acis – anterior cervical interbody spacer.synthes.vo.llnwd.net/o16/llnwmb8/int...

ACIS – ANTERIORCERVICAL INTERBODYSPACER. An enhanced system of implants andinstruments for interbody fusion.

SURGICAL TECHNIQUE

Instruments and implants approved by the AO Foundation.This publication is not intended for distribution in the USA.

Image intensifier control

WarningThis description alone does not provide sufficient background for direct use ofthe instrument set. Instruction by a surgeon experienced in handling theseinstruments is highly recommended.

Reprocessing, Care and Maintenance of Synthes InstrumentsFor general guidelines, function control and dismantling of multi-part instruments,please contact your local sales representative or refer to:www.synthes.com/reprocessing

Table of Contents

Introduction

Surgical Technique

Product Information

Bibliography

ACIS – Anterior Cervical Interbody Spacer 2

AO Principles 4

Indications and Contraindications 5

Preparation 6

Patient Positioning 7

Exposure and Discectomy 8

Segment Distraction 9

Endplate Preparation 10

Implant Size and Shape Determination 11

Implant Insertion 14

Supplemental Fixation 22

Implant Removal 23

Implants 24

Instruments 28

Sets 31

Additionally available 32

Also Available from Synthes: chronOS Putty – Spine 33

Bibliography 35

ACIS – Anterior Cervical Interbody Spacer Technique Guide DePuySynthes 1

The ACIS implant is designed to meet the specific demandsof anterior cervical interbody fusion procedures (1-6). The implant features a large central canal and is available in threefootprints, multiple heights and three sagittal profiles to accommodate various patient anatomies.

ACIS – Anterior Cervical InterbodySpacer. An enhanced system of implantsand instruments for interbody fusion.

Pyramidal teethProvide resistance to implant migration

Large central canalAccommodates autogenous bone graftor bone graft substitute to allow fusionto occur through the implant

Anatomic shapesMultiple implant variations offered to suit individualanatomical conditions

Lateral windows Windows on the lateralwalls of the cage to allowfor fusion

MaterialBiocompatible radiolucentpolymer (PEEK*) allows clearassessment of bony fusion

*Polyetheretherketone

Implant-Instrument interfaceStable interface for fast and effectiveconnection/release with the insertiondevice

Midline markersFacilitate implant positioning/alignmentin multilevel procedures

2 DePuySynthes ACIS – Anterior Cervical Interbody Spacer Technique Guide

Trial Implants– Preassembled trials for improved handling

– Double-sided trials for fastheight comparison

– Color coded by sagittalprofile

Insertion Device– Rigid interface for secureimplant placement

– Slim implant interface foroptimal visibility during insertion

– Multiple shaft options withand without depth stop to accommodate surgeonpreference

Implant Holder– Alternative implant inser-tion option for enhancedprecision control

– Quick implant engage-ment and disengagementwith one click squeeze-lock mechanism

_ Allows for excellent visibility


AO Principles

In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation7 .They are:– Anatomical reduction– Stable fixation– Preservation of blood supply– Early, active mobilizationThe fundamental aims of fracture treatment in the limbs and fusion of the spine are the same. A specific goal in thespine is returning as much function as possible to the injured neural elements7.

AO Principles as applied to the spine8

Anatomic alignmentRestoration of normal spinal alignment to improve the biomechanics of the spine.

Stable internal fixationStabilization of the spinal segment to promote bony fusion.

Preservation of blood supplyCreation of an optimal environment for fusion.

Early, active mobilizationMinimization of damage to the spinal vasculature.


Indications and Contraindications

Intended UseThe Synthes ACIS system is intended to replace cervical intervertebral discs and to fuse adjacent vertebral bodies at vertebral levels C2 – C7 following anterior cervical discectomy for reduction and stabilization of the cervicalspine. The use of autologous bone or bone graft substitute is recommended.

IndicationsCervical pathologies for which segmental arthrodesis is indicated:– Degenerative disc diseases and instabilities– Ruptured and herniated discs– Pseudarthrosis or failed spondylodesis

For multisegmental fusions with the ACIS system supplemen-tal fixation is recommended.

Contraindications– Osteoporosis– Severe instabilities– Vertebral body fractures– Spinal tumors– Infections


1

2

3

4

1Preparation

Required set

01.841.101 ACIS Standard Set in Vario Case

Optional sets

187.797 Cervical Retractors and Distractors

Have all necessary imaging studies readily available to planimplant placement and visualize individual patient anatomy.

Have all necessary sets readily available prior to surgery.

Preparation

2Assemble insertion device

Instrument

03.841.050 ACIS Insertion Device

Assemble the insertion device prior to use according to theassembling instruction shown here or refer to www.synthes.com/reprocessing.


Position the patient in a supine position on a radiolucent operating table. Ensure that the neck of the patient is in asagittally neutral position and supported by a cushion. Whentreating C6 – C7 make sure that the shoulders do not limitthe x-ray monitoring. For all cases, both vertebrae should becompletely visible.

Patient Positioning


1Access

Optional set


Locate the correct operative level under radiographic controland incise.

Expose the intervertebral disc and the adjacent vertebralbodies through a standard anterior approach to the cervicalspine.

Important: Careful positioning of the retractor is required toavoid soft tissue damage.

2Discectomy

Prepare the fusion site following the appropriate techniquefor the given indication.

Exposure and Discectomy


Optional set


Perform segmental distraction.

Note: Distraction of the segment is essential for restoringdisc height and for providing good access to the interverte-bral space.

Segment Distraction


Endplate Preparation

Optional instrument

03.841.150 Endplate Rasp

When the discectomy is complete, remove the superficial car-tilaginous layers of the endplates to expose bleeding bone.

Warning:– Adequate cleaning of the endplates is important for vas-cular supply of the autologous bone graft or bone graftsubstitute. Excessive cleaning, however, may result in removal of bone underlying the cartilaginous layers andweaken the endplates.

– The removal of any osteophytes is crucial for achievingcomplete decompression of the neural structures and foravoiding the risk of partial compression after implant insertion.

Note: The endplate rasp is double sided with a standarddepth on one side and a large depth on the other side. Theseare indicated by one (standard) and two (large) white bandson the shaft as well as etchings on the rear side of the rasp.The depth is limited by a stop. Depths are 14 mm for thestandard and 16 mm for the large. The width is 8 mm andthe height is 4 mm.

depth14 mm: standard16 mm: large

height 4 mm

width 8 mm


Implant Size and ShapeDetermination

Instruments

03.841.005–011 ACIS Trial Implant, standard, lordotic, heights 5–12 mm, double-sided, blue

03.841.105–111 ACIS Trial Implant, standard, parallel, heights 5–12 mm, double-sided, purple

03.841.205–211 ACIS Trial Implant, standard, convex, heights 5–12 mm, double-sided, yellow

03.841.305–311 ACIS Trial Implant, large, lordotic, heights 5–12 mm, double-sided, blue

03.841.405–411 ACIS Trial Implant, large, parallel, heights 5–12 mm, double-sided, purple

03.841.505–511 ACIS Trial Implant, large, convex, heights 5–12 mm, double-sided, yellow

03.841.605–611 ACIS Trial Implant, small, lordotic, heights 5–12 mm, double-sided, blue

03.841.705–711 ACIS Trial Implant, small, parallel, heights 5–12 mm, double-sided, purple

03.841.805–811 ACIS Trial Implant, small, convex, heights 5–12 mm, double-sided, yellow

Optional instrument

03.820.113 Mallet

For a complete overview of trial implants please refer to page 28.


The selection of the trial implant depends on the height,width and depth of the intervertebral space, the preparationtechnique and the patient’s anatomy. Choose a standard,large or small footprint trial implant with convex, lordotic orparallel sagittal shape of the appropriate height.

Notes:– The trial implants are double sided with different heightson either side. Colored bands on the shaft indicate whichside is of lesser (one band) or greater (two bands) height.In addition, heights are etched on the cranial and caudalsurfaces of the trial implants.

– Trial implants are color coded by sagittal shape: yellow,blue and purple bands on the shaft indicate that a trial im-plant is convex, lordotic or parallel. Furthermore, the following etchings on the cranial and caudal surfaces indi-cate the sagittal shape: “C” for convex, “L” for lordotic,and “P” for parallel.

– The footprint is indicated by the etchings “Small”, “Standard” and “Large” on the cranial and caudal surfaces of the trial implants.

Before carefully inserting the trial implant, ensure that theorientation of the trial implant is correct. Each convex trialimplant is etched with an arrow pointing cranially on the lat-eral walls to indicate the correct cranial/caudal alignment.

The lordotic and parallel trial implants do not have a dedi-cated cranial or caudal surface. They can be inserted into theintervertebral disc space with either surface pointing cranially.

Warning: Ensure that all disc material has been removedfrom the insertion path to avoid dislocation into the spinalcanal.

lesser heightgreater height

yellow – convex

blue – lordotic

purple – parallel

lordotic convex parallel

Implant Size and Shape Determination


If necessary, controlled and light hammering with the malletcan be used to help advance the trial implant into the inter-vertebral disc space.

Precautions:– Excessive impaction force during trial implant insertionmust be avoided.

– The trial implants do not have a depth limiter; an imageintensifier should be used to check the position during insertion.

Use image intensifier to confirm the fit of the trial implant. If the trial implant appears too loose or too tight, try the nextlarger or smaller size height until the most secure fit isachieved.

Important:– The height of the trial implants is undersized by 0.5 mmcompared to the implant, to ensure a tight fit for final implant insertion.

– With the segment fully distracted, the trial implant mustfit tightly and accurately between the endplates. To mini-mize potential increased risk to the patient, it is recom-mended to first trial with smaller height trial implants before trialing with taller trial implants.

– Trial implants are not for implantation and must be removed before insertion of the ACIS implant.

The mallet can be used for trial implant removal. While hold-ing the trial implant slide the mallet over the upper part ofthe trial implant’s shaft and apply an upward force. Repeatthis process until the trial implant has been removed.


Option A. Insertion device

1Attach implant to insertion device

Instruments

03.841.050 ACIS Insertion Deviceand03.841.057 Inner Shaft, small, with Stop, for 03.841.050or03.841.059 Inner Shaft, standard/large, without Stop, for 03.841.050or03.841.060 Inner Shaft, standard/large, with Stop, for 03.841.050or03.841.061 Inner Shaft, small, without Stop, for 03.841.050

Optional instruments

03.617.981 Impactor, flat

03.820.113 Mallet

Select the ACIS implant that corresponds to the footprint,shape and height determined using the trial implant.

Refer to page 6 for ACIS insertion device assembly. If desired,the insertion device can be combined with an inner shaftwith stop. It has a depth limiter that will contact the anterioredge of the vertebral body when the ACIS implant is insertedapproximately 1 mm beyond the anterior edge of the verte-bral body.

Attach the implant to the ACIS insertion device by aligningthe recessed grooves located on the side walls of the implantwith the prolonged tabs of the instrument tip and engagingthose. Turn the knob clockwise to secure the implant. Ensurethat the implant is held flush against the insertion device andsecurely in the tabs.

Implant Insertion


2Pack implant with autologous bone graft or bone graftsubstitute


03.841.054 Cancellous Bone Impactor

03.841.055 Packing Block

It is recommended to pack the ACIS implant with autologousbone or bone graft substitute.

Place the ACIS implant into the packing block. Small andstandard footprint implants fit into the cavity marked “Standard” while large footprint implants fit into the cavitymarked “Large”.

The cancellous bone impactor can be used to firmly pack theautologous or bone graft substitute into the implant cavity.

Precaution: Excessive impaction of the implant with thecancellous bone impactor should be avoided to prevent possible implant damage.

Notes:– To ensure optimal contact with the vertebral endplates, it is important to fill the implant until the autologous boneor bone graft substitute protrudes from the openings of the implant.

– A table on page 27 shows the approximate graft volumethat the ACIS implants hold, depending on the footprint,height and sagittal profile.


3Insert implant

Confirm the implant is securely attached. Carefully insert theimplant into the distracted segment, ensuring that the orientation of the implant is correct. Each convex implant isetched with an arrow pointing cranially on the left lateralwall to indicate the correct cranial/caudal alignment. The lor-dotic and parallel implants have a symmetrical sagittal profileand therefore do not require specific orientation.

If necessary, controlled and light hammering with the malletcan be used to help advance the implant into the interverte-bral disc space.

Turn the knob in a counterclockwise direction to release theimplant from the insertion device.

Remove the insertion device and if required use the flat impactor to seat the implant into its final position.

Implant Insertion


Use image intensifier to confirm the position of the implant.

Precautions:– If an inner shaft without stop is used then an image inten-sifier should be used to check the position during insertion.

– Excessive impaction must be avoided to prevent implantdamage or too deep insertion.

– Excessive tilting of the insertion device must be avoided toprevent implant separation or damage.

Important: Verify final implant position relative to the verte-bral bodies in the AP and lateral direction with the help of anintraoperative x-ray. The ACIS implant has three x-ray mark-ers incorporated in the implant to enable accurate intraoper-ative radiographic assessment of the implant position.

Notes:– B 1.0 mm TAV pins as x-ray markers.– The distance between pins and the anterior and posteriorwalls of the implant is approx. 1.0 mm.

– The posterior pin is centered.


Implant Insertion

Option B. Implant holder

1Attach implant to implant holder

Instrument

03.841.053 ACIS Implant Holder



03.820.113 Mallet

Select the ACIS implant that corresponds to the footprint,shape and height determined using the trial implant.

Attach the implant to the ACIS implant holder by aligningthe recessed grooves located on the side walls of the implantwith the prolonged tabs of the instrument tip. Engage thesqueeze-lock by applying slight pressure on the arms of theimplant holder.


2Pack implant with autologous bone graft or bone graftsubstitute




It is recommended to pack the ACIS implant with autologousbone or bone graft substitute.

Place the ACIS implant into the packing block. Small andstandard footprint implants fit into the cavity marked “Standard” while large footprint implants fit into the cavitymarked “Large”.

The cancellous bone impactor can be used to firmly pack theautologous or bone graft substitute into the implant cavity.

Precaution: Excessive impaction of the implant with thecancellous bone impactor should be avoided to prevent pos-sible implant damage.

Notes:– To ensure optimal contact with the vertebral endplates, it is important to fill the implant until the autologous boneor bone graft substitute protrudes from the openings of the implant.

– A table on page 27 shows the approximate graft volumethat the ACIS implants hold, depending on the footprint,height and sagittal profile.


Implant Insertion

3Insert implant

Confirm the implant is securely attached, carefully insert theimplant into the distracted segment, ensuring that the orien-tation of the implant is correct. Each convex implant isetched with an arrow pointing cranially on the left lateralwall to indicate the correct cranial/caudal alignment. The lor-dotic and parallel implants have a symmetrical sagittal profileand therefore do not require specific orientation.

Release the implant holder by applying slight pressure on thearms of the implant holder and disengaging the squeeze-lock. Remove the holder and if required use the flat impactorto seat the implant into its final position.

Use image intensifier to confirm the position of the implant.

Precautions:– The implant holder does not feature a depth stop. Imageintensifier control should be used to check the positionduring insertion.

– Excessive tilting of the implant holder must be avoided toprevent implant separation or damage.

Warning: Excessive impaction must be avoided to preventimplant damage or too deep insertion.


Important: Verify final implant position relative to the verte-bral bodies in the AP and lateral direction with the help of anintraoperative x-ray. The ACIS implant has three x-ray mark-ers incorporated into the implant to enable accurate intra-operative radiographic assessment of the implant position.

Notes:– B 1.0 mm TAV pins as x-ray markers.– The distance between pins and the anterior and posteriorwalls of the implant is approx. 1.0 mm.

– The posterior pin is centered.


Supplemental Fixation

Optional Sets

187.065 Cervical Spine Locking Plates with variable angle in Vario Case

187.070 Cervical Spine Locking Plates 4.0/4.35 (Pure Titanium) in Vario Case

01.613.210 Vectra in Vario Case

For multi-segmental instrumentation, ACIS is intended to beused with Synthes supplemental fixation, e.g. CSLP or Vectra.

Complete the procedure by following the steps indicated inthe respective surgical technique.


Instrument


Optional instrument

03.820.113 Mallet

Attach the ACIS insertion device to the implant in the discspace by aligning the pronged tabs of the instrument tip tothe recessed grooves located on the side walls of the implant.Tighten the knob clockwise until the implant has a rigid con-nection. Ensure that the implant is held flush against the insertion device and securely in the tabs. Remove the implantfrom the disc space.

Warning: Take care not to push the implant towards theposterior elements.

Precautions:– Excessive tilting of the insertion device must be avoided toprevent implant separation or damage.

– In case of visible damages on the implant it should not bereused.

The mallet can be used for implant removal.

While holding the insertion device, slide the mallet over the shaft of the insertion device and apply an upward force.Repeat this process until the implant has been removed.

Implant Removal


1 mm

1 mm

Three radiographic marker pinsEnable visualization of the implant position– B 1.0 mm TAV pins– Distance between pins and the anterior and posteriorwalls of the implant is approx. 1.0 mm

– Posterior pins are centered– Distance between anterior pins and lateral walls of the implant varies between the different footprint sizes:Small 3.0 mmStandard 4.0 mmLarge 5.0 mm

Implants

ACIS implants– Supplied sterile– Implant material: PEEK with Titanium alloy (Ti-6Al-4V) radiographic marker pins


12.5 mm

11.5 mm

14 mm

13 mm

16 mm

15 mm

Small Standard Large

Lordotic Parallel Convex

– 3 footprints:– Small (11.5 mm × 12.5 mm)– Standard (13 mm × 14 mm)– Large (15 mm × 16 mm)

– 3 sagittal shapes:– Lordotic– Parallel– Convex

– 8 heights ranging from 5 mm to 12 mm (in 1 mm increments)

Height

Height

Height


Lordotic Parallel Convex Height Implant Footprint depth × width

Small 08.843.605S 08.843.705S 08.843.805S 5 mm 11.5 mm × 12.5 mm

08.843.606S 08.843.706S 08.843.806S 6 mm 11.5 mm × 12.5 mm

08.843.607S 08.843.707S 08.843.807S 7 mm 11.5 mm × 12.5 mm

08.843.608S 08.843.708S 08.843.808S 8 mm 11.5 mm × 12.5 mm

08.843.609S 08.843.709S 08.843.809S 9 mm 11.5 mm × 12.5 mm

08.843.610S 08.843.710S 08.843.810S 10 mm 11.5 mm × 12.5 mm

08.843.611S 08.843.711S 08.843.811S 11 mm 11.5 mm × 12.5 mm

08.843.612S 08.843.712S 08.843.812S 12 mm 11.5 mm × 12.5 mm

Standard 08.843.005S 08.843.105S 08.843.205S 5 mm 13 mm × 14 mm

08.843.006S 08.843.106S 08.843.206S 6 mm 13 mm × 14 mm

08.843.007S 08.843.107S 08.843.207S 7 mm 13 mm × 14 mm

08.843.008S 08.843.108S 08.843.208S 8 mm 13 mm × 14 mm

08.843.009S 08.843.109S 08.843.209S 9 mm 13 mm × 14 mm

08.843.010S 08.843.110S 08.843.210S 10 mm 13 mm × 14 mm

08.843.011S 08.843.111S 08.843.211S 11 mm 13 mm × 14 mm

08.843.012S 08.843.112S 08.843.212S 12 mm 13 mm × 14 mm

Large 08.843.305S 08.843.405S 08.843.505S 5 mm 15 mm × 16 mm

08.843.306S 08.843.406S 08.843.506S 6 mm 15 mm × 16 mm

08.843.307S 08.843.407S 08.843.507S 7 mm 15 mm × 16 mm

08.843.308S 08.843.408S 08.843.508S 8 mm 15 mm × 16 mm

08.843.309S 08.843.409S 08.843.509S 9 mm 15 mm × 16 mm

08.843.310S 08.843.410S 08.843.510S 10 mm 15 mm × 16 mm

08.843.311S 08.843.411S 08.843.511S 11 mm 15 mm × 16 mm

08.843.312S 08.843.412S 08.843.512S 12 mm 15 mm × 16 mm

Implants


Filling volumeThe table below shows the approximate graft volume (in cc) that ACIS implants will hold, depending on the footprints, heights and sagittal profiles.

Convex

5 6 7 8 9 10 11 12

Small 0.2 0.3 0.3 0.3 0.4 0.4 0.5 0.5

Standard 0.4 0.5 0.6 0.6 0.7 0.8 0.9 1.0

Large 0.6 0.7 0.8 0.9 1.1 1.2 1.3 1.4

Parallel

5 6 7 8 9 10 11 12

Small 0.2 0.2 0.3 0.3 0.4 0.4 0.5 0.5

Standard 0.3 0.4 0.5 0.6 0.7 0.7 0.8 0.9

Large 0.5 0.6 0.8 0.9 1.0 1.1 1.2 1.4

Lordotic

5 6 7 8 9 10 11 12

Small 0.2 0.2 0.2 0.3 0.3 0.4 0.4 0.5

Standard 0.3 0.3 0.4 0.5 0.6 0.7 0.8 0.8

Large 0.4 0.5 0.6 0.8 0.9 1.0 1.1 1.2

Height

Height

Height


Double-sided Trial Implants

03.841.005 ACIS Trial Implant, standard, lordotic,03.841.007 heights 5/6 mm; 7/8 mm; 9/10 mm;03.841.009 11/12 mm, double-sided, blue03.841.011

03.841.105 ACIS Trial Implant, standard, parallel, 03.841.107 heights 5/6 mm; 7/8 mm; 9/10 mm;03.841.109 11/12 mm, double-sided, purple03.841.111

03.841.205 ACIS Trial Implant, standard, convex, 03.841.207 heights 5/6 mm; 7/8 mm; 9/10 mm;03.841.209 11/12 mm, double-sided, yellow03.841.211

03.841.305 ACIS Trial Implant, large, lordotic,03.841.307 heights 5/6 mm; 7/8 mm; 9/10 mm;03.841.309 11/12 mm, double-sided, blue03.841.311

03.841.405 ACIS Trial Implant, large, parallel, 03.841.407 heights 5/6 mm; 7/8 mm; 9/10 mm;03.841.409 11/12 mm, double-sided, purple03.841.411

03.841.505 ACIS Trial Implant, large, convex, 03.841.507 heights 5/6 mm; 7/8 mm; 9/10 mm;03.841.509 11/12 mm, double-sided, yellow03.841.511

03.841.605 ACIS Trial Implant, small, lordotic, 03.841.607 heights 5/6 mm; 7/8 mm; 9/10 mm;03.841.609 11/12 mm, double-sided, blue03.841.611

03.841.705 ACIS Trial Implant, small, parallel,03.841.707 heights 5/6 mm; 7/8 mm; 9/10 mm;03.841.709 11/12 mm, double-sided, purple03.841.711

03.841.805 ACIS Trial Implant, small, convex,03.841.807 heights 5/6 mm; 7/8 mm; 9/10 mm;03.841.809 11/12 mm, double-sided, yellow03.841.811

Instruments



03.841.051 Turning Knob for ACIS Insertion Device

03.841.053 ACIS Implant Holder



03.841.057 Inner Shaft, small, with Stop, for 03.841.050

03.841.059 Inner Shaft, standard/large, without Stop, for 03.841.050

03.841.060 Inner Shaft, standard/large, with Stop, for 03.841.050


03.841.061 Inner Shaft, small, without Stop, for 03.841.050

03.841.150 Endplate Rasp


03.820.113 Mallet

Instruments


Sets

68.841.000 ACIS Tray for Basic Instruments

68.841.001 ACIS Tray for Additional Instruments

68.841.002 ACIS Tray for Trial Implants

684.060 Lid for Modular Tray, size 1/2

689.515 Vario Case, Framing, size 1/2, height 88 mm

689.516 Vario Case, Framing, size 1/2, height 126 mm

689.537 Lid (Stainless Steel), size 1/2, for Vario Case


03.841.052 ACF Holder

03.841.104 Trial Implant, parallel, height 4 mm

08.843.104S ACIS, standard, parallel, height 4 mm,sterile

Additionally available


Also Available from Synthes:chronOS Putty – Spine

Indications*chronOS Putty with autologous bone marrow and/or bloodis intended for use in spine indications, such as:– Intraoperative filling of IBF cages and the space aroundthem

– Posterolateral fusion

* For complete indications, contraindications, precautions and warning notices,please refer to the instructions for use.

Benefits of chronOS Putty

No wash-out

X-ray visibility

Added osteoinductivity

Accelerated remodeling


chronOS Putty for Spine*

710.801S chronOS Putty, 1.0 cc




Bone Marrow Aspiration System (BMAS)

Art.No. Diameter Length Syringe

710.111S 11 ga 11 cm 20 ml

710.151S 11 ga 15 cm 20 ml

*Manufactured by:

Mathys AG BettlachGüterstrasse 5CH-2544 Bettlach

Ordering information

Distributed by:Synthes GmbHEimattstrasse 3CH-4436 Oberdorfwww.depuysynthes.com


Bibliography

1 Kaiser MG, RW Haid Jr., BR Suback, et al. “Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft”. Neurosurgery 50 (2002): 229 – 236.

2 Barsa P, P Suchomel. “Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion”. Eur Spine J. 16 (2007): 1395 – 1400.

3 Caspar W, FH Geisler, T Pitzen, et al. „Anterior Cervicalplate stabilization in one and two level degenerative disease: overtreatment or benefit?” J. Spinal Disord. 11 (1998): 1 – 11.

4 Fraser JF, R Hartl. “Anterior approaches to fusion of thecervical spine: a meta analysis of fusion rates”. J Neurosurg.Spine 6 (2007): 298 – 303.

5 Mobbs RJ, P Rao, NK Chandran. “Anterior cervical discectomy and fusion: analysis of surgical outcome with and without plating”. J. Clin. Neurosci. 14 (2007): 639 –642.

6 Moftakhar R, GR Trost. “Anterior cervical plates: a historical perspective”. Neurosurg. Focus. 16 (2004): E8.

7 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation, 3rd edition. Berlin: Springer-Verlag. 1991.

8 Aebi M, JS Thalgott, JK Webb. AO ASIF Principles in SpineSurgery. Berlin: Springer-Verlag. 1998.


Synthes GmbHEimattstrasse 3CH-4436 Oberdorfwww.depuysynthes.com ©

Synthes GmbH

2014. All rights reserved.

036.001.440

version AB 01/2014

50147599

0123

This publication is not intended for distribution in the USA.

All technique guides are available as PDF files at www.synthes.com/lit

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