screw fixation with rod constructs has attained global acceptance for stable spine fixation.1 A variety of techniques have been described in modern literature with free hand techniques having the unique advantage of being universally applicable, especially in the developing world with a dearth of equipment.2 These free-hand techniques rely heavily on a surgeon's experience and ability to locate the pedicle
entry point with anatomical landmarks.
The fibular artery supplied the fibularis brevis and longus muscles and the fibula; it gave branches to anastomose with the arterial pedicles
of the anterior tibial artery (Fig.
In our case, after determining the accurate vertebral level and pedicles
, the trace that progressed up to the corpus was followed by way of taking CTs step-by-step, although not through live imaging.
Computed tomography of thoracic spine (sagittal view) showing significant, unilateral sclerosis of the pedicle
and superior articular process with associated fracture lines.
subtraction osteotomy (PSO), a V-shaped wedge resection of the vertebral body, is the most popular technique in the surgical treatment of kyphosis in AS patients., In the PSO procedure, correction is obtained through a closing wedge osteotomy that hinges on the anterior column of the vertebral body.
A recent review analyzing the surgical results of FDIs from 13 manuscripts reported long-segment posterior fixation with pedicle
screws and rods as the most established surgical treatment in the literature, resulting in sustained improvements in kyphosis, neurological status, and functional back pain assessments .
Surgeries were divided into five intraoperative steps: (a) access to the abdominal cavity: time elapsed from skin incision to insertion of the multiport device; (b) right pedicle
: from grasping the uterine horn to transection of the pedicle
; (c) left pedicle
: the same as for approaching the right pedicle
; (d) uterine body: time elapsed between exteriorization of the uterus and replacement of the stump into the abdomen; and (e) synthesis: time spent from closing the linea alba to skin suture.
However, this came with the difficulty of ensuring that both the remaining glandular stump and the nipple were well vascularized by either an external pedicle
or internal pedicle
Therefore, transforaminal lumbar interbody fusion (TLIF) with bilateral pedicle
screw (BPS) fixation has been considered as the classical surgical approach in the recent years.
Focus on diminishing the bulk of the uterus so that you can get around the utero-ovarian pedicles
Most of previous studies of the morphometry of pedicle
are based on western population Morphometry of Vertebral Pedicles
: a Comprehensive Anatomical Study in the Lumbar Region" by different workers.
These include delaying, exteriorizing the pedicle
, keeping the pedicle
wider, mobilization of peroneal perforators in the intermuscular septum, supercharging, cross leg sural artery flap, leaving a skin extension over the pedicle
, and harvesting a midline cuff of the gastrocnemius muscle.