•  The end plate is clearly visualized. The spinous process is centered between both pedicles. The Jamshidi needle is started at the 2 o’clock position.

•  The Jamshidi trocar is advanced 15 mm until it is centered in the pedicle.

•  A guide wire is then advanced an additional 10 mm until it abuts the medial wall of the pedicle on the AP image.

•  The steps are repeated for the adjacent level. End plate visualization and centering the spinous process are essential steps for ensuring accurate percutaneous screw placement.

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