Preparation of Interbody Space

I use a Williams Microdisc tractor because it's so easy in and out. I can set it at will. I can remove it at will, and I can reset it at will without all the fumbling. My next step in the eye mask procedure is the transaminal lumbar inner body fusion from a posterior midline Approach.

So, I'm gonna go here to this medial facet.

And here's the screw. So right here I call this hole the a-hole when it's at fluoroscopically the superior vertebral line. So I am now stepping on fluora. I see the superior vertebral line. This is going to be my a-hole. Now I'm going to go here and expect that to be the top of the disc space at the inferior vertebral body of L5. That's the a-hole. We'll go to lateral fluoroscopic plane.

And, and I drill above the screw laterally, slightly obliquely towards the superior S1 or the bottom of the disc space. Here's the B hole. We'll confirm it fluoroscopically.

That gives us plenty of room. I'm gonna come a little lower to it actually. So this gives me with depth.

I'm going to follow this trajectory of this medial oblique pathway and I'm going to drill out the trapezoidal.

Partial facetectomy that will give me my Approach tunnel for my inner body manipulation and ultimately implant placement.

So I'm going to drill the cortical bone of the deep facet so that I can enter into the foraminal zone. As I get close to the foraminal zone, we're going to start to see epidural fat. We're going to start to see soft tissues which we see right there picking out.

And this will be the superior end plate of S1.

And the soft tissue of the posterior disc base.

Right here. So, we will deliver that.

Because that's gonna give us a nice Approach angle to the disc space. I'm gonna drill out in the facet zone, the remaining bone that's going to get in my way as it relates to discrete management, template management, and ultimately innerbo management.

I will drill all the way to cortical bone medially, maturing the medial limit. Right now, my sucker tip is exactly at the disc space, exactly on the posterior line. No neural elements. So now I'm gonna go in with a large straight curette.

We'll go straight to that disc space margin of this disc manipulation. So I use this curate to create a progressive path of least resistance. So I'm just creating a tunnel. Every subsequent instrument is going to find this tunnel and add to it.

We'll start with a TelixK template. I consider the template, the driver, and the most important part of the final implant placement. So we'll once again go through our path of least resistance. We'll gently navigate our way towards that posterior disc space and then go a little more vertical and turn the corner.

You turn the corner until it's perfectly lateral. We can still see.

Medal convergence angle. We know this tunnel is slightly medial to that pedicle screw. That's what optimizes the medial presence of this cage. Now we're going to use an up angle pituitary jour, keep it closed fluoroscopically, put it into the disc space, open it within the disc space and clean out residual end plate and disc tissue.

A 10 millimeter titanium Tusk in a vertebral cage filled with DBM biologic, um, we put it curvilinear towards the midline.

Find the tunnel vertically, gently deliver it all the way down the tunnel.

So we are where we wanna be. We'll release the handle, pull it out. Now we've got a laterally placed Telix K cage Deep within the L5-S1 disc space.