System Guide Adaptable MIS solutions for an evolving practice SURGEON DESIGNERS CONTENTS D. Greg Anderson, MD SYSTEM OVERVIEW 2 Thomas Jefferson University Hospital Rothman Orthopaedics LUMBAR DEGENERATIVE 5 Philadelphia, PA DEFORMITY 9 Robert Heary, MD University of Medicine & Dentistry New TRAUMA 13 Jersey Newark, New Jersey TUMOUR 17 Carl Lauryssen, MD SURGICAL TECHNIQUE GUIDE 21 Tower Orthopedic & Neurosurgical Spine Institute PRODUCT CATALOGUE 47 Beverly Hills, CA Tony Tannoury, MD Boston University Medical Center Boston, MA Professor Cornelius Wimmer, MD Behandlungszentrum Vogtareuth (Vogtareuth Treatment Center) Vogtareuth, Germany CONTRIBUTING SURGEONS Dirk Alander, MD Steve Ludwig, MD John Asghar, MD Paul Park, MD Eric Belanger, MD Kees Poelstra, MD Randal Betz, MD Khalid Sethi, MD Ashok Biyani, MD John Shiau, MD Andrew Cannestra, MD Harry Shufflebarger, MD Mitch Hardenbrook, MD Jonathan Song, MD Bradley Heiges, MD Mike Wang, MD Marty Herman, MD Faissal Zahrawi, MD Doug Linville, MD 1 System Overview VIPER® 2, the evolution of minimally invasive spine surgery. Building upon the groundbreaking design and intuitive techniques established by the original VIPER® System, VIPER 2 empowers Spine Surgeons to treat an unparalleled range of pathologies with a single platform solution. By delivering a comprehensive range of instrumentation and implant options, VIPER 2 provides surgeons with the confidence and control required to address more advanced indications with a less invasive approach. Born from EXPEDIUM®, evolved from VIPER, VIPER 2 takes percutaneous fixation to the next level. TRAUMA DEGENERATIVE DEFORMITY TUMOR 2 3 D EGENER PERCUTANEOUS TREATMENT OF A DEGENERATIVE A SPONDYLOLISTHESIS USING THE VIPER 2 SYSTEM TI Degenerative V Carl Lauryssen, MD and Pablo Pazmino, MD E Olympia Medical Center, Los Angeles, CA Figure 1: Flexion Figure 2: Neutral Figure 3: Extension Figure 4: Lateral Post-op Figure 5: A-P Post-op X-Ray X-Ray History of Present Illness Treatment Method Follow-up Results: and Imaging: and Materials: • 45 year old female with intense lower • Two level interbody fusions were • Patient was discharged on post-op back and leg pain who previously performed from an anterior day three and at one week reported underwent, L4 - S1 laminectomy approach at L4/L5 and L5/S1 relief of pre-operative symptoms and discectomy five years ago • The graft was secured using an • At three months follow up, • Her symptoms gradually worsened AEGIS® lumbar plate at L5/S1 radiographs demonstrated evidence over the past 5 years and and a buttress screw at L4/L5 of fusion and good alignment at currently reports a VAS of 10 • The patient was flipped and operative levels (Figures 4 and 5) • Imaging revealed a grade 1 posterior MIS decompression was • Presently, she reports good pain spondylolisthesis at L5 - S1, and performed using the SPOTLIGHT® relief and has resumed nearly full pars fracture at L4 - L5 with tubular retractor system job functions evidence of instability on flexion • Six VIPER pedicle screws were extension films (Figures 1, 2 & 3) placed percutaneously at the L4, L5 and S1 levels The VIPER 2 System provided a quick • Two 70mm pre-lordosed rods were and easy-to-use option for reducing this placed percutaneously and once patient’s degenerative spondylolisthesis in place, the VIPER 2 reduction with minimal muscle trauma. instrument was used to reduce the spondylolisthesis at L5 • Total anesthesia time was 4 hrs and the blood loss was 100cc’s SYSTEM GUIDE A FaSTER, SIMPLER APPROACH TO PERCUTANEOUS DEGENERATIVE FIXATION STREAMLINED ROD PLACEMENT SIMPLE PERCUTANEOUS REDUCTION OPTIONS • Simple and repeatable rod placement through insert & rotate 2 stab incisions • Comprehensive internal rod reduction options to simplify even the most difficult cases without compromising incision size X-Tab Screw MINIMAL MUSCLE TRAUMA (Extended Tab Reduction screw): • V2 X-Tab Implants bring integrated reduction • A truly percutaneous technique eliminates any tab technology to MIS surgery unnecessary incisions and tissue trauma 12mm outer diameter minimizes incision size Integrated Simple Pistol-Grip Reducer: break-off threaded reduction reduction • Quickly connect to any V2 Extension for easy tabs eliminate one-step internal reduction the need for extension assembly VIPER 2 Competitor 1 Competitor 2 6 7 PERCUTANEOUS SHORT SEGMENT ADULT DEFORMITY Deformity TREATMENT USING THE VIPER 2 SYSTEM D. Greg Anderson, MD Thomas Jefferson University, Department of Orthopaedics D EFORMITY Figures 1 and 2: AP and Lateral Views Figures 3 and 4: AP and Lateral Views of the Spine at the 1-year Postoperative Visit History of Present Illness Treatment Method Follow-up Results: and Radiographs: and Materials: • 57 year old male presented with a • Interbody fusions and releases of • Patient was mobilized to a chair the bilateral back, buttock and thigh the deformity were performed at evening of surgery and discharged pain and reports symptoms had the L2 - L5 disc spaces using a on postoperative day two progressively worsened for the last lateral approach • By post-op week two, he reported 5 years • The patient was then flipped and the good relief of his pre-operative • The patient had been treated with SPOTLIGHT tubular retractor system symptoms and was able to resume physical therapy, NSAIDS and epidural was used to posteriorly decompress normal work functions, including injections, but these treatments had areas of lateral recess stenosis at the attending a conference in another become ineffective over last year L2 - L5 levels. Bilateral decortication state by week three • Imaging revealed the presence of a of the facet joints for fusion was also • At one year, radiographs 30º degenerative scoliotic curve in performed at L2 - L5 at this time demonstrated a solid fusion at all the lumbar spine (Figures 1 and 2) • Using the same skin incisions, seven operative levels (Figures 3 and 4) percutaneous VIPER pedicle screws • Presently, he reports excellent pain were placed under fluoroscopic relief and has resumed an active guidance at the L2, L3 (unilateral), lifestyle L4 and L5 levels • Two 200mm straight VIPER 2 rods The VIPER 2 System allows for minimally were cut and contoured using the invasive treatment of adult degenerative tops of the screw extensions as a guide scoliosis, while still achieving satisfactory • The rods were placed percutaneously reconstruction and alignment. The and once in place, VIPER 2 reduction decreased muscle trauma afforded by and compression instruments the system allowed this patient to quickly were used to help correct the return to normal activities without sagittal and coronal alignment compromising long term results. • The total anesthesia time for both stages of the surgery was 4.5 hrs and the blood loss was 150cc’s SYSTEM GUIDE THE CONFIDENCE TO TREAT DEFORMITY WITH AN MIS APPROACH VERSATILE & SECURE CORRECTION SOLUTIONS POWERFUL INTERNAL APPROXIMATION OPTIONS Connection Strength: • Pistol Grip Approximation provides quick, intuitive • V2 Extension & Rod Holder technology are designed rod reduction without bulky external sleeves to withstand the demands of deformity correction • V2 X-Tab Screws offer the simplicity & control of integrated threaded reduction in an ultra-low profile design • V2 extension connection strength allows for 12mm 15mm 22mm vertebral body manipulation before or after rod LOW-PROFILE INSTRUMENT DESIGN insertion • V2 Extensions & X-Tab Screws designs are optimized to reduce instrument crowding and incision size for complex surgery Hex-End Rod Design: V2 X-Tab Screw • Bulleted V2 Hex-End Rod and novel connection V2 Extension feature provide 360º of percutaneous rod rotation control during and after rod placement Competitor S Extension 10 11 PERCUTANEOUS SPINAL TRAUMA TREATMENT USING THE VIPER 2 SYSTEM Trauma Tony Tannoury, MD Boston University, Department of Orthopaedics T R A UM Figure 1: Lateral CT Scan Figure 2: Axial CT of L1 Figure 3: Axial CT of L2 Figure 4: Post-op Lateral Figure 5: Post-op A-P A Radiograph Radiograph History of Present Illness Treatment Method Follow-up Results and Imaging: and Materials: • A 48 year old male construction • An anterior corpectomy was • The patient was ambulating on worker arrived at the ER after performed at L1/ L2 and an 80mm post-operative day three and falling from a three story building mesh cage was inserted into was discharged on day four • The patient was neurologically the space left from T12 to L3 • At the time of discharge, the intact but demonstrated signs • A unilateral anterior EXPEDIUM rod patient reported almost no of bilateral leg weakness and screw construct was inserted posterior muscle pain despite • Imaging revealed L1 and L2 burst laterally from T12 to L3 to support the 5-level instrumentation fractures with a severely compromised the anterior column • At six months post-op, the canal at both levels (Figures 1, 2, & 3) • Nine percutaneous VIPER screws patient was back to normal were placed bi-laterally at every function and had no signs of level from T12 to L4 except adjacent level degeneration or in the left pedicle on L1 post-traumatic alignment issues • Bilateral 120mm VIPER 2 rods were • The patient has no complaints of placed percutaneously starting incisional or muscle pain and the from T12 (Figures 4 & 5) to L4 skin incisions were observed to have • OR time for the posterior portion healed completely at six months of the case was approximately 75 minutes with 75cc of blood The VIPER 2 System’s percutaneous loss and no complications posterior