To implant an interspinous device, clamp, or interbody graft, the surgeon approaches the spine posteriorly through the skin and lumbar fascia. After separating muscular and fascial attachments and fully visualizing the posterior spine, removal of the interspinous ligament allows for placement of the Carmela Device.

Key features of the Carmela system include:

• Oval surgical window for enhanced direct and microscopic visualization

• Rack-and-pinion retraction mechanism for smooth, controlled distraction

• Oppositional U-shaped hooks that anchor securely at the base of the spinous process—where vertebral bone is strongest

• Four arm lengths (S, M, L, XL) to accommodate all patient sizes and surgical depths

This design delivers uniform longitudinal distraction of the interlaminar space and disc space, avoiding the complications common with pedicle-screw-based distractors that open unilaterally and risk loosening screws.

Once placed between the spinous processes, the diverging retractor arms provide exceptional direct and microscopic visualization of the interlaminar region—without slipping, obstructing the field, or interfering with the surgical microscope. After decompression is completed, the surgeon can proceed with interspinous device placement or TLIF interbody grafting with optimal clarity and access.