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Decompression and Fusion

L4-5 laminectomy and posterior fusion with pedicle screw placement under guidance from the Bolt Navigation System.

Patient Overview

Age

69 years old

Sex

Male

Surgery Details

Procedure

The patient agreed to undergo an L4-5 laminectomy and posterior fusion.

Levels with fixation

L4-5

Fixation type (pedicle screws, cortical screws, etc.)

Pedicle Screws

Approach

Operative Workflow

The patient was positioned in the prone position on a standard OR table and prepped and draped in the normal sterile fashion. The MRI of the lumbar spine taken 2 months prior to surgery was accessed on the computer in the OR. The screen was leveled using the Bolt Navigation Unit (BNU) and axial images of L4 and L5 were acquired. A C-arm (OEC 9900 General Electric, Chicago, Illinois) was draped and positioned, and a lateral L spine x-ray was taken of the lumbar spine. The images of L4 and L5 taken with the C-arm were separately acquired using the BNU. The BNU was then placed in a sterile drape and passed to the scrub technician.

A 7 cm incision was made and the L4 and L5 spinous processes and laminae were exposed. A decompressive laminectomy was then performed at L4 and L5. The entry point of the right L4 pedicle was located using a lateral x-ray. The BNU was then used to plan the trajectory of the right L4 pedicle screw. Once the trajectory was planned, the BNU was attached to the gearshift probe utilizing the single use case. Under guidance from the Bolt Navigation System, the gearshift probe was placed through the pedicle matching the trajectory guidance from the BNU, into the vertebral body. Once the pilot hole and trajectory were created, the path was tapped with a threaded tap (Alphatec Spine, Inc., Carlsbad, California). A pedicle screw was then placed. This was repeated for the right L5, left L4, and the left L5 pedicles. The posterior lateral gutters were then prepped. The pedicle screws were connected using rods and the procedure was completed.

Perioperative image

Surgery in progress

Post-op images

A post op xray of a spine
A post op xray of a spine

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