ROI-C

ANTERIOR CERVICAL CAGE

SURGICAL TECHNIQUE
TM

SURGICAL TECHNIQUE

ROI-C
Table of Contents
Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 Step 9

TM

page

- Disc location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 - Discectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 - Freshening the vertebral endplates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 - Trial implant selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 - Cage selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 - Cage preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 - Loading the cage on the implant holder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 - Cage positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 - Anchoring plates positioning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Step 10 - Implant holder removal and final control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Discectomy and endplates preparation

Step

Disc location
The approach to the intersomatic space is realised after locating the affected level under fluoroscopy. The surgical protocol and the technique used for the exposure of the intersomatic space are the same as for the standard anterior approach for cervical vertebral surgery.

Step

Discectomy
Place the Caspar pins 8mm from the superior and inferior endplates of the treated level in order to not impede insertion of the implant. Place the distractor on the pins. Distract the intersomatic space, then start disc resection with a thin, long scalpel and disc forceps. Continue the discectomy to the back of the endplates.
8 mm

8 mm

Remark: It is not necessary to remove all the annular disc tissue laterally. It is sufficient to remove only the amount corresponding to the cage (between the uncus); maintaining the lateral annular layers optimizes cage stability and facilitates arthrodesis.

0459

2-3

SURGICAL TECHNIQUE

ROI-C

TM

Step

Freshening the vertebral endplates

Prepare the implant space and the grafting surfaces with a curette and a rasp. Thorough freshening of the endplates favours the fusion.

Trial implant selection

Step

Trial implant selection

The trial implants vary in: depth x width and height. They are identifiable due to a colour code: each colour representing a size (depth x width)
12x15,5mm 14x14mm 12x14mm

14x15,5mm

14x17mm

Step

4a

Depth selection (12 or 14 mm)

Insert the chosen trial implant into the intervertebral space. Check under fluoroscopy correct positioning of the trial implant in depth and rotation. Important: The posterior side of the trial implant has to be at a minimum of 1mm from the posterior edge of the vertebra. If not the case, choose a trial implant of inferior depth.
1 mm

Remark: The trial implant hole must be visible, assuring the lack of rotation.

Step

4b

Width selection
After depth measurement, insert the chosen trial implant into the intervertebral space. Choose the trial implant that offers the best coverage of the vertebral endplate.

Remark: The trial implant has to be as large as possible, while staying stable on the vertebral endplate.

4-5

SURGICAL TECHNIQUE

ROI-C

TM

Step

4c

Height selection (from 4,5mm)

Insert the trial implant of the colour corresponding to the previously chosen size (depth x width) into the intervertebral space. Release briefly the distraction in order to make sure the trial implant is stable in the intervertebral space. Check under fluoroscopy the consistency between the height of the selected trial implant and the discal height of the adjacent levels. Restore the distraction in order to remove the trial implant from the intervertebral space.

Trial implant selection

Step

Cage selection
The colour code and the trial implant height determine the choice of the final implant. The information is located on the side of the implant boxes.
Sterilisation

Height

Colour code

Size
(depth x width)

Step

Cage preparation
The fusion chamber of the cages has to be filled with autograft or bone substitute. Option A Autograft Compact the graft in the fusion chamber of the ROI-C cage with the graft compactor.

Option B Bone substitute The BF+ bone substitute has an anatomical shape and is perfectly adapted to the cage dimensions.

Graft compactor

Insert the superior part (dome-shaped)of the bone substitute through the inferior opening of the cage.

Place the bevelled sides of the bone substitute (dome on top) in front of the cage slots to free the way for the anchoring plate.

6-7

SURGICAL TECHNIQUE

ROI-C

TM

Step

Loading the cage on the implant holder

Bring the cage close to the implant holder in such a way as to slot the implant holder hook in the notch on the left side of the cage.

Hook

Secure the cage on the implant holder with the threaded axis by screwing the impaction knob.
Threaded axis

Impaction knob

Step

Cage positioning
Set the adjustable stop to zero by screwing or unscrewing the impaction knob. Remark: It is up to the surgeon to select the standard stop or the enlarged one.

Standard stop or

Enlarged stop

Knurled wheel

Important: During cage positioning, make sure the cage is perfectly inserted in the axis of the intersomatic space.
OK

Insert the cage in the intervertebral space under fluoroscopy in order to verify correct positioning. Remark: From the lateral view, the marker shows the posterior position of the cage. The implant holders adjustable stop comes into contact with the anterior wall of the superior vertebra space. Antero-posterior positioning can be adjusted millimetre by millimetre with the knurled wheel.

Important: Each scale marked on the adjustable stop enables millimetric advancement of the cage towards the vertebral bodys posterior wall.

Once the antero-posterior positioning has been adjusted, release distraction and compress the segment.

8-9

SURGICAL TECHNIQUE

ROI-C

TM

Anchoring plate positioning

Step

9a

Insertion of the first half anchoring plate

Important: If the pins have not been properly placed during the discectomy, they can impede anchoring plate insertion. In this case, remove the distractor and the Caspar pins. When cage position is optimal and the segment put in compression, the anchoring plate (composed of two half anchoring plates) can be inserted. Impaction of the half anchoring plates is done one after another (in the inferior vertebra, then in the superior one). The first half anchoring plate is inserted in the superior slot of the cage holder with the ROI-C anchoring plate holder (in the axis of the cage holder with a minimum of obstruction). Important: During half anchoring plate insertion, make sure to push the plate all the way to the bottom of the implant holder head with the ROI-C anchoring plate holder. Impact the half anchoring plate using the ROI-C impactor (marked 1) until it reaches its mechanical stop.

ROI-C Anchoring plate holder

1st stage: Roi-C impactor (marked 1)

Mechanical stop

Complete the impaction using the ROI-C final impactor (marked 2).

2nd stage: ROI-C final impactor (marked 2)

Mechanical stop

Remark: Make sure the impactions are done in the axis of the intervertebral space.

Note: Use fluoroscopy during each step in order to verify correct positioning of the half anchoring plate.

10-11

SURGICAL TECHNIQUE

ROI-C

TM

Step

9b

Insertion of the second half anchoring plate

The second half anchoring plate is inserted and impacted following the same method used for the first one, making sure the second half anchoring plate is inserted in the opposite slot from the first one.

Reminder: The half anchoring plate inserted in the implant holders inferior guide penetrates into the superior vertebral body and inversely.

1st stage: Roi-C impactor (marked 1)

Note: Use fluoroscopy during each step in order to verify correct positioning of the half anchoring plate.

2nd stage: ROI-C final impactor (marked 2)

Implant holder removal and final control

Step

10a

Implant holder removal

Unscrew the impaction knob to release the cage from the threaded axis of the implant holder. Disengage the implant holder hook from the cage notch by moving the implant holder to the left. Carefully remove the implant holder in the axis of the intervertebral space. Remove the distractor and the Caspar pins.
Impaction knob

Step

10b

Final control
A control under fluoroscopy, from the front and lateral view, of anchoring plate position enables to ensure optimal trajectory. Final control

12-13

France Technople de lAube BP 2 10902 Troyes Cedex 9 France +33 (0)3 25 82 32 63 www.ldrmedical.com

China Beijing Global Trade Center #36 North Third Ring Road East, Unit 06, Level 19, Building A, Dongcheng District, Beijing, China, 100013 +86 10 58256655

Brazil Av. Pereira Barreto, 1395 Torre sul - CJ 193 - Bairro Paraiso Santo Andr - So Paulo CEP: 09190-610 Brazil +55 11 43327755

United States 4030 West Braker Lane, Suite 360 Austin, Texas 78759 512.344.3333

LDR, LDR Spine, LDR Mdical, BF+, BF+(ph), Easyspine, Laminotome, MC+, Mobi, Mobi-C, Mobi-L, Mobidisc, ROI, ROI-A, ROI-MC+, ROI-T, ROI-C and verteBRIDGE are trademarks or registered trademarks of LDR Holding Corporation or its affiliates in France, the United States or other countries.

Ref: IR-C ST 1 EN 04.2010 A