Sofamor Danek Zephir Chi Siamo Mt Ortho-Books Pdf

SOFAMOR DANEK ZEPHIR Chi siamo MT Ortho
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INTRODUCTION, Dear Fellow Colleague, Anterior cervical plating has become widely accepted when anterior spinal fusion surgery is. performed Through our surgical experience over the past years we have found the need for. a simple to use low profile plate which maintains the existing standards of strength for anterior. cervical fixation, The ZEPHIR Anterior Cervical Plate System developed in Lille France represents an advance in. cervical plate fixation For the surgeon the ZEPHIR System s minimized height and narrow. transverse width enhance visualization and plate manipulation for precise plate placement while. reducing the amount of traction on the trachea and esophagus The rotating drill guides. self tapping screws and integrated antimigration cap simplify plate fixation and reduce operative. time Finally the flexibility of the ZEPHIR System through variable angulation of screw trajectory. multiple screw lengths and revision screws allows the surgeon to individually tailor the. construct to each patient s anatomy We believe that these design features make implanting the. ZEPHIR System plate a nearly seamless component of the anterior cervical decompression and. stabilization procedure, The ZEPHIR System has been tested following the ASTM testing standards and was found to. perform equal to or better than other clinically available systems Prior to its launch the ZEPHIR. System was used worldwide by a group of surgeons to enhance the instrumentation and the. implants and to measure its clinical efficacy, The following monograph describes the ZEPHIR System as well as some of our personal thoughts. reflecting our current operative techniques, Richard Assaker M D Paul McCormick M D.
Lille University Hospital Columbia Presbyterian Hospital. Lille France New York New York, PAT I E N T P O S I T I O N I N G A N T E R I O R A P P R O A C H. The patient is placed in the supine position with the head in slight extension The posterior. cervical spine is supported to establish and maintain normal cervical lordosis The surgeon must. then choose a right or left sided approach to the cervical column. After exposing the cervical spine the self retaining retractor is placed to provide optimal. visualization Figure 1 A vertebral body distractor may be used The distraction pins are. positioned midline in the vertebral bodies adjacent to the level to be treated The distractor is. placed over the pins and the appropriate amount of distraction is applied. Pituitary forceps curettes and kerrisons may be used to remove the disc material and cartilage to. expose the posterior longitudinal ligament Bone graft is then positioned between the vertebrae. P L AT E S E L E C T I O N C O N T O U R I N G, Plate Selection. Anterior osteophytes are removed from the exposed vertebrae so that the plate may sit flush evenly. on the anterior cortex The plate length should be defined according to the chosen screw length. and angulation so that it does not interfere with the adjacent unfused disc spaces. Plate Contouring, The plate is machined into a lordotic curve However the Plate Bender can be used to increase. or decrease lordosis as necessary Figures 2 and 3 Bending at the extremities of the plate is not. recommended as it could damage the antimigration cap mechanism. FIGURE 2 FIGURE 3, For C2 fixation it is always necessary to contour. the superior aspect of the plate I bend the plate, just caudally with respect to the antimigration cap.
R Assaker M D, P L AT E P O S I T I O N I N G, To pick up a plate with the Plate Holder push the button on the proximal end of the Plate Holder. and insert the tip into any screw hole or central slot in the plate Release the button to engage the. plate Figure 4, Prefixation Pins can be used to assist positioning and to stabilize the plate in the midline prior to. screw insertion To open the jaws of the Prefixation Pin Holder pull the flange on the shaft toward. the handle Place it over a Prefixation Pin in the sterilization case and release the flange to engage. the pin Insert the pin through one of the four small holes along the midline of the plate Figure 5. Do not insert the pin through the bone screw holes Slide the jaws of the instrument to the side. and then lift it up to clear the pin Next pick up a second Prefixation Pin from the sterilization. case and insert it into one of the small holes at the other end of the plate. An alternative use for the Prefixation Pins is to assist in placing the plate along the midline First. place the superior pin in the midline of the superior body Figure 6 Insert the needle portion of. the pin only Next place the notch in the end of the plate against the bulb portion of the pin. Once the plate is precisely positioned insert the inferior pin through the plate in one of the small. midline holes at the other end of the plate Figure 7. Alternatively a screw distraction, post can be utilized to buttress. either end of the plate, P McCormick M D Prefixation. Pins here Prefixation, Plate prefixation allows me to.
precisely check the positioning and, the length selection of the plate. R Asssaker M D, FIGURE 4 FIGURE 7, The Mono Drilling Guide is most. Option 1 Mono Drilling Guide frequently used First I drill two. First position the Mono Drilling Guide into diagonally opposite screw holes and. the bone screw hole in the plate then I partially insert the screws. Then apply slight downward pressure until the R Assaker M D. leg support of the Drilling Guide comes into, contact with the plate Figure 8. The 180 rotation of the drill guide, The Mono Drilling Guide is designed to enhances the stability and control of. provide a maximum of 16 of angulation drilling by allowing me to comfortably. during the drilling step To achieve less, drill both superior and inferior holes.
angulation pivot the guide toward the end, of the plate The range of cephalad caudal with my dominant hand. angulation is from 0 to 16 Figures 8a and 8b P McCormick M D. Loosen the nut with the Universal Handle and, insert the tri flat drill bit into the handle I prefer to angle the rostral screws 5 to 10. Tighten the nut to securely hold the drill bit superiorly to optimize load sharing and. If using power to drill the tri flat or the permit some graft settling allowed by this. circular tip drill bit can be used The drilling semi constrained system I place the. depth is fixed to 13mm Figure 8b with a, caudal screws perpendicular to the plate. 0 3mm off center drill hole for graft, i e 0 angulation. compression Figure 8c which will be, achieved as the bone screw is inserted P McCormick M D.
The handle of the Mono Drilling Guide, rotates for optimal handle positioning. DRILLED HOLE, BONE SCREW, FIGURE 8a FIGURE 8c, FIGURE 8b FIGURE 8. Option 2 Dual Drilling Guide, The angulation is first determined by adjusting the leg support of the Dual Drilling Guide Figure 9. Two marks are engraved on the leg support If the leg support s upper mark is set to the top of the. platform the drilling angulation is 0 Figure 9a The lower mark yields a 16 drilling angulation. Figure 9b Angulation of the Dual Drilling Guide should not exceed 16. Place the double barrel of the Dual Drilling Guide into the bone screw holes of the plate and slightly. lower the guide until the leg support sits on the plate Drill both holes successively through the Drilling. Guide The drilling depth is fixed to 13mm with an offset of 0 3mm for graft compression See Figure 8c. Page 5 Once the drilling is performed remove the Drilling Guide The handle of the Dual Drilling. Guide rotates for optimal handle positioning, Upper Mark. Lower Mark, The construct could be constrained by aiming.
the screw hole at 0 For a hybrid construct, one set of screws could be directed at 0 and. FIGURE 9 the other set between 0 and 16, R Assaker M D. BONE SCREW SELECTION, The standard bone screw diameter is 3 5mm. and the revision central slot bone screw, diameter is 4 0mm These bone screws are. self tapping and come in 11 13 15 and, 17mm lengths The Screwdriver consists of.
two pieces the Sleeve and the Shaft, Separate the Sleeve from the Shaft and use. the Sleeve to pick up the appropriate diameter, and length bone screw Figure 10 Then place. the Shaft through the center of the Sleeve to, engage the cruciate drive in the screw Figure 11. To increase efficiency of the, plate insertion the scrub nurse. loads the screws while the, surgeon drills the screw holes.
The surgeon s eyes do not leave, the operative field at any time. during plate insertion, P McCormick M D, BONE SCREW INSERTION. Partially insert two bone screws diagonally, positioned in the plate Figure 12 Remove. the Prefixation Pins with the Pin Holder Fully, insert the two remaining screws Figure 13. Complete final tightening of the first two screws, The compression of the graft is achieved by the.
combination of the offset drilling 0 3mm and, the screw head interference with the plate. screw holes Figure 14 The red dot in the, illustration represents the drilled hole the black. dot represents the center of the bone screw, hole The drilled holes are off center by 0 3mm. per hole As the screw heads are seated in the, plate they pull the vertebral bodies toward. each other resulting in 0 3mm of graft, compression on each end of the plate or.
0 6mm of total compression FIGURE 12, When performing a multi level procedure and. intermediate vertebral body or graft fixation is, desired the 4 0mm diameter screws must be. used in the central slot Figure 15 These, screws are designed to self lock in the central. slots via an interference between the minor, diameter of the screw and the sides of the slot. It is recommended that the pilot hole be drilled, perpendicular to the slot.
CENTER OF DRILLED HOLE CENTER OF BONE SCREW HOLE Retraction of the Screwdriver Sleeve. once the screw is firmly engaged in, the bone improves visualization and. facilitates final screw tightening, P McCormick M D. Remove Prefixation Pins prior to final, tightening of the bone screws to. maximize the compression capabilities, FIGURE 14 FIGURE 15 R Assaker M D. A N T I M I G R AT I O N C A P L O C K I N G, The Antimigration Cap Pusher is assembled.
onto the Universal Handle by inserting the, UNLOCK tip into the handle and tightening. the nut on the handle, The translation of both antimigration caps is. FIGURE 16 obtained by inserting the LOCK tip into the. gap between the plate and the cap and giving, the instrument a quarter turn Figure 16 When. properly advanced the tips of the antimigration, caps will partially cover the bone screw heads. thus preventing screw migration The cap locks, in place via a hemisphere on the undersurface.
of the cap that rests in the midline hole Figure 17. when the cap is advanced Proper seating of the, screws ensures easy locking of the. antimigration caps, If unlocking is needed place the UNLOCK. tip between the end of the plate and the cap, and give it a quarter turn Figure 18. LOCKED UNLOCKED, FINAL CONSTRUCT, CLINICAL CASES, PRE OP POST OP LATERAL POST OP A P. 42 year old female C5 6 and C6 7 disc herniations with significant compression of the spinal cord. Post op C5 6 and C6 7 discectomies with ventral decompression and fixation using a 47 5mm. ZEPHIR plate and 5 screws, PRE OP POST OP LATERAL POST OP A P.
37 year old female with C6 radiculopathy from a left C5 6 disc herniation. Post op C5 6 discectomy and decompression were performed A P and lateral cervical spine films. show excellent fixation using a 25mm ZEPHIR plate and 13mm screws. P R O D U C T I N F O R M AT I O N, ANTERIOR CERVICAL PLATES. ITEM DESCRIPTION ITEM DESCRIPTION, 8799022 22 5mm Plate Ti 8799147 47 5mm Plate Ti. 8799025 25mm Plate Ti 8799150 50mm Plate Ti, 8799027 27 5mm Plate Ti 8799152 52 5mm Plate Ti. 8799130 30mm Plate Ti 8799155 55mm Plate Ti, 8799132 32 5mm Plate Ti 8799157 57 5mm Plate Ti. 8799135 35mm Plate Ti 8799160 60mm Plate Ti, 8799137 37 5mm Plate Ti 8799162 62 5mm Plate Ti.
8799140 40mm Plate Ti 8799165 65mm Plate Ti, 8799142 42 5mm Plate Ti 8799167 67 5mm Plate Ti. 8799145 45mm Plate Ti 8799170 70mm Plate Ti, SELF TAPPING CANCELLOUS SCREWS. ITEM DESCRIPTION ITEM DESCRIPTION, 8792111 3 5 x 11mm Self Tapping Cancellous Screw 8792711 4 0 x 11mm Self Tapping Cancellous Screw. 8792113 3 5 x 13mm Self Tapping Cancellous Screw 8792713 4 0 x 13mm Self Tapping Cancellous Screw. 8792115 3 5 x 15mm Self Tapping Cancellous Screw 8792715 4 0 x 15mm Self Tapping Cancellous Screw. 8792117 3 5 x 17mm Self Tapping Cancellous Screw 8792717 4 0 x 17mm Self Tapping Cancellous Screw. INSTRUMENTS, ITEM DESCRIPTION ITEM DESCRIPTION, 8796001 Plate Holder 8796036 Lock Screwdriver. 8796002 Pin Holder 8796071 Plate Bender, 8796003 Prefixation Pin 8796321 Screwdriver Shaft.
8796006 Dual Drilling Guide 8796322 Screwdriver Sleeve. 8796007 Mono Drilling Guide 8796912 13mm Drill Bit Tri Flat Sterile. 8796008 Mono Drilling Guide Without Kickstand 8796913 13mm Drill Bit Circular Sterile. 8796011 Universal Handle 8797000 Sterilization Case. 8796033 Central Slot Screw Removal Tool 8796084 11mm Screw Caddy. P R O D U C T I N F O R M AT I O N, Anterior Cervical Discectomy Fusion Instrument Set. HAND HELD RETRACTORS, Catalog Description, 875 050 Hand Held Retractor Straight 18. SOFAMOR DANEK as described by Richard Assaker M D Lille University Hospital Lille France Paul McCormick M D Columbia Presbyterian Hospital New York New York

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