Surgical Technique

Question 1

Patient Positioning

Answer 1

• Prone position with face in stabilizing Donut
• Slight FLEXION of head and neck to facilitate instrument placement
• MAYFIELD IN NOT NECESSARY

Question 2

Preoperative Skin Markings

Answer 2

1. AP View - Mark the medial and lateral border of the facet joint.
2. Lateral View - Using guide pin draw a parallel line through the facet joint for proper trajectory
3. Mark incision point two fingers below target level

Question 3

Step 1

Answer 3

1 - Use spinal needle to confirm trajectory

2 - Make initial horizontal incision and carry through fascia (incision typically made two levels below target level)

Question 4

Step 2a - Access Chisel

Answer 4

1. AP View

- Advance access chisel through incision with chisel blade in a vertical orientation until you reach bone.

Question 5

Step 2b - Access Chisel

Answer 5

1. Lateral View
   
   • Rotate chisel 90 degrees to a horizontal orientation.
   • Advance Access Chisel into facet joint using hand pressure. NOTE: As you advance access chisel, aim for the inferior lateral mass, and then advance up into the joint.

Question 6

Step 3 - Decortication Device

Answer 6

Lateral View

1. Advance Decortication Device over the access chisel until distal tip contacts bone.
2. Decorticate each lateral mass with 10 degree rotations.

Question 7

Step 4 - Guide Tube

Answer 7

Lateral View

1. Place Guide Tube over Access Chisel
   (maintaining downward pressure while removing DD)
2. Advance Guide Tube until it abuts the pedicle of the rostral vertebrae. Note: Final Guide Tube depth is achieved when proximal marker on Guide Tube is at the posterior facet.

Question 8

Step 5 - Confirm Positioning

Answer 8

1. Confirm positioning in Lateral and AP views.

Question 9

Step 6 - Chisel Rasp

Answer 9

Lateral View

1. Insert Chisel Rasp through Guide Tube until handles lock together.
2. Decorticate facet surfaces by inserting Chisel Rasp multiple times on both sides of Chisel Rasp.

Question 10

Step 7a - Implant

Answer 10

1. Pack DTRAX Cervical Cage with biologic.

Question 11

Step 7b - Implant

Answer 11

Lateral View

1. Advance DTRAX cage into guide tube.
   NOTE: Malleting may be required to fully insert implant and distract facet joint. Maintain downward pressure on Guide Tube while malleting.

Question 12

Step 7c - Implant

Answer 12

1. Confirm placement in Lateral and AP views

Question 13

Step 7d - Implant

Answer 13

1. Disengage implant from Delivery Tool by turning knob counter clockwise.
2. Remove Delivery Tool leaving Guide Tube in place.

Question 14

Step 8 - Bone Graft

Answer 14

1. Apply injectable bone graft material into guide tube and insert Bone Graft Delivery Tool.

Question 15

Step 9

Answer 15

Remove Guide Tube