Issuu on Google+

Lateral Access & Interbody Fusion System

Designed for: • Direct visualization of the psoas muscle • Clear fluoroscopic views • Muscle-splitting psoas retraction Including: • Streamlined instrumentation • Comprehensive portfolio of implants ™

Now featuring the Reveal™ Retractor


Blank Page


direct visualization Controlled retraction in the anterior/posterior plane via two independent blades

Inner Sleeve to maintain tissue retraction close to surgical site.

Reveal™ Radiolucent Tubular Retractor •

Designed to minimize tissue incursion for a safe working channel.

Available in three heights: 100, 120, 140mm.

Reveal™ Distal Psoas Retractor Blades •

Self-anchoring negating the need for securing pins or shims.

Available in five heights: 120, 140, 160, 180, 200mm.


seeing the possibilities

with direct and clear fluoroscopic visualization

Direct Visualization

Direct visualization of the psoas muscle

Psoas muscle after Interbody placement *

Fluoroscopic Visualization

Lateral view with Reveal™ retraction system in place

*Example from one clinical case study - Results may vary

A/P view with Reveal™ retraction system in place


Table of Contents

Patient Positioning

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Operating Room Setup

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Anatomy Identification and Marking

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Dilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Reveal Tubular Retractor Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12

Reveal Psoas Retractor Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17

Discectomy and Endplate Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . .

21

Implant Measurement

. . . . . . . . . . . . . . . . . . . . . . . . . . .

24

Interbody Cage Insertion

. . . . . . . . . . . . . . . . . . . . . . . . . . .

26

Psoas Retractor Removal

. . . . . . . . . . . . . . . . . . . . . . . . . . .

30

VEO Implants

Closure . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1 . . . . . . . . . . . . . . . . . . . . . . . . . . .

32

Lateral Access & Interbody Fusion System . . . . . . . . . . . . . . . . . . . . . . . . . . .

34

System Layout

. . . . . . . . . . . . . . . . . . . . . . . . . . .

38

| VEO Surgical Technique Manual |

5


Patient Positioning •

Place the patient in a lateral decubitus position on a radiolucent breaking table.

Stabilize and secure the patient to the table (Figure 1A) with surgical tape in the following places: A. Just below the iliac crest B. Over the thoracic region C. From the iliac crest to the knee, then secured to the table D. From the table to the knee, past the ankle, then secured back to the table.

FIGURE 1A (above) Patient positioned and secured to the table FIGURE 1B Patient positioned so iliac crest is over table break

Operating Room Setup •

Once patient is positioned, attach the Rail Clamp for the Table Mounted Retractor Arm to the side of the table.

Note:

6

When targeting the L1/L2 or L2/L3 disc space, the table break should be placed above the iliac crest.

When targeting the L3/L4 or L4/L5, the table break should be placed at the iliac crest.


Anatomy Identification and Marking Obtain true A/P and lateral images of the targeted disc (Figure 2 and 3).

FIGURE 2 Initial A/P image

Note:

FIGURE 3 Initial Lateral image

Adjust the patient’s position, taking into account spinal pathology and spinal positioning so that lateral images can be taken with the c-arm positioned at approximately 90°.

The exact position of the c-arm should be noted for subsequent imaging.

| VEO Surgical Technique Manual |

7


Locate the middle of the targeted disc space and draw an anterior-to-posterior line on the skin (Figure 4) to represent the centerline of the disc space.

Add hash marks to the anterior-to-posterior line to indicate the front, back and midline of the disc space.

FIGURE 4 Skin markings for incision

Note:

8

It may be useful to use a blunt k-wire or other instrument on top of the skin to determine the location of the markings with fluoroscopy.


Fixate the Radial Table Clamp (Figure 5A) for the Table Mounted Retractor Arm on the bed on the anterior side of the patient prior to draping.

Drape and prepare the surgical site in typical fashion.

Attach Table Mounted Retractor Arm (Figure 5B) to table after patient is draped.

FIGURE 5B Table Mounted Retractor Arm

| VEO Surgical Technique Manual |

FIGURE 5A Radial Table Clamp

9


Access •

Make a 35-40mm anterior-to-posterior incision over the center marking of the disc space.

Using finger or blunt dissection, open the incision down to fascia over the external oblique muscles (Figure 6).

Incise fascia in line with the muscle fibers.

Continue blunt or finger dissection through the muscle layers in the retroperitoneal space to the psoas muscle.

FIGURE 6 Finger dissection

Note:

10

A transverse, vertical or oblique skin incision can be made depending on preference.

Dissect carefully to avoid perforation of the peritoneum.

If possible, palpate the psoas muscle with finger.


Dilation •

Insert Dilator A into the incision and advance it down to the surface of the psoas muscle. Use the dilator holder (Figure 7B) to confirm placement of the tip of the dilator with a lateral fluoroscopy image, if desired.

Sequentially dilate the soft tissue with Dilator B by placing it over Dilator A and working it down the incision to the surface of the psoas.

Repeat the same action with Dilator C (Figure 7A).

Confirm placement of the tip of the dilators with a lateral and A/P fluoroscopy image, if desired.

Use the three markings (100mm, 120mm and 140mm) on the side of Dilator C (Figure 7A) to select the appropriate length Tubular Retractor. •

A

A

Dilator A

B

Dilator B

C

Dilator C

B

C

FIGURE 7A Dilators A, B and C

The value of the marking (100mm, 120mm and 140mm) closest to the skin corresponds to the length of the Tubular Retractor that should be selected.

Note:

A radiolucent dilator holder is available to aid targeting with the A Dilator.

The tip of the dilator should rest on the surface of the psoas muscle to maintain trajectory.

The orientation of the dilator’s flat side should face cephalad/caudal

| VEO Surgical Technique Manual |

FIGURE 7B Dilator A Holder

11


Reveal Tubular Retractor Insertion •

Insert the selected Tubular Retractor (Figure 8) over Dilator C and advance it down to the psoas muscle with the connecting arm pointing toward the Table Mounted Retractor Arm.

Secure the Tubular Retractor with the Table Mounted Retractor Arm (Figure 9).

Remove Dilators A, B and C from the Tubular Retractor. FIGURE 8 Tubular Retractor

FIGURE 9 Tubular Retractor inserted over the dilators

12


Take a lateral fluoroscopic image (Figure 10) to confirm placement of the Tubular Retractor.

Plug Fiber Optic Cable into a light source (see manufacturers instructions for light source).

Attach Stadium Mount Light to Fiber Optic Cable.

Attach the Stadium Mount Light to the Tubular Retractor (Figure 11) and visualize the surface of the psoas muscle (Figure 12).

FIGURE 11 Stadium Mount Light attached to Tubular Retractor Note:

FIGURE 12 View of psoas muscle through the Tubular Retractor

The Tubular Retractor should be centered over the targeted disc space. If it is not centered, adjust the Tubular Retractor so that it is directly over the disc space.

The top of the Tubular Retractor offers four separate places to attach the Stadium Mount Light.

| VEO Surgical Technique Manual |

FIGURE 10 Lateral image confirming placement of Tubular Retractor

13


While visualizing the psoas muscle and associated nerves, utilize neuromonitoring (see manufacturers instructions) to identify and locate the positioning of the nerves.

Using direct visualization, gently split the psoas using the Penfield Dissector (Figures 13-15) or Cobb Dissector (Figure 16A & 16B) avoiding nerves as needed.

Markings on Cobb and Penfield Dissectors may be used to measure psoas height in order to choose appropriate Psoas Retractor Blades (Figure 17).

FIGURE 13 View of Penfield Dissector splitting the psoas muscle

FIGURE 14 Straight Penfield Dissector

Note:

14

FIGURE 15 Angled Penfield Dissector

A Frazier suction tube is provided in the VEO Access Trays


FIGURE 16A & 16B Straight and Angled Cobb Dissectors

200 180 160 140 120

FIGURE 17 Close-up of markings on dissection instruments

| VEO Surgical Technique Manual |

The markings represent Psoas Retractor Blade heights starting at the distal end a t 120mm and increasing by 20mm to 200mm

15


Gently insert the 90° Nerve Retractor (Figure 18) along side the Dissector to maintain the psoas muscle split.

FIGURE 18 90° Nerve Retractor

Insert the Guide Pin (Figure 19) through the split along side of the Nerve Retractor 5-10mm into the center of the disc space.

FIGURE 19 Guide Pin •

Remove the Nerve Retractor from the incision.

Take a lateral image to verify that the Guide Pin is in the center (anterior to posterior) of the disc space.

Take an A/P fluoroscopic image and verify the Tubular Retractor is centered over the Guide Pin.

Carefully remove the Guide Pin.

Note:

16

The use of the Nerve Retractor is optional. A Penfield or Cobb Dissector may also be used.

The Guide Pin only needs to be inserted enough to hold it in place.

The Guide Pin, when centered in the disc space, should also be centered in the Tubular Retractor.

If needed, loosen the Table Mounted Retractor and adjust the Tubular Retractor so that the sides of the Retractor are perpendicular with the muscle fiber.


Reveal Psoas Retractor Insertion •

Insert a 90° Nerve Retractor through the split and retract the muscle posteriorly.

Choose the length of the Psoas Retractor (Figure 20A), based on graduations from Cobb/Pennfield, and attach corresponding Psoas Retractor Handle (Figure 20B) by sliding it firmly into the slot on the blade. Insert the first Psoas Retractor (Figure 20C) through the split and retract the psoas muscle anteriorly.

While the psoas muscle is retracted, maintain contact with the annulus and the vertebral body (Figure 20C).

FIGURE 20B Psoas Retractor Handle

FIGURE 20D Second Psoas Retractor Blades Inserted into Muscle

Maintain gentle downward pressure on the Psoas Retractor and remove the 90° Nerve Retractor.

A second Psoas Retractor should be inserted to retract the psoas posteriorly while maintaining the tip of both Retractors in contact with the annulus (Figure 20D).

Note:

Psoas Retractors are available in the following lengths: 120, 140, 160, 180, 200mm.

Ensure the Retractors are fully seated onto bone and minimal tissue has crept into working space. Should tissue be seen in the working space, sweep the tissue out of the way with a Penfield or Suction Tube or remove the Retractor and reset.

The Retractors should be directly over the disc space and perpendicular with the endplates.

| VEO Surgical Technique Manual |

FIGURE 20C First Psoas Retractor Inserted into Muscle

FIGURE 20A Psoas Retractor Blade

17


•

Maintain gentle pressure on both the anterior and posterior Psoas Retractors and insert the Reveal Inner Sleeve (Figure 21) between the two Retractors.

•

Retract the psoas with the Psoas Retractor Handles and gently advance the Inner Sleeve (Figure 22A) down the Tubular Retractor, under direct visualization, until the rim of the Sleeve is against the rim of the Tubular Retractor (Figure 22B).

FIGURE 21 Inner Sleeve

18

FIGURE 22A Insertion of Inner Sleeve Between Psoas Retractor Blades


FIGURE 22D Reveal Retractor Insertion Completed

FIGURE 22C Remove Psoas Retractor Handles

| VEO Surgical Technique Manual |

FIGURE 22B Inner Sleeve Insertion Completed

19


Take an A/P and a lateral fluoroscopic image to confirm Psoas Retractor placement.

Remove Psoas Retractor Blade handles (Figure 22C).

A

Tubular Retractor with tantalum markers

B

Psoas Retractor

A

B

FIGURE 23 Clear AP view of the disc space

FIGURE 24 Clear lateral view of the disc space

20


Discectomy and Endplate Preparation •

Incise the annulus and perform an annulotomy with a scalpel or bovie.

Use a Ronguer or other instrumentation to start the discectomy.

Connect the Paddle Shaver (Figure 25) to the Quick-Connect T-Handle (Figure 26) by pulling the T-Handle collar up toward the handle. With the collar up, insert the Shaver and release the collar. Ensure the instrument is fully seated before use by gently pulling down on it.

Under A/P fluoroscopy, insert a Paddle Shaver or Cobb Elevator across the disc space, parallel to the endplates.

Gently rotate the instrument 90° to release the fibers of the disc.

Note:

FIGURE 26 T-Handle

Discectomy and endplate preparation surgical technique will vary by surgeon.

Start with a smaller sized Paddle Shaver and work up to the larger ones.

Paddle Shavers may also be used to determine the approximate disc height and length for trial and cage placement.

| VEO Surgical Technique Manual |

FIGURE 25 Paddle Shaver - The holes in the shaver represent cage lengths starting at the distal end at 40mm and increasing by 5mm to 60mm.

21


Perform the discectomy and endplate preparation. A variety of instruments, which may include Cup Curettes, Ring Curettes, Ronguers, Rasps or other appropriate discectomy tools may be used (Figures 27-34).

FIGURE 27 Angled Ring Curette

FIGURE 28 Straight Ring Curette

FIGURE 29 Angled Cup Curette

FIGURE 30 Endplate Rasp

Note:

22

Discectomy and endplate preparation instruments are chosen based upon preference.

Take care when passing sharp instruments in and out of the operative site.


FIGURE 31 Pituitary Ronguer

| VEO Surgical Technique Manual |

FIGURE 32 6mm Kerrison Rongeur

23


Implant Measurement •

Interbody Trials are available to measure the height and width of the disc space so the appropriate interbody cage can be selected.

Insert the Interbody Trial into the disc space.

FIGURE 33 Interbody Trial

FIGURE 34 Interbody Trial connection

Using a mallet as needed, gently advance the Interbody Trial into the disc space until the tip of the Interbody Trial is at the contralateral edge of the vertebral body.

Take a lateral fluoroscopic image to confirm placement of Interbody Trial.

The Interbody Trials contain grooves and holes to fluoroscopically determine the width of the disc space. The groove and hole closest to the tip denotes the length of a 40mm long Interbody Cage. The remaining grooves are 10mm apart and denote the available lengths of Interbody Cages up to 60mm in length.

Attach the Reverse Slap Hammer (Figure 35A) by sliding the catch of the Reverse Slap Hammer over the grove of the Interbody Trial, and then remove the Interbody Trail. (Figure 35B & 35C)

Note:

24

When using the Lordotic Interbody Trials, ensure they are inserted properly by utilizing the markings with the “A” mark facing anterior and the “P” mark facing posterior.

Take care not to over-distract the disc space with the Interbody Trial.


FIGURE 35A Reverse Slap Hammer

FIGURE 35C Reverse Slap Hammer connected to Interbody Trial

| VEO Surgical Technique Manual |

FIGURE 35B Attaching Reverse Slap Hammer to Interbody Trial

25


Interbody Cage Insertion •

Select the desired Interbody Cage.

Attach the Interbody Cage to the Cage Inserter (Figures 38 to 39D).

FIGURE 36 Interbody Cage (0° Lordosis)

FIGURE 37 Interbody Cage (6° Lordosis)

FIGURE 38 Cage Inserter

26


FIGURE 39A Confirm collar is in unlocked position.

FIGURE 39B Align cage notch with Cage Inserter prong feature.

FIGURE 39D Rotate collar (Shown in green) 90° to locked position. Rotate retention knob (Shown in red) to finger tight.

Note:

•

If the collar (green) will not turn, the retention knob (red) is either too loose or too tight.

| VEO Surgical Technique Manual |

FIGURE 39C Place cage onto Cage Inserter.

27


Pack graft material into the reservoir of the Interbody Cage and insert into the disc space.

Take A/P and lateral fluoroscopic images to verify placement prior to releasing the Cage Inserter from the Interbody Cage.

FIGURE 40 Insertion of Interbody Cage into disc space.

A The position of the center marker should

align with the spinous process of the level above and below the disc space. B The close alignment of markers indicates

the Interbody Cage is in the proper position.

A B

FIGURE 41 A/P fluoro image showing Interbody Cage placement

Note:

28

It is important to pack the Interbody Cage after it is attached to the Cage Inserter as attachment requires rotating the Interbody Cage, which may dislodge the graft material.

Verify orientation of the Interbody Cage throughout delivery.

When using the Lordotic Interbody Cages, make certain they are inserted properly by ensuring the taller side of the cage is placed facing anterior and the shorter side facing posterior. When using the Lordotic Implants, make certain they are inserted properly by ensuring the handle of the cage inserter is pointed to the posterior of the patient. This will ensure the taller side of the cage is placed facing anterior and the shorter side facing posterior. VEO Lateral Access & Interbody Fusion System is designed to be used with autogenous graft.


Release the Interbody Cage from the Cage Inserter. •

Maintain gentle downward pressure on the Inserter.

Rotate retention knob (red) 7 to 8 turns only.

Rotate collar (green) 90° to the unlock position.

Remove Cage Inserter straight up from Cage without turning handle.

Obtain A/P and lateral images to confirm final placement.

Note:

A Cage Tamp is available if the Interbody Cage needs to be advanced in the disc space.

| VEO Surgical Technique Manual |

FIGURE 42

29


Psoas Retractor Removal •

Gently grasp and pull up on the rim of the Inner Sleeve Handle.

Continue to pull up until the Inner Sleeve is out of the Tubular Retractor.

Remove each Psoas Retractor from the surgical site one at a time.

FIGURE 43 Internal Retractor being removed from the operative site

Release the connection between the Table Mounted Retractor Arm and Tubular Retractor by turning the wing nut counter-clockwise.

Remove the Tubular Retractor from the incision.

Note:

30

VEO was designed to be used with supplemental fixation that is cleared for use in the lumbar spine


Closure Obtain final A/P and lateral images.

Close the incision in the typical fashion.

FIGURE 44 Final A/P

FIGURE 45 Final lateral

| VEO Surgical Technique Manual |

31


VEO® Implants 6° Lordotic Cages

0° Lordotic Cages

32

Part #

Length (mm)

Width (mm)

Height (mm)

Part #

Length (mm)

Width (mm)

Height (mm)

22-0475-01

40

22

7.5

22-0476-01

40

22

8

22-0475-02

45

22

7.5

22-0476-02

45

22

8

22-0475-02

50

22

7.5

22-0476-03

50

22

8

22-0475-04

55

22

7.5

22-0476-04

55

22

8

22-0475-05

60

22

7.5

22-0476-05

60

22

8

22-0466-01

40

22

9

22-0468-01

40

22

9

22-0466-02

45

22

9

22-0468-02

45

22

9

22-0466-03

50

22

9

22-0468-03

50

22

9

22-0466-04

55

22

9

22-0468-04

55

22

9

60

22

9

22-0466-05

60

22

9

22-0468-05

22-0466-07

40

22

11

22-0468-07

40

22

11

22-0466-08

45

22

11

22-0468-08

45

22

11

22-0466-09

50

22

11

22-0468-09

50

22

11

22-0466-10

55

22

11

22-0468-10

55

22

11

60

22

11

22-0466-11

60

22

11

22-0468-11

22-0466-13

40

22

13

22-0468-13

40

22

13

22-0466-14

45

22

13

22-0468-14

45

22

13

22-0466-15

50

22

13

22-0468-15

50

22

13

22-0466-16

55

22

13

22-0468-16

55

22

13

22-0466-17

60

22

13

22-0468-17

60

22

13

22-0466-19

40

22

15

22-0468-19

40

22

15

22-0466-20

45

22

15

22-0468-20

45

22

15

22-0466-21

50

22

15

22-0468-21

50

22

15

22-0466-22

55

22

15

22-0468-22

55

22

15

22-0466-23

60

22

15

22-0468-23

60

22

15


Part #

Length (mm)

Width (mm)

Height (mm)

Part #

Length (mm)

Width (mm)

Height (mm)

22-0489-01

40

17

7.5

22-0490-01

40

17

8

22-0489-02

45

17

7.5

22-0490-02

45

17

8

22-0489-03

50

17

7.5

22-0490-03

50

17

8

22-0489-04

55

17

7.5

22-0490-04

55

17

8

22-0489-05

60

17

7.5

22-0490-05

60

17

8

22-0467-01

40

17

9

22-0469-01

40

17

9

22-0467-02

45

17

9

22-0469-02

45

17

9

22-0467-03

50

17

9

22-0469-03

50

17

9

55

17

9

22-0467-04

55

17

9

22-0469-04

22-0467-05

60

17

9

22-0469-05

60

17

9

22-0467-07

40

17

11

22-0469-07

40

17

11

22-0467-08

45

17

11

22-0469-08

45

17

11

22-0467-09

50

17

11

22-0469-09

50

17

11

55

17

11

22-0467-10

55

17

11

22-0469-10

22-0467-11

60

17

11

22-0469-11

60

17

11

22-0467-13

40

17

13

22-0469-13

40

17

13

22-0467-14

45

17

13

22-0469-14

45

17

13

22-0467-15

50

17

13

22-0469-15

50

17

13

22-0467-16

55

17

13

22-0469-16

55

17

13

22-0467-17

60

17

13

22-0469-17

60

17

13

22-0467-19

40

17

15

22-0469-19

40

17

15

22-0467-20

45

17

15

22-0469-20

45

17

15

22-0467-21

50

17

15

22-0469-21

50

17

15

22-0467-22

55

17

15

22-0469-22

55

17

15

22-0467-23

60

17

15

22-0469-23

60

17

15

| VEO Surgical Technique Manual |

6째 Lordotic Cages

0째 Lordotic Cages

33


Blank Page

34


| VEO Surgical Technique Manual |

System Layout

35


Access Kit: Top Tray TR1 - 1105 PN 24 - 1005

A

A

36

1/2" Curved Cobb Elevator


Access Kit: Middle Tray TR1 - 1105 PN 24 - 1005

A B C

D

A

Dilator C

B

Dilator B

C

Dilator A

D

Dilator A Holder

E

100mm Tubular Retractor

F

120mm Tubular Retractor

G

140mm Tubular Retractor

H

Stadium Mount Light

E

F

G

| VEO Surgical Technique Manual |

H

37


Access Kit: Bottom Tray TR1 - 1105 PN 24 - 1005

A

B

38

A

Table Mounted Retractor Arm

B

Radial Table Clamp


| VEO Surgical Technique Manual |

Access Kit Tray 2: Top Tray TR1 - 1110 PN 24 - 1010

39


Access Kit Tray 2: Middle Tray TR1 - 1110 PN 24 - 1010

B A

A

40

A

Psoas Retractor Handle

B

Psoas Retractor Blades


Access Kit Tray 2: Bottom Tray TR1 - 1110 PN 24 - 1010

B

C

A

A

Guide Pins

B

90째 Nerve Retractors

C

Straight Cobb Dissector

D

Oblong Inner Sleeve

E

Angled Cobb Dissector

F

Angled Penfield Dissector

G

Frazier Suction Tube

H

Penfield Dissector

D

F

H

| VEO Surgical Technique Manual |

G E

41


Disc Preparation Kit: Top Tray TR1 - 1106 PN 24 - 1006 A

B

E

42

C

F

D

G

A

Pull Cup Curette

B

Angled Ring Curette

C

Push Cup Curette

D

Dual Sided Endplate Rasp

E

Straight Cup Curette

F

Straight Ring Curette

G

Angled Rake Curette


Disc Preparation Kit: Middle Tray TR1 - 1106 PN 24 - 1006

A

A

C

C

C

B

Bayonetted Scalpel

C

Paddle Shavers (7, 9, 11, 13, 15mm)

D

Ring Shavers (8, 10, 12, 14mm)

C

D

B

Quick Release T-Handle (x2)

D

D

D

| VEO Surgical Technique Manual |

C

A

43


Disc Preparation Kit: Bottom Tray TR1 - 1106 PN 24 - 1006

B

F

E

D

A

44

C

D

D

D

A

19mm Flat Cobb Elevator

B

16mm Flat Cobb Elevator

C

Osteotome (12mm)

D

Discectomy Broach (7, 9, 11, 13 mm)

E

Kerrison Rongeur (4, 6mm)

F

Pituitary Rongeur (4, 6mm)


22mm Implant & Instrument Kit: Top Tray TR1 - 1107 PN 24 - 1007

A

B

B

B

B

C

C

C

C

Trial T-Handle

B

6째 Lordosed Trials (8, 9, 11, 13, 15 mm)

C

0째 Lordosed Trials (7.5, 9, 11, 13, 15 mm)

C

| VEO Surgical Technique Manual |

B

A

45


22mm Implant & Instrument Kit: Middle Tray TR1 - 1107 PN 24 - 1007

B

C

D

E F

A

46

A

22mm Interbody Slides

B

Reverse Slap Hammer

C

Cage Tamp

D

Cage Removal Tool

E

22mm x 5mm Interbody Cage Distractor

F

Cage Inserter


22mm Implant & Instrument Kit: Bottom Tray TR1 - 1107 PN 24 - 1007 A

0째, 22mm Cage Caddy

B

6째, 22mm Cage Caddy

A

| VEO Surgical Technique Manual |

B

47


17mm Implant & Instrument Kit: Top Tray TR1 - 1109 PN 24 - 1009

B

A

48

C

D

E

A

17mm Interbody Slides

B

Reverse Slap Hammer

C

Cage Tamp

D

Cage Removal Tool

E

17mm x 5mm Interbody Cage Distractor

F

Cage Inserter

F


17mm Implant & Instrument Kit: Middle Tray TR1 - 1109 PN 24 - 1009

A

B

B

B

B

C

C

C

C

Trial T-Handle

B

6째 Lordosed Trials (8, 9, 11, 13, 15 mm)

C

0째 Lordosed Trials (7.5, 9, 11, 13, 15 mm)

C

| VEO Surgical Technique Manual |

B

A

49


17mm Implant & Instrument Kit: Bottom Tray TR1 - 1109 PN 24 - 1009

A

B

50

A

0째, 17mm Cage Caddy

B

6째, 17mm Cage Caddy


Blank Page


For more information, visit www.BaxanoSurgical.com

USA 110 Horizon Drive, Suite 230 Raleigh, NC 27615 Customer Service Tel: 866.256.1206 Fax: 910.332.1701

Authorized European Representative Indications For Use: The Baxano Surgical lateral Interbody Fusion device is indicated

for spinal fusion procedures in skeletally mature patients with degenerative disc disease (DDD) at one or two contiguous levels from L2-S1. DDD is defined as discogenic back pain with degeneration of the disc confirmed by patient history and radiographic studies. These DDD patients may also have up to Grade 1 spondylolisthesis or retrolisthesis at the involved level(s). These patients should have had six months of non-operative treatment. The Baxano Surgical Lateral Interbody Fusion Device is designed to be used with autogenous graft and supplemental spinal fixation that is cleared for use in the lumbar spine.

A

BaxanoSurgical.com MKT - 06640 US & Foreign Patents Applied For

Medpass International Limited Windsor House, Barnett Way Barnwood, Gloucester GL4 3RT, UK Tel/Fax: +44 (0) 1 452 619 2227 Baxano Surgical, VEO and Reveal are trademarks or registered trademarks of Baxano Surgical, Inc. Š Copyright Baxano Surgical Inc. 2004-2013. All Rights Reserved.


Veo technique manual mkt06640 reva1