Instruments/Trays
Procedures
Hotline Calls
IONM
2D & Lessray
200
These are the available tap sizes in the RELNAVSPOLY tray
4.5, 5.5, 6.5, 7.5, 8.5
200
A
200
You get a call from a rep who says the navigation screen on pulse was working fine but is now unresponsive and seems to be freezing. Line of site has been confirmed and standard troubleshooting has been verified. What is the most likely trouble shooting step to take?
There may be a Fovia issue have the rep try the key commands: CTL + SHFT + R, CTL + SHFT + 2 to see if refreshing works. *Bonus points: How long do you have to carry out the key press sequence before it times out?
200
This type of stimulation is generated from a stretch or compression of a nerve
Mechanical Stimulation
200
Name at least 3 factors that contribute to a good baseline when using the Align feature on Lessray.
Remove any metal or artifacts that can be removed from FOV, shoot on appropriate dose for best image quality, make sure the appropriate anatomy is included and lined up, leave adequate working corridor for surgeon, no motion, etc.
400
This navigation set is most commonly used for cortical screw placement
Reline MAS midline (RMMNAVS)
400
For most patients, where should the camera be placed when doing a L2-3 MAS Midline procedure with navigated cortical screws?
At the head due to cortical screw trajectory
400
A sales rep calls and says they are stimming the left side but getting right side responses. What is the most likely cause for these contralateral EMG responses?
Have the rep make sure the electrodes aren’t plugged in backwards on the harness.
400
A Twitch Test is performed by stimulating the _______ nerve 4 x and measuring the corresponding muscle contraction of each stimulation.
Peroneal
400
What anatomy should be included on the AP shot when setting up for S2AI screw scans with CIOS?
Include sciatic notch, acetabulum, sacral foramen with end of image past midline for overlap. Depending on prior scan, one of the hemi pelvic shots may need to include L5 pedicles.
Note: a hemipelvic shot is usually needed due to CIOS FOV
600
What are the depth stop options for the navigated drill guide (PULSEDRILLGUIDE) and what diameter drill bit fits each?
3.0 diamter: AO & ¼” 15mm-45mm
4.0 diamter: AO & ¼” 60mm-90mm
600
How should a patient be positioned on the table for a PCF with CIOS/Pulse, and what types of head holder are recommended?
Patients arms should be tucked to avoid a CIOS collision. Levo Mizuho head holder or C- flex should be used to avoid CIOS collision. Note: if a collision is questionable, do a dry collision check prior to draping as well as cant the CIOS if needed.
600
You get a call from a rep in an XLIF who says every time they stimulate a dilator it defaults to Twitch Test on Pulse. What trouble shooting steps can be taken?
Check to see if they are in the lateral tab. Proceed to Lateral tab or hit the gear icon and change default to XLIF mode.
600
What steps should be taken if impedance is not achieved when using surface electrodes?
Clean area, allow to dry, shave, abrade with pumice pad, replace lead.
600
A rep calls and says they are taking S2AI teardrop baselines with Lessray but are unable to learn it. Given the view they are trying to achieve what is the most likely cause for this issue?
There is currently a limitation on the amount of allowable rainbow on Pulse
800
These screw types are compatible when using drivers from the RSSNAVS tray
RSS & RMM
800
X360 (Dr Thomas performing a XLIF, XALIF, SPS w/ bilateral screws)
800
A rep calls saying “CIOS is broken we keep getting a message that ‘3D navigation is aborted by error’”. Assuming “pulse” was selected on CIOS dropdown, and the ports and cables are properly functioning, what is the most common trouble shooting step that should be investigated?
Is the rep in an active registration on Pulse? If not CIOS will abort the 3D scan.
800
When using EMG, if the nerve is in close proximity it will require a _____ amount of current to illicit a CMAP
low
800
What is the purpose of maintaining a green view finder with 75% overlap when performing a stitch with Lessray.
The tight overlap ensures there is no parallax on the final blended long film displaying an accurate stitch.
1000
These taps are included in the Reline Small Stature navigation set (RSSNAVS)
3.75mm solid, 4.5mm, 5.5mm 6.5mm cannulated.
1000
What is the preferred spot for PSIS pin when performing a MAS TLIF?
Opposite side of retractor
1000
A rep calls saying the MAS Consol tap won’t confirm but all other instruments confirmed with no issues. Spheres were changed, are seated, undamaged, and clean, they have also tried multiple instrument arrays. Correct array is assigned to corresponding instrument. What troubleshooting steps should you suggest?
Have the rep make sure the Stylet inserted into the cannulated tap and seated properly. Make sure the sharp tip of the stylet worn or bent
1000
What are the 2 landmarks that need to be located for proper peroneal twitch test lead placement?
Lateral tendon of bicep femoris & crease in posterior fossa of the knee.
1000
Explain how to utilize the Angle Grid feature to setup for a L5-S1 PSF for Ap and Lateral baselines
Take an AP image, enable angle grid, adjust the base of the c-arm so that the endplate of the vertebral body of interest is parallel to any one of the grid lines. Lock the base of the c-arm and move to a lateral position. Take your image. You should have the perfect lateral image of the vertebral body. Unlock the cant, adjust the cant so the endplate of the vertebral body of interest is parallel to any one of the endplates. Lock the cant, move the c-arm to AP, take an image. You should have the perfect AP ferguson of the vertebral body of interest.