CD HORIZON SOLERA 5.5/6 - OrthOracle

1 INTEGRATED SPINE SOLUTIONSTHERAPIESSERVICES & SUPPORTENABLING TECHNOLOGIESSPINAL SYSTEMS urgical TechniqueCAPSTONE PEEK Spinal System, CLYDESDALE Spinal System, CRESCENT Spinal System PEEK, CRESCENT Spinal System Titanium, and SOVEREIGN Spinal System incorporate technology developed by Gary K. Michelson, HORIZON SOLERA Performance. the thoracic spine to the ilium, the CD HORIZON SOLERA Spinal System facilitates surgeon choice and flexibility across patient types with a variety of implant options for treating multiple spinal pathologies with one system family. The CD HORIZON SOLERA Spinal System is detailed in another technique UC201105109EE. The CD HORIZON SOLERA Spinal System offers the opportunity to reduce overall metal mass and profile, and provide surgeon choice without compromising implant integrity, as seen in mechanical testing when compared to the CD HORIZON LEGACY System1.

2 Mechanical testing is not indicative of human clinical outcomes. The technology platform offered with this system is backed by more than 30 years and 600,000 cases of CD HORIZON clinical experience and Medtronic expertise2. The CD HORIZON SOLERA Spinal Systems is also compatible various enabling technologies that are complementary the therapy associated with these spinal implants include loosening, disassembly, bending and/or breakage of Based on mechanical testing of the CHROMALOY and CHROMALOY Plus rod construct per ASTM Based on internal sales TechniqueTable of ContentsINTEGRATED Spine Solutions 1 Implant Features 4 Instrument Set 6 Pedicle Screw Surgical Technique Thoracic Facetectomy and Starting Points 16 Screw Starting Points 17 Pedicle Preparation 18 Enabling Technologies 20 VERIFYI Implant Tracking System 21 Screw Placement 22 Interbody or VBR Options 25 Rod Selection 26 Rod Contouring and Placement 26 Provisional Driver Assembly 27 Rod Reduction 28 Apical Derotation 33 compression Distraction 36 Iliac Fixation 38 Final Tightening 39 Bone Graft and Anti-Adhesion Options 40 X10 CROSSLINK Plate Placement 41 Final Tightening of the Plate 43

3 Postoperative Care and Mobilization 44 Hook Surgical Technique Hook Implant 46 Surgical Strategy 47 Hook Site Preparation, Options, and Insertion 48 Decortication 50 Rod Contouring 50 Rod Insertion 51 Deformity Correction 51 compression and Distraction 52 Stabilization and Holding Rod Placement 52 Final Tightening 53 CD HORIZON X10 CROSSLINK 53 Plate Placement and ClosureSuggestions to Explant the 54 CD HORIZON SOLERA Spinal SystemProduct Ordering Information 56 Important Product Information 63 SPINAL SYSTEMCD HORIZON SOLERA Technique | CD HORIZON SOLERA Spinal System4 Implant FeaturesMULTI-AXIAL SCREW (MAS) screw features a 10% reduction in overall volume than CD HORIZON LEGACY MAS and is compatible with a rod or a rod diameter OSTEOGRIP dual lead threadform Cobalt Chrome tulip is designed to be compatible with CHROMALOY, CHROMALOY Plus, and Titanium Rods, allowing intra-operative flexibility by choosing appropriate rod stiffness and strength of the construct Saddle is color-coded by bone screw diameterSAGITTAL ADJUSTING SCREW (SAS)

4 A fixed pedicle screw that combines the sagittal forgiveness of a poly axial screw and the direct vertebral body control of a mono-axial screw Enables sagittal adjustment of vertebral bodies +/-13 cephalad and caudal Accepts and rod diameters to accommodate construct demand Saddle is color-coded by bone screw diameter OSTEOGRIP dual lead threadformFIXED ANGLE SCREW (FAS) screw features a 10% reduction in overall volume than CD HORIZON LEGACY FAS and is compatible with a rod or a rod diameter OSTEOGRIP dual lead threadform Titanium Head designed to be compatible with CHROMALOY, CHROMALOY Plus, and Titanium Rods, allowing intra-operative flexibility by choosing appropriate rod stiffness and strength of the construct Color-coded by bone screw diameterREDUCTION MULTI-AXIAL SCREW (RMAS)

5 Extended tabs allow for a larger window to capture and slowly reduce the spinal rod and are broken off when rod reduction is complete OSTEOGRIP dual lead threadform Cobalt Chrome tulip is designed to be compatible with CHROMALOY, CHROMALOY Plus, and Titanium Rods, allowing intra-operative flexibility by choosing appropriate rod stiffness and strength of the construct Saddle is Color-coded by bone screw diameterScrew Color-coding Size Technique | CD HORIZON SOLERA Spinal SystemImplant FeaturesBREAK-OFF SET SCREW Features a blunt start thread, reducing the chances of the set screw starting off-axis to the tulip The thread pattern on the set screw and the geometry of the tulip head forces the set screw to start in "one way.

6 " The reverse angle threadform maximizes the surface contact of the set screw threads with the tulip head The G4 reverse angle threadform patented technology also allows for a good tactile feedback and a reduced risk of head splay, hence reducing the chance of cross-threading The break-off patented technology improves security of final tightening by ensuring accurate tightening torqueROD OPTIONS Multiple material types and rod diameters for construct tailoring and intraoperative flexibility Precontoured and Precut CHROMALOY and Commercially Pure Titanium rods Straight CHROMALOY, CHROMALOY Plus, Commercially Pure Titanium, and Titanium Alloy Rods See Product Ordering Information on page 58 for the comprehensive list of rod optionsCD HORIZON X10 CROSSLINK PLATE Compatible with CHROMALOY, CHROMALOY Plus, and Titanium Rods Adjustable or fixed length options Adjustable plate attaches to the rod in the coronal, sagittal, or transverse planes in any orientation X10 Crosslink plate compatible with rods diameter offeringCD HORIZON LEGACYTM HOOKS* Compatible with CHROMALOY, CHROMALOY Plus.

7 And Titanium Rods Anatomic design to mimic the posterior spinal elementsCD HORIZON LEGACYTM ILIAC SPINE SYSTEM* Closed fixed head iliac screws available in 0 , 10 , and 20 angles Closed Multi-Axial Screws (CMAS) provide flexibility to position the screw head Lateral connectors compatible with CHROMALOY, CHROMALOY Plus, and Titanium Rods Lateral connectors allow medial/lateral adjustability which may prevent the need for coronal rod bendingCHROMALOY Pre-bent RodTitanium Alloy Rod*CHROMALOY Plus RodCHROMALOY RodCommercially Pure Titanium RodSurgical Technique | CD HORIZON SOLERA Spinal System6 PEDICLE PREPARATION AND SCREW SIZE SELECTIONSCREW PLACEMENTI nstrument SetsThoracic Probe8350294 Lumbar Probe8350293In-Line Handle Round Awl7480104 Quick Connect Ratcheting HandleG900000 Dual Ended Feeler Probe7480100 Sounding/Feeler Probe, 2mm8572102 Taps8350421 ( )*8350422 ( )8350424 ( )8350426 ( )8350428 ( )*8350430 ( )*8350432 ( )

8 *Quick Connect Ratchet-ing T-HandleG900100 Straight Holt Probe*803-292T-handle Holt Probe*803-290 Multi-Axial Screwdriver*5584109*May be ordered as an extra Angle Screw Lock Sleeve Driver5584334 Lock Sleeve Multi-Axial Screwdriver5584111 Dual Purpose Instrument55843397 Surgical Technique | CD HORIZON SOLERA Spinal System50cm Rod Template5484510 ROD HANDLINGI nstrument SetsRod Introducer/Holder5584312*May be ordered as an extra instrumentRod Inserter7480126 French Bender7480162 Rod Pusher*5584235(Shown with Adjustable Driver Handle)Table Top Rod Cutter*808-52920cm Rod Template5484520 Surgical Technique | CD HORIZON SOLERA Spinal System8 ROD REDUCTIONI nstrument SetsFINAL TIGHTENING/SET SCREWSDual Ended Set Screw Starter5484302 Set Screw Breakoff Driver8350316 Counter Torque5584150 Indicating Driver*5585147 VAdjustable Hex Shaft Provisional Driver5480131V(Shown with Adjustable Driver Handle)*May be ordered as an extra instrumentForceps Rocker7480142 Rocker Pusher*7480141 Beale Rod Reducer, Slots558 413 4 Beale Rod Reducer, Lateral74 8 013 69 Surgical Technique | CD HORIZON SOLERA Spinal SystemSMARTLINKTM EXTENDERS AND DEROTATORS (OPTIONAL)

9 Instrument SetsROD REDUCTION CONTINUED*May be ordered as an extra instrumentLateral Translator*5485904 Translator Driver*5485905 Open Extender5485900 Extender5485901 Guide5485906 , HS5485908 Link* 5485910 Interlink* 5485911 SMARTLINK Extender (Shown Assembled)Surgical Technique | CD HORIZON SOLERA Spinal System10 Distractor Pliers*5584171 Parallel Distractor7480170 Curved Compressor5584165 Hinged Translator5584172 Small Parallel Compressor7480165*May be ordered as an extra instrumentInstrument SetsROD CORRECTIONCOMPRESSION AND DISTRACTIONIn Situ BendersLeft 5584255 Right 5584260 Dual Action Rod Gripper5584006 Rod Rotation Wrench7480285 Coronal BendersLeft 5584265 Right 558427011 Surgical Technique | CD HORIZON SOLERA Spinal SystemInstrument SetsHOOK PLACEMENTHOOK PREPARATIONL aminar Elevator7480220 Pedicle Finder7480225 Transverse Process Elevator7480222 Hook Pusher for Implant Holder7480231 Implant Holder7480211 Implant Holder7480216 Pusher for Dual Purpose7480230

10 Technique | CD HORIZON SOLERA Spinal System12 TLIF Distractor*5584327 Hinged Translator*Left 5584173 Torx 20 Shaft*815-517 Screw Head Positioner Shaft5584003T25 Shaft*815-518 Self-Retaining Driver*7480114*May be ordered as an extra instrumentInstrument SetsREMOVALADDITIONALT27 Obturator7480154T25 Set ScrewObturator*8350322 Ball-ended T25 Bone ScrewRemoval Driver5480004V13 Surgical Technique | CD HORIZON SOLERA Spinal SystemInstrument SetsCD HORIZON X10 CROSSLINK PLATE INSTRUMENT SETC ounter Hex Head Shaft, Removal Driver 81105307/32" Torque-LimitingSet Screwdriver8110535 Plate Benders Bending Irons*8110525In-line Plate Holder8110511 Measuring Card 8110501 Measuring Caliper8110502T-bolt Implant Positioners808-545*May be ordered as an extra instrumentSurgical Technique | CD HORIZON SOLERA Spinal System1415 Pedicle ScrewSurgical TechniqueSurgical Technique | CD HORIZON SOLERA Spinal System16 Important: Do not start medial to the midpoint of the superior Facectomy and Starting PointsClean the facet joints and perform a partial inferior articular process osteotomy to enhance visualization and fusion.