In this video from Open Operating Theatre, Jens Castein, MD, from the Center for Spinal Surgery and Neurotraumatology in Frankfurt, Germany, discussed how to perform a percutaneous posterior stabilization of L1 to L5, with microsurgical decompression of L3/4 and percutaneous L3 biopsy, in a spinal metastasis.
The patient was placed in the prone position and the pedicles L1- L5 were marked. Four small incisions were made, and Jamshidi needles were inserted into the pedicles L1, L2, L4 and L5 under anteroposterior fluoroscopy. Screws were placed and the precontoured rods and locking screws were inserted. A two-level fluoroscopy control showed correct position of the implants.
A skin incision was made over the left L3 pedicle and a Jamshidi needle was inserted into the vertebral control for a punch biopsy followed by wound closure. A midline incision was made under L3/4. The muscles are prepared for decompression of the recess and the neural foramina L3/4 using a hemilaminectomy L3. A subfascial drain was inserted and the wound was closed.
This video is intended as a teaching tool to help surgeons prepare for surgery or they can use it as a refresher on the surgical technique and indications for this surgery.