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Synapse System. An enhanced setof implants and instruments for posteriorstabilization of the cervical and upperthoracic spine.
Technique Guide
Instruments and implants approved by the AO Foundation.
This publication is not intended fordistribution in the USA.
Image intensifier control
WarningThis description alone does not provide sufficient background for direct use ofthe instrument set. Instruction by a surgeon experienced in handling theseinstruments is highly recommended.
Reprocessing, Care and Maintenance of Synthes InstrumentsFor general guidelines, function control and dismantling of multi-part instruments,please contact your local sales representative or refer to:www.synthes.com/reprocessing
Introduction
Surgical Technique
Product Information
Biomaterial Implants
Assembly Guide
Synapse System 2
AO Principles 4
Indications and Contraindications 5
Preparation 6
Surgical Technique 8
Additional Technique – Top loading Hooks 24
Additional Technique – Transverse Connector 25(Head to Head)
Additional Technique – Transverse Connector 28(Rod to Rod)
Additional Techniques 31
Implant Removal 33
Implants 36
Instruments 39
Synapse System Compatibility 47
48
Screwdriver Assembly 49
Rod Introduction Instrument Assembly (03.614.027) 51
Drill Sleeve Assembly (388.393) 52
Depth Gauge Assembly (03.161.028) 53
Table of Contents
Synapse System Technique Guide DePuy Synthes 1
Synapse System. An enhanced set ofimplants and instruments for posteriorstabilization of the cervical and upperthoracic spine.
2 DePuy Synthes Synapse System Technique Guide
The Synapse System is an enhanced set of instruments andimplants, including clamps, top-loading variable axis screws,hooks, transverse connectors and transverse bars and rods,designed for posterior stabilization of the cervical and upperthoracic spine.
The implants provide flexibility required to accommodatevariations in patient anatomy.
The Synapse System uses 3.5 mm and 4.0 mm rods, allowingcomponents from Axon, CerviFix and Occipito-Cervical Fusion System to be used interchangeably. This allows theconstruct to extend from the occiput to the lower spine using the Occipito-Cervical Fusion System and the UniversalSpine System (USS) or any other Synthes posterior rod-screwsystem.
System features– 3.5 mm and 4.0 mm titanium* rods– Top-loading lamina hooks– Simple, efficient instrumentation– Multiple implant options for crossing the cervicothoracic
junction– Fully compatible with the Occipito-Cervical Fusion System– Square-threaded locking screws– Robust polyaxial screws– Top-loading transverse connectors
*Titanium – 6% Alluminium – 7% Niobium Alloy
Top-loading Transverse Connectors– Head to head connection for increased stability– Adjustable connector available in four variable lengths to
accommodate different patient anatomy– Assemble on the head of any Synapse polyaxial screw– Straight and angled versions offer enhanced flexibility
options
Synapse System Technique Guide DePuy Synthes 3
50° 50°
Robust polyaxial screws
4 DePuy Synthes Synapse System Technique Guide
– Top loading– 4.0 Screws accomodate � 3.5 mm and � 4.0 mm rods– One piece body– Self-tapping– Three diameters with cancellous profile:
– � 3.5 mm– � 4.0 mm (rescue screw)– � 4.5 mm
– � 3.5 mm and � 4.0 mm cancellous screws offer up to 50˚ angulation (� 4.5 mm screws offer up to 40˚ angulation)
Shaft screw– Lengths from 18 mm – 50 mm*
with a 10 mm unthreaded shaft (2 mm increments)
– Self-tapping– Shaft screws with cortical profile– Offers 40˚ angulation in all directions
The threaded driver eliminates driver“sticking” in the bone screw
*Screw length is total length.
Medial, 50 mm width Medial, 60 mm width
Lateral, 50 mm width Lateral, 60 mm width
Synapse System Technique Guide DePuy Synthes 5
Synapse is fully compatible with the Occipito-CervicalFusion System for posterior occipito-cervical fixationsThe Synthes Occipito-Cervical Fusion System is intended toprovide stabilization and promote fusion of the occipito- cervical junction. It includes a complete set of implants andinstruments designed to optimize fixation to the occiput and easily connect to all Synthes posterior cervical and tho-racic rod-screw systems.
Versatile fixation possibilities to the occiputThe Occipito-Cervical Fusion System offers several implantoptions to maximize fixation to the occiput and minimize theimplant footprint.
For further information see Technique Guide “Occipito- Cervical Fusion System“ (036.000.755).
Occipital plates for � 3.5 mm rods Occipital plates for � 4.0 mm rods
Medial, 50 mm width
Lateral, 60 mm width
Medial, 60 mm width
Lateral, 50 mm width
6 DePuy Synthes Synapse System Technique Guide
AO Principles
In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation.1 These are:– Anatomical alignment– Stable internal fixation– Preservation of blood supply– Early, active mobilization
The fundamental aims of fracture treatment in the limbs andfusion of the spine are the same. A specific goal in the spineis returning as much function as possible to the injured neu-ral elements.2
AO Principles as Applied to the Spine3
Anatomical alignmentIn the spine, this means reestablishing and maintaining thenatural curvature and the protective function of the spine. Byregaining this natural anatomy, the biomechanics of thespine can be improved and a reduction of pain may be expe-rienced.
Stable internal fixationIn the spine, the goal of internal fixation is to maintain notonly the integrity of a mobile segment, but also to maintainthe balance and the physiologic three-dimensional form ofthe spine.3 A stable spinal segment allows bony fusion at thejunction of the lamina and pedicle.
1 Müller ME, Allgöwer M, Schneider R, Willenegger H (1995) Manual of InternalFixation. 3rd, exp. a. completely rev. ed. 1991. Corr. 3rd printing. Berlin,Heidelberg, New York: Springer
2 Ibid.3 Aebi M, Arlet V, Webb JK (2007) AOSPINE Manual (2 vols), Stuttgart, New York:Thieme
Preservation of blood supplyThe proper atraumatic technique enables minimal retractionor disturbance of the nerve roots and dura, and maintainsthe stability of the facet joints. The ideal surgical techniqueand implant design minimize damage to anatomical struc-tures, i.e. facet capsules and soft tissue attachments remainintact, and create a physiological environment that facilitateshealing.
Early, active mobilizationThe ability to restore normal spinal anatomy may permit theimmediate reduction of pain, resulting in a more active,functional patient. The reduction in pain and improved func-tion can result when a stable spine is achieved.
Indications and Contraindications
The Synapse System is an enhanced set of instruments andimplants, including:– Top-loading variable axis screws– Hooks– Transverse bars – Rods
It is designed for posterior stabilization of the cervical spineand upper thoracic spine. The implants provide the flexibilityrequired to accommodate variations in patient anatomy.
IndicationsInstabilities in the upper cervical spine and in the occipito -cervical region:– Rheumatoid arthritis– Congenital anomalies– Posttraumatic conditions– Tumors– Infections
Instabilities in the lower cervical and upper thoracic spine:– Posttraumatic conditions– Tumors– Iatrogenic instabilities following laminectomy etc.
Degenerative and painful posttraumatic conditions in thelower cervical and upper thoracic spine.
Anterior cervical fusions requiring additional posterior stabilization.
Contraindications– Spinal destruction accompanied by a loss of ventral sup-
port (caused by tumors, fractures and infections) results in major instability of the cervical spine and upper thoracicspine. In this situation, stabilization with Synapse is notsufficient. Additional anterior stabilization is crucial.
– Severe osteoporosis.
Synapse System Technique Guide DePuy Synthes 7
01.614.012
Preparation
8 DePuy Synthes Synapse System Technique Guide
1Preparation
Required set
01.614.012 Synapse System in Vario Case (All implants are unsterile and for 3.5 mm rods only)
Optional sets
01.615.015 Synapse/Occipito-Cervical Fusion 4.0 Instrument Set
01.601.010 Occipito-Cervical Fusion System in Vario Case (All implants are unsterile and for 3.5 mm rods only)
Note: Rods for the Synapse System are available in � 3.5 mm and � 4.0 mm. Implants for � 3.5 mm are avail-able sterile and unsterile. Implants for � 4.0 mm are avail-able sterile only.
Where � 4.0 mm rods are used, these must be combinedwith Synapse 4.0 screws / OC-Fusion 4.0 plates / clamps andthe Synapse/Occipito-Cervical Fusion 4.0 Instrument set listedabove.
01.615.015 (Optional)
2Preoperative planning
All necessary imaging studies should be available to planimplant placement and visualize individual patient anatomy.
3Position patient
Patient positioning is critical for cervical posterior fusion pro-cedures. The patient should be placed on the operating tablein the prone position with the patient’s head securely immo-bilized. Proper patient position should be confirmed via directvisualization prior to draping and by radiograph.
Always use caution when positioning the patient, as physio-logic alignment may not be attainable.
4Approach
Use the standard surgical approach to expose the spinousprocesses and laminae of the vertebrae to be fused.
5Assemble instruments
The following instruments have to be assembled prior to use:– Screwdriver– Rod introduction instrument– Drill sleeve– Depth gauge
Assemble instruments according to the assembling instructions found on pg. 49 –53, or refer to www.synthes.com/reprocessing.
Synapse System Technique Guide DePuy Synthes 9
Surgical Technique
1Start screw hole
Instrument
388.397 Awl � 3.5 mm
Determine the entry point and trajectory for the screw anduse the awl to create a pilot hole. This helps to prevent dis-placement of the drill bit during initial insertion.
Confirm screw entry point, orientation and depth.
10 DePuy Synthes Synapse System Technique Guide
2Select screw and drill sleeve
Instrument
388.393 Drill Sleeve with Scale, for Drill Bit � 2.4 mmor 03.614.011 Drill Sleeve with Scale, for Drill Bit � 3.2 mm
Select the drill bit and drill sleeve that correspond to thescrew diameter to be used. � 3.5 mm and � 4.0 mm screwshave the same core diameter (2.4 mm) and are to be usedwith the same drill bit and drill sleeve, identified by a yellowband. � 4.5 mm screws have a larger core diameter (3.2 mm) and are to be used with the drill bit and drill sleeveidentified by a light blue color band. See table below.
Screw 3.5 mm 4.0 mm 4.5 mmdiameter
Drill bit 388.394 388.394 03.614.010
Drill sleeve 388.393 388.393 03.614.011
Synapse System Technique Guide DePuy Synthes 11
12 DePuy Synthes Synapse System Technique Guide
3Set drill sleeve depth
Instrument
388.393 Drill Sleeve with Scale, for Drill Bit � 2.4 mmor03.614.011 Drill Sleeve with Scale, for Drill Bits � 3.2 mm
To set the drill sleeve to the desired depth, slide back thelatch to release the inner tube; align the distal end of the in-ternal drill sleeve tube with the appropriate depth calibrationon the window. Release the latch to lock the drill sleeve atthe desired depth.
Surgical Technique
Synapse System Technique Guide DePuy Synthes 13
4Drill hole
Instruments
388.393 Drill Sleeve with Scale, for Drill Bit � 2.4 mm
388.394 Drill Bit � 2.4 mm with Stop, 2-flute, for Quick Coupling
388.549 Feeler, straight, with rounded tip
Drill to the desired trajectory and depth, using the � 2.4 mmdrill bit and drill sleeve. Use the feeler to confirm, by palpa-tion, accurate placement within the pedicle or lateral mass.
Note: Perform drilling in steps until the appropriate depth is reached. Confirm screw entry point, orientation and depth.
Alternative instruments
03.614.010 Drill Bit � 3.2 mm with Stop, 2-flute, for Quick Coupling
03.614.011 Drill Sleeve with Scale, for Drill Bits � 3.2 mm
Surgical Technique
14 DePuy Synthes Synapse System Technique Guide
Alternative technique
Instruments
03.614.012 Pedicle Probe � 2.4 mm, straight03.614.013 Pedicle Probe � 2.4 mm, curvedor03.614.037 Pedicle Probe � 3.2 mm, straight03.614.038 Pedicle Probe � 3.2 mm, curved
Pedicle preparation may also be performed using either thestraight or curved pedicle probe.
Optional technique
Instruments
389.473 Pedicle Marker, small with short markings
389.474 Pedicle Marker, small with long markings
The small pedicle markers may be used to radiographicallyconfirm position and orientation of screw sites.
Synapse System Technique Guide DePuy Synthes 15
5Measure
Instrument
03.161.028 Depth Gauge for Screws � 3.5 to 5.0 mm, measuring range up to 50 mm
Use the depth gauge to confirm hole depth and select thecorresponding screw length. The depth gauge reading andthe screw length indicate actual bone purchase. The depthgauge must sit directly on the bone.
6Tapping (optional)
Instruments
03.614.015 Tap for Cancellous Bone Screws � 4.5 mm
03.614.016 Guide Sleeve for Tap � 3.5 mm and � 4.5 mm
311.349 Tap for Cancellous Bone Screws � 3.5 mm
389.477 Tap for Cortex Screw � 3.5 mm
Dense bone may be tapped using the appropriate tap, depending on the chosen screw.
The guide sleeve may be used as a tissue protector, and toindicate tap depth.
16 DePuy Synthes Synapse System Technique Guide
Surgical Technique
7Insert screw
Instruments
03.614.017 Holding Sleeve with thread
03.614.036 Outer Sleeve for Holding Sleeve No. 03.614.017
03.614.039 Hexagonal Screwdriver Shaft, cross pinned
324.107 Handle with Quick Coupling
Refer to page 49 and 50 for screwdriver assembly and im-plant attachment instructions. Insert the selected � 3.5 mmor � 4.5 mm self-tapping Synapse screw. A � 4.0 mm emer-gency screw may be used if the primary � 3.5 mm screw hasless than optimal fixation.
Note: The outer sleeve should be used to grip the holdingsleeve during screw insertion.
Synapse System Technique Guide DePuy Synthes 17
8Place additional screws
Use the same technique to insert the remaining screws.
9Contour template
Instrument
388.868 Trial Rod � 3.5 mm
Contour the trial rod to fit the anatomy.
18 DePuy Synthes Synapse System Technique Guide
Surgical Technique
Internalledge
Alternative bending technique
Instruments
03.614.024 Bending Iron for Rods � 3.5 mm, left
03.614.025 Bending Iron for Rods � 3.5 mm, right
The bending irons can be used for both � 3.5 mm and � 4.0 mm rods. The bending irons can also be used as piperod benders. Insert the rod into the rear of each bending ironand lock in place by turning the thumbwheels clockwise.With both ends locked inside the irons, the rod may be con-toured.
Note: Repeated or reverse bending may weaken the rod.
10Bend and cut rod
Instruments
03.614.021 Cutting Pliers for Rods
03.614.022 Bending Pliers
Optional instrument
03.615.011 Rod Shearer for Rods � 4 mm
Use the bending pliers to contour the rod to match the curveof the template. The bend line arrow indicates where the rodwill be bent.
Use the cutting pliers to cut the rod to the appropriatelength.
Alternative techniqueShorter rod sections may be bent by placing one end of therod on the internal ledge of the bending feature.
Synapse System Technique Guide DePuy Synthes 19
11Insert rod
Instrument
388.407 Holding Forceps for Rods � 3.5 mm, length 181 mm
Optional instruments
03.614.024 Bending Iron for Rods � 3.5 mm, left
03.614.025 Bending Iron for Rods � 3.5 mm, right
03.614.034 Alignment Tool
Insert the rod into the variable axis heads of the screws usingthe holding forceps. The holding forceps can be used forboth � 3.5 mm and � 4.0 mm rods. The alignment tool maybe used to help orient the heads to the correct position. Thebending irons may be used to adjust the curve of the rod.
20 DePuy Synthes Synapse System Technique Guide
12Insert locking screw
Instruments
03.614.019 Screwdriver Shaft Stardrive for Locking Screw, T15
03.614.035 Handle with Torque Limiter, 2.0 Nm
Loosely fasten the locking screws using the screwdriver shaftwith the 2 Nm torque limiting handle. When inserting thelocking screws, they may be turned one-quarter to one-halfturn counterclockwise to seat the thread before tightening.
Note: If intending on inserting a transverse connector forhead-to-head connection, the Locking Screw for TransverseConnectors and Cap Nut 7.5 mm must be used as describedon page 25.
Surgical Technique
Alternative technique
Instrument
03.614.027 Rod Introduction Instrument
Optional instruments
03.614.026 Rod Pusher
03.615.009 Rod Introduction Instrument for � 4.0 mm
03.615.010 Rod Pusher for Rods � 4.0 mm
Use the rod introduction instrument or rod pusher to intro-duce the titanium rod into the variable axis head of thescrews. Place the instrument over the rod and onto the vari-able axis head until the tip of the instrument sits below thescrew head reduction feature. Squeeze the handle to engagethe instrument and introduce the rod into the head of thescrew. Loosely fasten the locking screws using the screw-driver shaft with the 2 Nm torque limiting handle throughthe cannulation of the rod introduction instrument. When inserting the locking screws, they may be turned one-quarterto one-half turn counterclockwise to seat the thread beforetightening.
Synapse System Technique Guide DePuy Synthes 21
22 DePuy Synthes Synapse System Technique Guide
Optional technique B: Compression or distraction
Instruments
03.614.028 Distraction Forceps
03.614.029 Compression Forceps
Compression or distraction with variable axis heads is onlypossible with the locking screws not tightened. Use compres-sion forceps to achieve compression, or the distraction for-ceps to achieve distraction, and then fully tighten the lockingscrews as described in step 14.
Surgical Technique
13Optional technique A: Rod Rotation
Instrument
03.614.023 Holding Forceps for Rods � 3.5 mm
If rotation of the rod is desired, it is recommended that theholding forceps be used.
14Lock construct
Instruments
03.614.019 Screwdriver Shaft, Stardrive for Locking Screw, T15
03.614.026 Rod Pusher
03.614.035 Handle with Torque Limiter, 2.0 Nm
Optional instrument
03.615.010 Rod Pusher for Rods � 4.0 mm
After final adjustment of the construct, fully tighten all lock-ing screws with the screwdriver shaft and the 2 Nm torquelimiting handle. The construct is now rigidly locked. Finaltightening should be accomplished after all locking screwshave been placed, and should be aided by a rod pusher.
Note: The rod pusher may be used in place of the rod intro-duction instrument to lock the construct.
Synapse System Technique Guide DePuy Synthes 23
24 DePuy Synthes Synapse System Technique Guide
Additional Technique –Top loading Hooks
Place top loading hooks
Instruments
03.614.019 Screwdriver Shaft Stardrive for Locking Screw, T15
03.614.030 Holding Forceps for Implants
324.107 Handle with Quick Coupling
a. Position hookAttach the holding forceps to the appropriate hook. Placethe hook in the desired location using the screwdriver as anaid.
b. Insert rod
c. Insert locking screwTighten the locking screw using the screwdriver shaft forlocking screw. Turn the screwdriver one-quarter to one-halfturn counterclockwise to seat the thread before tightening.
1Insert transverse connector for head to head connection
Instrument
388.407 Holding Forceps for Rods � 3.5 mm, length 181 mm
Select a straight or angled transverse connector of appro -priate length. Place the transverse connector on the Synapsescrew construct to assess fit. Hold the transverse connectorwith the holding forceps. Adjust as necessary. Both sides ofthe transverse connector should be placed over the lockingscrews before proceeding.
Note: Ensure the etched band on the transverse connectorshaft is not visible when implanting
Caution: Do not bend the transverse connector
Synapse System Technique Guide DePuy Synthes 25
Additional Technique –Transverse Connector (Head to Head)
26 DePuy Synthes Synapse System Technique Guide
Additional Technique –Transverse Connector (Head to Head)
2Tighten locking nut
Instruments
03.614.019 Screwdriver Shaft Stardrive for Locking Screw, T15
03.614.035 Handle with Torque Limiter, 2.0 Nm, with Quick Coupling
03.614.040 Screwdriver, hexagonal � 7.5 mm
Select and place the locking nut onto the transverse connec-tor locking screw using the hexagonal screwdriver. To providealignment, insert the Stardrive screwdriver shaft and the handle with torque limiter into the cannula of the hexagonalscrewdriver and engage the T15 recess.
Loosely thread the locking nut onto the transverse connectorlocking screw using the hexagonal screwdriver. After all locking nuts have been placed, firmly tighten them with thehexagonal screwdriver, using the Stardrive screwdriver shaftand the handle with torque limiter as countertorque.
Tip: Use the hexagonal screwdriver to help seat the trans-verse connector onto the transverse connector locking screw.
Caution: Use only one hand to tighten. Overtightening maymake removal difficult.
Note: When inserting the locking nuts, they may be turnedone-quarter to one-half turn counterclockwise to seat thethread before tightening.
locked
unlocked
3Lock connection
Instrument
388.038 Crimper for Transverse Connectors
Secure the locking sleeve with the crimper. When locking theconnection, ensure that the gold tip of the instrument istouching the gold portion of the transverse connector shaft.The transverse connector is now rigidly locked.
Note: If necessary, the connection can be unlocked using thesame instrument with the gold tip touching the blue portionof the transverse connector.
Note: Locking more than once may weaken the transverseconnector.
Synapse System Technique Guide DePuy Synthes 27
28 DePuy Synthes Synapse System Technique Guide
Additional Technique –Transverse Connector (Rod to Rod)
1Position the transverse connectors
Instrument
388.407 Holding Forceps for Rods � 3.5 mm, length 181 mm
Place the transverse connectors on the Synapse rod construct.The transverse connectors may be held with the holding for-ceps.
2Tighten clamp
Instruments
03.614.019 Screwdriver Shaft Stardrive for Locking Screw, T15
324.107 Handle with Quick Coupling
388.407 Holding Forceps for Rods � 3.5 mm, length 181 mm
Tighten the setscrew of the transverse connector hook onthe rod with the screwdriver shaft. Slide the rod within thehook if necessary. Hold the second hook in the appropriateposition and tighten the setscrew.
Tip: The rod may be bent to accommodate the anatomy.Locking one end of the transverse connector with thecrimper may facilitate placement.
Synapse System Technique Guide DePuy Synthes 29
30 DePuy Synthes Synapse System Technique Guide
3Lock connections
Instruments
03.614.021 Cutting Pliers for Rods
388.038 Crimper for Transverse Connectors
Lock both bushing connections with the crimper. Ensure thatthe golden tip of the instrument is facing medially whenlocking the connection. The transverse connector is nowrigidly locked.
Note: If necessary, the connection can be unlocked using thesame instrument with the golden tip facing laterally. Lockingmore than once may weaken the transverse connector. Therod may be shortened with the cutting pliers.
Additional Technique –Transverse Connector (Rod to Rod)
Synapse System Technique Guide DePuy Synthes 31
Adding transverse bars
Instruments
03.614.019 Screwdriver Shaft Stardrive for Locking Screw, T15
324.107 Handle with Quick Coupling
Place the opening of the titanium transverse bar over the rod.Loosely attach the transverse bar to the rod. Introduce thetransverse bar into the variable axis head of the screw. Insertthe locking screw in the variable axis head as described insteps 11 and 12. Tighten the setscrew of the transverse barusing the screwdriver shaft.
Occipital fusion techniqueOccipital plates or occipital clamps may be attached to theocciput as described in the Technique Guide for the Occipito-Cervical Fusion System (036.000.755). These plates orclamps can then be connected to the Synapse system via � 3.5 mm or � 4.0 mm rods or pre-bent rods.
Additional Techniques
32 DePuy Synthes Synapse System Technique Guide
Parallel ConnectorsAll parallel connectors are open and allow side-loading ofthe rods. They link � 3.5 mm to � 3.5 mm, � 4.0 mm, � 5.0 mm and � 6.0 mm rods. Either side of the connectormay be connected first. Tighten the setscrew on one side, then connect the remaining rod and tighten the setscrews.Parallel Connectors are also available to link � 4.0 mm to � 4.0 mm, � 5.0 mm and � 6.0 mm rods.
Connecting RodsConnecting rods may be used to extend a Synapse construct.Connect the � 3.5 mm or � 4.0 mm section to the Synapsepolyaxial screws as instructed in steps 8 –12 of the surgicaltechnique. Connect the � 5.0 mm / 6.0 mm end of the rodto the appropriate Universal Spine System (USS) or any otherSynthes posterior rod-screw system.
Additional Techniques
Synapse System Technique Guide DePuy Synthes 33
Instruments
03.614.019 Screwdriver Shaft stardrive for Locking Screw, T15
03.614.039 Hexagonal Screwdriver Shaft, cross pinned
03.614.040 Screwdriver, hexagonal � 7.5 mm
388.038 Crimper for Transverse Connectors
388.407 Holding Forceps for Rods � 3.5 mm, length 181 mm
324.107 Handle with Quick Coupling
All Synapse System implants can be removed with a T15Stardrive screwdriver. The transverse connectors also requirethat the crimper be used for removal. Additionally, removalof head to head transverse connectors requires that theScrewdriver, hexagonal � 7.5 mm be used.
Note: Synapse polyaxial screws may also be removed withthe cross pinned hexagonal screwdriver shaft.
Implant Removal
locked
unlocked
34 DePuy Synthes Synapse System Technique Guide
Implant Removal
Removing transverse connectors for head to headconnection
Instruments
03.614.040 Screwdriver, hexagonal � 7.5 mm
388.038 Crimper for Transverse Connectors
388.407 Holding Forceps for Rods � 3.5 mm, length 181 mm
Remove transverse connector If required, secure the transverse connector using the Hold-ing Forceps. Unlock the transverse connector with thecrimper. Ensure that the gold tip of the instrument is touch-ing the blue portion of the transverse connector.
Remove cap nutRemove the cap nut using the hexagonal screwdriver
Removing transverse connector for rod to rodconnection
Instruments
03.614.019 Screwdriver Shaft Stardrive for locking Screw, T15
324.107 Handle with Quick Coupling
388.038 Crimper for Transverse Connectors
388.407 Holding Forceps for Rods � 3.5 mm, length 181 mm
Unlock both bushing connections with the crimper. Ensurethat the gold tip of the instrument is facing laterally.
Using the holding forceps to hold the transverse connector,use the Stardrive screwdriver and the handle to unscrew thesetscrew. Slide the rod within the hook if necessary to accessthe second setscrew.
Synapse System Technique Guide DePuy Synthes 35
50° 50°
50° 50°
40° 40°
40° 40°
� 4.0 mm
� 3.5 mm � 4.5 mm
36 DePuy Synthes Synapse System Technique Guide
� 3.5 mm shaft screw
Implants
Variable axis screws
Cancellous screws– � 3.5 mm and � 4.0 mm cancellous screws
offer up to 50° of angulation in all directions– � 4.5 mm cancellous screws offer 40° of
angulation in all directions– Self-tapping– Thread length from 8 mm to 50 mm
(2 mm increments)– Square thread locking cap reduces occurrence
of cross-threading– 8.0 mm run on rod
Outer diameter Core diameter Color code(mm) (mm)
3.5 2.4 Gold
4.0 2.4 Green gray
4.5 3.2 Light blue
Shaft screws– Offer 40° of angulation in all directions– � 3.5 mm cortex self-tapping screws– Lengths from 18 mm to 50 mm* with a 10 mm
unthreaded shaft
*Screw length is total length.
Other implants
Lamina hooks– For sublaminar insertion and stabilization– Short/long offsets ease construct assembly– Top-loading hooks– Straight hooks– Side-loading hooks
Transverse connectors (rod-to-rod)– Preassembled transverse connectors are available in
lengths of 60 mm and 75 mm– Easily placed after Synapse construct is in position,
reducing operative time– Bushings allow clamps to be placed offset to each other– Assembly can be rigidly locked
3.5 mm and 4.0 mm rods– Rods are available in lengths of 80 mm, 120 mm, 240 mm
and 350 mm– Curved rods are available in lengths of 40 mm and 80 mm– � 3.5 mm rods (gold)– � 4.0 mm rods (aqua)
Connecting rods– Rods with dual diameter of 3.5 mm / 4.0 mm,
3.5 mm / 5.0 mm, 3.5 mm / 6.0 mm, 4.0 mm / 5.0 mmand 4.0 mm / 6.0 mm are available in various lengths
– 5 mm transition zone allows adjacent screws to be placedcloser together
– Link the Synapse system to the Universal Spinal System(USS) or any other Synthes posterior rod-screw system
Transverse connectors (head to head)– Increase construct stability– Assemble easily on the head of any Synapse polyaxial
screw – Adjustable connector comes in four variable lengths to
accommodate different patient anatomy– Straight and angled versions offer enhanced flexibility
options
Synapse System Technique Guide DePuy Synthes 37
38 DePuy Synthes Synapse System Technique Guide
Transverse bars– Provide a lateral offset of 9 mm or 15 mm from the rod to
the Synapse screw– Eliminate the need for severe rod contouring– Can be placed onto the rod from the top after the
Synapse construct is in position– � 5.0 mm and � 6.0 mm clamps facilitate connection be-
tween the Synapse system and thoracolumbar system
Parallel open rod connectors– Parallel open rod connectors link the Synapse construct to
the Universal Spinal System (USS) or any other Synthesposterior rod-screw system
Implants
03.161.028 Depth Gauge for Screws � 3.5 to 5.0 mm,measuring range up to 50 mm
03.614.010 Drill Bit � 3.2 mm with Stop, 2-flute, for Quick Coupling
03.614.011 Drill Sleeve with Scale, for Drill Bits � 3.2 mm No. 03.614.010
03.614.012 Pedicle Probe � 2.4 mm, straight
03.614.013 Pedicle Probe � 2.4 mm, curved
292.745 Kirschner Wire � 2.4 mm with Stop, length 170 mm
Instruments
Synapse System Technique Guide DePuy Synthes 39
40 DePuy Synthes Synapse System Technique Guide
Instruments
03.614.016 Guide Sleeve for Tap � 3.5 mm and � 4.5 mm
03.614.017 Holding Sleeve with thread
03.614.019 Screwdriver Shaft Stardrive for LockingScrew, T15, for Quick Coupling
03.614.021 Cutting Pliers for Rods
03.614.015 Tap for Cancellous Bone Screws� 4.5 mm, length 245 mm, for Quick Coupling
03.614.022 Bending Pliers for Rods � 3.5 mm and Plates 3.5 mm
03.614.023 Holding Forceps for Rods � 3.5 mm
03.614.024 Bending Iron, leftand03.614.025 Bending Iron, right
03.614.026 Rod Pusher
Synapse System Technique Guide DePuy Synthes 41
42 DePuy Synthes Synapse System Technique Guide
Instruments
03.614.027 Rod Introduction Instrument
03.614.034 Alignment Tool
03.614.028 Distraction Forceps
03.614.029 Compression Forceps
03.614.030 Holding Forceps for Implants
311.349 Tap for Cancellous Bone Screw � 3.5 mm,length 185/46 mm, for Quick Coupling
324.107 Handle with Quick Coupling
388.038 Crimper for Transverse Connectors
03.614.039 Hexagonal Screwdriver Shaft, cross pinned, for Quick Coupling
Synapse System Technique Guide DePuy Synthes 43
03.614.035 Handle with Torque Limiter, 2.0 Nm,with Quick Coupling
03.614.036 Outer Sleeve for Holding Sleeve No. 03.614.017
44 DePuy Synthes Synapse System Technique Guide
Instruments
388.393 Drill Sleeve with Scale, for Drill Bit � 2.4 mm No. 388.394
388.407 Holding Forceps for Rods � 3.5 mm,length 181 mm
388.549 Feeler, straight, with rounded tip
388.397 Awl � 3.5 mm, length 179.5 mm
388.394 Drill Bit � 2.4 mm with Stop, length 171/65 mm, 2-flute, for Quick Coupling
388.868 Trial Rod � 3.5 mm
Synapse System Technique Guide DePuy Synthes 45
389.477 Tap for Cortex Screw � 3.5mm,length 185 mm, for Quick Coupling
Pedicle Markers, small389.473 with short markings389.474 with long markings
46 DePuy Synthes Synapse System Technique Guide
03.615.010 Rod Pusher for Rods � 4.0 mm
03.615.009 Rod Introduction Instrument for Rods � 4.0 mm
03.614.040 Screwdriver, hexagonal � 7.5 mm
03.615.011 Rod Shearer for 4.0 mm Rods
Optional Instruments
Instruments
Synapse System Technique Guide DePuy Synthes 47
Synapse System Compatibility
Synapse System 3.5 Rod System 4.0 Rod System
Implants Unsterile 3
Sterile 3 3
Rods Connecting Rod � 3.5 mm / � 5.0 mm � 3.5 mm / � 6.0 mm
� 3.5 mm / � 4.0 mm� 4.0 mm / � 5.0 mm � 4.0 mm / � 6.0 mm
Straight Rod 3 3
Pre-bent Rod 3 3
Polyaxial Screws Polyaxial head height 10.5 mm Accommodate � 3.5 mm rods
11 mm Accommodate � 3.5 mm and � 4.0 mm rods
Polyaxial head diameter 9.5 mm Accommodate � 3.5 mm rods
10.5 mm Accommodate � 3.5 mm and � 4.0 mm rods
� 3.5 mm Cancellous Screws 8 mm – 50 mm (2 mm increments)
8 mm – 50 mm (2 mm increments)
� 4.0 mm Cancellous Screws 8 mm – 50 mm (2 mm increments)
8 mm – 50 mm (2 mm increments)
� 4.5 mm Cancellous Screws 8 mm – 50 mm (2 mm increments)
8 mm – 50 mm (2 mm increments)
� 3.5 mm Cortex Shaft Screws 18 mm – 50 mm (2 mm increments)
18 mm – 50 mm (2 mm increments)
Hooks Side loading Lamina hooks 3
Top loading Lamina hooks 3 3
Transverseconnectors
Head to head loading 3 3
Rod to rod 3 3
Transverse bars Accommodate � 3.5 mm rods
Accommodate � 3.5 mmand � 4.0 mm rods
Parallel connectors
Extend � 3.5 mm rods
Extend � 3.5 mm and � 4.0 mm rods
48 DePuy Synthes Synapse System Technique Guide
Biomaterial Implants
chronOS Strip, precast, sterile
07.801.200.02S 47 mm�18 mm�3 mm pack of 2 implants
Volume of bone marrow or blood: 5–10 cclength thickness length thickness
To facilitate fusion, bone graft is often applied in the lateralgutters. 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 Stripprecast, which optimally integrates with patient anatomyand implanted hardware. Perfusion of strip with bone marrow aspirate provides a favorable environment for bonyingrowth.
Synapse System Technique Guide DePuy Synthes 49
Figure 1
Button
“Speedbump”
Greencolorband
Outersleeve
Screwdriver Assembly
Instruments
03.614.017 Holding Sleeve with thread
03.614.039 Hexagonal Screwdriver Shaft, cross pinned
324.107 Handle with Quick Coupling
Optional instrument
03.614.036 Outer Sleeve for Holding Sleeve No. 03.614.017
– Add the outer sleeve to the holding sleeve. Insert theholding sleeve through the slotted end of the outer sleevepast the threads of the holding sleeve. Snap the outersleeve over the “speed bump”. (1)
– Insert the back end of the cross pinned hexagonal screw-driver shaft through the distal tip of the holding sleeve (2).Press the button on the holding sleeve while inserting thescrewdriver shaft. Ensure that the holding sleeve has bot-tomed out on the cross pin at the distal end of the screw-driver shaft.
– Connect the handle with quick coupling to the hexagonalscrewdriver shaft (3).
– Reset the driver by pressing the button on the sleeve andpulling back on the sleeve until it hits the handle (4). Thegreen color band on the sleeve should not be visible.
Driver is ready for use.
Figure 2 Figure 3 Figure 4
Attach screwdriver to polyaxial screw– Ensure that the driver is in the reset position. The green
color band on the holding sleeve should not be visible.
– Insert the tip of the hexagonal screwdriver shaft into thebone screw of the polyaxial screw (5).
– Slide the sleeve until it comes in contact with the body ofthe polyaxial screw (6).
– Rotate the sleeve clockwise until it bottoms out on thecross pin of the hexagonal screwdriver shaft (7). The greencolor band should be visible. The polyaxial screw is readyfor bone insertion.
Remove screwdriver from the polyaxial screw– Rotate the sleeve counterclockwise. Before accepting an-
other polyaxial screw the driver should be reset as shownin figure 4. The green color band on the holding sleeveshould not be visible.
Figure 5 Figure 6 Figure 7
Screwdriver Assembly
50 DePuy Synthes Synapse System Technique Guide
1
2
3
1
2
Rod Introduction InstrumentAssembly
(03.614.027)
Synapse System Technique Guide DePuy Synthes 51
1
1
2
2
Drill Sleeve Assembly (388.393)
52 DePuy Synthes Synapse System Technique Guide
1
2
3
4
Depth Gauge Assembly (03.161.028)
Synapse System Technique Guide DePuy Synthes 53
Synthes GmbHEimattstrasse 34436 OberdorfSwitzerlandTel: +41 61 965 61 11Fax: +41 61 965 66 00www.depuysynthes.com 0123 ©
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This publication is not intended for distribution in the USA.
All surgical techniques are available as PDF files at www.synthes.com/lit