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Final approach to the intervertebral disc
The upper articular process is resectioned to
expose the intervertebral foramen (Fig. 4).
The pedicle is prepared by removal of the pendent
upper articular process with a Kerrison punch
so that final access to the intervertebral disc is
obtained. At the access point to the intervertebral
space, bleeding must be carefully staunched. Above
all, care should be taken with the outgoing nerve
root and the lateral section of the dural sac. These
structures can be protected in every stage of the
operation with a dissector or nerve root retractor.
The annulus is sectioned in rectangular fashion to
create an aperture to the intervertebral space.
Fig. 4
Initial distraction
An initial distraction of the intervertebral space
is required to obtain access to the intervertebral
disc for a radical discectomy. A distraction can
be achieved by one of the following methods:
• Distraction via the pedicle screws
• Distraction via the spinous processes
• Distraction via retractors
The initial retractor is inserted horizontally with
respect to the collapsed intervertebral disc
space and then turned through 90 degrees to
obtain a distraction.
Fig. 5
Removal of the intervertebral disc
A radical discectomy is performed with a
combination of curettes, chisels and Luer cannulas.
It is important to ensure that the end plates are not
damaged during this process. A chisel or rasp can
be used for preparing the end plates. A straight or
angled Luer or punch is then used to completely
remove the loose disc material. Possibly a straight
osteotome can be used to resection the posterior
lips of the top and bottom end plates to facilitate
introduction of the cage. It is important during the
preparation to create a straight, parallel surface for
the introduction of the interbody implant.
Fig. 6
Surgical Technique ADONIS
®
-PLIF
De Mossel 11a, 1723 HZ Noord-Scharwoude |
