Post on 29-May-2018
TECHNIQUE GUIDE
The total solution for simple and complex spine pathology
MATRIX SPINE SYSTEM – DEGENERATIVE
Instruments and implants approved by the AO Foundation.This publication is not intended for distribution in the USA.
Image intensifier control
WarningThis description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling these instruments is highly recommended.
Reprocessing, Care and Maintenance of Synthes InstrumentsFor general guidelines, function control and dismantling of multi-part instruments, please refer to: www.synthes.com/reprocessing
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 1
INTRODUCTION MATRIX Spine System – Degenerative 2
AO Principles 6
Indications and Contraindications 7
SURGICAL TECHNIQUE Surgical Technique 8
Optional Technique 29• Screw Insertion with Retaining Sleeve, Locking 29• Unassembled Pedicle Screw Insertion 31• Polyaxial Head Removal 33• Reduction Screws 34• Adding Transverse Connectors 36• Adding Rod-to-Rod Connectors 37• Distraction for Posterior Interbody Fusion 39• Locking Cap Removal 42
PRODUCT INFORMATION How to Disassemble Instruments for Cleaning 47
Implants 51
Instruments 67
BIOMATERIALS IMPLANTS 81
TABLE OF CONTENTS
1 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
MATRIX SPINE SYSTEM – DEGENERATIVE
The Synthes MATRIX Spine System is a universal set of instruments and implants that cover degenerative dis-orders (open or minimally invasive access), deformities and trauma indications.
Unique Dual Core / Double Lead Screw Design• Fast and controlled insertion• Increased pull-out resistance due to optimal bone
purchase• Safe handling thanks to atraumatic tip and self-
tapping thread
PrimeLock – Screwdriver – Screw Interlock• Toggle free screw insertion• Precise and controlled screw placement• Direction of screw insertion possible
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 1
Modularity – Click-on and Preassembled Screws• For better visualization of the anatomi-
cal structure• Multiple screw head removal and
replacement without removing the bone screw from the pedicle
• Customized inventory possible
Snap-on Swiveling Transverse Connector• Offers fast and simple in-situ placement• Simple anatomical adjustment possible
15 mm
50° 50°
4 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
MATRIX Spine System – Degenerative
Preassembled Polyaxial and Reduction Pedicle Screw• Allows up to 50° of angulation to ease in situ connec-
tion to the longitudinal rod• The rod reduction features are located at the top of
the polyaxial head • Dual Core/Double Lead thread designed to securely
anchor the screw in cortical and cancellous bone• Threaded T25 Stardrive recess designed to deliver
torque effectively
Pedicle Screw• Increased visual access to the anatomical structures• Allows for improved access to the surgical field • Dual Core/Double Lead thread designed to securely
anchor the screw in cortical and cancellous bone• Threaded T25 Stardrive recess designed to deliver
torque effectively
Click-on Polyaxial and Reduction Screw Head• The polyaxial head of the implant is designed for rod
reduction• To ease intraoperative planning, the polyaxial heads
can be removed and replaced without removing the pedicle screw from the pedicle
• The reduction head allows for 15 mm rod reduction
IMPLANTS
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 1
Rods• Available in three material strengths: Hard pure tita-
nium, extra-hard titanium alloy (TAN), and extra-hard cobalt-chromium alloy, diameter 5.5 mm
• A choice of straight and curved rods to facilitate intra-operative construct assembly and technique maneuvers
Locking Cap• Square thread design minimizes cross threading under
high reduction loads• T25 Stardrive recess designed to reduce the risk of
damage at high loads• 1-step locking cap allows for complete fi xation in one
step (polyaxiality and run on rod)• Available fl at or with guidance
Transverse Connector• The snap-on transverse connector is preassembled and
requires only fi nal positioning and tightening• The jaws of the transverse connector swivel and are
spring loaded • Telescoping body is arched to accommodate grafts and
anatomical structures and is available in a range of lengths
• The locking screws use a T15 Stardrive which minimizes drive stripping while fi nal tightening
Instruments• Ergonomically designed handles• Intuitive, easy to use• Convenient, interchangeable options
6 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
AO PRINCIPLES
In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.¹ They are:• Anatomic reduction• Stable internal fixation• Preservation of blood supply• Early, active mobilization
The fundamental aims of fracture treatment in the limbs and fusion of the spine are the same. A specific goal in the spine is returning as much function as possible to the injured neural elements.²
AO Principles as Applied to the Spine³
Anatomic alignmentRestoration of normal spinal alignment to improve the biomechanics of the spine.
Stable internal fixationStabilization of the spinal segment to promote bony fusion.
Preservation of blood supplyCreation of an optimal environment for fusion.
Early, active mobilizationMinimization of damage to the spinal vasculature, dura, and neural elements, which may contribute to pain re-duction and improved function for the patient.
¹ Müller ME, Allgöwer M, Schneider R, Willenegger H (1995) Manual of Internal Fixation. 3rd, expanded and completely revised ed. 1991. Berlin, Heidelberg, New York: Springer
² Ibid.³ Aebi M, Arlet V, Webb JK (2007). AOSPINE Manual (2 vols.), Stuttgart, New
York: Thieme
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 7
INDICATIONS AND CONTRAINDICATIONS
The MATRIX Spine System is a posterior pedicle screw and hook fixation system (T1–S2) intended to provide precise and segmental stabilization of the spine for use in skeletally mature patients.
Indications• Degenerative disc disease• Spondylolisthesis• Trauma (i.e. fracture or dislocation)• Tumor• Stenosis• Pseudarthrosis• Failed previous fusion• Deformities (i.e. scoliosis, kyphosis and/or lordosis)
Contraindications• Osteoporosis• In fractures and tumors with severe anterior vertebral
body disruption, an additional anterior support or col-umn reconstruction is required
8 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
SURGICAL TECHNIQUE
1Prepare pedicles and determine screw lengths
Instruments
388.656 Pedicle Awl B 4.0 mm with Silicone Handle, length 255 mm, for Pedicle Screws B 5.0 to 7.0 mm
388.655 Pedicle Probe B3.7 mm with Silicone Handle, length 240 mm, for Pedicle Screws B5.0 to 7.0 mm
Locate pedicles and use the awl to perforate the cortex. Use the probe to open the pedicle canal. Using radio-graphic imaging, confirm pedicle location, orientation and depth by inserting the probe. When selecting the appropriate length screw, use the markings on the probe to determine the pedicle depth.
All MATRIX pedicle screws are self-tapping; however, if tapping is preferred, use the appropriate tap and tap handle.
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 9
Optional instruments
03.632.057 Pedicle Marker for Matrix
03.632.058 Inserter for Pedicle Marker, for Matrix
388.657 Pedicle Probe B3.8 mm, curved, with Silicone Handle, length 290 mm, for Pedicle Screws B5.0 to 7.0 mm
388.536 Pedicle Probe for Screws B4.2 mm, length 240 mm
388.545 Feeler for Screw Channel, straight, B2.3 mm, length 275 mm
388.546 Feeler for Screw Channel, curved, B2.3 mm, length 275 mm
388.549 Feeler, straight, with rounded tip
388.551 Pedicle Awl B 3.0 mm, length 230 mm, for Screws B 4.0 and 4.2 mm
03.632.103 Tap for Pedicle Screws B3.5 mm, length 180 mm
03.632.104 Tap for Pedicle Screws B4.0 mm, length 180 mm
03.632.105 Tap for Pedicle Screws B5.0 mm, length 180 mm
03.632.155 Tap for Pedicle Screws B5.5 mm, length 180 mm
03.632.106 Tap for Pedicle Screws B6.0 mm, length 180 mm
03.632.107 Tap for Pedicle Screws B7.0 mm, length 180 mm
03.632.108 Tap for Pedicle Screws B8.0 mm, length 180 mm
03.632.109 Tap for Pedicle Screws B9.0 mm, length 180 mm
388.654 Ratchet with Handle, with Hexagonal Quick Coupling 6.0 mm
11 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Surgical Technique
2Assemble screwdriver
Instruments
03.632.036 Retaining Sleeve, long, for Matrix 5.5
03.632.072 Screwdriver Shaft Stardrive, T25, long, for Matrix 5.5
03.620.061 T-Handle with Ratchet Wrench and with Torque Limiter, 10 Nm
Slide retaining sleeve on the screwdriver shaft and attach the ratchet handle.
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
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
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 on pedicle probe feedback.
Insert the screwdriver tip into the recess of the pedicle screw and rotate the green knob of the retaining sleeve clockwise until the tip of the sleeve is firmly attached to the pedicle screw.
Verify the screw length with the template provided in the screw module.
Note: Set the ratchet to the neutral position before picking up a screw.
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
11 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
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 sleeve during screw insertion.
To disengage the retaining sleeve, rotate the green knob counterclockwise and remove the screwdriver.
Notes: • Do not grasp the green knob during screw inser-
tion as this will cause the retaining sleeve to dis-engage from the screw.
• Ensure that the polyaxial screw head remains free to adapt its position and is not restricted by, or does not rest on, bony structures. If necessary, ad-just the screw height and/or ream space for the screw head.
• When countersinking, care should be taken in reaming the most superior (and inferior) level to protect the facet joints.
• If pedicle screws with separate polyaxial heads are used, follow the optional technique described on page 31.
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
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
14 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Surgical Technique
5Select, cut and bend rod
Instruments
03.632.007 Alignment Tool for polyaxial Screw Head, for Matrix 5.5
388.906 Trial Rod B5.0 mm, length 150 mm
03.632.017 Rod Bender with Silicone Handle
Use the head alignment tool to rotate and align the screw heads.
Use the trial rod to determine contour and length of the rod.
Select precontoured rod, or use rod bender to form rod according to the template.
Notes:• The screw height must be adjusted to the rod. If
necessary, adjust the screw height using a screw-driver without retaining sleeve.
• To restore polyaxiality of a screw head that has al-ready been tightened, insert the alignment tool in the screw head and apply sufficient pressure to re-lease the lock.
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
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 for eventual breakage of the implant.
16 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Surgical Technique
6Insert rod
Instrument
03.632.081 Rod Holding Forceps for Rods B5.5 mm
Insert the rod using the rod holding forceps.
Optional instrument
03.632.202 Holding Forceps for Rods B5.5 and B6.0 mm
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 17
7Reduce rod
Option A: Reduce rod with a rod pusher
Instruments
03.632.006 Rod Pusher/Counter Torque, standard, for Matrix 5.5
03.632.080 Handle, detachable, for Matrix
Connect detachable handle to the octagonal end of the rod pusher/counter torque.
Advance rod into the screw head using the rod pusher/ countertorque.
Optional instruments
03.632.076 Rod Pusher/Counter Torque, long, for Matrix 5.5
03.632.169 Rod Pusher for Rods B5.5/6.0 mm, for Matrix
03.632.000 Distraction Fork
18 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Surgical Technique
Option B:Reduce rod with a rocker fork
Instruments
03.632.010 Rocker Fork, small, for Matrix 5.5
03.632.012 Rocker Fork, medium, for Matrix 5.5
03.632.011 Rocker Fork, footed, for Matrix 5.5
Use a rocker fork to lever the rod into the head of the pedicle screw.
Reduction travels:Small Rocker Fork = 8.5 mmMedium Rocker Fork = 13.5 mmFooted Rocker Fork = 7.5 mm
Technique tip: Use the footed MATRIX rocker fork to aid in reducing the rod into adjacent screw heads.
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 19
Option C:Reduce rod with a rod persuader
Instrument
03.632.009 Rod Persuader, standard, for Matrix 5.5
Ensure that the ratchet handle is fully open. Place the rod persuader over the rod and onto the screw head. Press down firmly until the tips engage the head of the screw. Squeeze the handle to seat the rod into the head of the pedicle screw.
Reduction travel:15 mm
Note: The rod persuader can be used as counter torque for final tightening of the locking cap.
Optional instrument
03.632.079 Rod Persuader, long, for Matrix 5.5
11 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Surgical Technique
Option D: Reduce rod with a Reduction Instrument for Spondylolisthesis
Instruments
03.632.408 Reduction Instrument for Spondylolis-thesis, standard, for Matrix 5.5
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 the outer tube. Insert the black nut and press down firmly until audible feedback. Push the inner tube up to-wards the black nut and turn the black nut clockwise until the black line is visible at the 30 line.
Place the reduction instrument over the screw head. Press down firmly until the tips engage. Load the hexag-onal socket into the ratchet handle and insert it into the top of the reduction instrument.
Rotate the ratchet handle clockwise to reduce the rod into the screw head. Full reduction is achieved when the black line on the side of the instrument is visible at the 0 line.
Remove the hexagonal sockel to insert a locking cap through the instrument.
To remove the instrument from the screw head, turn the palm handle counter-clockwise until the line on the side of the instrument is visible at the 30 line.
Reduction travel: 30 mm
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
Parallel reduction can be achieved by the simultaneous use of two reduction instruments on the same vertebral body.
Note: The reduction instrument for spondylolisthe-sis can be used as counter torque for final tightening of the locking cap.
Optional instrument
03.632.409 Reduction Instrument for Spondylolis-thesis, long, for Matrix 5.5
11 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
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 of the locking cap. Press down firmly. The screwdriver shaft is self-retaining.
To ensure optimal cap alignment, insert the locking cap through the rod pusher/counter torque. Thread the lock-ing cap clockwise into the implant head.
Apply a light torque to provisionally tighten the locking cap and maintain the desired rod position. Place the re-maining caps and provisionally tighten.
1 2
3
4a
4b
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
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)
14 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Surgical Technique
9Distract
Instruments
388.410 Spreader Forceps for Pedicle Screws, length 330 mm
03.632.401 Screwdriver Shaft Stardrive, T25, long, straight tip, with Hexagonal Coupling, for Matrix
03.620.061 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 re-duced and provisionally tightened (see “Insert 1-step locking cap”). Failure to do so could poten-tially lead to a misalignment.
Finally tighten one locking cap completely to create a fixed point for distraction (see “Perform final tighten-ing”). Reverse the locking cap of the screw to be relo-cated a quarter of a turn.
Use the distraction forceps to distract the construct. Once in the desired position, tighten the locking caps with the screwdriver.
The holding forceps can be used as a temporary point of distraction when adjacent pedicle screws are too distant from each other.
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
Note: Always fully seat the counter torque on the rod. The instrument must be perpendicular to the rod during tightening.
Optional instruments
03.632.202 Holding Forceps for Rods B5.5 and B6.0 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
Correct Incorrect
16 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Surgical Technique
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 re-duced and provisionally tightened (see “Insert 1-step locking cap”). Failure to do so could poten-tially lead to a misalignment.
Finally tighten one locking cap completely to create a fixed point for distraction (see “Perform final tighten-ing”). Reverse the locking cap of the screw to be relo-cated a quarter of a turn.
Use the compression forceps to compress the construct. Once in the desired position, tighten the locking caps with the screwdriver.
The rod holding forceps can be used as a temporary point of compression when adjacent pedicle screws are too distant.
Note: Always fully seat the counter torque on the rod. The instrument must be perpendicular to the rod during tightening.
Optional instrument
03.632.202 Holding Forceps for Rods B5.5 and B6.0 mm
Correct Incorrect
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 17
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 re-duced and provisionally tightened (see “Insert 1-step locking cap”). Failure to do so could poten-tially lead to a misalignment.
Note: The handle of the counter torque must be ori-ented laterally or medially. Do not orient the handle of the countertorque in line with the rod. This ac-tion could cause misalignment of the rod with the implant.
Place the counter torque over the head of the screw. At-tach the screwdriver shaft to the T-handle with torque limiter. Insert the instrument through the counter torque cannula into the drive recess of the locking cap. Ensuring that the polyaxial head is perpendicular to the rod, tighten until there is a tactile release. This indicates that the required 10 Nm of torque has been applied. Repeat for all locking caps.
After initial final tightening of all screws, sequentially re-visit all locking caps. Start at the caudal left screw of the construct and proceed clockwise to systematically repeat final tightening of all locking caps of the construct.
Warning: Final tightening of the locking caps should only be performed with a Synthes 10 Nm torque handle. MATRIX screw implants achieve perfor-mance standard only when tightened to the re-quired 10 Nm tightening torque.
Correct Incorrect
18 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Surgical Technique
Notes:• Alternatively, the reduction instrument for spon-
dylolisthesis and the rod persuader can be used as counter torque for final tightening of the locking cap.
• Always fully seat the rod pusher/counter torque on the rod. The instrument must be perpendicular to the rod during final tightening.
Optional instruments
03.632.006 Rod Pusher/Counter Torque, standard, for Matrix 5.5
03.632.008 Reduction Instrument for Spondylolis-thesis, 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 Spondylolis-thesis, long, for Matrix 5.5
03.632.079 Rod Introduction Pliers, long, for Matrix 5.5
03.632.099 Counter Torque, long, for Matrix 5.5
Correct Incorrect
1
2
3
4
5
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 19
OPTIONAL TECHNIQUE Screw Insertion with Retaining Sleeve, Locking
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, depress the loading collar on the proximal end of the retaining sleeve (1).
Then slide the sleeve toward the handle on the shaft until it stops (2).
Release the loading collar and verify that the retaining sleeve is firmly attached to the screwdriver (3).
Retract the green locking ring towards the handle (4).
Place the screwdriver tip securely into the T25 StarDrive recess of the pedicle screw (5).
6
7
8
11 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Optional Technique Screw Insertion with Retaining Sleeve, Locking
When using a ratchet handle, make sure to set it to neu-tral setting.
Rotate the grey knob of the retaining sleeve clockwise. Firmly tighten to secure the implant, using the handle as countertorque (6).
Push the green locking ring toward the grey knob (7). If required, set the ratchet handle to the forward setting to insert the screw.
To release the screw from the retaining sleeve, retract the grey locking ring towards the handle, rotate the silver knob counterclockwise and remove the screw-driver (8).
Notes: • Polyaxial screwheads need to remain free and mo-
bile after insertion to allow accurate alignment to the rod during locking cap insertion and final tightening.
• The mobility of the screwhead cannot be assessed while the holding sleeve is attached.
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
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
OPTIONAL TECHNIQUEUnassembled 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 the unassembled pedicle screws as recommended in steps 1 to 4 of the surgical technique (pages 8–13).
Slide the reamer over the screwdriver shaft. Engage the tip of the screwdriver in the unassembled pedicle screw. Ream until the black line is visible on the shaft. This indi-cates that there is enough room for the implant head.
Note: When reaming the most superior and inferior levels take care to protect the facet joints.
Optional 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
11 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Optional TechniqueUnassembled Pedicle Screw Insertion
2Assemble polyaxial head
Instruments
03.632.037 Positioning Instrument for Polyaxial Screw Heads, for Matrix 5.5
68.632.125 Loading Station for Matrix 5.5
Insert the inner shaft of the positioning instrument into the handle and tighten in the clockwise direction.
To pick up a screwhead, align the positioning instrument for polyaxial screw heads to the rod slot features on the poly axial head implant and press down.
Position the placement tool with the polyaxial head over the unassembled pedicle screw and press down. To en-sure the polyaxial head is securely attached to the unas-sembled pedicle screw, gently lift up on the placement tool and angulate the polyaxial head.
To release the head placement tool, press the button lo-cated at the distal end of the instrument.
Notes:• If the polyaxial head does not successfully attach
to the head of the unassembled pedicle screw, ad-ditional reaming or screw height adjustment may be required to ensure sufficient space exists to allow free mobility of the head.
• Polyaxial screw heads can be removed a maxi-mum of three times without removing the pedicle screw; a new head must be used for each assembly.
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
OPTIONAL TECHNIQUEPolyaxial 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 the pedicle screw intraoperatively.
Remove any existing locking cap and the rod.
Connect the inner shaft of the removal tool for polyaxial screw heads to the ratchet and insert into the handle of the removal tool.
Ensure that the black line is visible on the inner shaft of the head removal tool.
Press the tip of the head removal tool into the polyaxial head. A tactile feedback may be felt as the tip of the head removal tool mates with the collet of the polyaxial head. While holding the handle, thread the inner shaft clockwise until it stops. Lift to remove the head.
To remove the implant head from the instrument, turn the ratchet counter-clockwise until the black line is visi-ble. Pull the head off the instrument.
Notes:• The head removal tool can be used to remove the
polyaxial head of both unassembled as well as pre-assembled screws.
• To remove the polyaxial reduction head, the tabs must first be broken off.
14 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
OPTIONAL TECHNIQUEReduction Screws
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 as click-on versions for subsequent assembly.
Follow the technique for preassembled polyaxial screw (page 10) or unassembled pedicle screw (page 31) to in-sert screw.
Pick up a locking cap from the screw module with a T25 screwdriver shaft. The screwdriver shaft is self-retaining.
Place the rod pusher/counter torque for reduction screws (03.632.042) over the screw head. Insert the locking cap through the counter torque. Turning the locking cap will reduce the rod into the screw head.
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
15 mm Reduction
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
To break off the reduction screw tabs, place the rod pusher/counter torque for reduction screws (03.632.026) with the handle over the screw head. Gently rock the tab removal tool medial then lateral to break the tab wall free from the polyaxial head.
Alternative technique for locking cap insertion
Instrument
03.632.029 Holding Crown for Reduction Screws, for Matrix 5.5
The holding crown for reduction screws can be used in-stead of the counter torque to provide guidance for the locking cap insertion.
16 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
OPTIONAL TECHNIQUEAdding Transverse Connectors
Instruments
03.632.053 Measuring Device for Transverse Connectors, Snap-on, for Matrix
03.632.204 Torque-limiting Handle, 3 Nm
03.632.052 Screwdriver Stardrive, T15, short, for Matrix
03.632.050 Retaining Sleeve for Transverse Connectors, Snap-on, for Matrix
Use the measuring device for transverse connectors to estimate the distance between the two rods. On the crossbar of the measuring device note the size of the ap-propriate transverse connector (1–8).
The transverse connectors are marked with sizes 1–8, matching the figures on the measuring device. Select the appropriate transverse connector.
The ends of the transverse connector can be clicked onto the rod to secure it at the desired point.
Use the screwdriver and the torque limiting handle to se-cure the transverse connector to the rods. When tight-ening the setscrews a tactile release is felt.
Note: Always use the retaining sleeve when tighten-ing the setscrew.
Warning: The MATRIX transverse connector contains Nitinol components. Implants that contain nitinol should not be used in patients with nickel sensitivities or allergies.
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 17
OPTIONAL TECHNIQUEAdding Rod-to-Rod Connectors
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 the rod diameters to be received. The diameters ac-cepted are etched on both sides of the connector to en-sure the correct rod size is attached to each opening.
Precaution: Parallel connectors with one set screw should be used in pairs on each side of the con-struct. Connectors with two set screws can be used one per side of the construct.
Attach the preferred connector to each rod. Mount the T15 screwdriver shaft to the 3 Nm torque-limiting handle and slide the retaining sleeve over the screwdriver shaft. To secure the connector to the rods, engage the T15 drive into each setscrew recess, slide the retractable re-taining sleeve to the distal position. Tighten all the set screws until a tactile release is felt.
18 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Optional TechniqueAdding Rod-to-Rod Connectors
Notes: • If any part of the construct requires further ad-
justment, all set screws must be loosened to the point of resistance. Do not remove set screws from the assembly. After final adjustment, retighten the set screws.
• Parallel connectors contain Nitinol components. Implants that contain Nitinol should not be used in patients with nickel sensitivities or allergies.
• The retaining sleeve for transverse connectors cannot be used when tightening parallel with two set screws.
Precautions:• Care should be taken not to tighten the connector
on a portion of the rod that has been contoured or deformed by a rod cutter.
• Synthes connectors are tested using Synthes 5.5 or 6.0 mm rods and not compatible with those rods of similar diameter from other manufacturers.
• Refer to the torque-limiting handle package and labeling for the recommended calibration mainte-nance.
Optional instrument
03.632.052 Screwdriver Stardrive, T15, short, for Matrix (self-holding)
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 19
OPTIONAL TECHNIQUEDistraction for Posterior Interbody Fusion
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 press firmly into the detachable retaining sleeve.
Insert the tip of the screwdriver shaft into the screw head. Make sure that the tip of the screwdriver is fully seated in the recess of the screw head. Turn the green knob clockwise.
Insert two pedicle screws.
To release the detachable retaining sleeve from the distractor tip, pull the green knob towards the handle. Remove the screwdriver and retaining sleeve and repeat the procedure for the second pedicle screw.
1
2
41 DePuy 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 distraction position (D) and rotate the wing nut screw clockwise until the desired distraction is achieved. Perform discectomy and interbody fusion.
Turn the rocker lever (2) to neutral (N) to unlock the an-gular position and remove the distractor.
Reattach the screwdriver/detachable retaining sleeve and turn the green knob counterclockwise.
Note: Do not allow the assembled tips to cross over otherwise the distractor will not work correctly. If necessary, use a different type of tip (see page 41).
1
2
3
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 41
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 be used in a variety of combinations.
The distractor tip for screws (1) can be used with pedicle, polyaxial, and polyaxial reduction screws. Parallel distrac-tion can be performed.
The distractor tip with screw heads (2) can be used with polyaxial, polyaxial reduction, and monoaxial screws. They are attached to the polyaxial screw head after in-sertion of the pedicle screw. If firmly tightened the screw becomes monoaxial and parallel distraction can be per-formed. These tips are particularly suitable for cases where the tips for bone screws would cross over as a re-sult of pronounced lordotic curvature of the spine.
The distractor tip with hook end (3) can be used with pedicle, polyaxial, and polyaxial reduction screws. Distraction can be performed.
41 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
OPTIONAL TECHNIQUELocking 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 detachable handle over the screwhead. Place the ratchet of the torque limiting handle in the neutral position, en-gage a T25 screwdriver with the Stardrive recess of the locking cap and turn counter-clockwise.
Note: Locking caps are designed to lock the con-struct safely and minimize the chance of post- operative loosening and rod-push-through. There-fore, in certain cases, the loosening torque may be higher than 10 Nm. In such cases, use the following techniques to remove a locking cap.
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 41
Sequentially turn clockwise and then immediately counter- clockwise. Turn until tactile or audible feedback from the implant is experienced. Repeat the steps until the locking cap is loose.
Notes: • For this technique, always use the torque limiting
handle (03.620.061) to reduce risk of damage to the T25 screwdriver shaft.
• If this method does not produce the desired result, follow the technique according to Option A (page 44) or Option B (page 46).
Optional 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
44 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Optional TechniqueLocking Cap Removal
If after multiple attempts to loosen the locking cap the torque is still excessive, the following techniques should be used:
Option A: Counter torque on a adjacent screw
Instruments
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 handle over an adjacent screw on the same rod (i.e. one level higher or lower). Simultaneously place the counter-torque over the locking cap to be loosened and engage the screwdriver shaft and torque limiting handle with the stardrive recess of the locking cap. Place the ratchet of the torque limiting handle in the neutral position and begin to sequentially turn clockwise and then immedi-ately counter-clockwise. Turn until tactile or audible feedback from the implant is experienced. Repeat the steps until the locking cap is loose.
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 41
Notes: • For this technique, always use the torque limiting
handle (03.620.061) to reduce risk of damage to the T25 screwdriver shaft.
• Retighten the locking cap on which the counter torque was applied to 10 Nm.
• To loosen the last locking cap, replace the counter torque, consisting of rod pusher/counter torque and handle, with a rod persuader.
• If this method does not produce the desired result, follow the technique according to Option B (page 46).
Optional 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
46 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Optional TechniqueLocking Cap Removal
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 Per-suader on the screw and firmly squeeze the handles. Place the ratchet of the torque limiting handle in the neutral position. With the reduction load applied begin to sequentially turn clockwise and then immediately counter-clockwise. Turn until tactile or audible feedback from the implant is experienced. Repeat the steps until the locking cap is loose.
Notes: • For this technique, always use the torque limiting
handle (03.620.061) to reduce risk of damage to the T25 screwdriver shaft.
• If this method does not produce the desired result, follow the technique according to Option A (page 44).
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
1
1
4
2
2
5
3
3
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 47
HOW TO DISASSEMBLE INSTRUMENTS FOR CLEANING
Screwdriver with retaining sleeve
Screwdriver with detachable retaining sleeve
1
1
2
2
1
2
48 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
How to Disassemble Instruments for Cleaning
Counter torque
Positioning instrument for polyaxial screw heads
1
1
2
2
1
2
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 49
Head removal tool
Torque limiting handle
1 2 3
1 2 3
11 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
How to Disassemble Instruments for Cleaning
Reduction instrument for spondylolisthesis MATRIX
Rod persuader MATRIX
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
IMPLANTS*
Pedicle Screw Matrix 5.5 Polyaxial B4.0 mm,preassembled, Titanium Alloy (TAN)
length (mm)
04.632.420 20
04.632.425 25
04.632.430 30
04.632.435 35
04.632.440 40
04.632.445 45
Pedicle Screw Matrix 5.5 Polyaxial B5.0 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 B5.5 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.
11 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Implants
Pedicle Screw Matrix 5.5 Polyaxial B6.0 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 B7.0 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
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
Pedicle Screw Matrix 5.5 Polyaxial B8.0 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 B9.0 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
14 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Implants
Reduction Screw Matrix 5.5, B4.0 mm,preassembled, Titanium Alloy (TAN)
length (mm)
04.634.420 20
04.634.425 25
04.634.430 30
04.634.435 35
04.634.440 40
04.634.445 45
Reduction Screw Matrix 5.5, B5.0 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, B5.5 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
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 11
Reduction Screw Matrix 5.5, B6.0 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, B7.0 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
16 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Implants
Reduction Screw Matrix 5.5, B8.0 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
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 17
Pedicle Screw Matrix 5.5 B4.0 mm,Titanium Alloy (TAN)
length (mm)
04.639.420 20
04.639.425 25
04.639.430 30
04.639.435 35
04.639.440 40
04.639.445 45
Pedicle Screw Matrix 5.5 B5.0 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 B5.5 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
18 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Implants
Pedicle Screw Matrix 5.5 B6.0 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 B7.0 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
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 19
Pedicle Screw Matrix 5.5 B8.0 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
61 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Implants
Pedicle Screw Matrix 5.5 B9.0 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
Also available:• Pedicle Screw Matrix 5.5, polyaxial, cannulated• Pedicle Screw Matrix 5.5, perforated• Intermediate lengths available upon request
Screw heads
04.632.001 Screw Head, polyaxial, for Matrix 5.5, Titanium Alloy (TAN)
04.634.002 Reduction Head, polyaxial, for Matrix 5.5, Titanium Alloy (TAN)
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 61
Curved rods
Rods B5.5 mm, hard, curved, Pure Titanium (TiCP)
length (mm)
04.636.030 30
04.636.035 35
04.636.040 40
04.636.045 45
04.636.050 50
04.636.055 55
04.636.060 60
04.636.065 65
04.636.070 70
04.636.075 75
04.636.080 80
04.636.085 85
04.636.125 125
Rods B5.5 mm, extra-hard, curved, Cobalt-Chrome Alloy (CoCrMo)
length (mm)
09.636.030 30
09.636.035 35
09.636.040 40
09.636.045 45
09.636.050 50
09.636.055 55
09.636.060 60
09.636.065 65
09.636.070 70
09.636.075 75
09.636.080 80
09.636.085 85
09.636.125 125
61 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Implants
Straight rods
Rods B5.5 mm, hard, straight, Pure Titanium (TiCP)
length (mm)
04.634.230 30
04.634.235 35
04.634.240 40
04.634.245 45
04.634.250 50
04.634.255 55
04.634.260 60
04.634.265 65
04.634.270 70
04.634.275 75
04.634.280 80
04.634.285 85
04.634.290 90
04.634.295 95
04.633.290 100
04.634.325 125
04.633.291 150
04.633.292 200
04.633.293 300
04.633.294 400
04.633.500 500
04.633.700** 700
** Available nonsterile packed only
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 61
Straight rods
Rods B5.5 mm, extra-hard, straight, Titanium Alloy (TAN)
length (mm)
04.616.130 30
04.616.135 35
04.616.140 40
04.616.145 45
04.616.150 50
04.616.155 55
04.616.160 60
04.616.165 65
04.616.170 70
04.616.175 75
04.616.180 80
04.616.185 85
04.616.190 90
04.616.195 95
04.633.279 100
04.616.225 125
04.633.281 150
04.616.275 175
04.633.282 200
04.633.283 300
04.633.284 400
04.633.285 500
04.616.700** 700
** Available nonsterile packed only
64 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Implants
Straight rods
Rods B5.5 mm, hard, straight, Cobalt-Chrome Alloy (CoCrMo)
length (mm)
09.631.030 30
09.631.035 35
09.631.040 40
09.631.045 45
09.631.050 50
09.631.055 55
09.631.060 60
09.631.065 65
09.631.070 70
09.631.075 75
09.631.080 80
09.631.085 85
09.631.090 90
09.631.095 95
09.633.100 100
09.631.125 125
09.633.150 150
09.631.175 175
09.633.190 200
09.633.191 300
09.633.192 400
09.633.193 500
09.631.700** 700
** Available nonsterile packed only
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 61
Connecting rods
Connecting Rod, length 500 mm,Pure Titanium (TiCP)
diameter (mm/mm)
04.633.187 5.5/6.0
Connecting Rods, length 500 mm,Titanium Alloy (TAN)
diameter (mm/mm)
04.633.190 5.5/3.5
04.633.191 5.5/4.0
04.633.188 5.5/6.0
Connecting Rod, length 500 mm, Cobalt-chrome alloy (CoCrMo)
diameter (mm/mm)
09.633.187 5.5/6.0
Also available:Pelvic Rods B5.5 mm, prebent
For an overview, please refer to www.synthes.com/e-catalog
66 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Implants
Locking cap
09.632.099 Locking Cap, fl at, one-step, for Matrix 5.5, Cobalt-chrome alloy (CoCrMo)
04.632.000 Locking Cap, one-step, for Matrix 5.5 Titanium Alloy (TAN)
Snap-On Transverse Connector
length size
04.633.317 17–22 mm 1
04.633.321 21–26 mm 2
04.633.326 26–31 mm 3
04.633.330 30–33 mm 4
04.633.333 33–38 mm 5
04.633.338 38–47 mm 6
04.633.347 47–62 mm 7
04.633.364 62–90 mm 8
Snap-On Open Parallel Connectors
diameters set screws
04.633.400 5.5 to 5.5 mm 1
04.633.401 5.5 to 6.0 mm 1
04.633.402 6.0 to 6.0 mm 1
04.633.403 5.5 to 5.5 mm 2
04.633.404 5.5 to 6.0 mm 2
04.633.405 6.0 to 6.0 mm 2
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 67
INSTRUMENTS
For pedicle preparation
03.632.057 Pedicle Marker for Matrix
03.632.058 Inserter for Pedicle Marker, for Matrix
Awls and probes with palm handle
388.656 Pedicle Awl B 4.0 mm with SiliconeHandle, length 255 mm, for Pedicle Screws B 5.0 to 7.0 mm
388.536 Pedicle Probe for Screws B4.2 mm, length 240 mm
388.655 Pedicle Probe B3.7 mm with Silicone Handle, length 240 mm, for Pedicle Screws B5.0 to 7.0 mm
388.657 Pedicle Probe B3.8 mm, curved, with Silicone Handle, length 290 mm, for Pedicle Screws B5.0 to 7.0 mm
388.551 Pedicle Awl B 3.0 mm, length 230 mm, for Screws B 4.0 and 4.2 mm
68 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Instruments
Ball tip feelers
388.545 Feeler for Screw Channel, straight, B2.3 mm, length 275 mm
388.546 Feeler for Screw Channel, curved, B2.3 mm, length 275 mm
388.549 Feeler, straight, with rounded tip
Tap for Pedicle Screws, length 180 mm
03.632.103 B3.5 mm
03.632.104 B4.0 mm
03.632.105 B5.0 mm
03.632.155 B5.5 mm
03.632.106 B6.0 mm
03.632.107 B7.0 mm
03.632.108 B8.0 mm
03.632.109 B9.0 mm
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 69
For screw insertion
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
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
71 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Instruments
Screwdrivers Stardrive T25 with straight handle
03.632.005 Screwdriver Stardrive, T25, with straight handle, standard, for Matrix 5.5
03.632.075 Screwdriver Stardrive, T25, long, with straight handle, for Matrix 5.5
03.620.019 Torque-limiting Handle, 10 Nm, for Pangea
03.636.008 T-Handle with Hexagonal Coupling 6.0 mm
03.632.090 T-Handle with Ratchet Wrench, with Hexagonal Coupling 6.0 mm
03.632.091 Handle with Ratchet Wrench, straight,with Hexagonal Coupling 6.0 mm
Handles with hexagonal coupling
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 71
03.632.037 Positioning Instrument for Polyaxial Screw Heads, for Matrix 5.5
03.632.045 Removal Instrument for Polyaxial Screw Heads, for Matrix 5.5
03.632.046 Reamer for Pedicle Screws, for Matrix 5.5
68.632.125 Loading Station for Matrix 5.5
For assembly and removal of polyaxial screw heads
03.632.007 Alignment Tool for polyaxial Screw Head, for Matrix 5.5
71 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Instruments
For rod cutting and bending
388.906 Trial Rod B5.0 mm, length 150 mm
03.632.017 Rod Bender with Silicone Handle
388.750 USS Rod Cutting and Bending Device
388.720 Bolt Cutter
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 71
For rod insertion
03.632.202 Holding Forceps for Rods B5.5 and B 6.0 mm
03.632.081 Rod Holding Forceps for Rods B5.5 mm
03.632.169 Rod Pusher for Rods B5.5/6.0 mm, for Matrix
74 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Instruments
388.422 Compression Forceps, length 335 mm, for Pedicle Screws
03.620.017 Compression Forceps, for Lumbar Spine
03.620.018 Distraction Forceps, for Lumbar Spine
388.410 Spreader Forceps for Pedicle Screws, length 330 mm
For distraction and compression
03.632.000 Distraction Fork
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 71
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
76 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Instruments
For cap introduction and tightening
03.620.061 T-Handle with Ratchet Wrench and with 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
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 77
For transverse and parallel connectors
03.632.050 Retaining Sleeve for Transverse Connectors, 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 Transverse Connectors, Snap-on, for Matrix
03.632.204 Torque-limiting Handle, 3 Nm
78 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Instruments
For rod reduction
Reduction instruments
03.632.408 Reduction Instrument for Spondylolis-thesis, 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
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 79
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
81 DePuy Synthes MATRIX Spine System – Degenerative Technique Guide
Instruments
03.632.042 Rod Pusher/Counter Torque for Reduction Screw, for Matrix 5.5
03.632.026 Rod Pusher/Counter Torque for Reduction Screws, for Matrix 5.5
03.632.029 Holding Crown for Reduction Screws, for Matrix 5.5
03.632.030 Tab Remover for Reduction Screws, for Matrix 5.5
Instruments for reduction screws
03.632.025 Counter Torque for Reduction Screws, for Matrix 5.5
MATRIX Spine System – Degenerative Technique Guide DePuy Synthes 81
BIOMATERIAL IMPLANTS
To facilitate fusion, bone graft is often applied in the lateral gutters. A suitable bone graft substitute (e.g. chronOS, DBX) may be used by itself or in combination with autograft.
The construct shown is complemented with chronOS Strip precast, which optimally integrates with patient anatomy and implanted hardware. Perfusion of Strip with bone marrow aspirate provides a favorable environ-ment for bony ingrowth.
chronOS Strip, precast, sterile
07.801.200.02S 47 mm × 18 mm × 3 mm pack of 2 implants
length lengththickness thickness
0123
Synthes GmbHEimattstrasse 34436 OberdorfSwitzerlandTel: +41 61 965 61 11Fax: +41 61 965 66 00www.depuysynthes.com
This publication is not intended for distribution in the USA.
All surgical techniques are available as PDF files at www.synthes.com/lit ©
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