SOFAMOR DANEK CD HORIZON LEGACY 5 - MT …

1 CD HORIZON LEGACY System Deformity Surgical TechniqueSOFAMOR DANEKA Masterpiece In Medical Device DesignHook technique described by:Pierre Lascombes, at the NancyUniversity School of MedicineOrthopaedic Pediatric Surgery Chief, Pediatric Surgery Service Children s Hospital, CHU ofNancy, FranceScrew technique described by:Lawrence G. Lenke, Jerome J. Gilden Professorof Orthopaedic Surgery Co-chief Adult/Pediatric SpineWashington UniversitySchool of MedicineChief, Spinal ServiceShriners Hospital for ChildrenSt. Louis, MissouriPage 1CD HORIZON LEGACY System DeformityTable of ContentsIntroduction .. 2 Implants .. 3 Instruments .. 5 Hook Surgical TechniqueSurgical Strategy .. 11 Hook Site Preparation/Options/Insertion .. 12 Hook Site Preparation/Options/Placement .. 13 Decortication.

2 16 Rod Contouring .. 17 Rod Insertion .. 18 Rod Reduction .. 19 Deformity Correction .. 23 Compression/Distraction .. 25 Stabilization/Holding Rod Placement .. 26 Final Tightening .. 27 Transverse Link Placement/Closure .. 28 Pedicle Screw Surgical TechniquePedicle Screw Correction Technique Introduction .. 29 Thoracic Facetectomy/Starting Points .. 30 Thoracic Pedicle Screw Starting Points (Perforated for Tear Out) .. 31 Pedicle Preparation .. 32 Screw Placement .. 35 Rod Contouring/Placement .. 36 Rod Reduction .. 37 Deformity Correction .. 39 Final Tightening/Decortication/X10 CROSSLINK Plate Placement .. 41 Case Presentation .. 42 Product Ordering Information .. 43 Important Product Information .. 46 Page 2CD HORIZON LEGACY System DeformityDear Colleagues:The CD HORIZON LEGACY Spinal System is the next generation in top-loading, top-tightening systems that support a spine surgeon s quest for optimal deformitycorrection.

3 Since the introduction of the original CD instrumentation, surgeon-driventechnologic advances have been partner to superior correction requires a comprehensive selection of implants and well-designed instruments. The CD HORIZON LEGACY Spinal System has a widechoice of implants that support posterior corrective from our CD heritage, CD HORIZON LEGACY Spinal System hookscome in sizes and blade geometries to optimize fit to each patient s CD HORIZON LEGACY Spinal System allows for different philosophies of rodreduction, from patented, state-of-the-art rod reducers to reduction implants, multiaxial screws, and CD HORIZON LEGACY Spinal System is a complete and comprehensiveuniversal system that offers significant performance and ease of use benefits andbrings innovation, versatility, and reliability to every surgical ,Lawrence G.

4 Lenke, Lascombes, 3CD HORIZON LEGACY System DeformityImplantsAxial Connector(84509HT)Domino Connector(84505HT) Rod(869-021)G4 Technologyis the fourth generation closure technology for CD HORIZON instrumentation. The set screw has been designed to thread easier and hold reverse-angle thread locking mechanism reverses the force vectors a set screwnormally exerts on the side walls of implants during final Technology maintainsstrength and decreases profileProvides optimal patient matchingwith seven screw diameters12% smaller implant footprintColor-Coding ReferenceNOTE: Color-coding available for titanium implants the ease of top-loading set screw introduction,yet eliminates difficulties ofcross-threadingTitanium screws are color-coded by screw Angle Screw( )Set screws are available inbreak-off and non break-off Page 4CD HORIZON LEGACY System DeformityHook Implants Bifid blade grasps thoracicpedicle for increased stability.

5 Lipped design can improvehook stability. Wider blade width distributesforces evenly over a wideraspect of bone. Lipped design can improvehook stability on the lamina. Narrower blade widthminimizes metal volume inthe spinal canal. Lipped design can improvestability on the lamina. Hook throat ramp preventsblade from pistoning into thespinal canal. Better aligns hook saddles fora pediculo-laminar claw inthe upper thoracic spine. Blade geometry designed tobetter fit the lumbar lamina. May obviate the need toremove the ligamentum. Can correct anatomicmisalignment between twolaminae in the dorso-ventralplane. Can be used to medialize orlateralize the rod insupralaminar or infralaminarposition. Can back up a pedicle screwat the same TYPEVERTEBRAL POSTERIORBLADEREGIONDESIGN FEATURESELEMENT PLACEMENTDIRECTIONOF SPINEPEDICLE HOOKARTICULAR PROCESST1 - T10 WIDE BLADE HOOKLAMINAT1 - L5 TRANSVERSE PROCESST1 - L5 NARROW BLADELAMINAT1 - L5 HOOKTRANSVERSE PROCESST1 - L5 THORACICLAMINAT1 - T10 SUPRALAMINAR HOOKTRANSVERSE PROCESSTHORACICLAMINAT1 - T3 ANGLED HOOKTRANSVERSE PROCESSLUMBARLAMINAT10 - L2 INFRALAMINAR HOOKTRANSVERSE PROCESSEXTENDED BODYLAMINAT1 - L5 HOOKTRANSVERSE PROCESST1 - L5 OFFSET HOOKLAMINAT1 - L5 TRANSVERSE PROCESST1 - L5 Page 5CD HORIZON LEGACY System DeformityInstrumentsHook PreparationWide Blade Laminar Elevator(7480220)Pedicle Elevator(7480225)Transverse Process Elevator(7480222)Hook PlacementHook Pusher for Implant Holder(7480231)

6 Implant Pusher for Dual Purpose Instrument(7480230)Dual Purpose Instrument(7480205)Lateral Implant Holder(7480211)Straight Implant Holder(7480216)Narrow Blade Laminar Elevator(7480221)Page 6CD HORIZON LEGACY System DeformityScrew PreparationThoracic Ball Handle Probe(7480112)Lumbar Ball Handle Probe(7480110)In-Line Round Awl(7480104)Quick Connect Ratcheting Handle(9339082) Tap (8684000) Tap (8684500) Tap (836-015) Tap (836-016) Tap (836-017)Dual Ended Feeler Probe(7480100)Sounding/Feeler Probe(8572102)Screw PlacementFixed Angle Screwdriver(7480280)Multi Axial Screwdriver(7480113)Self-Retaining Screwdriver(7480117)InstrumentsPage 7CD HORIZON LEGACY System DeformityInstrumentsRod ContouringRod Template(808-575)French Bender(7480162)Rod InsertionC-Shaped Rod Pusher(7480236)Rod Pusher(7480235)Rod Inserter(7480126)Page 8CD HORIZON LEGACY System DeformityRod ReductionBeale Rod Reducer(7480134)CorrectionInstrumentsFor ceps Rocker(7480142)Lateral Translator(7480240)(7480245)Coronal BendersLeft (7480265)Right (7480270)In-Situ BendersLeft (7480255)Right (7480260)Rod Gripper(7480175)Page 9CD HORIZON LEGACY System DeformityCompression and DistractionParallel Compressor, Small(7480165)InstrumentsParallel Compressor, Large(7480166)Distractor(7480171)Provisi onal Driver(7480131)Self-Retaining Break-Off Driver(7480144)Counter Torque(7480150)Final Tightening/Set ScrewsDual Ended Plug Starter(7480122)T27 Obturator(7480154)Page 10CD HORIZON LEGACY System DeformityInstrumentsCounter Torque(8110540) Hex Head Shaft, Removal Driver (8110530)

7 7/32" Torque-Limiting Set Screwdriver(8110535)Forceps Plate Holder(8110510) (optional)Plate Benders(8110525)45 In Line Plate Holder(8110511)Measuring Credit Card(8110501)Measuring Caliper(8110502)X10 CROSSLINK Plate Implants and InstrumentsX10 CROSSLINK Multi-Span PlateX10 CROSSLINK Fixed PlateImplant Positioners(808-545) (optional)STEPPage 11CD HORIZON LEGACY System DeformitySurgical StrategyPreoperatively, any spinal surgery should be studied and a scheme of theconstruct below are examples of some typical hook constructs for a T4-L1 adolescentidiopathic scoliosis and a T2-S1 neuromuscular scoliosis. These schemes, which arestrictly for illustrative purposes, are examples of how to treat these types of 1shows a standard right thoracic curve (Lenke Type 1AN/King Type III)instrumented with hooks from T4 to L1.

8 This case can also be treated using a hybridconstruct consisting of hooks and pedicle screws (Figure 2). Figure 3shows aconstruct treating neuromuscular scoliosis from T2 to 1 Figure 2 Figure 3 Hook Construct LegendEBH= Extended Body HookLIH= Lumbar Infralaminar HookNBH= Narrow Blade HookOH= Offset HookPH= Pedicle HookPS= Pedicle ScrewTAH= Thoracic Angled HookTSH= Thoracic SupralaminarHookWBH= Wide Blade Hook= Up-Going HookPHPHWBHWBHPHPHTSHNBHWBHEBHLIHTSHWBHP SPSOHOHSACRALPLATESPEDICLESCREWSPHPHTAHP HPHNBHTAHTSHTSHSTEP2 Page 12CD HORIZON LEGACY System DeformityHook Site Preparation/Options/InsertionThe CD HORIZON LEGACY Spinal System offers a number of top-loadinghooks of different anatomic shapes and sizes (see hook implants chart, page 4). AnyCD HORIZON LEGACY Spinal System hook may be treated as a closed hookby simply placing the set screw into the hook prior to insertion of the rod.

9 Thesurgeon must choose the appropriate hook based on the individual patient s anatomy,deformity degree and type, method of correction chosen, and amount ofcompression/distraction that will be needed to provide proper and stable purchase ofthe different instruments can be used for hook insertion: for example, the DualPurpose Instrument combined with the Hook Pusher (Figure 4) or the Straight orLateral Hook Holder combined with the captive Hook Pusher (Figure 5).Figure 5 Figure 4 STEP3 Page 13CD HORIZON LEGACY System DeformityCORRECTINCORRECTF igure 7 Figure 6 Pedicle HookThe Pedicle Hook may be used from T1 to T10. The hook blade is always cephalad(up-going) and is in the infralaminar position. The facet capsule is divided, and aportion of the inferior facet process may be removed to facilitate insertion of the hook(Figure 6).

10 Once the pedicle has been clearly identified with the help of the PedicleElevator (Figure 7), the hook may be needed, a mallet can be used to impact the Pedicle Hook. It is important that thePedicle Hook is placed into the joint cavity and is not splitting the inferior articularprocess (Figures 8a and 8b).Hook Site Preparation/Options/PlacementFigure 8bFigure 8aSTEP3 Page 14CD HORIZON LEGACY System DeformityHook Site Preparation/Options/Placement (cont.)Transverse Process HookThis is generally a Wide Blade Hook and is typically used in a pedicle-transverse clawconstruct as a caudal (down-going) hook (Figure 9). The Transverse Process Elevator orthe Laminar Elevator may be used to separate the ligamentous attachment between theundersurface of the transverse process and the posterior arch of the rib medial to therib-transverse joint.