Stryker Spinal Fusion with O-Arm and Medtronic Navigation

Fusing the vertebrae together helps to eliminate the pain patients feel from motion within a particular area of their spine, as well as, correcting any instability of the vertebral joints. Fusions are usually done when vertebral instability is present in conjunction with one of the following conditions:
• Degenerative Disc Disease
• Spinal Stenosis
• Spondylolisthesis

Fusions can be accomplished a variety of ways. Surgeon preference as well as patent symptoms will determine what approach the surgeon will use for the fusion:
ALIF (Anterior Lumbar Interbody Fusion) Abdominal Approach with possible Posterior Instrumentation
TLIF (Transforaminal Lumbar Interbody Fusion) Posterior Approach
PLIF (Posterior Lumbar Interbody Fusion) Posterior Approach
XLIF (eXtreme Lateral Interbody Fusion) Lateral Approach

Below are photos, along with descriptions of the instrumentation used to perform a Spinal Fusion. Photos can be clicked on to see a larger and with more detail.

The surgeon will need to remove the disc out the disc space so that he/she can place the cage that will aide in the fusion. This is accomplished with these Reamer /Distractors. The surgeon will start with a small size & work their way larger until they find a good fit.

After the disc space is cleaned out the surgeon will insert a cage. The size of the cage will be determined by the size of the Reamer/ Distractor previously used. The cage will be secured to one of these Cage Inserters (they are size specific), then filled with bone graft.

A mallet is used to insert the cage. If it needs to be inserted a litter further than the Blue Handled Impactor will be used. After the cage is inserted, then the surgeon will be ready to place the Pedicle Screws.

Medtronic NavLock Instrument Pan

Top Row
Colored Trackers will be placed on different pieces of instrumentation. These trackers, which are part of the Medtronic Stealth Navigation System work in conjunction with the O-Arm to created live time GPS for precision placement of the pedicle screws.

Bottom Row
Awl, Lumbar Probe Tip, and Thoracic Prob Tip. These tips are used to make the hole into the vertebra’s pedicle.

Medtronic Spinal Referencing Pan

These instruments are attached to the patient, and act as a stationary referencing point to base the live time navigated placement of the pedicle screws. This pan allows the surgeon to place the referencing device on 3 different ways, with each option having a short or long choice.

After the cage is in place, the surgeon will then choose & secure one of the three stationary referencing Instruments in place on the patient. the three different types of referencing instruments are shown below. Pleas not that all navigation instrumentation is supposed to have reflective spheres attached to them so they can be seen by the infrared monitor. For this post I didn't want to open them, so they are not shown in any of the photos (sorry).

Percutaneous Clamps

Open Spine Clamps

Percutaneous Iliac Spine Fixation

Pedical Hole Maker, used to create the hole for the Pedicle Screws
• NavLock Tracker
• Nav Lumbar Probe Tip
• Ratcheting Handle

Tap, used to cut threads for the screw to follow. Tap diameter will be determined by screw diameter surgeon will be using. can be used on power or by hand.
• NavLock Tracker
• Tap

Screwdriver
• NavLock Tracker
• Screwdriver Tip

PowerEase Drill for Tap & Screwdriver. The PowerEase drill works in conjunction with spinal monitoring.

Nav Probe (left) & Pedicle Probe (right), used before & after tapping to make sure the hole is down to cortical bone & didn’t blow out.

Screws will be inserted

Rods will be placed. When loading rod on Rod Holding Clamp, load it like a rainbow (or sad face)

Caps will lock rod into screw heads

This is what the configuration of Screws, Rods, & Caps will look like inside the patient.

The screws will be placed. After the screws are all in the pedicles, the surgeon will do a 2nd spin with the O-Arm to make sure that they are happy with the screw placement

After the screws are all in the pedicles, now the rods will be places. When loading the rods on the rod holder, clamp it as if the rod was a rainbow, or a sad face. If only fusing 1 level you can grasp the rod in the center. if doing a multi level fusion, grasp the rod towards the front 1/3 or back 1/3 of the rod. this is done so the rod holder will not interfere with the screw heads.

The rod may need to have a little more curve bent into it before being placed in the patient. This step is more common on multi level fusions.

If the surgeon is having a hard time making the poly-axial screw heads swivel once in the patient, then they might need to use the Head Breaker to achieve the swivel.

After the rods are placed on one side caps will be secured into the screw head to hold the rods in place. Then, the rod on the other side will be placed and the caps put on same a the previous side.

If the surgeon is having a hard time getting the cap to fit into the screw head then they may want to use the Persuader to help the cap fit on the screw head.

Before final tightening when the screw caps are just barley snug the surgeon may choose to use the Compression Clamp to squeeze the fusion together, so that there is a proper distance between vertebral bodies.

Before final tightening when the screw caps are just barley snug, the surgeon may choose to use the Distraction Clamp to widen the distance between the vertebral bodies so there will be proper distance when fused.

Final tightening of the screw caps into the screw heads, to firmly hold the rods in place. This is done with a torque screwdriver, as to make sure the proper tightness is achieved.