The peripheral nervous system refers to parts of the nervous system outside the brain and spinal cord. It includes the cranial nerves, spinal nerves and their roots and branches, peripheral nerves, and neuromuscular junctions. The anterior horn cells, although technically part of the central nervous system (CNS), are sometimes discussed with the peripheral nervous system because they are part of the motor unit.In the peripheral nervous system, bundles of nerve fibers or axons conduct information to and from the central nervous system. The autonomic nervous system is the part of the nervous system concerned with the innervation of involuntary structures, such as the heart, smooth muscle, and glands within the body. It is distributed throughout the central and peripheral nervous systems.The peripheral nervous system refers to parts of the nervous system outside the brain and spinal cord. It includes the cranial nerves, spinal nerves and their roots and branches, peripheral nerves, and neuromuscular junctions. The anterior horn cells, although technically part of the central nervous system (CNS), are sometimes discussed with the peripheral nervous system because they are part of the motor unit.In the peripheral nervous system, bundles of nerve fibers or axons conduct information to and from the central nervous system. The autonomic nervous system is the part of the nervous system concerned with the innervation of involuntary structures, such as the heart, smooth muscle, and glands within the body. It is distributed throughout the central and peripheral nervous system

1. Basic Instruments
for
Spinal Operations

3. 1) Basic Spinal Instruments
• Retractor
• Elevator
• Posterior Shear Cutter
• Currette
• Osteotome / Chisel
• Dissector / Nerve Root Retractor
• Bone Rongeur

4. Retractor

6. Beckman
Adson
Retractor
Adson Retractor
Norfolk & Norwich Retractor

7. Mollison
Self-retaining
Retractors
-1-2 levels hemi-
laminectomy
- cervical

8. Downing spinal retractor

9. Cervical Retractors

10. Meyerding Retractor

11. Periosteal
Elevator

13. AO Periosteal
Elevator
Cobb
Periosteal
Elevator

14. Posterior
Shear Cutter

17. Currette

18. Ligamentum Flavum

20. Osteotome /
Chisel

21. Osteotomes
Angled / Bayonet -
shaped
chisels

22. Sharp edges protected

23. Dissector
&
Nerve Root
Retractor

24. Nerve root
with a patch
of fat
Herniated disc

25. MacDonald Howarth
Nerve root retractors
Probe Dissector
Allerdyce

26. Probe Dissector

27. Nerve root retractor

28. Bone Punches
&
Rongeurs

30. •Up-cutting
•Down-cutting

31. Narrower tip – Cervical level
End plate Cutting edge
Broader tip – Thoracic to Lumbar level

32. Grooved +/-
centring pin

34. Pituitary Rongeur

35. Pituitary Rongeur

37. Cup-
shaped
jaw
Serrated jaw

38. 2) Optional Instruments
⚫ Cervical Instruments
• Thoracic Instruments
• Lumbar Instruments
• Bone Graft Instruments
• Power Instruments

39. Hartman’s retractor
( cervical )

40. Cervical Distractors – intervertebral space
distraction
(for cervical ASF)

41. Cervical Distractor

42. Caspar Pin

43. Thoracotomy
Instruments –
anterior approach
Rib Spreader
Rib approximator
Perioteal Elevators
Costotome
Rib Shears

44. Lung Retractor

45. Instruments for Lumbar level – anterior
approach

46. Shoehorn Retractor for lumbar spine

47. Longer instruments used in deep
cavity -- Thoracic to Lumbar levels

48. Bone Graft
Instruments
Ruler
Bone
Impactors
Taylor retractors

49. Bone
currettes

50. Osteotomes Gouges

51. Capener Gouge

52. Power Instruments -- Burrs / Saws

53. 3) Instruments for Screws/
Hooks/Wires

54. USS-Fracture System. FractureFixation
for Spine.

56. Instruments for Screw /
Hook / Wires

57. Screw site
preparation
- under X-ray
control
1. Bone awl -
perforate outer cortex
of pedicle
2. Pedicle probe
3. Sound probe
1

58. Pedicle
Probe
- path finder
-Open pedicle
canal
Sounding
Probe
-pedicle feeler
-ball tipped
-ensure path is
surrounded by
bone

59. Screw Fixation
Taps Wrench

60. Screw fixation

61. Rocker
(persuader)
Screw cap
driver
Rod holder

62. Instruments for Hooks

63. Hook starter
-for lamina hook,
to separate
ligamentum
flavum at
underside

64. Hook insertion
Hook holder
Hook
driver

65. For lamina hook, a small osteotome used to remove some part
of lamina for easy insertion of lamina hook

66. hooks

67. Instruments for Rod

68. Rod Cutter
Table - top

69. Rod Bender

70. Rod Holder
Serrated jaws

71. Distractor & Compressor
compressor
distractor
Effect on the screw-to-rod
clamps --- lordosis

73. Final tightening of screw cap
-wrench with side handle acts as a
counter torque device allowing
screw tightening

74. Final tightening
with torque
immediate after
compression or
distraction

76. Wire Instruments
- Wire Tightener
- Wire Cutter
- Pliers
Wire holding
Forceps

77. Transverse
connector
Reduce
rotational
instability

78. Cervical
instrumentation

79. Pedicle
screws
Transverse
connector
Locking cap for
transverse
connector
Locking cap
Rod

80. Awl – marks the
entry point, prevent
drilll bit slipping

81. -Pedicle probe / path
finder/ drill to make
the path for screw
-Pedicle marker or
feeler to check the
depth of the screw
path

82. Or using power
drill to drill path,
with a drill sleeve
with depth stop

83. • Depth gauge to
measure required
screw length
• Tapping is optional

84. • Insert polyaxial
screw with screw
driver

85. Use rod template as a
guide to bend rod

86. • Rod benders

87. Insert rod with
a rod holder

88. Locking cap
screwdriver to
mount caps
onto screw
head, but not
too tight

89. • Or using the rod
introduction
instrument /persuader
to push rod onto screw
head, by squeezing the
handle
• Locking screw is
inserted thro the
cannulation of the
instrument

90. • Compressing or
distracting screws at
required level in
increase or decrease
lordosis as required
• The locking screws
should be loosely
fastened before
using the
compressor or
distractor then
tightened

91. Place the
selected
transverse
connector over
the appropriate
level on the
construct (with
extended locking
screw) with a
holding forcep

92. -hex screwdriver to thread
locking washer over the
stardrive locking screw
-Then final tightening of
the stardrive locking
screws with countertorque

93. Lock the
transverse
connector
with a crimper

94. -To add
transverse bar
to prevent
severe rod
contouring
- Can be place
onto rod from
top

95. --Connect lamina
substitute with a
3.5mm rod
-- mount from top
--tighten screw with
hex driver

96. -Can be placed
from top
- lock the set
screw on the
rod
-Lock the swivel
ring on the both
sides of
connector with
hex driver

97. Summary
⚫ Recognise basic Spinal Instruments
⚫ Preparation of instruments for spine operation at different level
– Basic
– Optional : appropriate inst for required level
( Consideration: Approach, spinal instrumentation,
Bone grafting, Power instruments,
Surgeon’s preference )
⚫ Instruments for pedicle screw / hook / wire
⚫ Example of a cervical instrumentation system