TM
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`XLIF ™ 90˚
`
`A
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`L
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`T
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`C
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`H
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`N
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`U
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`G
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`C
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`Creativs Spine Technology®
`IPR2013'00508
`
`
`MSD 1175
`
`|PR2013-00506
`
`\; N UVASIVE®
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`CONTENTS
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`Preface
`
`Instrument System
`
`Access System
`
`NeuroVision System
`
`Presurgical Preparation
`
` - Equipment Requirements
`
` - Surgical Considerations
`
`XLIF 90˚ Surgical Technique
`
` - Patient Positioning & Operating Room Set-up
`
` - Anatomic Landmark Identification & Initial Incisions
`
` - Retroperitoneal Approach
`
` - Transpsoas Approach
`
` - Access
`
` - Annulotomy & Disc Space Preparation
`
` - Implant Insertion
`
` - Closure
`
` - Catalog
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`PREFACE
`
`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, CO2) 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 surgical access while minimizing the soft tissue disruption that often occurs during open surgery. The MaXcess
`System allows the surgical fundamentals of conventional surgical techniques while eliminating the unfamiliar surgical 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 90° 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,
`
`Luiz Pimenta, M.D.
`Hospital Santa Rita
`São Paulo, Brazil
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`INSTRUMENT SYSTEM
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`XLIF 90˚ INSTRUMENT SYSTEM
`
`KERRISONS - 3, 5mm x 40˚
`
`BROACHES - 8, 10, 12, 14mm x 14mm
`
`SIZERS - 7 - 14mm
`
`T-HANDLE
`
`NERVE
`RETRACTOR
`
` BIPOLAR
`FORCEPS-ANGLED
`
`BIPOLAR FORCEPS CABLE
`
`PENFIELD - LARGE
`
`IMPLANT TAMP
`
`SUCTION NERVE
`RETRACTOR
`
`ALLOGRAFT INSERTER - 14x25mm, 14x30mm
`
`SUCTION - 8, 10 FR
`
`ANNULOTOMY KNIFE
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`INSTRUMENT SYSTEM
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`GENERAL INSTRUMENT TRAY
`
`DISTRACTORS - 20˚ BEND, PEDICLE SCREW, STRAIGHT OFFSET
`
`LAMINA SPREADER
`
`PITUITARY RONGEURS - STRAIGHT, UP
`
`SCRAPER -
`STRAIGHT: 7mm
`
`CHISELS - STRAIGHT 7, 12mm - ANGLED 7mm
`
`CURETTES - STRAIGHT, LEFT, RIGHT, DOWN, UP
`
`DISC CUTTERS - 8, 10mm
`
`NERVE
`RETRACTOR
`
`DISSECTORS - 4, 7mm
`
`RASPS - STRAIGHT, ANGLED
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`MAXCESS ACCESS SYSTEM
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`

`

`MAXCESS ACCESS SYSTEM
`
`MAXIMUM AEEESS. MINIMUM DISRUPTIUN.
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`/
`
`MAXCESS”' XLIF"" 90" SURGICAL TECHNIUUE MA CESS
`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`MAXCESS ACCESS SYSTEM
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`MAXCESS ACCESS SYSTEM
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`ARTICULATING ARM ASSEMBLY
`
`DILATORS - NV 6, 9, 12mm (NeuroVision® Compatible)
`
`DILATORS - 6, 9, 12mm
`
`K-WIRE
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`MAXCESS ACCESS SYSTEM
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`ACCESS DRIVER
`
`BLADES - 30, 40, 50, 60, 70, 80mm, 3 EACH
`
`SHIM INSERTER
`
`SHIMS - STANDARD, INTRADISCAL, WIDE
`
`BLADES - 90, 100, 110, 120, 130mm, 3 EACH
`
`LIGHT CABLE (TIP, ADAPTORS NOT SHOWN)
`
`HEX DRIVER
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`NEUROVISION ® SYSTEM
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`CONTROL UNIT
`
`PATIENT MODULE
`
`EMG HARNESS
`
`STIMULATION HANDPIECE
`
`DYNAMIC STIMULATION CLIP - LARGE
`
`REFERENCE AND ANODE SURFACE ELECTRODES
`
`RECORDING SURFACE ELECTRODES
`
`PEDICLE PROBE (STERILE)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`PRESURGICAL PREPARATION
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`EQUIPMENT REQUIREMENTS:
`To successfully complete this technique, the following instruments are required:
`
`(cid:127) Radiolucent surgical table
`(cid:127) C-Arm
`(cid:127) Light source
`(cid:127) MaXcess Access System
`(cid:127) MaXcess XLIF 90˚ System
`(cid:127) Triad® General Instrument Tray
`(cid:127) NeuroVision® JJB System
`
`SURGICAL CONSIDERATIONS:
`The XLIF 90˚ procedure enables access to the lumbar spine via a direct lateral 90º, retroperitoneal approach. The anatomical reference points that
`a surgeon should consider when preparing for this technique are: the iliac crest, the 12th rib, and the lateral border of the erector spinae muscles.
`Blunt finger dissection is used to pass between these two muscle groups and access the retroperitoneal space. This technique offers simple access
`to the retroperitoneal space while minimizing the potential of visceral lesion.
`
`RETROPERITONEAL ACCESS
`Blunt finger dissection is used to safely enter the retroperitoneal space posteriorly and sweep peritoneal cavity anteriorly. Upon completion of
`this technique, care should be taken to ensure that the lateral surgical trajectory is clear of visceral contents. By escorting the dilators through the
`retroperitoneal space utilizing finger dissection, the potential of peritoneal disruption is minimized.
`
`
`TRANSPSOAS ACCESS
`The psoas should be split between the middle and anterior third of the muscle. This ensures that the nerves of the lumbar plexus are located
`posterior and outside the operative corridor. Location of mixed peripheral nerves may be confirmed utilizing the NeuroVision JJB System.
`Additionally, direct lateral trajectory through the psoas ensures that the great vessels remain anterior to the operative corridor.
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`STEP 1:
`PATIENT POSITIONING AND O.R. SET-UP
`The patient is placed in a direct lateral decubitus (90˚)
`position (left side up unless otherwise indicated) (See
`Fig. 1).
`
`The surgical table should be flexed in such a way as to
`increase the distance between the iliac crest and the rib
`cage. This can be accomplished by either flexion of the
`surgical table or by placing a cushion under the patient’s
`right-lateral side (Fig. 2). This helps open the intervertebral
`disc space.
`
`The NeuroVision® control unit should be placed opposite
`the surgeon to enable an unobstructed view (Fig. 3).
`
`ANESTHESIA
`
`(Fig. 1)
`
`(Fig. 2)
`
`(Fig. 3)
`
`NEUROVISION
`
`FLUORO
`
`FLUORO
`MONITORS
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`IDENTIFICATION &
`
`STEP 2:
`ANATOMIC LANDMARK
`INITIAL INCISIONS
`After 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 (Fig. 4). 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 posterior to this location
`at the lateral border of the erector spinae muscle (Fig. 5).
`
`Through this opening the finger dissection to the
`retroperitoneal space will be conducted. A longitudinal
`incision at this location is made at the border of the
`erector spinae and the oblique muscles.
`
`(Fig. 4)
`
`POSTEROLATERAL INCISION
`
`DIRECT LATERAL INCISION
`
`(Fig. 5)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`STEP 3:
`RETROPERITONEAL APPROACH
`Through this posterolateral incision, the subcutaneous
`layers are dissected until reaching the muscular masses.
`Blunt dissection scissors are used to carefully spread the
`muscle fibers until the retroperitoneal space is reached
`(Fig. 6). Care should be taken to avoid perforation of
`the peritoneum.
`
`Once inside the retroperitoneal space, the index finger is
`used to sweep the peritoneum anteriorly (Fig. 7). When
`the peritoneum is released, the finger is then used to
`palpate down to the psoas muscle (Fig. 8).
`
`(Fig. 6)
`
`(Fig. 7)
`
`(Fig. 8)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`STEP 3:
`RETROPERITONEAL APPROACH (CONT.)
`Once the psoas muscle is identified, the index finger is
`swept up to the direct lateral target mark (Fig. 9).
`
`An incision is made at this location (Fig. 10) and the initial
`Dilator is introduced (Fig. 11). The black, magenta and
`blue Dilators will be used in this procedure.
`
`DIRECT LATERAL INCISION
`
`(Fig. 9)
`
`POSTEROLATERAL INCISION
`
`(Fig. 10)
`
`(Fig. 11)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`STEP 3:
`RETROPERITONEAL APPROACH (CONT.)
`The index finger, which is already in the retroperitoneal
`space, is used to escort the Dilator safely from the direct
`lateral incision to the psoas muscle (Fig. 12).
`
`STEP 4:
`TRANSPSOAS APPROACH
`Upon reaching the psoas muscle with the initial Dilator,
`the location is verified with the image intensifier (Fig. 13).
`
`The fibers of the psoas muscle are then split utilizing
`blunt dissection and NeuroVision® neurophysiologic
`monitoring (Fig. 14). Care should be taken to minimize
`trauma to the psoas muscle.
`
`(Fig. 12)
`
`(Fig. 13)
`
`(Fig. 14)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`NEUROVISION® EMG MONITORING
`Attach the Large Dynamic Stimulation Clip to the
`proximal end of the MaXcess 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).
`
`In the posterior one–third of the psoas muscle lie the
`descending nerves of the lumbar plexus. The NeuroVision
`System assists with safe passage by 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 of the Dilator to the nerves. Experience
`has suggested that threshold values greater than 10mA
`indicate a distance that allows for both continued nerve
`safety and ample working space.
`
`(Fig. B)
`
`(Fig. A)
`
`(Fig. C)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`STEP 4:
`TRANSPSOAS APPROACH (CONT.)
`Once the disc is identified, fluoroscopic imaging should
`be used to confirm position (Fig. 15).
`
`A lateral image should confirm that the initial Dilator points
`directly to the center of the intervertebral disc. A cross
`table AP image confirms the Dilator is in the plane of, and
`directed to, the disc space.
`
`After confirmation, a K-Wire is introduced into the disc
`space to secure position (Fig. 16). Depth markings on the
`Dilator should be read at the skin level so that the appropri-
`ate length Blades can be affixed to the Access Driver on the
`back table (Fig. 17).
`
`(Fig. 15)
`
`00
`
`90
`
`80
`
`70
`
`60
`
`50
`
`40
`
`30
`
`(Fig. 16)
`
`(Fig. 17)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`STEP 4:
`TRANSPSOAS APPROACH (CONT.)
`The next two neurophysiologic driven Dilators are subse-
`quently introduced over the initial Dilator utilizing a twist-
`ing motion. NeuroVision® is used to minimize potential
`neural contact.
`
`Attach appropriate length Blades to Access Driver by
`tightening set screws (Fig. 18).
`
`(Fig. 18)
`
`STEP 5:
`ACCESS
`The Access Driver is introduced over the third Dilator
`(pointing handles directly posterior) (Fig. 19). Cross table
`AP fluoroscopy is used to confirm position of the Access
`Driver Blades on spine (Fig. 20).
`
`Attach Articulating Arm bedrail attachment to bedrail (Fig.
`21). Attach Articulating Arm post to bedrail attachment
`(Fig. 22). Attach opposite end of the Articulating Arm to
`the Access Driver (Fig. 23).
`
`(Fig. 21)
`
`(Fig. 22)
`
`(Fig. 19)
`
`(Fig. 20)
`
`(Fig. 23)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`STEP 5:
`ACCESS (CONT.)
`While holding the Access Driver in position using down-
`ward pressure, lock the Articulating Arm by tightening
`both large T-Handles clockwise in the order shown. To
`loosen arm, rotate T-Handles counterclockwise in the
`reverse order (Figs. 24, 25).
`
`(Fig. 24)
`
`(Fig. 25)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`STEP 5:
`ACCESS (CONT.)
`Blades are expanded in a cranial/caudal direction to
`desired aperture by squeezing the handles on the Access
`Driver (Figs. 26, 27).
`
`(Fig. 26)
`
`(Fig. 27)
`
`Anterior/Posterior exposure is achieved by turning the
`knobs on the sides of the Access Driver (Fig. 28). The
`independent blade adjusts aperture anteriorly so as to
`minimize blade pressure on the posterior portion of the
`psoas muscle. Approximate aperture dimensions can be
`identified on the Access Driver.
`
`(Fig. 28)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`LIGHT CABLE
`
`STEP 5:
`ACCESS (CONT.)
`The single end of the bifurcated Light Cable should be
`passed off and attached to a xenon arthroscopy light
`source. The two remaining ends of the light cable are
`placed into the Access Driver. The operative corridor is
`now established and should be thoroughly explored.
`
`Utilize direct visualization and the NeuroVision® Pedicle
`Probe to affirm a neurologically clear operative corridor.
`Bipolar electrocautery is used to prepare disc visualiza-
`tion (Fig. 29).
`
`STEP 6:
`ANNULOTOMY & DISC SPACE PREPARATION
`A 15-20mm annulotomy is created, and conventional
`disc removal and endplate preparation are performed.
`
`Disc Cutters, Pituitaries, Scrapers, Curettes, and other
`preparation tools are available to efficiently prepare the
`disc space (Fig. 30).
`
`Sizers are utilized to establish implant size for disc height
`restoration (Fig. 31). A Broach may be utilized to remove
`osteophytes to facilitate allograft insertion (Fig. 32).
`
`(Fig. 29)
`
`(Fig. 30)
`
`(Fig. 31)
`
`(Fig. 32)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`XLIF 90˚ SURGICAL TECHNIQUE
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`STEP 7:
`IMPLANT INSERTION
`Attach appropriately sized allograft to Inserter (Fig. 33)
`and gently impact into disc space (Fig. 34). Release
`implant from Inserter and liberally apply autograft or
`graft extenders in disc space.
`
`STEP 8:
`CLOSURE
`Once the procedure is completed, the Access Driver is
`removed while utilizing direct visualization to verify the
`absence of significant bleeding in the disc space or psoas
`muscle.
`
`The skin is closed utilizing standard subcuticular suture.
`
`The patient is subsequently positioned prone and
`posterior instrumentation is placed.
`
`30mm Length
`
`(Fig. 33)
`
`14mm Width
`
`(Fig. 34)
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`CATALOG
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`M A X C E S S S U R G E R Y
`
` MAXCESS XLIF 90˚ CATALOG #
`
`MaXcess XLIF 90˚ System
`MaXcess Access System
`Triad® General Instrument Tray
`NeuroVision® JJB System
`NeuroVision XLIF 90˚ Module (Disposables)
`
`3300000
`3200000
`7103000
`2011000
`8010008
`
`X L I F 9 0 ˚ S Y S T E M
`
` KERRISON RONGEURS CATALOG #
`3300010
`Kerrison - 3mm, 40 Deg.- Long
`3300011
`Kerrison - 5mm, 40 Deg.- Long
`
` BROACHES CATALOG #
`5007208
`Broach - 8 x 14mm
`5007210
`Broach - 10 x 14mm
`5007212
`Broach - 12 x 14mm
`5007214
`Broach - 14 x 14mm
`
` SIZERS CATALOG #
`5002407
`Sizer - 7mm
`5003408
`Sizer - 8mm
`5002409
`Sizer - 9mm
`5003410
`Sizer - 10mm
`5002411
`Sizer - 11mm
`5003412
`Sizer - 12mm
`5002413
`Sizer - 13mm
`5003414
`Sizer - 14mm
`
` INSERTERS CATALOG #
`
`Implant Inserter - 14 x 25mm
`Implant Inserter - 14 x 30mm
`
`5000805
`5000806
`
` IMPLANT TAMP CATALOG #
`3300019
`Implant Tamp
`
` PROBES/RETRACTORS CATALOG #
`
`Nerve Retractor - Long
`Suction Nerve Retractor - Long
`Penfield - Large, Long
`
`3300014
`3300015
`3300018
`
` SUCTION CATALOG #
`3300017
`Suction - 10 FR, Long
`3300016
`Suction - 8 FR, Long
`
` BIPOLAR FORCEPS CATALOG #
`3300012
`Bipolar Forceps - Angled, Long
`3300013
`Bipolar Forceps Cable
`
` ANNULOTOMY KNIFE CATALOG #
`
`Annulotomy Knife Handle
`Annulotomy Knife Blade
`
`3100053
`3100054
`
` T-HANDLE QTY CATALOG #
`2
`T - Handle
`5000901
`
` STERILIZATION CASE CATALOG #
`Sterilization Case Assembly MaXcess XLIF 90 Degree
`3300030
`3300031
`Sterilization Case Lid MaXcess XLIF 90 Degree
`3300032
`Sterilization Case Base MaXcess XLIF 90 Degree
`3300033
`Sterilization Case Tray 1 MaXcess XLIF 90 Degree
`3300034
`Sterilization Case Tray 2 MaXcess XLIF 90 Degree
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`CATALOG
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`G E N E R A L I N S T R U M E N T T R A Y
`
` STERILIZATION CASE CATALOG #
`7100003
`Sterilization Case
`
` SCRAPER CATALOG #
`7100080
`Scraper - Straight
`
` DISC CUTTERS CATALOG #
`Disc Cutter 8mm
`5001708
`Disc Cutter 10mm
`5001710
`
` RETRACTORS CATALOG #
`7100053
`Nerve Retractor
`7100054
`Dissector - 4mm
`7100055
`Dissector - 7mm
`
` RASPS CATALOG #
`
`Rasp - Straight
`Rasp - Angled
`
`7100056
`7100057
`
` DISTRACTORS CATALOG #
`
`Pedicle Screw Spreader
`Distractor - 20 degree Bend
`Distractor - Straight Offset
`Lamina Spreader
`
`7100024
`7100013
`7100014
`7100040
`
` PITUITARY RONGEURS CATALOG #
`Pituitary Rongeur - Straight
`7100041
`Pituitary Rongeur - Up-biting
`7100042
`
` CHISELS CATALOG #
`
`Chisel - Straight, 7mm
`Chisel - Straight, 12mm
`Chisel - Angled, 7mm
`
`7100043
`7100044
`7100045
`
` CURETTES CATALOG #
`7100046
`Curette - Straight
`7100047
`Curette - Left Angled
`7100048
`Curette - Right Angled
`7100049
`Curette - Down Angled
`7100050
`Curette - Up Angled
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 º S U R G I C A L T E C H N I Q U E
`
`CATALOG
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`A C C E S S S Y S T E M
`
` ARTICULATING ARM CATALOG #
`
` SHIMS / SHIM INSERTER QTY CATALOG #
`
`3200012
`3200013
`3200014
`3200015
`
`3 3 3 1
`
`Shim - Intradiscal
`Shim - Std
`Shim - Wide
`Shim Inserter
`
` LIGHT CABLE / ADAPTERS CATALOG #
`3200020
`Light Cable Assembly
`3200017
`Light Cable
`3200018
`Light Cable Tip
`3200045
`Light Cable Adapter ACMI
`3200046
`Light Cable Adapter Storz
`3200047
`Light Cable Adapter Olympus
`
` SET SCREWS / HEX DRIVERS QTY CATALOG #
`Set Screw - Short
`3200040
`Set Screw - Long
`3200041
`Hex Driver (3/32”)
`3200016
`Hex Key (3/32”)
`3200042
`
`2 1 1 1
`
` STERILIZATION CASE CATALOG #
`3200031
`Sterilization Case Assembly MaXcess Access
`3200032
`Sterilization Case Lid MaXcess Access
`3200033
`Sterilization Case Tray 1 MaXcess Access
`3200034
`Sterilization Case Tray 2 MaXcess Access
`3200035
`Sterilization Case Base MaXcess Access
`
`Articulating Arm Assembly
`
`3200021
`
` K-WIRE CATALOG #
`
`K-Wire (.062)
`
`3200011
`
` DILATORS CATALOG #
`Dilator - 6mm
`3202006
`Dilator - 9mm
`3202009
`Dilator - 12mm
`3202012
`Dilator - 6mm, NV
`3203006
`Dilator - 9mm, NV
`3203009
`Dilator - 12mm, NV
`3203012
`
` ACCESS DRIVER CATALOG #
`Access Driver
`3200010
`Access Driver - Body
`3200009
`Access Driver - Arm, Right
`3200007
`Access Driver - Arm, Left
`3200008
`
` BLADES QTY CATALOG #
`Blade - 30mm
`3201030
`Blade - 40mm
`3201040
`Blade - 50mm
`3201050
`Blade - 60mm
`3201060
`Blade - 70mm
`3201070
`Blade - 80mm
`3201080
`Blade - 90mm
`3201090
`Blade - 100mm
`3201100
`Blade - 110mm
`3201110
`Blade - 120mm
`3201120
`Blade - 130mm
`3201130
`
`3 3 3 3 3 3 3 3 3 3 3
`
`

`

`M A X C E S S ™ X L I F ™ 9 0 ° S U R G I C A L T E C H N I Q U E
`
`CATALOG
`
`MAXIMUM ACCESS. MINIMUM DISRUPTION.
`
`N E U R O V I S I O N ® J J B S Y S T E M
`
` NEUROVISION JJB SYSTEM CATALOG #
`
`2011000
`
`NeuroVision JJB System
`Includes:
` NV JJB Control Unit
` NV JJB Patient Module
` NV JJB Screw Test Handpiece
` NV JJB Handpiece Sterilization Case
` InStim™ Tap Insulator
` Impedance Meter
` Impedance Meter Leads
` NV JJB Quick Reference Manual
`
`N E U R O V I S I O N X L I F 9 0 ˚ M O D U L E ( D I S P O S A B L E S )
`
` NEUROVISION XLIF 90˚ MODULE (DISPOSABLES) CATALOG #
`
`8010008
`
`NeuroVision XLIF 90˚ Module (Disposables)
`Includes:
` NeuroVision EMG Harness Kit
` Recording Surface Electrodes (Pouch of 25)
` Reference Surface Electrodes (Pouch of 5)
` NeuroVision Dynamic Stimulation Clip - Large
` NeuroVision Pedicle Probe (Sterile)
`
`

`

`To order, please contact your NuVasive Sales Consultant or Customer Service Representative today at:
`10065 Old Grove Rd., San Diego, CA 92131 • phone: 800-475-9131 fax: 800-475-9134
`www.nuvasive.com
`© 2003. NuVasive, Inc. All rights reserved. , NuVasive, NeuroVision, Triad and Creative Spine Technology are federally registered trademarks of NuVasive, Inc. MaXcess, XLIF and InStim are common law trademarks of NuVasive, Inc. Patents pending.
`
`9003918 A.0
`
`