In this video from the Open Operating Theatre, Pedro Berjano, MD, PhD, of IRCCS Istituto Ortopedico Galeazzi in Milan, discussed how to perform minimally invasive posterior lumbar interbody fusion with divergent, cortical trajectory pedicle screws.
First, the patient was placed in the prone position. After a posterior midline approach, posterior elements at the L4-L5 level were dissected. Retractors with fiberoptic illumination were positioned, and entry points for the pedicle screws were identified. Fluoroscopy was used to mark the entry point and direction point of the L4-L5 cortical trajectory screws. Specifically designed screw shanks were inserted, and a midline decompression was extended laterally. Bilateral access was performed with standard disc resection and endplate preparation. Bilateral posterior lumbar interbody fusion cages were implanted laterally and anteriorly. The rest of disc space was filled with autologous bone. Tulips and rods were positioned, and compression was applied before the construct was tightened.
This video is intended as a teaching tool to help surgeons prepare for surgery or as a refresher on the surgical technique and indications for this surgery.