Direct Posterior Approach 

Muscle Anatomy  Superficial  Latismuss dorsi  Origin – spinous processes  Insertion – intertubercular groove of humerus  Implication  Deep  Superficial  Sacrospinalis (erector spinae) (medial to lateral)  Multifidus  Longismus  Iliocostalis  Deep  Rotatores  Origin: Base of spinous process  Insertion: leading edge of laminae  Intertransversari  Insertion – TP  Origin – Inf TP  Bony Anatomy  Approach  Landmark  Incision  Fascial incision  Bony exposure  ThoracicContinue reading “Direct Posterior Approach “

Approaches Summary

Access to Anterior Spine  Level  Anterior Approach  Posterior  C0-C2  Transoral/ transmandibular  No access  C2-T2  Smith Robinson  No access  T2-T5  Direct Anterior with manubriectomy  Transpedicular, Costotra  T5-T11  Transthoracic through IC space  5-8 Right side up avoid heart 8-11 Left up avoid liver    T11-L1  Thoracoabdominal (L up, 10th rib takedown, release diaphgragm)    L2-L4  Retroperitoneal    L5-S1  Anterio retroperritoneal    Considerations  Diaphragm  Insertions Continue reading “Approaches Summary”

Lateral Mass Screws 

Roy Camille  Start: Centre of cross  Axial: 10 degrees lateral  Short to the VA  Sagittal: neutral  Short to the VA  Magerl  Start: Centre of cross/ inferomedial quadrant  Axial: 25 degrees lateral  Lateral to VA  Sagittal: 45 degrees superior  Nerve root  VA Injury  Reduce screw length  Prevents full occlusion  Insert screw  Close wound  Send for angiography Continue reading “Lateral Mass Screws “

Thoracolumbar Decompression 

Indirect  Ligamentotaxis  Direct (below conus)  Laminectomy  Retraction of sac  Direct decompression of bone fragments  Direct (T-L5)  Laminectomy  Burring and thinning of pedicle to access vertebral body  Tamp fragments back into body  Decompress mass 

Odontoid Screw 

Indications  Type 2b (oblique)  Contraindications  Type 2c  Osteoporosis  Comminution  Irreducible  Chronic injuries  Barrel chest habitus  Complications  Intraoperative  Guidewire migration into brain – deatth  Technique  Anesthesia  Awake fiberoptic  Positioning  Supine  Bump under shoulders  Bite block  Halter traction  Imaging  Biplanar fluorscopy  Approach  Anterior  Fixation  Entry anteroinferior edge of C2  One midline   2 paramedian 3 mm apart  K wire  InnerContinue reading “Odontoid Screw “

C2 Screws (3) 

Anatomy and VA  Pars Screw  Why?  If pedicle screw not possible  Start point:  flat part  Lower than pedicle screw start point  Trajectory  Sag – straight  Cor – straight  Length – 16mm  Pedicle Screw  Preferable to pars  Above where the VA exits  No high riding vertebral artery  Start point  Line on upper 50% of lamina  LineContinue reading “C2 Screws (3) “

C1 Screw

C1 lateral mass  Do not dissection above the posterior arch of C1 1cm lateral to midline – VA risk  Artery travels on top of C1 in the Sulcus Arteriosus  Entry point  2-3mm from the medial aspect of thte lateral mass of C1  Section the C2 nerve root forr access  Bipolar the venous plexus nearby 

OC Fusion 

Preop  CT A or MRA – aberrant VA at C2 re: screw placement  Approach  Posterior midline  Fixation  O  Plate with adjustable rod holders  Unicortical screws (8mm max)  Major dural vessels just below  Safe zone – external occipital protuberance  C1 lateral mass  Do not dissection above the posterior arch of C1 1cm lateral to midline – VA risk  C2Continue reading “OC Fusion “

Anterior Cervical Approach 

Landmarks  C1 – Hard palate  C23 – Lower border mandible  C 3 – hyoid  C4 – top of thyroid  C5 – bottom of thyroid cartilage   C6 – cricoid, carotid ttubercle (on TP)  Steps  Transverse skin incision  Platysma longitudinal  Anterior border SCM, incise fascia  SCM lateral, strap medial  Pretracheal fascia  Carotid lateral  Trachea, esophagus medial  Sup and inf thyroid arteriesContinue reading “Anterior Cervical Approach “