L5 S1 Fusion TLIF Back Surgery Tutorial O Arm CT Vail Colorado
this is corenman and we're going totalk about a transforaminal lumbar interbody fusion using minimally invasive micro surgical technique stealth and the O Arm this is a typical picture of a verydegenerative L5 S1 disc the disc has collapsed and you can seeblack vacuum phenomenon this is the MRI finding where you cansee the lowest disc
is much collapsed compared to theones above with bone signal changes indicatingstress fracturing this is a discogram where the twodiscs above the degenerative disk obviously normal with a cotton ballappearance and the L5 S1 disc is quite degenerative this is the technique of the pedicle screw insertion we start first
by putting a small frame on the spinousprocess which you can see protruding out of the blue sheets there we cover it with a clear sheet in order to protectthe sterility of the field this device is an O Arm it's an introoperative CT scanner and this device can lend us images not only front toback and side to side but top to down which
makes surgery much safer and much easier for insertion of the screws we're going to watch how this CT worksthe light on top comes on and you'll see this image spin around and this is the actual CT scan and howlong it takes this CT is onethird the typicalexposure of a standard CT performed in a
here are the tools that we use in orderto identify the levels the incisision has alread been made that device that is protrudingout is attached to the spinous process the device I am and holding identifies thelevel that we are at after identify where the screw is going to be inserted I use a small burr to create a starting hole once that starting holes is created
then i use a tool called a pedicle finder or pedicle to find the pedicle and this is done under direct visualizationyou'll see here that this device that i have has these ballsattached and these balls reflect off of a frameand is very similar to a GPS device you can actually insert
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