Prevent abdominal pressure as it leads to an increase
in spinal venous pressure and bleeding intraoperatively.
Bolsters or horseshoe shaped pheasant cushion
may be used.
Pad the knees with foam rubber and shin and anterior
border with pillow.
Incision: A curved para
spinous incision about three finger breadth from the midline centered on the vertebral levels that need to be exposed.
Adrenaline infiltration: Depends on surgeon’s
preference, as the duration of action is limited. A 1: 500,000-epinephrine solution in saline can be injected into subcutaneous
The skin and subcutaneous
tissue is cut till dorsolumbar fascia is reached. The Fascial incisions are made at about the same lateral to the spinous
process, approximately three fourth of the way out laterally to sacrospinalis. The muscle mass can be bluntly dissected using
Palpate the transverse
processes and the posterosuperior iliac spine, which is present in the inferior aspect.
The facet joints present
medially can then be exposed and soft tissue cleared from it.
The fusion bed can then be prepared at desired levels.
Nerve root Damage: The traversing nerve root lie anterior to the transverse
process, however they risk a chance of injury if the dissection is inadvertently carried anterior to the transverse processes
or the intervening intertransverse membrane.
Clunial Nerve Damage.