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Surgical Technique


Contents The Expedium™ Spine System is

Expedium™ Polyaxial Screws

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Expedium™ Approximation Screws

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Expedium™ Hooks

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Expedium™ Translation Hooks

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a comprehensive thoracolumbar spinal system that offers posterior

Expedium™ Dual Innie Polyaxial Screws

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clinical solutions designed around the basic principles of speed, security and simplicity. The Expedium™ Spine System is indicated for the treatment of significant mechanical instability or deformity of the spine requiring fusion with instrumentation. These conditions are significant mechanical instability or deformity of the thoracic, lumbar or sacral spine secondary to degenerative spondylolisthesis with objective evidence of neurologic impairment, fracture, dislocation, scoliosis, kyphosis, spinal tumour or failed previous fusion (pseudoarthrosis).


Expedium™ Polyaxial Screws

Pedicle Screw Preparation

Pedicle preparation is performed utilising a selection of

Expedium™ Polyaxial Screws have a fully threaded, tapered

Awls, Pedicle Probes, Ball Tip Feelers and Bone Taps.

tip minimising the need to tap. However, taps are provided

Probes and Bone Taps are marked to indicate the

for surgeon preference.

appropriate length for Polyaxial Screw selection.

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Polyaxial Screwdriver Application

Step 1

Step 3

Place the tip of the Polyaxial

Step 2

Thread the Screwdriver into the

Screwdriver into the head of the

head of the screw, making sure

screw.

the screw shank is straight.

Slide the Screwdriver sleeve down into the head of the screw.

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Expedium™ Polyaxial Screws

Step 4

To adjust the screw height, rotate the outer sleeve counterclockwise.

Step 5

To disengage, retract the Screwdriver sleeve and unthread the driver from the head of the screw.

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Quick-Connect Screwdriver Application

Step 1

Place T20 Driver tip into the T20

Step 2

feature in the screw shank.

Slide the Screwdriver sleeve down and thread into the head of the screw.

Step 3

To adjust the screw height, rotate the handle counter-clockwise.

Step 4

To disengage the screw, unthread the Screwdriver sleeve.

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Expedium™ Polyaxial Screws

Polyaxial Screw Insertion

Monoaxial Screws Monoaxial Screws may be used according to surgeon preference. Polyaxial Screws are inserted using the Polyaxial

Head Adjuster

Screwdriver.

The Polyaxial Screw head can be adjusted and positioned using the Head Adjuster.

Note: See Polyaxial Screwdriver application (Page 3).

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Rod Insertion

Choose the appropriate length rod with the desired lordosis. Place the rod into the Polyaxial Screw heads.

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Expedium™ Polyaxial Screws

Single Innie Insertions

Alignment Guide

Using the Single Innie Inserter, pick up an Innie from the caddy. The Single Innie will self-retain on the inserter. Align with the screw head.

Thread into the screw head to capture the rod.

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Rod Capture

Capture the rod into the implant by inserting the Single Innie. The Alignment Guide can be used to help position the head and reduce the chance of cross-threading (see page 8).

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Expedium™ Polyaxial Screws

Rod Reduction – Clip-On Rod Approximator

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Attach the Clip-On Device to the TOP NOTCH™ feature at

Load the Single Innie from the caddy onto the combination

the top of the Polyaxial Screw head.

Reduction Tube/SI Inserter.


Rod Reduction – Clip-On Rod Approximator

Thread the Reduction Tube into the Clip-On Device to fully

Capture the rod by threading the Single Innie into the

seat the rod.

implant head until tight. Remove the Reduction Tube and Clip-On Device.

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Expedium™ Polyaxial Screws

Rod Reduction Using the Squeeze-Down Rod Approximator

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Attach the Squeeze-Down Device to the TOP NOTCH™

Load the Single Innie from the caddy and thread into the

feature at the top of the Polyaxial Screw head.

implant head through the guide in the Squeeze-Down Device.

Fully seat the rod by squeezing the handles together.

Disengage the device from the TOP NOTCH™ feature.


Compression / Distraction

Once the rod has been captured into all of the Polyaxial Screw heads, Compression and Distraction manoeuvres can be easily accomplished by simply loosening and tightening the Single Innie.

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Expedium™ Polyaxial Screws

Final Tightening

T-Handle Torque Wrench T-Handle Torque Wrench set to 9 Nm (80 in-lb). Final tightening is performed with the Hexlobe Shaft inserted

The Stabiliser is then slid down over the head of the

into the T-Handle Torque Wrench, set to 9 Nm (80 in-lb).

Polyaxial Screw and onto the rod. The Stabiliser handle can be held either perpendicular or parallel to the rod.

The shaft is inserted through the Rod Stabiliser and into the Single Innie.

The T-Handle is rotated clockwise until it clicks and resistance is no longer evident.

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Expedium™ Approximation Screws

Reduction

Tab Keys or Rings are placed on the extended implant flanges to prevent distortion during rod introduction.

Tab Key Placement

Tab Key

Tab Ring

Tab Ring Placement

The Expedium™ Polyaxial Approximation Screw

The Approximation Screw has removable tabs that allow

complements the innovative design of the existing

the surgeon to approximate the spine to the desired sagittal

Expedium™ Polyaxial Screw range. These screws

or axial profile.

help to address, correct and stabilise difficult anatomic variations.

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Expedium™ Approximation Screws

Reduction

Tab Remover

Following the corrective reduction manoeuvres, a Structural

After insertion of the Structural Interbody Fusion Device,

Interbody Fusion Device may be inserted via a PLIF or TLIF

compression and final tightening of the Polyaxial Screws

procedure, if required.

is performed. After final tightening, Approximation Tabs may be removed using the Approximation Tab Remover (see side panel).

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Expedium™ Hooks

Hook Preparation Instruments

There are four possible hook placement sites in the spine:

The facet is entered with the Pedicle Elevator.

pedicle, transverse process, Supra Lamina and Infra Lamina. The first site is the pedicle. Pedicle Hooks are placed in the thoracic spine via the facet joint. The direction for the Pedicle Hooks is always cephalad. The facet of the appropriate level is identified and the capsule is removed. The cartilage on the inferior articular process of the next distal level should be visualised.

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Expedium™ Hooks

The Pedicle Hook is inserted with either the Compact Hook

The second site is the transverse process. This is usually

Holder or the Hook Holding Forceps and seated flush

used in conjunction with a Pedicle Hook either at the same

against the facet and the pedicle.

level or one level distal. A Wide Blade Lamina Hook or Angled Body Lamina Hook is recommended for this site. An Elevator is used to dissect around the superior surface of the transverse process.

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The Wide Blade Lamina Hook or Angled Body Lamina

The third possible site is the Supra Lamina. The Reduced

Hook is then placed in the required position.

Distance Lamina Hook or the Narrow Blade Lamina Hook is recommended for this site. The direction is always caudal. These hooks may be combined with other hooks to produce a claw construct. The ligamentum flavum is divided in the midline and excised.

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Expedium™ Hooks

The inferior edge of the next proximal lamina is removed to

The appropriate lamina hook is then placed using the Hook

The fourth possible site is the infra lamina. The Angled

permit the intra canal placement of the hook.

Holding Forceps until well seated against the lamina.

Blade Hook is recommended for this site in the lumbar spine. The direction is always cephalad. Similar to the Supra Laminar hooks, the ligamentum flavum is divided in the midline and excised.

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The inferior edge of the selected lamina is removed to

The Angled Blade Lamina Hook is then placed using the

permit intra canal placement of the hook.

Hook Holding Forceps until well seated against the lamina.

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Expedium™ Translation Hooks

The Expedium™ Translation Hook is designed to further

Place the contoured rod into the spine anchors. Fully seat

complement the innovative design of the existing

and secure the rod by introducing the Single Innie. The

Expedium™ hook range. These hooks help to address,

extended tabs of the Translation Hooks provide a means

correct and also stabilise difficult anatomic variations.

of capturing a rod that may have crossed the midline and

The Translation Hook is designed with removable tabs that

would otherwise be out of reach of the anchor.

allow the surgeon to approximate the spine to the desired sagital or axial profile. Translation Hooks are most commonly placed at the apex of the concavity. Contour the rod to match the required spinal contours in the sagital plane.

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Advance the Single Innie within the flanged hook to bring the spinal anchors to the rod to correct the scoliosis.

Distraction is applied as the rod is translated into the hooks using the Single Innie.

Once the rod is fully seated, the Approximation Tabs can be removed using the Tab Remover. Additionally, Cross

Note: Minimal distraction between Translation Hooks should

Connectors can be used to add structural rigidity to the

be utilised during translation to prevent hook dislodgement.

construct.

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Expedium™ Dual Innie Proximal Screws

Pedicle Screw Preparation

Pedicle preparation is performed utilising a selection

Polyaxial Screws have a fully threaded, tapered tip minimising

of Awls, Pedicle Probes, Ball Tip Feelers and Bone Taps.

the need to tap. However, taps are provided for surgeon

Probes and Bone Taps are marked to indicate the

preference.

appropriate length for Polyaxial Screw selection.

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Polyaxial Screw Insertion

Polyaxial Screws are inserted using the DI Polyaxial

The Polyaxial Screw head can be adjusted and positioned

Screwdriver.

using the Head Adjuster.

Note: Polyaxial Screwdriver application is similar to the method described earlier (Page 3).

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Expedium™ Dual Innie Proximal Screws

Rod Insertion

Choose the appropriate length rod with the desired lordosis. Place the rod into the Polyaxial Screw heads.

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Dual Innie Insertions

Using the Dual Innie Inserter, pick up a Dual Innie from the

Align with the screw head.

caddy. The Dual Innie will self-retain on the inserter. The Alignment Guide can be used to help position the head and reduce the chance of cross-threading (see page 8). Thread into the screw head to capture the rod.

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Expedium™ Dual Innie Polyaxial Screws TLIF using Expedium™ Dual Innie Polyaxial Screws

Screw shank angulation can be locked by tightening the

Secure the rod to the proximal screw on each side of

outer blue setscrew of the closure mechanism using the

the spine by tightening the inner setscrew with the X-25

Cannulated T-Handle Intermediate Tightener. The X-25

Hexlobe driver.

Hexlobe driver should be used to center the Intermediate Tightener.

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Distraction along the entire vertebral body is achieved when

Distraction is held by locking the remaining inner setscrews

the polyaxial mechanism is locked for all screws.

with the X-25 Hexlobe driver.

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Expedium™ Dual Innie Polyaxial Screws

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With the distracted disc space temporarily held open,

Placement of the Structural Interbody Fusion Device can be

the intervertebral disc can be safely removed.

checked visually and, if appropriate, radiologically.


Parallel compressive forces can be applied to secure the

Note: The polyaxial mechanism can be released by

Structural Interbody Fusion Device. Simply loosen the

loosening the blue outer setscrew to ensure good

appropriate inner setscrew and tighten after Compression

apposition between the implant and the adjacent endplates.

is accomplished.

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Expedium™ Dual Innie Proximal Screws Final Tightening

Final tightening of the outer setscrew is performed with

Final tightening of the inner setscrew is performed with

the Dual Innie Tightener.

the Hexlobe shaft inserted into the T-Handle Torque Wrench, set to 9 Nm (80 in-lb).

T-Handle Torque Wrench

The shaft is inserted through the Rod Stabiliser and into

T-Handle Torque Wrench set to 9 Nm (80 in-lb).

the outer setscrew.

The shaft is inserted through the Rod Stabiliser and into the internal setscrew.

The Stabiliser is then slid down over the head of the Polyaxial Screw and onto the rod. The Stabiliser handle

The Stabiliser is then slid down over the head of the

can be held either perpendicular or parallel to the rod.

Polyaxial Screw and onto the rod. The Stabiliser handle can be held either perpendicular or parallel to the rod.

The T-Handle is rotated clockwise until tight. The T-Handle is rotated clockwise until it clicks and resistance is no longer evident.

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DePuy Spine™ is a joint venture with Biedermann Motech GmbH. This publication is not intended for distribution in the USA. DePuy Spine™, Expedium™ and TOP NOTCH™ are trademarks of DePuy Spine, Inc. MOSS® and MOSS® Miami are registered trademarks of Biedermann Motech, GmbH. © 2005 DePuy International Ltd. All rights reserved. Cat No: 9082-12-000


EXPEDIUM SURGICAL TECHNIQUE