surgical technique c roiroi-ctm ref: ir-c st 1 en 04.2010 a france technopôle de l’aube bp 2...

ANTERIOR CERVICAL CAGE

ROI-CTM

Ref: IR-C ST 1 EN 04.2010 A

FranceTechnopôle de l’Aube BP 210902 Troyes Cedex 9France+33 (0)3 25 82 32 63

ChinaUnit 08, Level 16, Building A,Beijing Global Trade Center #36North Third Ring RoadEast, Dongcheng District,Beijing, China, 100013+86 10 58256655

BrazilAv. Pereira Barreto, 1395Torre sul - CJ 193 - Bairro ParaisoSanto André - São PauloCEP: 09190-610Brazil+55 11 43327755

United States4030 West Braker Lane, Suite 360Austin, Texas 78759512.344.3333

www.ldrmedical.com

LDR, LDR Spine, LDR Médical, BF+, BF+(ph), Easyspine, Laminotome, MC+, Mobi, Mobi-C, Mobi-L, Mobidisc, ROI, ROI-A, ROI-MC+, ROI-T, ROI-C andverteBRIDGE are trademarks or registered trademarks of LDR Holding Corporation or its affiliates in France, the United States or other countries.

S U R G I C A L T E C H N I Q U E

TECHOP_ROICCOUV_GB:Miseenpage109/04/201015:10Page1

Step 1 - Disc location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Step 2 - Discectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Step 3 - Freshening the vertebral endplates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Step 4 - Trial implant selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Step 5 - Cage selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Step 6 - Cage preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Step 7 - Loading the cage on the implant holder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Step 8 - Cage positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Step 9 - Anchoring plates positioning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Step 10 - Implant holder removal and final control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

ROI-CTM


Table of Contents page

TECHOP_ROICCOUV_GB:Mise en page 1 09/04/2010 15:11

2-3

1Step Disc location

� The approach to the intersomatic space is realised after locating the affected levelunder fluoroscopy.

The surgical protocol and the technique used for the exposure of the intersomaticspace are the same as for the standard anterior approach for cervical vertebralsurgery.

0459

Discectomy

� Place the Caspar pins 8mm from the superior and inferior endplates of the treated level in order tonot impede insertion of the implant.

� Place the distractor on the pins.

� Distract the intersomatic space, then start disc resection with athin, long scalpel and disc forceps.

� Continue the discectomy to the back of the endplates.

Remark: It is not necessary to remove all the annular disc tissue laterally. It is sufficient to remove onlythe amount corresponding to the cage (between the uncus); maintaining the lateral annular layersoptimizes cage stability and facilitates arthrodesis.

2Step

Discectomy and endplates preparation

8 mm

8 mm

TECHOP_ROI-C_INT_GB:Mise en page 1 15/04/2010 10:05 Page 1


ROI-CTM

Trial implant selection

The trial implants vary in: depth x width and height.

They are identifiable due to a colour code: each colour representing a size

(depth x width)

4Step

3Step


Freshening the vertebral endplates

� Prepare the implant space and the grafting surfaces with a curette and a rasp. Thorough freshening of the endplates favours the fusion.

12x14mm

14x14mm

12x15,5mm

14x15,5mm14x17mm


4-5

4aStep

4bStep

Depth selection (12 or 14 mm)

� Insert the chosen trial implant into the intervertebral space.

� Check under fluoroscopy correct positioning of the trial implant in depth androtation.

Remark: The trial implant hole must be visible, assuring the lack of rotation.

Width selection

� After depth measurement, insert the chosen trial implant into theintervertebral space.

� Choose the trial implant that offers the best coverage of the vertebralendplate.

Remark: The trial implant has to be as large as possible, while stayingstable on the vertebral endplate.

Important: The posterior side of the trial implant has to be at a minimum of1mm from the posterior edge of the vertebra. If not the case, choose a trialimplant of inferior depth.

1 mm



ROI-CTM

4cStep

� Insert the trial implant of the colourcorresponding to the previously chosen size(depth x width) into the intervertebral space.

� Release briefly the distraction in order to makesure the trial implant is stable in theintervertebral space.

� Check under fluoroscopy the consistencybetween the height of the selected trial implantand the discal height of the adjacent levels.

� Restore the distraction in order to remove thetrial implant from the intervertebral space.

Height selection (from 4,5mm)

Cage selection

The colour code and the trial implant heightdetermine the choice of the final implant.

The information is located on the side ofthe implant boxes.

5Step


HeightColour code

Size(depth x width)

Sterilisation

�


6-7

6Step

Option B – Bone substitute

The BF+ bone substitute has an anatomical shape and is perfectlyadapted to the cage dimensions.

� Insert the superior part (dome-shaped)ofthe bone substitute through the inferioropening of the cage.

� Place the bevelled sides of the bonesubstitute (dome on top) in front ofthe cage slots to free the way for theanchoring plate.

Cage preparation

The fusion chamber of the cages has to be filled with autograft or bone substitute.

Option A – Autograft

� Compact the graft in the fusion chamber ofthe ROI-C cage with the graft compactor.

Graft compactor



ROI-CTM

7Step Loading the cage on the implant holder

Impactionknob

� Bring the cage close to the implant holder in such a way as to slotthe implant holder hook in the notch on the left side of the cage.

� Secure the cage on the implant holder with the threaded axis byscrewing the impaction knob.

Threaded axis

Hook


8-9

8Step Cage positioning

� Set the adjustable stop to zero by screwing or unscrewing the impaction knob.

Remark: It is up to the surgeon to select the standard stop or the enlarged one.

� Insert the cage in the intervertebral space under fluoroscopy in order to verifycorrect positioning.

Remark: From the lateral view, the marker shows the posterior position of the cage.

The implant holder’s adjustable stop comes into contact with the anterior wall ofthe superior vertebra space.

Antero-posterior positioning can be adjusted millimetre by millimetre with the knurledwheel.

� Once the antero-posterior positioning has been adjusted, release distraction and compressthe segment.

Important: During cage positioning, make sure the cage is perfectlyinserted in the axis of the intersomatic space.

Important: Each scale marked on the adjustable stop enables millimetricadvancement of the cage towards the vertebral body’s posterior wall.

Knurled wheel

OK

Standard stop Enlarged stop

or



ROI-CTM

9aStep Insertion of the first half anchoring plate

When cage position is optimal and the segment put in compression, theanchoring plate (composed of two half anchoring plates) can beinserted. Impaction of the half anchoring plates is done one afteranother (in the inferior vertebra, then in the superior one).

� The first half anchoring plate is inserted in the superior slot of the cageholder with the ROI-C anchoring plate holder (in the axis of the cageholder with a minimum of obstruction).

� Impact the half anchoring plate using the ROI-C impactor (marked 1)until it reaches its mechanical stop.

Anchoring plate positioning

Important: If the pins have not been properly placedduring the discectomy, they can impede anchoringplate insertion. In this case, remove the distractor andthe Caspar pins.

Important: During half anchoring plate insertion, makesure to push the plate all the way to the bottom of theimplant holder head with the ROI-C anchoring plateholder.

Mechanical stop

1st stage: Roi-C impactor (marked 1)

ROI-C Anchoringplate holder


� Complete the impaction using the ROI-C final impactor (marked 2).

Remark: Make sure the impactions are done in the axis of theintervertebral space.

Note: Use fluoroscopy during each step in order toverify correct positioning of the half anchoring plate.

2nd stage: ROI-C final impactor (marked 2)

Mechanical stop

10-11



ROI-CTM

9bStep Insertion of the second half anchoring plate

� The second half anchoring plate is inserted and impactedfollowing the same method used for the first one, makingsure the second half anchoring plate is inserted in theopposite slot from the first one.

Note: Use fluoroscopy during each step in order toverify correct positioning of the half anchoring plate.

Reminder: The half anchoring plate inserted in theimplant holder’s inferior guide penetrates into thesuperior vertebral body and inversely.

1st stage: Roi-C impactor (marked 1)

2nd stage: ROI-C final impactor (marked 2)


10aStep Implant holder removal

� Unscrew the impaction knob to release the cagefrom the threaded axis of the implant holder.

� Disengage the implant holder hook from the cagenotch by moving the implant holder to the left.

� Carefully remove the implant holder in the axis ofthe intervertebral space.

� Remove the distractor and the Caspar pins.

Final control

� A control under fluoroscopy, from the front andlateral view, of anchoring plate position enables toensure optimal trajectory.

10bStep

Implant holder removal and final control

Impactionknob

Fina

l con

trol

12-13


ANTERIOR CERVICAL CAGE

ROI-CTM

Ref:

IR-C

ST

1 EN

04.

2010

A

FranceTechnopôle de l’Aube BP 210902 Troyes Cedex 9France+33 (0)3 25 82 32 63

ChinaBeijing Global Trade Center #36North Third Ring Road East,Unit 06, Level 19, Building A,Dongcheng District,Beijing, China, 100013+86 10 58256655

BrazilAv. Pereira Barreto, 1395Torre sul - CJ 193 - Bairro ParaisoSanto André - São PauloCEP: 09190-610Brazil+55 11 43327755

United States4030 West Braker Lane, Suite 360Austin, Texas 78759512.344.3333

www.ldrmedical.com

LDR, LDR Spine, LDR Médical, BF+, BF+(ph), Easyspine, Laminotome, MC+, Mobi, Mobi-C, Mobi-L, Mobidisc, ROI, ROI-A, ROI-MC+, ROI-T, ROI-C andverteBRIDGE are trademarks or registered trademarks of LDR Holding Corporation or its affiliates in France, the United States or other countries.

SURGICAL TECHNIQUE

TECHOP_ROICCOUV_GB:Mise en page 1 09/04/2010 15:31 Page 1

surgical technique c roiroi-ctm ref: ir-c st 1 en 04.2010 a france technopôle de l’aube bp 2...

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