TLIF- With Pedicle Screw Fixation Flashcards

1
Q

Positioning

A

Patient is put in the prone position, belly hangs to achieve lordosis

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2
Q

Identify Correct Level

A

C-arm imaging to locate correct level/incision site.

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3
Q

Prep/Drape

A

Patient is prepped and draped. Incision site is marked with a sterile marker

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4
Q

Incision

A

a midline incision is made with a 15 blade. A bovie is used to control bleeding

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5
Q

Retract

A

gelpies or weitlanders are used to spread open incision site and retract muscles

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6
Q

Soft tissue removal

A

Cobb elevator is used to remove soft tissues off of transverse process and posterior arch

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7
Q

Facetectomy

A

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.

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8
Q

Keyhole Laminotomy

A

A Laminotomy is used to decompress cord and nerves and make an entry into disc space.

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9
Q

Osteophyte Removal

A

Kerrison rongeur is used to remove an osteophytes around the disc space

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10
Q

Distraction

A

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)

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11
Q

PLL

A

excise PLL with pituitary rongeur

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12
Q

Annulotomy

A

a box annulotomy is perform with an 11 blade

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13
Q

Discectomy

A

use a long angled scraper & pituitary rongeur to remove disc material

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14
Q

Decorticate endplates

A

use angled/curved rasp and curette to scape endplates to get good bleeding bone for fusion. (Not too deep you don’t want subsidence)

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15
Q

Trialing

A

You can insert paddle and confirm height with c-arm. Then Use trial cage with inserter and mallet. Confirm correct size using c-arm

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16
Q

Final Cage

A

Attach banana cage to inserter. Fill with autograft/biologics. Insert as anterior and contralateral as possible. It should be in the anterior 1/3 of vertebral body. An impactor is used to further advance the cage

17
Q

Back Fill

A

Backfill with autograft and remove distraction

18
Q

Awl

A

Use an awl to punch through the cortex

19
Q

Gearshift

A

Gearshift is used to create pilot holes with the correct trajectory and length

20
Q

Ball Tip Probe

A

Ball tip probe is used to verify the integrity of the hole

21
Q

Tap

A

Tap is used to create threads which allow for good purchase in bone

22
Q

Screw Insertion

A

Insert screws with ratchet screw driver. repeat 3x. Using c-arm to verify correct length and trajectory

23
Q

Alignment

A

Align Tulip heads with head turner and select correct rod length using rod template.

24
Q

Rod insertion

A

Insert Rod using the rod holder. Load set screws and provisionally tighten.

25
Q

Reduction

A

Reduction if needed for spondylolisthesis. (Spondy reduction reducers, set screw inserter)

26
Q

Compress

A

Compress with compressor for good fusion to promote Wolff’s law and obtain lordosis.

27
Q

Torque

A

Apply torque to locking caps with counter torque and torque driver 90 in lbs

28
Q

Bone Graft

A

Bone Graft is put into lateral gutters

29
Q

Final Steps

A

Final C-arm is taken, irrigate, and then close