`
`NUVASIVE 1055
`NuVasive, Inc. v. Warsaw Orthopedic, Inc.
`IPR2013-00206
`IPR2013-00208
`
`
`
`2
`
`
`
`‘l4
`
`DLIF
`
`SURGKCAL TECHNIQUE
`
`Neuromonitoring through the Psoas
`
`Step 1 After a safe retroperitoneal pathway to the psoas
`has been established, the NIMP X—PAl< Probe is
`guided down to the psoas while using the finger
`to protect the peritoneal membrane.The NlM""
`>(—PAK Probe includes an electrified handle stylet
`assembly and an insulated cannula that enables
`controlled electrification at the tip ofthe device
`(Figure 11).
`
`Step 2 A Needle Driver is used to position the Nll\/1“ ><—PAi<
`Probe onto the top surface of the psoas.The entry
`point ofthe NW1” X—PAi< Probe into the psoas
`should be targeted beiween tne anterior haltto
`third ofthe disc space in order to avoid the nerves
`ofthe lumbar plexus and to remain posterior to
`vascular structures. Cadaver studies have shown
`that the motor nerves typically reside in the
`posteriorone third otthe psoas muscle {Figure 12).
`Lateral fluoroscopy is used to make adjustments
`until the NIMP X—PAK Probe is in the proper position
`(Figure 13).
`
`Figure I
`
`I
`
`3
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