2. Access Needle and K-wire Insertion

Create an incision slightly larger than the outer diameter of the radiolucent sleeve, approximately 18mm.
Using fluroscopy, insert the Access Needle Stylet and Access Needle Sheath into the pedicle. Remove the stylet and insert the K-wire through the Access Needle Sheath. Confirm the position of the K-wire with A/P and lateral views. Once the K-wire position is determined, remove only the Access Needle Sheath.

3.AWL

4.TAP

Insert Dilator #4 over Dilator #3. Remove Dilator #3. A radiolucent Dilator #4 is available for increased visualization under fluoroscopy.

Securely attach the Ratcheting Handle to the cannulated Tap. Pass the Tap over the K-wire. Utilizing fluoroscopy to ensure that the K-wire does not advance, tap to the desired depth. Confirm depth measurement on the Tap against the top of Dilator #4 and select the appropriate screw length.

5. Screw Placement

Once tapping is complete, remove Tap and insert Dilator #5 over Dilator #4. Remove Dilator #4. A radiolucent Dilator#5 is available for increased visualization under fluoroscopy and nerve monitoring.

Polyaxial Screw Attachment
Securely attach the Ratcheting Handle to the Screw Driver. Insert the tabs of the polyaxial screw into the sleeve of the Screw Driver.
Securely align the Screw Driver tip with the saddle and hex of the polyaxial screw. Rotate the proximal knob on the Screw Driver clockwise to secure the polyaxial screw to the Screw Driver.
Utilizing fluoroscopy, insert the polyaxial screw over the K-wire to the appropriate depth. Turn the proximal knob on the Screw Driver counter clockwise and remove the Screw Driver from the polyaxial screw.
Place remaining screws using the same technique.

6. Rod Measurement

Create an incision between the polyaxial screws to allow for rod insertion. Place the Rod Calipers into the tabs of the screws. Seat the Calipers fully into the screw head and measure the required rod length on the Calipers.
All rod measurements on the Calipers include a total of 12mm rod overhang.

7. Rod Insertion

Turn the knob on the Rod Inserter counter clockwise and once loose, push the knob to open the distal end of the Rod Inserter. Attach the selected rod to the Rod Inserter and push the bayonet forward to grab the rod. While holding the bayonet against the rod, turn the knob clockwise to secure the rod.

Insert the rod into the polyaxial screw. If required, use the Rod Pusher to advance the rod. Confirm rod position fluoroscopically.

8. Breakaway Insertion

Securely attach the Breakaway into the Switching Stick. While holding the rod in position with the Rod Inserter, insert the Switching Stick through the extended tabs and rotate clockwise to seat the Breakaway and secure the rod in place. Confirm rod position fluoroscopically with A/P and lateral views. Place remaining breakaways using the same technique.

9. Reduction

Confirm the amount of reduction on the Reducer. Once reduction is achieved (Reducer must read zero), remove the Switching Stick. Attach the breakaway securely into the Switching Stick and insert through the Reducer and Counter Torque Wrench. Rotate the Switching Stick clockwise to secure the breakaway and rod.

10. Compression/Distraction

While pressing the button on the Torque Handle, securely attach it to the Counter Torque Wrench. Slide the Counter Torque Wrench over the extended tabs and the polyaxial screws. Insert the Breakaway T-Handle through the extended tabs and over the breakaway. Apply a primary clockwise torque of 110 in-lbs to secure the head angulation. An audible and tactile confirmation indicates that the required torque has been applied.

After the primary break, compression and distraction may be performed.

Attach the Compressor or Distractor to the Counter Torque Wrench and orient the system.

Appy desired compression or distraction.

11. Final Tightening

Slide the Counter Torque Wrench over the extended tabs and the Polyaxial Screws. Insert the Breakaway T-Handle through the extended tabs and over the breakaway. Apply the secondary clockwise torque of 40 in-lbs to lock the
rod and secure the construct.
To eject the breakaway remnant, slightly retract the ejector pin and reinsert into the Breakaway T-handle. The light impaction created during the reinsertion will disengage the remnant from the Breakaway T-handle. Discard all
remnants. Perform final tightening on all breakaways using the same technique.

12. Tab Removal

With the Counter Torque Wrench seated over the screws, insert the Extended Tab Remover into the screws. Insert the extensions on the Remover fully into the slot of the screws. Once inserted completely (confirmed by tactile feedback), turn the Remover clockwise until it engages the horizontal slots of the screw. This is confirmed with tactile feedback. Continue turning the Remover clockwise and applying torque until both tabs have separated from the screw.

13. Removal

Insert the Counter Torque Wrench and Collar Remover over the screws. Turn the Collar Remover counter clockwise to remove the breakaway. Repeat for all screws and remove the rod. Securely insert the screw driver to the screw and turn counter clockwise to remove the screw.

14. Closure

Wound closure is performed in the customary manner.

7°PLATEAU®-X Espaciador, 7 °

Bi-Convex

Angular