La Solución Total Para Patologías Espinales Simples y Complejas (DEGENERATIVAS)

84
MATRIX Spine System – Degenerative. The total solution for simple and complex spine pathology. Technique Guide

description

traumatología y ortopedia

Transcript of La Solución Total Para Patologías Espinales Simples y Complejas (DEGENERATIVAS)

Page 1: La Solución Total Para Patologías Espinales Simples y Complejas (DEGENERATIVAS)

MATRIX Spine System –Degenerative. The total solution forsimple and complex spine pathology.

Technique Guide

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MATRIX Spine System – Degenerative Technique Guide Synthes 1

Table of Contents

Introduction

Surgical Technique

Product Information

Biomaterials Implants 80

MATRIX Spine System – Degenerative 2

AO Principles 6

Indications and Contraindications 7

Surgical Technique 8

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

How to Disassemble Instruments for Cleaning 47

Implants 51

Instruments 66

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 refer to: www.synthes.com/reprocessing

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2 Synthes MATRIX Spine System – Degenerative Technique Guide

The Synthes MATRIX Spine System is a universal set of instru-ments and implants that cover degenerative disorders (openor minimally invasive access), deformities and trauma indica-tions.

MATRIX Spine System –Degenerative. The total solution forsimple and complex spine pathology.

– Fast and controlled insertion– Increased pull-out resistance due to optimal bone

purchase– Safe handling thanks to atraumatic tip and self

tapping thread

Unique Dual Core /Double Lead Screw Design

– Toggle free screw insertion– Precise and controlled screw placement– Direction of screw insertion possible

PrimeLock – Screwdriver –Screw Interlock

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– For better visualization of the anatomical structure

– Multiple screw head removal and replacementwithout removing the bone screw from thepedicle

– Customized inventory possible

Modularity – Click-on andPreassembled Screws

– Offers fast and simple in-situ placement– Simple anatomical adjustment possible

Snap-on SwivelingTransverse Connector

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50° 50°

15 mm

MATRIX Spine System – Degenerative. The total solution forsimple and complex spine pathology.

– Allows up to 50° of angulation to ease in situ connectionto the longitudinal rod

– The rod reduction features are located at the top of thepolyaxial head

– Dual Core/Double Lead thread designed to securely anchor the screw in cortical and cancellous bone

– Threaded T25 Stardrive recess designed to deliver torqueeffectively

Preassembled Polyaxial andReduction 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

Pedicle Screw

– The polyaxial head of the implant is designed for rod reduction

– To ease intraoperative planning, the polyaxial heads canbe removed and replaced without removing the pediclescrew from the pedicle

– The reduction head allows for 15 mm rod reduction

Click-on Polyaxial and ReductionScrew Head

Implants

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– Available in three material strengths: Hard pure titanium,extra-hard titanium alloy (TAN), and extra-hard cobalt-chromium alloy, diameter 5.5 mm

– A choice of straight and curved rods to facilitate intraoper-ative construct assembly and technique maneuvers

Rods

– Square thread design minimizes cross threading underhigh reduction loads

– T25 Stardrive recess designed to reduce the risk of damage at high loads

– 1-step locking cap allows for complete fixation in one step(polyaxiality and run on rod)

– Available flat or with guidance

Locking Cap

– The snap-on transverse connector is preassembled and requires only final positioning and tightening

– The jaws of the transverse connector swivel and arespring loaded

– Telescoping body is arched to accommodate grafts andanatomical structures and is available in a range oflengths

– The locking screws use a T15 Stardrive which minimizesdrive stripping while final tightening

Transverse Connector

– Ergonomically designed handles– Intuitive, easy to use– Convenient, interchangeable options

Instruments

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In 1958, the AO formulated four basic principles, which havebecome 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 andfusion of the spine are the same. A specific goal in thespine is returning as much function as possible to the injuredneural 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, andneural elements, which may contribute to pain reduction andimproved function for the patient.

AO Principles

1 Müller ME, Allgöwer M, Schneider R, Willenegger H (1995) Manual of InternalFixation. 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

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Indications and Contraindications

The MATRIX Spine System is a posterior pedicle screw andhook fixation system (T1–S2) intended to provide preciseand segmental stabilization of the spine for use in skeletallymature 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 columnreconstruction is required

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1Prepare pedicles and determine screw lengths

Instruments

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

388.655 Pedicle Probe � 3.7 mm with Silicone Handle, length 240 mm, for Pedicle Screws � 5.0 to 7.0 mm

Locate pedicles and use the awl to perforate the cortex. Usethe probe to open the pedicle canal. Using radiographic imaging, confirm pedicle location, orientation and depth byinserting the probe. When selecting the appropriate lengthscrew, use the markings on the probe to determine the pedicle depth.

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

Surgical Technique

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Optional instruments

03.632.057 Pedicle Marker for Matrix

03.632.058 Inserter for Pedicle Marker, for Matrix

388.657 Pedicle Probe � 3.8 mm, curved, with Silicone Handle, length 290 mm, for Pedicle Screws � 5.0 to 7.0 mm

388.536 Pedicle Probe for Screws � 4.2 mm, length 240 mm

388.545 Feeler for Screw Channel, straight, � 2.3 mm, length 275 mm

388.546 Feeler for Screw Channel, curved, � 2.3 mm, length 275 mm

388.549 Feeler, straight, with rounded tip

03.632.103 Tap for Pedicle Screws � 3.5 mm, length 180 mm

03.632.104 Tap for Pedicle Screws � 4.0 mm, length 180 mm

03.632.105 Tap for Pedicle Screws � 5.0 mm, length 180 mm

03.632.155 Tap for Pedicle Screws � 5.5 mm, length 180 mm

03.632.106 Tap for Pedicle Screws � 6.0 mm, length 180 mm

03.632.107 Tap for Pedicle Screws � 7.0 mm, length 180 mm

03.632.108 Tap for Pedicle Screws � 8.0 mm, length 180 mm

03.632.109 Tap for Pedicle Screws � 9.0 mm, length 180 mm

388.654 Ratchet with Handle, with Hexagonal Quick Coupling � 6.0 mm

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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 theratchet handle.

Optional instruments

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

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3Pick up screw

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

Choose the appropriate screw diameter and length based onpedicle probe feedback.

Insert the screwdriver tip into the recess of the pedicle screwand rotate the green knob of the retaining sleeve clockwiseuntil the tip of the sleeve is firmly attached to the pediclescrew.

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

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

Optional instruments

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

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Surgical Technique

4Insert screw

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

Insert the screw. Hold the black part of the retaining sleeveduring screw insertion.

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

Notes: – Do not grasp the green knob during screw insertion as

this will cause the retaining sleeve to disengage from thescrew.

– Ensure that the polyaxial screw head remains free to adaptits position and is not restricted by, or does not rest on,bony structures. If necessary, adjust the screw heightand/or ream space for the screw head.

– When countersinking, care should be taken in reamingthe most superior (and inferior) level to protect the facetjoints.

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

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Optional Instruments

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

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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 � 5.0 mm, length 150 mm

03.632.017 Rod Bender with Silicone Handle

Use the head alignment tool to rotate and align the screwheads.

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 screwdriver without re-taining sleeve.

– To restore polyaxiality of a screw head that has alreadybeen tightened, insert the alignment tool in the screwhead and apply sufficient pressure to release the lock.

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MATRIX Spine System – Degenerative Technique Guide Synthes 15

Optional instruments

03.632.017 Rod Bender with Silicone Handle

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 foreventual breakage of the implant.

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6Insert rod

Instrument

03.632.081 Rod Holding Forceps for Rods � 5.5 mm

Insert the rod using the rod holding forceps.

Optional instrument

03.632.202 Holding Forceps for Rods � 5.5 and � 6.0 mm

Surgical Technique

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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 rodpusher/counter torque.

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

Optional instruments

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

03.632.169 Rod Pusher for Rods � 5.5/6.0 mm, for Matrix

03.632.000 Distraction Fork

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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 inreducing the rod into adjacent screw heads.

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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 rodpersuader over rod and onto the screw head. Press downfirmly until the tips engage the head of the screw. Squeezethe 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

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Surgical Technique

Option D: Reduce rod with a reduction instrument for Spondylolisthesis

Instruments

03.632.408 Reduction Instrument for Spondylolisthesis, standard, for Matrix 5.5

388.654 Ratchet with Handle, with Hexagonal Quick Coupling � 6.0 mm

03.620.091 Socket, hexagonal � 6.0 mm

To assemble the instrument, slide the inner tube through theouter tube. Insert the black nut and press down firmly untilaudible feedback. Push the inner tube up towards the blacknut and turn the black nut clockwise until the black line isvisible at the 30 line.

Place the reduction instrument over the screw head. Pressdown firmly until the tips engage. Load the hexagonal socketinto the ratchet handle and insert it into the top of the reduction instrument.

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

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

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

Reduction travel: 30 mm

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

Note: The reduction instrument for spondylolisthesis can beused as counter torque for final tightening of the locking cap.

Optional instrument

03.632.409 Reduction Instrument for Spondylolisthesis, long, for Matrix 5.5

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Surgical Technique

8Insert 1-step locking cap

Instruments

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

03.632.080 Handle, detachable, for Matrix

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

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

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

To ensure optimal cap alignment, insert the locking capthrough the rod pusher/counter torque. Thread the lockingcap clockwise into the implant head.

Apply a light torque to provisionally tighten the locking capand maintain the desired rod position. Place the remainingcaps and provisionally tighten.

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1 2

3

4a

4b

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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)

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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

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

03.632.049 Counter Torque, standard, for Matrix 5.5

Precaution: Ensure all locking caps are fully reduced andprovisionally tightened (see “Insert 1-step locking cap”). Fail-ure to do so could potentially lead to a misalignment.

Finally tighten one locking cap completely to create a fixedpoint for distraction (see “Perform final tightening”). Reversethe locking cap of the screw to be relocated a quarter of aturn.

Use the distraction forceps to distract the construct. Once inthe desired position, tighten the locking caps with the screw-driver.

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

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� �IncorrectCorrect

Note: Always fully seat the counter torque on the rod. Theinstrument must be perpendicular to the rod during tighten-ing.

Optional instruments

03.632.202 Holding Forceps for Rods � 5.5 and � 6.0 mm

03.632.072 Screwdriver Shaft Stardrive, T25, long, for Matrix

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

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

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

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10Compress

Instruments

388.422 Compression Forceps, length 335 mm, for Pedicle Screws

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

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

03.632.049 Counter Torque, standard, for Matrix 5.5

Precaution: Ensure all locking caps are fully reduced andprovisionally tightened (see “Insert 1-step locking cap”). Fail-ure to do so could potentially lead to a misalignment.

Finally tighten one locking cap completely to create a fixedpoint for distraction (see “Perform final tightening”). Reversethe locking cap of the screw to be relocated a quarter of aturn.

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

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

Note: Always fully seat the counter torque on the rod. Theinstrument must be perpendicular to the rod during tighten-ing.

Optional instrument

03.632.202 Holding Forceps for Rods � 5.5 and � 6.0 mm

Surgical Technique

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11Perform final tightening

Instruments

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

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

03.632.049 Counter Torque, standard, for Matrix 5.5

03.632.080 Handle, detachable, for Matrix

Precaution: Ensure all locking caps are fully reduced andprovisionally tightened (see “Insert 1-step locking cap”). Fail-ure to do so could potentially lead to a misalignment.

Note: The handle of the counter torque must be orientedlaterally or medially. Do not orient the handle of the counter-torque in line with the rod. This action could cause misalign-ment of the rod with the implant.

Place the counter torque over the head of the screw. Attachthe screwdriver shaft to the T-handle with torque limiter. In-sert the instrument through the counter torque cannula intothe drive recess of the locking cap. Ensuring that the polyax-ial head is perpendicular to the rod, tighten until there is atactile release. This indicates that the required 10 Nm oftorque has been applied. Repeat for all locking caps.

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

Warning: Final tightening of the locking caps should onlybe performed with a Synthes 10 Nm torque handle. MATRIXscrew implants achieve performance standard only whentightened to the required 10 Nm tightening torque.

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IncorrectCorrect

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Notes:– Alternatively, the reduction instrument for spondylo -

listhesis and the rod persuader can be used as countertorque for final tightening of the locking cap.

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

Optional instruments

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

03.632.008 Reduction Instrument for Spondylolisthesis, standard, for Matrix 5.5

03.632.009 Rod Persuader, standard, for Matrix 5.5

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

03.632.078 Reduction Instrument for Spondylolisthesis, 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

28 Synthes MATRIX Spine System – Degenerative Technique Guide

Surgical Technique

IncorrectCorrect

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2

3

4

5

Insert screw with retaining sleeve, locking

Instruments

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

03.616.043 Retaining Sleeve, locking, long, for Matrix 5.5

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

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

Release the loading collar and verify that the retaining sleeveis 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).

MATRIX Spine System – Degenerative Technique Guide Synthes 29

Optional Technique

Screw Insertion with RetainingSleeve, Locking

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6

7

8

When using a ratchet handle, make sure to set it to neutralsetting.

Rotate the grey knob of the retaining sleeve clockwise. Firmlytighten to secure the implant, using the handle as counter-torque (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 thegrey locking ring towards the handle, rotate the silver knobcounterclockwise and remove the screwdriver (8)

Notes: – Polyaxial screwheads need to remain free and mobile after

insertion to allow accurate alignment to the rod duringlocking cap insertion and final tightening.

– The mobility of the screwhead cannot be assessed whilethe holding sleeve is attached.

Optional instruments

03.632.072 Screwdriver Shaft Stardrive, T25, long, for Matrix

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

03.632.042 Retaining Sleeve, locking, standard, for Matrix 5.5

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

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

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

30 Synthes MATRIX Spine System – Degenerative Technique Guide

Optional Technique Screw Insertion with Retaining Sleeve, Locking

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Optional Technique

Unassembled Pedicle Screw Insertion

1Insert unassembled pedicle screw

Instruments

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

03.632.046 Reamer for Pedicle Screws, for Matrix 5.5

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

Slide reamer over screwdriver shaft. Engage tip of screw-driver in unassembled pedicle screw. Ream until the blackline is visible on the shaft. This indicates that there is enoughroom for the implant head.

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

Optional instruments

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

03.632.072 Screwdriver Shaft Stardrive, T25, long, for Matrix

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

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

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

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

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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 thehandle and tighten in the clockwise direction.

To pick up a screwhead, align the positioning instrument forpolyaxial 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 theunassembled pedicle screw and press down. To ensure thepolyaxial head is securely attached to the unassembled pedi-cle screw, gently lift up on the placement tool and angulatethe polyaxial head.

To release the head placement tool, press the button locatedat the distal end of the instrument.

Notes:– If the polyaxial head does not successfully attach to the

head of the unassembled pedicle screw, additional ream-ing or screw height adjustment may be required to ensuresufficient space exists to allow free mobility of the head.

– Polyaxial screw heads can be removed a maximum ofthree times without removing the pedicle screw; a newhead must be used for each assembly.

Optional TechniqueUnassembled Pedicle Screw Insertion

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Optional Technique

Polyaxial Head Removal

Instruments

03.632.045 Removal Instrument for Polyaxial Screw Heads, for Matrix 5.5

388.654 Ratchet with Handle, with Hexagonal Quick Coupling � 6.0 mm

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

Remove any existing locking cap and the rod.

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

Ensure that the black line is visible on the inner shaft of thehead 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 removaltool mates with the collet of the polyaxial head. While hold-ing the handle, thread the inner shaft clockwise until it stops.Lift to remove the head.

To remove the implant head from the instrument, turn theratchet counter-clockwise until the black line is visible. Pullthe head off the instrument.

Notes:– The head removal tool can be used to remove the polyax-

ial head of both unassembled as well as preassembledscrews.

– To remove the polyaxial reduction head, the tabs mustfirst be broken off.

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15 mmReduction

Instruments

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

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

03.632.080 Handle, detachable, for Matrix

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 asclick-on versions for subsequent assembly.

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

Pick up a locking cap from the screw module with a T25screwdriver 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 capthrough the counter torque. Turning the locking cap will reduce the rod into the screw head.

Optional instruments

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

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

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

03.632.025 Counter Torque for Reduction Screws, for Matrix 5.5

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

Optional Technique

Reduction Screws

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To break off the reduction screw tabs, place the rodpusher/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 freefrom 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 insteadof the counter torque to provide guidance for the lockingcap insertion.

MATRIX Spine System – Degenerative Technique Guide Synthes 35

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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 esti-mate the distance between the two rods. On the crossbar ofthe measuring device note the size of the appropriate trans-verse 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 therod to secure it at the desired point.

Use the screwdriver and the torque limiting handle to securethe transverse connector to the rods. When tightening thesetscrews a tactile release is felt.

Note: Always use retaining sleeve when tightening thesetscrew.

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

Optional Technique

Adding Transverse Connectors

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Instruments

03.632.204 Torque-limiting Handle, 3 Nm

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

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

Choose the snap-on open parallel connector according therod diameters to be received. The diameters accepted areetched on both sides of the connector to ensure the correctrod size is attached to each opening.

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

Attach the preferred connector to each rod. Mount the T15screwdriver shaft to the 3 Nm torque-limiting handle andslide the retaining sleeve over the screwdriver shaft. To se-cure the connector to the rods, engage the T15 drive intoeach setscrew recess, slide the retractable retaining sleeve tothe distal position. Tighten all the set screws until a tactile release is felt.

Optional Technique

Adding Rod-to-Rod Connectors

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38 Synthes MATRIX Spine System – Degenerative Technique Guide

Optional TechniqueAdding Rod-to-Rod Connectors

Notes: – If any part of the construct requires further adjustment, all

set screws must be loosened to the point of resistance. Donot remove set screws from the assembly. After final ad-justment, retighten the set screws.

– Parallel connectors contain Nitinol components. Implantsthat contain Nitinol should not be used in patients withnickel sensitivities or allergies.

– The retaining sleeve for transverse connectors cannot beused when tightening parallel with two set screws.

Precautions:– Care should be taken to not tighten the connector on a

portion of the rod that has been contoured or deformedby a rod cutter.

– Synthes connectors are tested using Synthes 5.5 or6.0 mm rods and not compatible with those rods of simi-lar diameter from other manufacturers.

– Refer to the torque-limiting handle package and labelingfor the recommended calibration maintenance.

Optional instrument

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

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MATRIX Spine System – Degenerative Technique Guide Synthes 39

Instruments

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

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 pressfirmly 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 therecess of the screw head. Turn the green knob clockwise.

Insert two pedicle screws.

To release the detachable retaining sleeve from the distractortip, pull the green knob towards the handle. Remove thescrewdriver and retaining sleeve and repeat the procedurefor the second pedicle screw.

Optional Technique

Distraction for Posterior InterbodyFusion

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2

40 Synthes MATRIX Spine System – Degenerative Technique Guide

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 distrac-tion position (D) and rotate the wing nut screw clockwise un-til the desired distraction is achieved.

Perform discectomy and interbody fusion.

Turn the rocker lever (2) to neutral (N) to unlock the angularposition and remove the distractor.

Reattach the screwdriver/detachable retaining sleeve andturn the green knob counterclockwise.

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

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Alternative instruments

03.632.083 Distractor Tip, for Bone Screws, for Matrix 5.5

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 beused in a variety of combinations.

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

The distractor tip with screw heads (2) can be used withpolyaxial, polyaxial reduction, and monoaxial screws. Theyare attached to the polyaxial screw head after insertion ofthe pedicle screw. If firmly tightened the screw becomesmonoaxial, parallel distraction can be performed. These tipsare particularly suitable for cases where the tips for bonescrews would cross over as a result of pronounced lordoticcurvature of the spine.

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

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42 Synthes MATRIX Spine System – Degenerative Technique Guide

Optional Technique

Locking Cap Removal

Loosen locking cap

Instruments

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

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

03.632.049 Counter Torque, standard, for Matrix 5.5

03.632.080 Handle, detachable, for Matrix 5.5

To remove a locking cap, slide the counter torque with de-tachable handle over the screwhead. Place the ratchet of thetorque limiting handle in the neutral position, engage a T25screwdriver with the Stardrive recess of the locking cap andturn counter-clockwise.

Note: Locking caps are designed to lock the construct safelyand minimize the chance of post-operative loosening androd-push-through. Therefore, in certain cases, the looseningtorque may be higher than 10 Nm. In such cases, use the following techniques to remove a locking cap.

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MATRIX Spine System – Degenerative Technique Guide Synthes 43

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 capis loose.

Notes: – For this technique, always use the torque limiting handle

(03.620.061) to reduce risk of damage to the T25 screw-driver shaft.

– If this method does not produce the desired result, followthe technique according to Option A (page 44) or OptionB (page 46).

Optional instruments

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

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

03.632.072 Screwdriver Shaft Stardrive, T25, long, for Matrix

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44 Synthes MATRIX Spine System – Degenerative Technique Guide

Optional TechniqueLocking Cap Removal

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

Option A: Counter torque on a adjacent screw

Instruments

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

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

03.632.049 Counter Torque, standard, for Matrix 5.5

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

03.632.080 Handle, detachable, for Matrix

Place the rod pusher / counter torque with detachable handleover an adjacent screw on the same rod (i.e. one level higheror lower). Simultaneously place the countertorque over thelocking cap to be loosened and engage the screwdriver shaftand torque limiting handle with the stardrive recess of thelocking cap. Place the ratchet of the torque limiting handle inthe neutral position and begin to sequentially turn clockwiseand then immediately counter-clockwise. Turn until tactile oraudible feedback from the implant is experienced. Repeatthe steps until the locking cap is loose.

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MATRIX Spine System – Degenerative Technique Guide Synthes 45

Notes: – For this technique, always use the torque limiting handle

(03.620.061) to reduce risk of damage to the T25 screw-driver shaft.

– Retighten the locking cap on which the counter torquewas applied to 10 Nm.

– To loosen the last locking cap, replace the counter torque,consisting of rod pusher/counter torque and handle, witha rod persuader.

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

Optional instruments

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

03.632.009 Rod Persuader, standard, for Matrix 5.5

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

03.632.072 Screwdriver Shaft Stardrive, T25, long, for Matrix

03.632.079 Rod Introduction Pliers, long, for Matrix 5.5

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46 Synthes MATRIX Spine System – Degenerative Technique Guide

Option B:Apply a downward force to the rod

Instruments

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

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

03.632.079 Rod Introduction Pliers, long, for Matrix 5.5

Apply a downward force to the rod. Place the Rod Persuaderon the screw and firmly squeeze the handles. Place theratchet of the torque limiting handle in the neutral position.With the reduction load applied begin to sequentially turnclockwise and then immediately counter-clockwise. Turn untiltactile 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 screw-driver shaft.

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

Optional Instruments

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

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

03.632.009 Rod Persuader, standard, for Matrix 5.5

Optional TechniqueLocking Cap Removal

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MATRIX Spine System – Degenerative Technique Guide Synthes 47

Screwdriver with retaining sleeve

Screwdriver with detachable retaining sleeve

How to Disassemble Instruments for Cleaning

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48 Synthes MATRIX Spine System – Degenerative Technique Guide

Counter torque

Positioning instrument for polyaxial screw heads

How to Disassemble Instruments for Cleaning

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1 2

1

2

MATRIX Spine System – Degenerative Technique Guide Synthes 49

Head removal tool

Torque limiting handle

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2 31

50 Synthes MATRIX Spine System – Degenerative Technique Guide

Reduction instrument for spondylolisthesis MATRIX

Rod persuader MATRIX

How to Disassemble Instruments for Cleaning

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MATRIX Spine System – Degenerative Technique Guide Synthes 51

Implants*

Pedicle Screw Matrix 5.5 Polyaxial � 4.0 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

Pedicle Screw Matrix 5.5 Polyaxial � 5.0 mm,preassembled, Titanium Alloy (TAN)

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

Pedicle Screw Matrix 5.5 Polyaxial � 5.5 mm,preassembled, Titanium Alloy (TAN)

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.

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52 Synthes MATRIX Spine System – Degenerative Technique Guide

Implants

Pedicle Screw Matrix 5.5 Polyaxial � 6.0 mm,preassembled, Titanium Alloy (TAN)

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

Pedicle Screw Matrix 5.5 Polyaxial � 7.0 mm,preassembled, Titanium Alloy (TAN)

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

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MATRIX Spine System – Degenerative Technique Guide Synthes 53

Pedicle Screw Matrix 5.5 Polyaxial � 8.0 mm,preassembled, Titanium Alloy (TAN)

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

Pedicle Screw Matrix 5.5 Polyaxial � 9.0 mm,preassembled, Titanium Alloy (TAN)

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

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54 Synthes MATRIX Spine System – Degenerative Technique Guide

Implants

Reduction Screw Matrix 5.5, � 4.0 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

Reduction Screw Matrix 5.5, � 5.0 mm, preassembled,Titanium Alloy (TAN)

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

Reduction Screw Matrix 5.5, � 5.5 mm, preassembled,Titanium Alloy (TAN)

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

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MATRIX Spine System – Degenerative Technique Guide Synthes 55

Reduction Screw Matrix 5.5, � 6.0 mm, preassembled,Titanium Alloy (TAN)

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

Reduction Screw Matrix 5.5, � 7.0 mm, preassembled,Titanium Alloy (TAN)

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

Reduction Screw Matrix 5.5, � 8.0 mm, preassembled,Titanium Alloy (TAN)

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

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56 Synthes MATRIX Spine System – Degenerative Technique Guide

Implants

Pedicle Screw Matrix 5.5 � 4.0 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

Pedicle Screw Matrix 5.5 � 5.0 mm,Titanium Alloy (TAN)

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

Pedicle Screw Matrix 5.5 � 5.5 mm,Titanium Alloy (TAN)

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

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MATRIX Spine System – Degenerative Technique Guide Synthes 57

Pedicle Screw Matrix 5.5 � 6.0 mm,Titanium Alloy (TAN)

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

Pedicle Screw Matrix 5.5 � 7.0 mm,Titanium Alloy (TAN)

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

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58 Synthes MATRIX Spine System – Degenerative Technique Guide

Implants

Pedicle Screw Matrix 5.5 � 8.0 mm,Titanium Alloy (TAN)

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

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MATRIX Spine System – Degenerative Technique Guide Synthes 59

Pedicle Screw Matrix 5.5 � 9.0 mm,Titanium Alloy (TAN)

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

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)

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

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60 Synthes MATRIX Spine System – Degenerative Technique Guide

Implants

Curved rods

Rods � 5.5 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 � 5.5 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

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MATRIX Spine System – Degenerative Technique Guide Synthes 61

Straight rods

Rods � 5.5 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

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62 Synthes MATRIX Spine System – Degenerative Technique Guide

Implants

Straight rods

Rods � 5.5 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

**Available nonsterile packed only

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MATRIX Spine System – Degenerative Technique Guide Synthes 63

Straight rods

Rods � 5.5 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

**Available nonsterile packed only

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64 Synthes MATRIX Spine System – Degenerative Technique Guide

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 � 5.5 mm, prebent

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

Implants

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MATRIX Spine System – Degenerative Technique Guide Synthes 65

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

Locking cap

09.632.099 Locking Cap, flat, 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 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

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66 Synthes MATRIX Spine System – Degenerative Technique Guide

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 � 4.0 mm with Silicone Handle, length 255 mm, for Pedicle Screws � 4.0 to 7.0 mm

388.536 Pedicle Probe for Screws � 4.2 mm, length 240 mm

388.655 Pedicle Probe � 3.7 mm with Silicone Handle, length 240 mm, for Pedicle Screws � 5.0 to 7.0 mm

388.657 Pedicle Probe � 3.8 mm, curved, with Silicone Handle, length 290 mm, for Pedicle Screws � 5.0 to 7.0 mm

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MATRIX Spine System – Degenerative Technique Guide Synthes 67

Tap for Pedicle Screws,length 180 mm

03.632.103 � 3.5 mm

03.632.104 � 4.0 mm

03.632.105 � 5.0 mm

03.632.155 � 5.5 mm

03.632.106 � 6.0 mm

03.632.107 � 7.0 mm

03.632.108 � 8.0 mm

03.632.109 � 9.0 mm

Ball tip feelers

388.545 Feeler for Screw Channel, straight, � 2.3 mm, length 275 mm

388.546 Feeler for Screw Channel, curved, � 2.3 mm, length 275 mm

388.549 Feeler, straight, with rounded tip

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68 Synthes MATRIX Spine System – Degenerative Technique Guide

Instruments

For screw insertion

Screwdriver Shafts Stardrive T25

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

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

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

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

for Matrix

Screwdrivers Stardrive T25 with T-Handle

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

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

Retaining Sleeves

03.632.001 Retaining Sleeve, standard, for Matrix 5.5

03.632.036 Retaining Sleeve, long, for Matrix 5.5

03.616.042 Retaining Sleeve, locking

03.616.043 Retaining Sleeve, locking, long

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MATRIX Spine System – Degenerative Technique Guide Synthes 69

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, withHexagonal Coupling � 6.0 mm

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

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

Handles with hexagonal coupling

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70 Synthes MATRIX Spine System – Degenerative Technique Guide

For assembly and removal of polyaxial screw heads

03.632.007 Alignment Tool for polyaxial Screw Head,for Matrix 5.5

03.632.037 Positioning Instrument for Polyaxial ScrewHeads, for Matrix 5.5

03.632.045 Removal Instrument for Polyaxial ScrewHeads, for Matrix 5.5

03.632.046 Reamer for Pedicle Screws, for Matrix 5.5

68.632.125 Loading Station for Matrix 5.5

Instruments

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MATRIX Spine System – Degenerative Technique Guide Synthes 71

For rod cutting and bending

388.906 Trial Rod � 5.0 mm, length 150 mm

03.632.017 Rod Bender with Silicone Handle

388.750 USS Rod Cutting and Bending Device

388.720 Bolt Cutter

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72 Synthes MATRIX Spine System – Degenerative Technique Guide

For rod insertion

03.632.202 Holding Forceps for Rods � 5.5 and� 6.0 mm

03.632.081 Rod Holding Forceps for Rods � 5.5 mm

03.632.169 Rod Pusher for Rods � 5.5 / 6.0 mm,for Matrix

Instruments

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MATRIX Spine System – Degenerative Technique Guide Synthes 73

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

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74 Synthes MATRIX Spine System – Degenerative Technique Guide

Instruments for toothed rack retractor

03.632.083 Distractor Tip, for Bone Screws, for Matrix 5.5

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

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MATRIX Spine System – Degenerative Technique Guide Synthes 75

For cap introduction and tightening

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

Rod Pusher/Counter Torques

03.632.049 Counter Torque, standard, for Matrix 5.5

03.632.080 Handle, detachable, for Matrix

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

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

03.632.099 Counter Torque, long, for Matrix 5.5

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76 Synthes MATRIX Spine System – Degenerative Technique Guide

For transverse and parallel connectors

03.632.050 Retaining Sleeve for TransverseConnectors, Snap-on, for Matrix

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 TransverseConnectors, Snap-on, for Matrix

03.632.204 Torque-limiting Handle, 3 Nm

Instruments

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MATRIX Spine System – Degenerative Technique Guide Synthes 77

For rod reduction

Reduction instruments

03.632.408 Reduction Instrument for Spondylolisthesis, standard, for Matrix 5.5

03.620.091 Socket, hexagonal � 6.0 mm

388.654 Ratchet with Handle, with Hexagonal Quick Coupling � 6.0 mm

03.632.409 Reduction Instrument for Spondylolisthesis,long, for Matrix 5.5

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78 Synthes MATRIX Spine System – Degenerative Technique Guide

Rocker forks

03.632.010 Rocker Fork, small, for Matrix 5.5

Rod persuader/ Rod introduction pliers

03.632.009 Rod Persuader, standard, for Matrix 5.5

03.632.079 Rod Introduction Pliers, long, for Matrix 5.5

03.632.012 Rocker Fork, medium, for Matrix 5.5

03.632.011 Rocker Fork, footed, for Matrix 5.5

Instruments

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MATRIX Spine System – Degenerative Technique Guide Synthes 79

03.632.042 Rod Pusher /Counter Torque for ReductionScrew, for Matrix 5.5

03.632.026 Rod Pusher /Counter Torque for ReductionScrews, 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

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80 Synthes MATRIX Spine System – Degenerative Technique Guide

length thickness length thickness

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 cc

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.

Biomaterial Implants

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0123All technique guides are available as PDF files at www.synthes.com/lit

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