Lumbar Interbody Fusion SystemSurgical Technique

®AnyPlus SystemPeek ALIF Cage

1. Surgical Technique

Step 1. Preparation

Step 2. Size Determination

Step 3. Implant Preparation

Step 4. Cage Insertion

Step 5. Verification

2. Instruments

3. Implants and Trials Sizing

Table of Contents

1. Surgical Technique

Before the final implants are positioned, their size has to be determined with trial implants. The threaded bolt on the impactor shaft is inserted into the threaded hole of the trial implant. It is compulsory that the notches lateral to the threaded bolt are inserted into the gaps beside the threaded hole. It is recommended to start with a small trial implant to avoid over-distraction. The size of the trial implant should progressively increase until it fits firmly between the endplates.

The use of the sliding mallet with the shock-absorbing layer prevents divergence during the implantation maneuver. Extraction of the trial implants can be facilitated by pulling the sliding mallet towards the hexagonal nut.

Step 2. Size Determination

After identification of the segment to be treated, discectomy and removal of disc tissue is performed by using instruments from the AnyPlus PEEK Cage system. (After complete resection of the disc material, progressive distraction of the intervertebral disc space is performed.) Once the desired disc heights are achieved; reamers and anterior curettes can be used to prepare the endplates, thereby carefully preserving subchondral bone to avoid subsidence of the cage.

Step 1. Preparation

Before the cages are introduced into the intervertebral disc space, they should be filled with autograft, allograft, or any other bone substitute. Therefore, the cages are threaded onto the impactor shaft and then fixed to the cage-holder. The Cages can now be packed with bone material. To compress the bone material, the small or large graft tamper can be used.

Step 3. Implant Preparation

The cages are placed in the same manner as the trial cages. To obtain optimal cage positioning, the front edge of the implant should be located approximately 1-2mm from the anterior vertebral border.

Final positioning of the cages is performed by using the final impactor. The bolt on the lower end of the final impactor is inserted into the threaded hole of the cage; additionally, a groove placed 5mm from the bolt gives the surgeon a visual indication of the cage position.

Step 4. Cage Insertion

In optimal position, the cage is located approximately 1-2mm distal from the anterior vertebral border. Exact position can be verified with the radiopaque markers and an image intensifier.

Compression - After optimal cage placement, it is recommended to perform compres-sion over the posterior or anterior stabilization system to make sure that the vertebral endplates lay press fit onto the cage to avoid any implant displacement.

Step 5. Verification

2. Instruments

ALIF Cage Inserter GS134-1851

Slap HammerGS133-3600

Bone ImpactorGS134-1410

Slap HammerAdaptor

GS133-3610

DistractorGS134-2810

Graft HolderGS134-1310

ALIF Cage Inserter, Short

GS134-1853

ALIF Squid Inserter*(special order)

GS137-1830

3. Implants and Trials SizingANYPLUS® ALIF PEEK IMPLANT ALIF PEEK IMPLANT 31mm (W) x 23mm (L) 4° Height Catalog # Trial #10 1103-3410 GS134-073112 1103-3412 GS134-073314 1103-3414 GS134-073516 1103-3416 GS134-073718 1103-3418 GS134-0739 ANYPLUS® ALIF PEEK IMPLANT 31mm (W) x 23mm (L) 8° Height Catalog # Trial #10 1103-3810 GS134-074212 1103-3812 GS134-074414 1103-3814 GS134-074616 1103-3816 GS134-074818 1103-3818 GS134-0750 ANYPLUS® ALIF PEEK IMPLANT 35mm (W) x 27mm (L) 4° Height Catalog # Trial #10 1103-7410 GS134-103112 1103-7412 GS134-103314 1103-7414 GS134-103516 1103-7416 GS134-103718 1103-7418 GS134-1039

ANYPLUS® ALIF PEEK IMPLANT 35mm (W) x 27mm (L) 8° Height Catalog # Trial #10 1103-7810 GS134-104212 1103-7812 GS134-104414 1103-7814 GS134-104616 1103-7816 GS134-104818 1103-7818 GS134-1050

ANYPLUS® ALIF PEEK IMPLANT 35mm (W) x 27mm (L) 11° Height Catalog # Trial #10 1103-7110 GS134-105312 1103-7112 GS134-105514 1103-7114 GS134-105716 1103-7116 GS134-105918 1103-7118 GS134-1061

ANYPLUS38MM (W) X 29MM (L) 4°Height Catalog# Trial#10 1103-9410 GS134-083112 1103-9412 GS134-083314 1103-9414 GS134-083516 1103-9416 GS134-083718 1103-9418 GS134-0839

ANYPLUS® ALIF PEEK IMPLANT 38mm (W) x 29mm (L) 8° Height Catalog # Trial #10 1103-9810 GS134-084212 1103-9812 GS134-084414 1103-9814 GS134-084616 1103-9816 GS134-084818 1103-9818 GS134-0850

ANYPLUS® ALIF PEEK IMPLANT 38mm (W) x 29mm (L) 11° Height Catalog # Trial #10 1103-9110 GS134-085312 1103-9112 GS134-085514 1103-9114 GS134-085716 1103-9116 GS134-085918 1103-9118 GS134-0861 ANYPLUS® ALIF PEEK IMPLANT 42mm (W) x 31mm (L) 4° Height Catalog # Trial #10 1103-1410 GS134-093112 1103-1412 GS134-093314 1103-1414 GS134-093516 1103-1416 GS134-093718 1103-1418 GS134-0939

ANYPLUS® ALIF PEEK IMPLANT 42mm (W) x 31mm (L) 8° Height Catalog # Trial #10 1103-1810 GS134-094212 1103-1812 GS134-094414 1103-1814 GS134-094616 1103-1816 GS134-094818 1103-1818 GS134-0950

ANYPLUS® ALIF PEEK IMPLANT 42mm (W) x 31mm (L) 11° Height Catalog # Trial #10 1103-1110 GS134-095312 1103-1112 GS134-095514 1103-1114 GS134-095716 1103-1116 GS134-095918 1103-1118 GS134-0961

Contact customer service toinquire about additional sizingand other options available forspecial order.

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