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Pedicle Hook blade direction is always cephalad (an up-going hook) and is in the infralaminar position. The facet capsule is divided, and a portion of the inferior facet process may be removed to facilitate insertion of the hook. Once the pedicle has been clearly identified, the hook may be inserted with a hook holder, a hook pusher, or with the hook holder, captive hook pusher, and mallet combined. It is important that pedicle hooks are placed under the pedicle and not splitting the pedicle.