# Polyaxial Pedicle Screw OR Training By James Levin Topic: Human Body & Medicine [Open the interactive Jig](https://ask.jig.com/j/jzg8SopZnNQm) ## Guide ### 1. Polyaxial Pedicle Screw OR Training This module prepares you to support a posterior lumbar polyaxial pedicle screw and rod construct at L4–L5\. You will compare head designs, learn each component, follow the surgical sequence and your role at the table, then take a 10\-question assessment\. Training only, not for clinical use\. For sizes and torque values, always refer to the surgical technique guide\. ### 2. Polyaxial vs Monoaxial A monoaxial head is fixed to its shank, so every rod slot points wherever its screw points\. A polyaxial head, called the tulip, swivels on a ball, so each slot can be turned to meet the rod\. Switch between the two and watch the rod\. The swivel only works until final tightening\. Then the construct becomes rigid\. ### 3. Components and What They Do Exploded view of one screw\. The threaded shank grips bone, and the cutting flute at its tip cuts a path as it advances\. The spherical head lets the tulip swivel\. The tulip’s U\-shaped rod slot receives the rod, the set screw locks it, and the rod links the levels\. Tap any part to highlight it\. ### 4. Step 1 · Entry Point The surgeon marks the entry point at the junction of the facet joint and the transverse process, then opens the outer bone with an awl\. Have the awl ready before it is called for\. ### 5. Step 2 · Probe the Pedicle The pedicle probe is a blunt instrument pushed gently through the pedicle into the vertebral body, angled toward the midline\. It follows the soft inner bone instead of cutting a new path\. A probe is never forced\. Unexpected resistance means the surgeon will stop and reassess\. ### 6. Step 3 · Ball\-Tip Feeler The ball\-tip feeler checks the channel\. The surgeon feels the floor and all four walls for solid bone\. Any soft spot or give may mean a breach, a hole through the pedicle wall\. ### 7. Step 4 · Tap The tap cuts a thread pattern into the channel so the screw follows a clean path\. The tap size is chosen by the surgeon for the patient and the system\. Refer to the surgical technique guide for tap and screw sizes\. ### 8. Step 5 · Insert the Screw The driver tip seats fully in the hexalobe recess, a six\-lobed star socket in the screw head\. The screw is turned clockwise down the tapped channel until the head sits just above the bone\. The other screws follow the same steps\. A driver that is not fully seated can strip the recess\. Check engagement before handing\. ### 9. Step 6 · Align the Tulips Each screw points its own way, but the tulips swivel on their spherical heads\. The surgeon turns them until all the rod slots line up along one path\. ### 10. Step 7 · Seat the Rod A contoured rod is placed into the aligned slots with the rod holder\. Because the tulips already face the rod, it drops in with little force and little bending\. ### 11. Step 8 · Provisional Set Screws Each set screw is started by hand on the starter, straight down the tulip axis, and turned clockwise until it is just snug\. This holds the rod while the surgeon makes final adjustments\. Start every set screw straight\. Never force one that binds\. ### 12. Step 9 · Final Tighten with Counter\-Torque The counter\-torque slides over the tulip and grips the rod\. The torque\-limiting driver turns the set screw inside it until it clicks\. The counter\-torque takes the twisting force, so it is not passed into the spine\. Never quote a torque value\. Refer to the surgical technique guide\. ### 13. Your Role: The Right Instrument Stay one step ahead\. Hand each instrument in order, tip first, oriented for the surgeon’s grip: awl, probe, ball\-tip feeler, tap, screw on driver, rod holder, set screw starter, then counter\-torque with the torque\-limiting driver\. Confirm every implant size against the surgeon’s call and the technique guide\. ### 14. Your Role: Avoid Common Mistakes Two mistakes cause real problems\. A cross\-threaded set screw goes in at an angle and damages the threads\. Final tightening without counter\-torque twists the construct and the spine\. Switch between the views to see each one\. ### 15. Skills Assessment Ten questions, one at a time\. Some ask you to tap a part on the model, some to put steps in order, and some are multiple choice\. Each answer is explained\. The pass mark is 80%\. Use the arrow to begin\. ### 16. Question 1 of 10 Why does a polyaxial screw make rod capture easier? Choose one answer in the question panel\. ### 17. Question 2 of 10 Tap the cutting flute on the model\. Tap a part of the screw\. ### 18. Question 3 of 10 Put these four steps in the order the surgeon performs them\. Tap all four in the question panel, first to last\. ### 19. Question 4 of 10 Tap the set screw on the model\. Tap a part of the assembly\. ### 20. Question 5 of 10 The surgeon has just probed the pedicle\. Which instrument do you hand next? Choose one answer in the question panel\. ### 21. Question 6 of 10 What must be in place before the set screw is final tightened? Choose one answer in the question panel\. ### 22. Question 7 of 10 Tap the spherical head on the model\. Tap a part of the screw\. ### 23. Question 8 of 10 Put these four steps in order, from first to last\. Tap all four in the question panel, first to last\. ### 24. Question 9 of 10 A set screw binds after less than a turn\. What should happen? Choose one answer in the question panel\. ### 25. Question 10 of 10 The surgeon asks you for the final tightening torque\. What do you say? Choose one answer in the question panel\. ### 26. Your Result Your score and result are shown in the results panel\. The pass mark is 80%, eight of ten\. Review any listed sections, then retake the assessment if you need to\. Training only, not for clinical use\. ### 27. Competency Sign\-Off With a PASS, complete the sign\-off checklist with your assessor\. Record the trainee’s name, the date and the score, and have the assessor sign\. Keep the signed record with your training file\.