`
`NUVASIVE 1055
`NuVasive, Inc. v. Warsaw Orthopedic, Inc.
`IPR2013-00206
`IPR2013-00208
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`2
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`14
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`DLIF
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`SURGKCAL TECHNIQUE
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`Neuromonitoring through the Psoas
`
`Step 1 After a safe retroperitoneal pathway to the psoas
`has been established, the NIM® X—PAK Probe is
`guided down to the psoas while using the finger
`to protect the peritoneal membrane. The NIM‘m
`X—PAK Probe includes an electrified handle stylet
`assembly and an insulated cannula that enables
`controlled electrification at the tip of the device
`(Figure 11).
`
`Step 2 A Needle Driver is used to position the NIM” X—PAK
`Probe onto the top surface ofthe psoas.The entry
`point ofthe NlM” X—PAK Probe into the psoas
`should be targeted beiween the 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 or'the psoas muscle {Figure 12).
`Lateral fluoroscopy is used to make adjustments
`until the MM” X—PAK Probe is in the proper position
`(Figure 13).
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`Figure l
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`4i
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`4/5
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`Si
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`3s
`3i
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`4:
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`5/5
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`Figure 73
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`3
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