经皮椎弓根螺钉固定的技术精选.ppt

Fig. 6.前后位透视显示小椎弓的经皮套管植入．将C形臂摆到一定角度，使椎弓根 Angulating the II machine so that the surgeon is looking down the pedicle – the ‘‘bulls eye’’ view (arrows) – assists in placement in dif?cult pedicles. (Insert) The II technique results in highly accurate pedicle screw insertion – a 5.5 mm screw into a 6 mm pedicle. Fig. 7. Intra-operative photograph of skin incision for multi-level constructs. The black line is showing all four incisions along a straight trajectory – making the insertion of the rod technically much easier. The white line shows the incisions in a staggered fashion – the rod insertion here will be more dif?cult. Fig. 8. Intra-operative photographs showing insertion of rod in a patient requiring multi-level surgery. (a) Rod insertion can be performed with a semicircular technique (arrows), making sure that the rod is under the fascial layer with (b, c) advancing the rod. Always start the insertion at the pedicle screw head that is most super?cial/closest to the skin. (d) Aerial view. Fig. 9. Axial CT scans showing sclerotic pedicles that may result in the necessity for screw placement using an open technique. (a) The arrow points towards a Jamshidi needle tract created when the Jamshidi needle ‘‘hit’’ a sclerotic bar of bone between the pedicle and vertebral body – safe cannulation of the pedicle/vertebral body could not be achieved and a high-speed drill was used to cannulate the pedicle. (b) This pedicle (arrows) was sclerotic – Jamshidi placement required an open screw positioning. Fig. 10. Middle panel. Post-operative photograph of illustrative patient 1, a 73- year-old male who presented with L4/5 degenerative spondylolisthesis with neurogenic claudication. (a) Lateral image intensi?er (II) radiograph showing Grade I spondylolisthesis; (b) sagittal T2-weighted MRI showing severe canal stenosis; (c) photograph at 8 weeks showing post-operative incision; (d) lateral II image showing initial midline incision and posterior lumbar interbody fusion; (e) lateral