CONCORDE® Bullet Device
The key feature of the CONCORDE Bullet Interbody Cage is the bulleted nose for ease of insertion into the interbody space. Available in carbon fiber reinforced polymer (CFRP), titanium, and titanium integrated material (PROTI 360°™), CONCORDE Bullet offers optimized area for bone graft and tantalum markers (CFRP option) also allow you to visualize the position of the cage in situ. CONCORDE Bullet is designed for surgeons who prefer a straight, oblique placement of the implant and is intended to be used with supplementary posterior instrumentation.
Pedicle screws can be placed either before or after the interbody reconstruction. It is often advantageous to have screws as a distraction point during the procedure. Many surgeons place screws before the spinal canal is exposed. If placing screws is done after the facetectomy as shown (Figure 1), take extra care to avoid dural injury during the placement of guide wires, taps, or screws.
Identify proper pedicle insertion points for guide wires, taps or screws. The optimal insertion point is at the intersection of the transverse process and superior articular process. Consult the EXPEDIUM® Spinal System Surgical Technique, EXPEDIUM VERSE® System Guide, or VIPER® 2 System Guide for additional details on pedicle screw insertion.In order to gain transforaminal access to the disc space, a unilateral facetectomy is performed. The side chosen for the approach is often determined by the location of the pathology or the presence of scar tissue. Resect the ligamentum flavum from the anterior surface of the lamina with a curette.