A, Recipient bed prepared for autogenous cancellous bone graft. B, Posterior elements overlying affected nerve root are excised. C, Variable-angle pedicle screw and bone graft inserted. D, Paraspinal approach can be used when the multifidus muscle is too tight for pedicle screw insertion through the midline. E, Rod attached to head of screw with variable-angle eyebolt. Laminar hook attached to rod. SEE TECHNIQUE 44.50.