Surgical Technique

A. Positioning and Approach

• Place the patient in a supine position, stabilizing the cervical spine appropriately.
  
  
• Confirm positioning and vertebral levels to be visualized via fluoroscopy.
  
  
• Perform a standard surgical exposure of the anterior cervical spine.

B. Disc space and end plate preparation

• Perform a discectomy, removing disc material and cartilage from the endplates (Figure 1).
  
  
• Remove vertebral osteophytes to ensure a proper fit of both the graft and instruments.

• Distract the intervertebral space to optimize sagittal alignment. A variety of techniques and standard instruments, such as pin distraction, may be used to facilitate distraction.
  
  
• Select an appropriate size graft that is large enough in diameter to penetrate both the superior and the inferior endplates by at least 1.5mm each (Figure 2).
  
  
• Center the corresponding Sleeve over the intended disc space.
  
  
• Place the Sleeve Cap over the end of the Sleeve and use a light mallet to gently tap the Sleeve into place (Figure 3). Be sure that the base of the Sleeve is flush with the anterior cortex (Figure 4).

Figure 3 Figure 4

• Insert the appropriate Reamer through the Sleeve (Figure 5). Turn the Reamer clockwise to prepare a hole at least 12 mm deep (Figure 6). Stops on the Reamer prevent advancement of the instrument beyond 14.0 mm.

E. Tap Graft Site

• Insert the appropriate Tap through the Sleeve. Thread the full depth of the hole by turning the Tap in a steady clockwise motion (Figure 7). Do not over advance the tap since this will strip the threads.
  
  
• Remove the Tap by gently turning counter-clockwise.

F. Graft Insertion

• Rehydrate the Graftech^® Cervical Dowel as directed. Tip: Grafton® DBM Gel may be infused into the dense, cancellous graft to promote bone healing.
  
  
• Place the graft firmly on the Inserter by sliding the two Inserter prongs into the holes on the face of the Graftech^® Cervical Dowel.
  
  
• Gently thread the graft into the prepared host bone (Figure 8). Do not force the graft or thread beyond the depth of the prepared hole, as this will strip the threads or damage the graft.
  
  
• Final position of the graft should be flush or recessed approximately 1-2 mm from the anterior cortex of the vertebral body (Figures 9 & 10). The holes on the graft face do not need to be in any particular alignment.
  
  
• Remove the Inserter from the graft by pulling it out along the axis of the graft.

G. Closure

• Perform wound closure in the customary
  manner.