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Cessys Product User Guide PDF
Cessys Product User Guide PDF
Cessys Product User Guide PDF
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3 INTRODUCTION
4 CONCEPT
5 INSTRUMENTS
6 INDICATIONS
9 ACCESS PLANNING
10 ACCESS
13 DECOMPRESSION
15 NOTES
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Advantages
This procedure can be performed with the patient under general anesthesia or monitored
anesthesia care (MAC). MAC greatly reduces the risks associated with general anesthesia
and has the added benefit of immediate patient feedback if contact is made with the neural
structures. This procedure is performed with the patient in the supine position.
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Working tubes
outer diameter 5 mm
working length 100 mm
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Radiographic Indications
Soft disc herniations which are clearly visible on computed tomography
(CT) or magnetic resonance imaging (MRI).
Contraindications
Dried or sequestered disc herniations
Significant ossification of the posterior
longitudinal ligament (PLL)
Cervical stenosis
Cervical spondylosis
Segmental instability
Other pathological conditions such as:
fractures, tumors or active infections
Bone spurs or osteophytes greater than 2 mm
Any hindrance of radiographic visualization during
the procedure (i.e. obstructed lateral imaging of
C6/7 and C7-T1)
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Diagnosis Confirmation
Confirm the diagnosis and treatment of cervical disc disease as indicated for endoscopic spine
surgery in accordance with the guidelines of your country.
Preoperative Planning
Determine the precise herniation location via sagittal and axial MRI imaging prior to
access with the CESSYS instrumentation. The images should be consistent with the clinical
diagnosis and current symptoms and no more than three months old. In addition, preoperative
films (lateral and A/P) should be available.
Anesthesia
The CESSYS procedure can be performed under MAC or general dependent upon patient
toleration. Recommendations can be found in the joimax brochure, "Anesthesia Options".
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Access Planning
Determine the precise herniation location via sagittal and axial MRI imaging prior to access
with the CESSYS instrumentation.
Anatomical landmarks are identified and marked for optimal access planning. It is helpful to
identify and mark the chin at midline, sternal notch, larynx, directional line of the sternocleido-
mastiod muscle and both clavicles. Under fluoroscopic view, mark the intervertebral disc line
at the level to be treated.
1
4
2 5
3
Marking lines on the patient; Sagittal MRI of the herniated C3/4 intervertebral
1. Clavicle 2. Sternum 3. Larynx disc
4. Sternocleidomastoid Muscle 5. Midline
Note
Provides case manner and to uniquely identify the nucleus tissue a Chromographie with indigo
After insertion of the 18G needle, discography with Indigo Carmine, provides clear identification
of nuclear tissue (see page 11).
Discography
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Access
The ventral neck is palpated via the middle and index
fingers (see right). The esophagus and the trachea are
manually displaced medially and the neurovascular
bundle laterally.
To avoid risk of injury to the vertebral arteries and spinal nerves, is important to ensure the
access to the intervertebral disc space is not positioned too far laterally. In the correct position,
the needle tip should be positioned at the dorsal edge of the annulus and directed toward the
pathology. The stylet of the needle is removed and the guide wire is then inserted through the
needle. The needle is removed and the guide wire position is maintained.
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An incision of approximately 0.5 cm is made prior to sequential dilation. The guiding rod and
the guiding tube are then inserted over the guide wire.
The instrument tip is located directly before the herniation, but still within the intervertebral
disc. Over the guiding tube the appropriate working tube is pushed (5.0 mm OD). Depending on
the location of the pathology can be made between three different tip configurations. In the
lateral X-ray the tip of the working tube is pushed gently to the posterior vertebral body edge.
The internal instrument are now removed.
There are three variations of the working tube which are selected according to the location of
the disc herniation and the structures to be protected.
Fenes
trated
Work
ing Tube,
45
Rinsing Outflow
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In many cases, bone removal may be necessary in order to reach the pathology. Various
instruments are available to achieve this. The longitudinal ligament and annulus may also
need to be opened dependent upon the diagnosis and location of the herniation.
For central herniations, the tip of the working tube should be directed toward midline
under A/P fluoroscopic control.
For transforaminal herniations, the tip of the working tube should be directed toward the
affected foramen in the A/P fluoroscopic view.
The distal tip of the working tube should never extend beyond the edge of the
vertebral body edge, posteriorly.
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Intraoperative Diagnosis
During the surgery, the correct position of the instruments must be checked by radiation moni-
toring (X-rays lateral and ap) and to document if necessary.
The compressive tissue and fragments can be removed through the annulus
with various forceps. It is important to ensure the spinal cord and nerve
roots are not injured during decompression.
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Sufficient decompression may be confirmed through visualization of the freed nerve root or
pulsation of the dura.
Patients under MAC anesthesia may verbally indicate absence of pain and symptomatic relief
during the procedure.
Wound Closure
At the end of the procedure, con-
firm in the disc space the ab-
sence of retained fragments.
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Notes
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joimax, TES, TESSYS, iLESSYS, CESSYS, PeNuts, Vitegra, EndoLIF, Vitegra, Camsource,
Shrill, Versicon, Endovapor, Vaporflex, Legato, Kyverment, Tigrip and SPOT are registered
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CAUTION: U.S. FEDERAL LAW RESTRICTS THIS DEVICE TO SALE BY OR ON THE ORDER OF A PHYSICIAN