MSD 1177
`IPR2013-00506
`IPR2013-00508
`
`
`
`l\lU\V/ASIVE"
`
`

`
`CONTENTS
`
`MA C1sss;.»p
`\,
`MAXIMUM ACCESS. MINIMAL DISEUFTIDN."
`
`\
`
`Preface
`
`Instrument System
`
`Access System
`
`Decompression System
`
`Equipment Requirements
`
`Patient Positioning and Operating Room Set-up
`
`Exposure
`
`Bony Decompression and Annular Exposure
`
`Disc Removal and Endplate Preparation
`
`Disc Space Distraction and Allograft Sizing
`
`Broaching
`
`Allagraft Insertion
`
`Final Allograft Positioning
`
`Catalog
`
`

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`MAXIMUM RECESS MINIMAL Dl$Rl.ll’l'lEl?l."
`
`0
`
`PREFACE
`
`W
`
`MA CESS’
`
`\,
`
`Technological advances have allowed many surgical techniques to evolve into "minimally invasive" procedures with less risk and superior outcomes.
`Unfortunately, posterior spinal fusion has not been one of these procedures. Inadequate exposure and limited visualization often compromises the
`surgeon's ability to adequately and safely perform this operation. When compared to conventional techniques, the risk—benefit ratio of “minimally
`invasive" posterior fusion techniques has not justified acceptance by most spinal surgeons and patients... until now.
`
`The MaXcess System provides maximum surgical access while minimizing the soft tissue disruption that occurs during open techniques. The system's
`modular blade assembly assures a proper size for each patient. The operative corridor is illuminated and may be expanded and angulated to provide
`direct visualization of the patient's anatomy. The split blade design allows instruments to be angled against the wound edge to optimize position and
`safety. These features of the MaXcess System offer the surgeon the opportunity to perform procedures with conventional surgical instruments and
`techniques, without the added morbidity of conventional open exposures.
`
`This guide describes the MaXcess technique for transforaminal lumbar interbody fusion through a minimal muscle-splitting approach. The morbidity of this
`operation has been minimal, with most patients requiring only "23—hour inpatient observation” postoperatively. Since clinical and radiographic results seem
`to compare favorably to similar open procedures, it is our belief that this operation should be seriously considered for any patients that require posterior
`interbody fusion.
`
`/Z»% 25% W}?
`
`Mark Peterson, M.D.
`Orthopedic Spine Surgeon
`Southern Oregon Orthopedics
`Medford, OR
`
`William Taylor, M.D.
`Associate Clinical Professor
`Department of Neurosurgery, UCSD
`San Diego, CA
`
`

`
`\
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`MA CESSif
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`MAXIMIJM ACEESS. MINIMAL TIISRIJPTHJR."
`
`
`
`INSERTER — mun: 7x25.11x25mm
`
`BRDAIIHES - a.1n.12.1Amm x 11mm
`
`INSERTER - smuem: 9:25, Hx25mm
`:5
`
`INSTRUMENTS — TLIF TRAY I GENERAL INSTRUMENT TRAY
`
`
`TLIFTRAY
`
`SIZERS - 7—llamm
`
`
`
`IMPLANT TAMP
`
`BENERALINSTRUMENTTRAY
`
`BISTRACTURS — 20- mm. reams scnew. STRAIGHT osrser
`
`LAMINA SPREADER
`
`

`
`GENERAL INSTRUMENT TRAY (CONT)
`
`L
`MAXIMUM ACCESS. MINIMAL BlSRNPTlflN.'
`
`MA CESS
`
`GENERAL INSTRUMENT TRAY
`
`CHISELS - smneum. 12mm
`
`‘
`
`CHISEL — ANGLED: 7mm
`
`_
`
`SERAPER - smnsm; 7mm
`
`_
`
`‘ DISC CUTTERS - a. mum
`
`RASPS - smmsnr. ANGLED
`
`NERVE RETRACTDR
`
`TJISSECTIJRS - 5. 7mm
`
`CURETTE - snmem
`
`

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`Q
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`MA CESS
`
`MAXIMUM ACCESS MINIMAL DlSRI.|PTlDll'
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`MAXDESS ACCESS SYSTEM (CONT)
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`MA C1353
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`MAXIMUM AEEESS MINIMAL MSRVJPYIDN '
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`

`
`MAXCESS ACCESS SYSTEM
`
`\
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`MA CESS
`
`"
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`‘‘
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`MAXIMUM ACCESS MINIMAL DISRUPTIDIU
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`ARTICUI-ANNE ARM
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`MA CESS
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`MHIMUM ACCESS MHHMAL DISRIJPTHIN '
`
`MAXCESS ACCESS SYSTEM (CONT)
`
`ACCESS DRIVER
`
`BLADES - 3l1.hfl. so. 60. 7o.
`
`SHIM INSERTER
`
`SHIMS — STANDARD.|NTRA!HSEAL.W|DE
`
`
`
`BLADES - 9u.1un. HD.1ZD.13Dmrn.3EAl3R
`
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`MA C1553
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`“W555 UEWMPRESSIUN SYSTEM
`
`KERRISIJN RIJNEEURS - 3. 5mm MD‘. 90'
`
`KERRISUN RUNGEIIRS - cuavm 2. Arnm
`
`émm; UP. STRAIGHT
`PITUITARY RBNGEURS — 2mm; up, STRAIGHT, uowu
`Zmm MICRO: UP. STRAIGHT
`
`EURETTES - sum. was x smnsm. up. new
`
`NERVE RETRAETUR
`
`PENFIELD - smu_uuzss
`
`A
`
`IJISSECTIIR
`
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`
`SUCTION NERVE RETRACTDR
`
`MAXCESS DECDMPRESSIUN SYSTEM ICUNT.)
`
`MWWSSVm__MWm..
`
`
`BIPOLAR FURCEPS - snwanw. ANGLED
`
`BIPOLAR FURCEPS CABLE
`
`ANNULOTDMY KNIFE
`
`

`
`Milli!-1l.lM ACEESS MINIMAL DlSRUPTlDll"
`
`TLlF SURGICAL TECHNIQUE
`
`EQUIPMENT REQUIREMENTS:
`- C—Arm
`
`- Radiolucent Surgical Table
`- Xenon Light Source
`- Spinal Needle
`- Triad“ TLIF Tray
`- Triad General instrument Tray
`- Maxcess Access System
`- MaXcess Decompression System
`- NeuroVision® (optional) for pedicle screw testing
`
`STEP 1 :
`PATIENT POSITIONING AND O.R. ser-up
`
`Patient is placed on the operating table in a prone position
`(Fig. 1). Ensure a bedrail exists on the table to which an
`articulating arm will mount. The patient is then prepared and
`draped in a conventional manner (Hg. 2).
`
`

`
`TLIF SURGICAL TECHNIQUE
`
`STEP 2:
`EXPOSURE
`
`Fluoroscopy in the AP and Lateral views is used to locate
`the affected level. Transforaminal access to the disc space
`is typically performed on the most symptomatic side.
`Palpate spinous process to define midline. Move 2—4cm off
`of midline to mark incision point on skin with a surgical
`pen at the level of the disc space. Proper location may be
`confirmed using a spinal needle. Make a small (~1cm)
`longitudinal incision at the location of the spinal needle. It
`is recommended to incise the fascia to facilitate the insertion
`of subsequent Dilators (Hg. 3).
`
`Replace spinal needle with K—Wire and advance through the
`fascia. Care is taken not to advance the K-Wire through inter-
`laminar space. Exchange the blunt tipped initial Dilator over
`K—Vlfire prior to advancing to the medial aspect of the facet joint
`(Figs. 4, 5). The stainless steel Dilators should be used to opti-
`mize fluoroscopic visualization.
`
`Using lluoroscopy, confirm that the initial Dilator is parallel
`to the disc space in the sagittal plane. Upon confirmation of
`position on lateral fluoroscopy, extend the incision lcm on
`either side of the initial Dilator (~3cm total).
`
`MAXIMUM ACCESS MlNlMAL lJlSRUPlll)N "
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`MA CESS
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`L
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`2-4cm
`
`(Fig. 3)
`
`INCISION
`
`”l palpate and identify the inferior edge of the superior
`lamina with the initial Dilator. I find this to be a simple and
`reproducible technique to locate this common anatomical
`landmark.”
`
`- William Taylor, M.D.
`
`
`
`”By controlling the C-arm myself, lensure that I am getting
`the exact images I need during this important part of the
`procedure.”
`
`—- Mark Peterson, M.D.
`
`
`
`

`
`MAXIMUM ACCESS MINIMAL DISRUPTION"
`measurement of the depth markings at the skin level (I-7g. 6).
`
`
`\
`
`MA crass J
`
`
`
`STEP 2:
`EXPOSURE (CONT.)
`Pass the subsequent two Dilators over the first and note the
`
`Attach appropriate length blades by tightening the set screws on
`the Access Driver (Fig. 7).
`
`Upon confirming position of Dilators and Blade length under
`tluoroscopy, slide the Access Driver over the Dilators down to
`the facet keeping the handles directed medially across patient
`The Access Dn'ver should be angled obliquely to gain proper
`exposure (Fig. 8).
`
`to bedrail
`Attach Articulating Arm bedrail attachment
`(Fig. 9). Attach Articulating Arm post to bedrail attachment
`(Fig. 10). Attach opposite end of the Articulating Arm to the
`Access Driver (Hg. I I).
`
`
`
`(Fig. 9)
`
`

`
`MAXIMUM ACEES5 HlHlMAL illSRLlPTlUN'"
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`T
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`MA CESS
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`
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`
`
`
`(CONT)
`,
`, _
`.
`_
`_
`,
`'
`While holding the Access Driver in position using downward
`force,
`lock the Articulating Arm by tightening both large
`Articulating Arm T-Handles clockwise in the order shown (Figs.
`I20, 72b). To loosen arm, rotate knobs counterclockwise in the
`reverse order
`
`’’I find it helpful to load blades that are Iomm longer into
`the two lateral arms ofme Access Driver: .45 I open these
`blades, they fall lateral to the facetjoint and improve tissue
`remain” in that may
`
`_ Mm-am Tam, M_D_
`
`
`
`Squeeze the handles of the Access Driver to expand the
`Blades in a cranial/caudal direction to desired aperture (Figs.
`13, I4). A selection of different Blade lengths may be placed
`independently in the Access Driver in order to accommodate
`varying anatomy during exposure.
`
`"AtL5-S1 the inferior Blade may need to be ~mmm longer
`than the superior Blade due to the sagittal angulation
`necessary to gain proper access to the disc space.”
`
`— Mark Peterson, M.D.
`
`
`
`

`
`MAXIMUM ACCESS MINIMAL DISRUPIIQII"
`
`\
`
`MA CESS‘
`
`\,
`
`TLIF SURGICAL TECHNIQUE
`
`STEP 2:
`EXPOSURE (CONT.)
`
`Medial/Lateral exposure may be independently controlled
`by turning the knobs on the sides of the Accss Driver (Fig.
`75)‘ Approximate aperture dimensions can be identified on
`the Access Driver. Place ends of Light Cable into Blades
`(standard arthroscopy xenon light sources should be used
`for optimal illumination) (Fig. I6).
`
`Shims are provided that effectively extend (standard shims),
`or widen (wide shims) the Blades to restrict encroachment
`of tissue into operative corridor (Fig. I7). Light Cables may
`need to be removed while inserting Shim.
`
`Handles maybe removed from the Access Driver by pulling
`the button on the handle in direction of the arrow and lifting
`from Driver.
`
`
`
`
`
`INFERIOR EDGE
`OF LAMINA
`
`LIGHT CABLE
`
`

`
`\
`MA CESS
`
`ARTICULAR PROCESS
`
`TO BE REMOVED
`
`MAXIMUM ACEESS MINIMM l]|SRllPTlDIl,' PORTION OF INFERIOR
`
`STEP 33
`BONY DECOMPRESSION AND ANNULAR EXPOSURE
`
`Expose the anatomical landmarks using a Bovie and Pituitary
`Rongeurs. Begin bony removal of facet joint by removing the
`inferior articular process of the superior vertebra (Figs I8, 79).
`This is performed using a combination of Kenisons and burrs.
`
`Continue facetectomy until pedicle-to—pedicle exposure
`is achieved. Using bipolar cautery, coagulate and divide
`epidural veins at base of caudal pedide. Expose disc by gentle
`cephalad mobilization of veins. The disc space is exposed
`within the axlla of the exiting nerve root and the lateral margin
`of the dura (I-7g. 20).
`
`An annular window is created along the inferior borders of
`the exiting nerve root to the lateral border of the dura using
`the Annulotomy Knife.
`
`”Contralateral decompression can be achieved if necessary
`by undercutting the lamina at the base of the spinous
`process. Removal ofcontralateralhypertrophied ligamentum
`flavum and bony decompression of the lateral recess may
`be achieved by utilizing a curved Kerrison. Access Driver
`may be rotated to assist in this additional medial exposure.
`It also can be angled‘inferiorly to enable foraminotomy of
`the l'PS'70f€f0/'579TV9 "301"
`
`- William 707101‘: MD-
`
`"I utilize the inferior edge of the laminar/facet junction as
`my starting point for bony removal The decompression is
`performed up to the Iigamentous insertion cranially and
`then laterally to the superior pedicle where the exiting
`nerve root is identified. This pedicle to pedicle exposure is
`perhaps the most important factor in ensuring a successful
`P’°“’d"’9-”
`
`— William Taylor, M.D.
`
`‘’l define the anatomical landmarks including the pars,
`facet joint, and medial aspect of transverse processes by
`removing attached soft tissue. I begin the facetectomy by
`debullring the facet complex with rongeurs or a burr. I then
`complete bony removal with appropriate sized Kerrison
`Rongeurs. Resection of bone and ligament is performed
`until exposure is flush with inferior wall of cephalad pedi-
`cle and the superior wall of caudal pedicle, and the lateral
`margin of them! sac is exposed.”
`
`— Mark Peterson, M.D.
`
`

`
`TLIF SURGICAL TECHNIQUE
`
`MA CESSS
`
`\,
`MAXIMUM ACCESS MHHMAL DISRUPTXUIW
`
`\
`
`STEP 4:
`DISC REMOVAL AND ENDPLATE PREPARATION
`
`The Triad“ Lumbar Allograft — TLlF system offers a compre-
`hensive set of disc space preparation instruments. A combi-
`nation of these instruments and other Nuvasive devices may
`be used based on surgeon preference.
`
`PITUITARY RONGEURS
`
`Use Pituitary Rongeurs to remove nucleus, creating space for
`the other disc removal instruments to be inserted into disc
`space.
`
`‘
`
`”
`
`F
`
`CHISEL
`
`If necessary, use the 7mm Straight Chisel to remove posterior
`endplate osteophytes for increased access to the disc space
`(Fig. 21).
`
`DISC CUTTER
`
`Place the Disc Cutter into the disc space. Using a rotating
`motion, the disc material is cut and loosened from the end-
`plates. By withdrawing the Disc Cutter, material is removed
`from the disc space. Remaining loose disc material can be
`removed with Pituitary Rongeurs (Fig. 22).
`
`CU RETl'ES
`
`Use the Straight, Left, Right, Up, and Down Angled Curettes
`to reach the extents of the disc space, and scrape disc mate-
`rial and cartilage from the endplates (Fig. 23).
`
`SCRAPER
`Place the Scraper into the disc space. Using a pulling motion,
`scrape the endplates to remove residual disc material and
`cartilage (Fig. 24).
`
`DSP"" BRUSH (provided separately)
`Using the DSP V-Retractors, retract and protect neural struc-
`tures prior to using the Brush. Place the DSP Brush into the
`disc space. Using a rotating motion, use the brush to capture
`disc material and clean cartilage from the endplates (Fig. 25).
`Remove from disc space, release from T-Handle, and dispose
`of brush. Repeat sequence with new brush until desired
`level of disc space preparation is achieved. Refer to the DSP
`Technical Brochure (P/N 9003326) for more information on
`the DSP System.
`
`RASPS
`
`Use the Straight and Angled Rasp with a push/pull motion as
`a final step in preparing the endplates (Fig. 26).
`
`A
`
`_
`(H9 23)
`
`’
`
`(H-97‘ 24)
`
`
`
`'
`
`i
`
`-2
`
`(Fig. 25)
`
`(F79. 26) .
`
`”The ability to angle the instruments against the skin to
`gain maximum access to the disc space is one of the most
`important benefits of this system.”
`
`— William Taylor, M.D.
`
`

`
`TLIF SURGICAL TECHNIIIUE
`
`\
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`MA CESS’
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`\,
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`MAXlMlll4 ACCESS MlNIMAl. DlSRllPTllJll."
`
`
`STEP 5:
`DISC SPACE DISTRACTION AND ALLOGRAFT SIZING
`
`Gently impact the TLIF sizers into the interbody space to distract
`and determine final allograft implant size. Sequentially increase
`the size used until adequate distraction is achieved (Hg. 27).
`
`STEP 6:
`BROACHING
`
`Further removal of endplate osteophytes may be achieved
`by using Broaches. Broach size is determined by the height
`of the largest sizer accommodated in the disc space. The
`atraumatic tangs of the appropriate sized Broach are posi-
`tioned medial and lateral and seated into the disc space.
`Assure the cutting blades are parallel to the endplates prior
`to impaction.
`Impact the Broach into the disc space to
`remove posterior endplate osteophytes (Fig. 28).
`
`STEP 7:
`ALLOGRAFT INSERTION
`
`The height of the Triad” Lumbar Allograft is determined by
`the last TLIF Sizer used.
`
`Allograft insertion may be accomplished by using either an
`impacted technique or an insert and rotate technique.*
`
`IMPACTED TECHNIQUE
`Select either a straight or angled lnserter that corresponds to
`the size of the allograft selected (Fig. 29).
`
`Place the allograft implant onto lnserter with concave surface
`facing the long tang (Fig. 30). Lock implant in place by rotat-
`ing the lnserter Sleeve relative to the T-Handle in a clockwise
`direction.
`
`* US. Patent No. 6,368,325.
`
`
`
`Mill;:5ill
`
`(F/'9 30)
`
`

`
`TLIF SURGICAL TECHNIQUE
`
`\
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`MA CESSJ)
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`MAXIMUM LEEESS Mlllllllhl. DISRUPTION"
`
`STEP 7:
`ALLOGRAFT msennon (com)
`The implant is positioned adjacent to the opening of the
`annulus with the concave surface held by the long tang of the
`lnserter facing medial. it is then gently impacted into the disc
`space (Figs. 37, 32) and released from the lnserter (Hg. 33).
`
`INSERTAND ROTATE TECHNlQUE*
`Select a Straight lnserter that corresponds to the size of the
`allograft selected.
`
`Place the implant at the opening of the annulus such that the
`concave surface held by the long tang of the lnserter faces
`inferiorly. This is 90° from its eventual orientation within the
`disc space. It is then gently impacted into the disc space, posi-
`tioned obliquely across the disc space, and then rotated 90°
`such that the concave surface then faces medially (Fig. 34).
`
`”The ‘insert and rotate’ technique of graft placement has
`several potential advantages over conventional methods.
`Inserting the graft in a 90° rotatedposition creates a geo-
`metric match between the rectangular profile of the graft
`and the annulotomy site . This relationship allows the graft
`to be inserted into the interspace with little or no retraction
`of the exiting nerve root or them! sac. This reduces risk of
`nerve root injury and often improves visualization by elim-
`inating the need of a nerve root retractor vw'thin the opera-
`tive field. Once within the interspace the graft position may
`be easily adjusted, as the graft has not yet engaged the
`endplates. With the graft in the desiredposition, interspace
`distraction may be achieved by rotating the graft 90°. This
`maneuver decompresses the contralateral foramen and
`result in endplate engagement and graft compression.
`When the graft is placed across the anterior third of the
`interspace this technique also produces lordodic segmental
`alignment.”
`
`— Mark Peterson, M.D.
`
`
`The implant is then released from the inserter (Fig. 35).
`
`
`
`(/:,g_ 35)
`
`”When using the ‘insert and rotate’ technique, lprefer to
`rotate the graft prior to placing it all the way into the disc
`space. The stronger endplate bane near the annulus allows
`
`me to get better distraction of the disc space and reduces
`the chance of endplate damage.”
`
`Q
`
`* US. Patent No. 6,368,325.
`
`— lllfilliam Taylor, M.D.
`
`

`
`MAXIMHM Accsss. MKNIHH. msnuvnnu"
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`MA CESS’
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`STEP 8:
`FINAL ALLOGRAFT POSITIONING
`
`The implant is then positioned against the anterior annulus
`using the Implant Tamp (Hg. 36).
`
`’
`
`’
`
`Graft material of the surgeon's preference is then placed into
`the disc space posterior to the allograft implant and packed
`with the Straight and Angled Autograft Tamps (Fig. 37).
`
`The final implant position is shown (Hg. 38).
`
`(Hg. 57)
`
`
`
`

`
`CATALOG
`
`7
`
`MA CESS
`
`MAXIMUM ACCESS MINIMAL iiistiui=nnii."
`
`MAXDESS SURGERY CONFIGURATION
`
`GENERAL INSTRUMENT TRAY
`
`'“‘““5‘55 7"’
`
`‘"‘“°“ #
`
`Triad‘? TI-'F THY
`Triad General instrument Tray
`Maxcess Access System
`Maxcess Decompression System
`
`7102000
`7103000
`3200000
`3100000
`
`TL I F T R AY
`
`STERHIZATION CASE
`Sterilization Case
`
`5'1"“
`
`Sfzer ' 7"“
`Sizer - 8mm (c0lor—coded)
`Sfzer " g""“
`Sizer - 10mm (color-coded)
`
`Sizer- 12mm (color-coded)
`Sizer _ Bmm
`Sizer - 14mm (color-coded)
`
`BROACHES
`
`Broach - 8mm (color-coded)
`Broach - 10mm (color-coded)
`Broach - 12mm (color-coded)
`Broach - 14mm (color-coded)
`
`“MP5
`
`Autograft Tamp - Straight
`
`Autograft Tamp - Footed
`Implant Tamp
`
`'
`msmtfls
`9 x 25mm Straight lnserter
`
`9 x 25mm Angled lnserter
`11 x 25mm Straight lnserter
`11 x 25mm Angled lnserter
`
`CATALOG #
`7100002
`
`""‘“°“ "
`
`719°°°7
`7191008
`7190009
`7191010
`
`7191012
`7190013
`7191014
`
`CAIALOG #
`
`5005208
`5005210
`5005212
`5005214
`
`CAT“-05 #
`
`7100058
`
`7100059
`7100061
`
`CATALOG #
`7100070
`
`7100071
`7100072
`7100073
`
`I‘-HANDLE
`T-Handle
`
`QTY
`2
`
`CATALOG #
`5000901
`
`Q
`
`SIERILIZATION cnsz
`
`Sterilization Case
`
`mg-RAG-ans
`P d, I S
`S
`d
`e ic e crew prea er
`Distractor - 20-degree Bend
`Distractor - Straight Offset
`Lamina Spreader
`
`"mun" RONGEURS
`Pituitary Rongeur - Straight
`Pituitary Rongeur - Up~biting
`
`cmsecs
`
`Chisel - Straight, 7mm
`Chm _ Svaight 12mm
`Chisel - Angled, 7mm
`
`“minis ‘
`Curette ' Straight
`Cumte ' Left Angled
`Curette - Right Angled
`Curette - Down Angled
`
`Curette - Up Angled
`
`SCRAP“
`5CTaPe" ' Straight
`
`DISC CUTTERS
`
`Disc Cutter - 8mm
`Disc Cutter - 10mm
`
`RETRAUORS
`Nerve Retractor
`Dissector - 4mm
`Dissector - 7mm
`
`“MP5
`
`RBSP ' Stralght
`Rasp - Angled
`
`CATALOG #
`
`7100003
`
`CA-I-M05 #
`7100024
`7100013
`7100014
`7100040
`
`CATALOG #
`7100041
`7100042
`
`CATALOG #
`
`7100043
`7100044
`7100045
`
`(“M06 #
`7100046
`7700047
`7100048
`7100049
`
`7100050
`
`CATALOG #
`7100030
`
`CATALOG #
`
`5001708
`5001710
`
`(Ammo #
`7100053
`7100054
`7100055
`
`CHANG #
`
`7100055
`7100057
`
`

`
`MAXIMUM ACCESS MINIMAL DlSHlJPTlllll."
`
`\
`
`3
`
`MA CESS
`
`\,e
`
`MAXCESS ACCESS SYSTEM
`
`ARTICUI-ATAN5 ARM
`Articulating Arm Assembly
`
`K""“‘5
`K—Wire (.062)
`
`D"-A7035
`003°" ' 5mm
`Dilator - 9111111
`010001 ’ 1211"“
`Dflator " 6011“: NV
`D"3t°’ ' 9mm: NV
`003°’ ' lzmmr NV
`
`‘W555 '’'“V‘'‘
`Am“-55 0'09’
`Access Driver - Body ‘
`Access Driver — Arm, Right
`Access Driver - Arm, Left
`
`“A055
`Blade ‘ 30mm
`Blade ‘ 400""
`Blade ' 50mm
`Blade ‘ 50'0"‘
`Blade ' 70mm
`Blade - 80mm
`Blade - 90mm
`Blade - 100mm
`Blade - 110mm
`Blade - 120mm
`Blade - 130mm
`
`0"
`3
`3
`3
`3
`3
`3
`3
`3
`3
`3
`3
`
`CA7“-05 #
`3200021
`
`"-AW-0° #
`3200011
`
`0‘T“l°‘ #
`3202005
`3202009
`33020‘?
`3203005
`3203009
`3203012
`
`“‘T‘“°‘ ‘*
`32°00”
`3200009
`3200007
`3200008
`
`‘‘“‘“-°° #
`32m030
`M0040
`320050
`320m6°
`32°l070
`320lU30
`320L090
`3201100
`3201110
`3201120
`3201130
`
`SHIMS / SHIM INSEIITER
`Shim - lntradiscal
`Shim - Standard
`
`Shim - Wide
`Shim lnserter
`
`uam CABLE / ADAPTERS
`Light Cable Assembly
`Light Cable
`Light Cable Tip
`Light Cable Adapter ACMl
`Light Cable Adapter Storz
`Light Cable Adapter Olympus
`
`sn scn£ws/ HEX muvzns on
`Set Screw - Short
`2
`Set Screw _ Long
`1
`Hex Driver 6/32..)
`1
`Hex Key (3/321.)
`1
`
`CATALOG #
`3200012
`3200013
`
`3200014
`3200015
`
`CATALOG #
`3200020
`3209017
`3200018
`3200045
`3200046
`3200047
`
`cnmoc #
`3200040
`320004]
`3200016
`3200042
`
`S'l'ERll.lZAT|0N cases
`Sterilization Case Assembly MaXcess Access
`Sterilization Case Lid Maxcess Access
`Sterilization Case Tray 1 MaXcess Access
`Sterilization Case Tray 2 Maxcess Access
`Sterilization Case Base Maxcess Access
`
`CATALOG #
`3200031
`3200032
`3200033
`3200034
`3200035
`
`

`
`MlXlMl.lM AECESS. MINIMAL DISRUPTIDM."
`
`MA CESS.
`
`\,
`
`9
`
`CATALOG
`
`SCISSOIIS
`
`Scissors
`
`suction 10 FR . short
`suction 3 FR - 511011
`
`Bipolar Forceps - Angled, Short
`Bipolar Forceps - Straight Short
`Bipolar Forceps Cable
`
`Annulotomy Knife Handle
`Annulotomy Knife Blade
`
`sflmuznnon CASES
`
`Sterilization Case Assembly Maxcess Decompression
`Sterilization Case Lid Maxcess Decompresslori
`Sterilization Case Base MaXcess Decompression
`Sterilization Case Insert 1 MaXcess Decompression
`Sterilization Case Insert 2 MaXcess Decompression
`
`CATALOG #
`
`3100037
`
`3100045
`3100047
`
`3100050
`3100051
`3100052
`
`3100053
`3100054
`
`(“Mac #
`
`3100060
`3100061
`3100062
`3100063
`3100064
`
`MAXCESS DECUMPRESSIUN SYSTEM
`
`KEIIRISON RONGEIIRS
`
`CATALOG #
`
`Kerrison - 3mm, 40 Deg.
`Kerrison ~ 5mm, 40 Deg.
`Kerrison - 3mm, 90 Deg.
`
`Curved Kerrison - 2mm
`Curved Kerrison - 4mm
`
`pituitary - up, 2mm
`Pituitary - Straight, 2mm
`Pituitary - Down, 2mm
`Micro Pituitary — Up, 2mm
`Micro Pituitary - Straight, 2mm
`
`Pituitary - Straight, 4mm
`
`3100010
`3100011
`3100012
`
`3100014
`3100015
`
`3100030
`3100031
`3100032
`3100033
`3100034
`
`3100035
`
`CUITETTES
`
`CATALOG #
`
`Curette — Straight, Small
`Curette - Straight, Large
`Curefle _ Up Sm“
`00,900 _ 00' Large
`curate _ Down Small
`00,000 _ Down’ Large
`
`3100020
`3100021
`3100022
`3100023
`3100024
`3100025
`
`PROBES/DISSECTORS/RETRACTOIIS
`Woodson
`Ball Tip Probe
`Penfield - Large
`Penfield - Small
`Nerve Hook
`Dissector
`Nerve Retractor — Short
`Suction Nerve Retractor - Short
`
`CATALOG #
`3100040
`3100041
`3100042
`3100043
`3100044
`3100045
`3100048
`3100049
`
`

`
`MAXMUM ACCESS. MINIMAL BISRUPTIUIW
`
`MA)(CESS'
`
`\
`
`\,
`
`K’ T?’
`
`I
`
`-_
`
`-—-Kym.-...-‘~‘.:—-—
`
`_ M
`
`'1 '—
`
`'—"——’————
`
`

`
`
`
`

`
`
`
`

`
`'Q;NuVAs1vE°
`
`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
`
`.
`
`9003917 CD
`
`* US. Patent No. 6,368,325.
`© 2005. Nuvasive, inc All rights reserved.
`Q Nuvasive, Triad, Neurovision, Maxass, and Creative Spine Tedinology are federally registered lrademarkspl Nuvasive, Inc. "Maximum Access. Minimal Disruption.” and DSP are common law trademarks of Nuvasive, Inc. Patent(s) pending.