L5 S1 Fusion | TLIF Back Surgery Video | O Arm CT| Vail Colorado


this is doctor corenman and we’re going to
talk about a transforaminal lumbar interbody fusion using minimally invasive micro surgical technique stealth and the O Arm this is a typical picture of a very
degenerative L5 S1 disc the disc has collapsed and you can see
black vacuum phenomenon this is the MRI finding where you can
see the lowest disc is much collapsed compared to the
ones above with bone signal changes indicating
stress fracturing this is a discogram where the two
discs above the degenerative disk obviously normal with a cotton ball
appearance 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 spinous
process which you can see protruding out of the blue sheets there we cover it with a clear sheet in order to protect
the sterility of the field this device is an O Arm it’s an intro
operative CT scanner and this device can lend us images not only front to
back 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 works
the light on top comes on and you’ll see this image spin around and this is the actual CT scan and how
long it takes this CT is one-third the typical
exposure of a standard CT performed in a
hospital here are the tools that we use in order
to identify the levels the incisision has alread been made that device that is protruding
out is attached to the spinous process the device I am and holding identifies the
level 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 visualization
you’ll see here that this device that i have has these balls
attached and these balls reflect off of a frame
and is very similar to a GPS device you can actually insert the device into the pedicle without any
problems because you’re looking at the pedicle both a front and side and a top-down
view you’ll see this in a second here we will switch to the screen and you’ll see
exactly what i’m staring at so there is the vertebra the blue device is the all itself and you can see that i can easily find my way down the pedicle by the feel of the device while i’m
actually physically inserting it and by the visualization that i see both on the front
side top and middle views once this device is in we have a track the screw is going to
follow we remove the device and it should be in there pretty rigidly
and then we want to tap the hole just like you would tap a wood screw and so we take the device out that finds the
pedicle and this is the tap that we use to tap the hole after we’re finished with the tap we will then insert the screw itself that’s attached to the same type of
tracking device that we used to find the hole in the first
place and we can follow the screw down into the pedicle so here the tap is being removed here the screw is now being inserted
into the tapped hole and then once we visualize its flight
planned so-to-speak the screw is inserted and it should be inserted with some good
force because the pedicle should be a strong pedicle and hold the screw
well these are the screws that are going to
hold a vertebra in place while the fusion is taking place once the screw device is removed then we insert the other three screws but here is what i’m visualizing when
the screw is being inserted you can literally watch the screw marching down
the pedicle and avoiding all of the sensitive
structures such as the nerves and the vascular supply this is one screw insertion and four
screws are inserted at this point in order to be able to complete the surgery once the screws finished being inserted
we can actually save the screw in position then we test the screw we run a little
bit of electricity through the screw and by watching this monitor the technician
the neural monitoring technician can determine whether this screw could be irritating
the nerve root or not and with this device the O Arm and stealth it is almost impossible to have a screw irritating a nerve this is what the final screw insertion
looks like from the front to back view you can see that white metal which is
attached to the spinous process that’s the registration probe we will have a side view here also and you
can see the screws inserted and where they exist in the morphology of the vertebral body
or the sacrum and the bottom screws we complete the rest of the surgery after we perform a second O Arm
scan to confirm that the screw position is appropriate and once these are done then we can
review the CT scan and here’s a good example of the vertebra and the screw positioning where
you will see the screws are nicely placed within the pedicle and
within the confines of the vertebra indicating that there is no screw that’s going to irritate a
vascular structure or a nerve root we have post operative films this is a
front to back view of the TLIF the white arrows point to the solid fusion between the vertebra here is the arrow pointing to the solid
fusion between the body of L5 the sacrum and then this is the CT scan at six
months indicating a rock-solid fusion with the
arrow pointing to the solid fusion we will see this is the front to back
view again of the interbody with solid bone formation and this is just at six months it really
gets much greater at a year again the arrows pointing to a solid fusion and this is exactly how we insert pedicle screws using the O Arm
thank you


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