WO2000048521A1 - Transiliac approach to entering a patient's intervertebral space - Google Patents

Transiliac approach to entering a patient's intervertebral space Download PDF

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Publication number
WO2000048521A1
WO2000048521A1 PCT/US1999/012610 US9912610W WO0048521A1 WO 2000048521 A1 WO2000048521 A1 WO 2000048521A1 US 9912610 W US9912610 W US 9912610W WO 0048521 A1 WO0048521 A1 WO 0048521A1
Authority
WO
WIPO (PCT)
Prior art keywords
cannula
ilium
patient
bone
fastening element
Prior art date
Application number
PCT/US1999/012610
Other languages
French (fr)
Other versions
WO2000048521A8 (en
Inventor
James F. Marino
Original Assignee
Nuvasive, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to US8866398P priority Critical
Priority to US60/088,663 priority
Priority to US12066399P priority
Priority to US60/120,663 priority
Priority to US60/129,703 priority
Priority to US12970399P priority
Application filed by Nuvasive, Inc. filed Critical Nuvasive, Inc.
Priority to PCT/US1999/012610 priority patent/WO2000048521A1/en
Priority claimed from AU45479/99A external-priority patent/AU4547999A/en
Publication of WO2000048521A1 publication Critical patent/WO2000048521A1/en
Publication of WO2000048521A8 publication Critical patent/WO2000048521A8/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1637Hollow drills or saws producing a curved cut, e.g. cylindrical
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1664Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3417Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421Cannulas
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22031Gripping instruments, e.g. forceps, for removing or smashing calculi
    • A61B2017/22034Gripping instruments, e.g. forceps, for removing or smashing calculi for gripping the obstruction or the tissue part from inside

Abstract

The present invention provides methods for percutaneously accessing the patient's intervertebral space (18) by creating an access portal (30) through the patient's ilium (16) and into the patient's intervertebral space (18). The access portal (30) created is preferably at a posterolateral angle, (preferably in the range of 40 to 90 degrees to an anterior/posterior axis through the patient), thereby being at the optimal angle of approach to the intervertebral space (18) for these lower L5/S1 vertebrae. Methods are also provided for advancing surgical instruments through the passage, and into the intervertebral space (18).

Description

TRANSILIAC APPROACH TO ENTERING A PATIENT'S INTERVERTEBRAL SPACE

CROSS-REFERENCES TO RELATED APPLICATIONS The present application is a regular application claiming benefit under 35 USC §119 (e) from U.S. Provisional Patent Applications Serial No. 60/120,663 filed February 19, 1999; and U.S. Provisional Patent Application No. 60/129,703, filed April 16, 1999; the complete disclosure of which are hereby incorporated herein by reference in their entirety for all purposes.

BACKGROUND OF THE INVENTION

A major problem when accessing a patient's intervertebral space during spinal surgery is the problem of avoiding sensitive nerves and ligaments during the operative procedure. When accessing the para-spinal space or a specific intra-discal space to perform a discal or intervertebral procedure, the optimal angle of approach to avoid sensitive nerves and ligaments is a posterolateral angle. However, this angle of approach is not practical when accessing the lower vertebrae, specifically the L5/S1 inter-vertebral space, due to the patient's ilium bone which blocks such an angle of approach. Consequently, when performing surgical procedures at L5/S1 it is necessary to enter the intervertebral space from another angle, thus increasing the danger of interfering with the cauda equina and ligaments at such lower vertebrae.

SUMMARY OF THE INVENTION

The present invention provides methods for percutaneously accessing the patient's intervertebral space by creating an access portal through the patient's ilium and into the patient's intervertebral space. The access portal created by the present invention is preferably at a posterolateral angle, (preferably in the range of 40 to 90 degrees to an anterior-posterior axis through the patient) , thereby being at the optimal angle of approach to the intervertebral space for these lower L5/S1 vertebrae. Methods are also provided for advancing surgical instruments through the passage and into the intervertebral space.

A system is also provided for conveying and depositing bone wax into bone interstices created by the coring of the ilium, thereby reducing bleeding.

As dual cannulae system of accessing a patient's intervertebral space is also provided.

BRIEF DESCRIPTION OF THE DRAWINGS

Fig. 1 is a schematic view of a cannulated obturator inserted percutaneously into the patient's back. Fig. 2 is a schematic view of the cannulated obturator of Fig. 1 placed in contact with the patient's ilium, with a screw-fastening element inserted therethrough.

Fig. 3A is a schematic view of a bone cutting drill adapted with a spiral bonewax depression to deposit bone wax during cutting, with the fastening element screwed through the patient's ilium.

Fig. 3B shows the bone cutting drill advanced through the patient's ilium.

Fig. 4 is a schematic view of a cut-out section of the patient's ilium being removed by a cannulated fastening element .

Fig. 5 is a schematic view of a cannulated access portal through the patient's ilium.

Fig. 6 is a schematic view of a surgical instrument passing through the patient's ilium and through a second cannula and into the patient's intervertebral space.

Fig. 7 is an illustration of a pair of percutaneously inserted cannulae approaching a patient's ilium in posterolateral angles. Fig. 8 is an illustration of a pair of percutaneously inserted cannulae approaching a patient's ilium in posterolateral angles with a bone cutter passing through the patient's ilium.

Fig. 9 is a view of a racetrack-shaped hole passing through the ilium.

DESCRIPTION OF THE SPECIFIC EMBODIMENTS

Figs. 1-5 are to be viewed in sequence and show different aspects of the present method of providing a surgical access portal through a patient's ilium. Fig. 6 shows a method of inserting a surgical device into the intervertebral space through a second cannula which is received through the first cannula and through the access portal cut in the ilium.

Fig. 1 shows a cannulated obturator 10 received in a cannula 12 which is percutaneously introduced through the back 14 of a patient having an ilium 16 and an intervertebral space 18. Obturator 10 has a narrow tapered end 11 enabling it to pass through the patient's tissues such that end 11 can be advanced to a position adjacent ilium 16 as is seen in Fig. 2. After obturator 10 reaches ilium 16, cannula 12 can be slipped down thereover such that a distal end 13 of cannula 12 can be placed in contact with ilium 16. Preferably, as is shown in Figs. 1 and 2, distal end 13 of cannula 12 can have a angled end such that it can be rotated about its longitudinally extending central axis to abut against ilium 16 although ilium 16 is angled to cannula 12.

A fastening element is then attached to the ilium. In a preferred aspect, this fastening element comprises a screw-type fastening element 20 which is preferably held within bore 9 of obturator 10. Fastening element 20 can then be rotated to be screwed into ilium 16, as shown.

As seen in Fig. 3A, obturator 10 is then removed and a bone cutting device 15, which is preferably hollow as shown, is inserted into cannula 12 over fastening screw 20 such that bone cutting device 15 abuts against ilium 16. Screw-type fastening element 20 is received within a hollow bore 21 of bone cutter 15 as shown. Back and forth oscillation or continuous rotation of bone cutter 15 will eventually bore through ilium 16 to the position shown in Fig. 3B. Bone cutter 15 is adapted to provide for the conveyance and deposition of bone wax into bone interstices created by the coring of the ilium, thereby reducing intraoperative and postoperative bleeding. Specifically, spiral grooves 23 on the exterior surface of bone cutter 15 are adapted to hold bone wax or paraffin therein such that the bone wax or paraffin will be heated and melt with the cutting friction, thereby being deposited into the cored bone region. Accordingly, bone healing is promoted.

In a preferred aspect, bone cutter 15 comprises an oscillating "cast" drill (ie: a drill which cuts through rigid objects but not soft objects), which is adapted to cut through the hard bony tissue of the ilium without damaging softer surrounding tissues.

As shown in Fig. 4, oscillation or rotation of bone cutter 15 will eventually cut out a circular section 19 of ilium 16 which can be removed as follows. Since fastening element 20 is rotated to be screwed into section 19 of ilium 16, removal of fastening element 20 and bone cutter 15 from within cannula 20 will thus also cause circular cut-out section 19, (which is attached to fastening element 20), to be removed as well. When bone cutter 15 and fastening element 20 are simultaneously removed, section 19 will preferably remain within the cannula of bone cutter 15. Rotational or axial movement of fastening element 20 relative to bone cutter 15 will subsequently remove section 19 from the cannula of bone cutter 15. As a result, a cannulated access portal 30 will be provided passing percutaneously through the patient's ilium as is shown in Fig. 5. Subsequently, as is shown in Fig. 6, a surgical tool 25 which may comprise an intervertebral insert, bone decorticator, camera, articulating forceps, intervertebral insert positioning systems, bone-graft introducer, electrocoagulator, bone wax applicator, shaver or curette, can then be inserted through cannula 20 and through ilium 16 such that surgical tool 25 can reach intervertebral space 18. Specifically, in a preferred aspect, a second cannula 22 is dimensioned to be slidably received within first cannula 12 such that cannula 22 can be advanced to intervertebral space 18. Surgical tool 25 can then be inserted therethrough such that surgical tool 25 can be positioned at intervertebral space 18, as shown. In a preferred aspect, the second cannula may have an oval cross section.

In another preferred aspect, nerve . surveillance electrodes 31 are positioned at the distal end of cannula 22 or on surgical device 25, (which may comprise a blunt obturator) . Electrodes 31 can be adapted to sense the presence of a para-spinal nerve as cannula 22 is advanced through access portal 30. In alternative aspects, expandable trocars may be inserted through cannula 22 to access the patient's intervertebral space.

Cut-out section 19 can itself be used as bone graft material for packing around or within intervertebral inserts which are positioned in the intervertebral space using the present system.

As is shown in Fig. 9, a racetrack-shaped hole 40 can be drilled through the ilium 16 by sequentially drilling overlapping first and second circular holes 42 and 44 using the present method. As can be appreciated holes of various shapes, (including elongated racetrack shapes), can be drilled through the patient's ilium. An advantage of racetrack-shaped hole 40 is that it permits cannulae having oval or racetrack-shaped cross sections to be passed through ilium 16, and into the patient's intervertebral region.

As the present invention is adapted to provide a passage through the patient's ilium as is set forth herein, an optimal posterolaterally angled access portal through to the patient's L5/S1 intervertebral spaces can be provided. Fig. 7 shows a pair of percutaneously inserted cannulae 12 approaching the patient's ilium 16 in posterolateral angles, which are preferably in the range of 40° to 90° to an anterior axis through the patient. Fig. 8 shows the pair of percutaneously inserted cannulae 12 positioned against the patient's ilium 16 in posterolateral angles with the distal end of bone cutter 15 passing through patient's ilium 16.

The present invention also provides kits for providing a surgical access portal through a patient's ilium, comprising: a cannula; a bone cutting drill dimensioned to be received within the cannula; a fastening element dimensioned to be received within the bone cutting drill; and instructions for use setting forth any of the methods herein described.

The present invention also provides kits for providing access to a patient's intervertebral space through a patient's ilium, comprising: a first cannula; a bone cutting drill dimensioned to be received within the first cannula; a fastening element dimensioned to be received within the bone cutting drill; and instructions for use setting forth any of the methods herein described.

Claims

WHAT IS CLAIMED IS:
1. A method of providing a surgical access portal through a patient's ilium, comprising: positioning a distal end of a cannulated obturator against the patient's ilium; advancing a fastening element through the cannula of the obturator so that the fastening element reaches the patient's ilium; securing the fastening element to the patient's ilium; advancing a cannulated bone cutting drill over the fastening element such that a distal end of the cannulated bone cutting drill contacts the patient's ilium; drilling a hole through the patient's ilium with the bone cutting drill; removing a circular cut portion of the ilium attached to the fastening element, thereby providing an access portal through the patient's ilium.
2. The method of claim 1, further comprising: introducing the cannulated obturator into the patient through a percutaneously inserted first cannula.
3. The method of claim 1, further comprising accessing a patient's intervertebral space by: inserting a second cannula through the first cannula; and advancing a distal end of the second cannula through the access portal in the ilium and into the patient's intervertebral space.
4. The method of claim 3, further comprising: advancing a surgical instrument through the access portal and into the intervertebral space.
5. The method of claim 2, wherein the first cannula is introduced in a posterolateral approach.
6. The method of claim 5, wherein, the posterolateral approach is at an angle of in the range of 40 to 90 degrees to an anterior-posterior axis through the patient.
7. The method of claim 1, wherein, the first cannula has a longitudinal axis extending therethrough and the distal end of the first cannula is angled with respect to the longitudinal axis, wherein positioning the distal end of the first cannula comprises rotating the first cannula about the longitudinal axis such that the angled end substantially fully contacts the ilium.
8. The method of claim 1, wherein, securing the fastening element to the ilium comprises screw-fastening a distal end of the fastening element into the ilium.
9. The method of claim 1, wherein, the bone cutting drill and the fastening element are removed simultaneously from the first cannula with the circular cut portion of the ilium held within the bone cutting drill.
10. The method of claim 9, wherein, the circular cut portion of the ilium is removed from the bone cutting drill by displacing an axially-adjustable plug in the bone cutting drill.
11. The method of claim 10, wherein, the axially- adjustable plug is received over the fastening element and within the bone cutting drill.
12. The method of claim 4, wherein advancing a surgical instrument comprises advancing an intervertebral insert, bone decorticator, camera, articulating forceps, intervertebral insert positioning systems, bone-graft introducer, electrocoagulator, bone wax applicator, shaver or curette into the intervertebral space.
13. The method of claim 1, further comprising, depositing bone wax around the surface of the hole as the hole is drilled through the ilium.
14. A kit for providing a surgical access portal through a patient's ilium, comprising: a cannula; a bone cutting drill dimensioned to be received within the cannula; a fastening element dimensioned to be received within the bone cutting drill; and instructions for use setting forth the method of claim 1.
15. A system for providing a surgical access portal through a patient's ilium, comprising: a first cannula; a bone cutting drill dimensioned to be received within the first cannula; and a fastening element dimensioned to be received within the bone cutting drill.
16. The system of claim 15, wherein, the first cannula has an annular cross-section.
17. The system of claim 15, wherein, the bone cutting drill is an oscillating drill.
18. The system of claim 15, wherein, the fastening element has a distal end shaped to be screw-fit into the ilium.
19. The system of claim 15, wherein, the bone cutting drill has a grooved exterior surface adapted to hold bone wax or paraffin therein.
20. The system of claim 15, wherein, the first cannula has an angled distal end.
21. The system of claim 15, wherein, the first cannula has a round or oval-shaped cross section.
22. The system of claim 15, further comprising, a second cannula dimensioned to be received within the first cannula.
23. The system of claim 22, wherein, the second cannula has a round or oval-shaped cross section.
24. The system of claim 23, further comprising, an expandable trocar dimensioned to be received within the first and second cannulae.
25. The system of claim 22, further comprising, a surgical instrument dimensioned to be received within the second cannula.
26. The system of claim 25, wherein, the surgical instrument is an intervertebral insert, bone decorticator, endoscope, articulating forceps, intervertebral insert positioning systems, bone-graft introducer, electrocoagulator, bone wax applicator, shaver or curette.
27. The system of claim 15, further comprising, an intervertebral implant dimensioned to be received within the first and second cannulae.
PCT/US1999/012610 1998-06-09 1999-06-04 Transiliac approach to entering a patient's intervertebral space WO2000048521A1 (en)

Priority Applications (7)

Application Number Priority Date Filing Date Title
US8866398P true 1998-06-09 1998-06-09
US60/088,663 1998-06-09
US12066399P true 1999-02-19 1999-02-19
US60/120,663 1999-02-19
US12970399P true 1999-04-16 1999-04-16
US60/129,703 1999-04-16
PCT/US1999/012610 WO2000048521A1 (en) 1998-06-09 1999-06-04 Transiliac approach to entering a patient's intervertebral space

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
AU45479/99A AU4547999A (en) 1999-02-19 1999-06-04 Transiliac approach to entering a patient's intervertebral space
PCT/US1999/012610 WO2000048521A1 (en) 1998-06-09 1999-06-04 Transiliac approach to entering a patient's intervertebral space
CA002345918A CA2345918A1 (en) 1998-06-09 1999-06-04 Transiliac approach to entering a patient's intervertebral space
JP2000599316A JP2002537014A (en) 1998-06-09 1999-06-04 Iliac between the approach to enter the intervertebral space of a patient
EP99928407A EP1113756A1 (en) 1999-02-19 1999-06-04 Transiliac approach to entering a patient's intervertebral space

Publications (2)

Publication Number Publication Date
WO2000048521A1 true WO2000048521A1 (en) 2000-08-24
WO2000048521A8 WO2000048521A8 (en) 2001-08-16

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PCT/US1999/012610 WO2000048521A1 (en) 1998-06-09 1999-06-04 Transiliac approach to entering a patient's intervertebral space

Country Status (3)

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JP (1) JP2002537014A (en)
CA (1) CA2345918A1 (en)
WO (1) WO2000048521A1 (en)

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7963970B2 (en) 2005-11-23 2011-06-21 Trinity Orthopedics Percutaneous transpedicular access, fusion, discectomy, and stabilization system and method
WO2011151606A1 (en) * 2010-06-04 2011-12-08 Spineart Sa Instruments for mini-invasive spinal column surgery and uses thereof
US8439925B2 (en) 2009-05-11 2013-05-14 Trinity Orthopedics, Llc Transiliac-transsacral method of performing lumbar spinal interventions
US8834508B2 (en) 2011-05-27 2014-09-16 Spinefrontier Inc Methods, tools and devices for percutaneous access in minimally invasive spinal surgeries

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2019093723A1 (en) * 2017-11-10 2019-05-16 경북대학교 산학협력단 Endoscopic end effector for bone surgery

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5484437A (en) * 1988-06-13 1996-01-16 Michelson; Gary K. Apparatus and method of inserting spinal implants
US5632747A (en) * 1995-03-15 1997-05-27 Osteotech, Inc. Bone dowel cutter
US5899908A (en) * 1993-02-10 1999-05-04 Sulzer Spine-Tech Inc. Spinal drill tube guide

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5484437A (en) * 1988-06-13 1996-01-16 Michelson; Gary K. Apparatus and method of inserting spinal implants
US5899908A (en) * 1993-02-10 1999-05-04 Sulzer Spine-Tech Inc. Spinal drill tube guide
US5632747A (en) * 1995-03-15 1997-05-27 Osteotech, Inc. Bone dowel cutter

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7963970B2 (en) 2005-11-23 2011-06-21 Trinity Orthopedics Percutaneous transpedicular access, fusion, discectomy, and stabilization system and method
US8777957B2 (en) 2005-11-23 2014-07-15 Trinity Orthopedics, Llc Percutaneous transpedicular access, fusion, discectomy, and stabilization system and method
US8439925B2 (en) 2009-05-11 2013-05-14 Trinity Orthopedics, Llc Transiliac-transsacral method of performing lumbar spinal interventions
WO2011151606A1 (en) * 2010-06-04 2011-12-08 Spineart Sa Instruments for mini-invasive spinal column surgery and uses thereof
FR2960764A1 (en) * 2010-06-04 2011-12-09 Spineart Sa Instruments for minimally invasive spinal surgery and their applications
CN102933162A (en) * 2010-06-04 2013-02-13 脊柱工艺公司 Instruments for mini-invasive spinal column surgery and uses thereof
US8834508B2 (en) 2011-05-27 2014-09-16 Spinefrontier Inc Methods, tools and devices for percutaneous access in minimally invasive spinal surgeries

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JP2002537014A (en) 2002-11-05
CA2345918A1 (en) 2000-08-24
WO2000048521A8 (en) 2001-08-16

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