The Implant. (Klappen außen sind nur 192 mm breit!) Ordering information. You start we help with our clearly arranged Starter Kit:

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1 ATHLET PRODUCT INFORMATION The Implant 1 construct = 1 main body + 1 end body (Klappen außen sind nur 192 mm breit!) Latch mechanism for secure connection of the implant components Ordering information ATHLET end body Art.-No. Height (mm) 1 AT AT AT ATHLET main body Art.-No. Height (mm) 4 AT AT AT AT AT AT implant components: 6 main bodies and 3 end bodies ATHLET accessories Art.-No. ATM309 Connector Screw for TOSCA Cervical Plates L = 9 mm, Ø = 3 mm Screwdriver FZ-1201 is integrated in the TOSCA Instrument Set You start we help with our clearly arranged Starter Kit: Your mobile warehouse with all implant components

2 This document was written by SIGNUS technical staff and is intended only to introduce the product. Information contained within this brochure should not be construed as surgical advice or medical opinion expressed or implied by SIGNUS. SIGNUS Medizintechnik GmbH Carl-Zeiss-Strasse Alzenau /Germany phone: +49 (0) / fax: +49 (0) / info@signus-med.de web: RABEA Vertebral Body Fusion simple and efficient Cervical Cage NUBIC Vertebral Body Fusion simple and efficient Cervical Cage Retractor System For free access Cervical Retractor System KAINOS + Exceptional Osteoconductivity Fully Resorbable Bone substitute TOSCA Cervical Plate System with Expansion Screws ACF System 01/Nov 2007 v01

3 ATHLET Cervical VBR in PEEK-OPTIMA The real winner ATHLET Vertebral body replacement ACF PRODUCT INFORMATION

4 TECHNICAL INFORMATION The Concept A vertebral body replacement requires top performance: Simple intra- and postoperative control Reliable fusion Anatomic adaptation Economic product concept and simple handling ATHLET (athlitis = Greek for the contestant ) meets this challenge! Its unique concept combines all required characteristics in one product making it a real winner. Manufactured from PEEK-OPTIMA Radiolucent and artefact-free Simple positioning by means of titanium markers Lordotic implant angulation Natural reconstruction of the cervical spine Generous fenestration Optimal provision for bony in-growth Large contact area, toothed endplates High primary and secondary stabilization Heights from mm Applicable for a broad range of indications and patient anatomies Heights from mm (in 2 mm increments) (Klappen außen sind nur 192 mm breit!) Clearly arranged instrumentation Easy handling reduces the risk of complications The SIGNUS solution The TOSCA Plates, whose curvature is matched to the lordosis in ATHLET, can be fixed directly to the implant. The bone substitute KAINOS + provides optimal fusion results 15 mm 14 mm 14 mm

5 ATHLET PRODUCT INFORMATION Instruments Art. No. Description 1 AT0002 Height indicator 2 AT0004 Template 3 AT0003 Disconnector 4 AT0001 Inserter 1 2 A AT0005 Inserter Plate small (for main body 4 and 5) B AT0006 C AT0007 Inserter Plate medium (for main body 6 and 7) Inserter Plate large (for main body 8 and 9) 3 4 A B C (Klappen außen sind nur 192 mm breit!) 5 AT001AY Container with instrument reposition 5 Indications ATHLET is a vertebral body replacement for stabilization and reconstruction of the cervical (C3 - C7) spine. The implantation is performed after anterior approach and cervical corpectomy for: Instabilities and stenosis due to various origins Contraindications are: Severe osteoporosis Partial corpectomy

6 TECHNICAL INFORMATION Short description of the implantation Preoperative planning The extent of the resection and therewith the height of the vertebral body replacement can be estimated as usual with the preoperative radiographs and CT /MRI scans. Optionally, SIGNUS offers templates for various imaging modalities that can assist with planning. Patient positioning The patient is placed in the supine position. Approach Expose the vertebral bodies through a corresponding approach to the cervical spine. To have a clear layout of the operative field, we recommend the SIGNUS Cervical Retractor System. Performing the corpectomy and preparing the endplates After anterior preparation the corpectomy is performed. To achieve an optimal fusion result the exposed vertebral body endplates are cleaned carefully. Cervical retractor system, ref. to SIGNUS-brochure 01/Nov 07 V01 Attention: Avoid excessive cleaning or complete removal of the cortical bone. This may weaken the endplates which leads to an increased risk of implant subsidence into the adjacent vertebral bodies.

7 ATHLET PRODUCT INFORMATION Determination of the implant height To determine the height of the defect the Height Indicator 1 is inserted into the patient situs and distracted until the tips of the instrument rest against the adjacent endplates of the vertebral bodies. Apply the Height Indicator to the scale of the Template 2 and read off the required height. Assembly of the implant components For simple identification all implant components are provided with a number from 1 9 (according to the height). On the Template e 2 you will find an overview of all the heights that can be bridged with ATHLET and the implant combinations to achieve these heights. Assemble the main body and end body required for the construct. The implant components are connected together by a latch mechanism that engages with an audible click. Disassembly of the implant components The connected implant components can only be disassembled with the Disconnector 3. Hold the instrument with the labeling upwards. Place the implant between the jaws of the instrument so that the protrusion fits into the window below the latch mechanism. By pressing the release button, the implant components are separated from each other. Note: Ensure the implant is correctly oriented during the disassembly process otherwise the implant can be damaged.

8 TECHNICAL INFORMATION Distraction and implantation Distract the spinal segment to the desired height with a suitable spreader, for example with the SIGNUS Pin-Spreader which is included in our Cervical Retractor System. Select the appropriate Inserter Plate A the tip of the Inserter 4. B C for the implant and slide this onto The implant heights and the corresponding Inserter Plates are listed in the instrument description. The assembled implant is threaded onto the Inserter by rotating the blue thumb wheel. The cervical vertebral body replacement ATHLET can now be introduced into the situs of the patient. The insertion of the implant is performed under imaging control. Additional fixation As with all vertebral body replacements, ATHLET requires supplemental fixation. For this we recommend the TOSCA Cervical Fixation System, whose pre-countered plates are matched to the lordotic curvature of ATHLET. Optionally, TOSCA and ATHLET can be connected together with the Connector Screw ATM309. It is recommended to use this screw as a plate holder while the bone screws are placed into the adjacent vertebral bodies. adjustment slots (Klappen außen sind nur 192 mm breit!) Note: To improve the fusion results it is recommended to place bone graft and /or a bone substitute, such as KAINOS+, into and around the implant. Control of the implant position: The final position is confirmed under imaging control. The x-ray image shows the optimal position of ATHLET. In this case it is used in conjunction with the TOSCA Cervical Fixation System.