Unlocking New Possibilities in Complex Spinal Revision Procedures

On July 22, the Traumatology Department of the León University Hospital Complex performed a highly complex surgery. The surgeons opted to use TOR JIG S surgical guides to tackle the challenges of this intricate procedure.

The patient had previously undergone anterior cervical fusion from C5 to C7 and posterior thoracic fusion from T1 to T3. Due to an abnormal forward inclination of the cervical spine caused by insufficient fixation, along with screws in the thoracic region positioned outside the vertebral pedicle, a revision surgery was performed. This procedure extended the instrumentation from vertebra C6 to T4 to correct the alignment and stabilize the spine.

To approach the surgery, DIGITAL ANATOMICS guides were utilized—a personalized technology designed for spinal surgeries. TOR JIG S guides the instruments by providing the optimal trajectory for implants to achieve the best clinical outcomes. This innovative tool is developed using a 3D reconstruction of the patient’s spine, created with the company’s proprietary software. This enables a detailed analysis of the anatomy and pre-surgical planning. The process facilitates trajectory definition, improves precision, minimizes risks, and ensures that all necessary materials are prepared in advance.

With a significant reduction in patient radiation exposure, revision rates, and surgical time, DIGITAL ANATOMICS technology optimizes postoperative outcomes with a 99% success rate.

The revision surgery required three different types of guides: classic guides for vertebral fusion (TOR JIG S), revision guides (TOR JIG S R), and a variant with a positioner.

TOR JIG S GUIDES

TOR JIG S R Revision Guides

DA has patented the design of revision guides that enable the tracing of new trajectories for implants.

They feature a support point on the head of the initial screw, a drilling cylinder, and a support leg that contacts the vertebra’s anatomy.

The support on the initial screw is crucial as it provides an invariant reference, ensuring the stability of the guide.

TOR JIG S R Guides with Positioner

DA has also designed a type of guide that uses the trajectories of removed screws as support points.

This guide includes two positioners that are inserted into two of the holes left by the initial screws to achieve stable support, allowing for the new trajectory to be traced through the drilling cylinder.

The wide range of guides offered by DA made it possible to approach the surgery with excellence despite the associated difficulty. Although only six levels required instrumentation, a caudal-to-cranial placement strategy was devised, combining different types of guides to trace trajectories and ensure the precise placement of screws.

The procedure began with the most caudal guide, allowing the complexity of the surgery to increase progressively. The screws on the left side were first removed, and revision guides, which relied on the heads of the screws still in place, were used to trace new trajectories on the opposite side.

3D reconstruction of the spine: removal of screws on the left side.

Once the left side was completed, the screws on the right side were removed, leaving the spine free of previous instrumentation. This allowed the use of guides with positioners, which used the holes left by the previous screws as references to trace the new trajectory.

3D reconstruction of the spine: removal of screws on the right side.

T3D guide with positioner.

T2D guide with positioner.

During the process, small bone resections were necessary to provide support for the guides, such as on the spinous processes of C5-C7. This facilitated the precise placement of transpedicular screws at C7, a challenging trajectory due to the proximity of important blood vessels.

3D reconstruction of the spine: removal of the spinous processes from C5 to C7 to avoid blocking the drilling trajectory. C7 transpedicular guide.

Finally, C6 was instrumented to the lateral masses using a traditional TOR JIG S guide.

C6 guide for lateral masses. The biomodel illustrates how the removal of the spinous processes enables the correct positioning of the guide.

The surgery was a resounding success. The nine strategically interchanged guides allowed for the repositioning of the initial screws in a reduced time frame and without any complications.

Thanks to the use of TOR JIG S surgical guides and the advanced TOR JIG S R revision guides, the patient experienced significant improvement. The precision of the trajectories achieved during the surgery matched the preoperative planning perfectly, enabling accurate correction of the alignment and stabilization of the spine.

DIGITAL ANATOMICS guides are a revolutionary tool in spinal surgery. Choosing TOR JIG means opting for an innovative approach that combines cutting-edge technology with exceptional surgical care, ensuring the best possible outcomes for patients.

Unlocking New Possibilities in Complex Spinal Revision Procedures