Complete set of sizes for open, mis and deformity procedures Self-tapping screw for insertion even without tapping Great mechanical properties Double thread for improved sealing Sophisticated yet compact instrumentation Cannulated screw for injection of cement or bone substitute Sterile packaging Stabilization system thoracolumbar vertebral Misano is the first stabilization system thoracolumbosacral, totally made of titanium, which allows the use of a single pedicle screw for the treatment of all degenerative, traumatic, and deformity pathologies. The self-tapping screw can be inserted without...

Appropriately used, the Misano thoracolumbar-sacral stabilization system from Clover Orthopedics is indicated to promote the development of solid thoracic, lumbar and sacral arthrodesis. It is recommended in cases of spinal deformity, degenerative disc disease, traumatic vertebral fractures, vertebral tumors, spinal stenosis, spondylolisthesis, pseudoarthrosis, and previous unsuccessful attempts at vertebral arthrodesis. Any surgical decisions other than those recommended by the manufacturer are at the discretion and responsibility of the surgeon. Do not use 4.5 mm diameter screws in the lumbar...

<• CLOVER INSTRUMENTS Clover has invested heavily in instrument design and care with the goal of creating ergonomic, functional, and compact instrumentation.Designed for the surgeon and his team. CASE 1|TRAY 1 ^3 NARROW GEAR SHIFT PROBE CURVED MSN-B1SS00000S NARROW GEAR SHIFT PROBE STRAIGHT MSN-B0SS00000S ^5 GEAR SHIFT PROBE STRAIGHT MSN-B0SS00001S ^6 GEAR SHIFT PROBE CURVED MSN-B1SS00001S RATCHETING T-HANDLE KIRCHNER WIRES

<• CLOVER INSTRUMENTS CASE 1 | TRAY 2 @©©@e© ©e POLYAXIAL SCREWDRIVER POLYAXIAL CANNULATED SCREWDRIVER ^22 FREEHAND POLYAXIAL SCREWDRIVER MSN-I1SS28520S TULIP ALIGNMENT ^4 CEMENT NEEDLE ADAPTER MSN-K0SS00200S ^5 COUNTER TORQUE HANDLE MSN-Q0SS00000S ^6 LOSCKSCREW GUIDE TOWER MSN-Q0SS00002S

INSTRUMENTS CASE 2 | TRAY 1

NARROW GEAR SHIFT PROBE CURVED NARROW GEAR SHIFT PROPED STRAIGHT GEAR SHIFT PROBE CURVED GEAR SHIFT PROBE STRAIGHT RATCHETING HANDLE

POLYAXIAL SCREWDRIVER POLYAXIAL CANNULATED SCREWDRIVER FREEHAND POLYAXIAL SCREWDRIVER

TULIP ALIGNMENT KIRCHNER WIRES COUNTER-TORQUE HANDLE LOCKSCREW GUIDE DEROTATION TOWER HEAXGONAL WRENCH

ROCKER FORCEPS CEMENT NEEDLE ADAPTER PARALLEL DISTRACTOR PARALLEL COMPRESSOR

OPEN SURGICAL TECHNIQUE 1— Preparation of the pedicle screw After determining the entry point proceed via thoracic or lumbar awl through the pedicle. Subsequently, open the pedicle canal with the curved or straight gear shift. Use the straight or curved sounding to assess the integrity of the pedicle walls. Although Misano pedicle screws are self-tapping, taps can be used to prepare the screw housing. Tapping undersized by one size relative to the selected screw size is recommended. The taps - available in diameters 4.5 mm, 5.5 mm, 6.5 mm, 7.5 mm and 8.5 mm - must be assembled to the handle....

OPEN SURGICAL TECHNIQUE 2— Inserting the screw Connect the polyaxial screwdriver to the ratcheting handle: - connect the screwdriver to the screw by inserting its tip inside the tulip until the thread reaches the head of the screw and then turn the screwdriver nut clockwise to make the final tightening; - proceed to implant the screw. Once the desired insertion depth is reached, the screwdriver is disengaged from the screw by turning the screwdriver nut counterclockwise. 3— Adjustment of the screw head If necessary, you can use the freehand screwdriver by placing the tip of the screwdriver directly...

OPEN SURGICAL TECHNIQUE Opt. — Cementing Connect the cement needle adapter by inserting its tip inside the screw, and then turn the guide ring clockwise to make the final tightening. After checking that the two elements are firmly seated together, proceed to introduce the disposable bone filler to cement the screw. Before injecting the cement, make sure that the bone filler has come to rest against the screw stem. 4— Rod preparation Once all screws are in place use the rod template to determine the length of the final bar. If necessary to bend and shape the bars you can use the rod bender. 5—...

OPEN SURGICAL TECHNIQUE 6A — Positioning of the clamping nut — A To ensure proper positioning of the clamping nut on the screw, the lockscrew guide derotation tower can be used. The latter has a slightly larger distal end that is positioned over the head of the screw. At the same time, by exerting downward pressure, you properly seat the bar inside the screw. You can then proceed to position the clamping nut with the cap holder. If necessary, the rod pusher can be used. 6B — Positioning of the clamping nut — B As an alternative to the rod pusher, the rocker can be used. Grasp the waist head with...

OPEN SURGICAL TECHNIQUE 6C — Positioning of the clamping nut — C Alternatively, it is possible to use the axial persuader with folding handle, which allows, with greater force, the bar to be brought closer to the head of the screw and the tightening nut then positioned. With the handles fully open, engage the persuader to the tulip of the screw. By then tightening the handles, the mechanism lowers the bar until it is inserted into the head of the screw. Next, introduce the clamping nut inside the persuader using the long clamping cap holder. Then release the persuader from the screw tulip by...

OPEN SURGICAL TECHNIQUE 8— Compression and Distraction Once the bar has been fully inserted into all polyaxial screw heads and the clamping nuts are in place, distraction or compression can be performed using the distractor or compressor. 9— Final tightening Proceed to the final tightening of the system. Final tightening is carried out using the countertorque system, consisting of the countertorque handle connected to the lockscrew guide derotation tower, and the cap screwdriver previously assembled to the 9Nm dynamometric T-handle