Luxor™ - Rontis
Contents
1. Prepare the endplate for the interbody fusion 21 22 Luxor Surgical Technique Figure 30 Graft Insertion Once the disc space is meticulously prepared insert cancellous bone into the disc space using angled and straight forceps Subsequently use available bone tamps to impact the cancellous bone The anterior longitudinal ligament and remaining annulus will contain the graft Insert the allograft Carefully use an angled osteotome or bone tamp to slide the allograft The chamfered edge facilitates this maneuver Pack additional cancellous bone medial to the first graft then insert the second graft To achieve a posterolateral fusion decorticate the facet pars transverse processes and sacral ala using a burr chisels curettes kerrisons and or rongeurs in the normal manner Place the bone graft over the decorticated bone in the usual manner Instrument Bar Screw Insertion Cannulated 10 Gauge 9 inch 48237110 The Luxor System is used in conjunction with 10 Gauge 5 inch 48237105 Stryker Spine systems i e Xia Precision System re O 5 n pes Techtonix See the appropriate Surgical uden ds e 2 Technique for additional information and device jensen package insert for indications contraindications warnings amp precautions a 2 Figure 31 e y A gt Insert the Jam Shidi 48237 105 110 115 135 through the Luxor Retractor to the inter2. 30 Figure 46 Repeat the process for additional bone screws After inserting additional bone screws the head of the bone screws should be the same height Note The polyaxial bone screws may lock upon insertion Use the Xia Inserter 48047009 to unlock the heads before introducing the rod Figure 47 Screw Insertion Non Cannulated Use the Bayoneted Awl 48250350 to create a starting hole for the pedicle screw through the Luxor Retractor while not obscuring the surgeon s view Instrument Bar 48231310 OO Xia Precision Polyaxial Screwdriver 48237009 dd Screwdriver Protection Sleeve 5 5mm 482315 35 50 6 5mm 482316 30 55 7 5mm 482317 30 55 Xia Precision Screw Sharp 48230230 Blunt 48230231 K Wire 48047009 Xia Inserter 48250350 Bayoneted Awl E ES R C 31 32 Luxor Surgical Technique Use the Bayoneted Gear Shift 48250300 to open up the pathway of the pedicle through the Luxor Retractor while not obscuring the surgeon s view The Gear Shift should contact the bone at all times The correct rotational insertion of the instrument will allow the Gear Shift to follow a path of least resistance without violating the pedicle walls Figure 48 Use the Tapered Ball Probe 48250360 to feel the wall of pedicle Note The Tapered Ball Probe has markings at 30 40 50 and 60mm Use imaging to determi
3. 37 EE s kaca syn n w EE kat di u DEY 40 OS r r rm lr rmr r m_e_em_m r HH a 41 ContralateralSide scared TET 41 CAOS muta rotas vs EDJN e oe DR3 N oE II AND J EN E HH a wek 42 Removal or Revisi n Procedures 4u s 2 kak ds ec 46 DO a a ae e 47 Luxor Surgical Technique Acknowledgments Stryker Spine wishes to thank the global Luxor Surgeon Panel for their dedication to the development of the Luxor System Introduction The objective of Stryker Spine Less Invasive Technologies LITe is to replicate the clinical results of the corresponding open procedure What sets the minimally invasive procedures apart from open procedures is that while delivering similar clinical results these procedures offer reduced intraoperative blood loss reduced post operative mobilization times and the potential for minimized postoperative consumption of orally administered narcotics The Luxor Retractor part of the LITe platform was designed to provide access to the thoracic and lumbar spine from a posterior approach via a small incision The oval design of Luxor reduces the medial lateral muscle retraction seen in some circular retractors while providing more working space at the level of the incision Important This Surgical Technique sets forth detailed recommended procedures for using the Luxor System It offers guidance that you should heed but as with any such te
4. Cable 233 050 071 Stryker ACMI Zimmer Lightsource Adapter 233 050 073 Storz Lightsource Adapter 233 050 072 Olympus Lightsource Adapter 233 050 074 Wolf Dyonics Lightsource Adapter 48250200 Driver 48240005 Reliance LITe Decompression Tray 48242240 Kerrison Bayoneted 2mm 40 degree 48242290 Kerrison Bayoneted 2mm 90 degree 48242340 Kerrison Bayoneted 3mm 40 degree 48242390 Kerrison Bayoneted 3mm 90 degree 48242440 Kerrison Bayoneted 4mm 40 degree 48242490 Kerrison Bayoneted 4mm 90 degree 48242540 Kerrison Bayoneted 5mm 40 degree 48242590 Kerrison Bayoneted 5mm 90 degree 48242200 Kerrison Bayoneted Upbiting curved up at tip 2mm 48242400 Kerrison Bayoneted Upbiting curved up at tip 4mm 43 44 Luxor Surgical Technique Catalog Description Instruments 48243045 Woodson Probe Bayoneted 45 degree 48243090 Woodson Probe Bayoneted 90 degree 48243000 Ball Probe Bayoneted 110 degree Straight Long 48243001 Ball Probe Bayoneted 110 degree Straight Short 48244102 Penfield Bayoneted Pull 2 48244202 Penfield Bayoneted Push 2 48244104 Penfield Bayoneted Pull 44 48244204 Penfield Bayoneted Push 4 48241103 Nerve Hook Bayoneted 90 degree Blunt Tip 48241201 Nerve Root Retractor 48241202 Nerve Root Retractor Wide 48245001 Suction Tip with Bend 48245002 Suction Tip with Bend with Lip 48245010 Micro Scissor Single Action 20 1490KI Bi Polar Forceps US Connection Angled E1457 C
5. is felt once the nut contacts the Caliper stems Figure 53 5 Remove the Rod Caliper from the Retractor The stems will spring back to the position inside the Retractor 6 Compare the distal span of the Rod Caliper stems with the rod sizes Note Another way to determine rod lengths is by placing a rod of the estimated length in the Rod Holder and holding it over the surgical site Use imaging to help determine the appropriate rod length Figure 54 Instrument Bar 48250320 et Rod Calipers 03807010 pie d Xia French Bender Figure 55 48250330 Y Rod Introducer gt Perform rod bending with the Xia French Bender 03807010 to fit the desired spinal contours ES R C Figure 56 The Rod Introducer 48250330 is used through the Retractor to 1 Transition the rod from a vertical to a horizontal orientation 2 Seat the rod into the screw head 3 Hold the rod in between screw heads 4 Adjust the rod between screw heads 5 Remove the rod during the surgical procedure Grasp the appropriate length rod in the middle using the Rod Introducer Rotate the rod to a off vertical orientation 35 36 Luxor Surgical Technique Figure 58 Insert the rod through the Retractor Base Place the distal section of the rod into the head of either the inferior or superior screw Push down on the center of the rod to seat it into the remaining screw hea
6. to further increase visibility by reducing glare while working through the Retractor Handle profiles and shaft diameters minimized to provide greater visibility Tips rounded for safety Ball Probe Bayoneted Nerve Root Retractor Suction Tip with Bend Micro Scissor Disc Prep gt z aL y 19 20 Luxor Surgical Technique Figure 25 Disc Preparation and Removal Continued Identify the offending disc material Enter the disc space at the vertebral margins Resect the posterior lip of the vertebral body This will simultaneously help free the cartilagenous endplate and provide direct entry to the disc space Remove the offending disc material with a Sypert Rongeur 48247001 Intradiscal and extradiscal work can be executed as one would normally perform during a microdiscectomy 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 Instrument Bar 48247001 Sypert Ronguer Figure 26 Interbody Fusion A shaver TPS Saber Stryker Endoscopy is ideal to free the cartilagenous endplates while preserving the bony endplate Disc Prep gt z x y Figure 27 If an Interbody Fusion is to be performed complete the discectomy leaving the anterior and lateral aspects of the annulus intact
7. with clear waterproof dressing Figure 67 Contralateral Side Move to the opposite side of the patient and repeat the steps of the technique on the contralateral side It is recommended that a visible inspection of the surgical site be performed followed by irrigation and suction post procedure to insure that no existing implantable materials are left in situ Instrument Bar 03807028 Xia Torque Wrench 48027000 Anti Torque Key 41 42 Luxor Surgical Technique Catalog Description Instruments 48250000 Luxor Retractor Tray 48250230 Snake Arm 48250240 Arm Post 48250010 Guide Pin 48250011 Cobb Style Initial Dilator 48250017 Kelly Retractors 48250018 Blunt Dissector 48250020 Retractor Base 48250040 Set of Retractor Blades 40mm 48250050 Set of Retractor Blades 50mm 48250060 Set of Retractor Blades 60mm 48250070 Set of Retractor Blades 70mm 48250080 Set of Retractor Blades 80mm 48250090 Set of Retractor Blades 90mm 48250105 Set of Retractor Blades 105mm 48250120 Set of Retractor Blades 120mm 48251040 Set of Silicon Sleeves 40mm 48251050 Set of Silicon Sleeves 50mm 48251060 Set of Silicon Sleeves 60mm 48251070 Set of Silicon Sleeves 70mm 48251080 Set of Silicon Sleeves 80mm 48251090 Set of Silicon Sleeves 90mm 48251105 Set of Silicon Sleeves 105mm 48251120 Set of Silicon Sleeves 120mm Catalog Description Instruments 48250210 Lighting Component 48250215 Universal Light
8. Figure 20 Figure 21 16 gt Attach the Snake Arm to the Retractor Base Lock the Snake Arm to the Retractor Base post by turning the collet Secure the Arm Assembly by tightening the knobs Remove the Blunt Dissector This establishes an oval operative corridor to the lamina and interlaminar space Use imaging to confirm appropriate positioning Note If repositioning of the Retractor is necessary to expose the laminar edge use the Driver 48250200 to collapse the Retractor The Retractor can then be moved or angled over the pathology using the cobb style Initial Dilator Once in the proper location the Arm Assembly is tightened Retractor Variable Opening Closing Mechanism Insert the Driver 48250200 into the post of the Retractor Base and screw down clockwise the variable drive screw to expand the distal end of the Retractor Blades gt If necessary gently rock the Retractor Base in the cephalo caudal direction during expansion Instrument Bar 48250230 Snake Arm 48250020 Retractor Base S 5 sjel 48250018 8 t Figure 22 Blunt Dissector 2 a gt Confirm expansion and position of the Luxor System with imaging 48250200 Note Distal opening of the Retractor is dependant on the Gene Blade length There is a mechanical stop in the Retractor base with a maximum opening of 22 5 degrees This correlates to Blade Retractor Maximum Length Dista
9. K Wire Note The K Wire is 1 2mm in diameter Note The K Wire is a single use instrument 25 26 Luxor Surgical Technique Li 4 7 f Figure 37 Figure 38 Figure 39 Use the K Wire Guide Tube 48230235 to prevent the K Wire from bending or moving during insertion Place the K Wire Guide Tube over the K Wire and dock on the Jam Shidi gt Use the Slap Hammer to impact the K Wire Once the K Wire is inserted remove the outer shaft of Jam Shidi Hold the K Wire in position when removing the Jam Shidi gt Prepare the pedicle by placing the Xia Precision Square Awl 48237001 over the K Wire and twisting into the pedicle gt Hold the K Wire in position when removing the Awl Use the cannulation of the Slap Hammer to impact the Awl Note The Awl has a stop at 12 0mm Instrument Bar Sharp 48230230 Blunt 48230231 K Wire 48230235 K Wire Guide Tube 48237120 Slap Hammer Figure 40 48237001 Xia Precision Square Awl gt If the bone is too hard the appropriate Tap may be used to pre pare the pedicle screw canal 5 5mm 48230165 The Xia Precision Taps 5 5mm 48230165 6 5mm 6 5mm 48230166 48230166 7 5mm 48230167 are calibrated and laser etched 7 5mm 48230167 with 10 0mm intervals to help indicate the depth at which the Xia Precision Taps Tap has been inserted as well as to help determine proper sc
10. OR Choose the corresponding Luxor Lightsource Adapter 48250210 C Lighting Component Stryker ACMI Zimmer Lightsource Adapter 233 050 071 Storz Lightsource Adapter 233 050 073 233 050 071 Stryker ACMI Zimmer e Olympus Lightsource Adapter 233 050 072 sec a K N A k 233 050 072 Olympus i e Wolf Dyonics Lightsource Adapter 233 050 074 233 050 074 Wolf Dyonics Lightsource Adapters Attach the Universal Light Cable 48250215 to the appropriate Adapter and insert into the light source Attach the other end of the Universal Light Cable to the Lighting Component 48250210 Turn on the light source power to verify light output Note the Universal Light Cable is made of clear fiber optics This is designed to easily identify broken fibers If light output is low this instrument may need to be replaced Note The Lighting Component is a single use instrument Luxor Surgical Technique Figure 5 Establishing Access A P images are used to confirm placement of the Luxor System The Retractor Base is delivered via a dilation system at approximately the same angle as the pedicle screws are to be inserted Upon insertion the Luxor retractor exposes portions of the lamina facet joints and transverse process The following steps are taken to assure the correct positioning of the Luxor System Markings Using A P imaging place the Guide Pin 48250010
11. 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 Products referenced with designation are trademarks of Stryker Products referenced with designation are registered trademarks of Stryker Literature Number TLLUXST1A GC GS 1m 11 05 Copyright 2005 Stryker Printed in USA stryker Joint Replacements Trauma Spine Micro Implants Orthobiologics Instruments Interventional Pain Navigation Endoscopy Communications Patient Handling Equipment EMS Equipment 2 Pearl Court Allendale New Jersey 07401 t 201 760 8000 www stryker com
12. ar Xia Precision Square Awl handles using the quick release mechanism 5 5mm 48230165 6 5mm 48230166 Preload the 7 5mm 48230167 Screwdriver Xia Precision Taps Protection Sleeve 48237009 onto the Xia Precision ie Screwdriver TE 48231310 Sl Xia Precision Polyaxial Screwdriver 48237009 Screwdriver Protection Sleeve ES R C Place a Xia Precision Bone Screw on the distal end of the screwdriver and lock into place Note The Xia Polyaxial Screwdriver 48041310 may be too short to use with some of the longer Luxor Retractor Blades INACIO A NAO 9 29 Luxor Surgical Technique Note With the Xia Precision Bone Screw engaged with the Precision Screwdriver the Screwdriver Protection Sleeve is slid over the proximal end of the screwhead to prevent the screwhead from contacting instruments during implantation Figure 43 Place the Xia Precision Bone Screw over the K Wire and insert into the pedicle Figure 44 After driving the screw assembly into the pedicle remove the K Wire to prevent it from advancing Be certain that the screw assembly is not inserted too far If the multi axial head of the Xia Precision Bone Screw is driven too forcefully against bone it will lose its multi axial capabilities making it difficult to connect the assemblies during subsequent steps Figure 45
13. chnical guide each surgeon must consider the particular needs of each patient and make appropriate adjustments when necessary and as required Always refer to the package insert product label and or instructions before using any Stryker implant or instrument Note No acid or alkaline solvents should be used in the cleaning of anodized components Note Upon the completion of each surgical procedure use adequate suction and irrigation to ensure the removal of any existing non implantable materials Note This is intended as a guide only There are multiple techniques and as with any surgical procedure a surgeon should be thoroughly trained before proceeding Data on file at Stryker Spine Key Design Features Radiolucent Complete visualization of anatomical landmarks Silicon sleeve amp Anatomical blades gt Prevent tissue from entering surgical site Cobb style initial dilator gt Facilitates tissue dissection while incorporating insertion safety Large distal span Maximum access at surgical site Oval design gt Maximizes working amp visualization channels while minimizing tissue damage Thin shadowless lighting component Continuous panoramic lighting that conforms to surgical site Reliance LITe Decompression Instruments Bayoneted Non reflective coating Thinner shaft profiles Increased working shaft length Fixation Instruments Accommodates Cannulated and Non Cannula
14. ds Adjust the positioning of the rod such that it extends through the screws as seen on the lateral x ray Note It is recommended not to release the rod from the Rod Inserter until the Blockers are inserted into the screwheads Figure 59 Blocker Insertion The Inserter 48047009 can help align the Universal Tightener 5mm 03807008 and the Blocker 03756230 through the Retractor The two engraved lines on the Universal Tightener denote the following 1 When the lower line is aligned with the top of the Inserter the Blocker is at the top of the implant 2 When the upper line is aligned with the top of the Inserter the Blocker is fully introduced into the implant Instrument Bar 6 0mm 482180 30 50 a 6 0mm 482180 60 90 Xia Rad Rod 48047009 E Xia Inserter 03807008 Xia Universal Tightener 5mm 03756230 Xia Blocker g ES C 37 38 Luxor Surgical Technique Figure 61 Figure 62 Insert the Universal Tightener into the Blocker Place the Inserter through the Retractor and dock it onto the screw head Note Maintain the position of the rod in the screwheads using the Rod Inserter Slide the Universal Tightener and Blocker through the Inserter and secure it in the tulip head of the screw Rotate the Blocker clockwise to properly seat and temporarily tighten the Blocker Note Do not perform final tightening of the Blocker w
15. ey 48027000 and the Torque Wrench 03807028 Insert the Torque Wrench through the Anti Torque Key Mate the top of Anti Torque Key with the bottom of the handle of the Torque Wrench Insert the final tightening assembly through the Retractor Visualize the distal end of the Torque Wrench entering the Blocker Dock the Anti Torque Key on the Screw Line up the two arrows on the Torque Wrench to achieve the optimum torque of 12Nm for final tightening of the implants Note The Anti Torque Key must be used for final tightening The Anti Torque performs two important functions 1 It allows the Torque Wrench to align with the axis of the tightening axis 2 It allows one to maximize the torque needed to lock the implant assembly Note If the Anti Torque Key cannot be easily removed from the implant head the rod may not be fully seated Apply bone graft to the fusion site and close in the usual manner Note For additional information please refer to the Xia Surgical Technique Figure 66 Closure Examine the site for bleeding Close the Retractor Base with the Driver before withdrawing it from the incision The muscle and fascia close as the retractor 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
16. ger than the longest Retractor Blade being used Note In cases where the Retractor cannot be actuated due to docking on bone using Blades of different length is recommended Note The Silicon Sleeve may need to be cut or altered to accommodate the varying blade lengths chosen Note The sterile Sleeve should be cut with a sterile cutting instrument prior to assembly onto the Retractor Note No jagged edges or visible silicon fragments should be present on the Sleeve when introducing the Retractor assembly into the incision Instrument Bar 48251040 40mm 48251050 50mm 48251060 60mm 48251070 70mm 48251080 80mm 48251090 90mm 48251105 105mm 48251120 120mm Silicone Sleeve 48250210 Lighting Component Retractor Insertion Figure 18 Insert the Lighting Component into the Retractor Base The Lighting Component should be inserted between the Retractor Blade and Silicon Sleeve 48250020 Retractor Base The Lighting Component is inserted until the black bar on the Component is even with the Retractor Base The Lighting Component should be oriented so that the Stryker LITe logo is facing up 48250018 dn mn Blunt Dissector Figure 19 Retractor Insertion Slide the closed Retractor assembly over the Blunt Dissector with the variable drive screw and post positioned laterally Dock the Retractor on the lamina 15 Luxor Surgical Technique
17. ith the Inserter in place or it will not be possible to remove the Inserter Repeat for other bone screws Release the Rod Inserter from the rod once the Blockers are introduced Note The Retractor may need to be repositioned for easier Blocker insertion by adjusting the Snake Arm or distal expansion Note Use imaging and monitoring as preferred for added information during bone screw insertion Note For easier blocker insertion the Retractor may need to be repositioned by adjusting the Snake Arm or increasing the Retractor s distal blade expansion Figure 63 In the event the rod is forced down while tightening the Blocker be sure that the Blocker is fully engaged into the bone screw head This will help resist the high reactive forces generated by the final tightening maneuvers Extra caution is advised when 1 The rod is not horizontally placed into the screw head 2 The rod is high in the screw head 3 An acute convex or concave bend is contoured into the rod Instrument Bar 48047009 Xia Inserter 03807008 Xia Universal Tightener 5mm 03756230 Xia Blocker 03807019 Xia Rod Pusher C ES R Eg 39 40 Luxor Surgical Technique Figure 64 Figure 65 Construct Tightening Once the correction procedures have been carried out and the spine is fixed in a satisfactory position the final tightening of the Blocker is done by utilizing the Anti Torque K
18. l Span Rod with Silicon Length mm mm mm 40 58 55 50 63 60 60 68 65 70 75 70 80 79 75 90 82 80 105 80 80 120 78 Z3 17 Luxor surgical Technique Disc Preparation and Removal Luxor System offers a comprehensive set of Reliance LITe decompression instruments This Reliance LI Te set consists of 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 the nerve Woodson Probes Exploration of the disc space Suction Tips Provide suction capabilities to evacuate fluid and debris from surgical site Kerrison Rongeurs Remove disc material cartilage and hard connective tissue Sypert Rongeur Remove hard connective tissue Instrument designed exclusively for use through the Luxor Retractor Bovie Dissect soft tissue Bi Polar Dissect soft tissue ig Penfield Bayoneted Sypert Rongeur Nerve Hook Bayoneted Woodson Probe Bayoneted These instruments are designed with Bayoneted working shafts provide greater visibility while working through the Retractor Working lengths of the 16cm or more for surgical procedures in the lower posterior thoracic and lumbar spine Non reflective coating
19. mm 48250120 120mm Retractor Blades Figure 14 Retractor Assembly Assemble each Retractor Blade into the Retractor Base 48250020 1 Orient the Retractor Base so that the variable driving screw and post are pointing up 2 Align the hole in the proximal end of the Retractor Blade with the pin in the Retractor Base 3 Lightly squeeze the Retractor Blade on the proximal edges and insert the Retractor Blade into the Retractor Base 13 14 Luxor Surgical Technique Figure 15 Figure 16 Figure 17 4 Release the Retractor Blade so that it engages the Base 5 The cutouts at the top of the Blade should snap into the rectangular features in the Base 6 Repeat the process for the second Blade Note If a side of the Retractor Blade does not engage the Retractor Base push on the 1mm edge of the Blade that is not engaged toward the cephalo caudal orientation of the Base Note The Blades and Base are color coded Match the appropriate Blade color with the corresponding Base color during assembly Based on the Blade length obtain the corresponding Silicon Sleeve 48251 040 120 With the Retractor in the closed state dip the Retractor Blades in a saline bath Slowly slide the corresponding Silicon Sleeve onto the Retractor Blades until it contacts the Retractor Base Note The Silicon Sleeve is a single use instrument Note The Silicon Sleeve should be slightly lon
20. n be used to remove the implants Any decision by a physician to remove the internal fixation device should take into consideration such factors as the risk to the patient of the additional surgical procedure as well as the difficulty of removal Removal of an unloosened spinal screw may require the use of special instruments to disrupt the interface at the implant surface This technique may require practice in the laboratory before being attempted clinically Implant removal should be followed by adequate postoperative management to avoid fracture or re fracture Removal of the implant after fracture healing is recommended Metallic implants can losen bend fracture corrode migrate cause pain or stress shield bone CEMI PAZ e 48 Luxor Surgical Technique Notes surgeon must always rely on his or 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 knee implant surgeries before performing any knee surgeries Surgeon must always rely on their own clinical judgment when deciding which treatment and products to use with their patients The information presented in this brochure 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
21. ne the appropriate screw length Note To ensure maximum exposure and maneuverability of the Luxor System decortication can be facilitated when it is performed after pedicle probing and tapping and prior to screw placement 3 MAD 14 Figure 49 See the Xia Spinal System Operative Technique for pedicle screw insertion and package insert for indications contraindications warnings amp precautions Instrument Bar 48250300 _ gt e Bayoneted Gear Shift 48250360 Tapered Ball Probe 48047033 mm Xia Poly Adjustment Driver Figure 50 Rod Insertion 48250310 ra Screw Head Adjuster Adjust the bone screw height using the Xia Poly Adjustment Driver 48047033 ES R C Align the tulip heads of the bone screws using the Screw Head Adjuster 48250310 to facilitate rod insertion 33 34 Luxor Surgical Technique Use the Rod Calipers 48250320 to determine the appropriate rod length 1 Adjust the length of the Rod Caliper stems based on the corresponding Blade Length 2 Collapse the Rod Caliper stems and insert into the Retractor Note When using the Rod Caliper start with arms adjusted to longest blade length being used When using the 120 mm blades the Rod Caliper arms should be fully extended Figure 52 3 Dock the Rod Caliper stems onto the most superior and inferior bone screw heads 4 Twist the nut on the Rod Caliper until slight pressure
22. olorado MircoNeedle 7 inch Sleeve 2 inch 45 degree bend 48247001 Sypert Rongeur Catalog Description Instruments 48250001 Luxor Fixation Instruments Tray 48250300 Bayoneted Gear Shift 48250310 Screw Head Adjuster 48250320 Rod Calipers 48250330 Rod Introducer 48250350 Bayoneted Awl 48250360 Tapered Ball Probe 48047033 Xia Poly Adjustment Driver 03807008 Xia Universal Tightener 5mm 48047009 X1a Inserter 03807028 Xia Torque Wrench 03807010 Xia French Bender 48027000 Anti Torque Key 03807019 Xia Rod Pusher 45 46 Luxor surgical Technique Removal or Revision Procedures The spinal implants are temporary internal fixation devices designed to stabilize the operative site during the normal healing process After healing occurs these devices usually serve no functional purpose and can be removed Removal may also be recommended in other cases such as J Corrosion with a painful reaction gt Migration of the implant with subsequent pain and or neurological articular or soft tissue lesions D Pain or abnormal sensations due to the presence of the implants D Infection or inflammatory reactions gt Reduction in bone density due to the different distribution of mechanical and physiological stresses and strains gt Bone growth restraint due to the presence of the implants in pediatric use D Failure or mobilization of the implant Standard ancillaries provided by Stryker Spine ca
23. rew length Sa CET D 00 A Note The length of the Taps thread is 25mm 27 Luxor Surgical Technique Figure 42 28 Note 1 0cm interval markings on the K Wire provide the cannulated instruments depth in the pedicle As an instrument advances into the pedicle the proximal end of the instrument will move relative to the markings If this does not occur during insertion the procedure should be stopped and fluoroscopy should be used to verify the position of the K Wire in relation to the Precision Square Awl or Precision Tap The Tap Sleeve 48231315 can be used to prevent soft tissue from contacting the Taps thread Check pedicle depth with either fluoroscopy or read the depth from the Tap Sleeve as it moves along the proximal shaft of the Taps There are markings at 30 40 and 50mm Note The Tap Sleeve is made of radiolucent Ultem Poly Ether Imide Note Slide the Tap Sleeve proximal to the Tap shaft to engage the friction fit Hold the K Wire in position when removing the Precision Tap Instrument Bar Screw Insertion mr With the pedicle pathways prepared and proper screw length and Blunt 48230231 diameter determined the bone screw is prepared for insertion K Wire The Xia Precision Polyaxial Screwdriver 48231310 provides a very rigid connection between the polyaxial bone screws and the screwdriv 48237001 er The screwdriver can be attached to any of the cannulated modul
24. rs have depth markings 40 50 60 70 80 90 105 120mm laser etched which correlate to retractor blade lengths Choose a Retractor Blade length 48250 040 120 based on where the top of the skin meets the Dilator Note If the skin is between two markings on the Dilator choose the next longest Blade Instrument Bar 48250011 Cobb Style Initial Dilator 48250040 40mm 48250050 50mm 48250060 60mm 48250070 70mm 48250080 80mm 48250090 90mm 48250105 105mm 48250120 120mm Figure 9 Retractor Blades Insertion n O Use the cobb style Initial Dilator to palpate the lamina in both the sagittal and transverse planes This confirms an appropriate approach laterally The tip of the Dilator is used to sweep the paraspinal musculature off the laminar edge Note The Dilator 22mm width is designed not to enter the intralaminar space when oriented cephalo caudal Note By keeping the Dilator tip in the subperiosteal space the dissection is essentially bloodless 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
25. section of the facet and transverse process gt Confirm that the appropriate pedicle starting place has been determined using both A P and lateral images 23 24 Luxor Surgical Technique Figure 32 Figures 33A amp 33B Figures 34A amp 34B Use the Jam Shidi needle to gain access to the pedicle gt After placing the Jam Shidi at the intersection of the facet and the transverse process the needle may be advanced partially through the pedicle using the Slap Hammer 48237120 gt As the pedicle is navigated with the Jam Shidi it should approach the medial wall of the pedicle on the A P view and should approach the base of the pedicle on the lateral view When the needle reaches the medial wall on the A P view verification needs to be performed in the lateral view to ensure the needle is past the base of the pedicle Instrument Bar o 10 Gauge 9 inch 48237110 10 Gauge 5 inch 48237105 11 Gauge 5 inch 48237115 13 Gauge 5 inch 48237135 Jam Shidi 48237120 Slap Hammer Figure 35 Sharp 48230230 Blunt 48230231 K Wire gt Remove the inner trocar of the Jam Shidi se O 0 Figure 36 The removal of the Jam Shidi inner trocar allows the K Wire Sharp 48230230 Blunt 48230231 to be inserted into the pedicle Caution should be practiced with regards to the position of the K Wire in order to avoid the advancement of the
26. stryker Spine Luxor ourgical Technique Minimally invasive procedures Luminated expandable oval retractor Complete visualization and optimal working space Luxor Surgical Technique Table of Contents 18 06 61 IE Ko EN 0500 4 Key Design Felures ss u s ss ku kaya Wa 4 a kil al kik haa ave cr E 5 Patient POSiGONINE gt s cl l s na dns au ame DS 6 Arm Assembly POSItIODIDS escri l Wla k u walk W lad w S E 6 Behns PRP lt ns s kn a k n n kad AA XAK cas io ec aa n WA W UL 7 PStablisl EEE CEN LAT 8 Mal SC DE 8 Initial Dilstor Inserllon gt i c xa Wa nenn d Wn ll ah en W Ban ace 10 Subsequent Dilator Inserti n se gt s misk a ha ecards E 12 ROE GOE OD EE EE 2 13 Reaccion aser sc s asa kl yan u a saw n b n dya naa n a 2ha kann a WEN K 15 Retractor Variable Opening Closing Mechanism 16 Disc Preparation and Removal 2231 42 2e EA DE A ked ua da A 18 Disc Pr paration and Removal Continued A KK KK KK KK KK K k k 20 Hile bol OE eo CT 21 CA o A NE ce oem ea eee 22 Screw Insertion Canned gt c Sa n seye n a k ha BA kal DWA 0 OO 25 Screw Insertion Non Cannulated as 24 i as varias denne teense TE 31 Rod Insertion EEE ENER F R 33 Blocker Seron a au suba n dan d l k k w b kh An a i d E
27. ted screws Rod insertion Blocker insertion Construct adjustment and final tightening c A D 5 Q g ze Luxor Surgical Technique Figure I Figure 2 Figure 3 Patient Positioning Luxor can be used successfully under local epidural spinal or general anesthesia General anesthesia is commonly used since it is the most comfortable for the patient and allows immediate postoperative neurological assessment The patient is prepped and draped in the usual sterile manner for posterolateral fusion with pedicle screw fixation Arm Assembly Positioning The Mediflex Flex Arm Post 48250240 mounts to the hospital bed rail Check compatibility of the Mediflex Flex Arm Post to the hospital bed prior to surgery Mount the Arm Post to the bed rail on the opposite side of the surgeon near the patient s hip Turn the Arm Post locking mechanism clockwise to secure it to the bed Once the Arm Post is secure attach the Snake Arm 48250230 to the Arm Post and lock into place The Snake Arm should be positioned to lie across the patient and wrap in front of the surgeon Note For additional information see the Mediflex Flex Arms Surgical User s Manual Instrument Bar 48250240 Arm Post 48250230 Snake Arm ge Fi 48250215 JJ igure 4 Universal Light Cable Lighting Preparation Determine the type of light source available in the
28. to the nerve root or deeper structures Note To ensure that the Guide Pin was not bent during a prior surgical procedure pass the Guide Pin through the cannulation in the cobb style Initial Dilator This activity confirms that the Guide Pin is not bent and reduces the risk of the Guide Pin being advanced forward into the canal space when used through the cobb style Initial Dilator during the dilation process 11 12 Luxor Surgical Technique Figure 10 Figure 11 Figure 12 Subsequent Dilator Insertion gt Slide the Kelly Retractors 48250017 around the cobb style Initial Dilator and into the incision Remove the cobb style Initial Dilator gt Insert the Blunt Dissector 48250018 Remove the Kelly Retractors Use the Blunt Dissector to penetrate and gently spread and dissect soft tissue down to the lamina Use imaging to confirm the placement of the Blunt Dissector on the superior facet Note The Blunt Dissector may be used to probe and identify the anatomy Note If additional assistance is needed introducing the Blunt Dissector use both the Kelly Retractors 48250017 together to facilitate introduction Instrument Bar y we 48250017 e Kelly Retractors S 5 a AS 48250018 Blunt Dissector Figure 13 48250020 Retractor Base 48250040 40mm 48250050 50mm 48250060 60mm 48250070 70mm 48250080 80mm 48250090 90mm 48250105 105
29. transversely across the mid line of the cephalad pedicles Draw a line extending several inches lateral to the pedicles Instrument Bar 48250010 Guide Pin Figure 6 Repeat for the caudal pedicles 10 Luxor Surgical Technique Figure 7 Figure 8 Carefully determine the appropriate entry point and trajectory for the Luxor For decompression the entry point is approximately 2cm off mid line with a more medial trajectory For pedicle screws 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 A 3 5cm incision parallel to the spine is made at the puncture site gt Incise the fascia to make tissue dilation easier Note For procedures not requiring distal expansion of the retractor a 3 0cm incision can be used for insertion Note If tissue dilation is difficult increase the fascial incision Initial Dilator Insertion Place the cobb style Initial Dilator 48250011 through the incision Advance the Dilator through the tissue while directing it toward the inferior aspect of the superior lamina under lateral imaging The Dilator is advanced through the lumbodorsal fascia Location of the cobb style Initial Dilator is confirmed using imaging Note the depth marking of the Dilator in relation to the skin The Dilato
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