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TruFUSE® Procedure Localize the facet joint either by direct visualization during open surgery or indirectly by fluoroscopy. Mark the facet joint with a Steinmann pin bilaterally. Oblique imaging “opens” the facet joint for optimal visualization Slide the beveled spatula over the Steinmann pin and insert into the facet joint bilaterally. In cases of significant joint narrowing, impaction with a mallet may be required. Severe facet overgrowth may prevent entry into the joint and necessitate conversion to an open technique. Once firmly in place, the spatula is aligned with the plane of the joint, ensuring proper drill angle and graft placement. Correct positioning of the spatula is confirmed manually (inability to rotate the spatula in the joint) and radiographically. The drill guide is passed over the spatula and centered over the facet joint. Note that the cross hairs on the drill guide line up with markings on the spatula. The guide should be positioned at the mid-portion of the joint to engage the superior and inferior articular processes equally. Additionally, care is taken to maintain proper alignment along the plane of the joint. The drill guide has prominent teeth superiorly and inferiorly which are intended to enter the joint. Lightly tap the drill guide so as to engage the teeth into the joint. Drilling is performed under a small steady stream of irrigation used to dissipate heat generated during this step. Be sure to advance the reamer to its maximum depth when drilling (a drill stop is provided on the reamer and guide to prevent drilling too deep) and hold the drill guide steady to ensure a precise tunnel. Using the graft holder tamp, place the TruFUSE dowel in the pre-drilled hole and impact the graft at the same angle as the facet joint was drilled until it is fully seated. Set dowel 25% by hand, and then tap the inserter with the hammer until the dowel is countersunk 1-2 mm into the compaction drilled tunnel. |