What anatomic structures provide potential sites for posterior spinal arthrodesis

In the cervical region, posterior spinal fusions are achieved by applying bone graft to the lamina, facet joints, and spinous process. In the thoracic and lumbar regions, the lamina, facet joints, spinous processes, and transverse processes are available sites for arthrodesis. These bone surfaces require meticulous preparation including removal of all overlying soft tissue prior to graft application. In addition, it is critical to remove the outer cortical bone surface (decortication) in order to expose underlying cancellous bone and provide access to the pluripotent stem cells within the patient's bone marrow in order to achieve a consistent and high likelihood of successful fusion. See Figure 24-1.

Figure 24-1. Posterior spinal arthrodesis technique. A, Posterior fusion. Posterior osseous structures (lamina, facet joints, transverse processes) are cleaned of soft tissue, and the outer cortical bone is removed (decortication) to expose underlying cancellous bone. B, Facet joint fusion. The facet joint cartilage is excised, and the joint surfaces are prepared for bone graft application. (From Laurin CA, Riley LH Jr, Roy-Camille R. Atlas of Orthopaedic Surgery. vol. 1. General principles. Spine. Chicago: Year Book Medical Publishers, Inc., and Paris: Masson; 1989.)

Figure 24-1. Posterior spinal arthrodesis technique. A, Posterior fusion. Posterior osseous structures (lamina, facet joints, transverse processes) are cleaned of soft tissue, and the outer cortical bone is removed (decortication) to expose underlying cancellous bone. B, Facet joint fusion. The facet joint cartilage is excised, and the joint surfaces are prepared for bone graft application. (From Laurin CA, Riley LH Jr, Roy-Camille R. Atlas of Orthopaedic Surgery. vol. 1. General principles. Spine. Chicago: Year Book Medical Publishers, Inc., and Paris: Masson; 1989.)

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