Tecnica Quirurgica

SURGICAL TECHNIQUE

Table of Contents
Surgeon’s Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 2 Design Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 3 Preoperative Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 4 Intraoperative Preparation and Approach . . . . . . . . . . . . . . . . . .. page 5 Step 1: Identifying the Midline . . . . . . . . . . . . . . . . . . . . . . . . . . page 6 Step 2: Performing the En Bloc Discectomy . . . . . . . . . . . . . . . . . page 7 Step 3: Mobilizing the Segments and Removing Posterior Osteophytes . page 8 Step 4: Trialing for Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 9 Step 5: Using the 4-in-1 Guide . . . . . . .. . . . . . . . . . . . . . . . . . . page 10 Step 5A: Identifying Intraoperative Lordosis with the 4-in-1 Guide. . . . page 11 Step 5B: Measuring Anterior-Posterior Depth with the 4-in-1 Guide. . . page 12 Step 5C: Measuring Height Distraction with the 4-in-1 Guide. . . . . . . page 12 Step 5D: Chiseling with the 4-in-1 Guide . . . . . . . . . . . . . . . . . . . page 13 Step 6: Loading andInserting the A-MAV™ Anterior Motion Segment Replacement . . . . . . . . . . . . . . . . . . page 14 Implant Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 15 Product Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 16 Important Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 17

Surgeon’sPerspective
As described by:

Tai Friesem, M.D.
United Kingom

Jean-Charles Le Huec, M.D., Ph.D
France

Hallett Mathews, M.D.
United States

Thomas Zdeblick, M.D.
United States

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Design Rationale
Metal-on-Metal Design
• Significantly less wear debris than metal/poly • Increased reliability versus ceramic • Based on decades of total joint arthroplasty experience • Cobaltchromium alloy ASTM standard

Posterior Center of Rotation
• Maintains normal kinematics of the spine • Engages facet joints in motion • Allows surgeon a “tolerable zone” for device placements

HA Coating Fixation
• Used for arthroplasty devices worldwide for 15 years • 50µm thick, highly crystalline coating • Provides excellent bone-device fixation surface • Thermal spray deposition

SimpleSurgical Technique
• Instrumentation provides simple, accurate, and reproducible placement • Both implant component pieces are assembled together prior to insertion and implanted as one device

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Preoperative Planning
The correct component size may be determined pre-operatively by utilizing the CT templates. The templates may be laid over the axial cut CT scan to check which footprintsize best fits the patient anatomy. The largest footprint possible should be chosen.

TO COME VISUAL: CT scan with the template superimposed over the CT scan

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Intraoperative Preparation and Approach
The patient is placed on the operative table in a supine position. Compression stockings should be placed on the patient. General anesthesia with endotracheal intubation is administered. Thelumbar spine may be approached through either a transperitoneal or retroperitoneal exposure. The amount of great vessel release and retraction should be limited to that required for insertion of the instruments and constructs. At the L4-L5 level, the iliolumbar and segmental vessels should be identified and ligated if necessary in order to achieve adequate mobilization of the great vessels. At theL5-S1 level, the middle sacral artery is typically ligated and divided. Care should be taken at L5-S1 to only use blunt dissection in order to minimize injury to the presacral neural plexus.

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STEP 1
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Identifying the Midline
With the assistance of the C-Arm, locate the midline of the vertebral body.

Fluoroscopy from the AP as well as lateral views should be used for assistance....