Additional Questions about Lateral Primary

Was lumbar spine previously fused? Yes No
If yes, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6 LIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6
Was lumbar spine fused during this procedure? Yes No
If yes, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6 LIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6

Additional Questions about Posterolateral Primary

Was lumbar spine previously fused? Yes No
If yes, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6 LIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6
Was lumbar spine fused during this procedure? Yes No
If yes, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6 LIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6

Additional Questions about Lateral Revision Procedures

Reminder: Please complete Information on devices removed.

Additional Questions about Posterolateral Revision Procedures

Reminder: Please complete Information on devices removed.

Additional Questions about Bedrock Configuration

Bedrock means an SI-BONE implant is supplementing another implant. The following are questions about that other implant.

What pelvic fixation is/are implants supplementing? Granite* Commercially available pedicle screw: SEL Medtronic Nuvasive Stryker Globus SeaSpine Other
*Ensure that Granite entered in list of devices placed.

In this procedure, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6
Was lumbar spine fused during a previous procedure? Yes No
If yes, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6 , LIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6

Additional Questions about Lateral Fixation for Fracture/Disruption

Energy type causing fracture:
High (MVA, fall from great height)
Low (fall at home, fragility, insufficiency)

Other devices used during case (check all that apply): Iliosacral screw into S1
Iliosacral screw into S2
TNT screw through S1 corridor
TNT screw through S2 corridor
Another device:

Was lumbar spine fused during this procedure? Yes No
If yes, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6 , LIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6

Questions about Granite in Iliac Trajectory

In this procedure, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6
Was lumbar spine fused during a previous procedure? Yes No
If yes, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6 , LIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6

Questions about Granite in SAI Trajectory

In this procedure, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6
Was lumbar spine fused during a previous procedure? Yes No
If yes, UIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6 , LIV= SEL T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 L6

Questions about Revision Procedure in SAI Trajectory

No questions. Please ensure you completed "Devices Adjusted or Removed" section.

Questions about Revision Procedure in Iliac Trajectory

No questions. Please ensure you completed "Devices Adjusted or Removed" section.

Other Use of SI-BONE Product

Describe the procedure in which an SI-BONE device was used but is not described by the other procedure-trajectory choices. Examples include: placement in knee, femoral head.

Questions about Non-sacral Fracture

Describe the procedure in which an SI-BONE device was used outside of the sacrum (e.g., ankle fracture, hip fracture).

Additional Questions about Non-Fracture Use Outside of Sacrum

Describe the procedure in which an SI-BONE device was used for something other than a fracture outside the sacrum. Examples: placement in ankle for chronic pain