Add: No.-8, Tianshan Road, Xinbei District, Changzhou, Jiangsu, China 23022 Tel: 0086 59 8595556 Fax: 0086 59 859555 Http://www.kanghui.com Add: F25, Shanghai International Pharmaceutical Trad & Exhibition Tower, No,399, Jinqiao Road, Pudong District, Shanghai, China 20029 Tel: 0086 2 503996 Fax: 0086 2 503293 L8 Spine System SURGICAL TECHNIQUE
Contents Introduction Surgical Technique Instruments Implants L8 3 2
Introduction Introduction One of the products of the lowest profile and volume Facilitates preservation of facets No interference between screw heads at L5-S Does not impinge underlying bone Increased graft area Better fit for use in thoracic spine and in smaller patients L8 Spinal Fixation System is an advanced device based in L2 System. Simplity in operation, low profile, Universal application are the major features. Top Loading Top Tightening Single Closure Mechanism Reduced Number of Implants Revisable Vector Force Vector Force Reduce spread force Facility the plug driving Safer Nut Implant Head Nut Implant Head Thread Buttress Thread v Lumbar, Thoracic Sacral & Ilio-Sacral Degenerative Deformity Tumor/Trauma 2
Surgical Technique Surgical Technique STEP 2 INSERT PEDICLE SCREW PATIENT POSITIONING STEP 2. IDENTIFICATION OF THE PEDICLES Accurate identification of the pedicle canal is necessary to ensure proper screw placement. The junction of the transverse process and the superior articular facet is the typical landmark for the entry site to the pedicle canal. However, anatomic variations in individual patients may cause slight differences in the entry site. These differences should be considered carefully and noted on the pre-operative MRI or CT images and on the intra-operative x-rays. The patient is placed on the operating table in the prone position.a spine surgery frame should be used which will avoid any pressure on the abdomen, there by avoiding vena caval compression. SURGICAL APPROACH Screw insertion should follow the angle of the pedicle canal. The surgical approach is carried out through a standard midline incision to the spinal column over the spinous processes. The incision should be long enough to ensure expose expected. The lumbar fascia is incised on the sides of each of the spinous processes. The supraspinous and interspinous ligaments should be preserved, particularly above the area of instrumentation, as these are important posterior stabilizers. Meticulous subperiosteal exposure of the posterior elements is performed. The paraspinal musculature is detached to the outer margins of transverse processes. Soft tissue and bony decompression are performed to relieve neurological STEP 2.2 MAKING THE ENTRANCE Make the entrance at the porper point with awl.then the straight awl is inserted along the direction of the pedicle into the vertebral body. 3 4
Surgical Technique Surgical Technique STEP 2.3 DETERMINING SCREW LENGTH The calibrations on the Straight Awl shaft show the depth in the pedicle and help to determine appropriate screw length. Having opened the channel of the pedicle, all four walls of the pedicle can be palpated with a probe to ensure that the walls of the pedicle have not been violated. Then the radiographic markers can be use to view the canals directions and depth. It can be use to select the appropriacte screw length as well. STEP 2.4 PPING THE PEDICLES STEP 2.5 SCREW INSERTION With the pedicle canals prepared and the pedicle screws length determined, the pedicle screws are sequentially inserted using the screwdriver. Insert the pedicle screw into the screwdriver and drive into L8 instrumentation offers two taps (5mm,6mm) which correspond to the bone screw diameters. The appropriate diameter tap is inserted through the pedicle and into the vertebral body. A probe can be used to follow the tap threads through the cancellous bone and palpate for any perforations in the pedicle walls. the pedicles following the previously prepared canal. When fully inserted, the pedicle screws should extend 50-80% into the vertebral body and be parallel to the endplates. The multi axial screw may be angled up to 25 medial and lateral to facilitate in the placement of the rod with minimal bending/contouring. Note: Tapping process is optional. 5 6
Surgical Technique Surgical Technique STEP 3 ROD INSERTION Usually, rod push forceps can be used to push the rod into screws head symply. There are a various length of the rod in L8 system so that the operating of cutting rods is not necessary. A rod template may be used to determine the rod contour needed for construct assembly. The rod may be bent into lordosis using the rod bender. The rod does not have to be precisely bent for attachment to the pedicle screws, especially for a single-level fusion. However, bending the rod to an appropriate lordotic curvature lowers the profile of the implants and improves the biomechanics of the construct by reducing the bending moment and thus reducing the stresses on the pedicle screws. A lordotic bend in the rod also allows an element of medial or adjustment on a multi-level lateral construct. STEP 4 COMPRESSION/ DISTRACTION If compression or distraction will be used, it is carried out at this time.the provisional plug driver may be used to maintain temporary locking and security of the rod/screws construct. Temporary fixation of the nut/screws may be done many times without damage to either the aut or the screw threads. Compression or distraction may be performed. In either maneuver, the plug on one side of the motion segment should be provisionally tightened, with the other plug loose in the structure. Compression or distraction will occur against the provisionally tightened the auts. Once satisfactory compression or distraction has achieved, final tightening may be performed. Note: Distraction is seldom indicated other than while performing a PLIF because of the increased risk of implant failure, pseudoarthrosis an creating segmental kyphosis. After the rod is place near to the top of the pedicle screw head,the reduction forceps is used for the rod reduction. The reduction forceps cover the screw s head and clip it, The handles of the reducer are parallel to the rod. With the grasping the reducer handles slowly, the sleeve of the reducer will slide down and seat the rod. The elastic nuts holder with the nut is then inserted through the reduction forceps tube into the head of the pedicle screw. 7 8
Surgical Technique Surgical Technique STEP 5 DEVELOPING THE FUSION BED The facet joint capsules are removed. The articular cartilage of the facet joints is removed and cancellous bone is exposed. Cancellous bone graft is packed into each facet joint. The transverse processes, sacral alae and the lateral walls of the facet joints are decorticated. Corticocancellous bone graft are firmly pressed onto the bone fusion bed. STEP 7 BONE GRAFTING, CROSSLINK SYSTEM AND CLOSURE Decortication and bone grafting can also now perform. Wound closure is then performed in the customary manner. Transverse connector can be assembled in this time. STEP 6 FINAL TIGHTENING While the hex driver is inserted through the cannulation of the counter torque, the T-handle provides adequate leverage for tightening the nut. The handle of the counter torque device should be held firmly to prevent torquing of the construct while the nut is secured and long arm of the reduction screws sheared off. 9 0
Instruments Implants L8 Spine Implants L8 Spine Instruments Set Product Code Product Description Material Remark Instrument Code Contents Quantity L8 Spine Instruments Set L8 Spine Instruments Set(empty) L8 Spine Instruments Case L8 Spine Instruments Tray 806000 80600 07020 0702 3222025 3222030 3222035 3222040 3222045 3222050 32222030 32222035 32222040 32222045 32222050 32223030 32223035 32223040 32223045 32223050 32224035 32224040 32224045 32224050 32224055 32225030 32225035 32225040 32225045 32225050 32225055 32226035 32226040 32226045 32226050 32226055 32227035 32227040 32227045 32227050 32227055 2 2 5 5 2 T-Handle with Quick Coupling, 8.0 Awl Straight Awl Curved Awl Probe 5mm Tap 6mm Tap 3mm Screwdriver Rod Template 25mm Rod Template 50mm Rod Pusher Rod Rotation Wrench Rod Holder, 5.5mm Rod Bender Compressor Rod Holder Forceps Break Off Iron Distractor Nuts Screwdriver, for L8 Monoaxial Screwdriver, for L8 Multiaxial Screwdriver, for L8 Nuts Holder, elastic, for L8 Counter Torque, for L8 Break Off Protector, for L8 Rod Push Forceps, for L8 Reduction Forceps, for L8 Marker Inserter Marker, left Marker, right Bending Iron, left Bending Iron, right Ratchet Handle Anterior Distraction Rod, for L8 Crosslink Hooks Holder L8 Spine implants Case 030050 03 023 024 040 020053 020063 0203 0380 038 023 0222 0230 0250 0262 0240 0370 0272 0633 0642 0652 06200 0663 0603 0620 0690 0550 0552 0553 0580 058 030060 0680 0340 07060 : Customer Made 2 *
Implants Implants L8 L8 32237025 32237030 32237035 32237040 32237045 32237050 32237055 32238025 32238030 32238035 32238040 32238045 32238050 32238055 32239025 32239030 32239035 32239040 32239045 32239050 32239055 32240030 32240035 32240040 32240045 32240050 32240055 32240060 3224030 3224035 3224040 3224045 3224050 3224055 3224060 32242030 32242035 32242040 32242045 32242050 32242055 32242060 32243030 32243035 32243040 32243045 32243050 32243055 32243060 32228030 32228035 32228040 32228045 32228050 32229030 32229035 32229040 32229045 32229050 32230035 32230040 32230045 32230050 32230055 3223035 3223040 3223045 3223050 3223055 32232035 32232040 32232045 32232050 32232055 Product Code Product Description Material Remark Product Code Product Description Material Remark * : Customer Made * : Customer Made 3 4
Implants Implants Product Code Product Description Material Remark Product Code Product Description Material Remark 3280 32820 32830 32840 32850 32860 32870 32880 328200 328220 328240 328250 328260 328280 328300 328320 328340 328350 328360 328380 328400 328420 32244030 32244035 32244040 32244045 32244050 32245030 32245035 32245040 32245045 32245050 32246035 32246040 32246045 32246050 32246055 32247035 32247040 32247045 32247050 32247055 32248035 32248040 32248045 32248050 32248055 40mm Crosslink Bar 55mm Crosslink Bar 60mm Crosslink Bar 65mm Crosslink Bar 70mm Crosslink Bar 75mm Crosslink Bar 80mm Crosslink Bar 32235040 32235055 32235060 32235065 32235070 32235075 32235080 L8 Nuts for all L8 screws Crosslink Hooks 32233000 328050 328060 328070 328080 328090 32800 5 * : Customer Made * : Customer Made 6