Disclaimer Mr D S Marks FRCS FRCS(Orth) is a consultant to DePuy Spine & Medtronic He receives royalties from Depuy Spine Some instrumentation and / or.

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Presentation transcript:

Disclaimer Mr D S Marks FRCS FRCS(Orth) is a consultant to DePuy Spine & Medtronic He receives royalties from Depuy Spine Some instrumentation and / or techniques shown may not be approved for use by the FDA but are approved for use by the NHS

Spine V Chest

Angels & Demons

Would you do a Total Hip Replacement on this hip?

When the Pathology is here?

Then why subject a ‘normal’ thorax to this !!

Chest Instrumentation limitations Only Congenital Scoliosis has rib pathology – why operate here in a ‘normal’ thorax

Chest Instrumentation limitations VEPTR stiffens chest wall FVC after VEPTR FEV1 Residual volume John Emans (Boston) Mayer & Redding (Philadelphia) Motoyama et al (Pittsburgh)

Chest Instrumentation limitations Chest instrumentation has difficulty in addressing sagittal / transverse planes In Kyphosis it either won’t fit the top OR BOTH ! ……….or it pulls out at the bottom

Chest Instrumentation limitations Limited Fixation points / members Hooks Whereas spinal instrumentation has - Wires Fully contorable rods Screws

Chest Instrumentation limitations Cannot deal with selective spinal pathology ie hemi-metameric shift Spinal Instrumentation has the flexibilty to do this

Chest Instrumentation limitations Issues of Implant size (better with VEPTR II)

Go Where the Pathology is ! His Spine needs treatment BUT he doesn’t need a stiff chest Her Spine AND Chest need treatment

Spine V Chest ?

Spine V Chest ?

Spine & Chest