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Sawbones models of grade 4 osteotomy following LLIF. Grade 4 osteotomy in the L4 vertebral body at a 30° angle was made by an osteotome and a small drill bar toward the center of the LLIF cage between L3 and L4 (left) and supported by gradually bent temporary rods (right). The amount of bone cut is smaller than that typical for grade 4 osteotomy. Stabilization of the anterior longitudinal ligament made the LLIF cage stabilize.
