ALIF

Question 1

Positioning

Answer 1

Place patient in supine position, jelly roll under the lower back for initial distraction.

Question 2

Prep & Drape

Answer 2

drape patient and apply loban skin sticker. Initial C-Arm identification & localization of the L5-S1 disc space.

Question 3

Incision

Answer 3

Access/general surgeon makes a 3-8 in. incision in the lower abdomen

Question 4

Dissection

Answer 4

retract the soft tissues and muscles with blunt finger and hand dissection. In a retroperitoneal approach, viscera moved aside

Question 5

Retraction

Answer 5

smooth retractors are used to retract the peritoneum (minimize injury to neural plexus)

Question 6

Vessels retracted

Answer 6

Mid- Sacral vessels are ligated or tied off to gain access to the anterior aspect of the disc space using a bovie or vascular clips

Question 7

Spinal Surgeon

Answer 7

is called to the operating room to scrub into the case (if not already present)

Question 8

C-Arm

Answer 8

This confirms the correct disc level

Question 9

Annulotomy

Answer 9

the surgeon takes an 11 blade and incises through ALL and the annulus fibrosus to perfom a box annulotomy

Question 10

Discectomy

Answer 10

damaged/diseased disc is extracted using a pituitary rongeur and curettes.

Question 11

Distraction

Answer 11

Distractor instrument may be inserted between vertebral bodies to help with disc access and or decompression step

Question 12

Decompression

Answer 12

Surgeon removes any posterior endplate osteophytes or the PLL if needed (Kerrison rongeur)

Question 13

Endplate Prep

Answer 13

surgeon uses curettes or scrapers to decorticate endplate and get good bleeding bone

Question 14

Trial

Answer 14

Surgeon uses various trials with impactor and mallet to create correct footprint (height and lordosis) C-arm/Fluroscopy shot used to confirm size

Question 15

Cage Selection

Answer 15

Cage is loaded onto inserter, packed with biologics. Surgent gently mallets cage into the cleared disc space. C-arm to used to confirm placement and height restoration

Question 16

Screw Placement

Answer 16

Attach drill guide if necessary. Awl or drill used to break cortex. drive 3-4 screws into superior and inferior vertebral bodies. C-arm may be utilized to confirm length and trajectory. Engage locking mechanism

Question 17

Final Image

Answer 17

C-arm used to ensure proper placement

Question 18

Close

Answer 18

Access surgeon is called back to the operating room to scrub back in and close the retroperitoneal approach