Technique Guide - synthes.vo.llnwd.netsynthes.vo.llnwd.net/o16/LLNWMB8/INT Mobile/Synthes...Position...

Synapse System. An enhanced setof implants and instruments for posteriorstabilization of the cervical and upperthoracic spine.

Technique Guide

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 Synthes 1

Synapse System. An enhanced set ofimplants and instruments for posteriorstabilization of the cervical and upperthoracic spine.

2 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


50° 50°

Robust polyaxial screws


– 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 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


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.


01.614.012

Preparation


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.


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.


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



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


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


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.


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.


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.


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.


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.


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.


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.



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


03.614.035 Handle with Torque Limiter, 2.0 Nm

Optional instrument


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.



Additional Technique –Top loading Hooks

Place top loading hooks

Instruments


03.614.030 Holding Forceps for Implants


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


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


Additional Technique –Transverse Connector (Head to Head)


Additional Technique –Transverse Connector (Head to Head)

2Tighten locking nut

Instruments


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.



Additional Technique –Transverse Connector (Rod to Rod)

1Position the transverse connectors

Instrument


Place the transverse connectors on the Synapse rod construct.The transverse connectors may be held with the holding for-ceps.

2Tighten clamp

Instruments




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.



3Lock connections

Instruments



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)


Adding transverse bars

Instruments



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


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


Instruments

03.614.019 Screwdriver Shaft stardrive for Locking Screw, T15






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


Implant Removal

Removing transverse connectors for head to headconnection

Instruments




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




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.


50° 50°

50° 50°

40° 40°

40° 40°

� 4.0 mm

� 3.5 mm � 4.5 mm


� 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



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 4.5 mm,measuring range 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



Instruments

03.614.016 Guide Sleeve for Tap � 3.5 mm and � 4.5 mm


03.614.019 Screwdriver Shaft Stardrive for LockingScrew, T15, for Quick Coupling


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




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



03.614.039 Hexagonal Screwdriver Shaft, cross pinned, for Quick Coupling


03.614.035 Handle with Torque Limiter, 2.0 Nm,with Quick Coupling



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


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



03.615.009 Rod Introduction Instrument for Rods � 4.0 mm


03.615.011 Rod Shearer for 4.0 mm Rods

Optional Instruments

Instruments


Synapse System Compatibility

Synapse System 3.5 Rod System 4.0 Rod System

Implants Unsterile ✓

Sterile ✓ ✓

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 ✓ ✓

Pre-bent Rod ✓ ✓

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)





� 3.5 mm Cortex Shaft Screws 18 mm – 50 mm (2 mm increments)


Hooks Side loading Lamina hooks ✓

Top loading Lamina hooks ✓ ✓

Transverseconnectors

Head to head loading ✓ ✓

Rod to rod ✓ ✓

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


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.


Figure 1

Button

“Speedbump”

Greencolorband

Outersleeve

Screwdriver Assembly

Instruments




Optional instrument


– 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


1

2

3

1

2

Rod Introduction InstrumentAssembly

(03.614.027)


1

1

2

2

Drill Sleeve Assembly (388.393)


1

2

3

4

Depth Gauge Assembly (03.161.028)


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Technique Guide - synthes.vo.llnwd.netsynthes.vo.llnwd.net/o16/LLNWMB8/INT Mobile/Synthes...Position...

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