VERTEBRIS lumbar

VERTEBRIS stenosis

VERTEBRIS cervical

Equipment Unit

Trans-/ extraforaminal technique

The trans- or extraforaminal technique uses the intervertebral foramen as access to the pathology. The access to the intervertebral disk through the intervertebral foramen (transforaminal) or pedicle (extraforaminal) is placed under X-ray control with a puncture cannula. After dilation and insertion of the working sleeve, further surgery is performed through the diskoscopes under continuous irrigation with high-resolution endoscopic imaging.

Precision instruments such as forceps, punches, electrodes and burrs with a special design enable the surgeon to perform the surgery effectively and accurately.

VERTEBRIS transforaminal

• High-resolution diskoscopes with working length for posterolateral and lateral transforaminal approach.
• Optimized ratio of large working channel to outside diameter for minimal invasive access and effective operation.
• Optimized fluid management by sophisticated dimensioning of in and outflow  - Prevention of neural compression by high pressures of the irrigation fluid.
• Work Sleeves with atraumatic distal design to protect neural structures.
• Stable grasping forceps and punches for effective soft tissue and bone resection with overload protection.
• Endoscopic high-speed drilling system with reusable and disposable tools for mechanical bone and soft tissue resection. 
• Tipcontrol instruments for 4 MHz radiofrequency coagulation and ablation. 

Interlaminar technique

In interlaminar surgery, the access to the spinal canal is done via the posterior interlaminar window. The dilator is guided directly to the flavum ligament with a dilator without prior puncture. After placing the working sleeve over the dilator, the operation is performed through the high-resolution diskoscope under continuous irrigation. The functionality of the components of the access system and the instruments are precisely coordinated and allow to pass through the ligamentum flavum and the nerve root with minimal traumatization.

With special manual instruments and a variety of high-speed burrs available, herniated discs can be effectively removed and bone parts of spinal stenoses can be resected under a full-endoscopic view.

VERTEBRIS interlaminar

• High resolution discoscopes with shorter working length for interlaminar approach.
• Endoscope adapter to control the distance between endoscope and working sleeve for more ergonomic work.
• Optimized ratio of large working channel to outside diameter for minimal invasive access and effective operation.
• Optimized fluid management by optimizing in- and outflow  - Prevention of compression of neural structures by high pressures of the irrigation fluid.
• Working Sleeves with atraumatic distal design to protect neural structures.
• Stable grasping forceps and punches with shorter working length for interlaminar approach with overload protection.
• Endoscopic high-speed drill system with reusable and disposable tools for mechanical bone and soft tissue resection for lateral recess stenoses.
• Tipcontrol instruments for 4 MHz radiofrequency coagulation and ablation.

Interlaminar technique

In interlaminar surgery, the access to the spinal canal is done via the posterior interlaminar window. The dilator is guided directly to the flavum ligament with a dilator without prior puncture. After placing the working sleeve over the dilator, the operation is performed through the high-resolution diskoscope under continuous irrigation. The functionality of the components of the access system and the instruments are precisely coordinated. It even allows to pass through the ligamentum flavum and the nerve root with minimal traumatization.

With special manual instruments and a variety of high-speed burrs available, bone parts of spinal stenoses can be resected under a full-endoscopic view.

VERTEBRIS stenosis

• High resolution 4K endoscopes with shorter working length and increased irrigation rate for full-endoscopic interlaminar approach stenosis surgery.
• Endoscope adapter to control the distance between endoscope and working sleeve for more ergonomic operation.
• Optimized ratio of large working channel (5.6 mm) to outside diameter (10.5 mm) for least invasive access trauma and highly effective operation.
• Fluid management optimized by engineered dimensioning of inflow and outflow preventing neural compression by high pressures of the irrigation fluid.
• Working Sleeves with atraumatic distal design to protect neural structures.
• Stable grasping forceps and punches with overload protection and shorter working length for interlaminar approach.
• Large diameter (5.5 mm) bone punches and Kerrison punches for rapid and precise manual bone removal.
• Endoscopic high-speed drill system with a variety of large diameter reusable and disposable burrs for mechanical bone resection of laminae and facet.
• TipControl instruments for 4 MHz radiofrequency coagulation and ablation, and hollow tip RF probes for large scale tissue coagulation and ablation. 

Ipsilateral decompression on one side

After the access has been created, the bony structures are exposed. It may be helpful to start decompression at the caudal end of the descending facet. Depending on the pathology, decompression is then commenced with resection of parts of the medial descending facet, the cranial and caudal lamina, and the ligamentum flavum. The extent of decompression generally continues cranially at least until the tip of the ascending facet and caudally to half of the pedicle. The medial portions of the ascending facet and the ligamentum flavum are then resected until sufficient decompression of the neural structures can be clearly seen - cranially, caudally and laterally. In the case of a central stenosis, the ligamentum flavum generally needs to be resected medially to the midline. Finally, it may be necessary to remove protruding annulus parts and osteophytes in the ventral epidural space.

Contralateral decompression in over-the-top technique

If bilateral symptoms occur with a central stenosis, a unilateral approach is carried out with "over-the-top" access using the undercutting technique to the opposite side. For this purpose, bone in the ventral area of the spinous process is resected until the contralateral side can be accessed dorsally up to the dura of the spinal cord. If possible, the ligamentum flavum is initially left in place to protect the dura and bony decompression is again carried out by laminotomy and partial facetectomy. The ligamentum flavum is then completely resected. Finally, the contralateral recess needs to be extended. The decompression is completed when the dura and the spinal nerves have been clearly decompressed.

An extended and uninterrupted excessive retraction of the neural structures with the working sleeve in a medial direction must be avoided particularly in cranial areas, or only carried out intermittently, in order to avoid the risk of neurological damage. Experience indicates that as with all new techniques there is generally an enhanced risk of problems occurring during the learning curve.

Posterior technique

The posterior cervical instrument system includes a specially designed instrument set and a well defined, repeatable, technique for the posterior approach to the cervical spinal canal. The instrumentation includes bone burrs that give the surgeon the ability to perform bone resection under visualization in the area of the foramen, the uncinate process or the posterior edge of the spinal column.

Since the cervical spinal cord cannot be manipulated, the posterior approach is limited to herniations where the main portion of the herniation is localized laterally to the lateral edge of the spinal cord. Under the proper indications, the posterior cervical system provides an excellent endoscopic alternative to open techniques.

VERTEBRIS cervical posterior

• High resolution endoscopes with shorter working length for full-endoscopic posterior approach.
• Optimized ratio of large working channel (3.1mm) to outside diameter (7mm) for minimal invasive access and effective operation.
• Fluid management optimized by engineered dimensioning of inflow and outflow preventing neural compression by high pressures of the irrigation fluid.
• Working Sleeves with atraumatic distal design to protect neural structures.
• Stable grasping forceps and punches with shorter working length and overload protection for posterior approach.
• Endoscopic high-speed drill system with reusable and disposable tools for mechanical bone and soft tissue resection for cervical foraminotomy.
• TipControl instruments for 4 MHz radiofrequency coagulation and ablation. 

Anterior technique

Herniations presenting with their main portion located medially to the lateral edge of the spinal cord are regarded as indications for an anterior approach to the cervical spine. The anterior cervical system includes a custom designed dilator-sleeve system which interfaces with a unique cervical endoscope, as well as specialized instrumentation, to provided excellent access to the posterior disc area. The full-endoscopic anterior cervical approach provides a significantly less traumatic alternative to conventional surgery.

VERTEBRIS cervical anterior

• Special access system with oval working sleeves to minimize the outer diameter and intradiscal trauma.
• High resolution endoscopes without integrated working channel for full-endoscopic anterior cervical approach.
• Endoscope adapter to control the distance between endoscope and working sleeve for more ergonomic work.
• Fluid management optimized by engineered dimensioning of inflow and outflow preventing neural compression by high pressures of the irrigation fluid.
• Stable forceps up to 3mm diameter and punches with overload protection for effective soft tissue and bone resection.
• Endoscopic high-speed burr system with reusable and disposable tools for mechanical bone and soft tissue resection.
• TipControl instruments for high frequency coagulation.
• TipControl instruments for 4 MHz radiofrequency coagulation and ablation. 

Radiofreqency surgical system

The Radioblator RF4 Radiofrequency Generator with a working frequency of 4 MHz is the centerpiece of an effective tissue-preserving coagulation system. By comparison with standard radiofrequency devices supplied commercially in the marketplace, the electricity frequency of the Radioblator RF4 is approximately 10 times higher.

While safe coagulation and ablation of the tissue can be achieved at the electrode through contact with the tissue, neighboring areas of tissue experience significantly less heat. The occurrence of thermally induced tissue necrosis and irritations in adjacent nerves are thereby minimized. The actively articulating TipControl RF Electrode facilitates the controlled posi-tioning of the radio frequency application in the tissue.

Burr & Shaver system

The expansion of indications for full-endoscopic techniques to treat conditions ranging from disk herniations to bony spinal canal stenosis requires efficient bony and soft-tissue resection. The powerful PowerSpeed AS1, M5 motor and High-speed handpieces, and associated burrs and resectors meet this requirement.

A wide range of sterile and reusable burrs are available for every application and every surgical need. Several innovative burrs and shavers have been developed specifically as integral parts of many of the VERTEBRIS instrument sets.

Fluid managment

FLUID CONTROL Arthro is a new pump system for arthroscopy and full-endoscopic spine surgery. The particular strength of this system consists of a combination of high performance and cost-effective overall concept. The new software and technical enhancements make FLUID CONTROL Arthro ideal for interventional and surgical procedures.

The particularly refined control quickly equalizes the pressure but also recognizes abrupt interruptions in the irrigation flow, for example by blocking the outflow on the endoscope. Optical and acoustic alerts are given when critical overpressures occur.

Endoscopic imaging

We define a new quality of imaging in full-endoscopic spine surgery. With Richard Wolf camera systems, very small and fine structures can be clearly identified and differentiated.

Recognizing details is important for spine surgery. A clear, meaningful picture to identify structures is the prerequisite for a safe surgery. Thanks to state-of-the-art video technology, Richard Wolf's camera systems make the finest structures appear clearly.