Basics and Benefits
Medtronic Sofamor Danek, the global leader in spinal instrumentation, is please to introduce VERTE-SPAN™, the latest advancement in vertebral body replacement technology. The VERTE-SPAN™ device allows surgeons to reconstruct and stabilize certain types of anterior column defects in the spine.

Background
One of the most challenging problems facing spinal surgeons today is vertebral body replacement. The introduction and widespread acceptance of interbody techniques in the early 1990s has led to an increased interest in the role of the anterior column in reconstruction of complex spinal disorders. Leading orthopedic surgeons and neurosurgeons have worked to increase the versatility of interbody devices in order to address an increasingly complex array of spinal problems. The most common indication for vertebral body replacement is for reconstruction of the anterior column of the spine after the resection of spinal tumors or severely fractured anterior spinal elements.

The ability to rapidly stabilize and reconstruct large vertebral body defects provides patients with improved post-operative pain control, early mobility, and, most importantly, better function with preservation of quality of life after surgical procedures to treat these malignant and traumatic disorders of the spine.

Technology
VERTE-SPAN™ Vertebral Body Replacement represents the next step in the evolution of devices available for complex anterior reconstruction of vertebral body defects. Prior spinal instrumentation has focused on stabilizing the anterior column with plate-and-screw or rod-and-screw constructs. The space between the vertebral bodies is often filled with a variety of structural and non-structural bone grafts.

The size and shape of the vertebral body defects that result from trauma or the surgical excision of part of the anterior column are all unique, however, and the reconstruction of these defects can be challenging. This challenge is compounded by the fact that surgeons are often required to reconstruct the sagittal alignment of the spine, most often by restoring the appropriate amount of lordosis. Restoration can be difficult when distraction of the vertebral bodies at either end of the defect is complicated, and when the vertebral body replacement device is not adjustable. To improve this procedure, Medtronic Sofamor Danek has developed a device that is highly versatile and readily expandable to reconstruct the variable, complex spinal defects that result from this form of surgery.

Features and Benefits
The VERTE-SPAN™ Vertebral Body Replacement device consists of a perforated cylinder and two threaded endplates that allow for vertebral replacement in the thoracic, thoracolumbar, and lumbar spine. The perforated cylinder is threaded at each end. There are a variety of different cylinder lengths and diameters to accommodate the variability of patient size, anatomic variation, and the location and the size of the vertebral body defect. The threaded endplates have large spikes on each end. These spikes help stabilize the device in the vertebral endplates, and resist rotation and expulsion of the construct. Expansion to the proper length and stability is achieved by rotating the central cylinder within the endplates, lengthening the overall assembly. There are a variety of endplate angle options that make it possible to restore the normal contour of the spine. The variable length and diameter of the VERTE-SPAN™ device provides surgeons the ability to span up to two vertebral bodies. Each cylinder has multiple perforations for placement of bone graft.

VERTE-SPAN™ Vertebral Body Replacement is not a stand-alone device, and must be used with supplemental spinal fixation. Either anterior or posterior instrumentation must be utilized to enhance the stability of the reconstruction.

Indications
VERTE-SPAN™ Vertebral Body Replacement is intended for the surgical correction and stabilization of the spine where vertebral body resection is required and replacement of the vertebral body is either necessary or desirable. This commonly occurs after resection of a tumor (i.e., swelling or tumefaction) in the anterior vertebral body. The spine and it surrounding elements have a generous blood supply, draining many of the structures of the lower abdominal cavity through a system of veins called Batson's Plexus. This venous plexus is felt to be the reason that certain intra-abdominal and pelvic tumors have a tendency to spread to the spine. The spread or metastasis of tumors from elsewhere in the body to the spine may occur after a cancer has been growing in another part of the body.

A second indication for VERTE-SPAN™ Vertebral Body Replacement is to restore vertebral body height and alignment following trauma, such as a vertebral body fracture or burst. The most common types of fractures affecting the low back are compression fractures which usually result from a fall. Burst fractures usually occur through a violent compressive load resulting in failure of both the anterior and middle columns of the vertebrae. In this case vertebral height is significantly decreased. This type of fracture is considered unstable and requires immediate stabilization of the body.