REXIOUS SPINAL SYSTEM
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1 REXIOUS SPINAL SYSTEM SURGICAL TECHNIQUE Site Preparation. Screw Insertion 3. Rod Preparation and Insertion 4. Rod Instruction 5. Set screw Insertion 6. Compression, Distraction & Rotation 7. Final Tightening 8. Reduction Cut & Transverslink 9. Revision or Removal SURGICAL TECHNIQUE
2 . Site Preparation Awl Straight & curved Pedicle probe Ball Tip Tester. Awl. Probe 3. Guide Pin 4. Ball Tip Tester 5. Tap with Ratchet A B Tap with Ratchet Guide Pin SURGICAL TECHNIQUE / SITE PREPARATION s for Site Preparation Pedicle hole preparation is began with a sharp Awl that penetrates the pedicle hole starting point. Determine the pedicle canal entry site. Insert the Probe or Curved Probe into the established entry site, gently pressing through the pedicle canal to determine hole depth.
3 3 Confirmation of bony continuty on all sides and bottom of the prepared holes is achieved with a Tester. The Tester is used to palpate all four sides and the bottom of the pedicle hole, to ensure that it is within bone. 4 Insert the Guide Pin into the pedicle canal. The Guide Pin may be placed to identify appropriate Screw trajectory via a lateral X-ray or fluoroscopy view. 5 Taps are available for each of 5.5, 6.5 & 7.5mm diameters. SURGICAL TECHNIQUE / SITE PREPARATION
4 . Screw Insertion Monoaxial Screw Driver Ratchet Handle Polyaxial Screw driver. Ratchet Handle. Monoaxial Screw Driver 3. Monoaxial Pedicle Screw 4. Polyaxial Screw Driver 5. Polyaxial Pedicle Screw Monoaxial Pedicle screw Polyaxial Pedicle screw SURGICAL TECHNIQUE / SCREW INSERTION s for Screw Insertion Screw Drivers have two parts for locking. To loose or tighten the Screw, select the dial first. To lock the Screw, locate dial at Lock and use a Screw locking handle below the Driver locking dial. Driver Lock / Release Dial Screw Locking Handle Insert the Pedicle Screw into the vertebral body until it is the desired height. 3 To separate Screw Driver and Screw, locate dial at Release and use a Screw Locking Handle below the Driver Locking Dial. If you didn t change the dial, the Screw can be loosened instead of seperated.
5 3. Rod preparation & Insertion Rod Holder. Rod Bender. Rod Holder 3. In-Situ Rod Bender Rod Bender In-Situ Rod Bender s for Rod Preparation & Insertion The appropriate length Rod should be chosen according to the construct, allowing approximately 4-5mm of Rod overhang on either end of the construct. The Rod is bent to fit into the desired spinal contours as closely as possible, using the Rod Bender. The angle of bend can be varied by adjusting the central button on the Rod Bender. 3 The Rod is placed into the rod channel using the Rod Holder. 4 Should further contouring be desired after the Rod is inserted, the In-Situ Rod Benders are available. These instruments address lordotic and kyphotic in-situ bending procedures. SURGICAL TECHNIQUE / ROD PREPARATION & INSERTION
6 4.. Rod Screw Instruction Insertion Rod Pusher Persuader. Rod Fork. Rod Pusher 3. Persuader Rod Fork SURGICAL TECHNIQUE / ROD INSTRUCTION s for Rod Instruction The Rod Fork is designed to straddle the implant and Rod while introducing the Rod into the open implant. Rod Fork Rod Pusher The Rod Pusher is used to apply gentle force to the Rod while engaging the Set Screw. As with all Rod Pushers, control is essential. Excessive force should be avoided.
7 5. Set Screw Insertion Set Screw Guide Driver Retractor. Set Screw Guide Driver. Set Screw 3. Retractor Set Screw s for Set Screw Insertion Set Screws are loaded onto the Set Screw Guide Driver and loosely inserted into each housing. Do not final tighten the Set Screw with the Set Screw Guide Driver. The Retractor is used to make a space for the Set Screw Guide Driver. The Fork of the Retractor is located under the housing. SURGICAL TECHNIQUE / SET SCREW INSERTION
8 6.. Compression, Screw Insertion Distraction &Rotation SURGICAL TECHNIQUE / COMPRESSION, DISTRACTION & ROTATION Spreader. Compressor. Spreader 3. Derotator Once the Rod has been captured in the rod channel, compression and distraction maneuvers can be easily accomplished utilizing the Compressor and Spreader. Screw Compression Compressor Derotator s for Compression, Distraction & Rotation Screw Distraction The Derotator is used to firmly grasp the Rod for rotation or to establish a purchase point for distraction or compression if necessary.
9 7. Final Tightening Set Screw Driver. Power Holder. Set Screw Driver 3. Torque Wrench (for 5mm Hexa Driver) 4. 5mm Hexa Driver Power Holder Torque Wrench 5mm Hexa driver s for Final Tightening Place the tip of the Set Screw Driver into the Set Screw, and the Power Holder over the Set Screw and Rod. Begin turning the Set Screw Driver (or 5mm Hexa Driver with Torque Wrench by N) to tighten the Set Screw. Place the Set Screw Driver through the appropriate arm of the Power Holder. Place the tip of the Set Screw Driver (or 5mm Hexa Driver with Torque Wrench) into the Set Screw and Power Holder over the Set Screw and Rod. SURGICAL TECHNIQUE / FINAL TIGHTENING Assemble Torque Wrench & 5mm Hexa Driver
10 8.. Reduction Screw Insertion Cut & Transverse Link SURGICAL TECHNIQUE / RESUXTION CUT & TRANSVERSE LINK Cutter Cross Link Driver 4mm Hexa Driver Torque Wrench s for Reduction Cut & Transverse Link. Cutter. Cross Link Driver 3. Torque Wrench (for 4mm Hexa Driver) 4. 4mm Hexa Driver The Reduction Cutter is used to break off the Extended Arms. Both hooks of the Transverse Link are hooked on the Rod. Tighten Screw to half torque position, and then tighten every Screw to final torque position with the Cross Link Driver. [or 4mm Hexa Driver with Torque Wrench by 7N]
11 9. Revision or Removal Steps for Screw removal or revision. Step Remove Transverse Link Release the Set Screw using the Torque Wrench for T/L. Remove the Set Screw from the T/L hook. Then remove the Transverse Link using the Rod Holder. Step Remove Set Screw 3 Remove the Rod using the Rod Holder Release the Set Screw by creating Anti-Torque with the Torque Wrench. Rotate the Set Screw around just once to release. Remove the Set Screw using the Set Screw Driver Guide. 4 In case of revision, remove the Set Screw after doing the #3 procedure above. SURGICAL TECHNIQUE / REVISION OR REMOVAL
12 Step 3 Remove Screw Combine the Screw to be removed with the Mono Screw Driver or the Poly Screw Driver. Use full force of hand to combine the Screw and the Screw Driver. Rotate the Mono Screw Driver or Poly Screw Driver counterclockwise slowly. Rotate as slow as possible when the screw is not rotating. SURGICAL TECHNIQUE / REVISION OR REMOVAL 3 All Screws should be removed using step above. In revision use a bigger size Screw than previously used. (recommend +0.5mm)
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