`
`PLAINTIFF’S
`EXHIBIT
`
`CASE
`NO.
`
`08CV 01512
`
`EXHIBIT
`
`NO. PX1698
`
`\fi NUVASIVE”
`
`Creative Spine Tr-(‘lIno/Ugy‘”
`
`N0000001
`NOOOOOO1
`
`MSD 1140
`|PR2013-00506
`
`PX1698-0001
`PX1698-0001
`
`IPR2013-00508
`
`PX1698
`
`

`

`Preface
`
`XLIF ® Instrument System
`
`General Instrument System
`
`MaXcess® II Access System
`
`NeuroVision• System
`
`Presurgical Preparation
`
`- Equipment Requirements
`
`- Surgical Considerations
`
`XLIF ® Surgical Technique
`
`- Patient Positioning & Operating Room Setup
`
`-Anatomic landmark Identification & Initial Incisions
`
`- Retroperitoneal Access
`
`- Retroperitoneal Approach
`
`- Transpsoas Approach
`
`- NeuroVision EMG Monitoring
`
`- Access
`
`- Annulotomy & Disc Space Preparation
`
`- Implant Sizing and Placement
`
`- Closure
`
`- Catalog
`
`2
`
`3
`
`4
`
`8
`
`9
`
`9
`
`9
`
`10
`
`10
`
`11
`
`12
`
`13
`
`14
`
`15
`
`17
`
`20
`
`21
`
`21
`
`22
`
`PX1698-0002
`
`N0000002
`
`

`

`luiz Pimenta. M.D .
`
`Until now, widespread acceptance of minimally invasive techniques has evaded spine surgery. One reason for this is the inherent difficulties new
`technologies (endoscopes, optical trocars, C02) typically introduce while attempting to achieve the same surgical objectives as conventional surgery.
`This becomes a major obstacle for surgeons when trying to adopt these techniques.
`
`The MaXcess• System provides maximum surg1cal access while minimizing the soft tissue disruption that often occurs during open surgery. The
`MaXcess System allows the fundamentals of conventional surgical techniques while eliminating the unfamiliar requirements of operating coaxially
`through tubular portals. Additionally, since there are no necessary adJunctive visualization tools (e.g., endoscope), the MaXcess System enables direct
`visualization of the patient's anatomy through conventional methods.
`
`This guide describes the XLIF• technique that utilizes a direct lateral, retroperitoneal approach to access the intervertebral disc without muscular
`disruption or trauma to nearby structures.
`
`As we strive to decrease patient morbidity, we should require that these new minimally invasive techniques do not undermine surgical fundamentals
`that have served us well.
`
`Obrigado,
`
`Hospital Santa Rita
`Sao Paulo, Brazil
`
`PX1698-0003
`
`N0000003
`
`

`

`XLW INSTRUMENT SYSTEM
`
`KERRISUNS - 3,5mmxlal]:
`
`BRUAEHES - 6,3,10,12,11m1mx13mm
`
`SIZERS - 7— 14mm
`
`T-HANDLE
`T-HANDLE
`
`NERVE
`RETRACTUR
`
`BIPOLAR FORCEPS-
`ANGLED
`
`BIPOLAR FORCEPS CABLE
`
`PENFIELD - LARGE
`
`IMPLANT TAMP
`
`SUCTION NERVE RETRACTDR
`
`SUCTION - 8, 10 FR
`
`XLIF DISTRACTOR
`
`2
`
`PX1698-0004
`PX1698-0004
`
`N0000004
`NOOOOOO4
`
`

`

`LAMINA SPREADER
`
`CURETTES- STRAIGHT LEFT RIGHT DOWN UP
`
`DISC CUTTERS - o IOmm
`
`SLAP HAMMER
`
`3
`
`N0000005
`
`PX1698-0005
`
`

`

`MAXCEESS“ ll ACCESS 5‘i’STEM
`
`4
`
`PX1698-0006
`PX1698-0006
`
`N0000006
`NGDDGU’OE'
`
`

`

`MAXCESSEIIACCESS SYSTEM
`
`O)Q
`
`g‘g'gi‘a‘cvk
`
`PX1698-0007
`PX1698-0007
`
`5
`
`N0000007
`NOOOOOO7
`
`

`

`ARTICULATING ARM
`
`D IL AT 0 R S - NV 6, 9 11mm (NeuroVISIOniD Compatible)
`
`DILATORS - 6. 9 t1mm
`
`90
`
`80
`
`70
`
`60
`
`so
`
`40
`
`40
`
`3
`
`2
`
`P- 0
`
`9d
`
`Gq
`
`0
`
`0
`
`6
`
`PX1698-0008
`
`N0000008
`
`

`

`ACCESS DRIVER
`
`LIGHT CABLE ITIP ADAPTORS NOT SHDVINI
`
`SHIMS -STANDARD
`
`INTRADISCAL
`
`\VIDE EXTRA \VIDE RIGHT EXTRA WIDE LEFT
`
`BLADES - 4D so 6o. 10. oomm
`
`BLADES - 90 , 1Do. no. 120.130 140mm
`
`SHIM INSERTER
`
`BLADE ROTATIOII SPREADER
`
`BLADE ROTATION WRENCH
`
`SHIM TAMP I REMOVAL TOOL
`
`HEX DRIVER
`
`PX1698-0009
`
`7
`
`N0000009
`
`

`

`CONTROL UNIT
`
`PATIENT MODULE
`
`,ro~ -
`LA - -
`
`STIMULATION HANDPIECE
`
`EMG HARNESS
`
`REFERENCE. ANODE. AND RECORDING SURFACE ELECTRODES
`
`PEDICLE PROBE (STERILE)
`
`8
`
`PX1698-001 0
`
`N0000010
`
`

`

`EQU IPM ENT REQUIREMENTS:
`To successfully complete this technique, the following instruments are required:
`
`• Radiolucent bendable surgical table
`• C-Arm
`• Light source
`• MaXcess® II Access System
`• MaX cess XLI r System
`• Triad® General Instrument Tray
`• NeuroVision® JJ B System
`
`SURGICAL CONSIDERATIONS:
`The XLIF procedure enables access to the spine via a direct-lateral, retroperitoneal approach. The anatomic landmarks the surgeon should consider
`when preparing for this technique are: the iliac crest, the 12th rib, and the lateral border of the erector spinae muscles.
`
`Two small incisions will be made during this procedure. The surgeon will use the first incision, located near the lateral border of the erector spinae
`muscles, to access the retroperitoneal space and safely guide the Initial NeuroVision Dilator to the psoas muscle. The second incision, located in a
`direct lateral position, will be used to place the Dilators and retractor, and will provide disc space access. This two-incision technique was specifically
`developed to offer simple and efficient access to the spine, while minimizing the potential for peritoneal injury.
`
`RETROPERITONEAL ACCESS
`Alternate blunt scissor and finger dissection is used to safely enter the retroperitoneal space. Once the index finger is inside the space, a gentle
`sweeping motion is used to release the peritoneum anteriorly and create a safe space though which the Dilators and retractor will pass. The initial
`NeuroVision Dilator will first pass through the oblique muscle layers and meet the index finger just inside the retroperitoneal space. The index
`finger will then escort the Dilator safely past the peritoneum down to the surface of the psoas muscle.
`
`TRANSPSOAS ACCESS
`Once the initial NeuroVision Dilator is on the surface ofthe psoas muscle, NeuroVision 1s connected to the Dilator. As the Dilator is advanced through
`the psoas, the surgeon uses NeuroVision to avoid the nerves of the lumbar plexus. A direct lateral trajectory targeting approximately the middle
`of the disc minimizes the chance of encountering a nerve and ensures that the anterior vessels remain well anterior to the access corridor.
`Once docked on the spine, the Dilator is affixed to the disc with a K-Wire and subsequent dilation and muscle-splitting retraction establish the
`operative corridor.
`
`9
`
`N0000011
`
`PX1698-0011
`
`

`

`STEP 1:
`PATIENT POSITIONING AND O.R. SETUP
`The patient is placed on a bendable surgical table in a
`direct lateral decubitus (90°) position so that the iliac
`crest is directly over the table break. The patient is then
`secured with tape at the following locations (Fig. 1):
`
`A) Just below the il1ac crest
`B) Over the thoracic region
`C) From the iliac crest to the knee, then secured to
`the table
`D) From the table to the knee, past the ankle, then
`secured to the table
`
`This configuration ensures the pelvis tilts away from the
`spine allowing access to all lumbar levels, particularly L4-L5.
`
`Using fluoroscopy to verify location, the surgical table
`should be flexed to increase the distance between the
`iliac crest and the rib cage in order to gain direct access
`to the disc (Fig. 2).
`
`Once the patient is secured, adjust the table so that the C(cid:173)
`arm provides true AP images when at 0°, and true lateral
`images when at 90° (Figs. 3, 4).
`
`Table should be adjusted independently when accessing
`each level in order to maintain this relationship.
`
`The NeuroVision• control unit should be placed opposite
`the surgeon to enable an unobstructed view (Ag. 5).
`
`DISTINCT ENDPLATES
`
`DISTINCT ENDPLATES
`
`NEUROVISIO
`
`(Fig. I)
`
`(Fig. 2)
`
`(Fig. 4)
`
`FLUORO ' .
`MONITOR
`'
`
`SPINOUS PROCESS
`CENTERED BETVVEEN
`PEDICLES
`
`10
`
`PX1698-0012
`
`N0000012
`
`

`

`STEP 2:
`ANATOMIC LANDMARK IDENTIFICATION &
`INITIAL INCISIONS
`Following aseptic preparation, the disc space is localized
`using lateral fluoroscopy. This
`is accomplished by
`crossing two K-Wires over the pathologic level centered
`over the indicated disc space (Rg. 6) A mark on the skin
`is made at the intersection of the K-Wires to serve as the
`location of the skin incision for the operative corridor.
`
`Another mark is made on the skin at a posterolateral
`location between the Ilium and the rib cage. Typically,
`this is a finger length's distance from the lateral incision
`and just lateral to the erector spinae muscles (Rg. 7).
`It
`is through this incision that the retroperitoneal
`space will be accessed via blunt scissor and
`finger dissection.
`
`a:
`0
`ii w
`u... z
`
`ANTERIOR
`
`POSTERIOR
`
`(Rg. 6)
`
`DIRECT LATERAL
`INCISION
`
`LATE
`
`I
`/
`
`a:
`0
`ii w
`c.
`::I
`"'
`
`POSTERIOR
`
`(Rg. 7)
`
`POSTEROLATERAL
`INCISION
`
`a:
`0
`ii w
`u...
`z
`
`11
`
`N0000013
`
`PX1698-0013
`
`

`

`STEP 3:
`RETROPERITONEAL ACCESS
`Through the posterolateral inciston, the subcutaneous
`tissue layers are dissected using alternating blunt scissor
`and finger dissection (Fig. 8). The blunt scissors are used
`to carefully spread the muscle fibers, while subsequent
`finger advancement enables the surgeon to determine
`whether resistance by the muscle tissue exists. Typically
`a loss of resistance by the muscle tissue tndicates that
`the retroperitoneal space has been reached. Care should
`be taken to avoid abrupt advancement, which could
`cause perforation ofthe peritoneum.
`
`Once inside the retroperitoneal space, the index ftnger is
`used to create space and sweep the peritoneum anteri(cid:173)
`orly (Fig. 9). When the peritoneum is released, the finger
`is then used to palpate the psoas muscle (Fig. 10).
`
`12
`
`PX1698-0014
`
`N0000014
`
`

`

`STEP 4:
`RETROPERITONEAL APPROACH
`Once the psoas muscle is identified, the index finger is
`swept up to the ins1de abdominal wall underneath the
`direct lateral skin mark (Rg. II). Th1s step ensures that
`a safe pathway exists between the abdominal wall and
`the psoas muscle.
`
`An incision is made at this location (Rg. 12) and the initial
`NeuroVision® Dilator (black) is introduced (Rg. 13).
`
`The 1ndex finger that is inside the retroperitoneal space is
`then used to escort the initial Dilator safely down to the
`psoas muscle (Fig. 14).
`
`DIRECT LATERAL
`INCISION
`
`POSTEROLATERAL
`INCISION
`
`(Rg. 12)
`
`13
`
`N0000015
`
`PX1698-0015
`
`

`

`STEP 5:
`TRANSPSOAS APPROACH
`initial
`Upon reaching the psoas muscle with the
`NeuroVision® Dilator, the location is verified with a
`lateral fluoro image. The ideal location is approximately
`at the center (or just postenor to center) of the disc
`space (Fig. 15).
`
`The Large Dynamic Stimulation Clip is attached to the
`initial Dilator and NeuroVision is activated in Detection
`mode (see opposite page for more detail). The fibers of
`the psoas muscle arethen split using blunt dissection with
`the initial Dilator. It is slowly advanced while NeuroVision
`is active in Detection mode (Ag. 16). If the Dilator is deter(cid:173)
`mined to be too close to a nerve, the Dilator is slowly
`rotated 360° to determine the location of the nerve.
`A line on the proximal end of the Dilator corresponds to
`an electrode on the side of the distal tip. NeuroVision
`will indicate a higher value when the electrode faces
`away from the nerve. The Dilator is then removed
`from the psoas, moved a couple of millimeters in this
`direction, and a new path through the psoas muscle is
`attempted.
`
`-
`
`n
`
`+--·
`
`!CO
`
`1co
`
`R. Tibialis Anterior
`
`(Fig. 15)
`
`(Fig. 16)
`
`14
`
`PX1698-0016
`
`N0000016
`
`

`

`NEUROVISION ~ EMG MONITORING
`Attach the Large Dynamic Stimulation Cl ip to the
`proximal end of the NeuroVision Dilator as shown
`(Fig. A). The Dilators are insulated to minimize current
`shunting while an isolated electrode at the distal tip acts
`as the stimulation source (Fig. B).
`
`The descending nerves of the lumbar plexus tend to
`lie in the posterior one-third of the psoas muscle. The
`NeuroVision® System assists with safe passage past
`these nerves and/or confirmation of their posterior
`location via evoked-EMG monitoring. In Detection mode,
`the NeuroVision System Will continuously search for the
`stimulus threshold that elicits an EMG response on the
`myotomes monitored and audibly and visually report
`the thresholds (Fig. C).
`
`As the Dilator is advanced through the psoas muscle,
`the stimulus necessary to elicit an EMG response will
`vary with distance from the nerve - i.e., the closer the
`stimulus source is to the nerve, the less stimulus intensity
`will be required to elicit a response, and the lower the
`resulting threshold will be, providing an indication of
`relative proximity ofthe Dilator to the nerves. Experience
`has suggested that threshold values greater than lOmA
`indicate a distance that allows for both continued nerve
`safety and ample working space.
`
`(Fig. C)
`
`15
`
`N0000017
`
`PX1698-0017
`
`

`

`STEP 5:
`TRANSPSOAS APPROACH (CONT.)
`Once the initial Dilator is docked on the disc, fluoroscopy
`should be used to confirm position.
`
`A lateral image should confirm that the Dilator is approxi(cid:173)
`mately centered on the disc (Fig. 17). lfthe Dilator is not
`at the optimal position, NeuroVision® may be activated
`and the Dilator's position adjusted.
`
`A cross-table AP image should confirm that the Dilator is
`in the plane of, and flush with the disc space (Fig. 18).
`
`Following confirmation of position, a K-Wire is introduced
`about halfway into the disc space to secure position
`(Fig. 19). Depth markings on the Dilator indicate the size
`of the appropriate length Blades to be attached to the
`MaXcess® Access Driver (Fig. 20).
`
`(Fig. 18)
`
`16
`
`PX1698-0018
`
`N0000018
`
`

`

`STEP 5:
`TRANSPSOAS APPROACH (CONT.)
`The next two NeuroVision® Dilators (magenta, blue) are
`subsequently introduced over the initial Dilator using a
`twisting motion. NeuroVis1on is used as with the previ(cid:173)
`ous Dilator to minimize potential nerve contact.
`
`Attach appropriate length Blades to the Access Driver by
`tightening the set-screws (Fig. 21).
`
`STEP 6:
`ACCESS
`The Access Driver is introduced over the third Dilator
`with the handles pointing posterior. The NeuroVision
`Dynamic Stimulation Clip may be attached to the post
`on top of the center Blade to stimulate an electrode
`on the distal end of the Blade (Fig. 22). Cross-table AP
`fluoroscopy is used to confirm the correct position ofthe
`Access Driver Blades on the spine, and that the Blades
`are parallel to the disc space (Fig. 23).
`
`Attach Articulating Arm bed rail attachment to the bed
`rail (Fig. 24). Slide Articulating Arm post through the
`bed rail attachment adjust to the desired height and
`lock the position by tightening the handle on the bed
`rail attachment (Fig. 25). Attach the opposite end ofthe
`Articulating Arm to the Access Driver (Fig. 26).
`
`PX1698-0019
`
`a::
`0
`
`ii ... 1-z
`
`c:r:
`
`NEUROVISION
`DYNAMIC STIMULATION CLIP
`
`SUPERIOR
`
`(Fig. 23)
`
`a::
`0
`
`ii ...
`Iii
`0 c.
`
`INFERIOR
`
`(Fig. 26)
`
`17
`
`N0000019
`
`

`

`STEP 6:
`ACCESS (CONT.)
`While holding the Access Driver in position using
`downward pressure, turn the knob on the Articulating
`Arm clockwise to lock into place (Fig. 27).
`
`Blades are expanded approximately two or three "clicks"
`in a superior/inferior direction by squeezing the handles
`on the Access Driver (Fig. 28).
`
`Anterior/Posterior exposure is achieved by turning the
`knobs on the sides of the Access Driver in the direction of
`the arrows (Fig. 29). This adJusts the aperture anteriorly
`to minimize Blade pressure on the posterior portion
`of the psoas muscle where the maJority of the nerves
`are located.
`
`a::
`0
`ii2 w
`1-z
`c:r:
`
`(Fig. 27)
`
`INFERIOR
`
`(Rg. 28)
`
`(Rg. 29)
`
`18
`
`PX1698-0020
`
`N0000020
`
`

`

`STEP 6:
`ACCESS (CONT.)
`Pass the single end of the bifurcated Light Cable and the
`appropriate light source connector off the sterile field
`where it will then be attached to a I ight source. Place the
`two remaining ends of the Light Cable about halfway
`down the left and right Blades of the Access Driver and
`bend flush to the surface of the Access Driver (Ag. 30).
`
`Thoroughly explore any residual tissue at the bottom
`of the exposure. Use the NeuroVision® Pedicle Probe to
`confirm that nerves are not w1thin the exposure.
`
`Shims are available in various sizes to either effectively
`widen or lengthen the Blades to keep tissue out of
`the exposure. Place Shims down the Blades and use
`the Penfield or Nerve Retractor to tuck residual tissue
`behind the Shims (Ag. 31). An lntradiscal Shim may be
`placed into the disc space to further stabilize the retractor
`(Ag. 32). Use bipolar electrocautery, if necessary, to
`further prepare for disc visualization.
`
`ANTERIOR
`
`POSTERIOR
`
`(Fig. 30)
`
`(Ag. 31)
`
`(Ag. 32)
`
`19
`
`N0000021
`
`PX1698-0021
`
`

`

`STEP 6:
`ACCESS (CONT.)
`If necessary, use either the Blade Rotation Wrenches or
`Blade Rotation Spreader to rotate either one or both of
`the Blades (Ags. 33, 34). This expands the distal part oft he
`exposure and may be helpful to preferentially adJust the
`exposure in either direction (e.g., inferiorly at L4-5 under
`the 11 iac crest) to gain optimal access to the disc space.
`Slide the Blade rotation locks toward the Blades on the
`left and right arm of the Access Driver to secure Blade
`position (Fig. 35).
`
`STEP 7:
`ANNULOTOMY & DISC SPACE PREPARATION
`Create an annulotomy approximately 18mm in length
`(anterior to posterior) with the Annulotomy Knife. Pass
`the Cobb Elevator along both end plates and completely
`through the contralateral annulus (Ag. 36). This step is crit(cid:173)
`ical tofacil itate distraction oft he disc space, achieve proper
`coronal alignment, and place a large implant that spans
`the ring apophysis.
`
`Use Pituitaries, Curettes, Disc Cutters, Scrapers and other
`disc preparation instruments to thoroughly evacuate the
`disc and prepare the end plates for fusion (Ag. 37).
`
`20
`
`(Ag. 35)
`
`(Fig. 36)
`
`(Ag. 37)
`
`PX1698-0022
`
`N0000022
`
`

`

`STEP 8:
`IMPLANT SIZING AND PLACEMENT
`Use the XLIF Distractor and Sizers to distract the disc
`space and gauge the appropriately sized Trial. Place the
`selected Trial onto the Inserter and tighten the thumb(cid:173)
`wheel lock to secure (Fig. 38). Under AP fluoroscopy,
`gently impact the Trial into the disc space until centered
`(Fig. 39). Verify proper anterior/posterior position under
`lateral fiuoroscopy.
`
`If satisfied with placement and f1t of Trial, remove
`the Trial from the disc space. Use the Slap Hammer if
`necessary to facilitate Trial removal.
`
`Select corresponding implant, fill the implant with graft
`material, and attach to Inserter. Gently impact the
`implant into the disc space while monitoring placement
`under AP fluoroscopy and NeuroVision® Free-Run EMG.
`Ideal placement of implant is centered across the disc
`space from a medial/lateral perspective, and between
`the anterior third and middle third of the disc space from
`an anterior/posterior perspective (Figs. 40, 41).
`
`STEP 9:
`CLOSURE
`Once the procedure is completed, remove the Access
`Driver while using direct visualization to ver1fy the
`absence of significant bleeding in the disc space or
`psoas muscle.
`
`Close the skin using standard subcuticular suture.
`
`Add supplemental instrumentation as warranted.
`
`(Fig. 38)
`
`(Fig. 39)
`
`(Fig. 40)
`
`PX1698-0023
`
`21
`
`N0000023
`
`

`

`MA XC ESS" XLI F.
`
`SYSTEMS
`
`MaX cess XLI F System
`MaXcess II Access System
`Triad• GenerallnstrumentTray
`NeuroVision• JJB System
`NeuroVision XLIF Module (Disposables)
`
`XLI F. SYS TEM
`
`KERRISON RONGEURS
`
`Kerrison- 3mm, 40 Deg.- Long
`Kerrison - 5mm, 40 Deg.- Long
`
`BROACHES
`
`Broach- 6 x 18mm
`Broach- 8 x 18mm
`Broach- 10 x 18mm
`Broach- 12 x 18mm
`Broach - 14x 18mm
`
`SIZERS
`
`Sizer -7mm
`Sizer- 8mm
`Sizer- 9mm
`Sizer - 10mm
`Sizer- llmm
`Sizer- 12mm
`Sizer- 13mm
`Sizer- 14mm
`
`XLIF DISTRACTOR
`
`XLIF Distractor
`
`XLIF COBB ELEVATOR
`
`XLIF Cobb Elevator
`
`CATALOG #
`
`3300010
`3300011
`
`CATALOG#
`
`5001206
`5001208
`5001210
`5001212
`5001214
`
`CATALOG #
`
`5002407
`5003408
`5002409
`5003410
`5002411
`5003412
`5002413
`5003 414
`
`CATALOG#
`
`33000 40
`
`CATALOG#
`
`3300041
`
`IMPLANT TAMP
`
`lmplantTamp
`
`CATALOG#
`
`3300019
`
`PROBES/RETRACTORS
`
`CATALOG #
`
`Nerve Retractor - Long
`Suction Nerve Retractor- Long
`Penfield - Large, Long
`
`SUCTION
`Suction - 1 o FR, Long
`Suction - 12 FR, Long
`
`BIPOLAR FORCEPS
`
`Bipolar Forceps -Angled, Long
`Bipolar Forceps Cable
`
`3300014
`3300015
`3300018
`
`CATALOG #
`
`3300017
`3300028
`
`CATALOG#
`
`3300012
`3300013
`
`ANN ULOTOMY KNIFE
`
`CATALOG#
`
`Annulotomy Knife (disposable)
`
`3101055
`
`T-HANDLE
`
`T - Handle
`
`QTY
`
`2
`
`CATALOG#
`
`5000901
`
`STERILIZATION CASE
`
`CATALOG#
`
`Sterilization Case MaXcess XLIP
`
`3300030
`
`22
`
`PX1698-0024
`
`N0000024
`
`

`

`GE NERAL
`
`IN STRUM ENT TR AY
`
`DISTRACTORS I LAMINA SPREADER CATALOG#
`Pedicle Screw Spreader
`7100024
`Distractor -20° Bend
`7100013
`Distractor - Straight Offset
`7100014
`Lamina Spreader
`7100040
`
`PITUITARY RONGEURS
`
`Pituitary Rongeur- Straight
`Pituitary Rongeur- Up-biting
`
`CHISELS
`
`Chisel -Straight, 7mm
`Chisel -Straight, 12mm
`Chisel - Angled, 7mm
`
`CURETTES
`
`Curette - Straight
`Curette- Left Angled
`Curette - Right Angled
`Curette - Down Angled
`Curette - Up Angled
`
`CATALOG#
`
`7100041
`7100042
`
`CATALOG#
`
`7100043
`7100044
`7100045
`
`CATALOG#
`
`7100046
`7100047
`7100048
`7100049
`7100050
`
`SCRAPER
`
`Scraper- Straight
`
`DISC CUTTERS
`
`Disc Cutter 8mm
`Disc Cutter 10mm
`
`RETRACTOR I DISSECTORS
`Nerve Retractor
`Dissector- 4mm
`Dissector - 7mm
`
`RASPS
`
`Rasp - Straight
`Rasp - Angled
`
`SLAP HAMMER
`
`Slap Hammer
`
`STERILIZATION CASE
`
`Sterilization Case
`
`CATALOG#
`
`7100080
`
`CATALOG #
`
`5001708
`5001710
`
`CATALOG #
`
`7100053
`7100054
`7100055
`
`CATALOG #
`
`7100056
`7100057
`
`CATALOG#
`
`5000020
`
`CATALOG#
`
`7100003
`
`23
`
`N0000025
`
`PX1698-0025
`
`

`

`MAXCEss • I I ACCESS SYSTE M
`
`ACCESS DRIVER
`
`CATALOG#
`
`BLADE ROTATION INSTRUMENTS
`
`CATALOG#
`
`Access Driver - Body
`Access Driver- Handle, Right
`Access Driver- Hand le, Left
`
`3200209
`3200107
`3200108
`
`Blade Rotation Wrench
`Blade Rotation Spreader
`
`3220050
`3220051
`
`BLADES
`
`40m m Left Blade
`50mm Left Blade
`60mm Left Blade
`70mm Left Blade
`80mm Left Blade
`90mm Left Blade
`100mm Left Blade
`11 Omm Left Blade
`120mm Left Blade
`130mm Left Blade
`140mm Left Blade
`
`40mm Right Blade
`50mm Right Blade
`60mm Right Blade
`70mm Right Blade
`80mm Right Blade
`90mm Right Blade
`1 oomm Right Blade
`11 Omm Right Blade
`120mm Right Blade
`130mm Right Blade
`140m m Right Blade
`
`40mm Center Blade
`50mm Center Blade
`60m m Center Blade
`70mm Center Blade
`80mm Center Blade
`90mm Center Blade
`100mm Center Blade
`11 omm Center Blade
`120mm Center Blade
`130mm Center Blade
`140mm Center Blade
`
`CATALOG #
`
`DILATORS
`
`CATALOG#
`
`3211040
`3211050
`3211060
`3211 070
`3211080
`3211090
`3211 100
`321lll 0
`3211120
`3211 130
`3211 140
`
`3212040
`3212050
`3212060
`3212070
`3212080
`3212090
`3212100
`321211 0
`3212120
`3212130
`3212140
`
`3213040
`3213050
`3213060
`3213070
`3213080
`3213090
`3213 100
`3213110
`3213120
`3213130
`3213140
`
`Dilator- 6mm
`Dilator- 9mm
`Dilator - 12mm
`Dilator- 6mm, NV
`Dilator- 9mm, NV
`Dilator - 12mm, NV
`
`3202006
`3202009
`3202012
`3203006
`3203009
`3203012
`
`SET SCREWS/ DRIVERS
`
`CATALOG#
`
`Set Screw - Short
`Set Screw- Long
`Set Screw- Center Blade
`Hex Driver (3/32")
`Hex Key (3/ 32 ")
`
`3210033
`3210034
`3210035
`3200016
`3200042
`
`LIGHT CABLE ADAPTERS
`
`CATALOG#
`
`Light Cable Adapter - ACMI
`Light Cable Adapter- Storz
`Light Cable Adapter - Olympus
`
`K-WIRE
`
`K-Wire
`
`3200045
`3200046
`3200047
`
`CATALOG#
`
`3200011
`
`SHIMS /INSTRUMENTS
`
`CATALOG#
`
`Shim - lntradiscal
`Shim -Standard
`Shim -Wide
`Shim -Extra Wide Right
`Shim - Extra Wide Left
`Shim Inserter
`Shim Tamp
`
`3200012
`3200013
`3200014
`3200025
`3200026
`3200215
`3200051
`
`ARTICULATING ARM
`
`CATALOG#
`
`STERILIZATION CASE
`
`CATALOG#
`
`Articu lating Arm
`Articulating Arm Bed Ra il Clamp
`
`3220121
`3220122
`
`Sterilization Case - MaXcess II Access System
`
`3220020
`
`24
`
`PX1698-0026
`
`N0000026
`
`

`

`NEURO VI SION • JJB SYSTEM
`
`NEUROVISION JJB SYSTEM
`
`CATALOG#
`
`2011 000
`
`NeuroVision JJB System
`Includes:
`NV JJB Control Unit
`NV JJB Patient Module
`NV JJB Stimulation Handpiece
`NV JJB Handpiece Sterilization Case
`lnStim™ Tap Insulator
`Impedance Meter
`Impedance Meter Leads
`NV JJB Quick Reference Manual
`
`NEURO VISION JJB XLI F. MODULE ( DISPOSABLE S)
`
`NEUROVISION XLIF MODULE (DISPOSABLES)
`
`CATALOG#
`
`8010020
`
`NeuroVision JJB XLI F Modu le (Disposables)
`Includes:
`(1) NeuroVision JJB Sterile Pedicle Probe
`(1) Large Dynamic Stimulation Clip
`Dual EMG Electrodes
`Twitch Test Stimulation Leads
`EMG Harness Kit
`Patient Preparation Su pplies
`
`25
`
`N0000027
`
`PX1698-0027
`
`

`

`(l NUVASIVE.
`
`Creative Spine Technology•
`
`To order, please contact your NuVasive Sales Consultant or Customer Service Representative today at:
`4545 Towne Centre Court, San Diego, CA 92121 • phone: 800-475-9131 fax: 800-475-9134
`www.nuvasive.com
`© 2006. NuVasr.te, Inc. All rights reserved. I:) , NuVasive, Creative Spine Technology, MaXcess, NeuroVision, Triad and XLIF are federally registered trademarks of NuVasive, Inc.
`MAS and lnStim are common law trademarks of NuVa~ve, Inc.
`
`9004243 A.O
`
`N0000028
`
`PX1698-0028
`
`