Aesculap Spine
Aesculap® Mini-Open Retractor SystemSurgical Technique
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Patient Benefits1
Reduced blood lossReduced pain through minimal muscle devitalizationFaster patient recoveryShortened hospital stay
Visualization
Direct visualization to the spine greatly reduces radiation exposureMinimal learning curve due to direct visualization of the anatomical landmarks without fluoroscopic guidance
Minimal Incision
Extended exposure through minimal incision allows for improved implant placement
Versatility
Compress or distract through the Mini-Open Retractor without an additional incision
Indications
FacetectomyDecompressionDiscectomyLumbar fusionTLIF
1 „Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up“ Sanjay S. Dhall, M.D., Michael Y. Wang, M.D., Praveen V. Mummaneni, M.D., December 2008, Volume 9, Number 6, pp. 560-565, Journal of Neurosurgery: Spine.
Aesculap® Mini-Open Retractor SystemSurgical Technique
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Example of use
A) Lumbar minimally invasive approach for facetectomy.
The Aesculap® Mini-Open Retractor System is designed to providepatients all the benefits of Minimally Invasive Surgery (MIS) whileat the same time reduce the surgeons´ learning curve and radiationexposure as compared to percutaneous surgery. When partneredwith S4® Spinal System and TSPACE® interbody fusion device, theAesculap® Mini-Open Retractor System is especially suited to provide patients the benefits of Minimally Invasive Surgery.
B) Minimally invasive approach to the lumbar spine for a posterior lumbar fusion.
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A Surgical Technique
A.1 Muscle Dilatation
A.1.1 Determination of Blade Length
A.2 Retractor Positioning
A.2.1 Cranial-Caudal Blade Assembly
A.2.2 Retractor Insertion
A.2.3 Medial-Lateral Blade Assembly
A.2.4 Final Construct
A.3 Blade Exchange
A.4 Table Fixation
A.5 Lighting
B Instrument Overview
B.1 Blade Components
B.2 Dilator Components
B.3 Retractor Components
B.4 MIS Implant Instruments
B.5 Table Stabilization
B.6 Lighting Components
C Set Configurations
C.1 Blade Set
C.2 Retractor / Dilator Set
C.3 MIS Implant Instrument Set
C.4 Mechanical Table Arm Set
C.5 Lighting Set
Content
Aesculap® Mini-Open Retractor SystemSurgical Technique
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The cranial-caudal blades have a tubular profile and come in 16.5 mm, 20 mm and 24 mm diameters. The incremental dilatorsystem contains corresponding dilators for each blade diameter.
Dilate the spinal muscles starting with the smallest diameterdilator (ME389T) and work up to the diameter of the cranial-caudal retractor blades which are intended to use.
The dilator handle (ME394T) may be attached to each dilator if desired.
A.1 Muscle Dilatation
The dilators (ME389T – ME393T) are marked with depth indicators.The blade depth references reach from 40 mm up to 110 mm in10 mm increments.
After inserting the final dilation diameter, based on the desiredcranial-caudal blade size, reference blade length.
A.1.1 Determination of Blade Length
Aesculap® Mini-Open Retractor SystemSurgical Technique
Before starting the blade insertion the retractor frames have tobe assembled. For this purpose, both frame racks (ME304R) needto be equipped with a corresponding right frame arm and leftframe arm. By pushing the ratchet release, the frame arms can be positioned on the frame rack. The frame configurations are asfollows:
Lower frame:• Frame Rack (ME304R)• Lower Right Frame Arm (ME302R)• Lower Left Frame Arm (ME303R)
Upper frame:• Frame Rack (ME304R)• Upper Right Frame Arm (ME300R)• Upper Left Frame Arm (ME301R)
A.2 Retractor Positioning
Select the lower frame.
Choose the correct blade length and desired diameter from thereference depth of the dilator.
Insert the cranial-caudal blades by loosening the grub screw,engaging the blades into the frame, and then tightening thegrub screw.
A.2.1 Cranial-Caudal Blade Assembly
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Note:Divide the musculotendinous attachments to the underlying boneprior the insertion of the Mini-Open Retractor System.
After attaching the cranial-caudal blades to the frame arms,the retractor is brought into a tubular position by bringing theframe arms together.
The retractor is lowered over the dilators into the wound.
The dilator handle (ME394T) can be positioned to remove thetissue dilators.
Note:Use the smallest diameter tubular retractor blades required toprovide the necessary exposure.
Lateral fluoroscopy can be used to confirm the right placementof the Mini-Open Retractor.
A.2.2 Retractor Insertion
The blades are opened slightly in the cranio-caudal orientationby rotating the keys of the retractor.
Note:Avoid over-retraction at this stage.
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Aesculap® Mini-Open Retractor SystemSurgical Technique
The blades of the lower retractor may be flared to provide thedesired conical field of view.
Insert the arm rotator (ME380R) into the retractor frame armsand rotate the arms towards each other in an inward direction.
Note:Each blade can be adjusted independently to fine-tune the finalplacement of the retractor and to avoid under- and over-retraction. Each blade can be flared up to 30 degree, in 7.5 degree increments.
If additional medial-lateral retraction is needed, a second retrac-tor frame equipped with flat blades is nested onto the first oneat a 90 degree angle.
The medial-lateral blades of the upper retractor may be inser-ted in a similar fashion using the upper frame of the retractor.The upper retractor frame has gold anodization on the collarfor easy identification.
Note:Tilting of the medial blade allows for exposure of the lateralaspect of the lamina for decompression of the lateral recess.Tilting of the lateral blade exposes the transverse processes forposterolateral fusion.
A.2.3 Medial-Lateral Blade Assembly
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Place the upper retractor arm over the lower retractor arm andexpand and flare the upper retractor in a similar fashion as thelower retractor.
A.2.4 Final Construct
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Aesculap® Mini-Open Retractor SystemSurgical Technique
Blade lengths and shapes may be changed in situ through the use of the blade holding instrument (ME381R).
Rotate the knob clockwise in order that the clamping arms ofthe blade removal tool get in initial position.
To remove a blade, insert the blade holding instrument intothe blade notches and rotate the knob counter-clockwise.
Loosen the grub screw of the frame arm and remove the blade.
A.3 Blade Exchange
To insert a new blade, place the new blade in the retractorarm, tighten the grub screw and rotate the blade removal knobclockwise to disengage the tool.
Note:If necessary, to release the force of the soft tissue on the retractorblades, insert the arm rotator (ME380R) into the retractor andpull back on the collar and rotate the arm to the neutral position.Re-inserting the final dilator will hold the soft tissue while theretractor blade is exchanged.
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If desired, the lower arms of the retractor can be attached tothe table arm.
Attach the fixation element (FF280R) to the operating table.
The mechanical holding arm (FF168R) is fixed to the fixationelement by sliding it into its collar.
Attach the table arm connection block (ME382R) to the retractor frame rack (ME304R).
A.4 Table Fixation
Attach table arm connection block (ME382R) to the mechanicalholding arm (FF168R) by sliding the connection block into thecollar and tighten the knob.
The Mini-Open Retractor is now attached to the table armassembly.
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Aesculap® Mini-Open Retractor SystemSurgical Technique
If desired for additional surgical visibility, the re-sterilizablelight rod (ME421R) can be attached to the 24 mm blade usinga light clip.
• Cranial-caudal light clip (ME387R)• Medial-lateral light clip (ME388R)
Attach the re-sterilizable light rod to the flexible light cable(OP922).
Attach the light clip to the corresponding blade by pushing the clip along the guiding groove of the blade until an audiblesound is perceived.
Insert the metallic part of the re-sterilizable light rod into thelight clip.
For additional visibility, the medial blade and the medial-lateral light clip will provide the best visibility.
It is recommended whenever possible to use an Aesculap® LightSource (OP930) or similar light source rated at 300 W or less.
Note:Using a Light Source greater than 300 W will lead to excessiveheating of the light cable and connector.
A.5 Lighting
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Item No. Description Diameter x Blade Length Shape
ME342T Spyder Retractor C/C Blade 40 x 16.5 mm 16.5 x 40 mm Tubular
ME343T Spyder Retractor C/C Blade 50 x 16.5 mm 16.5 x 50 mm Tubular
ME344T Spyder Retractor C/C Blade 60 x 16.5 mm 16.5 x 60 mm Tubular
ME345T Spyder Retractor C/C Blade 70 x 16.5 mm 16.5 x 70 mm Tubular
ME346T Spyder Retractor C/C Blade 80 x 16.5 mm 16.5 x 80 mm Tubular
ME347T Spyder Retractor C/C Blade 90 x 16.5 mm 16.5 x 90 mm Tubular
ME348T Spyder Retractor C/C Blade 100 x 16.5 mm 16.5 x 100 mm Tubular
ME349T Spyder Retractor C/C Blade 110 x 16.5 mm 16.5 x 110 mm Tubular
ME365T Spyder Retractor C/C Blade 40 x 20 mm 20 x 40 mm Tubular
ME366T Spyder Retractor C/C Blade 50 x 20 mm 20 x 50 mm Tubular
ME367T Spyder Retractor C/C Blade 60 x 20 mm 20 x 60 mm Tubular
ME368T Spyder Retractor C/C Blade 70 x 20 mm 20 x 70 mm Tubular
ME369T Spyder Retractor C/C Blade 80 x 20 mm 20 x 80 mm Tubular
ME370T Spyder Retractor C/C Blade 90 x 20 mm 20 x 90 mm Tubular
ME371T Spyder Retractor C/C Blade 100 x 20 mm 20 x 100 mm Tubular
ME372T Spyder Retractor C/C Blade 110 x 20 mm 20 x 110 mm Tubular
ME319T Spyder Retractor C/C Blade 40 x 24 mm 24 x 40 mm Tubular
ME320T Spyder Retractor C/C Blade 50 x 24 mm 24 x 50 mm Tubular
ME321T Spyder Retractor C/C Blade 60 x 24 mm 24 x 60 mm Tubular
ME322T Spyder Retractor C/C Blade 70 x 24 mm 24 x 70 mm Tubular
ME323T Spyder Retractor C/C Blade 80 x 24 mm 24 x 80 mm Tubular
ME324T Spyder Retractor C/C Blade 90 x 24 mm 24 x 90 mm Tubular
ME325T Spyder Retractor C/C Blade 100 x 24 mm 24 x 100 mm Tubular
ME326T Spyder Retractor C/C Blade 110 x 24 mm 24 x 110 mm Tubular
B.1 Blade Components
Aesculap® Mini-Open Retractor SystemInstrument Overview
Cranial-Caudal Blades
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Item No. Description Length Blade Shape
ME327T Spyder Retractor Delta Blade 40 x 7-17 mm 40 mm Delta
ME328T Spyder Retractor Delta Blade 50 x 7-19 mm 50 mm Delta
ME329T Spyder Retractor Delta Blade 60 x 7-22 mm 60 mm Delta
ME330T Spyder Retractor Delta Blade 70 x 7-24 mm 70 mm Delta
ME331T Spyder Retractor Delta Blade 80 x 7-27 mm 80 mm Delta
ME332T Spyder Retractor Delta Blade 90 x 7-29 mm 90 mm Delta
ME333T Spyder Retractor Delta Blade 100 x 7-31 mm 100 mm Delta
ME334T Spyder Retractor Delta Blade 110 x 7-34 mm 110 mm Delta
ME287T Spyder Retractor M/L Blade CVD 40 x 7 mm 40 mm Straight
ME288T Spyder Retractor M/L Blade CVD 50 x 7 mm 50 mm Straight
ME289T Spyder Retractor M/L Blade CVD 60 x 7 mm 60 mm Straight
ME290T Spyder Retractor M/L Blade CVD 70 x 7 mm 70 mm Straight
ME291T Spyder Retractor M/L Blade CVD 80 x 7 mm 80 mm Straight
ME292T Spyder Retractor M/L Blade CVD 90 x 7 mm 90 mm Straight
ME293T Spyder Retractor M/L Blade CVD 100 x 7 mm 100 mm Straight
ME357T Spyder Retractor Delta Blade 40 x 20-26 mm 40 mm Delta
ME358T Spyder Retractor Delta Blade 50 x 20-29 mm 50 mm Delta
ME359T Spyder Retractor Delta Blade 60 x 20-32 mm 60 mm Delta
ME360T Spyder Retractor Delta Blade 70 x 20-35 mm 70 mm Delta
ME361T Spyder Retractor Delta Blade 80 x 20-37 mm 80 mm Delta
ME362T Spyder Retractor Delta Blade 90 x 20-40 mm 90 mm Delta
ME363T Spyder Retractor Delta Blade 100 x 20-43 mm 100 mm Delta
ME364T Spyder Retractor Delta Blade 110 x 20-43 mm 110 mm Delta
ME373T Spyder Retractor M/L Blade CVD 40 x 20 mm 40 mm Straight
ME374T Spyder Retractor M/L Blade CVD 50 x 20 mm 50 mm Straight
ME375T Spyder Retractor M/L Blade CVD 60 x 20 mm 60 mm Straight
ME376T Spyder Retractor M/L Blade CVD 70 x 20 mm 70 mm Straight
ME377T Spyder Retractor M/L Blade CVD 80 x 20 mm 80 mm Straight
ME378T Spyder Retractor M/L Blade CVD 90 x 20 mm 90 mm Straight
ME379T Spyder Retractor M/L Blade CVD 100 x 20 mm 100 mm Straight
B.1 Blade Components
Medial-Lateral Blades
Item No. Description
ME381R Spyder Retractor Blade Handle
Blade Removal
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Item No. Description Diameter
ME389T Spyder Retractor Tissue Dilator 6.0 mm 6 mm
ME390T Spyder Retractor Tissue Dilator 10.0 mm 10 mm
ME391T Spyder Retractor Tissue Dilator 16.5 mm 16.5 mm
ME392T Spyder Retractor Tissue Dilator 20.0 mm 20 mm
ME393T Spyder Retractor Tissue Dilator 24.0 mm 24 mm
ME394T Spyder Retractor Tissue Dilator Handle
B.2 Dilator Components
Aesculap® Mini-Open Retractor SystemInstrument Overview
Item No. Description
ME304R Spyder Retractor Mini-Open Frame Rack
ME300R Spyder Retractor Upper Right Frame Arm
ME301R Spyder Retractor Upper Left Frame Arm
ME302R Spyder Retractor Lower Right Frame Arm
ME303R Spyder Retractor Lower Left Frame Arm
ME380R Spyder Retractor Frame Arm Rotator
B.3 Retractor Components
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Item No. Description
ME299R S4® MIS Set Screw Driver
ME396R S4®/S4® Element MIS Counter Torque Tube
ME307R S4® MIS Compressor
ME308R S4® MIS Distractor
ME309R S4® MIS Counter Torque Handle
ME314R S4® MIS Set Screw Starter
ME395R S4®/S4® Element MIS Clicking Torque Wrench
B.4 MIS Implant Instruments
MIS Implant Instruments Components
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Aesculap® Mini-Open Retractor SystemInstrument Overview
B.5 Table Stabilization
Item No. Description
ME382R Spyder Table Arm Pivot Connection Block
FF168R Holding Arm Mech. 3 Joints RT Adapter
FF280R Adapter F/Or Table W/Ball/Socket Joint
FF169270 Silicone Pad
Item No. Description
OP922 Light Cable, 2.5 mm Diameter, 250 cm Length
ME421R Spyder Reusable Fiber Optic Light Rod
ME387R Spyder Light Clip for Cranial-Caudal Blades
ME388R Spyder Light Clip for Medial-Lateral Blades
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B.6 Lighting Components
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Item No. Description Length Recommended Optional
ME365T 20 mm Cranial/Caudal Blade 40 mm 2
ME366T 20 mm Cranial/Caudal Blade 50 mm 2
ME367T 20 mm Cranial/Caudal Blade 60 mm 2
ME368T 20 mm Cranial/Caudal Blade 70 mm 2
ME369T 20 mm Cranial/Caudal Blade 80 mm 2
ME370T 20 mm Cranial/Caudal Blade 90 mm 2
ME371T 20 mm Cranial/Caudal Blade 100 mm 2
ME372T 20 mm Cranial/Caudal Blade 110 mm 2
ME342T 16.5 mm Cranial/Caudal Blade 40 mm 2
ME343T 16.5 mm Cranial/Caudal Blade 50 mm 2
ME344T 16.5 mm Cranial/Caudal Blade 60 mm 2
ME345T 16.5 mm Cranial/Caudal Blade 70 mm 2
ME346T 16.5 mm Cranial/Caudal Blade 80 mm 2
ME347T 16.5 mm Cranial/Caudal Blade 90 mm 2
ME348T 16.5 mm Cranial/Caudal Blade 100 mm 2
ME349T 16.5 mm Cranial/Caudal Blade 110 mm 2
*S76341 Tray for C/C Blades (16.5 and 20 mm)
C.1 Blade Set
Aesculap® Mini-Open Retractor SystemSet Configurations
Cranial-Caudal Blades (16.5 und 20 mm Diameter)
Item No. Description Length Recommended Optional
ME319T 24 mm Cranial/Caudal Blade 40 mm 2
ME320T 24 mm Cranial/Caudal Blade 50 mm 2
ME321T 24 mm Cranial/Caudal Blade 60 mm 2
ME322T 24 mm Cranial/Caudal Blade 70 mm 2
ME323T 24 mm Cranial/Caudal Blade 80 mm 2
ME324T 24 mm Cranial/Caudal Blade 90 mm 2
ME325T 24 mm Cranial/Caudal Blade 100 mm 2
ME326T 24 mm Cranial/Caudal Blade 110 mm 2
ME381R Spyder Retractor Blade Handle 2
*S76342 Tray for C/C Blades (24 mm)
Cranial-Caudal Blades (24 mm Diameter)
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Item No. Description Length Recommended Optional
ME327T 7 mm Medial/Lateral Delta Blade 40 mm 1
ME328T 7 mm Medial/Lateral Delta Blade 50 mm 1
ME329T 7 mm Medial/Lateral Delta Blade 60 mm 1
ME330T 7 mm Medial/Lateral Delta Blade 70 mm 1
ME331T 7 mm Medial/Lateral Delta Blade 80 mm 1
ME332T 7 mm Medial/Lateral Delta Blade 90 mm 1
ME333T 7 mm Medial/Lateral Delta Blade 100 mm 1
ME334T 7 mm Medial/Lateral Delta Blade 110 mm 1
ME287T 7 mm Medial/Lateral Straight Blade 40 mm 1
ME288T 7 mm Medial/Lateral Straight Blade 50 mm 1
ME289T 7 mm Medial/Lateral Straight Blade 60 mm 1
ME290T 7 mm Medial/Lateral Straight Blade 70 mm 1
ME291T 7 mm Medial/Lateral Straight Blade 80 mm 1
ME292T 7 mm Medial/Lateral Straight Blade 90 mm 1
ME293T 7 mm Medial/Lateral Straight Blade 100 mm 1
ME373T 20 mm Medial/Lateral Straight Blade 40 mm 1
ME374T 20 mm Medial/Lateral Straight Blade 50 mm 1
ME375T 20 mm Medial/Lateral Straight Blade 60 mm 1
ME376T 20 mm Medial/Lateral Straight Blade 70 mm 1
ME377T 20 mm Medial/Lateral Straight Blade 80 mm 1
ME378T 20 mm Medial/Lateral Straight Blade 90 mm 1
ME379T 20 mm Medial/Lateral Straight Blade 100 mm 1
ME357T 20 mm Medial/Lateral Delta Blade 40 mm 1
ME358T 20 mm Medial/Lateral Delta Blade 50 mm 1
ME359T 20 mm Medial/Lateral Delta Blade 60 mm 1
ME360T 20 mm Medial/Lateral Delta Blade 70 mm 1
ME361T 20 mm Medial/Lateral Delta Blade 80 mm 1
ME362T 20 mm Medial/Lateral Delta Blade 90 mm 1
ME363T 20 mm Medial/Lateral Delta Blade 100 mm 1
ME364T 20 mm Medial/Lateral Delta Blade 110 mm 1
*S76343 Tray for Medial/Lateral Blades
C.1 Blade Set
Medial-Lateral Blades
* Recommended container for blade sets (all 3 sets together): bottom JK446 and lid JK489 (for single set): bottom JK440 and lid JK489
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Item No. Description Length Recommended Optional
ME300R Spyder Retractor Upper Right Frame Arm 1
ME301R Spyder Retractor Upper Left Frame Arm 1
ME302R Spyder Retractor Lower Right Frame Arm 1
ME303R Spyder Retractor Lower Left Frame Arm 1
ME304R Spyder Retractor Mini-Open Frame Rack 2
ME380R Spyder Retractor Frame Arm Rotator 2
ME389T Spyder Retractor TI Tissue Dilator 6 mm 1
ME390T Spyder Retractor TI Tissue Dilator 10 mm 1
ME391T Spyder Retractor TI Tissue Dilator 16.5 mm 1
ME392T Spyder Retractor TI Tissue Dilator 20 mm 1
ME393T Spyder Retractor TI Tissue Dilator 24 mm 1
ME394T Spyder Retractor Tissue Dilator Handle 1
*S76340 Tray for Retractor/Dilator Set
C.2 Retractor / Dilator Set
Aesculap® Mini-Open Retractor SystemSet Configurations
Item No. Description Recommended Optional
ME299R S4® MIS Set Screw Driver 1
ME396R S4® MIS Counter Torque Tube 1
ME307R S4® MIS Compressor Handle 1
ME308R S4® MIS Distractor Handle 1
ME309R S4® MIS Counter Torque Handle 1
ME314R S4® MIS Set Screw Starter 1
ME395R S4® Clicking Torque Wrench 1
*S76344 Tray for MIS Implant Instrument Set
C.3 MIS Implant Instrument Set
* Recommended container: bottom JK440 and lid JK489
* Recommended container: bottom JK440 and lid JK489
Item No. Description Recommended Optional
ME382R Spyder Table Arm Pivot Connection Block 1
FF168R Mechanical Holding Arm 1
FF280R Flexible Fixation Element (3-D Arm Table Connector) 1
FF169270 Silicone Disc 1
*S76345 Tray for Mechanical Table Arm Set
C.4 Mechanical Table Arm Set
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Item No. Description Recommended Optional
OP922 Light Cable, 2.5 mm Diameter, 250 cm Length 1
ME421R Spyder Reusable Fiber Optic Light Rod 1
ME387R Spyder Light Clip for Cranial-Caudal Blades 1
ME388R Spyder Light Clip for Medial-Lateral Blades 1
*S76346 Tray for Lighting Set
C.5 Lighting Set
* Recommended container: bottom JK740 and lid JK789
* Recommended container: bottom JK440 and lid JK489
Aesculap AG | Am Aesculap-Platz | 78532 Tuttlingen | GermanyPhone +49 7461 95-0 | Fax +49 7461 95-2600 | www.aesculap.com
Aesculap – a B. Braun company
Subject to technical changes. All rights reserved.This brochure may only be used for the exclusivepurpose of obtaining information about ourproducts. Reproduction in any form partial orotherwise is not permitted.
The main product trademark ‘Aesculap’ andthe product trademarks ‘TSPACE’ and ‘S4’ areregistered marks of Aesculap AG.
Brochure No. O57002 0815/1/1