Johnson & Johnson DePuy Synthes INSIGHT Lateral Access System User manual

Surgical Technique
Minimal Invasive Access System for the Thoracolumbar Spine
INSIGHT™ Lateral
Access System

Image intensifier control
This description alone does not provide sufficient background for direct use
of DePuy Synthes products. Instruction by a surgeon experienced in handling
these products is highly recommended.
Processing, Reprocessing, Care and Maintenance
For general guidelines, function control and dismantling of multi-part
instruments, as well as processing guidelines for implants, please contact your
local sales representative or refer to:
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
For general information about reprocessing, care and maintenance of Synthes
reusable devices, instrument trays and cases, as well as processing of Synthes
non-sterile implants, please consult the Important Information leaflet
(SE_023827) or refer to:
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

INSIGHT Lateral Access System Surgical Technique DePuy Synthes 1
Introduction INSIGHT™ Lateral Access System 2
Description of Retractor Parts 4
AO Spine Principles 5
Indications and Contraindications 6
Surgical Technique Preparation 7
Access and Exposure 9
Retraction 14
Accessories 25
Removal 32
Product Information Cleaning Positions/Assembly 36
Instruments 44
Instruments for Neuromonitoring 48
Trays and Vario Cases 49
Bibliography 50
Table of Contents

2 DePuy Synthes INSIGHT Lateral Access System Surgical Technique
INSIGHT™ Lateral Access System
The INSIGHT™ Lateral Access System is a comprehensive
modular system designed to support the minimal inva-
sive approach to the spine.
X-Ray Visibility:
• Key parts are semi radiolucent (alumi-
num) for  uoroscopic visualization
• Radiolucent carbon fi ber handles
to avoid interference during anterior/
posterior  uoroscopy
Low Profile Accessories:
• In blade embedded accessories designed
to enhance surgeon view
• Winglets to provide further 7 mm
anterior/posterior soft tissue retraction
• Blade extensions to provide additional
10 mm of blade length in situ
• Disc anchor blade designed to increase
retractor stability

INSIGHT Lateral Access System Surgical Technique DePuy Synthes 3
Retractor Blades:
• Click-on blades for
quick assembly
• Blade length 40 to
180 mm
Independent Angulation:
Individual left and right blade
angulation up to 20°
Seamless Retraction:
Speed nut designed
for quick and fi ne
adjustment of
retractor opening
up to 70 mm
Different Retraction Techniques:
Various fi xation points to strong arm
system are designed to enable surgeon
preferred technique:
• Backward retraction of third blade
(fi xation to retractor body)
• Forward retraction of left-right blades
(fi xation to third blade holder)
Light System:
• Light accessory to illumi-
nate the surgical fi eld
• Disposable light with ad-
justable depth

4 DePuy Synthes INSIGHT Lateral Access System Surgical Technique
Description of Retractor Parts
Attachment point for connector for
Strong Arm for forward retraction
Attachment point for connector for
Strong Arm for backward retraction
Speed nut
RETRACT nut
PUSH button
Third blade holder
Left blade holder
Left and right
blade
Right
blade
holder
Angulation nuts
Accessory
grooves
Light
slot

coronal
axial
sagittal
1Aebi et al (1998)
2Aebi et al (2007)
INSIGHT Lateral Access System Surgical Technique DePuy Synthes 5
The four principles to be considered as the foundation for
proper spine patient management underpin the design
and delivery of the Curriculum: Stability – Alignment–
Biology – Function.1,2
AO Spine Principles
Stability
Stabilization to achieve
a specifi c therapeutic out-
come
Biology
Etiology, pathogenesis,
neural protection,
and tissue healing
Copyright © 2012 by AOSpine
Alignment
Balancing the spine in
three dimensions
Function
Preservations and resto-
ration of function to pre-
vent disability

6 DePuy Synthes INSIGHT Lateral Access System Surgical Technique
Indications and Contraindications
Intended Purpose
The INSIGHT Lateral Access System is a surgical access
system intended to provide a minimally invasive ap-
proach to the thoracolumbar spine. It is designed for
needs of various indications and/or surgical techniques.
Indications and Contraindications
In case the INSIGHT Lateral Access System is used in
combination with implants or instruments, please refer
to the respective surgical techniques for indications and
contraindications and additional surgical steps.

1
INSIGHT Lateral Access System Surgical Technique DePuy Synthes 7
Preparation
1. Patient Positioning
Instruments
03.662.028S Electrode Kit for Neuromonitoring
03.809.942 Table Clamp for Universal Arm
03.816.800 Strong Arm
or
03.809.941 Universal Arm
For the lateral approach, the patient is placed and taped
in the lateral decubitus position as illustrated (1).
Note: Ensure that the position of the operative level
is perpendicular to the oor for easier orientation of
uoroscopy and approach by conrming:
• In lateral uoroscopy, the endplates are parallel
with superimposed pedicles.
• In A/P uoroscopy, the endplates are parallel, the
pedicles reside in the cranial portion of the verte-
bral body and the spinous process is equidistant
to both pedicles.
For further information, please refer to the dedicated
implant surgical techniques. If neuromonitoring is being
used, refer to the respective neuromonitoring surgical
technique.
Precaution: A thorough education and a compre-
hensive understanding of the respective anatomy
as well as practical experience in performing
the lateral approach to the thoracolumbar spine
is a prerequisite for use of this system.

2
8 DePuy Synthes INSIGHT Lateral Access System Surgical Technique
2. Set Up Strong Arm System
Install table clamp onto the preferred side of the operat-
ing table by loosening it and attaching it onto the table
rail. Insert the strong arm or universal arm with at side
facing away from the table (2). Secure table clamp by
tightening it.
Precaution: Ensure that the rotation of the strong
arm or universal arm is securely locked by the
table clamp.
Preparation