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Category Archives: Techniques
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 “
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 withContinue reading “Posterior TL Approach “
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 “
Anterior Cervical Discectomy and Fusion (ACDF)
Mrs. Rachel Lynde lived just where the Avonlea main road dipped down into a little hollow, fringed with alders and ladies’ eardrops and traversed by a brook that had its source away back in the woods of the old Cuthbert place; it was reputed to be an intricate, headlong brook in its earlier course throughContinue reading “Anterior Cervical Discectomy and Fusion (ACDF)”
The Spine Book 