Rishi
Indications
- Spondylodiscitis not resolving with abx, back pain and leg pain
- Lytic listhesis
- Recurrent disc prolapse > 3
Procedure
- Prone
- Bilateral strip
- Place pedicle screws might need satellite screw for L5
- Place rods on contralateral side and distract
- Remove cranial and caudal interspinal ligament until flavum visible. This might entail removing the whole spinous process of the cranial vertebrae
- Osteotome the inferior articulating process to expose the SAP and facet joint
- Use leksell to remove the lamina attached to the SAP of the cranial vertebrae.
- Remove the lamina
- Remove the medial SAP to get far lateral to the nerve root.
- Get assistant to retract nerve root. If the nerve root is conjoint do not retract it.
- Open the disc space on one side. With kinfe.
- If it is an infection case or the listhesis is high grade and requires correction the open both sides.
- Use the disc spreader to open disc space and then use the endplate scrapper.
Outcome
- Reoperation rates
- TLIF: Rihn et al. (Spine J 2009, Thomas Jefferson Univ Hospital) – 12.1% reoperation rate.
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