In situ contouring is a surgical technique used in thoracolumbar scoliosis surgery and thoracolumbar fracture reduction and fixation.
Procedure
Thoracolumbar scoliosis surgery
The key of this technique is to " make the rod take the shape of the spine and then to make the spine take the shape of the rod" 1. Cranial to T10 pedicle hooks are used, and distal to T10 pedicle screws are used with every second level instrumented. A working rod is placed (thoracic concave, lumbar convex) and both frontal and sagittal contouring manoeuvers are performed by iron benders with the aim to move the thoracic apex backwards (sagittal manoeuver) and medially (frontal manoeuver). This technique aims for derotation, reduction of scoliosis and improved kyphosis 1,2.
Thoracolumbar fracture reduction and fixation
Typically performed via a posterior approach, two rods are countered and fixated across the kyphotic deformity (two screws above and below the fracture level +/- hooks) and contouring maneuvers are performed simultaneously to reduce the kyphotic deformity 3.