TLIF- With Pedicle Screw Fixation Flashcards
Positioning
Patient is put in the prone position, belly hangs to achieve lordosis
Identify Correct Level
C-arm imaging to locate correct level/incision site.
Prep/Drape
Patient is prepped and draped. Incision site is marked with a sterile marker
Incision
a midline incision is made with a 15 blade. A bovie is used to control bleeding
Retract
gelpies or weitlanders are used to spread open incision site and retract muscles
Soft tissue removal
Cobb elevator is used to remove soft tissues off of transverse process and posterior arch
Facetectomy
use an osteome and mallet to remove facets and create window on the affected side. Remove bone with Kerrison rongeur which can be used for autograft later.
Keyhole Laminotomy
A Laminotomy is used to decompress cord and nerves and make an entry into disc space.
Osteophyte Removal
Kerrison rongeur is used to remove an osteophytes around the disc space
Distraction
use lamina spreaders or insert screws to distract off of. Use nerve root retractor to retract cauda equina and nerves out of the way/ protect dura. (Fluoroscopy)
PLL
excise PLL with pituitary rongeur
Annulotomy
a box annulotomy is perform with an 11 blade
Discectomy
use a long angled scraper & pituitary rongeur to remove disc material
Decorticate endplates
use angled/curved rasp and curette to scape endplates to get good bleeding bone for fusion. (Not too deep you don’t want subsidence)
Trialing
You can insert paddle and confirm height with c-arm. Then Use trial cage with inserter and mallet. Confirm correct size using c-arm