Chesapeake ®

Anterior-Lumbar Stabilization System

Surgical technique guide

 Table of contents

Surgical technique steps

Step 1: Planning, approach, and patient

positioning. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Step 2: Discectomy and endplate preparation . . . . . . 5
Step 3: Disc elevation . . . . . . . . . . . . . . . . . . . . . . . . . 6
Step 4: Determining interbody size . . . . . . . . . . . . . . 7
Step 5: Interbody selection . . . . . . . . . . . . . . . . . . . . . 8
Step 6: Interbody insertion. . . . . . . . . . . . . . . . . . . . 10
Step 7: Drill guides . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Step 8: Create pilot hole and drill . . . . . . . . . . . . . . . .
vertebral body. . . . . . . . . . . . . . . . . . . . . . . . 16
Step 9: Screw preparation and insertion. . . . . . . . . 17
Step 10: Final locking . . . . . . . . . . . . . . . . . . . . . . . . 18
Step 11: Implant removal . . . . . . . . . . . . . . . . . . . . . 20

Product catalog
Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Instruments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Implants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Instructions for use. . . . . . . . . . . . . . . . . . . . . . . . . . 32

This publication sets forth detailed recommended procedures for using the Chesapeake Anterior-Lumbar Stabilization
System. It offers guidance that you should heed, but, as with any such technical guide, each surgeon must consider the
particular needs of each patient and make appropriate adjustments when and as required.

2 Surgical technique
Surgical technique

Chesapeake | Anterior-Lumbar Stabilization System 3

 Step 1

Planning, approach, and patient positioning

Pre-surgical planning helps define the type of
construct, the most appropriate implants, and
the optimal implant location. The Chesapeake
Anterior-Lumbar set is designed to facilitate
anterior surgical approaches.

Cranial

Caudal

4 Surgical technique
 Step 2

Discectomy and endplate preparation

A selection of disc preparation instruments is Note: For a complete listing of instrument options,
available to facilitate a complete discectomy and please see the Product Catalog.
decortication of the vertebral endplates. These
instruments include a variety of cup style Curettes,
Pituitary Rongeurs, Rasps, Chisels, and Cobbs.

#4 Forward Angled Curette 4mm Anterior Pituitary 8mm Double Action Curette Connector Shaft
Rongeur 45° Rongeur

Curette Handle Convex Rasp Small Cobb Chisel

Chesapeake | Anterior-Lumbar Stabilization System 5

 Step 3

Disc elevation
A Disc Spreader may be inserted as a temporary
spacer while additional preparation is performed on
the contralateral side. Modular Disc Spreaders, which
connect to a Fixed T-Handle, are included in the set.

A starter size of 5mm is available for initial

distraction. Sizes increase sequentially thereafter
from 7 - 19mm in 2mm increments. Distraction is
performed until the appropriate height is achieved.

Disc Spreader Fixed T-Handle

6 Surgical technique
 Step 4

Determining interbody size

Trials are available in 5°, 10°, 15°, 20°, 25°, and
30° of lordosis to aid in initial test fitting and size
confirmation of the interbody. Load the Trial onto
the distal end of the Trial Inserter. The thumbwheel,
located on the proximal end of the Trial Inserter, is
turned in a clockwise direction to secure the Trial.

Trials are 0.5mm undersized to allow for a slight

press fit of the implant. If the Trial appears to be too
small, gradually increase the size until a secure fit is
achieved.

Trial Inserter 24 x 30mm 5° Trial

Chesapeake | Anterior-Lumbar Stabilization System 7

 Step 5

Interbody selection
An appropriately sized interbody is chosen at the Note: 21mm height is only available in
discretion of the surgeon. The interbody should hyperlordotic implant options.
be securely seated with a tight fit between the
endplates when the segment is fully distracted is
rcommended. Implants are sized at 24 x 30, 28 x 36,
and 30 x 40mm footprints. Each of these footprints
is available in 5°, 10°, 15°, 20°, 25°, and 30° lordotic
angles in heights ranging from 11 - 21mm in 2mm
increments.

24mm
28mm

30mm
36mm

30mm

40mm

8 Surgical technique
Each footprint includes a color-coded SMARTLock
insert to easily indentify the degrees of lordosis. The
height of the interbody is measured from tip-of-
tooth to tip-of-tooth.

The interbodies are included in color-coded caddies

for ease of height identification. The implant is
indicated for spinal fusion procedures to be used
with autogenous bone graft in skeletally mature
patients.

Chesapeake Lordotic Sizes

5° - Dark blue 10° - Green 15° - Gold

20° - Magenta 25° - Light blue 30° - Light green

Chesapeake | Anterior-Lumbar Stabilization System 9

 Step 6
Interbody insertion
Insertion option 1: Anterior Insertion Ramp
The Anterior Insertion Ramp utilizes a controlled
threaded mechanism which is designed to provide
parallel distraction, resulting in a zero-impact load
on the implant. To help ensure proper use of the
Anterior Insertion Ramp, complete the following
Chesapeake Modular Tip
Anterior Insertion Ramp
10 Surgical technique
Steps:
1. Hold the instrument vertically to allow the
distraction ramps to open.
2. Insert the inner shaft through the proximal end
of the Inserter and rotate clockwise 1-2 turns to
engage the threads.
3. Place the Chesapeake Modular Tip over the Inner
Shaft.
4. Turn the gold thumbwheel clockwise and
finger tighten until the threads disappear and
components mate flush.
5. Attach the implant to the Chesapeake Modular
Tip.
6. Final tighten the implant by turning the knob
of the inner shaft on the proximal end of the
Inserter.
7. Adjust the countersink depth on the Anterior
Insertion Ramp from 0 - 6mm by rotating
the silver knurled thumbwheel behind the
countersink depth bar on the modular tip.
8. Rotate the Anterior Insertion Ramp 180° to close
the distraction ramps.
9. Place the distal end of the distraction ramps into
the disc space until the Vertebral Body Stops
make contact with the anterior surface of the
vertebrae.
10. Turn the T-Handle clockwise to advance the
implant into the disc space.

Vertebral Body Stops Modular Tip Thumbwheel

Distraction Ramps Knurled Countersink

Countersink Depth Bar Thumbwheel

Chesapeake | Anterior-Lumbar Stabilization System 11

 Step 6

Interbody insertion (cont.)

Insertion option 1: Anterior Insertion Ramp (cont.)

11. When the Countersink Depth Bar makes contact 12. Disengage the implant by turning the Inner Shaft
with the vertebral bodies, the Anterior Insertion knob on the proximal end of the Inserter counter-
Ramp is designed to begin to remove itself from clockwise.
the disc space, while maintaining the position of 13. Completely remove the Inner Shaft for cleaning
the implant according to the pre-set countersink once insertion is complete.
depth. Continue to thread the inner shaft until the
distraction ramp is fully removed from the disc
space. Fluoroscopy can be used to confirm the
final position of the implant before removing the
insertion ramp.

12 Surgical technique
Insertion option 2: Chesapeake Implant Inserter
1. Insert the Inner Shaft through the proximal end
of the Inserter and rotate clockwise 1–2 turns to
engage the threads.
2. Load the interbody onto the Chesapeake Implant
Inserter.
3. Turn the inner shaft thumbwheel on the proximal
end of the Implant Inserter in a clockwise
direction to secure the implant. The Large Mallet
may be used to aid in implant placement. X-ray
or fluoroscopy may be used live or periodically to
verify placement.
Chesapeake | Anterior-Lumbar Stabilization System
4. After the implant is properly seated in the
disc space, turn the Inner Shaft knob at the
proximal end of the Inserter counter-clockwise to
disengage the implant.
Care must be taken to protect the vascular elements
before removing the Chesapeake Implant Inserter
from the surgical site. If needed, the Removal Tool
may be used to adjust the implant anteriorly.
Chesapeake Implant Inserter Chesapeake Implant Inserter
-Inner Shaft
13
 Step 7

Drill guides
Two Drill Guides are available for use: A Single
Barrel Drill Guide and a Expandable Drill Guide.
The Single Barrel Drill Guide is used to awl and drill
at a fixed trajectory of 35°. The Expandable Drill
Guide is used to awl, tap, drill, and insert screws at
a fixed trajectory of 40°. Expandable Drill Guides are
available in sequential heights from 11 - 19mm in
2mm increments.

Drill Guide Inserter

Single Barrel Drill Guide

Expandable Drill Guide

14 Surgical technique
The Three Barrel Drill Guides correspond to each
interbody height. Load the Three Barrel Drill Guide
onto the distal end of the Drill Guide Inserter by
pulling back on the outer shaft of the Drill Guide
Inserter to secure. Insert the instrument into the
interbody making sure to match up the markings for
correct screw orientation. Turn the green silicone
handle clockwise to secure the Three Barrel Drill
Guide to the interbody.

Drill Guide Inserter 11mm 13mm 15mm 17mm 19mm

Chesapeake | Anterior-Lumbar Stabilization System 15

 Step 8

Create pilot hole and drill vertebral body

If preferred, the 20mm Spring Loaded Punch Awl,
20mm Universal Awl, or 20mm Awl may be used to
perforate the vertebral body.
Note: The Spring Loaded Punch Awl does not awl
through the Single Barrel or Three Barrel Drill
Guides.
Select the Ø3.0 x 20mm Drill and attach it to
the Ratcheting Hudson Handle. These Drills are
designed to restrict the depth to 20mm through the
Drill Guides. If a Power Drill is required, the Hudson
Adapter may be used to connect the drill bit to
power.

20mm Spring Loaded Chesapeake Ratcheting 20mm Awl 20mm Universal Awl
Punch Awl Hudson Handle

20mm Drill 20mm Universal Drill 20mm Tap 20mm Universal Tap

16 Surgical technique
 Step 9

Screw preparation and insertion

The Chesapeake screws are color-coded by length. If preferred, the Size 20 Universal Driver may be
The screws are self-tapping; however, the 20mm used when it is necessary to insert the screw off-
Tap or 20mm Universal Tap may be inserted through axis.
the Drill Guides concentric to the pilot hole at the
same angulation it was drilled to tap the vertebral Note: Repeat Steps 8 and 9 for the remaining
bodies. Once the appropriately sized screw is screws.
selected, insert it through the implant using the
Size 20 Tapered Driver attached to the Ratcheting
Hudson Handle, and preliminarily tighten the screw.
The Driver has a tapered, self holding tip to allow
for easy insertion of the screws.

20mm 25mm 30mm

20mm Tapered Driver 20mm Universal Tapered Chesapeake Ratcheting

Driver Hudson Handle

Chesapeake | Anterior-Lumbar Stabilization System 17

 Step 10

Final locking
Final screw locking should only be performed
once the screw positions have been verified via
intra-operative radiographs. Once the screws are
tightened, they are designed to become locked to the
SMARTLock insert.
Use the Size 20 Non-Tapered Driver attached to the
Gray Torque Limiting Handle to final tighten the
screws to 20 in-lbs.
When the screw head engages on the locking lip of
the SMARTLock insert, the insert will lag down to
the bone and the SMARTLock technology is designed
to engage. Due to a difference in material hardness
and design, the screw head begins to deform the
SMARTLock insert through a reshaping process and
thus forms an autogenic lock.

Image displays 500X magnification of

SMARTLock screw “fusing” to a plate

Size 20 Non-Tapered Driver Chesapeake Torque Wrench –

20 in-lbs

18 Surgical technique
The Torque Limiting Handle emits an audible “click”
at 20 in-lbs to signify the screw has formed an
autogenic lock with the SMARTLock insert. Use of
the Torque Limiting Handle further helps ensure
that the screw is not over tightened. No additional
locking step is required.
Note: If hyperlordotic interbodies (20°, 25°, and 30°)
were implanted, supplemental fixation (posterior)
is required. See the Mesa Spinal System, Everest
Spinal System or Serengeti Minimally Invasive
Retractor System Surgical Techniques for additional
instruction.

Optionally, if realignment of the screw is required

after final tightening, the screw may be unlocked
using the Ratcheting Hudson Handle and the Size
20 Tapered Driver. The screw may be locked and
unlocked up to three times without compromising
the locking mechanism.

Chesapeake | Anterior-Lumbar Stabilization System 19

 Step 11

Implant removal
If screw removal is required, each screw may be
unlocked using the Ratcheting Hudson Handle and
Size 20 Tapered Driver. If interbody removal is
required, use the Chesapeake Implant Inserter or
Removal Tool.

Chesapeake Ratcheting
Hudson Handle

Size 20 Non-Tapered Driver Implant Inserter Removal Tool

20 Surgical technique
Product catalog

Chesapeake | Anterior-Lumbar Stabilization System 21

 Trials

Description Heights

24 x 30mm Trial 9 - 21mm Unique catalog numbers exist for each Trial in each
footprint, height, and degree of lordosis. Please
28 x 36mm Trial 9 - 21mm
contact your local sales consultant with any
questions you may have about the Chesapeake
Anterior-Lumbar Stabilization System.

Note: Heights are available in increments of 2mm.

24 x 30mm 5°, 10°, 15°, 20°, 25°, and 30° trials

Heights (mm): 9, 11, 13, 15, 17, 19, 21

28 x 36mm 5°, 10°, 15°, 20°, 25° and 30° trials

Heights (mm): 9, 11, 13, 15, 17, 19, 21

Note: 9mm Trials are for use with the Aleutian Anterior-Lumbar Interbody System.
21mm Trials are for use with the Chesapeake Anterior-Lumbar Interbody System.

22 Product catalog
 Trials

Description Heights
Unique catalog numbers exist for each Trial in each
30 x 40mm Trial 11 – 21mm
footprint, height, and degree of lordosis. Please
contact your local sales consultant with any
questions you may have about the Chesapeake
Anterior-Lumbar Stabilization System.

Note: Heights are available in increments of 2mm.

30 x 40*mm 5°, 10°, 15°, 20°, 25°, and 30°

Heights (mm): 11, 13, 15, 17, 19, 21

Chesapeake | Anterior-Lumbar Stabilization System 23

 Instruments

Catalog # Description Catalog # Description

702-90001 #2 Straight Curette 702-90058 5mm Disc Spreader

702-90002 #4 Straight Curette 702-90059 7mm Disc Spreader
702-90162 #2 Forward Angled Curette 702-90060 9mm Disc Spreader
702-90003 #4 Forward Angled Curette 702-90061 11mm Disc Spreader
702-90163 #2 Serrated Curette 702-90062 13mm Disc Spreader
702-90164 #4 Serrated Curette 702-90063 15mm Disc Spreader
702-90165 #2 30° Forward Curette 702-90064 17mm Disc Spreader
702-90166 #4 30° Forward Curette 702-90065 19mm Disc Spreader
602-90010 Curette Connector Shaft
702-90210 Curette Handle

#2 Straight Curette

#4 Straight Curette

#2 Forward Angled Curette

#4 Forward Angled Curette

#2 Serrated Curette

#4 Serrated Curette

#2 30° Forward Curette

#4 30° Forward Curette

Curette Connector Shaft

Curette Handle

5mm Disc Spreader

7mm Disc Spreader

9mm Disc Spreader

11mm Disc Spreader

13mm Disc Spreader

15mm Disc Spreader

17mm Disc Spreader

19mm Disc Spreader

24 Product catalog
 Instruments

Catalog # Description Catalog # Description

602-90225 Fixed T-Handle with Hudson 702-90099 13” 4mm Anterior Pituitary Rongeur with Teeth
702-90068 Large Cobb 702-90100 13” 6mm Anterior Pituitary Rongeur with Teeth
702-90067 Small Cobb 702-90101 8mm Double Action Rongeur
702-90158 15mm Chisel 702-90066 Large Scalpel Blade Holder
702-90159 17mm Chisel 702-90182 Small Scalpel Blade Holder
702-90208 Pusher
702-90098 13” 4mm Anterior Pituitary Rongeur 45°
702-90157 13” 6mm Anterior Pituitary Rongeur 45°

Fixed T-Handle with Hudson

Large Cobb

Small Cobb

15mm Chisel

17mm Chisel

Pusher

13” 4mm and 6mm Anterior Pituitary Rongeur 45°

13” 4mm and 6mm Anterior Pituitary Rongeur with Teeth

8mm Double Action Rongeur

Large Scalpel Blade Holder

Small Scalpel Blade Holder

Chesapeake | Anterior-Lumbar Stabilization System 25

 Instruments

Catalog # Description

2008-90018 Modular Anterior Insertion Ramp

2008-90019 Inner Shaft Assembly
2008-90055 Chesapeake Modular Tip – Zero Countersink
702-90103 Angled Rasp
702-90183 Convex Rasp
702-90167 Trial Inserter
702-90052 Large Mallet
702-90181 Slap Hammer

Modular Anterior Insertion Ramp

Inner Shaft Assembly

Chesapeake Modular Tip – Zero Countersink

Angled Rasp

Convex Rasp

Trial Inserter

Large Mallet

Slap Hammer

26 Product catalog
 Instruments

Catalog # Description

2008-90040 20mm Tap

2008-90054 20mm Universal Tap
2008-90028 20mm Awl
2008-90025 20mm Universal Awl
2008-90046 20mm Spring-Loaded Punch Awl
2008-90029 20mm Drill

20mm Tap

20mm Universal Tap

20mm Awl

20mm Universal Awl

20mm Spring-Loaded Punch Awl

20mm Drill

Chesapeake | Anterior-Lumbar Stabilization System 27

 Instruments

Catalog # Description

2008-90051 20mm Universal Drill

2008-90030 Size 20 Tapered Driver
2008-90044 Size 20 Non-Tapered Driver
2008-90024 Size 20 Universal Tapered Driver
2008-90042 Ratcheting Hudson Handle
2008-90043 Torque Wrench – 20 in-lbs

20mm Universal Drill

Size 20 Tapered Driver

Size 20 Non-Tapered Driver

Size 20 Universal Tapered Driver

Ratcheting Hudson Handle

Torque Wrench – 20 in-lbs

Catalog # Description Torque Values and Accuracy

2008-90043 Torque Handle, 20 in-lbs (2.3 N-m) 2.3 ± 0.23 Nm (10%)

28 Product catalog
 Instruments

Catalog # Description

2008-90039 Single Barrel Drill Guide

2008-90058 Expandable Drill Guide – 11mm
2008-90059 Expandable Drill Guide – 13mm
2008-90060 Expandable Drill Guide – 15mm
2008-90061 Expandable Drill Guide – 17mm
2008-90062 Expandable Drill Guide – 19mm
2008-90037 Drill Guide Inserter

Single Barrel Drill Guide

Expandable Drill Guide – 11mm

Expandable Drill Guide – 13mm

Expandable Drill Guide – 15mm

Expandable Drill Guide – 17mm

Expandable Drill Guide – 19mm

Drill Guide Inserter

Chesapeake | Anterior-Lumbar Stabilization System 29

 Instruments

Catalog # Description

2008-90063 Chesapeake Implant Inserter

2008-90065 Chesapeake Implant Inserter – Inner Shaft
2008-90068 Removal Tool

Chesapeake Implant Inserter

Chesapeake Implant Inserter – Inner Shaft

Removal Tool

30 Product catalog
 Implants

Description Heights

24 x 30mm Implant 11 - 21mm

Unique catalog numbers exist for each implant
in each height and for each degree of lordosis.
28 x 36mm Implant 11 - 21mm
Please contact your local sales consultant with
30 x 40mm Implant 11 - 21mm any questions you may have about the Chesapeake
Anterior-Lumbar Stabilization System.

Note: Heights are available in increments of 2mm.

Some heights are not available in 20°, 25°, and 30°
lordosis.

24 x 30mm 5°, 10°, 15°, 20°, 25°, and 30°

Heights (mm): 11, 13, 15, 17, 19, 21

28 x 36mm 5°, 10°, 15°, 20°, 25°, and 30°

Heights (mm): 11, 13, 15, 17, 19, 21

30 x 40mm 5°, 10°, 15°, 20°, 25°, and 30°

Heights (mm): 11, 13, 15, 17, 19, 21

Screws

Description Lengths Unique catalog numbers exist for each screw length
Ø5.5mm 20, 25, and 30mm
for each degree of lordosis. Please contact your local
sales consultant with any questions you may have
about the Chesapeake Anterior-Lumbar Stabilization
System.

Ø5.5mm Screws
Lengths (mm): 20, 25, 30

Chesapeake | Anterior-Lumbar Stabilization System 31

 Instructions for use

IFU Reference
Number:

32 Instructions for use

PI021-0A11-05 Rev 0
Stryker Spine
600 Hope Parkway SE
Leesburg, VA 20175
t: 571.919.2000
http://www.stryker.com

Chesapeake | Anterior-Lumbar Stabilization System 33

 Notes

34 Notes
Chesapeake | Anterior-Lumbar Stabilization System 35
Spine division Manufactured by:
A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when K2M, Inc.
treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any
particular product before using it in surgery. 600 Hope Parkway SE
Leesburg, VA 20175
The information presented is intended to demonstrate the breadth of Stryker product offerings. A surgeon must always refer to the package
insert, product label and/or instructions for use before using any Stryker product. The products depicted are CE marked according to t: 571 919 2000
either the Medical Device Directive 93/42/EEC or Regulation (EU) 2017/745. Products may not be available in all markets because product
availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Stryker representative if you www.stryker.com
have questions about the availability of Stryker products in your area.
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