MATRIX SPINE SYSTEM – DEGENERATIVE - Limelight …synthes.vo.llnwd.net/o16/LLNWMB8/INT Mobile/Synthes International... · MATRIX Spine System – Degenerative Technique Guide DePuy

TECHNIQUE GUIDE

The total solution for simple and complex spine pathology

MATRIX SPINE SYSTEM – DEGENERATIVE

Instruments and implants approved by the AO Foundation.This publication is not intended for distribution in the USA.

Image intensifier control

WarningThis description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling these instruments is highly recommended.

Reprocessing, Care and Maintenance of Synthes InstrumentsFor general guidelines, function control and dismantling of multi-part instruments, please refer to: www.synthes.com/reprocessing

MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 1

INTRODUCTION MATRIX Spine System – Degenerative 2

AO Principles 6

Indications and Contraindications 7

SURGICAL TECHNIQUE Surgical Technique 8

Optional Technique 29• Screw Insertion with Retaining Sleeve, Locking 29• Unassembled Pedicle Screw Insertion 31• Polyaxial Head Removal 33• Reduction Screws 34• Adding Transverse Connectors 36• Adding Rod-to-Rod Connectors 37• Distraction for Posterior Interbody Fusion 39• Locking Cap Removal 42

PRODUCT INFORMATION How to Disassemble Instruments for Cleaning 47

Implants 51

Instruments 67

BIOMATERIALS IMPLANTS 81

TABLE OF CONTENTS

1 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide

MATRIX SPINE SYSTEM – DEGENERATIVE

The Synthes MATRIX Spine System is a universal set of instruments and implants that cover degenerative dis-orders (open or minimally invasive access), deformities and trauma indications.

Unique Dual Core / Double Lead Screw Design• Fast and controlled insertion• Increased pull-out resistance due to optimal bone

purchase• Safe handling thanks to atraumatic tip and self-

tapping thread

PrimeLock – Screwdriver – Screw Interlock• Toggle free screw insertion• Precise and controlled screw placement• Direction of screw insertion possible


Modularity – Click-on and Preassembled Screws• For better visualization of the anatomi-

cal structure• Multiple screw head removal and

replacement without removing the bone screw from the pedicle

• Customized inventory possible

Snap-on Swiveling Transverse Connector• Offers fast and simple in-situ placement• Simple anatomical adjustment possible

15 mm

50° 50°


MATRIX Spine System – Degenerative

Preassembled Polyaxial and Reduction Pedicle Screw• Allows up to 50° of angulation to ease in situ connec-

tion to the longitudinal rod• The rod reduction features are located at the top of

the polyaxial head • Dual Core/Double Lead thread designed to securely

anchor the screw in cortical and cancellous bone• Threaded T25 Stardrive recess designed to deliver

torque effectively

Pedicle Screw• Increased visual access to the anatomical structures• Allows for improved access to the surgical field • Dual Core/Double Lead thread designed to securely

anchor the screw in cortical and cancellous bone• Threaded T25 Stardrive recess designed to deliver

torque effectively

Click-on Polyaxial and Reduction Screw Head• The polyaxial head of the implant is designed for rod

reduction• To ease intraoperative planning, the polyaxial heads

can be removed and replaced without removing the pedicle screw from the pedicle

• The reduction head allows for 15 mm rod reduction

IMPLANTS


Rods• Available in three material strengths: Hard pure tita-

nium, extra-hard titanium alloy (TAN), and extra-hard cobalt-chromium alloy, diameter 5.5 mm

• A choice of straight and curved rods to facilitate intra-operative construct assembly and technique maneuvers

Locking Cap• Square thread design minimizes cross threading under

high reduction loads• T25 Stardrive recess designed to reduce the risk of

damage at high loads• 1-step locking cap allows for complete fi xation in one

step (polyaxiality and run on rod)• Available fl at or with guidance

Transverse Connector• The snap-on transverse connector is preassembled and

requires only fi nal positioning and tightening• The jaws of the transverse connector swivel and are

spring loaded • Telescoping body is arched to accommodate grafts and

anatomical structures and is available in a range of lengths

• The locking screws use a T15 Stardrive which minimizes drive stripping while fi nal tightening

Instruments• Ergonomically designed handles• Intuitive, easy to use• Convenient, interchangeable options


AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.¹ They are:• Anatomic reduction• Stable internal fixation• Preservation of blood supply• Early, active mobilization

The fundamental aims of fracture treatment in the limbs and fusion of the spine are the same. A specific goal in the spine is returning as much function as possible to the injured neural elements.²

AO Principles as Applied to the Spine³

Anatomic alignmentRestoration of normal spinal alignment to improve the biomechanics of the spine.

Stable internal fixationStabilization of the spinal segment to promote bony fusion.

Preservation of blood supplyCreation of an optimal environment for fusion.

Early, active mobilizationMinimization of damage to the spinal vasculature, dura, and neural elements, which may contribute to pain re-duction and improved function for the patient.

¹ Müller ME, Allgöwer M, Schneider R, Willenegger H (1995) Manual of Internal Fixation. 3rd, expanded and completely revised ed. 1991. Berlin, Heidelberg, New York: Springer

² Ibid.³ Aebi M, Arlet V, Webb JK (2007). AOSPINE Manual (2 vols.), Stuttgart, New

York: Thieme


INDICATIONS AND CONTRAINDICATIONS

The MATRIX Spine System is a posterior pedicle screw and hook fixation system (T1–S2) intended to provide precise and segmental stabilization of the spine for use in skeletally mature patients.

Indications• Degenerative disc disease• Spondylolisthesis• Trauma (i.e. fracture or dislocation)• Tumor• Stenosis• Pseudarthrosis• Failed previous fusion• Deformities (i.e. scoliosis, kyphosis and/or lordosis)

Contraindications• Osteoporosis• In fractures and tumors with severe anterior vertebral

body disruption, an additional anterior support or col-umn reconstruction is required


SURGICAL TECHNIQUE

1Prepare pedicles and determine screw lengths

Instruments

388.656 Pedicle Awl B 4.0 mm with Silicone Handle, length 255 mm, for Pedicle Screws B 5.0 to 7.0 mm

388.655 Pedicle Probe B3.7 mm with Silicone Handle, length 240 mm, for Pedicle Screws B5.0 to 7.0 mm

Locate pedicles and use the awl to perforate the cortex. Use the probe to open the pedicle canal. Using radio-graphic imaging, confirm pedicle location, orientation and depth by inserting the probe. When selecting the appropriate length screw, use the markings on the probe to determine the pedicle depth.

All MATRIX pedicle screws are self-tapping; however, if tapping is preferred, use the appropriate tap and tap handle.


Optional instruments

03.632.057 Pedicle Marker for Matrix

03.632.058 Inserter for Pedicle Marker, for Matrix

388.657 Pedicle Probe B3.8 mm, curved, with Silicone Handle, length 290 mm, for Pedicle Screws B5.0 to 7.0 mm

388.536 Pedicle Probe for Screws B4.2 mm, length 240 mm

388.545 Feeler for Screw Channel, straight, B2.3 mm, length 275 mm

388.546 Feeler for Screw Channel, curved, B2.3 mm, length 275 mm

388.549 Feeler, straight, with rounded tip

388.551 Pedicle Awl B 3.0 mm, length 230 mm, for Screws B 4.0 and 4.2 mm

03.632.103 Tap for Pedicle Screws B3.5 mm, length 180 mm








388.654 Ratchet with Handle, with Hexagonal Quick Coupling 6.0 mm


Surgical Technique

2Assemble screwdriver

Instruments

03.632.036 Retaining Sleeve, long, for Matrix 5.5

03.632.072 Screwdriver Shaft Stardrive, T25, long, for Matrix 5.5

03.620.061 T-Handle with Ratchet Wrench and with Torque Limiter, 10 Nm

Slide retaining sleeve on the screwdriver shaft and attach the ratchet handle.


03.616.043 Retaining Sleeve, locking, long

03.632.074 Screwdriver Stardrive, T25, long, with T-Handle, for Matrix 5.5

03.632.075 Screwdriver Stardrive, T25, long, with straight handle, for Matrix

03.616.042 Retaining Sleeve, locking

03.632.001 Retaining Sleeve, standard, for Matrix 5.5

03.632.002 Screwdriver Shaft Stardrive, T25, standard, for Matrix 5.5

03.632.004 Screwdriver Stardrive, with T-Handle, standard, for Matrix 5.5

03.632.005 Screwdriver Stardrive, T25, with straight handle, standard, for Matrix 5.5


3Pick up screw

Instruments




Choose the appropriate screw diameter and length based on pedicle probe feedback.

Insert the screwdriver tip into the recess of the pedicle screw and rotate the green knob of the retaining sleeve clockwise until the tip of the sleeve is firmly attached to the pedicle screw.

Verify the screw length with the template provided in the screw module.

Note: Set the ratchet to the neutral position before picking up a screw.











Surgical Technique

4Insert screw

Instruments




Insert the screw. Hold the black part of the retaining sleeve during screw insertion.

To disengage the retaining sleeve, rotate the green knob counterclockwise and remove the screwdriver.

Notes: • Do not grasp the green knob during screw inser-

tion as this will cause the retaining sleeve to dis-engage from the screw.

• Ensure that the polyaxial screw head remains free to adapt its position and is not restricted by, or does not rest on, bony structures. If necessary, ad-just the screw height and/or ream space for the screw head.

• When countersinking, care should be taken in reaming the most superior (and inferior) level to protect the facet joints.

• If pedicle screws with separate polyaxial heads are used, follow the optional technique described on page 31.


Optional Instruments










Surgical Technique

5Select, cut and bend rod

Instruments

03.632.007 Alignment Tool for polyaxial Screw Head, for Matrix 5.5

388.906 Trial Rod B5.0 mm, length 150 mm

03.632.017 Rod Bender with Silicone Handle

Use the head alignment tool to rotate and align the screw heads.

Use the trial rod to determine contour and length of the rod.

Select precontoured rod, or use rod bender to form rod according to the template.

Notes:• The screw height must be adjusted to the rod. If

necessary, adjust the screw height using a screw-driver without retaining sleeve.

• To restore polyaxiality of a screw head that has al-ready been tightened, insert the alignment tool in the screw head and apply sufficient pressure to re-lease the lock.




388.750 USS Rod Cutting and Bending Device

388.720 Bolt Cutter

Notes: • The USS rod cutting and bending device must be

used to cut cobalt chromium rods.• Do not reverse bend rods. Reverse bending may

produce internal stresses, which may become the focal point for eventual breakage of the implant.


Surgical Technique

6Insert rod

Instrument

03.632.081 Rod Holding Forceps for Rods B5.5 mm

Insert the rod using the rod holding forceps.

Optional instrument

03.632.202 Holding Forceps for Rods B5.5 and B6.0 mm


7Reduce rod

Option A: Reduce rod with a rod pusher

Instruments

03.632.006 Rod Pusher/Counter Torque, standard, for Matrix 5.5

03.632.080 Handle, detachable, for Matrix

Connect detachable handle to the octagonal end of the rod pusher/counter torque.

Advance rod into the screw head using the rod pusher/ countertorque.


03.632.076 Rod Pusher/Counter Torque, long, for Matrix 5.5

03.632.169 Rod Pusher for Rods B5.5/6.0 mm, for Matrix

03.632.000 Distraction Fork


Surgical Technique

Option B:Reduce rod with a rocker fork

Instruments

03.632.010 Rocker Fork, small, for Matrix 5.5

03.632.012 Rocker Fork, medium, for Matrix 5.5

03.632.011 Rocker Fork, footed, for Matrix 5.5

Use a rocker fork to lever the rod into the head of the pedicle screw.

Reduction travels:Small Rocker Fork = 8.5 mmMedium Rocker Fork = 13.5 mmFooted Rocker Fork = 7.5 mm

Technique tip: Use the footed MATRIX rocker fork to aid in reducing the rod into adjacent screw heads.


Option C:Reduce rod with a rod persuader

Instrument

03.632.009 Rod Persuader, standard, for Matrix 5.5

Ensure that the ratchet handle is fully open. Place the rod persuader over the rod and onto the screw head. Press down firmly until the tips engage the head of the screw. Squeeze the handle to seat the rod into the head of the pedicle screw.

Reduction travel:15 mm

Note: The rod persuader can be used as counter torque for final tightening of the locking cap.

Optional instrument

03.632.079 Rod Persuader, long, for Matrix 5.5


Surgical Technique

Option D: Reduce rod with a Reduction Instrument for Spondylolisthesis

Instruments

03.632.408 Reduction Instrument for Spondylolis-thesis, standard, for Matrix 5.5


03.620.091 Socket, hexagonal 6.0 mm

To assemble the instrument, slide the inner tube through the outer tube. Insert the black nut and press down firmly until audible feedback. Push the inner tube up to-wards the black nut and turn the black nut clockwise until the black line is visible at the 30 line.

Place the reduction instrument over the screw head. Press down firmly until the tips engage. Load the hexag-onal socket into the ratchet handle and insert it into the top of the reduction instrument.

Rotate the ratchet handle clockwise to reduce the rod into the screw head. Full reduction is achieved when the black line on the side of the instrument is visible at the 0 line.

Remove the hexagonal sockel to insert a locking cap through the instrument.

To remove the instrument from the screw head, turn the palm handle counter-clockwise until the line on the side of the instrument is visible at the 30 line.

Reduction travel: 30 mm


Parallel reduction can be achieved by the simultaneous use of two reduction instruments on the same vertebral body.

Note: The reduction instrument for spondylolisthe-sis can be used as counter torque for final tightening of the locking cap.

Optional instrument

03.632.409 Reduction Instrument for Spondylolis-thesis, long, for Matrix 5.5


Surgical Technique

8Insert 1-step locking cap

Instruments





Insert the tip of the screwdriver shaft into the T25 recess of the locking cap. Press down firmly. The screwdriver shaft is self-retaining.

To ensure optimal cap alignment, insert the locking cap through the rod pusher/counter torque. Thread the lock-ing cap clockwise into the implant head.

Apply a light torque to provisionally tighten the locking cap and maintain the desired rod position. Place the re-maining caps and provisionally tighten.

1 2

3

4a

4b


Note:Confirm that the rod is fully aligned to the polyaxial head. (1)Examples of misalignment:• The rod is sitting high in the polyaxial head. (2)• The rod is not perpendicular to the polyaxial

head. (3)• A severe bend is positioned within the polyaxial

head. (4a, 4b)


Surgical Technique

9Distract

Instruments

388.410 Spreader Forceps for Pedicle Screws, length 330 mm

03.632.401 Screwdriver Shaft Stardrive, T25, long, straight tip, with Hexagonal Coupling, for Matrix


03.632.049 Counter Torque, standard, for Matrix 5.5

Precaution: Ensure all locking caps are fully re-duced and provisionally tightened (see “Insert 1-step locking cap”). Failure to do so could poten-tially lead to a misalignment.

Finally tighten one locking cap completely to create a fixed point for distraction (see “Perform final tighten-ing”). Reverse the locking cap of the screw to be relo-cated a quarter of a turn.

Use the distraction forceps to distract the construct. Once in the desired position, tighten the locking caps with the screwdriver.

The holding forceps can be used as a temporary point of distraction when adjacent pedicle screws are too distant from each other.


Note: Always fully seat the counter torque on the rod. The instrument must be perpendicular to the rod during tightening.



03.632.072 Screwdriver Shaft Stardrive, T25, long, for Matrix



03.632.400 Screwdriver Shaft Stardrive, T25, standard, straight tip, with Hexagonal Coupling, for Matrix




Correct Incorrect


Surgical Technique

10Compress

Instruments

388.422 Compression Forceps, length 335 mm, for Pedicle Screws





Finally tighten one locking cap completely to create a fixed point for distraction (see “Perform final tighten-ing”). Reverse the locking cap of the screw to be relo-cated a quarter of a turn.

Use the compression forceps to compress the construct. Once in the desired position, tighten the locking caps with the screwdriver.

The rod holding forceps can be used as a temporary point of compression when adjacent pedicle screws are too distant.

Note: Always fully seat the counter torque on the rod. The instrument must be perpendicular to the rod during tightening.

Optional instrument


Correct Incorrect


11Perform final tightening

Instruments






Note: The handle of the counter torque must be ori-ented laterally or medially. Do not orient the handle of the countertorque in line with the rod. This ac-tion could cause misalignment of the rod with the implant.

Place the counter torque over the head of the screw. At-tach the screwdriver shaft to the T-handle with torque limiter. Insert the instrument through the counter torque cannula into the drive recess of the locking cap. Ensuring that the polyaxial head is perpendicular to the rod, tighten until there is a tactile release. This indicates that the required 10 Nm of torque has been applied. Repeat for all locking caps.

After initial final tightening of all screws, sequentially re-visit all locking caps. Start at the caudal left screw of the construct and proceed clockwise to systematically repeat final tightening of all locking caps of the construct.

Warning: Final tightening of the locking caps should only be performed with a Synthes 10 Nm torque handle. MATRIX screw implants achieve perfor-mance standard only when tightened to the re-quired 10 Nm tightening torque.

Correct Incorrect


Surgical Technique

Notes:• Alternatively, the reduction instrument for spon-

dylolisthesis and the rod persuader can be used as counter torque for final tightening of the locking cap.

• Always fully seat the rod pusher/counter torque on the rod. The instrument must be perpendicular to the rod during final tightening.






03.632.078 Reduction Instrument for Spondylolis-thesis, long, for Matrix 5.5

03.632.079 Rod Introduction Pliers, long, for Matrix 5.5

03.632.099 Counter Torque, long, for Matrix 5.5

Correct Incorrect

1

2

3

4

5


OPTIONAL TECHNIQUE Screw Insertion with Retaining Sleeve, Locking

Insert screw with retaining sleeve, locking

Instruments


03.616.043 Retaining Sleeve, locking, long, for Matrix 5.5

To assemble the screwdriver and the retaining sleeve, depress the loading collar on the proximal end of the retaining sleeve (1).

Then slide the sleeve toward the handle on the shaft until it stops (2).

Release the loading collar and verify that the retaining sleeve is firmly attached to the screwdriver (3).

Retract the green locking ring towards the handle (4).

Place the screwdriver tip securely into the T25 StarDrive recess of the pedicle screw (5).

6

7

8


Optional Technique Screw Insertion with Retaining Sleeve, Locking

When using a ratchet handle, make sure to set it to neu-tral setting.

Rotate the grey knob of the retaining sleeve clockwise. Firmly tighten to secure the implant, using the handle as countertorque (6).

Push the green locking ring toward the grey knob (7). If required, set the ratchet handle to the forward setting to insert the screw.

To release the screw from the retaining sleeve, retract the grey locking ring towards the handle, rotate the silver knob counterclockwise and remove the screw-driver (8).

Notes: • Polyaxial screwheads need to remain free and mo-

bile after insertion to allow accurate alignment to the rod during locking cap insertion and final tightening.

• The mobility of the screwhead cannot be assessed while the holding sleeve is attached.




03.632.042 Retaining Sleeve, locking, standard, for Matrix 5.5

03.632.004 Screwdriver Stardrive, T25, standard, with T-Handle, for Matrix




OPTIONAL TECHNIQUEUnassembled Pedicle Screw Insertion

1Insert unassembled pedicle screw

Instruments


03.632.046 Reamer for Pedicle Screws, for Matrix 5.5

Prepare the pedicle and insert the unassembled pedicle screws as recommended in steps 1 to 4 of the surgical technique (pages 8–13).

Slide the reamer over the screwdriver shaft. Engage the tip of the screwdriver in the unassembled pedicle screw. Ream until the black line is visible on the shaft. This indi-cates that there is enough room for the implant head.

Note: When reaming the most superior and inferior levels take care to protect the facet joints.









Optional TechniqueUnassembled Pedicle Screw Insertion

2Assemble polyaxial head

Instruments

03.632.037 Positioning Instrument for Polyaxial Screw Heads, for Matrix 5.5

68.632.125 Loading Station for Matrix 5.5

Insert the inner shaft of the positioning instrument into the handle and tighten in the clockwise direction.

To pick up a screwhead, align the positioning instrument for polyaxial screw heads to the rod slot features on the poly axial head implant and press down.

Position the placement tool with the polyaxial head over the unassembled pedicle screw and press down. To en-sure the polyaxial head is securely attached to the unas-sembled pedicle screw, gently lift up on the placement tool and angulate the polyaxial head.

To release the head placement tool, press the button lo-cated at the distal end of the instrument.

Notes:• If the polyaxial head does not successfully attach

to the head of the unassembled pedicle screw, ad-ditional reaming or screw height adjustment may be required to ensure sufficient space exists to allow free mobility of the head.

• Polyaxial screw heads can be removed a maxi-mum of three times without removing the pedicle screw; a new head must be used for each assembly.


OPTIONAL TECHNIQUEPolyaxial Head Removal

Instruments

03.632.045 Removal Instrument for Polyaxial Screw Heads, for Matrix 5.5


If required, the polyaxial head can be removed from the pedicle screw intraoperatively.

Remove any existing locking cap and the rod.

Connect the inner shaft of the removal tool for polyaxial screw heads to the ratchet and insert into the handle of the removal tool.

Ensure that the black line is visible on the inner shaft of the head removal tool.

Press the tip of the head removal tool into the polyaxial head. A tactile feedback may be felt as the tip of the head removal tool mates with the collet of the polyaxial head. While holding the handle, thread the inner shaft clockwise until it stops. Lift to remove the head.

To remove the implant head from the instrument, turn the ratchet counter-clockwise until the black line is visi-ble. Pull the head off the instrument.

Notes:• The head removal tool can be used to remove the

polyaxial head of both unassembled as well as pre-assembled screws.

• To remove the polyaxial reduction head, the tabs must first be broken off.


OPTIONAL TECHNIQUEReduction Screws

Instruments


03.632.042 Rod Pusher / Counter Torque for Reduction Screw, for Matrix 5.5


03.632.026 Rod Pusher / Counter Torque for Reduction Screws, for Matrix 5.5

03.632.030 Tab Remover for Reduction Screws, for Matrix 5.5

Reduction screws are available in preassembled form or as click-on versions for subsequent assembly.

Follow the technique for preassembled polyaxial screw (page 10) or unassembled pedicle screw (page 31) to in-sert screw.

Pick up a locking cap from the screw module with a T25 screwdriver shaft. The screwdriver shaft is self-retaining.

Place the rod pusher/counter torque for reduction screws (03.632.042) over the screw head. Insert the locking cap through the counter torque. Turning the locking cap will reduce the rod into the screw head.





03.632.025 Counter Torque for Reduction Screws, for Matrix 5.5

03.632.074 Screwdriver Stardrive, T25, long, with T-Handle, for Matrix

15 mm Reduction


To break off the reduction screw tabs, place the rod pusher/counter torque for reduction screws (03.632.026) with the handle over the screw head. Gently rock the tab removal tool medial then lateral to break the tab wall free from the polyaxial head.

Alternative technique for locking cap insertion

Instrument

03.632.029 Holding Crown for Reduction Screws, for Matrix 5.5

The holding crown for reduction screws can be used in-stead of the counter torque to provide guidance for the locking cap insertion.


OPTIONAL TECHNIQUEAdding Transverse Connectors

Instruments

03.632.053 Measuring Device for Transverse Connectors, Snap-on, for Matrix

03.632.204 Torque-limiting Handle, 3 Nm

03.632.052 Screwdriver Stardrive, T15, short, for Matrix

03.632.050 Retaining Sleeve for Transverse Connectors, Snap-on, for Matrix

Use the measuring device for transverse connectors to estimate the distance between the two rods. On the crossbar of the measuring device note the size of the ap-propriate transverse connector (1–8).

The transverse connectors are marked with sizes 1–8, matching the figures on the measuring device. Select the appropriate transverse connector.

The ends of the transverse connector can be clicked onto the rod to secure it at the desired point.

Use the screwdriver and the torque limiting handle to se-cure the transverse connector to the rods. When tight-ening the setscrews a tactile release is felt.

Note: Always use the retaining sleeve when tighten-ing the setscrew.

Warning: The MATRIX transverse connector contains Nitinol components. Implants that contain nitinol should not be used in patients with nickel sensitivities or allergies.


OPTIONAL TECHNIQUEAdding Rod-to-Rod Connectors

Instruments


03.632.055 Screwdriver Shaft Stardrive, T15, standard (straight tip)


Choose the snap-on open parallel connector according the rod diameters to be received. The diameters ac-cepted are etched on both sides of the connector to en-sure the correct rod size is attached to each opening.

Precaution: Parallel connectors with one set screw should be used in pairs on each side of the con-struct. Connectors with two set screws can be used one per side of the construct.

Attach the preferred connector to each rod. Mount the T15 screwdriver shaft to the 3 Nm torque-limiting handle and slide the retaining sleeve over the screwdriver shaft. To secure the connector to the rods, engage the T15 drive into each setscrew recess, slide the retractable re-taining sleeve to the distal position. Tighten all the set screws until a tactile release is felt.


Optional TechniqueAdding Rod-to-Rod Connectors

Notes: • If any part of the construct requires further ad-

justment, all set screws must be loosened to the point of resistance. Do not remove set screws from the assembly. After final adjustment, retighten the set screws.

• Parallel connectors contain Nitinol components. Implants that contain Nitinol should not be used in patients with nickel sensitivities or allergies.

• The retaining sleeve for transverse connectors cannot be used when tightening parallel with two set screws.

Precautions:• Care should be taken not to tighten the connector

on a portion of the rod that has been contoured or deformed by a rod cutter.

• Synthes connectors are tested using Synthes 5.5 or 6.0 mm rods and not compatible with those rods of similar diameter from other manufacturers.

• Refer to the torque-limiting handle package and labeling for the recommended calibration mainte-nance.

Optional instrument

03.632.052 Screwdriver Stardrive, T15, short, for Matrix (self-holding)


OPTIONAL TECHNIQUEDistraction for Posterior Interbody Fusion

Instruments


03.632.085 Retaining Sleeve, detachable, for Matrix 5.5

03.632.083 Distractor Tip, for Bone Screws, for Matrix 5.5

03.632.087 Toothed Rack Retractor, for Matrix

Slide detachable retaining sleeve over long T25 screw driver. Slide the distractor tip over the screwdriver tip and press firmly into the detachable retaining sleeve.

Insert the tip of the screwdriver shaft into the screw head. Make sure that the tip of the screwdriver is fully seated in the recess of the screw head. Turn the green knob clockwise.

Insert two pedicle screws.

To release the detachable retaining sleeve from the distractor tip, pull the green knob towards the handle. Remove the screwdriver and retaining sleeve and repeat the procedure for the second pedicle screw.

1

2


Optional TechniqueDistraction for Posterior Interbody Fusion

Insert both posts of the distractor into the distractor tips. Lock the angular position of the rotatable distractor arm (1) by turning the lever. Switch the rocker lever (2) to the distraction position (D) and rotate the wing nut screw clockwise until the desired distraction is achieved. Perform discectomy and interbody fusion.

Turn the rocker lever (2) to neutral (N) to unlock the an-gular position and remove the distractor.

Reattach the screwdriver/detachable retaining sleeve and turn the green knob counterclockwise.

Note: Do not allow the assembled tips to cross over otherwise the distractor will not work correctly. If necessary, use a different type of tip (see page 41).

1

2

3


Alternative instruments


03.632.084 Distractor Tip, for Screw Heads, for Matrix 5.5

03.632.089 Distractor Tip, with Hook End, for Matrix 5.5

Alternative distractor tips and techniquesThree different distractor tips are available, which can be used in a variety of combinations.

The distractor tip for screws (1) can be used with pedicle, polyaxial, and polyaxial reduction screws. Parallel distrac-tion can be performed.

The distractor tip with screw heads (2) can be used with polyaxial, polyaxial reduction, and monoaxial screws. They are attached to the polyaxial screw head after in-sertion of the pedicle screw. If firmly tightened the screw becomes monoaxial and parallel distraction can be per-formed. These tips are particularly suitable for cases where the tips for bone screws would cross over as a re-sult of pronounced lordotic curvature of the spine.

The distractor tip with hook end (3) can be used with pedicle, polyaxial, and polyaxial reduction screws. Distraction can be performed.


OPTIONAL TECHNIQUELocking Cap Removal

Loosen locking cap

Instruments




03.632.080 Handle, detachable, for Matrix 5.5

To remove a locking cap, slide the counter torque with detachable handle over the screwhead. Place the ratchet of the torque limiting handle in the neutral position, en-gage a T25 screwdriver with the Stardrive recess of the locking cap and turn counter-clockwise.

Note: Locking caps are designed to lock the con-struct safely and minimize the chance of post- operative loosening and rod-push-through. There-fore, in certain cases, the loosening torque may be higher than 10 Nm. In such cases, use the following techniques to remove a locking cap.


Sequentially turn clockwise and then immediately counter- clockwise. Turn until tactile or audible feedback from the implant is experienced. Repeat the steps until the locking cap is loose.

Notes: • For this technique, always use the torque limiting

handle (03.620.061) to reduce risk of damage to the T25 screwdriver shaft.

• If this method does not produce the desired result, follow the technique according to Option A (page 44) or Option B (page 46).






Optional TechniqueLocking Cap Removal

If after multiple attempts to loosen the locking cap the torque is still excessive, the following techniques should be used:

Option A: Counter torque on a adjacent screw

Instruments






Place the rod pusher/counter torque with detachable handle over an adjacent screw on the same rod (i.e. one level higher or lower). Simultaneously place the counter-torque over the locking cap to be loosened and engage the screwdriver shaft and torque limiting handle with the stardrive recess of the locking cap. Place the ratchet of the torque limiting handle in the neutral position and begin to sequentially turn clockwise and then immedi-ately counter-clockwise. Turn until tactile or audible feedback from the implant is experienced. Repeat the steps until the locking cap is loose.




• Retighten the locking cap on which the counter torque was applied to 10 Nm.

• To loosen the last locking cap, replace the counter torque, consisting of rod pusher/counter torque and handle, with a rod persuader.

• If this method does not produce the desired result, follow the technique according to Option B (page 46).








Optional TechniqueLocking Cap Removal

Option B:Apply a downward force to the rod

Instruments




Apply a downward force to the rod. Place the Rod Per-suader on the screw and firmly squeeze the handles. Place the ratchet of the torque limiting handle in the neutral position. With the reduction load applied begin to sequentially turn clockwise and then immediately counter-clockwise. Turn until tactile or audible feedback from the implant is experienced. Repeat the steps until the locking cap is loose.



• If this method does not produce the desired result, follow the technique according to Option A (page 44).

Optional Instruments





1

1

4

2

2

5

3

3


HOW TO DISASSEMBLE INSTRUMENTS FOR CLEANING

Screwdriver with retaining sleeve

Screwdriver with detachable retaining sleeve

1

1

2

2

1

2


How to Disassemble Instruments for Cleaning

Counter torque

Positioning instrument for polyaxial screw heads

1

1

2

2

1

2


Head removal tool

Torque limiting handle

1 2 3

1 2 3


How to Disassemble Instruments for Cleaning

Reduction instrument for spondylolisthesis MATRIX

Rod persuader MATRIX


IMPLANTS*

Pedicle Screw Matrix 5.5 Polyaxial B4.0 mm,preassembled, Titanium Alloy (TAN)

length (mm)

04.632.420 20

04.632.425 25

04.632.430 30

04.632.435 35

04.632.440 40

04.632.445 45


length (mm)

04.632.520 20

04.632.525 25

04.632.530 30

04.632.535 35

04.632.540 40

04.632.545 45


length (mm)

04.632.120 20

04.632.125 25

04.632.130 30

04.632.135 35

04.632.140 40

04.632.145 45

04.632.150 50

04.632.155 55

04.632.160 60

* All implants are also available sterile packed. Add suffix “S” to article number.


Implants


length (mm)

04.632.620 20

04.632.625 25

04.632.630 30

04.632.635 35

04.632.640 40

04.632.645 45

04.632.650 50

04.632.655 55

04.632.660 60

04.632.665 65


length (mm)

04.632.725 25

04.632.730 30

04.632.735 35

04.632.740 40

04.632.745 45

04.632.750 50

04.632.755 55

04.632.760 60

04.632.765 65

04.632.770 70

04.632.775 75

04.632.780 80

04.632.785 85

04.632.790 90

04.632.795 95

04.632.799 100



length (mm)

04.632.825 25

04.632.830 30

04.632.835 35

04.632.840 40

04.632.845 45

04.632.850 50

04.632.855 55

04.632.860 60

04.632.865 65

04.632.870 70

04.632.875 75

04.632.880 80

04.632.885 85

04.632.890 90

04.632.895 95

04.632.899 100


length (mm)

04.632.930 30

04.632.935 35

04.632.940 40

04.632.945 45

04.632.950 50

04.632.955 55

04.632.960 60

04.632.965 65

04.632.970 70

04.632.975 75

04.632.980 80

04.632.985 85

04.632.990 90

04.632.995 95

04.632.999 100


Implants

Reduction Screw Matrix 5.5, B4.0 mm,preassembled, Titanium Alloy (TAN)

length (mm)

04.634.420 20

04.634.425 25

04.634.430 30

04.634.435 35

04.634.440 40

04.634.445 45


length (mm)

04.634.520 20

04.634.525 25

04.634.530 30

04.634.535 35

04.634.540 40

04.634.545 45

04.634.550 50

04.634.555 55


length (mm)

04.634.120 20

04.634.125 25

04.634.130 30

04.634.135 35

04.634.140 40

04.634.145 45

04.634.150 50

04.634.155 55

04.634.160 60



length (mm)

04.634.620 20

04.634.625 25

04.634.630 30

04.634.635 35

04.634.640 40

04.634.645 45

04.634.650 50

04.634.655 55

04.634.660 60

04.634.665 65


length (mm)

04.634.725 25

04.634.730 30

04.634.735 35

04.634.740 40

04.634.745 45

04.634.750 50

04.634.755 55

04.634.760 60

04.634.765 65


Implants


length (mm)

04.634.825 25

04.634.830 30

04.634.835 35

04.634.840 40

04.635.845 45

04.635.850 50

04.635.855 55

04.635.860 60

04.635.865 65


Pedicle Screw Matrix 5.5 B4.0 mm,Titanium Alloy (TAN)

length (mm)

04.639.420 20

04.639.425 25

04.639.430 30

04.639.435 35

04.639.440 40

04.639.445 45


length (mm)

04.639.520 20

04.639.525 25

04.639.530 30

04.639.535 35

04.639.540 40

04.639.545 45

04.639.550 50

04.639.555 55


length (mm)

04.639.120 20

04.639.125 25

04.639.130 30

04.639.135 35

04.639.140 40

04.639.145 45

04.639.150 50

04.639.155 55

04.639.160 60


Implants


length (mm)

04.639.620 20

04.639.625 25

04.639.630 30

04.639.635 35

04.639.640 40

04.639.645 45

04.639.650 50

04.639.655 55

04.639.660 60

04.639.665 65


length (mm)

04.639.725 25

04.639.730 30

04.639.735 35

04.639.740 40

04.639.745 45

04.639.750 50

04.639.755 55

04.639.760 60

04.639.765 65

04.639.770 70

04.639.775 75

04.639.780 80

04.639.785 85

04.639.790 90

04.639.795 95

04.639.799 100



length (mm)

04.639.825 25

04.639.830 30

04.639.835 35

04.639.840 40

04.639.845 45

04.639.850 50

04.639.855 55

04.639.860 60

04.639.865 65

04.639.870 70

04.639.875 75

04.639.880 80

04.639.885 85

04.639.890 90

04.639.895 95

04.639.899 100


Implants


length (mm)

04.639.930 30

04.639.935 35

04.639.940 40

04.639.945 45

04.639.950 50

04.639.955 55

04.639.960 60

04.639.965 65

04.639.970 70

04.639.975 75

04.639.980 80

04.639.985 85

04.639.990 90

04.639.995 95

04.639.999 100

Also available:• Pedicle Screw Matrix 5.5, polyaxial, cannulated• Pedicle Screw Matrix 5.5, perforated• Intermediate lengths available upon request

Screw heads

04.632.001 Screw Head, polyaxial, for Matrix 5.5, Titanium Alloy (TAN)

04.634.002 Reduction Head, polyaxial, for Matrix 5.5, Titanium Alloy (TAN)


Curved rods

Rods B5.5 mm, hard, curved, Pure Titanium (TiCP)

length (mm)

04.636.030 30

04.636.035 35

04.636.040 40

04.636.045 45

04.636.050 50

04.636.055 55

04.636.060 60

04.636.065 65

04.636.070 70

04.636.075 75

04.636.080 80

04.636.085 85

04.636.125 125

Rods B5.5 mm, extra-hard, curved, Cobalt-Chrome Alloy (CoCrMo)

length (mm)

09.636.030 30

09.636.035 35

09.636.040 40

09.636.045 45

09.636.050 50

09.636.055 55

09.636.060 60

09.636.065 65

09.636.070 70

09.636.075 75

09.636.080 80

09.636.085 85

09.636.125 125


Implants

Straight rods

Rods B5.5 mm, hard, straight, Pure Titanium (TiCP)

length (mm)

04.634.230 30

04.634.235 35

04.634.240 40

04.634.245 45

04.634.250 50

04.634.255 55

04.634.260 60

04.634.265 65

04.634.270 70

04.634.275 75

04.634.280 80

04.634.285 85

04.634.290 90

04.634.295 95

04.633.290 100

04.634.325 125

04.633.291 150

04.633.292 200

04.633.293 300

04.633.294 400

04.633.500 500

04.633.700** 700

** Available nonsterile packed only


Straight rods

Rods B5.5 mm, extra-hard, straight, Titanium Alloy (TAN)

length (mm)

04.616.130 30

04.616.135 35

04.616.140 40

04.616.145 45

04.616.150 50

04.616.155 55

04.616.160 60

04.616.165 65

04.616.170 70

04.616.175 75

04.616.180 80

04.616.185 85

04.616.190 90

04.616.195 95

04.633.279 100

04.616.225 125

04.633.281 150

04.616.275 175

04.633.282 200

04.633.283 300

04.633.284 400

04.633.285 500

04.616.700** 700



Implants

Straight rods

Rods B5.5 mm, hard, straight, Cobalt-Chrome Alloy (CoCrMo)

length (mm)

09.631.030 30

09.631.035 35

09.631.040 40

09.631.045 45

09.631.050 50

09.631.055 55

09.631.060 60

09.631.065 65

09.631.070 70

09.631.075 75

09.631.080 80

09.631.085 85

09.631.090 90

09.631.095 95

09.633.100 100

09.631.125 125

09.633.150 150

09.631.175 175

09.633.190 200

09.633.191 300

09.633.192 400

09.633.193 500

09.631.700** 700



Connecting rods

Connecting Rod, length 500 mm,Pure Titanium (TiCP)

diameter (mm/mm)

04.633.187 5.5/6.0

Connecting Rods, length 500 mm,Titanium Alloy (TAN)

diameter (mm/mm)

04.633.190 5.5/3.5

04.633.191 5.5/4.0

04.633.188 5.5/6.0

Connecting Rod, length 500 mm, Cobalt-chrome alloy (CoCrMo)

diameter (mm/mm)

09.633.187 5.5/6.0

Also available:Pelvic Rods B5.5 mm, prebent

For an overview, please refer to www.synthes.com/e-catalog


Implants

Locking cap

09.632.099 Locking Cap, fl at, one-step, for Matrix 5.5, Cobalt-chrome alloy (CoCrMo)

04.632.000 Locking Cap, one-step, for Matrix 5.5 Titanium Alloy (TAN)

Snap-On Transverse Connector

length size

04.633.317 17–22 mm 1

04.633.321 21–26 mm 2

04.633.326 26–31 mm 3

04.633.330 30–33 mm 4

04.633.333 33–38 mm 5

04.633.338 38–47 mm 6

04.633.347 47–62 mm 7

04.633.364 62–90 mm 8

Snap-On Open Parallel Connectors

diameters set screws

04.633.400 5.5 to 5.5 mm 1

04.633.401 5.5 to 6.0 mm 1

04.633.402 6.0 to 6.0 mm 1

04.633.403 5.5 to 5.5 mm 2

04.633.404 5.5 to 6.0 mm 2

04.633.405 6.0 to 6.0 mm 2


INSTRUMENTS

For pedicle preparation

03.632.057 Pedicle Marker for Matrix

03.632.058 Inserter for Pedicle Marker, for Matrix

Awls and probes with palm handle

388.656 Pedicle Awl B 4.0 mm with SiliconeHandle, length 255 mm, for Pedicle Screws B 5.0 to 7.0 mm

388.536 Pedicle Probe for Screws B4.2 mm, length 240 mm

388.655 Pedicle Probe B3.7 mm with Silicone Handle, length 240 mm, for Pedicle Screws B5.0 to 7.0 mm

388.657 Pedicle Probe B3.8 mm, curved, with Silicone Handle, length 290 mm, for Pedicle Screws B5.0 to 7.0 mm

388.551 Pedicle Awl B 3.0 mm, length 230 mm, for Screws B 4.0 and 4.2 mm


Instruments

Ball tip feelers

388.545 Feeler for Screw Channel, straight, B2.3 mm, length 275 mm

388.546 Feeler for Screw Channel, curved, B2.3 mm, length 275 mm

388.549 Feeler, straight, with rounded tip

Tap for Pedicle Screws, length 180 mm

03.632.103 B3.5 mm

03.632.104 B4.0 mm

03.632.105 B5.0 mm

03.632.155 B5.5 mm

03.632.106 B6.0 mm

03.632.107 B7.0 mm

03.632.108 B8.0 mm

03.632.109 B9.0 mm


For screw insertion

Retaining Sleeves





Screwdriver Shafts Stardrive T25





Screwdrivers Stardrive T25 with T-Handle




Instruments

Screwdrivers Stardrive T25 with straight handle


03.632.075 Screwdriver Stardrive, T25, long, with straight handle, for Matrix 5.5

03.620.019 Torque-limiting Handle, 10 Nm, for Pangea

03.636.008 T-Handle with Hexagonal Coupling 6.0 mm

03.632.090 T-Handle with Ratchet Wrench, with Hexagonal Coupling 6.0 mm

03.632.091 Handle with Ratchet Wrench, straight,with Hexagonal Coupling 6.0 mm

Handles with hexagonal coupling


03.632.037 Positioning Instrument for Polyaxial Screw Heads, for Matrix 5.5

03.632.045 Removal Instrument for Polyaxial Screw Heads, for Matrix 5.5

03.632.046 Reamer for Pedicle Screws, for Matrix 5.5

68.632.125 Loading Station for Matrix 5.5

For assembly and removal of polyaxial screw heads

03.632.007 Alignment Tool for polyaxial Screw Head, for Matrix 5.5


Instruments

For rod cutting and bending

388.906 Trial Rod B5.0 mm, length 150 mm


388.750 USS Rod Cutting and Bending Device

388.720 Bolt Cutter


For rod insertion

03.632.202 Holding Forceps for Rods B5.5 and B 6.0 mm

03.632.081 Rod Holding Forceps for Rods B5.5 mm

03.632.169 Rod Pusher for Rods B5.5/6.0 mm, for Matrix


Instruments

388.422 Compression Forceps, length 335 mm, for Pedicle Screws

03.620.017 Compression Forceps, for Lumbar Spine

03.620.018 Distraction Forceps, for Lumbar Spine

388.410 Spreader Forceps for Pedicle Screws, length 330 mm

For distraction and compression

03.632.000 Distraction Fork


Instruments for toothed rack retractor


03.632.084 Distractor Tip, for Screw Heads, for Matrix 5.5

03.632.085 Retaining Sleeve, detachable, for Matrix 5.5

03.632.087 Toothed Rack Retractor, for Matrix

03.632.089 Distractor Tip, with Hook End, for Matrix 5.5


Instruments

For cap introduction and tightening


Rod Pusher/Counter Torques





03.632.099 Counter Torque, long, for Matrix 5.5


For transverse and parallel connectors


03.632.052 Screwdriver Shaft Stardrive, T15, short, for Matrix (self holding)

03.632.055 Screwdriver Shaft Stardrive, T15, standard (straight tip)

03.632.053 Measuring Device for Transverse Connectors, Snap-on, for Matrix



Instruments

For rod reduction

Reduction instruments


03.620.091 Socket, hexagonal 6.0 mm


03.632.409 Reduction Instrument for Spondylolisthesis, long, for Matrix 5.5


Rocker forks

03.632.010 Rocker Fork, small, for Matrix 5.5

Rod persuader/Rod introduction pliers



03.632.012 Rocker Fork, medium, for Matrix 5.5

03.632.011 Rocker Fork, footed, for Matrix 5.5


Instruments

03.632.042 Rod Pusher/Counter Torque for Reduction Screw, for Matrix 5.5

03.632.026 Rod Pusher/Counter Torque for Reduction Screws, for Matrix 5.5

03.632.029 Holding Crown for Reduction Screws, for Matrix 5.5

03.632.030 Tab Remover for Reduction Screws, for Matrix 5.5

Instruments for reduction screws

03.632.025 Counter Torque for Reduction Screws, for Matrix 5.5


BIOMATERIAL IMPLANTS

To facilitate fusion, bone graft is often applied in the lateral gutters. A suitable bone graft substitute (e.g. chronOS, DBX) may be used by itself or in combination with autograft.

The construct shown is complemented with chronOS Strip precast, which optimally integrates with patient anatomy and implanted hardware. Perfusion of Strip with bone marrow aspirate provides a favorable environ-ment for bony ingrowth.

chronOS Strip, precast, sterile

07.801.200.02S 47 mm × 18 mm × 3 mm pack of 2 implants

length lengththickness thickness

0123

Synthes GmbHEimattstrasse 34436 OberdorfSwitzerlandTel: +41 61 965 61 11Fax: +41 61 965 66 00www.depuysynthes.com

This publication is not intended for distribution in the USA.

All surgical techniques are available as PDF files at www.synthes.com/lit ©

DeP

uy S

ynth

es S

pine

, a d

ivis

ion

of S

ynth

es G

mbH

. 201

5.

All

right

s re

serv

ed.

036.

001.

185

DS

EM

/SP

N/0

115/

0266

02

/15

Documents

MATRIX SPINE SYSTEM – DEGENERATIVE - Limelight …synthes.vo.llnwd.net/o16/LLNWMB8/INT Mobile/Synthes International... · MATRIX Spine System – Degenerative Technique Guide DePuy