05/01/2024
l1 burst. every spine case i was taught to measure pedicle diameter and tranaverse pedicle angulation and then note where lamina , tp, spinous process , pedicle broken . here pedicle brokn so avoided index and then placed long segment . avoids intra op anxiety. thoracic pedicle screw . entry point is lateral 4/6th of the facet s.a.p.( superior articular process ) and at the midpoint of transverse process. transverse pedicle angle is almost straight at d12 and increases every degree till l5 ... cephalocauda trajectory l is two types in thoracic vertebra... anatomical which is cephalad to caudal in thoracic. crucial step is locating the medial and lateral edges of the facet joint in thoracic vertebra. . lumbar pedicle screw. entry point is nibble superior articular process . try to stay lateral . lenke usage is two types .use concave initial 15 mm facing lateral . convex will hit and slip off the medial pedicle wall and then flip lenke ..concave will face medially and convex will hit lateral cortex of anterior verbral body . other way is to use straight lenke .some use all the time medial concave lenke..my preference is medial convex initially and lateral concave .
