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Fusion techniques spine
- 1. Fusion techniques inspine
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- 5. ANTERIOR CERVICAL DISCECTOMY/ CARPECTOMY AND FUSION WITH LOCKING PLATE
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- 9. • Boundaries ofthe lateral mass, which consist of the superior joint line, the inferior joint line, the lateral border, and the medial sulcus at the junction with the lamina • Entry portal 1 mm medial to the center of the lateral mass and penetrate only the cortex with a burr • Drilling of the lateral mass should be directed 25 to 35 degrees laterally and 25 degrees cephalad
- 11. Thoracic and lumbarspine
- 12. THORACIC AND LUMBAR SEGMENTAL FIXATIONWITH PEDICLE SCREWS
- 13. Thoracic • Obtain atrue anteroposterior view of the vertebra. • On this view the superior endplate should appear as a sharply defined line with the superior most portion of the pedicle just rostral to the endplate
- 14. • Position aburr near the superior medial base of the transverse process such that it is superimposed at the 2-o’clock position on the right pedicle or the 10-o’clock position on the left pedicle
- 15. • As theprobe is advanced, direct it slightly caudally. • The most narrow pedicles are typically at the T4 to T6 levels
- 17. Lumbar • Obtain atrue lateral view of the vertebra as indicated by sharply defined endplates with perfectly superimposed pedicles. • The probe is advanced anteriorly and medially simultaneously - usually 20 to 30 degrees at L5 and 0 to 10 degrees at the L1 level
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- 19. • Make anincision overlying the rib and dissect down to the rib periosteum with electrocautery. • Elevate the periosteum circumferentially around the rib and elevate the neurovascular bundle from the inferior rib margin
- 20. • Resect theportion of the rib necessary for access to the spine. • Make sure to remove enough rib posteriorly.
- 21. • For atransthoracic approach (T4 to T10), enter the pleural space and retract the lung with a wet laparotomy sponge. • Shape a malleable retractor to maintain the operative field. • Some prefer to deflate the lung and use a double lumen endotracheal tube.
- 22. • For aretroperitoneal approach (T11 to L3), maintain the pleura intact if possible and enter the retroperitoneal space, dissecting bluntly down to the iliopsoas. • The crus of the diaphragm is taken down as needed, depending on the level of injury. • Meticulously clean the two endplates of all cartilage and soft tissue.
- 23. • Place thefirst screw in the posterior position of the caudal vertebra.