Neupsy Key

•  The patient is placed into a direct lateral position. •  It is essential that the patient be directly perpendicular to the ground to ensure true anteroposterior (AP) and lateral…

Superficial landmarks include: •  hyoid C3 •  thyroid cartilage C4–5 •  cricoid C6 •  A horizontal incision is made just medial to the sternocleidomastoid muscle (SCM). •  A decision on…

Step 1: Pedicle Start Point Is Identified •  The pedicle start point is identified through the working portal. This allows for medial-lateral orientation in the anteroposterior (AP) plane. •  Lateral…

•  By use of an AP fluoroscopic image, key bony landmarks are identified: – midline (spinous processes) – pedicular line (lateral edge of the pedicle) vertical horizontal – skin incision…

Skin Incision •  A midline incision is used over the levels that are to be resected. •  The fascia is clearly identified prior to incision. •  The fascia is then…

Exposure and Approach •  A lateral fluoroscopic image should be obtained before incision to localize the surgical level. At the L5-S1 level, the great vessels (aorta/vena cava) have bifurcated. At…

•  Subperiosteal exposure of the occiput and the C1–C2 vertebral levels is essential for instrumentation placement. •  The vertebral artery travels along the superior lateral surface of the C1 arch…

•  Lateral fluoroscopic visualization is essential to confirm the appropriate level. •  The incision is typically made 4 cm lateral to the midline. The tube is docked onto the lateral…

•  The initial exposure should involve subperiosteal dissection of the muscle to the facet joint. •  Resection of the facet capsule and exposure of the superior articular process (caudad vertebra)…

•  Typical lateral positioning of the patient. •  The dilator has been docked over the pathologic vertebral body. The psoas is retracted posteriorly. •  A high speed burr is used…