ESL® Elliptical Shaped Lumbar Spine System Surgical Technique · ESL® Spinal System is also indicated for treating fractures of the thoracic and lumbar spine. The ESL® Spinal System

$Page 1: ESL® Elliptical Shaped Lumbar Spine System Surgical Technique · ESL® Spinal System is also indicated for treating fractures of the thoracic and lumbar spine. The ESL® Spinal System$
Surgical Technique

ESL®

Elliptical Shaped Lumbar Spine System

Elliptical ShapeCreates a Natural Fit

Available in

• Unique,EllipticalDesign

• InterbodyFusionDevice

• ComprehensiveRange of Sizes

Contents

Introduction ................................................Page1

DesignFeatures ..........................................Page2

Instruments ................................................Page3

SurgicalTechnique .....................................Page4

Closure and Postoperative Care ..................Page9

IndicationsforUse .....................................Page9

ProductInformation ...................................Page13

FurtherInformation .....................................Page14

1

Introduction

TheESL®SpineSystemisdesignedtorestorethe

biomechanicalintegrityoftheanterior,middleandposterior

columnevenintheabsenceoffusionforaprolonged

periodoftimewhenusedasaVBRdevice.Whenusedasa

fusiondevice,theESL®SpinalSystemisdesignedforuse

withautografttofacilitatefusionandintendedforusewith

supplementalfixationsystemsclearedforuseinthelumbar

spine.TheESL®SpinalSystemmayalsobeimplanted

usingtheAccuVision®Systemtoprovidethesurgeonwith

aminimallyinvasiveapproachforposteriororposterolateral

spinalsurgery.

Product Overview

TheESL®Spacer’sanatomicallycorrectshapeandopen

design,coupledwithsubsidenceandretropulsionresistant

features,accommodatesfusionsandcanrestoresagittal

planealignment.TheESL®Spacerhasbeendesignedwith

anellipticalformthatmatchesthecontourshapeofthe

vertebralbody.Bymatchingtheellipticalcurvesofthe

vertebralspacein1.0mmheightincrements,theESL®

Spacerprovidesaneasyinsertion,improvedfit,andstability

withinthevertebralspace.

TheESL®Spacerdesignenablesendplatestobepreserved,

sincetheydonotneedtobecutorreamed.Bysparing

theendplates,subsidenceisinherentlyreduced.The

implant’sserratedteethandellipticalshapeengagethebony

endplates,resistingsheerandrotationalforces.TheESL®

Spaceraccommodatesfusionwithlargecaudalandcranial

openings,andisreadilyfilledutilizingabonemoldcontained

intheinstrumentationkit.

Inadditiontothebonemold,theESL®SpineSystemoffers

anarrayofinstrumentsthataresimpleandintuitivetouse.

ThemodularT-Handlesaredesignedtoquicklyconnect

and disconnect to the ESL® Trialsforeaseofuse.The

color-codedESL® Trialsprovideeasyidentificationwhen

determiningtheappropriateimplantsizeintraoperatively.

TheESL® Implantsareavailablein8-14mmheightsin

PEEK-OPTIMA® (Polyetheretherketone)forradiolucency.

ESL® ImplantsinPEEK-OPTIMA® areavailableinlengths

of21mm,25mmand29mm,providingadditionalsizing

optionstosuitpatientanatomy.Tantalummarkers

helpvisualizeimplantorientationwithinthespine

whenconductingintraoperativeandpostoperative

radiographicassessment.

TheESL® spacers in PEEK-OPTIMA® can be used unilaterally

orbilaterally.Thissurgicaltechniqueillustratestheirusewith

either approach.

TheESL®SpinalSystemisindicatedforvertebralbody

replacementandintervertebralfusion.Whenusedfor

vertebralbodyreplacement,theESL®SpinalSystemis

indicatedforuseinthethoracolumbarspine(i.e.,T1-L5)

forpartialreplacementofadiseasedvertebralbodyresected

orexcisedforthetreatmentoftumorsinordertoachieve

anteriordecompressionofthespinalcordandneuraltissues,

andtorestoretheheightofacollapsedvertebralbody.The

ESL®SpinalSystemisalsoindicatedfortreatingfractures

ofthethoracicandlumbarspine.TheESL®SpinalSystem

isdesignedtorestorethebiomechanicalintegrityofthe

anterior,middle,andposteriorspinalcolumneveninthe

absenceoffusionforaprolongedperiodoftime.

Asanintervertebralbodyfusiondevice,theESL® Spinal

Systemisindicatedforintervertebralbodyfusionatonelevel

ortwocontiguouslevelsinthelumbarspinefromL2toS1

inpatientswithdegenerativediscdisease(DDD)withupto

Grade1spondylolisthesisattheinvolvedlevel(s).DDDis

definedasbackpainofdiscogenicoriginwithdegeneration

ofthediscconfirmedbypatienthistoryandradiographic

studies.Thesepatientsshouldbeskeletallymatureandhave

hadsixmonthsofnon-operativetreatment.

2

Image To Come

• Implantsare available in the

followinglengths:21mm(short),25mm(medium)and29mm(long)

Design Features

Available in a Wide Range of Sizes

• Implantheightsavailablefrom8mmto14mm in1mmincrements

Unique, Elliptical Design

• Conformstoconcaveshapeofthevertebralbodies

• Providesappropriatelordosiswithsingledesign

• Easyinsertionshapewithbulletednose

Self Distracting Tips

• Easesinsertionpastposteriorlip

• Reducesasurgicalstepbyeliminatingboxchiseling

Endplate Sparing

• Preservingendplateresistssubsidence

• Reducesasurgicalstepbyeliminating endplatecuttingandreaming

Serrated Teeth

• Providesstabilitybyengaging bony endplates

Open Design

• Accommodatesthefusionprocess withlargesuperior/inferioropenings

• Subsidenceresistance• Radiolucentmaterialoffersanaccuratevisualization andassessmentofthefusion

• Providesidealmodulusofelasticityandload sharingattributes

3

Instruments

Image To Come

8mmBoneRasp

T-Handle

BoneMold

VariousinstrumentsareavailablewiththeESL® SpineSystem

forusebythesurgeontofacilitateimplantationofthedevice.

Mallet

Elliptical Paddle Scraper

Two-PieceInserterDisassembled

Two-PieceInserterassembledandattachedtotheESL® Spacer

TrialSpreader

4

1. Distraction/Trialing

ALaminaSpreaderisdesignedtoprovidedistraction

toaccommodateendplatepreparationandconfirmthe

appropriate size ESL® Spacer in PEEK-OPTIMA® prior to

implantation.TheLaminaSpreaderisinsertedintothedisc

spacewiththeteethcomingintodirectcontactwiththe

superiorandinferiorlamina.TheLaminaSpreaderisthen

squeezed,providingdistraction.

TheTrialSpreadersarealsodesignedtoprovidedistraction

aswellastoconfirmtheappropriatesizeESL® Spacer

in PEEK-OPTIMA® priortoimplantation.Thetipsofthe

TrialSpreadersareetchedtoindicatetheirheightsizein

millimeters(SeeFigure1).TheTrialSpreaderisinserted

intothediscspacewiththeflatsurfacecomingintodirect

contactwiththevertebralbodyasshowninFigure2.The

TrialSpreaderisthenrotated90°orientingtheflatsof

thetipperpendiculartothevertebralbody(SeeFigure3).

Fluoroscopy can be used to verify the position and

orientationoftheTrialSpreadertippriortoinsertion

of the ESL® Spacer in PEEK-OPTIMA®.

AlloftheTrialSpreadersmatchtheellipticalshapeofthe

ESL® SpacerasshowninFigure4.TheheightoftheTrial

Spreadersmatchesthetipoftheserratedteethofthe

correspondingESL® Spacer in PEEK-OPTIMA®. Greater

stabilityafterimplantationcanbeachievedbyimplantinga

largersizedESL® Spacer(SeeFigure4).

Surgical Technique

Figure1

Figure2

Figure3

Figure4

New in This Step:

TrialSpreader

5

3. End Plate Preparation

InadditiontothePaddleScrapers,theESL® SpineSystem

alsohasaRaspinstrumentthatcanbeusedtoremove

thediscmaterialandhelppreparetheendplateasshown

inFigure7.

Figure5

Figure6-Rotated90°

2. Disc Space Preparation

ThePaddleScrapersareusedtofacilitatetheremovalof

discmaterial.TheScrapersfeaturecuttingflutesthatallow

theinstrumenttocutintwodirectionsbyrotatingtheQuick

ConnectT-Handleclockwiseandcounterclockwiseasshownin

Figures5and6.

IMPORTANT!BesurethatthePaddleScraperisalwayssecurely

attachedtotheQuickConnectT-Handlepriortoinsertion.

Figure7

New in This Step:

Elliptical Paddle Scraper

8mmBoneRasp

6

4. Autograft Placement

TheESL® BoneMoldisspecificallydesignedforthe

impactionofautograftorallograftmaterialintothecavity

of the ESL® ImplantinPEEK-OPTIMA® dependingonthe

indication. After the ESL® Implanthasbeenselected,attach

theInserter,thenplaceitintothecorrespondingcavitysizein

the ESL® BoneMold(Figure8).Autograftisimpactedintothe

ESL® Implantusingabonetampinstrumentforaninterbody

indication;allograftmaybeusedinVBRprocedures.

Surgical Technique (Continued)

Figure8

New in This Step:

BoneMold

7

5. Implant Insertion

TheESL® Inserterisatwo-pieceinstrument(SeeFigure9).

TheInsertersecurelyattachestotheESL® Spacer in

PEEK-OPTIMA® byplacingtheinnershaftintotheouter

shaftandturningtheknurledknobclockwiseengaging

the ESL® Implant(SeeFigure10).

WhentheInserterisattachedtotheESL® Implant,theblack

T-Handlewillbeparalleltotheopentopandbottomofthe

ESL® Implant.TheblackT-Handlewillhelptodeterminethe

orientation of the ESL® Spacerduringimplantation.Impact

the ESL® Implanttothedesiredposition.(SeeFigure11).

IMPORTANT! Do Not Twist or Rotatethetwo-pieceimplant

inserterinstrumentduringorafterimplantinsertion.When

implantingthePEEK-OPTIMA® Implantitisrecommended

toavoidexcessiveimpactionforceduringimplantation.

Ifbeingusedbilaterally,repeatthesamestepsforthe

contralateralside(SeeFigure12).

Figure10

Figure9

Figure11

Figure12

New in This Step:

Two-PieceInserterDisassembled

8

Figure15

PosteriorMarkers

AnteriorMarkers

Surgical Technique (Continued)

Figure13

Figure14

5. Implant Insertion (Continued)

Additionalgraftmaterialisthenplacedbetweenandbeside

theimplants(SeeFigure13).

Ifbeingusedunilaterally,asingleimplantisutilized

(SeeFigure14).

Imagingcanbeusedtoconfirmthedesiredpositionofthe

ESL® Spacer in PEEK-OPTIMA® priortodisconnectingthe

ImplantInserterfromtheSpacer.SeeFigure15forlocations

ofanterior/posteriortantalummarkersusedforlocatingthe

PEEK-OPTIMA® Spacer.

9

Aroutinewoundclosureisthenperformed.

• Routinemonitoringofthevitalsigns,andofthe hemodynamicandneurologicstatusofthepatient

• Painmedication

• NGtubesand/orFoleycathetersshouldbediscontinued within24-48hours

• Dietisrestrictedtosmallamountsofliquidsuntilreturn ofbowelfunctioniscompleted

• Thepatientisencouragedtoambulateassoon aspossible.Theindividualsurgeondetermines

activity level

• Bracesaretobeusedaspereachsurgeon’sdiscretion

Indications for UseClosure and Postoperative Care

TheESL®SpinalSystemisindicatedforvertebralbody

replacementandintervertebralfusion.Whenusedfor

vertebralbodyreplacement,theESL®SpinalSystemis

indicatedforuseinthethoracolumbarspine(i.e.,T1-L5)

forpartialreplacementofadiseasedvertebralbodyresected

orexcisedforthetreatmentoftumorsinordertoachieve

anteriordecompressionofthespinalcordandneuraltissues,

andtorestoretheheightofacollapsedvertebralbody.The

ESL®SpinalSystemisalsoindicatedfortreatingfractures

ofthethoracicandlumbarspine.TheESL®SpinalSystem

isdesignedtorestorethebiomechanicalintegrityofthe

anterior,middle,andposteriorspinalcolumneveninthe

absenceoffusionforaprolongedperiodoftime.

Asanintervertebralbodyfusiondevice,theESL® Spinal

Systemisindicatedforintervertebralbodyfusionatonelevel

ortwocontiguouslevelsinthelumbarspinefromL2toS1

inpatientswithdegenerativediscdisease(DDD)withupto

Grade1spondylolisthesisattheinvolvedlevel(s).DDDis

definedasbackpainofdiscogenicoriginwithdegeneration

ofthediscconfirmedbypatienthistoryandradiographic

studies.Thesepatientsshouldbeskeletallymatureandhave

hadsixmonthsofnon-operativetreatment.

TheESL®SpinalSystemisdesignedforusewithautograft

tofacilitatefusionandisintendedforusewithsupplemental

fixationsystemsclearedforuseinthelumbarspine.

TheESL®SpinalSystemmayalsobeimplantedusing

theAccuVision®Systemtoprovidethesurgeonwitha

minimallyinvasiveapproachforposteriororposterolateral

spinalsurgery.

PleaserefertotheAccuVision®SurgicalTechniquefor

instructionsonusingtheminimallyinvasiveinstrumentation.

10

Indications for Use (Continued)

Description of Device

TheESL®PEEKimplanthasconvextopandbottomsurfaces

tomatchtheanatomicalshapeofthevertebralendplates

withinthevertebralspace.Thetopandbottomsurfacesalso

haveteethtoresistshearandrotationalforcesbyengaging

thebonyendplates.ThePEEKimplantalsohasanopen

designtopromotebonegrowthbetweentheendplatesof

theadjacentvertebralbodies.TheESL®PEEKimplantis

availableinheightsizesfrom8mm-14mmandinthree

lengths,21mm,25mm,and29mm.TheESL®PEEKimplant

ismadefromPEEK-OPTIMA®(aregisteredtrademarkof

InvibioLimited)asdescribedbyASTMF-2026,titanium

alloy(Ti-6Al-4VELI),conformingtoASTMStandardF136,

withtantalumradio-opaquemarkersmadetothestandard

ASTMF-560.InstrumentsfortheESL®SpinalSystemare

madefromstainlesssteelconformingtoASTMStandards

A276,A564,A582,orF899,aluminumconformingto

ASTMStandardB221orB209,orarecomponentsofthe

AccuVision®System.

Instructions for Use

CAUTION:TheESL®SpinalSystemshouldonlybeimplanted

bysurgeonswhoarefullyexperiencedintheuseofsuch

implantsandtherequiredspecializedspinalsurgery

techniques.RefertotheESL®SpinalSystemSurgical

TechniqueManualforcompleteInstructions-for-Use.

RefertotheAccuVision®SystemSurgicalTechnique

forcompleteInstructions-for-Usefortheminimally

invasiveinstrumentation.

Contraindications

Contraindicationsinclude,butarenotlimitedto,infection,

systemic,spinalorlocalized;morbidobesity;signsof

localinflammation;feverorleukocytosis;metalsensitivity/

allergiestotheimplantmaterials;anymedicalorsurgical

conditionwhichwouldprecludethepotentialbenefitofspinal

implantsurgery,suchastheelevationofsedimentationrate

unexplainedbyotherdiseases,elevationofwhitebloodcount

(WBC),oramarkedleftshiftintheWBCdifferentialcount;

grosslydistortedanatomyduetocongenitalabnormalities;

rapidjointdisease,boneabsorption,osteopenia,and/or

osteoporosis (osteoporosis is a relative contraindication

sincethisconditionmaylimitthedegreeofobtainable

correction,theamountofmechanicalfixation,and/orthe

qualityofthebonegraft);anycasenotneedingabonegraft

andfusionorwherefracturehealingisnotrequired;anycase

requiringthemixingofmetalsfromdifferentcomponents;

anypatienthavinginadequatetissuecoverageoverthe

operativesiteorwherethereisinadequatebonestock,bone

quality,oranatomicaldefinition;anycasenotdescribedin

theindications;anypatientunwillingtocooperatewiththe

postoperativeinstructions;anytimeimplantutilization

wouldinterferewithanatomicalstructuresorexpected

physiologicalperformance.

11

Warnings

Thesurgeonshouldbeawareofthefollowing:

1. Thecorrectselectionoftheimplantisextremely

important.Thepotentialforsuccessisincreasedby

theselectionofthepropersize,shapeanddesignof

theimplant.Thesizeandshapeofthehumanspine

presentslimitingrestrictionsofthesizeandstrengthof

implants.Noimplantcanbeexpectedtowithstandthe

unsupportedstressesoffullweightbearing.

2. Thesurgeonmustensurethatallnecessaryimplants

andinstrumentsareonhandpriortosurgery.Thedevice

mustbehandledandstoredcarefully,protectedfrom

damage,includingfromcorrosiveenvironments.They

shouldbecarefullyunpackedandinspectedfordamage

prior to use.

3. Allinstrumentsmustbecleanedandsterilizedprior

tosurgery.

4. Aswithallorthopaedicimplants,theESL®SpinalSystem

shouldneverbereusedunderanycircumstances.

5. Properimplantselectionandpatientcomplianceto

postoperativeprecautionswillgreatlyaffectsurgical

outcomes.Patientswhosmokehavebeenshowntohave

anincreasedincidenceofnonunion.Therefore,these

patientsshouldbeadvisedofthisfactandwarnedofthe

potentialconsequences.

6. Postoperativecareisimportant.Thepatientshouldbe

instructedinthelimitationsofhis/herimplantandshould

becautionedregardingweightbearingandbodystress

ontheappliancepriortosecurebonehealing.

7. TheESL®SpinalSystemhasnotbeenevaluatedfor

safetyandcompatibilityintheMRenvironment.The

ESL®SpinalSystemhasnotbeentestedforheatingor

migrationintheMRenvironment

Precautions

Preoperative:Onlypatientsthatmeetthecriteriadescribed

in the indications should be selected. Patient conditions

and/orpre-dispositionssuchasthoseaddressedinthe

Contraindications Section should be avoided. Care should be

usedinthehandlingandstorageoftheimplantcomponents.

Theimplantsshouldnotbescratchedorotherwisedamaged.

Implantsandinstrumentsshouldbeprotectedduringstorage

especiallyfromcorrosiveenvironments.Allinstruments

should be cleaned and sterilized before use.

Intraoperative:Anyinstructionmanualsshouldbecarefully

followed.Atalltimes,extremecautionshouldbeused

aroundthespinalcordandnerveroots.Damagetonerves

mayoccurresultinginalossofneurologicalfunctions.

Postoperative:Thephysician’spostoperativedirections

andwarningstothepatientandthecorrespondingpatient

complianceareextremelyimportant.

Detailedinstructionsontheuseandlimitationsofthedevice

shouldbegiventothepatient.Ifpartialweight-bearingis

recommendedorrequiredpriortofirmbonyunion,the

patientmustbewarnedthatbending,looseningorbreakage

ofthecomponentsarecomplicationswhichcanoccuras

aresultofexcessiveorearlyweight-bearingorexcessive

muscularactivity.Theriskofbending,loosening,or

breakageofaninternalfixationdeviceduringpostoperative

rehabilitationmaybeincreasedifthepatientisactive,orif

thepatientisdebilitated,demented,orotherwiseunableto

usecrutchesorothersuchweightsupportingdevices.The

patientshouldbewarnedtoavoidfallsorsuddenjoltsin

spinal position.

12

Indications for Use (Continued)

Toallowmaximumchancesforasuccessfulsurgicalresult,

thepatientordeviceshouldnotbeexposedtomechanical

vibrationsthatmayloosenthedeviceconstruct.Thepatient

shouldbewarnedofthispossibilityandinstructedtolimit

andrestrictphysicalactivities,especiallylifting,twisting

motionsandanytypeofsportparticipation.Thepatient

shouldbeadvisednottosmokeorconsumealcoholduring

thebonegrafthealingprocess.

Ifanonuniondevelopsorifthecomponentsloosen,

bend,and/orbreak,thedevice(s)shouldberevisedand/

orremovedimmediatelybeforeseriousinjuryoccurs.

Failuretoimmobilizeadelayedornonunionofbonewill

resultinexcessiveandrepeatedstressesontheimplant.

Bythemechanismoffatiguethesestressescancause

eventualbending,loosening,orbreakageofthedevice(s).

Itisimportantthatimmobilizationofthespinalsurgical

sitebemaintaineduntilfirmbonyunionisestablishedand

confirmedbyradiographicexamination.Thepatientmustbe

adequatelywarnedofthesehazardsandcloselysupervised

toensurecooperationuntilbonyunionisconfirmed.

Donotreuseimplants.Whileanimplantmayappear

undamaged,previousstressmayhavecreatedimperfections

thatwouldreducetheservicelifeoftheimplant.Donot

treatpatientswithimplants/devicesthathavebeeneven

momentarilyplacedinorusedonadifferentpatient.

Potential Adverse Effects and Complications

Possibleadverseeffectsinclude,butarenotlimited

to,bending,looseningorfractureoftheimplantsor

instruments;lossoffixation;sensitivitytoametallicforeign

body,includingpossibletumorformation;skinormuscle

sensitivityinpatientswithinadequatetissuecoverageover

theoperativesite,whichmayresultinskinbreakdownand/or

woundcomplications;nonunionordelayedunion;infection;

nerveorvasculardamageduetosurgicaltrauma,including

lossofneurologicalfunction,duraltears,radiculopathy,

paralysisandcerebralspinalfluidleakage;gastrointestinal,

urologicaland/orreproductivesystemcompromise,

includingsterility,impotencyand/orlossofconsortium;

painordiscomfort;bonelossduetoresorptionorstress

shielding,orbonefractureat,aboveorbelowthelevelor

surgery(fractureofthevertebra);hemorrhageofblood

vesselsand/orhematomas;malalignmentofanatomical

structures,includinglossofproperspinalcurvature,

correction,reductionand/orheight;bursitis;bonegraft

donorsitepain;inabilitytoresumeactivitiesofnormaldaily

living;reoperationordeath.

Sterilization

TheESL®PEEKimplantisprovidedsterile.Theproductis

gammaradiationsterilized.Thepackageshouldbeinspected

prior to use to ensure the sterile barrier has not been

compromised.Donotresterilize.

Caution

Federal(USA)lawrestrictsthesedevicestosalebyoronthe

order of a licensed physician.

13

PEEK-OPTIMA® Implant Loaner Tray Short

(Catalog No. 80982)

Catalog # Implant

60208 8mmShortSpacer







PEEK-OPTIMA® Implant Loaner Tray Medium and Long

(Catalog No. 5500181)

Catalog # Implant

60468 8mmMediumSpacer







60478 8mmLongSpacer

60479 9mmLongSpacer

60480 10mmLongSpacer





*Productshighlightedareavailableasspecialorder.

Loaner Instrument Tray

(Catalog No. 80980)

Catalog # Instruments

60260 Inserter Inner Shaft

60261 InserterOuterSleeve

60287 T-Handle

60288 8mmTrialSpreader








60338 8mmBoneRasp

60277 7mmEllipticalPaddleScraper








60215 BoneMold

60207 Mallet

Product Information

14

Further Information

Thisbrochuredescribesthesurgicaltechniqueusedby

PaulS.Lin,M.D.Thesurgeonwhoperformsanyimplant

procedureisresponsiblefordeterminingtheappropriate

product(s)andutilizingtheappropriatetechnique(s)forsaid

implantationineachindividualpatient.Thecontentsofthis

brochureareintendedtobeonlyaguideandarenot

intended to set a standard of care.

Forfurtherinformation,pleasecontacttheCustomerService

Departmentat:

BiometSpine

100InterpaceParkway

Parsippany,NJ07054

973.299.9300•800.526.2579

www.biometspine.com

15

Notes:

16

Notes:


AtBiomet,engineeringexcellenceisourheritageand

ourpassion.Forover25years,throughvarious

divisionsworldwide,wehaveappliedthemost

advancedengineeringandmanufacturingtechnology

tothedevelopmentofhighlydurablesystemsfora

widevarietyofsurgicalapplications.

Tolearnmoreaboutthisproduct,

contactyourlocalBiometSalesRepresentativetoday.

100InterpaceParkway•Parsippany,NJ07054800.526.2579•www.biometspine.com•BSP228009L08/10

©2010EBI,LLC.AlltrademarksarethepropertyofBiomet,Inc.oroneofitssubsidiariesunlessotherwiseindicated.PEEK-OPTIMA®isaregisteredtrademarkofInvibio®Limited.U.S.PatentNo.6,325,827RxOnly.

ESL® Elliptical Shaped Lumbar Spine System Elliptical Shape Creates a Natural Fit

Documents

ESL® Elliptical Shaped Lumbar Spine System Surgical Technique · ESL® Spinal System is also indicated for treating fractures of the thoracic and lumbar spine. The ESL® Spinal System