Becker's Spine Review

10 EXECUTIVE BRIEFING 2 EXECUTIVE BRIEFING SPONSORED BY Two Neurosurgeons and Their Thoughts on Medtronic's CD Horizon™ ModuLeX™ 5.5 Spinal System M edtronic's CD Horizon™ ModuLeX™ 5.5 Spinal System has been developed as a headless in-situ modular attachment solution to offer increased visualization of the surgical working area compared to a pre-assembled screw, and the ability to intraoperatively assemble solutions to meet a wide variety of treatment goals. The CD Horizon™ ModuLeX™ 5.5 Spinal System is compatible with all 5.5 rods within the CD Horizon™ product family and is integrated for use with Medtronic's advanced surgical technologies, including O-arm™ imaging, StealthStation™ navigation systems and Powerease™ System. This interview is conducted with Daniel Spomar, MD (Section Chief of Neurosurgery at Franciscan Health Indianapolis and Staff Neurosurgeon at Goodman Campbell Brain and Spine) and Joseph Osorio, MD, PhD (Assistant Professor of Neurological Surgery, Director, Spinal Oncology and Deformity Surgery, UC San Diego Health). They were asked 5 questions about how they use ModuLeX™ 5.5 in their practice and the benefits they have seen from it. Doctors Spomar and Osorio are paid consultants for Medtronic. What benefits does ModuLeX™, a modular screw system, bring to your OR? Dr. Spomar: "The main benefit of the ModuLeX™ 5.5 modular screw system is having the ability to place my screws first with navigation, then easily work around the screws. This includes being able to do a precise decompression and decortication of bone structures, the facet joints, and transverse processes without any interference from the tulip heads," which can occur with a preassembled system. Additionally, "the ModuLeX™ 5.5 system provides for excellent low-profile distraction of the screws while performing interbody work. After the decompression, decortication and fusion is performed, the tulip heads and rods can be placed." Dr. Osorio: "ModuLeX™ 5.5 is a great platform for utilization with the Mazor™ Robot platform system, it is the reason why I introduced it into my practice. I was seeking a platform that would allow me versatility to place a pedicle screw without the inconvenience of the tulip head causing a physical obstruction to the bone work within a surgical plan; this would include osteotomies, decompression, and decortication. Prior to ModuLeX™ if I needed to perform osteotomies, I simply would not place screws with tulip heads prior to my bone work, and this would not allow the workflow of utilizing my preoperative planned screws. ModuLeX™ allows the surgeon to place the screw early in a case and use the workflow of preoperative CT planning to intraoperative X-ray registration within the Mazor™ platform, which I feel is a major advantage in OR time efficiency. Additionally, it allows the streamline capability for the tech assisting the surgeon to simply focus on the shank size and this limits the implant bandwidth for the tech making workflow efficiencies at the time of screw placement. In the near future, there will be other options that span beyond the current tulip head capabilities." In what type of procedures do you use ModuLeX™ 5.5? Dr. Spomar: "I use the ModuLeX™ 5.5 modular screw system for all instrumented thoracic and lumbar cases. The system is especially helpful when performing a mini open, 'midlif' approach for lumbar fusion. With a small working space, there is no interference from the tulip heads while performing the procedure." Dr. Osorio: "At this time I use ModuLeX™ 5.5 for all my degenerative spine cases because I find that within a limited corridor it is beneficial to have a shank that will allow for unobstructed decortication of the transverse processes, interbody placement, and decompression. The open TLIF has been a case that has easily benefited from this new platform in my cases, and this has allowed me to maintain a smaller incision without the common struggles that come from working in a small corridor. Additionally, in an educational setting with resident and fellow surgeons the screw shanks provide a critical landmark with the pedicle being highlighted and this aspect is very navigating to the assistant surgeon. I have also incorporated it into the adult spinal deformity cases because it allows the capability to place pedicle shank in revision settings around pre-existing hardware in regions that do not have prior screws placed within a limited corridor where a tulip system would have been limited because of prior hardware. In addition to the above traditional approaches, I find that I am using the cortical screw trajectory for cases that are single level in deeper patients allow not only a limited incision, but this also comes with the added benefit that an adequate limited working corridor in a larger patient provides a smaller incision which is better for the higher risk patient - especially for wound healing."

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