Issue link: https://beckershealthcare.uberflip.com/i/571000
50 Executive Briefing: tulips to be medial and in close proximity. As such, the screw head design needs to be as small as possible to limit crowding, simplify assembly and above all avoid adjacent level impingement. Screw shank design is also important. With the increase in cortical engage- ment, a tapered tip with a self-tapping feature can be very helpful in screw starting and advancement. Additionally, because of the trajectory variation, 4.5mm diameter screws as short as 25mm in length, that retains as much cross section as possible in the neck, are a requirement. Cage design for a me- dial IBF implantation also has special requirements. While a traditional PLIF lends itself nicely to this procedure, it is also com- mon for surgeons to use a single implant technique (ex. TLIF) as it only requires the exposure of a single nerve root. The new gener- ation of articulating curved TLIF cages lend themselves nicely to this procedure. Due to the vertical (PA) or even divergent nature of the exposure, however, using a device that can be articulated to a full 90 de- grees is important. When using tradition- al open pedicular fixation methods, the lateral-to-me- dial screw trajectory de- mands a large incision and wide retraction to place screws. When using a diver- gent angle screw trajectory the incision size is greatly reduced. This requires a re- tractor specifically designed for the medial approach. The key design feature is the blade toeing capability, as it greatly limits incision size, dissection, and retraction, while still providing excel- lent visualization. The learning curve for placing corticocancellous screws and interbody devices through a medial approach is relatively short compared to other minimal- ly invasive procedures. This is directly attributable to the direct visualization provided by the approach and most surgeon's familiarity with other posterior procedures and landmarks used to target and place screws and cages. n Rampart T Interbody fusion system (Spineology Inc. St. Paul, MN) Medius Retractor System (Spineology Inc. St. Paul, MN) Sponsored by: TM Spineology, the innovator in anatomy-conserving spine surgery, develops surgical techniques, instruments and implants that conserve spinal bone, nerve and muscle tissues. Spineology is committed to increasing procedural efficiency, reducing surgical morbidity and accelerating patient recovery. Learn more at spineology.com. Posterior Spinal Fusion Fortress Pedicular Fixation System (Spineology Inc. St. Paul, MN)