Luminary ALIF. Disc preparation and implant insertion ...

Luminary ALIF. Disc preparation
and implant insertion instruments.

Technique Guide

Instruments and implants
approved by the AO Foundation

Table of Contents Luminary ALIF 2
AO Principles 4
Introduction
Surgical Technique Preparation 5
Product Information Straight Anterior Approach 6
Anterolateral Approach (30º Offset) 16

Instruments 18
Set Lists 21

Image intensifier control

Synthes Spine

Luminary ALIF 26 mm depth

Anterior Approach 30 mm
The Luminary ALIF instruments can be width
used in an anterior lumbar interbody
fusion procedure using a straight
anterior approach to the lumbar spine.
The illustration depicts a Luminary
CC-ALIF Spacer being implanted at the
L5–S1 level.

ALIF Synthes Quick Inserter/Distractor (SQUID)
Provides distraction of disc space,
insertion of implant and ejection of
instrument in one simple procedure
– No assembly required
– Easy to use, integrated adjustable

countersink, 3 mm and 6 mm depths
from the outer wall of the implant to
the outer wall of the vertebral body
– Shaft can be released for quick set-up
and can be engaged for controlled
insertion
– Spring ramps firmly hold implant
during procedure
– Impact-free insertion

2 Synthes Spine Luminary ALIF

Anterolateral Approach

The Luminary ALIF instruments can
also be used in an anterior lumbar
interbody fusion procedure using an
anterolateral approach, or 30° offset
from straight anterior. This approach
preserves the anterior longitudinal
ligament and avoids patient
vasculature. The illustration depicts
a Luminary CC-ALIF Spacer being
implanted at the L4–L5 level.

3 mm 6 mm

Synthes Spine 3

AO Principles

In 1958, the AO formulated four basic principles,1 which have
become the guidelines for internal fixation. They are:
– Anatomic reduction
– Stable internal fixation
– Preservation of blood supply
– Early, active mobilization
The fundamental aims of fracture treatment in the limbs and
fusion of the spine are the same. A specific goal in the spine
is returning as much function as possible to the injured neural
elements.2
AO Principles as Applied to the Spine3
Anatomic alignment
Restoration of normal spinal alignment to improve the
biomechanics of the spine.
Stable internal fixation
Stabilization of the spinal segment to promote bony fusion.
Preservation of blood supply
Creation of an optimal environment for fusion.
Early, active mobilization
Minimization of damage to the spinal vasculature, dura, and
neural elements, which may contribute to pain reduction and
improved function for the patient.

1. M.E. Müller, M. Allgöwer, R. Schneider, H. Willenegger: AO Manual of Internal
Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991.
2. Ibid.
3. M. Aebi, J.S. Thalgott, J.K. Webb. AO ASIF Principles in Spine Surgery. Berlin:
Springer-Verlag. 1998.

4 Synthes Spine Luminary ALIF

Preparation 50 2 SYNTHES Spine

1 40 1690 Russell Road, Paoli, PA 19301
To order: 1-800-522-9069
Preoperative planning 30
Determine surgical approach (anterior or anterolateral). 1 ALIF SPACER
The surgical approach, based on surgeon preference, PREOPERATIVE PLANNER
determines the implant type. 20
Actual Size
2 10 Lateral view
00
Determine implant height mm Inches
Instrument
8052* ALIF Preoperative Planner ANTERIOR 9 mm 11 mm 13 mm 15 mm
Preoperative planning is recommended for precise HEIGHT
selection of a Luminary CC-ALIF spacer. Determine the
implant height by comparing a lateral view on the ALIF 30 mm
preoperative planner with adjacent intervertebral discs
on a lateral radiograph. ANTERIOR 17 mm 19 mm 21 mm
The implant must be firmly seated with a secure fit HEIGHT
between the endplates when the segment is fully
distracted. It is essential to use the tallest possible 24 mm
implant, as determined by the preoperative planning,
to maximize segmental stability. 100% NOTE: All ALIF Spacers are 24 mm in anterior-posterior direction GP1739-A 3/01 J3554
Due to variations in radiographic magnification, and 30 mm in lateral width.
the templates only provide an estimate of the ideal actual size
implant size.
Templates represent 40%–80% (in 5% increments) ALIF Preoperative Planner (8052)
and 100% actual size for use with MRI and CT scans.
10% and 15% magnification templates are available
for x-ray use.

* Also available

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Straight Anterior Approach

Optional sets

01.605.600 ProPrep Disc Preparation Set

105.939 Anterior Instrument Set

The ProPrep instrument set is a comprehensive collection
of traditional disc preparation instruments to facilitate a
complete discectomy.

01.605.600

1

Expose the disc

Expose the midline of the intervertebral disc.

6 Synthes Spine Luminary ALIF

2

Perform discectomy

Instrument

03.808.001 Scalpel Handle*

Using a scalpel, cut a window in the annulus, centered on
the vertebral midline to prepare the position for the implant.

For the quickest and most effective removal of a disc,
separate the disc from the endplate with an endplate
elevator. Endplate elevators for ALIF surgery are available
in the optional sets and individually through the Synthes
catalog.

*Note: Blades are not included in the set.

Synthes Spine 7

Straight Anterior Approach continued

2

Perform discectomy continued
Instruments
03.808.012 Disc Excisor Rongeur, 9 mm height
03.808.013 Disc Excisor Rongeur, 11 mm height
03.808.014 Disc Excisor Rongeur, 13 mm height

Remove disc material from the intervertebral disc space
using any combination of the following options: disc
excisor rongeur, side-biting rongeur, or disc shaver/excisor.
Note: Removing the superficial layers of the cartilaginous
endplates exposes bleeding bone. Adequate preparation of
the endplates is important to facilitate vascular supply to the
bone graft. Excessive cleaning, however, may weaken the
endplate due to removal of bone underlying the cartilaginous
layers.
Use the disc excisor rongeur to begin removing the disc.
The disc excisor rongeurs are also effective to remove disc
in the posterolateral disc space (Figure 1).

Figure 1

8 Synthes Spine Luminary ALIF

Instruments

03.808.022 Bone Rongeur, side-biting, 9 mm height

03.808.023 Bone Rongeur, side-biting, 11 mm height

03.808.024 Bone Rongeur, side-biting, 13 mm height

03.808.032– ALIF Spreaders, 9 mm–21 mm
03.808.038

03.808.042– Disc Shavers/Excisors, 9 mm–21 mm
03.808.048

Use the side-biting rongeurs to remove disc material and
cartilaginous tissue from the superior and inferior surfaces
of the vertebral endplates. The double-sided cutting edges
allow both surfaces to be cleaned simultaneously.

Use the ALIF disc shavers/excisors for thorough removal of
disc material and cartilaginous tissue from the intervertebral
disc space. Multiple flutes maximize scraping and collection
of disc material.

The ALIF spreaders can be used to distract the disc space
while allowing room to work contralaterally.

The disc shavers/excisors can be used in a controlled manner
to clean the lateral disc space.

Synthes Spine 9

Straight Anterior Approach continued

3

Prepare endplates

Instrument

03.808.101 ALIF Trial Spacer Rasp, with handle,
7 mm height

After the discectomy is complete, use the double-sided rasp
to remove the superficial cartilaginous layers of the endplates
and expose bleeding bone.

Note: Excessive removal of the subchondral bone may
weaken the vertebral endplate. If the entire endplate is re-
moved, subsidence and loss of segmental stability may result.

4

Determine implant size

Instruments

03.808.102– ALIF Trial Spacer Rasps, quick release,
03.808.108 9 mm–21 mm

03.808.112– ALIF Trial Spacers, quick release,
03.808.118 9 mm–21 mm

394.951 Quick Release T-Handle

The trial spacer rasps can be used to simultaneously trial the
disc space for the implant while exposing bleeding bone.

For final size determination, connect the appropriately sized
trial spacer or trial spacer rasp to the desired length quick
release T-handle. Insert the trial spacer into the intervertebral
disc space using gentle impaction. Fluoroscopy can assist in
confirming the fit and geometry of the trial spacer.

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If the trial spacer appears too small or too tight, try the next
larger or smaller size until the most secure fit is achieved. It is
essential to use the tallest clinically reasonable implant to
maximize segment stability.

Optional instruments

03.808.003 Quick Release T-Handle, 185 mm

PDL102 Slotted Mallet

The slotted mallet can be used to facilitate the insertion or
removal of the trial spacers and trial spacer rasps.

Synthes Spine 11

Straight Anterior Approach continued

5 T-handle

Insert implant Screw
shaft
Option 1: Using SQUID

Instruments ALIF Synthes Quick Inserter/Distractor
03.808.121 (SQUID)

519.97* Autoclavable Oil

Release the main thread by pushing the release button on Engage/
the grip and slide the ejector fully back. release
button
Set the countersink depth 3 mm or 6 mm by turning the
ejector in either direction with your fingers. The number Spring ramp
closer to the tips of the instrument is the current setting. guides

Note: Ejector can only be turned when in the keyhole.

SQUID Care Instructions Keyhole
To ensure maximum longevity of SQUID, complete these Ejector
four steps after each use:

1. Wash and disinfect instrument after surgery.

2. Apply autoclavable oil over entire length of
the screw shaft.

3. Spread autoclavable oil over entire thread length by
engaging the button and screwing the T-handle all the
way down and back.

4. Sterilize SQUID before use (see package insert).

Pusher
Tips

*Also available
12 Synthes Spine Luminary ALIF

Once the countersink depth is set, place the instrument flat
on the table to load the implant.
Pack bone graft material into the center of the implant as
appropriate. Place the implant onto the bottom spring ramp.
Holding both sides of the implant, engage the grooves with
the spring ramp guides and gently slide the implant forward
until the implant is held without sliding back.
Note: The tips of the inserter will be inserted into the disc
space up to the depth stops on the spring ramps; to allow
full insertion, the tips must not be spread apart.
Slide the pusher up to the implant and engage the main
thread by pressing the engage button.
The implant is now held securely.

Depth
stops

Main thread

Synthes Spine 13

Straight Anterior Approach continued

5

Insert implant continued
Option 1: Using SQUID continued
Place the tips of the instrument into the disc space so the
depth stops on the spring ramps touch the anterior rim of
the vertebral body. The tips of the instrument are 26 mm
deep and 30 mm wide.
Note: It is important to remember that the pusher will be
moving toward the vertebral body and the ejector is proud
above the spring ramps and stops. Be aware of soft tissue
and blood vessels that may be in the path of the pusher and
ejector as they move toward and push against the vertebral
bodies.
With the main thread engaged, turn the T-handle on the
SQUID to advance the implant down the spring ramps and
into the disc space. The force required to turn the T-handle
will increase as the implant advances down the spring ramps
and the instrument distracts the disc space.
Continue turning the T-handle until the instrument is fully
ejected and released. An audible click as the spring ramps
spring back to meet each other confirms that the implant is
seated and the instrument is fully ejected and released.

14 Synthes Spine Luminary ALIF

Option 2: Using implant holder and impactor
Instruments
03.808.122 ALIF Implant Holder
03.808.123 ALIF Impactor, crescent
Insert the implant using the ALIF implant holder, ensuring
that the tallest side of the implant lies against the holder. The
implant holder aligns with the preformed grooves or slot on
the implant for easy insertion. Ensure that the implant is held
flush against the holder. Tighten the locking screw on the
implant holder to firmly secure the instrument jaws against
the implant.
Introduce the spacer into the intervertebral disc space until
the implant is flush or slightly recessed.
Slight impaction on the implant holder may be necessary.
Release the implant holder by loosening the locking screw
and use the impactor to fully seat the implant.
Important: Before use, ensure that the impactor fits flush
against the implant. Do not forcibly strike the impactor when
tapping the implant into position.

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Anterolateral Approach (30° Offset)

1

Expose and remove disc and prepare endplate
For anterolateral insertion, the center of the implant will sit
30° offset to the anterior vertebral midline. Remove the disc
and prepare the endplates according to Steps 2 and 3 of the
straight anterior approach (pages 7–10).

2

Distract and size
Instruments
03.808.101 ALIF Trial Spacer Rasp with handle, 7 mm
03.808.102– ALIF Trial Spacer Rasps, quick release,
03.808.108 9 mm–21 mm
03.808.112– ALIF Trial Spacers, quick release,
03.808.118 9 mm–21 mm
Determine the correct implant size using the ALIF trial
spacers or trial spacer rasps. The same trial spacers and
trial spacer rasps can be used for anterior or anterolateral
approaches. The desired approach can be changed by
unscrewing the sleeve, aligning the head in the correct
position and reattaching the sleeve.
Insert the trial spacer and determine the correct implant size as
described in Step 4 of the anterior approach (page 10).

16 Synthes Spine Luminary ALIF

3

Insert the implant
Insert the implant according to Step 5 of the straight
anterior approach (pages 12–15).

Synthes Spine 17

Instruments

03.808.001 Scalpel Handle
03.808.003 Quick Release T-Handle, 185 mm

03.808.012– Disc Excisor Rongeurs, 9 mm–13 mm height
03.808.014

03.808.022– Bone Rongeurs, side-biting,
03.808.024 9 mm–13 mm height

03.808.032– ALIF Spreaders, 9 mm–21 mm height
03.808.038

18 Synthes Spine Luminary ALIF

03.808.042– Disc Shavers/Excisors, 9 mm–21 mm height
03.808.048

03.808.101 ALIF Trial Spacer Rasp, with handle,
7 mm height

03.808.102– ALIF Trial Spacer Rasps, quick
03.808.108 release, 9 mm–21 mm height

03.808.112– ALIF Trial Spacers, quick release,
03.808.118 9 mm–21 mm height

03.808.121 ALIF Synthes Quick Inserter/Distractor (SQUID)

Synthes Spine 19

Instruments continued

03.808.122 ALIF Implant Holder, with grooves

03.808.123 ALIF Impactor, crescent

394.951 Quick Release T-Handle

PDL102 Slotted Mallet

20 Synthes Spine Luminary ALIF

Luminary ALIF Disc Preparation Instrument Set (01.808.003)

Graphic Case Graphic Case, for Luminary ALIF Disc
60.808.000 Preparation Instrument Set

Instruments Scalpel Handle*
Quick Release T-Handle, 185 mm
03.808.001 Quick Release T-Handle, 2 ea.
03.808.003
394.951

Disc Excisor Rongeurs

03.808.012 9 mm height

03.808.013 11 mm height

03.808.014 13 mm height

Bone Rongeurs, side-biting

03.808.022 9 mm height

03.808.023 11 mm height

03.808.024 13 mm height

ALIF Spreaders 9 mm height
03.808.032 11 mm height
03.808.033 13 mm height
03.808.034 15 mm height
03.808.035 17 mm height
03.808.036 19 mm height
03.808.037 21 mm height
03.808.038

Disc Shavers/Excisors

03.808.042 9 mm height

03.808.043 11 mm height

03.808.044 13 mm height

03.808.045 15 mm height

03.808.046 17 mm height

03.808.047 19 mm height

03.808.048 21 mm height

* Blades not included
Note: For additional information, please refer to package insert.

Synthes Spine 21

Luminary ALIF Insertion Instrument Set (01.808.103)

Graphic Case Graphic Case for Luminary ALIF Insertion
60.808.002 Instrument Set

Instruments Quick Release T-handle, 185 mm
03.808.003 ALIF Trial Spacer Rasp, with handle,
03.808.101 7 mm height
ALIF Synthes Quick Inserter/Distractor
03.808.121 (SQUID)
ALIF Implant Holder, with grooves
03.808.122 ALIF Impactor, crescent
03.808.123 Quick Release T-handle, 2 ea.
394.951 Slotted Mallet
PDL102

ALIF Trial Spacer Rasps, quick release

03.808.102 9 mm height

03.808.103 11 mm height

03.808.104 13 mm height

03.808.105 15 mm height

03.808.106 17 mm height

03.808.107 19 mm height

03.808.108 21 mm height

ALIF Trial Spacers, quick release

03.808.112 9 mm height

03.808.113 11 mm height

03.808.114 13 mm height

03.808.115 15 mm height

03.808.116 17 mm height

03.808.117 19 mm height

03.808.118 21 mm height

22 Synthes Spine Luminary ALIF

Also Available

Optional Sets

01.605.600 ProPrep Disc Preparation Set

105.939 Anterior Instrument Set

Instruments

Disc Excisor Rongeurs

03.808.011 7 mm height

03.808.015 15 mm height

03.808.016 17 mm height

03.808.017 19 mm height

03.808.018 21 mm height

Bone Rongeurs, side-biting

03.808.025 15 mm height

03.808.026 17 mm height

03.808.027 19 mm height

03.808.028 21 mm height

8052 ALIF Preoperative Planner

Synthes Spine 23

Synthes Spine Synthes (Canada) Ltd. www.synthes.com
1302 Wrights Lane East 2566 Meadowpine Boulevard
West Chester, PA 19380 Mississauga, Ontario L5N 6P9
Telephone: (610) 719-5000 Telephone: (905) 567-0440
To order: (800) 523-0322 To order: (800) 668-1119
Fax: (610) 251-9056 Fax: (905) 567-3185

© 2006 Synthes, Inc. or its affiliates. All rights reserved. ProPrep and Synthes are trademarks of Synthes, Inc or its affiliates. Printed in U.S.A. 8/08 J6782-B