/2023/05/INTRAP1-2.png)
ADVISE™ is used in the left side, to provide the rod shape visualizartion in the iPad screen which will be used as template to bend the rod.
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b.png)
![INTROP](https://neo-medical.com/wp-content/uploads/2023/05/INTROP-4.png)
![INTROP1](https://neo-medical.com/wp-content/uploads/2023/05/INTROP1-5.png)
![INTROP2](https://neo-medical.com/wp-content/uploads/2023/05/INTROP2-2.png)
Same surgical steps, rod placement and final fixation, are applied in the left side
![INTROP](https://neo-medical.com/wp-content/uploads/2023/05/INTROP-6.png)
![INTROP1](https://neo-medical.com/wp-content/uploads/2023/05/INTROP1-6.png)
Final screw tightening and check before closing
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
Post OP
Radiographs after final fixation of the posterior construction
![POSTOP](https://neo-medical.com/wp-content/uploads/2023/05/POSTOP.png)
T12-Iliac without connector
![POSTOP1](https://neo-medical.com/wp-content/uploads/2023/05/POSTOP1.png)
![ligne](https://neo-medical.com/wp-content/uploads/2021/01/ligne.png)