Transforaminal Posterior Atraumatic Lumbar Interbody Cage System
T-PAL™ Interbody System
Addendum to Surgical Technique
T-PAL™ Interbody System Addendum to Surgical Technique DePuy Synthes 1
The T-PAL Advanced Applicator has a reduced profile
compared to the Standard Applicator (see Figures 1 and
2) and is designed to allow for flexibility in the angle of
approach and to facilitate release of the implant from
the applicator following final placement.
The T-PAL Advanced Applicator is designed to work with
the existing T-PAL Trial Implants (03.812.307–317 and
03.812.507–517) and Implants (08.812.007S–017S,
This addendum includes information on the correct
attachment of the implants and trials to the applicator
and the final implant positioning.
Fig. 1 Advanced Applicator (03.812.520/521)
Fig. 2 Standard Applicator (03.812.001/003)
2 DePuy Synthes T-PAL™ Interbody System Addendum to Surgical Technique
Surgical Technique: Key Points
03.812.520 Advanced Applicator Outer Shaft
03.812.521 Advanced Applicator Inner Shaft
03.812.004 Applicator Knob
If using the T-PAL Advanced Applicator take note of
the following key points in addition to the other details
described in the complete T-PAL surgical technique
The T-PAL Advanced Applicator Outer Shaft and Inner
Shaft have three etch lines (Figure 3) to distinguish them
from the standard applicator Outer Shaft and Inner
Shaft. Note that the Advanced Applicator Outer Shaft is
compatible with the existing trial implants (03.812.307–
317 and 03.812.507–517) but the shaft of the trial
implants does not have three etch lines.
Warning: The clamp on the Inner Shaft of the
Advanced Applicator is asymmetric. When attaching
the implant to the applicator the longer finger must
be attached to the lateral (convex) side of the implant
(Figure 4). There is an etch line on the edge of the
longer finger so that proper attachment can be
confirmed (Figure 5).
T-PAL™ Interbody System Addendum to Surgical Technique DePuy Synthes 3
Precaution: With the Advanced Applicator it is
possible for the implant to pivot greater than 90
degrees (Figure 6). Therefore, careful attention
should be paid to fluoroscopy to ensure the implant
is in the desired position (see Figures 7–10).
Warning: The T-PAL Advanced Applicator Outer
Shaft and Inner Shaft should not be used in
combination with the standard Applicator Outer
Shaft (03.812.001) and Inner Shaft (03.812.003).
4 DePuy Synthes T-PAL™ Interbody System Addendum to Surgical Technique
Surgical Technique: Implant Positioning and
T-PAL Implant (PEEK)
From the lateral view the T-PAL implant markers should
appear as one single line as they will be superimposed
one on top of the other if the implant is properly seated
(Figure 7). The distance from the superimposed line to
the edge of the PEEK is approximately 2 mm. Addition-
ally the horizontal marker will appear as a single dot.
Verify that the T-PAL implant is properly positioned in
the AP view. If properly seated, the vertical markers
should appear to be equidistant from the midline of the
spinous process of the spinal column. The horizontal
marker will appear perpendicular to the vertical markers.
From an AP perspective these two markers will straddle
the spinous process (Figure 8).
T-PAL Implant (Titanium)
From the lateral view the T-PAL Ti implant should show a
visible circular window if the implant has been pivoted
into the proper position (Figure 9).
Verify that the implant is properly positioned in the AP
view. If properly seated, the furthermost right window
on the T-PAL Ti implant shall be centrally located inline
with the spinous process of the spinal column
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