•  A midline posterior approach is utilized, with dissection performed through the avascular ligamentum nuchae.

•  Subperiosteal exposure is performed, extending out to the lateral edge of the lateral mass.

– Bleeding is typically encountered along the lateral edge of the lateral mass.

– This bleeding can be controlled with bipolar cautery.

•  The lateral mass is exposed and clearly defined, exposing the superior, inferior, and medial lateral borders.

•  Once the lateral mass is defined, the starting point should be created with a high-speed burr.

– The center of the lateral mass is burred first.

– The drill is then directed 20° cephalad and lateral, thereby avoiding the vertebral artery and nerve root.

•  Once the lateral mass screw holes are created, a laminectomy can be performed.

– Two troughs are created with a high-speed burr.

– The troughs are created just medial to the screw start points at the junction of the lateral mass and lamina.

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Cervical Surgical Positioning Thoracic and Lumbar Surgical Positioning Posterior Cervical Laminaplasty with Instrumentation Minimally Invasive Thoracic Corpectomy Open Laminectomy and Diskectomy Percutaneous Pedicle Screw Placement

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