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Additional info for Adult & Pediatric Spine
Subfascially, the paravertebral muscles and ligaments are prepared and detached from the lamina by either sharp dissection using a sharp periosteal elevator or by blunt dissection using a blunt (Langenbeck) retractor with bipolar coagulation and dissection by normal or microscissors. When placed close to the immediate working area, the manually guided retractor also helps to keep the working channel open and facilitates, later on, the insertion of other retractors or specula. The use of a Cobb periosteal elevator is possible; however, when starting surgery immediately with the assisting microscope, the Cobb is usually in the surgeon’s line of vision due to its long handle (standard length 290 mm).
Only bimanually guided controlled forward curetting should be performed to avoid any slippage out of the intervertebral space with the potential risk of harming surrounding anatomical structures. 3 Microinstruments Because of the limited space available in the spinal canal, a miniaturization of spinal canal instruments is required. These microinstruments require long handles and springs thus guaranteeing an optimal hold. Bore holes in the handles allow reliable gripping and holding of the instruments which is important for deep surgery.
1 Instruments for Wound Opening There is basically no big difference between microscopic and macroscopic instruments for opening the skin even when using the microscope from the beginning. Standardized incision scalpels serve to open the skin and to traverse the subcutaneous tissue. Forceps of standard size and length can be used for skin and tissue retraction, however, delicate forceps such as Adson forceps are more comfortable under microscope assistance. Self-retaining wound retractors with sharp or blunt teeth keep the wound open.