Posterior TL Approach  

Dr. Wilson 

  • Landmark, mark with lines 
  • Skin with knife 
  • Cautery below, 2 12 inch guys (large SRs) 
  • No subcutaneous flaps 
  • Find SPs 
    • Mark each one 
    • Connect the dots and expose the tops 
  • Bottom to top always 
    • Muscles insert that way 
    • Bleeders are recognizable 
  • Cautery down to laminas and over to joints 
    • Scrape and retract with Cobb, cautery other hand 
    • Get to facet capsule, release the tendon inserting on it 
  • First raytech cobb swipe 
    • Top hand retract, bottom packs in a ray tech 
    • Walk the way up 
  • Crank retractor in, with cobb assistance 
  • Dissect out slightly more laterally to exposure part of TPs so we can landmark (start point, sup inf and med lat) 
  • Readjust cranks 

Dr. Lewis 

  • Drape insanely wide 
  • Mark 
    • Line C7 – buttcrack 
    • Line 2 UIV to LIV 
    • Final line between the two, but must end at buttcrack (in case need to extend to pelvis) 
  • Exposure 
    • Skin, sub small flaps, Cerebellar 
    • Mark 4 SPs, connect dots 
    • Go deep to lamina halfway up TP on 3-4 top and 3-4 bottom 
      • Gets you the right depth 
    • Cerebellar deeper now, add Wheatlaner 
    • Now there is tension at the right depth 
    • Keep going 
    • Ride up the TPs then trace out the pats 
      • Leave the dorsal NV bundle intact