PERCUTANEOUS LUMBAR PEDICLE SCREWS

1. Flourocopic X-rays are used to localize the pedicle insertion point and the Jam-Shidi needle is placed through the pedicle and into the vertebral body under image guidance.
   
   
2. The inner part of the Jam-Shidi needle is removed and a longer guide wire is placed through the outer cannula of the Jam-Shidi needle into the anterior part of the vertebral body.
   
   
3. Soft tissue dilators are now placed sequentially with increasing diameters to secure the soft tissue minimally invasive corridor. The wire can now be tested electro-physiologically to ensure there is no contact with a spinal nerve.
   
   
4. A cannulated tap is now deployed over the guide wire to prepare the path for the pedicle screw. The tap is also tested continuously in real time to ensure the pedicle wall is not breached and there is no proximity to a spinal nerve.
   
   
5. Cannulated minimally invasive titanium screws are not inserted with attached sleeves. The sleeves are used to guide the rod to the screw heads. At this time the process is repeated for as many screws as are needed.
   
   
6. Finally, the rod is delivered through the screw sleeves, locking caps are screwed into the screw heads on top of the rod,locking the rod to each screw and the sleeves are disconnected from the screw heads to leave behind the final construct of pedicle screws and rods.

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