Keyhole Decompression

Now we're gonna go to what I consider the most critical, most important part of the case. The Primary direct microsurgical decompression of the target zone, L5-S1. Uh, specifically, I'm gonna go to what I call the keyhole. The keyhole is a small

Uh, tunnel at the high interparticular segment here's the L5 screw. So on the left side it ends up being between 4 and 5 o'clock Ml a few millimeters. This right here, if I look fluoroscopically, will take me to the high foramen L5-S1 left. So with those.

Boundaries in mind. I will create a curvilinear bone. Here's the inferior pedicle right here. I'll confirm that fluoroscopically. I am now in the high foramen L5-S1. OK, so that's the L5 nerve root preforaminal foraminal junction right here. I'll take a 3 curate.

I'm gonna specifically open that up.

All right, there you go. I've got a nice exposure of all of that bone. I know where the traversing fecal sac and traversing L5 nerve root is. All right, so I'm gonna take a Murphy ball detector.

I'm going to go high in the L5 foramen. On lateral flora, we'll look at the 4 or 5 disc space. You can see my ball detector easily passes up above the inferior aspect of the L4 or 5 disc, which we know to not have any Pathology. So no matter what, I have freed up the junctional zone. Now we'll go laterally.

Microsurgically in the foraminal zone and I have an easy pathway. We'll confirm it fluoroscopically. I'm exactly at the descending L5 foramen so I'm done with my high interpedicular decompression. Let me go with the down angled green for that.

We will come in here behind the S1 vertebral body, slide it in under that nerve root fluoroscopically.

Elevate it slightly over that disc.

I can already feel that most of it is gone. Gently tamp down into the disc space. OK, up angled pituitary.

There's a piece of disc removed.

I'll do the same thing again.

There's a bigger piece of this removed. I can see I've got easy clean passageway.