Data Collection Form Email Surgeon Name Patient Code Date Left Peak Removal Torque Nm L1 Nm L2 Nm L3 Nm L4 Nm L5 Nm S1 Right Peak Removal Torque L1 Nm L2 Nm L3 Nm L4 Nm L5 Nm S1 Nm Fusion status Fused Nonunion Unknown Duration since hardware implantation days Explanted device product name Explanted device manufacturer name Explanted set screw material type Rod material type Interbody fusion device present at revised level(s)? Yes No If yes, what type? ALIF DLIF TLIF PLIF Explanted pedicle screw, set screw, and rod provided to sponsor? Yes No
