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LITe Decompression Tubes

1. 48081603 48081604 48081605 48081606 48081607 48081608 48081609 48082203 48082204 48082205 48082206 48082207 48082208 48082209 48082603 48082604 48082605 48082606 48082607 48082608 48082609 Catalog Description Instrument Part Numbers Tube 016mm x 3cm Tube 016mm x 4cm Tube 016mm x 5cm Tube 016mm x 6cm Tube 016mm x 7cm Tube 016mm x 8cm Tube 016mm x 9cm Tube 022mm x 3cm Tube 22mm x 4cm Tube 022mm x 5cm Tube 22mm x 6cm Tube 022mm x 7cm Tube 022mm x 8cm Tube 022mm x 9cm Tube 26mm x 3cm Tube 026mm x 4cm Tube 26mm x 5cm Tube 26mm x 6cm Tube 26mm x 7cm Tube 26mm x 8cm Tube 26mm x 9cm Catalog Description Instrument Part Numbers 48250010 Guide Pin 48080006 Dilator 1 6mm OD x 27 5cm 48080012 Dilator 2 O10 75mm OD x 25cm for 12mm tube 48080014 Dilator 3 O12 75mm OD x 23cm for 14mm tube z 48080016 Dilator 4 014 75mm OD x 21cm for 16mm tube So 48080018 Dilator 5 016 75mm OD x 19cm for 18mm tube E 48080020 Dilator 6 018 75mm OD x 17cm for 20mm tube 48080022 Dilator 7 O20 75mm OD x 15cm for 22mm tube r 48080026 Dilator 8 O24 75mm OD x 13cm for 26mm tube E 48080230 Snake Arm 48250240 Arm Post 48080000 Container 48080001 Auxiliary Container 21 LiTe Decompression Tubes Surgical Protocol Notes A surgeon must always rely on his o
2. the dilators and tubes can also be used for proper selection Tube Insertion gt Slide the tube over the dilators and dock on the lamina Instrument Bar 48250010 ee Guide Pin 48080006 Dilator 1 48080230 Snake Arm 48080012 A Dilator 2 Figure 11A aso FR Dilator 3 Tube c i Q H 48080016 DE Dilator 4 48080018 Z Dilator 5 48080020 Dilator 6 48080022 _ ____ Dilator 7 Figure 11B 48080026 r Dilator 8 gt Insert the handle of the tube into the clamp of the Snake Arm See Catalog Decompression Tube 11 LiTe Decompression Tubes Surgical Protocol gt Secure the tube by closing the clamp Figure 12 5 Q at Eo is Note To ensure proper locking the handle of the tube should be inserted entirely into the Snake Arm clamp The engagement feature of the tube is not coated with ee the non reflective PVD coating and should not be seen l when properly inserted into the clamp Figure 13A Figure 13B Figure 14 gt Secure the arm assembly by tightening the knobs Note If repositioning of the tube is necessary to expose the laminar edge the tube can be wanded over the pathology using the dilators Once in the proper location the arm assembly is tightened Note Check fitment of dilators and tubes prior to surgery for any potential of deformation during handling or cleaning process Instr
3. A Figure 5B Figure 6 gt Repeat for caudal pedicles Carefully determine the appropriate entry point and trajectory for the LITe Decompression Tube gt For decompression the entry point is approximately 2cm off mid line with a more medial trajectory gt Fora TLIF the entry point is approximately 4cm off mid line with a more lateral trajectory Note The entry point is typically at or cephalad to the accessory process AP on the transverse process gt An incision the size of the tube to be used is made parallel to the spine gt The fascia can also be incised to make tissue dilation easier This is optional and can be performed later if tissue dilation is difficult For this technique we will demonstrate with a 26mm diameter Tube Figure 7 Dilation gt Place Dilator 1 through the incision Advance the dilator through the tissue while directing it toward the inferior aspect of the superior lamina under lateral imaging gt The dilator is advanced through the lumbodorsal fascia gt Location of the dilator is confirmed using lateral imaging Use the dilator to palpate the lamina both in the sagittal and transverse planes This confirms appropriate approach laterally gt The tip of the dilator is used to sweep the paraspinal musculature off the laminar edge Instrument Bar 48080006 Dilator 1 fey E CE F C ag Tube c T Q a E 10 LiTe Deco
4. ent Bar See Catalog Decompression Tube and Removal 6 a G 2 2 A x a a Interbody Fusion Figure 17B gt Prepare the endplate for interbody fusion 17 Life Decompression Tubes Surgical Protocol Graft Insertion gt Insert the interbody device For detailed instructions please see the AVS PL and AVS PL UniLIF surgical technique Bone graft may be placed lateral ventral and or dorsal to the implanted interbody device Closure gt Examine the site for bleeding gt It is recommended that a visible inspection of the Figure 18B surgical site be performed followed by irrigation and suction post procedure to ensure that no existing implantable materials are left in situ Fusion gt 3 2 de O gt Remove the tube from the incision gt The muscle and fascia close as the Tube is withdrawn through the dilated tissues gt If accessible close the fascia with one or two interrupted sutures The subcutaneous tissue is closed in an inverted manner A subcuticular closure is performed Cover the skin edge with clear waterproof dressing Contralateral Side gt Fixation on the contralateral side can be performed with the MANTIS Spinal System Figure 19 18 Instrument Bar See Catalog smed Decompression Tube Fusion DA xo fe Ke m Q el 19 20 LiTe Decompression Tubes Surgical Protocol
5. erform a minimally invasive UniLIF procedure It offers guidance that you should heed but as with any such technical guide each surgeon must consider the particular needs of each patient and make appropriate adjustments when necessary and as required The objective of all minimally invasive surgeries MIS is to replicate the clinical results of the corresponding open procedure What sets MIS procedures apart from open procedures is that while delivering similar clinical results these procedures have the potential to offer reduced intraoperative blood loss reduced post operative mobilization times and minimize postoperative consumption of orally administered narcotics The LITe Decompression Tube System was designed to provide a comprehensive minimally invasive tubular platform This would complement the existing MANTIS AVS PL UniLIF AVS PL and Reliance LITe platforms in order to perform minimally invasive spine procedures Key Design Features gt Minimally invasive approach gt Non reflective PVD coating gt Large selection of tubes gt Fast rigid connection to bed fey 25 OG F C ag a LiTe Decompression Tubes Surgical Protocol Figure 1 Figure 2 Figure 3 Patient Positioning The LITe Decompression Tubes can be successfully used under local epidural spinal or general anesthesia General anesthesia is commonly used since it is the most comfortable for the patient and allow
6. ibility gt Tips rounded for safety Note Instruments should be visually and physically checked for fit with each tube Nerve Root Retractor Suction Tip with Bend Micro Scissor LiTe Decompression Tubes Surgical Protocol Disc Preparation and Removal gt Identify the offending disc material gt Enter the disc space at the vertebral margins gt Resect the posterior lip of the vertebral body This will simultaneously help free the cartilaginous endplate and provide direct entry to the disc space gt Remove the offending disc material with a pituitary rongeur gt Intradiscal and extradiscal work can be executed as one would normally perform during a microdiscectomy Figure 15 gt The nerve root and spinal canal are explored to ensure the decompression is complete Once the nerve root is decompressed irrigate the disc space thoroughly Interbody Fusion gt A shaver TPS Saber Stryker Endoscopy is ideal to free the cartilaginous endplates while preserving the bony endplate and Removal O s G Q 2 a x A Note Care must be taken when using a high speed burr Contacting the tube with a high speed drill may reduce the life of the tube Fusion gt If an interbody fusion is to be performed complete Figure 16A the discectomy leaving the anterior and lateral aspects of the annulus intact V Interbody Figure 16B 16 Instrum
7. mpression Tubes Surgical Protocol Figure 8 Figure 9 Figure 10 gt Note the depth marking of the dilator in relation to the skin The dilators have depth markings laser etched which correlate to the tube length gt Choose the appropriate tube size based on where the skin meets the dilator Note If the skin is between two markings on the dilator choose the longer tube Note By keeping the dilator tip in the subperiosteal space this will help lessen bleeding Note Feel fluoroscopy anatomical knowledge review of preoperative images and partial visualization may all contribute towards desired instrument placement accuracy Note Great care must be taken to avoid penetration of the ligamentum flavum and inadvertent dural puncture with possible nerve injury or spinal fluid leak Note If using the Guide Pin do not direct it lateral to the lamina or facet which risks injury to the nerve root or deeper structures Note To ensure that the Guide Pin is not bent pass the Guide Pin through the cannulation in Dilator 1 Note Wipe guide pin after each use Subsequent Dilator Insertion gt Slide the subsequent dilators over Dilator 1 and into the incision gt Use the subsequent dilators to penetrate and gently spread and dissect soft tissue down to the lamina gt Match the color of the dilator with the color of the disc on the tube to ensure selection of the proper tube diameter Laser markings on
8. r her own professional clinical judgment when deciding to use which products and or techniques on individual patients Stryker is not dispensing medical advice and recommends that surgeons be trained in implant surgeries before performing any surgeries The information presented is intended to demonstrate the breadth of Stryker product offerings Always refer to the package insert product label and or user instructions before using any Stryker product Products may not be available in all markets Product availability is subject to the regulatory or medical practices that govern individual markets Please contact your Stryker representative if you have questions about the availability of Stryker products in your area Stryker Corporation or its divisions or other corporate affiliated entities own use or have applied for the following trademarks or service marks AVS LITe MANTIS and Stryker All other trademarks are trademarks of their respective owners or holders Literature Number TLDECST09091 MS GS 08 10 Copyright 2010 Stryker Printed in USA stryker Joint Replacements Trauma Extremities amp Deformities Craniomaxillofacial Spine Biologics Surgical Products Neuro amp ENT Interventional Spine Navigation Endoscopy Communications Imaging Patient Care amp Handling Equipment EU Operations Z I Marticot 33610 Cestas FRANCE t 33 0 5 57 97 06 30 f 33 0 5 57 97 06 31 www stryker com US Operations 2 Pea
9. rl Court Allendale NJ 07401 USA t 1 201 760 8000 f 1 201 760 8108 www stryker com
10. s immediate postoperative neurological assessment gt The patient is prepped and draped in the usual sterile manner for posterolateral fusion with pedicle screw fixation Arm Assembly Positioning The Mediflex Arm Post mounts to the hospital bed rail Check compatibility of the Arm Post to the hospital bed prior to surgery gt Mount the Arm Post to the bed rail on the opposite side of surgeon near the patient s hip gt Turn the Arm Post locking mechanism clockwise to secure it to the bed gt Once secure attach the Snake Arm to the Arm Post and lock into place gt The Snake Arm should be positioned across the patient and wrap in front of the surgeon Note For additional information see the Mediflex s Flex Arms Surgical User s Manual Instrument Bar 48250010 Guide Pin tez E oS ud C ag A Figure 4A Figure 4B Establishing Access A P images are used to confirm placement of the LITe Decompression Tube The tube is delivered via a dilation system at approximately the same angle as the interbody device to be inserted The following steps are taken to assure the correct positioning of the LI Te Decompression Tube Markings gt Using A P imaging place the Guide Pin transversely across the mid line of the cephalad pedicles gt Draw a line extending several inches lateral to the pedicles Patient Positioning LiTe Decompression Tubes Surgical Protocol Figure 5
11. stryker Spine Life Decompression Tubes Surgical Protocol e Minimally invasive approach e Large selection of tubes e Fast rigid connection to bed Less Invasive Technologies LiTe Decompression Tubes Surgical Protocol Table of Contents PERMOW ledo me 2 5 4 9 nci ess eas tout oe ee eee eee hand EERE ser eeiacesa ses 4 TnttodAc On seerias yrei EENE PER ESKE KER ERKKI 4 Arm Assembly Positioning essesessssssessssssossssosssessseeoese 6 Patient Posihioning sesers seni DE EEN REED E a 6 Establis hne ACCESS vens EENEN NEERA ENESE 7 Mark MOS erener rinsar IRANE SET EEES ETATE ERR ESS ERE ER SSR SEENA 7 DUSO eee EEEE AEE E A ET 9 Mibe Inserto ers rrine raa EEE E EE ERA IEEE 10 Subsequent Dilator Insertion sesesssssssssessesossesesoesossee 10 I terbDody PUSION 64226 t cace nae ans KREERET NERE EE E ARES 16 Disc Preparation and Removal sssensessssssssosssssesososseseeeoes 16 OSSE sorridia os eee oe eee heres E EEA E EIEEE EEA 18 Poe ee E E ET E ETT 18 Catalon oopan aa E A ENEA EA RAEE EEES 20 WaAtHINGS soroden ien nrar E raS EAA E e 22 LiTe Decompression Tubes Surgical Protocol Acknowledgments Stryker Spine wishes to thank the following physicians for authoring this surgical technique Terrence Julien MD Reginald Knight MD Jeffrey Roh MD Introduction This Surgical Technique sets forth detailed recommended procedures for using the LITe Decompression Tube System in order to p
12. ument Bar See Catalog Decompression Tube 48080230 Snake Arm 6 im art Fo i 13 LiTe Decompression Tubes Surgical Protocol Disc Preparation and Removal Stryker Spine offers a comprehensive set of Reliance LITe decompression instruments This Reliance LITe set consists of gt gt Penfield Bayoneted Penfield Elevators Inspection of the surgical site between dura and bone Nerve Hooks Retract nerve during surgical procedure Blunt tip to help protect nerve Nerve Retractors Retract compressed nerve root away from disc space Nerve Probes Inspection of the surgical site The ball tip helps to prevent damage of nerve Woodson Probes Exploration of the disc space Suction Tips Provide suction capabilities to evacuate fluid and debris from surgical site O Kerrison Rongeurs Remove disc material cartilage and hard connective tissue O Bovie Dissect soft tissue Bi Polar Dissect soft tissue Nerve Hook Bayoneted Woodson Probe Bayoneted Ball Probe Bayoneted These instruments are designed with gt Bayoneted working shafts provide greater visibility while working through the Tube gt Working lengths of 16cm or more for surgical procedures in the lower posterior thoracic and lumbar spine gt Non reflective coating to further increase visibility by reducing glare while working through the Tube gt Handle profiles and shaft diameters minimized to provide greater vis

LITe Decompression Tubes

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