Dohler System: Spalte
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SURGICAL TECHNIQUE FOR ARZZT SPALTE SCREWS

Techniques ARZZT Spalte Screw ► REFERENCE POINT IDENTIFICATION ► PREPARATION FOR SCREW PLACEMENT ► DISTRACTION AND COMPRESSION PROCEDURE

ARZZT Techniques Spalte Screw INTRODUCTION The present guideline is aimed to explain the recommended techniques and applications for using the ARZZT Lumbar Spine SCREW by Orthopedic and Trauma Surgeons for fracture treatment. The recommendations for use are not to be intended to interfere with the surgeon's experience or the specific needs of each patient according to the basic canons in fracture treatment. Spondylolisthesis Fractures Non-treatable Low Back Pain Congenital malformations Progressive malformations Degenerative instabilities Post-surgical instabilities Combination of the...

ARZZT Techniques Spalte Screw IMPLANT DESIGN Poly-axial Screw Titanium 5.5 x 35 mm,40 mm,45 mm,50 mm Poly-axial Screw Titanium 6.5 x 35 mm, 40 mm, 45 mm, 50 mm Poly-axial Screw Titanium 7.5 x 35 mm, 40 mm, 45 mm, 50 mm PATIENT POSITION • Patient position on operating table should allow a chest full support leaving suspend the abdominal cavity, completely pressure-free in order to decrease a venous bleeding and increase the neck safety.

ARZZT Techniques Spalte Screw • The patient position in any long spinal fusion, including sacrum, is very important. For long fusions, a normal sagittal plane on the spine must be essentially maintained and trunk anterior slope lumbar lordosis loss should be prevented. • Patient is positioned in ventral decubitus, with foam pillows under thighs in order to stimulate the hip extension. The spinal shape should be maintained as if the patient is at standing position, maintaining the normal lumbar lordosis. SURGICAL APPROACH The approach to the posterior midline is the most used because it...

ARZZT Techniques Spalte Screw REFERENCE POINT IDENTIFICATION The exemplary point for screw insertion in pedicle is located at the junction of inter-articular area with the transverse apophysis midpoint and the lowest point of superior articular angle. Thoracic reference point – The thoracic reference point is located at the vertical line intersection crossing through middle the convex part of each vertebra with a horizontal line drawn from middle to the upper third of vertebra. This intersection is normally located 2 mm below the articular cartilage end and at the same level of the small...

ARZZT Techniques Spalte Screw Lumbar reference point – The lumbar reference point is located at the intersection of the vertical line crossing through the union space between the angle and the horizontal line crossing through the middle of the vertebra base. These two reference lines are bind at the small cortical bone ridge which is a very reliable reference point because it is not articulated and it is not being affected by osteoarthritic malformations. Sometimes, the articular angles are covered by osteophytes making their identification difficult. Sacral reference point – The sacral...

ARZZT Techniques Spalte Screw PREPARATION FOR SCREW PLACEMENT The osteotomy from spinal apophysis in the vertebra allows a proper linkage of the screw head, positioning it at a vertebra anterior area to decrease the “mechanical stress”. In the previously indicated entry point, an incision to the pedicle is prepared with puncture instrument introducing it approximately 10 mm (instrument needle tip length). The probe is inserted to the incision to indicate the screw orientation and to exploit the internal area of the vertebra and also facilitate the introduction and exploration of the...

ARZZT Techniques Spalte Screw Introducing the probe, the surgeon obtains a perception of the vertebra's depth, passing through its cancellous bone. However, introducing the probe with slope of 10°, it can be seen via radiographic for better status verification inside the vertebra. Likewise, it is advisable to introduce the probe into the sacrum with a slope of 10°. When the probe has been introduced into all pedicles by hand contact, the surgeon may place metal markers on each pedicle in order to obtain a complete radiographic confirmation scan of the position in which the pedicle screws...

ARZZT Techniques Spalte Screw INSERTING SCREWS The chosen pedicle screw is properly positioned in the initial wrench. The screw tip is placed at the pedicle entry point and threated initially with the fingertips. The pedicle screw initial wrench is a quick-hitching type and two different handle types can be used depending on the surgeon's preference. The “T”-shaped sleeve model generates more push force and more caution is recommended when it used. Pedicle screw is a self-centering with self-tapping tip and no direction is needed as it will penetrate the pedicle through the hole previously...

ARZZT Techniques Spalte Screw It is important to note that once the screws were implanted, they should not be removed to correct position since they may loosen in the future. It is therefore necessary that the screws are properly implanted and line them with a regular line and bar can be easily inserted. The mobility of poly-axial screw head allows the bar placement corrosion during surgical procedure. When poly-axial heads of poly-axial screw are fixed at the end of the surgical procedure, they must provide the same strength as mono-axial screws.

ARZZT Techniques Spalte Screw BAR PLACEMENT Due to the large amount of existing bar lengths, the more proper length can be chosen for surgical needs. The bar is malleable and it can be curved following the pedicle screw placement in order to provide the proper form to the desired spinal outline. LORDOTIC: Lumbar Spine KYPHOTIC: Spine or Chest. To achieve the desired outline, the bar folding should be gradually made to ensure a better effort distribution. This is achieved by a bar folding machine and thanks to its double-curve radio.

ARZZT Techniques Spalte Screw For long reconstructions, it is recommended to set the bar at one end to facilitate the bar placement in remaining pedicle screws. Once the bar is positioned, the blocking screws will be placed with the initial placement wrench which gently allows center and introduce them. DISTRACTION AND COMPRESSION PROCEDURE DISTRACTION: It is subject to the spine curve concavity and increases the intervertebral space eliminating nerve root compression. The distraction clamp is applied between two adjacent vertebrae which are occasionally separated by a third one. The...