Colibri II - Power For Spine

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Colibri II - Power For Spine

Philip Horsting, Jean Ouellet

The Expedium 5.5 Power Instrument Set is designed to augment the current instrument set for the Expedium 5.5 implant family of products in three main areas:

Enhanced surgeon ergonomics and health
Speed and efficiency
Safety and accuracy

Details
Instruments
Clinical Cases
Videos
Disclaimer

It is a well-known fact that spinal deformity surgeries are long procedures with repetitive forceful maneuvers often in a less than ideal ergonomic position. Such repetitive tasks lead to chronic overuse injury. Auerbach [1] quantified the type of work-related injuries that spine surgeons experienced over their careers (Table 1).

The conclusion that can be derived from research such as in Table 1 is that compared with disease estimates in the general population, spine surgeons have a higher prevalence of MSDs.

The instrument length in the Expedium 5.5 Power Instrument Set is designed to improve surgeon ergonomics and provides a more comfortable shoulder and torso positioning during surgical procedures. Additionally, the powered hand piece reduces the number of repetitive motions that can lead to surgeon fatigue or overuse injuries.

Improving ergonomics as well as decreasing the repetitive motions of the upper extremity would indeed improve the health of operating clinicians.
There is a growing need for surgeons to adapt their practice to incorporate better ergonomics. This can be achieved with good training programs and attaining a good understanding of the risks and benefits of using power in spine surgery.

Table 1 Operating clinicians at the Scoliosis Research Society were surveyed to assess the prevalence of musculoskeletal disorders (MSDs) among spine surgeons. The most common self-reported diagnoses included: neck pain/strain/spasm (38%, 215/561), lumbar disc herniation/radiculopathy (31%, 172/561), cervical disc herniation/ radiculopathy (28%, 155/561), rotator cuff disease (24%, 134/561), varicose veins or peripheral edema (20%, 112/561), and lateral epicondylitis (18%, 99/561). Among active spine surgeons, multiple linear regression analysis revealed that total caseload correlated with neckpain (P = 0.01) and lower extremity edema (P = 0.03), while the number of deformity cases correlated with wrist pain (P =0.003) and hand pain (P = 0.03). Age was correlated with shoulder (P = 0.03), elbow (P = 0.04), and hand pain (P = 0.02).

Speed and efficiency

The application of powered instruments also offers potential timesaving for each screw implant. The greatest cumulative benefit is expected during deformity procedures.

Safety and accuracy

The power hand piece is designed to facilitate steadier hand positioning during pedicle preparation and screw delivery, potentially reducing the off-axis motion associated with manual pedicle preparation and screw delivery.

Seehausen [2] showed that the use of power tools to create pedicle tracts and place pedicle screws was associated with shorter fluoroscopy times and a lower revision rate compared with using manual tools. He showed that both techniques posed similar low risks of injury to the patient.

Power drilling also guarantees high accuracy of the navigation system
as low downward forces are applied to the spine.

Comparison of surgeon posture using manual and powered instruments

During pedicle preparation and screw delivery, powered instrumentation allows the surgeon to maintain a low shoulder position, an elbow position close to the torso, and decreases the amount of lateral bending often seen when using manual instrumentation (Figs 1 and 2). Maintaining alignment to the torso while minimizing the extension of the
upper extremities provides an opportunity to reduce muscle recruitment and surgeon fatigue. Similarly, using powered instruments reduces the number of repetitive motions required during spine surgery, reducing energy expenditure and decreasing the potential for musculoskeletal disorders associated with overuse [1].

Fig 1a-b Comparison of shoulder height and elbow position: a Manual; b Powered instruments.

Fig 2a-b Comparison of spine lateral bend and elbow lift: a Manual; b Powered instruments.

References

Auerbach JD , Weidner ZD, Milby AH, et al. Musculoskeletal disorders among spine surgeons-results of a survey of the Scoliosis Research Society Membership. Spine. 2011 Dec; 36(26):e17151721.
Seehausen DA, Skaggs DL, Andras LM, et al. Safety and efficacy of powerassistedpedicle tract preparation and screw placement. Spine Deformity. 2015 March;3(2):159165.

Expedium 5.5 spine system

The Expedium 5.5 Power Instrument Set will address the key ergonomic and repetitive use injuries for surgeons performing high volumes of deformity or degenerative surgery as well as potentially reducing OR time and improving accuracy. This is accomplished through the ability to utilize the Expedium 5.5 product portfolio (ie, polyaxial, monoaxial, uniplanar screws) with powered pedicle preparation and screw delivery.

The instruments were developed in close collaboration with deformity surgeons. Through optimization of instrument length and geometry, shoulder, elbow, and trunk positioning is improved when compared to manual instrumentation.

Product overview

The Expedium 5.5 power system uses the Colibri II power device (Fig 3), (which is known as the Small Battery Drive II (SBDII) in the USA). The features and benefits of using the system are shown.

The powered instruments for the Expedium 5.5 system enable powered drilling, tapping, and screw delivery with a cordless hand piece, quick coupling attachment, and optimized instrumentation (Fig 4).

Fig 3 The Colibri II power device (known as the Small Battery Drive II (SBDII) in the USA).

Fig 4a-c The powered instruments for the Expedium 5.5 system.

Case provided by Jean Ouellet, Montreal, Canada

Case: A two-level VCR

A T2 to pelvis, two-level vertebral column resection (VCR) was completed at the McGill University Health Center in 7 hours (Figs 5–7).

Fig 5a-b Preoperative radiographs.

Fig 7a-b Postoperative radiographs.

Fig 6a-c Intraoperative images showing the use of the power tool.

Important Considerations for the Safe & Efficient Use of Powered Pedicle Screw Insertion

Presentation delivered by Jean A Ouellet (Canada) during the 2016 Meet the Experts sessions.

Hazards and labeling

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