- Step 1: Patient should be positioned supine on the operating table. Ample padding should be used to cushion pressure points. The spine should be placed in a neutral position. Radiographic equipment can assist in confirming the precise intraoperative position of the implant. Anterior-posterior and/or lateral radiographs should be used to identify the operative level and determine placement of the starting incision. The intended surgical level should be directly visualized and confirmed radiographically. Self-retaining and/or hand held retractors should be used to protect the internal organs and neurovascular structures when possible. Caspar pins should be used only to assist with exposure and soft tissue retraction. Distraction across the corpectomy channel via the Caspar system should be avoided.
- Step 2: All pathologic material (disk, bone, tumor, and/or cartilage) should be removed and discarded. The dissection should continue until healthy subchondral bone is exposed. Excessive removal of healthy subchondral bone should be avoided as it may lead to implant subsidence and segmental instability. Healthy bone from the channel corpectomy may be recovered and used as autograft inside an implant.
- Step 3: Using the Blustone caliper, a neurosurgical caliper or surgeons preferred measuring device, place the tips so that they contact the anterior lip of the vertebral bodies. Caliper tips should be placed as close as possible to the anterior face of the vertebral body. Extend the caliper to the appropriate defect height. Determine implant height from scale on caliper.
- Step 4: An inserter is attached to the implant by aligning inserter and implant interface and turning inserter handle to engage threads. Pack the implant with graft material. Introduction of the implant into the disc space is done cautiously. Intraoperative fluoroscopic guidance is used to insure proper placement of the implant and to prevent injury to neurologic structures. The implant has two tantalum markers that are radiopaque and mark the most ventral and dorsal aspect of the implant. Before releasing the implant from the inserter, perform a final check that the tantalum beads are within the vertebral body boundaries and the implant is in the position desired by the Surgeon. The inserter is removed from the implant by turning handle to unthread from the implant. Fluoroscopy should be utilized to confirm implant position.
Supplemental fixation, such as a plate or posterior instrumentation, should be used in addition to the implant. Failure to provide supplemental fixation may result in loosening, displacement or expulsion of the implant A pusher can be used to fine tune placement of the implant and move it dorsally to keep the implant and ventral bodies in line in the caudal rostral direction. Again verification of the implant must be done after any manipulation with fluoroscopic images.