Zimmer Biomet Avenue T Surgical Technique Manual Download Page 1 | Manualshive

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Avenue

®

T

TLIF Cage

Thoracolumbar Solutions

Surgical Technique Guide

erteBRIDGE

®

P L A T I N G T E C H N O L O G Y

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Summary of Contents for Avenue T

Page 1: ...Avenue T TLIF Cage Thoracolumbar Solutions Surgical Technique Guide erteBRIDGE P L A T I N G T E C H N O L O G Y with ...

Page 2: ...2 Avenue T TLIF Cage Surgical Technique 2 VerteBRIDGE Plating is the integrated fixation designed specifically for the Avenue T cage ...

Page 3: ... techniqueusedineachcasewilldependon thesurgeon smedicaljudgmentasthebest treatmentforeachpatient Resultswillvary basedonhealth weight activityandother variables Notallpatientsarecandidates forthisproductand orprocedure Patient Positioning 4 Facetectomy and Disc Space Preparation 5 Distraction 6 Discectomy and Endplate Preparation 7 Implant Size Selection 8 Cage Preparation 9 Implant to Cage Holde...

Page 4: ...l Technique Guide STEP 1 Placethepatientintheproneorknee chestpositionona radiolucentoperatingtable Adjustthetable asneeded sothattheC ArmprovidestrueA Pimageswhenat90 andtruelateralimagesat0 Figure 1 OR layout PATIENT POSITIONING ...

Page 5: ...ts Nerverootretractors 6and10mm maybeusedto protectsurroundingnervestructures Note Facet resection is not mandatory if the approach allows sufficient access for the discectomy Identifythedesireddiscandstartdiscresectionusing ascalpel Performthediscectomyusingthesurgeon s preferredtechniqueandinstruments e g cobbs pituitary rongeurs orcurettes Figure2 FACETECTOMY AND DISC SPACE PREPARATION Figure 2...

Page 6: ...sistent with the disc heights of the adjacent levels Figure3 Note Proper distraction is required to achieve and maintain desired disc height Complete a thorough discectomy to ensure that the proper implant size is chosen 0 paddle distractors in 6 and 7mm heights do not refer to an available cage size in the system and are provided for initial distraction Figure 3 Distraction DISTRACTION ...

Page 7: ...aightand orangledrightorleftcurettes Figures4b 4c Note Angled curettes can be used to complete the resection in areas of reduced access or to clear an area for additional bone graft insertion Caution Do not use shavers for distraction of the interbody space Caution Endplate preparation should result in vascularization between the endplate and bone graft without weakening the cortical bone Figure 4...

Page 8: ... oversizing the implant Confirm the position of the paddle distractor or trial using fluoroscopy A P View Lateral coverage and rotational position the more visible the paddle hole the more rotation in the axial plane Figure 5d Lateral View Length height lordosis and anteroposterior positioning the posterior edge of the cage should end 2 to 5mm away from the posterior vertebral walls Once the prope...

Page 9: ... The graft fusion chamber must be filled with allograft or autograft Place the cage in the graft support and lock the cage by turning the graft support knob Compact the draft in the bone graft chamber of the cage using the graft compactor Figure6 Figure 6 Graft fusion chamber ...

Page 10: ...rt the inner threaded rod into the threaded hole on the cage Tighten the cage on the cage holder by turning the cage holder knob Figure 7 Caution The connection between the cage and the cage holder is critical Tighten until the connection is firm but not excessive in order to avoid damaging the screw thread Caution Confirm the grooves in the knob align with the grooves in the cage holder handle so...

Page 11: ...r and the peg must be locked into the slots on the cage holder Figure 8c Insert impactors on each side of the cage holder handle and slide them until they are locked by the flexible blades The distal tips of the impactors must be engaged inside the plate holders Figure 8b Figure 8a Cage holder assembly Figure 8c Plate holders length PEG MARKING PLATE HOLDER SLOT LOCKED HOLDERS Figure 8 Toeing pad ...

Page 12: ...body space with successive impactions on the cage holder parallel to the endplates A non parallel insertion may weaken the end plates due to conflict with the cage Take care to position the cage as close as possible to its final position Confirm proper implant placement using fluoroscopy Figure9 A P View Lateral and rotational positioning Lateral View Anteroposterior and rotational positioning Fig...

Page 13: ...ate insertion must be done with care to avoid any interference between both constructs Figure10 In normal bone structure the insertion of the plates is a simple step Avoid applying excessive force to insert plates Engage the double impactor on the proximal side of the cage holder until it contacts the impactors PLATE INSERTION Figure 10 Plate Insertion DOUBLE IMPACTOR CONTACT LOCKED IMPACTORS UNLO...

Page 14: ... of the plates If the cage and the cage holder are misaligned the plates won t be able to follow their predefined trajectory resulting in contact with the cage Impact the double impactor with a mallet until the mechanical stop is reached while holding the cage holder handle firmly to prevent advancement of the cage Figure11a Caution Once the impactors have reached the mechanical stop impaction wit...

Page 15: ...the cage from the cage holder Figure12a Remove the cage holder Use A P and lateral fluoroscopy to confirm final implant positioning Figure12b 12c Caution Do not impact the plate and the cage once the cage holder has been removed Discard the plate holders at the end of the procedure Figure 12a Cage holder removal Figure 12b A P View Figure 12c Lateral View ...

Page 16: ...nction with supplemental fixation cleared by FDA for use in the lumbar spine Implant the supplemental fixation according to the recommended surgical technique for the specific system used Caution If using a pedicle screw system as supplemental fixation care should be taken to avoid interference between the screws and VerteBRIDGE plates SUPPLEMENTAL FIXATION ...

Page 17: ...Cage Surgical Technique Guide 17 Figure 13 Implant removal tools STEP 13 If needed the unlocking threaded shaft facilitates removal of the plates from the cage If insertion of the unlocking threaded shaft is too difficult use the revision threaded shaft and restart the removal steps Figure13 Important Never reuse a cage or plates IMPLANT REMOVAL FOR REVISION ...

Page 18: ...ng threaded shaft Figure14a Insert the removal screwdriver inside the tube To unlock the plates screw the removal assembly into the threaded hole on the posterior side until it stops turning Figure14b Caution Make sure to protect the dura and nerve roots during revision Figure 14a Implant removal tube Figure 14b Implant plate removal ...

Page 19: ...te to remove Figure 15a The removal hook must be parallel to the removal tube Figure 15b Figure 15b Insert removal hook Figure 15a Find removal hole REVISION HOLE STEP 16 Position the removal hook guide on the tube and removal hook to ensure both are parallel and positioned together This facilitates removal of the first plate Figure 16a 16b Figure 16a Guide approach Figure 16b Final position of th...

Page 20: ... be replaced with forceps to grab the plate partly inserted in the bone to complete its removal When the first plate is removed repeat the steps to remove the second plate while making sure the guide is positioned on the side of the hook Screw the removal handle on the removal tube Figure 17b Gradually remove the cage using the slotted mallet Figure 17c IMPLANT REMOVAL FOR REVISION continued Figur...

Page 21: ...G045R IR9046R or IG046R IR9047R or IG047R Trial H8mm 0 H9mm 0 H10mm 5 H11mm 5 H12mm 5 H13mm 5 H14mm 5 AT9046R AT9047R AT9053R AT9054R AT9055R AT9056R AT9057R DESCRIPTION SIZE PART NUMBER T Handle G103521 Curette Right Left Straight IG014R IG015R IG012R Nerve Root Retractor 6mm 10mm IR921R or IG038R IR923R or IG039R Unlocking Threaded Shaft AT9038R Revision Threaded Shaft AT9039R Removal Handle AT9...

Page 22: ...of the device or to failure of the device itself Recent infection fever or hyper leukocytosis Open wounds Patients having inadequate tissue coverage over the operative site Pregnancy Inflammation Other medical for example anesthetics risks or surgical conditions which would preclude the potential benefit of spinal implant surgery such as the presence of bone tumors congenital abnormalities elevati...

Page 23: ...nique or to provide temporary relief Before clinical use the surgeon should thoroughly understand all aspects of the surgical procedure and limitations of the system This device is recommended for use only by surgeons familiar with preoperative and surgical techniques cautions and potential risks associated with spinal surgery Knowledge of surgical techniques proper reduction selection and placeme...

Page 24: ...snotintendedfor laypersons Informationontheproductsandprocedurescontainedinthisdocumentis ofageneralnatureanddoesnotrepresentanddoesnotconstitutemedicaladviceor recommendations Becausethisinformationdoesnotpurporttoconstituteanydiagnostic ortherapeuticstatementwithregardtoanyindividualmedicalcase eachpatientmustbe examinedandadvisedindividually andthisdocumentdoesnotreplacetheneedforsuch examinati...

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