Pedicle Screws 101 

This section summarizes the anatomic considerations related to posterior instrumentation with respect to  Start Points  Trajectory  Pedicle Diameters  Types of Instrumentation  Lumbar  Start Point  50% TP  Lateral edge SAP  Mamillary processes  Trajectory  L1234 almost straight  L5 30 degrees medial  Pedicle Diameter  Increases L1-L5  Pearls  PSIS can interfere with instrumentation handles on L5 

Posterior Column Osteotomy Dr. Lewis  

See colby notes deformity section  This osteotomy is what some people call a “SPO”. This is the Dr. Lewis version of it. Obviously the greatest possible version of if it  (leaves the IAP intact while removing the SAP (where the flavum attaches) so it actually allows the most correction while stitll leaving full boney contat)  Osteotomies are ambiuously named, and people mislabelContinue reading “Posterior Column Osteotomy Dr. Lewis  “

TL Decompression  

Dr. Wilson  Lumbar Decompression  Bottom to top by level and by lamina  SP removal with leksell  Decortication – purpose: thin the shelf so kerrisen can bite (some people use Burr, DW uses Leksell)  Narrow leksell as it is sharper and can decorticate outter lamina cortex  5 leksell to decorticate  Find bony edge (ie: at L5S1 find L5 bottom edge of lamina  Nerve hook or penfield toContinue reading “TL Decompression  “

TL Pedicle Screws – Dr. Lewis  

Level  Start Point  Trajectory ML  Width  Pearls                      T1-T11  Top ridge of TP Lateral 50% of SAP  T1 30 degrees medial Linear decrease to straight until T11 straight  T4 smallest Transverse and Sagittal increase as lower  Funnel concept Bevel away (cord level)  T12-L1  Mamillary process  straight    T12 is theContinue reading “TL Pedicle Screws – Dr. Lewis  “