Advanced Research Medical · Arrow Cage · K173947
Oblique Lateral Lumbar Interbody Fusion
A minimally invasive lumbar fusion through Kambin’s triangle, done prone, with biplanar fluoroscopy and neuromonitoring. OR / procedure reference organized for the surgical team — surgeon, tech, and scrub.
Technique is illustrative. Surgeon judgment governs each case. See the IFU and 510(k) for indications, contraindications, warnings, and precautions. Federal law restricts this device to sale by or on the order of a physician.
01 — What this is
OR / procedure material only. Not a patient site. Approach, room, implant, and what this is not.
The implant and instruments take the pathway through Kambin’s triangle to the lumbar disc.
TLIF removes some or all of the facet on the approach side. OLLIF is facet-sparing.
XLIF/DLIF enters anterior to Kambin’s triangle and passes through psoas. OLLIF does not go through psoas; the path is posterior to iliopsoas.
ARM Arrow Cage. Titanium alloy 6Al-4V. Cannulated bullet nose, graft windows, toothed endplates. Rectangular, parallel configuration. No markers or pins.
Indicated L2–S1, one or two contiguous levels, for DDD with up to Grade I spondylolisthesis after six months of non-operative treatment, with supplemental fixation and autograft.
02 — Tech and scrub first
One room map. Stations as drawn. Do not add furniture that is not on the diagram.
Photographs from the room. Open any on Drive.
Named setup films first, then the numbered walkthrough. Click to play.
03 — Preference card
POSTERIOR APPROACH OLLIF · LUMBAR FUSION, MIS, 1 LEVEL. Source: General Preference Card — OLLIF FINAL.xlsx. Three columns: open / hold (PRN) / open-conversion.
| Item | Status | Note |
|---|---|---|
| NS irrigation 1000 ml | Open | |
| 0.75% PF bupivacaine 30 ml | Open | Anesthesia calculates by kg. Preferred Exparel noted. |
| 0.25% bupivacaine 1 ml + Kenalog / triamcinolone 40 mg in 3 ml syringe | Open | End of case. Depo-Medrol available. |
| Lidocaine 1% / epi 1:100000 29 ml + bupivacaine 29 ml mixed 1:1 | Open | |
| Thrombin 5000 u | Hold | |
| Bacitracin ointment / bacitracin 50k in 1 L NS | Hold | For open |
| Thrombin + Surgifoam powder | Hold | For open |
| TXA 10 mg | Hold / PRN |
Headlight. Midas Rex IPC + 14MH30 + footpedal. Valley Lab cautery ×2. Neptune 2 + 4-port manifold + 14 Fr tip. Cushing bayonet bipolar. Hemovac 10 Fr. 0 Vicryl J740D (×2 one-level / ×3 two-level). 2-0 Vicryl. #10. 12 ga angiocath. Telfa. Surgifoam. Coude Foley.
Available: neuro set, large Gelpis, x-long rongeurs, rod cutter, x-long Cobbs / curettes, long rotating Kerrison, watchmaker, slotted mallet, Penfield tray, Leksell.
Need to open if converting: osteotomes, lumbar fusion curettes, double-end ball elevator, short rotating Kerrison, retractors, bipolar, drill, medium mallet.
04 — Scrub
Access tray and posterior instrumentation. Official ARM set from STG MM-01-1 REV C, 2023-03-10.
| PN | Description | Qty |
|---|---|---|
| 01-00 | OLLIF Inserter assembly | — |
| 01-00-1 | Outer | 2 |
| 01-00-2 | Inner | 2 |
| 01-01 | Dilator | 1 |
| 01-02 | Access portal | 1 |
| 01-03 | Disc drill | 1 |
| 01-04 | Shaper assembly (body, knob, blades ×2) | — |
| 01-05 | Pituitary rongeur | 1 |
| 01-06 | Flexible curette assembly | — |
| 01-07 | Articulating curette | 1 |
| 01-08 | Graft delivery tube | 1 |
| 01-09 | Graft tamp | 1 |
| 01-10 | Impactor | 1 |
| 01-11 | Mallet | 1 |
| 01-12 | Wrench | 1 |
| 01-100 | ¼″ QC palm handle | 1 |
| 01-101 | Mini AO palm handle | 1 |
| 01-9080-18T | Threaded GW 18″ | 20 |
| 01-9080-18U | Unthreaded GW 18″ | 20 |
| MP214-3.0/1 | Technomed monopolar probe with sleeve | 1 / pack |
Arrow cage lengths 27 / 30 / 33 mm. Heights 08–15 mm, color-coded. Titanium 6Al-4V, cannulated bullet nose, graft windows, toothed endplates.
Sterilization (IFU). Steam pre-vac 270°F / 132°C, 4 min, 4 pulses, 30 min dry. Non-sterile as supplied. Do not reuse implants. Previously implanted devices must never be reused.
05 — Surgeon
Numbered flow from STG MM-01-1 REV C and the example op note. Each step is short. Judgment at the table governs.
GA, SCD, Foley, pre-op antibiotic. Jackson + Wilson, modified prone, left-side access. Both C-arms up. Neuromonitoring live.
Landmarks: spinous process, transverse process, disc, endplates, pedicles.
Jamshidi in the upper pedicle through a separate incision. Mix aspirate with TCP.
AP: confirm midline (pedicles equal). Mark midline. Mark disc trajectory.
Lateral: endplates lined up. Mark disc angle across the flank. Transfer the distance from disc center to flank apex, from midline — that is the incision. Confirm with a spinal needle. 10 mm skin and fascia.
Neuromonitoring probe through the incision toward the inferior pedicle / inferior foramen. Tip between medial and lateral pedicle, inferior foramen.
Do not cross the medial pedicle on AP until the probe is anterior to the posterior vertebral body on lateral. Stay out of the canal. Stimulate. Find a silent window.
Advance the sleeve onto the anulus, remove the probe, pass a K-wire into the disc, then dilator, then access portal. Portal: medial to the pedicle on AP, about 0.5 cm into the disc on lateral. One hand stays on the portal against the skin.
Through the 10 mm portal: disc drill, shaper (clockwise only, expand in 1 mm increments), pituitary, articulating and flexible curettes. Decorticate endplates under biplanar fluoro.
Drill shaft markings estimate implant length (27 / 30 / 33 mm). Shaper window estimates height. New flexible-curette blade per level. Do not rotate the flexible curette with the blade exposed.
TCP soaked in BMA via graft tube and tamp. Bevel on the sleeve aims the graft. Then place a guide wire through the portal into the graft mass and remove the portal.
Arrow titanium cage packed with TCP/BMA, inserted over the K-wire under biplanar fluoro and neuromonitoring. Mallet the inserter. Endplate surface is perpendicular to the T-handle. Release by turning the retainer knob counterclockwise; wrench if needed.
Goal in the op note: restore height and indirect decompression.
Rotate to true prone. Percutaneous pedicle screws and rods. Posterolateral TCP/BMA. Screws silent to 25 mA. Close 2-0 Vicryl, Steri-Strips.
ESI: 2 cc air, confirm epidural / no CSF, then 40 mg Kenalog + 1 cc 0.25% Marcaine.
Then 0.75% Marcaine deep and paravertebral (op note: 20 cc + 20 cc). Counts correct. PACU.
Open STG on Drive · MM-01-1 REV C
Indications, contraindications, cleaning, sterilization, postoperative mobilization. MM-01-2 REV B.
Template: OLLIF + posterior MIS screws + ESI + transpedicular BMA. Left-side modified prone. Screws silent to 25 mA.
Removal, if needed: re-access with neuromonitoring probe and guide wire, seat the dilator in the pocket on the back of the cage, pass the wire into the threaded aperture, thread the inserter inner shaft, tap the implant out.
06 — Perioperative
Protocols from the Drive care folder. IFU: careful loading for the first three months; brace and activity per surgeon; smoking and noncompliance raise nonunion risk.
07 — Papers and coding
White papers as Drive links. No commentary beyond the titles. Coding from the FY2026 summary only.
From the ARM FY2026 coding summary. 2026 outpatient: 22558 is now allowed as the IPO list changes.
| CPT | Description | 1-level | 2-level |
|---|---|---|---|
| 22558 | Lumbar spine fusion (anterior) | 1 | 1 |
| 22612 | Lumbar spine fusion (posterolateral) | 1 | 1 |
| 22853 | Insertion, biomechanical device | 1 | 2 |
| 22840 | Spine fixation, 2 vertebral segments | 1 | — |
| 22842 | Spine fixation, 3–6 vertebral segments | — | 1 |
| 63056 | Decompress spinal cord, lumbar | 1 | 1 |
| 63057 | Decompress spinal cord, add-on | 1 | 1 |
| 22585 | Additional spinal fusion (anterior) | — | 1 |
| 22614 | Spine fusion extra segment (posterolateral) | — | 1 |
DRGs listed: 402 (single-level combined A/P except cervical); 450 (single-level fusion except cervical w/ MCC); 428 (multi-level combined A/P w/o CC/MCC); 427 (multi-level w/ CC); 426 (multi-level w/ MCC).
08 — Complete Drive map
Every folder and file named in the source Drive, so nothing is lost. Original files still live on the public Drive and open there.
Advanced Research Medical, LLC
1515 Highway 13 East, Burnsville, MN 55337 · (612) 440-1865 · www.AdvResMed.com · info@AdvResMed.com
Original files live on the public Drive and open there. This page reorganizes that material for the OR. Arrow Cage / OLLIF · K173947 · MM-01-1 REV C · MM-01-2 REV B. Technique is illustrative. Surgeon judgment governs. See IFU / 510(k) for indications.
