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

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

Technique Guide

0x6.001.190_AB 26.11.12 11:16 Seite Cvr1

0x6.001.190_AB 26.11.12 11:16 Seite Cvr2

MATRIX Spine System – MIS Instrumentation Technique Guide Synthes 1

Table of Contents

Introduction

Surgical Technique

Product Information

MATRIX Spine System – MIS Instrumentation 2

AO Principles 6

Indications 7

Preparation 8

Pedicle Preparation 11

Screw Insertion 19

Rod Introduction 28

Rod Reduction and Locking Cap Introduction 43

Compression and Distraction 52

Locking Cap Loosening 56

Retraction Blade Removal 57

Revision/Removal 58

Implants 59

Instruments 67

Image intensifier control

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

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

0x6.001.190_AB 26.11.12 11:16 Seite 1

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

Matrix MIS is an instrument set designed for insertion of cannulated MATRIX pedicle screws and rods through a percutaneous or mini-open muscle sparing approach.

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

purchase – Safe handling thanks to atraumatic tip and self

tapping thread

Unique dual core /Double lead screw design

– Toggle free screw insertion – Precise and controlled screw placement

PrimeLock – screwdriver – screw interlock

2 Synthes MATRIX Spine System – MIS Instrumentation Technique Guide

0x6.001.190_AB 26.11.12 11:16 Seite 2

Final Tightening

– Minimized muscle trauma – Clear access and direct visualization– Optimized instruments for treatment of the

lumbar-sacral junction

Slim retraction blades

– Cap guide for rod reduction, locking cap insertion and final tightening

– Plug in and robust final tightening concept

Three functions in oneinstrument

Rod Reduction Cap Insertion


0x6.001.190_AB 26.11.12 11:16 Seite 3

50°


Radius 100

Radius 200

Straight

MATRIX Spine System – MIS Instrumentation. The total solution for simple and complex spine pathology.

– Allows 50° of angulation to ease in situ connection to thelongitudinal rod

– Standard Polyaxial head incorporates features to easilymate with retraction blades

– 1.8 mm cannulation for use over 1.6 mm Kirschner wires– 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

Preassembled Cannulated PolyaxialScrew

Locking Cap

– 5.5 mm diameter in pure titanium– Bullet-nosed to ease navigation through soft tissue– Straight and curved options for optimal anatomical

adjustment– Large rod length portfolio of straight, 100 mm and

200 mm bend radius

MIS Rods

Implants

– Square thread design minimizes cross threading underhigh reduction loads

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

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

– Available flat or with guidance

0x6.001.190_AB 26.11.12 11:16 Seite 4


Mini- openretraction blades

Percutaneousretraction blades

Rod Introduction Instrument

Instruments

– Allows rod to pivot with user controlled braking– Maintains rod position during cap insertion– Easy rod detachment– Ergonomic instrumentation– Controlled rod insertion

– Slim blades for mini-open and percutaneous approach– Enable clear access and direct visualization– Provide tissue protection– Optimized instruments for treatment of the lumbar-sacral

junction

Screw-mounted Slim RetractionBlades

A comprehensive set of MIS specific instruments allows thesurgeon to precisely implant the MATRIX MIS System.– Dedicated instrument to control the advancement and

removal of the Kirschner wire– Distraction and compression tool for effective final

correction of the vertebral bodies– Efficient construct assembly with reduced instrument

exchanges

MIS Instruments

0x6.001.190_AB 26.11.12 11:16 Seite 5


AO Principles

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

2 Ibd.3 M Aebi, V Arlet, JK Webb (2007). AOSPINE Manual (2 vols.), Stuttgart, New York:Thieme

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

The fundamental aims of fracture treatment in the limbs andfusion of the spine are the same. A specific goal in thespine is returning as much function as possible to the injuredneural elements.2

AO Principles as Applied to the Spine3

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

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

Preservation of blood supplyCreation of an optimal environment for fusion.

Early, active mobilizationMinimization of damage to the spinal vasculature, dura, andneural elements, which may contribute to pain reduction andimproved function for the patient.

0x6.001.190_AB 26.11.12 11:16 Seite 6

Indications and Contraindications

The MATRIX System is a posterior pedicle screw and hook -fixation system (T1–S2) intended to provide precise and seg-mental stabilization of the spine in skeletally mature patients.MATRIX MIS is an instrument set designed for insertion ofcannulated MATRIX pedicle screws and rods through a per-cutaneous or mini-open muscle sparing approach.

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

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

body disruption, an additional anterior support or columnreconstruction is required.


0x6.001.190_AB 26.11.12 11:16 Seite 7

1Patient positioning

Position the patient on a radiolucent OR table in the proneposition. To obtain optimal visualization of the spine, the ORtable should have enough clearance available for a fluoro-scopic C-arm to rotate freely for AP, oblique and lateral views.Accurate visualization of the anatomic landmarks and fluoro-scopic visualization of the pedicles are imperative for usingthe MATRIX MIS System. In the following sections, the use ofAP and lateral fluoroscopy will be described.

Preparation


0x6.001.190_AB 26.11.12 11:16 Seite 8

2Approach

Option A: Percutaneous approach

Instrument

03.616.046 Dissector, blunt

The percutaneous approach facilitates atraumatic blunt dissection of the muscles through small individual incisions,through which single implants are placed.

Using fluoroscopy, locate and mark the lateral borders ofeach pedicle to receive a screw. These marks indicate wherethe individual incisions will be made. Each incision shouldhave a sagittal orientation and should be approximately15 mm in length, depending on patient anatomy and fluoro-scopic location of the pedicles.

After determining the appropriate locations, make each inci-sion in the skin and the fascia where appropriate. The bluntdissector can be used to facilitate dissection of the tissueprior to subsequent insertion of pedicle preparation instru-ments.


0x6.001.190_AB 26.11.12 11:16 Seite 9

Option B: Mini-open or Wiltse method

Instrument


The mini-open approach advocates atraumatic blunt dissec-tion of the muscles so that all instruments and implants areintroduced through a common incision. A Wiltse or modifiedWiltse approach is suggested.4

Using fluoroscopy, locate and mark the lateral borders of thepedicles. This will indicate where the fascial incisions shouldbe made. As a general guide, the incisions should be made2 cm–4 cm lateral to the midline. This depends on patientanatomy and actual fluoroscopic location of the pedicles.

Lateral or bilateral skin and fascial incisionsAfter determining the surgical trajectory, make an incision inthe skin and the fascia of the appropriate size (approximately30 mm for single-level procedures). Following incision of thefascia, locate the cleavage plane between the multifidus andlongissimus muscle groups. Using a Wiltse approach, bluntlydissect between the multifidus and longissimus muscleplanes down to the bony anatomy. Careful separation of themuscle planes can yield an avascular dissection. Ensure thatadequate dissection is performed to accommodate furtherinstrument and implant placement. The blunt dissector canbe used to facilitate dissection of the tissue planes.

Midline skin incisionAlternatively, a midline skin incision with lateral or bilateralfascial incisions can be applied.

Preparation

4 LL Wiltse, CW Spencer. “New Uses and Refinements of the Paraspinal Approachto the Lumbar Spine”. Spine 13(6) (1988): 696–706.


0x6.001.190_AB 26.11.12 11:16 Seite 10

1Perforate cortex of pedicle with Jamshidi needle

Working through the incision, locate the pedicles as described in AO ASIF Principles in Spine Surgery.5

Place the tip of the Jamshidi needle at the entry point of thepedicle and align the Jamshidi needle with the pedicle trajec-tory. If necessary, reinsert and realign the needle. Advancethe Jamshidi needle into the pedicle by tapping lightly with amallet. Twist the handle one-quarter turn to detach the tro-car from the Jamshidi needle while ensuring the Jamshidineedle remains in place.

Note: Use fluoroscopy to monitor position of the Jamshidineedle during insertion.

5 Aebi, M, JS Thalgott, and JK Webb. AO ASIF Principles in Spine Surgery.Berlin: Springer-Verlag. 1998. 102.


Pedicle Preparation

0x6.001.190_AB 26.11.12 11:16 Seite 11

1

3

2

4


Pedicle Preparation

Alternative technique

Perforate cortex of pedicle with cannulated awl

Instruments

03.600.032 Pedicle Awl � 3.8 mm, for Screws � 5.0 to 7.0 mm

03.606.021 Trocar Holder, for No. 03.606.020

03.616.062 Trocar, for Cannulated Awl

Optional Instrument

03.600.030 Pedicle Awl � 5.6 mm, for Screws � 8.0 to 9.0 mm

Assemble cannulated awlUnscrew the knob from the trocar holder and place it on aflat surface. Insert the large end of the trocar and seat it inthe knob recess (1).

Slide the holding sleeve over the trocar and tighten (2).

When the trocar and trocar holding sleeve are assembled,the end of the trocar should be seated in the knob, making itflush with the knob (3).

Note: Select the cannulated awl that corresponds to the appropriate screw diameter.

Insert the assembled trocar with holding sleeve into the palmhandle of the cannulated awl and tighten (4).

0x6.001.190_AB 26.11.12 11:16 Seite 12


Perforate cortex of pedicle with cannulated awl Working through the incision, locate the pedicles as de-scribed in AO ASIF Principles in Spine Surgery.6 Use a cannulated awl with the trocar and trocar holder to perforatethe cortex of the pedicle. While maintaining the awl’s posi-tion within the pedicle, rotate the trocar assembly counter -clockwise to remove it from the end of the awl.

Note: Use fluoroscopy to monitor position of the awl duringinsertion.


0x6.001.190_AB 26.11.12 11:16 Seite 13


3Insert Kirschner wire

Instrument

02.606.003 Kirschner Wire � 1.6 mm without trocar tip, Length 480 mm

Warning: Ensure the Kirschner wires remain securely in position throughout the entire duration of the procedure.

Note: Monitor the tip of the Kirschner wire under fluo-roscopy to ensure it does not penetrate the anterior wall ofthe vertebral body.

Ensure the Kirschner wires do not slip out before the screwsare inserted.

The Kirschner wires are long enough to be held in place byhand during pedicle preparation and soft tissue dilation.

Insert the Kirschner wire into the end of the cannulated awlor Jamshidi needle.

Note: Advance the Kirschner wire, guided by fluoroscopy, tothe appropriate depth. Kirschner wire etch lines can be usedas a depth reference.

The Kirschner wire can be advanced manually or with the handle for Kirschner wire (see alternative technique usinghandle for Kirschner wire).

Insert all Kirschner wires as required.

Pedicle Preparation

0x6.001.190_AB 26.11.12 11:16 Seite 14


Alternative technique: Using the handle for Kirschner wire

Instrument

03.616.070 Handle for Kirschner Wire � 1.6 mm

The handle for Kirschner wire is used to either advance or re-move Kirschner wires during the procedure. The arrow onthe tool indicates direction of Kirschner wire advancement orremoval. To use the handle for Kirschner wire, depress thelocking trigger and slip the tool over the Kirschner wire. Release the trigger to locate the tool at a position above theend of the cannulated awl or Jamshidi needle. The distancebetween the tool and the cannulated awl or Jamshidi needleshould be equal to the insertion depth of the Kirschner wire.

Lightly mallet the impaction surface to advance the Kirschnerwire.

Stop impacting when the tool reaches the top of the cannulated awl or Jamshidi needle.

Insert all Kirschner wires as required.

0x6.001.190_AB 26.11.12 11:16 Seite 15


Pedicle Preparation

4Pedicle Probe

Instrument

03.600.033 Pedicle Probe � 3.5 mm, cannulated, length 240 mm, for Screws � 5.0 to 7.0 mm

Optional Instrument

03.600.031 Pedicle Probe � 5.0 mm, cannulated, length 240 mm, for Screws � 8.0 and 9.0 mm

While maintaining the position of the Kirschner wire withinthe pedicle, remove the cannulated awl or Jamshidi needle.Place the tip of the cannulated probe over the end of theKirschner wire. Probe pedicles as described in AO ASIF Princi-ples in Spine Surgery.7

Note: To prevent inadvertent advancement of the Kirschnerwire, align the trajectory of the probe with the Kirschner wireand monitor the Kirschner wire position using fluoroscopy.


0x6.001.190_AB 26.11.12 11:17 Seite 16


5Tap pedicle (optional)

Instruments

03.620.205 Tap, cannulated, for Pedicle Screws � 5.0 mm with dual core, length 230 /15 mm





03.620.225 Protection Sleeve 7.2 /5.3, for No. 03.620.205, violet

03.620.226 Protection Sleeve 8.2 /6.3, for No. 03.620.206, blue

03.620.227 Protection Sleeve 9.2 /7.3, for No. 03.620.207, green

03.620.228 Protection Sleeve 10.2 /8.3, for No. 03.620.208, pink

03.620.229 Protection Sleeve 11.2 /9.3, for No. 03.620.209, turquoise

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

0x6.001.190_AB 26.11.12 11:17 Seite 17


Pedicle Preparation

Prepare a pathway for the dual core screws with the cannu-lated taps by penetrating the pedicle prior to screw insertion.To minimize trauma to surrounding soft tissues, protectionsleeves cover the proximal tip of the tap. To lock the protec-tion sleeve onto the cannulated tap shaft, align the arrowsand push together. To unlock the protection sleeve, hold theknurled portion of the protection sleeve and advance the tapclockwise. Depth graduations are provided at both ends ofthe tap to estimate depth measurement for proper implantsizing.

Note: To prevent inadvertent advancement of the Kirschnerwire, align the trajectory of the tap with the Kirschner wireand monitor the Kirschner wire position using fluoroscopy.

Note: To minimize trauma to surrounding soft tissues, pro-tection sleeves to cover proximal tip of the tap must be used.

0x6.001.190_AB 26.11.12 11:17 Seite 18

85 mm 115 mm


Retraction blades, longRetraction blades,standard

Screw Insertion

1Select retraction blades

Instruments

03.610.001 Dilator � 1.8 /10.0 mm, cannulated, for Guide Wire � 1.6 mm

03.616.035 Retraction blade, percutaneous

03.616.036 Retraction blade, mini-open

Optional instruments:

03.616.037 Retraction blade, percutaneous, long

03.616.038 Retraction blade, mini-open, long

The correct length of the retraction blade (standard or long)and type (mini-open or percutaneous) must be determinedafter the Kirschner wires have been placed and pedicles havebeen prepared.

Insert the 10 mm dilator over the Kirschner wire until the tipreaches the pedicle entry point.

To prevent inadvertent advancement of the Kirschner wirewhile inserting the dilator, monitor the Kirschner wire posi-tion using fluoroscopy.

Etch markings on the side of the dilator indicate tissue depth.Use the standard retraction blade for approaches up to80 mm. Use the long retraction blade for any approachgreater than 80 mm.

Note: For the mini-open method, a single level construct willutilize only retraction blade, mini-open.For percutaneous method and multilevel constructs, use theretraction blade, percutaneous at all levels.

0x6.001.190_AB 26.11.12 11:17 Seite 19

Retraction blade, mini-open

Retraction blade, percutaneous


Screw Insertion

2aAttach retraction blade to pedicle screw seated in thescrew module

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

Press the retraction blade onto the pedicle screw in the screwmodule until they snap together.

Note: To ensure proper fit of pedicle screws, verify the dia meter of the pedicle awl / probe and the selected screwcorrespond to each other.

Note: When using a retraction blade, mini-open pinch theretraction blade while pressing the blade onto the pediclescrew until they snap together.

Note: To avoid glove damage, do not hold the retractionblade near the bottom of the deflecting tab.

Note: Check by push and pull of the retraction blade / screwconstruct to ensure a secure attachment.

0x6.001.190_AB 26.11.12 11:17 Seite 20

1

2


2bAlternative technique:Freehand attachment of retraction blade

To connect a retraction blade, mini-open to the screw, holdthe pedicle screw and the retraction blade in opposite hands,and align the slots. Pinch the retraction blade as shown in (1)while pressing the retraction blade onto the pedicle screwuntil they snap together.

To connect a retraction blade, percutaneous to the screw,snap the first retraction blade onto one side of the pediclescrew (2).

Snap a second retraction blade onto the opposite side of thepedicle screw.

Note: To avoid glove damage, do not hold the retractionblade near the bottom of the deflecting tab.

Note: Check by push and pull of the retraction blade / screwconstruct to ensure a secure attachment.

0x6.001.190_AB 26.11.12 11:17 Seite 21

Optional technique:polyaxial head assembly

Instrument

03.632.037 Positioning Instrument for Polyaxial Screw Heads, for Matrix 5.5

In case an unassembled cannulated pedicle screw is used thepolyaxial head needs to be assembled prior to the attach-ment of the retraction blades.

To pick up a screw head, align the positioning instrument forpolyaxial screw heads to the rod slot features on the poly -axial head implant and press down.Position the placement tool with the polyaxial head over theunassembled pedicle screw and press down. To ensure thepolyaxial head is securely attached to the unassembled pedi-cle screw, gently lift up on the placement tool and angulatethe polyaxial head.To release the head placement tool, press the button locatedat the distal end of the instrument.

Notes – Polyaxial heads and screws can be assembled a maximum

of three times. – Ensure that polyaxial head is securely attached to the

unassembled pedicle screw by gently lifting the position-ing instrument and angulate the polyaxial head.

– In case an unassembled cannulated pedicle screw is usedthe polyaxial head needs to be assembled prior to the attachment of the retraction blades and the insertion ofscrew assembly.


Screw Insertion

0x6.001.190_AB 26.11.12 11:17 Seite 22

1

2

3


3Load screw assembly to retaining sleeve

Instruments

03.632.036 Retaining Sleeve, long, for Matrix 5.5

03.632.073 Screwdriver Shaft, T25, cannulated, long


Optional Instruments:

03.632.001 Retaining Sleeve, standard, for Matrix 5.5

03.632.003 Screwdriver Shaft, T25, cannulated, standard

Assemble the ratchet handle to a cannulated shaft.

To assemble the polyaxial screwdriver, retract the green knobdistally, then slide the sleeve toward the handle on the can-nulated shaft until it stops (1).

Load a retraction blade and pedicle screw onto the retainingsleeve by inserting the tip of the retaining sleeve through theretraction blade and into the polyaxial screw.

Place the screwdriver tip securely into the T25 Stardrive re-cess of the polyaxial pedicle screw and rotate the green knobof the retaining sleeve clockwise. Firmly tighten to secure theimplant (2).

Note: Ensure when loading a screw the ratchet handle is always in neutral position.

Set the ratchet handle to the forward position to insert thescrew. To release the sleeve, rotate the green knob counter-clockwise and remove the screwdriver (3).

Note: Ensure that the retraction blade is properly seated before engaging a screwdriver.

0x6.001.190_AB 26.11.12 11:17 Seite 23

1

2


Screw Insertion

4Insert screw

Instrument


Match the screw axis to the Kirschner wire axis by passingthe retaining sleeve assembly over the Kirschner wire untilthe tip of the screw reaches the pedicle entry point. Prior to advancing the screw, fluoroscopy should be used to ensureproper placement.

Warning: Do not advance the screw into the pedicle untilthe screw axis is aligned with the Kirschner wire to preventkinking or unintended advancement. Monitor the tip of theKirschner wire under fluoroscopy to ensure it does not pene-trate the anterior wall of the vertebral body.

Advance the screw into the pedicle by turning the ratchethandle clockwise (1).

The black part of the retaining sleeve and the retractionblade below the green knob can be held during insertion toguide trajectory.

Note: Do not grasp the green knob during insertion as it willcause the retaining sleeve to disengage from the screw.

Control the Kirschner wire exiting the proximal end of theratchet handle.

Remove the Kirschner wire once the tip of the screw entersthe vertebral body. The handle for Kirschner wire can beused (2).

0x6.001.190_AB 26.11.12 11:17 Seite 24


Note: During insertion, use fluoroscopy to confirm screw tra-jectory and depth. Polyaxial screw heads need to remainfree and mobile after insertion to allow accurate alignmentto the rod during locking cap insertion and final tightening.The mobility of the screw head cannot be assessed while theretaining sleeve is attached.

Detach the screwdriver and retaining sleeve by rotating thegreen knob on the retaining sleeve counterclockwise whileholding the ratchet handle as countertorque.

Remove the retaining sleeve and screwdriver.

The retraction blade and polyaxial head should now pivotfreely.

Insert all remaining screws in the same manner.

Note: After insertion, use fluoroscopy to confirm final screwplacement is correct.

0x6.001.190_AB 26.11.12 11:17 Seite 25


Screw Insertion

5Orient retraction blade

Instrument

03.616.050 Polyaxial Head Alignment Tool

Option A: For retraction blade, percutaneous

Visually assess retractor blade orientation after screw inser-tion is complete. Insert the alignment tool through the re-traction blade and seat it in the polyaxial head.

Rotate the retraction blade as needed to achieve proper ori-entation. The black lines should direct towards the sagittalplane.

Use the alignment tool on the retraction blade, percuta-neouss to orient rod slots as needed.

Mobilize polyaxial heads (optional)If required insert the alignment tool through the retractionblade and seat it in the polyaxial head. If head is immobileturn screw one turn back by using the T25 screwdriver.

Note: Use the head alignment tool to confirm that the headis still mobile and free from the surrounding anatomy prior toinserting the rod.

0x6.001.190_AB 26.11.12 11:17 Seite 26

� �


IncorrectCorrect

Rotate the retraction blade as needed to achieve proper orientation. Arrows should point toward each other intothe middle of the constructs.

Option B: For retraction blade, mini-open

Visually assess retraction blades’ orientation after screw inser-tion is complete. If required insert the alignment toolthrough the retraction blade and seat in the polyaxial head.

Mobilize polyaxial heads (optional)Insert the alignment tool through the retraction blade andseat it in the polyaxial head. If head is immobile turn screwone turn back by using the T25 screw driver.

Note: Use the head alignment tool to confirm that the headis still mobile and free from the surrounding anatomy prior toinserting the rod.

0x6.001.190_AB 26.11.12 11:17 Seite 27


Rod Introduction

1Determine rod length

Option A: For percutaneous method

Instrument

03.600.425 Bending Template for Rods � 6.0 mm, length 200 mm, for NFlex

For percutaneous and multi-level constructs the bendingtemplate can be used to determine the rod length at the skinlevel. The corresponding rod length can be read at the tem-plates scale.

Additionally the template can be bent in the dedicated shapeof the final rod.

0x6.001.190_AB 26.11.12 11:17 Seite 28


Option B: For mini-open method

Instrument

03.616.003 Template for Rod Length

For a single level mini-open approach use the rod lengthtemplate to determine the length of the rod.

Insert the ball tips of the rod length template through the retraction blade until seated in the polyaxial heads.

The scale on the top of the instrument indicates which MISrod to select. After selecting the rod, verify the length chosenagainst the caliper scale to ensure proper selection.

Important: Do not force open or distract the natural posi-tion of the retraction blade by expanding the tips of the tem-plate.

0x6.001.190_AB 26.11.12 11:17 Seite 29


Rod Introduction

2Contour rod (optionally)

Instrument

03.632.017 Rod Bender with Silicone Handle

Contour the rod, as needed, before insertion.

Note: Do not reverse bend rods. Reverse bending may pro-duce internal stresses which may become the focal point foreventual breakage of the implants.

0x6.001.190_AB 26.11.12 11:17 Seite 30


3aPrepare rod introducer – attach centering sleeve

Instruments

03.616.048 Rod Holder

03.616.047 Centering Sleeve for Rod Holder No. 03.616.048

Optional instrument

03.616.044 Centering Sleeve for Rod Holder No. 03.616.048, long

Assemble the rod introducer prior to use in the wound. Usethe centering sleeve length that corresponds to the retractionblade length.

Snap the centering sleeve onto the rod introducer along theentire length. Slide the centering sleeve up the post towardthe handle until it stops.

The centering sleeve is removed by pushing off from theback side of the golden knob until it detaches.

0x6.001.190_AB 26.11.12 11:17 Seite 31


Rod Introduction

3bPrepare rod introducer – load rod

Instrument


Pull the golden knob to open the capture mechanism. Thered line near the handle indicates the mechanism is open.

Place the machined end of the selected MIS rod onto the receiving features at the distal tip of the rod introducer.

Squeeze the brake lever to close the capture mechanism. Thered line must no longer be visible.

Squeeze the brake lever to maintain the rod at a desired insertion angle. Ensure the rod is securely attached.

Note: The rod can be released if the rod introducer is in theopen position and the rod is perpendicular to the shaft ofthe instrument.

0x6.001.190_AB 26.11.12 11:17 Seite 32


4Place rod

Option A: For percutaneous method/ retraction blade

Instrument


The rod may be inserted from either cranial or caudal direction.

Align the slots of the retraction blade prior to rod insertion.

With the rod pointed down, insert the rod through the re-traction blade. With the tip below the fascia and near thehead of the screw, push the rod through the muscle towardthe adjacent retraction blade.

0x6.001.190_AB 26.11.12 11:17 Seite 33


Rod Introduction

Note: Verify rod placement through adjacent retractionblade by attempting to rotate the blade. If the retractionblade will not rotate, then the rod has been insertedcorrectly.

Once the bullet nose of the rod is past the last adjacent retraction blade of the construct, push the heel of the rod introducer down into the head of the first MATRIX implant.

Note: Verify final rod position using lateral fluoroscopy. Oncethe rod is perpendicular to the introducer shaft, keep fingerpressure on the brake lever.

0x6.001.190_AB 26.11.12 11:17 Seite 34

1

2


Option B: For mini-open method/ retraction blade

Instrument

03.616.048 Rod holder

The rod may be inserted from either the cranial or caudal direction.

Align the slots of the retraction blade prior to rod insertion.

With the rod pointed down, position the bullet nose of therod against the inside wall of the cranial or caudal retractionblade (1).

Slide the rod down until it passes through the window andslightly past the head of the MATRIX implant (2).

0x6.001.190_AB 26.11.12 11:17 Seite 35

3Drag the heel of the rod introducer into the inside wall of theopposite retraction blade (3).

Push the heel down into the head of the opposite MATRIXimplant.

Note: Verify rod placement through adjacent retractionblade by attempting to rotate the blade. If the blades will not rotate, then the rod has been inserted correctly.

Note: Verify final rod position using lateral fluoroscopy. Oncethe rod is perpendicular to the introducer shaft, keep fingerpressure on the brake lever.


Rod Introduction

0x6.001.190_AB 26.11.12 11:17 Seite 36


5Secure rod introducer

Instruments


03.616.047 Centering Sleeve for Rod Holder No. 03.616.048

Optional instrument

03.616.044 Centering Sleeve for Rod Holder No. 03.616.048, long

The post of the rod introducer should be coaxial with the retraction blade.

Slide the centering sleeve down the post and into the retraction blade until the black line is visible.

Do not remove the rod introducer until the rod is secured bya locking cap.

0x6.001.190_AB 26.11.12 11:17 Seite 37

Rod Introduction

Alternative technique for percutaneous method:Load rod using fixed angle rod holder

Instrument

03.616.069 Rod Holder, percutaneous, with fixed angle

For use with percutaneous retraction blades, the fixed anglerod holder can be used.

Turn the green knob counterclockwise until it is in the fullyunlocked position.

Depress and hold the green knob to open the attachmentmechanism.

Place the proximal machined end of the selected MIS rodinto the receiving feature of the distal tip of the rod holder.

Release the green knob to fully capture the rod.


open

0x6.001.190_AB 26.11.12 11:17 Seite 38

Turn the green knob clockwise to lock the rod in place. Ensure the rod is securely attached.


closed

0x6.001.190_AB 26.11.12 11:17 Seite 39

Rod Introduction

Alternative technique for percutaneous method:Introduce rod using fixed angle rod holder

Instrument


For use with percutaneous retraction blades, the fixed anglerod holder can be used.

Align the slots of the retraction blades prior to insertion.


With the rod pointed down, insert the rod through the retraction blades. With the tip below the fascia, push the rodthrough the muscle toward the adjacent retraction blades.In case of increased resistance, confirm that the rod haspassed through or been placed below the fascia. The rodholder shaft should sit outside of the retraction blades.

Once the bullet nose of the rod is past the last adjacent retraction blades of the construct, push the rod holder downand position the rod holder shaft on the outside of the retraction blades.

Verify placement through adjacent retraction blades by attempting to rotate the retraction blades. If the retractionblades will not rotate, then the rod had passed throughproperly.

Note: Verify final rod position using lateral fluoroscopy. Ensure the coupling at the end of the MIS rod is seated out-side the screw head.

Precaution: If significant reduction forces are encountered,consider:– Screw height adjustments– Rod placement to minimize muscle entrapment


0x6.001.190_AB 26.11.12 11:17 Seite 40

1

2

Alternative technique for mini-open method:Introduce rod using rod forceps

Instrument

03.616.053 Rod Forceps

Clasp the selected rod with the forceps.


The rod can pivot while attached to the rod forceps (1).

With the rod pointed down, introduce the rod until it passesthrough the window of the first retraction blade (2).


0x6.001.190_AB 26.11.12 11:17 Seite 41

3

4

Pass the opposite end of the rod through the window of theopposite retraction blade (3).

Push down on the forceps to seat the rod in the MATRIX implants (4).

Do not remove the forceps until the rod is secured by a locking cap.

Note: Verify final rod position using lateral fluoroscopy.


Rod Introduction

0x6.001.190_AB 26.11.12 11:17 Seite 42

Rod Reduction and Locking Cap Introduction

1Load locking cap

Instrument

03.616.051 Cap Guide, one-step

Optional instrument

03.616.052 Cap Guide, one-step, long

Properly orient and position the cap guide over the lockingcap on the holding tray. Press down firmly to capturethe locking cap. The locking cap will snap into the distal tipof the cap guide.


0x6.001.190_AB 26.11.12 11:17 Seite 43


2Insert locking cap

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


Optional instrument


Insert the cap guide into the retraction blade with the blackindicator facing the middle of the construct.

Insert the screwdriver until it is seated in the locking cap. Ifpersuasion is required please refer to step 3, page 46.

Seat the locking cap with a light downward pressure.

Apply a light torque to provisionally tighten the locking capand maintain the desired rod position. After rod position hasbeen secured, detach the rod introducer (step 5, page 49).Place the remaining locking caps and provisionally tighten.

Remove the driver or proceed to final tightening (step 4,page 47).

Note: Only attempt to tighten the locking cap if the blackline of the cap guide is in line with the black line on the retraction blade. If these lines are not in line, please proceedwith step 3, page 46.


0x6.001.190_AB 26.11.12 11:17 Seite 44

� � �

� �

1 2

3 4a 4b

Note: Confirm with lateral fluoroscopy that the rod is fullyaligned to the polyaxial head. (1)Examples of misalignment:1. The rod is sitting high in the polyaxial head. (2)2. The rod is not perpendicular to the polyaxial head.(3)3. A severe bend is positioned within the polyaxial head.

(4a, 4b)

Precaution: The polyaxial head must align perpendicular tothe rod. The use of curved rods might cause the instrumentsto cross each other. If necessary adjust position of instru-ments laterally and medially.


0x6.001.190_AB 26.11.12 11:17 Seite 45


Persuasion required

3Rod reduction with persuader (optional)

Instruments

03.616.056 Rod Persuader


03.632.072 Screwdriver Shaft Stardrive, T25, long


Optional instruments



When the etch lines on the cap guide and the retractionblade are not aligned, rod persuasion is required.

Attach the top fork of the persuader to the cap guide, thenpivot down to engage the retraction blade.

Squeeze the handle to persuade the rod. Once reduction hasbeen achieved, the handle will remain in the reducedposition.

Proceed with cap insertion as indicated in step 2, page 44.

Precaution: The polyaxial head must align perpendicular tothe rod. The use of curved rods might cause the instrumentsto cross each other. If necessary adjust position of instru-ments laterally and medially as shown on the previous page.


0x6.001.190_AB 26.11.12 11:17 Seite 46

4Final tighten locking cap

Instruments

03.616.057 Counter Torque



Precaution:– Ensure all locking caps are fully reduced and provisionally

tightened (see Locking Cap Insertion). Failure to do socould potentially lead to a misalignment.

– Slide the counter torque down the driver shaft and seat itin the proximal socket on the cap guide. Adjust the orien-tation of the counter torque handle laterally or medially.

– Ensure that the implant is perpendicular to the rod. Finaltighten the locking cap with the 10 Nm torque limiting handle until there is a tactile release.


0x6.001.190_AB 26.11.12 11:17 Seite 47

�

�


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

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

Warning: Refer to the torque limiting handle package andlabeling for the recommended calibration maintenance.

Notes: Ensure the required torque of 10 Nm is applied toeach locking cap by using the torque limiting handle.

If a locking cap needs to be loosened or removed afterhaving been tightened to 10 Nm, use a counter torque andsolid screwdriver shaft with torque limiting handle.

Warning: Never use a fixed or ratcheting T-handle screwdriver for this technique. If the torque limiting attachment isnot used, breakage of the driver may occur and could poten-tially harm the patient.


0x6.001.190_AB 26.11.12 11:17 Seite 48

1

2

5Detach rod introducer

Ensure the first locking cap is provisionally tightened prior torod introducer detachment.

Slide the centering sleeve up and out of the retractionblade (1).

Pull the golden knob to open the capture mechanism on therod introducer.

The red line indicates the tool is ready to be detached fromthe rod (2).

Remove the rod introducer from the retraction blade.


0x6.001.190_AB 26.11.12 11:17 Seite 49

Alternative technique for percutaneous method:Detach fixed angle rod holder

Instrument


Prior to rod holder detachment ensure at least one lockingcap has been finally tightened and all other locking capshave been provisionally tightened.

Turn the green knob counterclockwise until it is in the fullyunlocked position.



0x6.001.190_AB 26.11.12 11:17 Seite 50

While depressing the green knob to open the attachmentmechanism, push the tip of the rod holder to the left.

Remove the rod holder from the wound.

Note: Avoid rod displacement by excess lateral or medial tilting of the instrument.


0x6.001.190_AB 26.11.12 11:17 Seite 51

Compression and Distraction

1aCompress mini-open Construct (optional)

Instruments


03.616.059 Compression Instrument, mini-open






To prepare the compression instrument, mini-open for use,insert the first locking cap and final tighten, following theprocedure outlined in steps 1 through 4 of rod reduction andlocking cap introduction, pages 43 –48.

Pick-up of locking capProperly orient and position the compression instrument,mini-open over the locking cap on the holding tray. Pressdown firmly to capture the locking cap. The locking cap willsnap into the distal tip of the compression instrument, mini-open.

With the loaded locking cap retracted into the cannula shaftinsert cannula into the other retraction blade. Place thedriver through the compression instrument, mini-open can-nula and seat it into the socket of the untightened lockingcap.


0x6.001.190_AB 26.11.12 11:17 Seite 52

1bCompression mini-open construct

With the K-bar in the unlocked position, lift the K-bar armwhile moving toward the cannula of the Compression instrument, mini-open. Lower the arm and slide outward un-til the K-bar arm catches on the tightened locked locking cap.

Lock the K-bar and turn the knob to desired compression.

Note: Perform compression under fluoroscopy.

Attach the countertorque with the handle pointing towardslateral or medial and final tighten the locking cap.


0x6.001.190_AB 26.11.12 11:17 Seite 53

Compression and Distraction

2aDistract mini-open construct (optional)

Instruments


03.616.058 Distraction instrument, mini-open







To prepare the Distraction instrument, mini-open for use, insert the first locking cap and final tighten. Following theprocedure outlined in steps 1 through 4 of rod reduction andlocking cap introduction (pages 43 –48), insert the secondlocking cap, but do not tighten.

Insert the cannula of the distractor into the retraction bladewith the locking cap inserted, but not tightened.

Insert the driver through the cannula of the distraction instrument, mini-open and seat it into the socket of theuntightened locking cap.


0x6.001.190_AB 26.11.12 11:17 Seite 54

2bDistract mini-open construct

Position the K-bar next to the adjacent implant.

Note: Set the rack to lock and turn the knob to distract. Perform distraction under fluoroscopy.

Attach the countertorque with the handle pointing towardslateral or medial and final tighten the locking cap.

Warning: Never use a fixed or ratcheting T-handle screwdriver for this technique. If the torque limiting attachment isnot used, breakage of the driver may occur and could potentially harm the patient.


0x6.001.190_AB 26.11.12 11:17 Seite 55

Locking Cap Loosening

Loosen locking cap (optional)

Instruments



03.632.099 Counter Torque, long, for Matrix 5.5

03.632.080 Handle, detachable, for Matrix

If a locking cap needs to be loosened after tightened to10 Nm, use a countertorque with detachable handle,MATRIX screwdriver shaft, and a 10 Nm torque limitinghandle to loosen the locking cap.

Note: Locking caps are designed to lock the construct andresist postoperative loosening and rod push through. There-fore, in certain cases, the loosening torque may be higherthan 10 Nm. In such cases, apply the following technique toloosen a locking cap.

Place the torque handle in the neutral position and begin tosequentially tighten and then immediately loosen the lockingcap. Turn until tactile or audible feedback from the implantsis experienced. It is important to approach the torque limitof the handle, but not exceed through the limit. Repeat thetightening / loosening steps until the locking cap is loose.To ensure the screwdriver shaft is protected from damage, always use the 10 Nm torque limiting handle.

Warning: Never use a fixed or ratcheting T-handle screwdriver for this technique. If the torque limiting attachment isnot used, breakage of the driver may occur and could poten-tially harm the patient.


0x6.001.190_AB 26.11.12 11:17 Seite 56

Retraction Blade Removal

Remove retraction blades

Instrument

03.616.039 Retraction Blade Removal Instrument

Optional instrument

03.616.040 Retraction Blade Removal Instrument, long

Insert the retraction blade removal instrument with tabs fac-ing the windows on the retraction blade. Apply light pressureuntil the tabs snap into the windows. Pull the remover withthe attached retraction blade from the incision.


0x6.001.190_AB 26.11.12 11:17 Seite 57

Revision/Removal

Construct revision/ removal

Instruments




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


If the construct requires revision or removal, use a minimallyinvasive approach to gain access to the construct.

Insert the rod pusher / counter torque, with detachable handle attached.

Refer to loosen locking cap section for instructions on loosening of locking caps for removal.

Remove the 10 Nm torque limiting ratchet handle with lock-ing cap from the incision site. Use the rod forceps to recoverthe rod once the locking caps are removed.

Once the rod has been recovered, use the ratchet T-handle /driver construct to back out each pedicle screw.


0x6.001.190_AB 26.11.12 11:17 Seite 58

Implants*

MIS Rods curvedradius 100 mm, � 5.5 mm, hard

Length mm

04.651.035 35

04.651.040 40

04.651.045 45

04.651.050 50

04.651.055 55

04.651.060 60

04.651.065 65

04.651.070 70

04.651.075 75

04.651.080 80

04.651.085 85


Length mm

04.651.090 90

04.651.095 95

04.651.100 100

Also available

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


0x6.001.190_AB 26.11.12 11:17 Seite 59

Implants


Length mm

04.651.230 30

04.651.235 35

04.651.240 40

04.651.245 45

04.651.250 50

04.651.255 55

04.651.260 60

04.651.265 65

04.651.270 70

04.651.275 75

04.651.280 80

04.651.285 85

04.651.290 90

04.651.295 95

04.651.300 100

04.651.305 105

04.651.310 110

04.651.315 115

04.651.320 120

04.651.325 125

04.651.330 130


0x6.001.190_AB 26.11.12 11:17 Seite 60

MIS Rods straight� 5.5 mm, hard

Length mm

04.651.430 30

04.651.435 35

04.651.440 40

04.651.445 45

04.651.450 50

04.651.455 55

04.651.460 60

04.651.465 65

04.651.470 70

04.651.475 75

04.651.480 80

04.651.485 85

04.651.490 90

04.651.495 95

04.651.500 100

04.651.505 105

04.651.510 110

04.651.515 115

04.651.520 120

04.651.525 125

04.651.530 130

04.651.540 140

04.651.550 150

04.651.560 160

04.651.570 170

04.651.580 180

04.651.590 190

04.651.600 200


0x6.001.190_AB 26.11.12 11:17 Seite 61

Implants

MIS Rods straight� 5.5 mm, hard

Length (mm)

04.651.610 210

04.651.620 220

04.651.630 230

04.651.640 240

04.651.650 250

04.651.660 260

04.651.670 270

04.651.680 280

04.651.690 290

04.651.700 300

04.651.710 310

04.651.720 320

04.651.730 330

04.651.740 340

04.651.750 350

Also available


0x6.001.190_AB 26.11.12 11:17 Seite 62

Pedicle Screws Matrix Polyaxial � 5.0 mmpreassembled, cannulated, Titanium Alloy (TAN)

Length (mm)

04.606.520 20

04.606.525 25

04.606.530 30

04.606.535 35

04.606.540 40

04.606.545 45

04.606.550 50

04.606.555 55


Length (mm)

04.606.625 25

04.606.630 30

04.606.635 35

04.606.640 40

04.606.645 45

04.606.650 50

04.606.655 55

04.606.660 60

04.606.665 65


0x6.001.190_AB 26.11.12 11:17 Seite 63

Implants


Length (mm)

04.606.725 25

04.606.730 30

04.606.735 35

04.606.740 40

04.606.745 45

04.606.750 50

04.606.755 55

04.606.760 60

04.606.765 65


Length (mm)

04.606.825 25

04.606.830 30

04.606.835 35

04.606.840 40

04.606.845 45

04.606.850 50

04.606.855 55

04.606.860 60

04.606.865 65


0x6.001.190_AB 26.11.12 11:17 Seite 64


Length (mm)

04.606.930 30

04.606.935 35

04.606.940 40

04.606.945 45

04.606.950 50

04.606.955 55

04.606.960 60

04.606.965 65

Pedicle Screws Matrix Polyaxial � 5.0 mmcannulated, Titanium Alloy (TAN)

Length (mm)

04.616.530 30

04.616.535 35

04.616.540 40

04.616.545 45

04.616.550 50

04.616.555 55


Length (mm)

04.616.630 30

04.616.635 35

04.616.640 40

04.616.645 45

04.616.650 50

04.616.655 55

Also available


0x6.001.190_AB 26.11.12 11:17 Seite 65


Length (mm)

04.616.735 35

04.616.740 40

04.616.745 45

04.616.750 50

04.616.755 55


Length (mm)

04.616.835 35

04.616.840 40

04.616.845 45

04.616.850 50

Locking Caps

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

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


Implants

0x6.001.190_AB 26.11.12 11:17 Seite 66

03.600.032 Pedicle Awl � 3.8 mm, cannulated,length 255 mm, for Screws � 5.0 to 7.0 mm

03.600.030 Pedicle Awl � 5.6 mm, cannulated, length 255 mm, for Screws � 8.0 and 9.0 mm

Instruments

03.606.021 Trocar Holder, for No. 03.606.020

03.616.062 Trocar for cannulated Awl

MATRIX MIS standard preparation instruments

02.606.003 Kirschner Wire � 1.6 mm without trocartip, length 480 mm, Stainless Steel



0x6.001.190_AB 26.11.12 11:17 Seite 67

Instruments

03.600.031 Pedicle Probe � 5.0 mm, cannulated, length 240 mm, for Screws � 8.0 and 9.0 mm

03.600.033 Pedicle Probe � 3.5 mm, cannulated,length 240 mm, for Screws � 5.0 to 7.0 mm

03.610.001 Dilator � 1.8 /10.0 mm, cannulated,for Guide Wire � 1.6 mm


03.616.056 Rod Persuader

03.600.425 Bending Template for Rods � 6.0 mm,length 200 mm, for NFlex


MATRIX MIS standard instruments 1


0x6.001.190_AB 26.11.12 11:17 Seite 68

03.600.030 Pedicle Awl � 5.6 mm, cannulated,length 255 mm, for Screws � 8.0 and 9.0 mm

03.632.001 Retaining Sleeve, standard, for Matrix 5.5

03.632.003 Screwdriver Shaft, T25, cannulated,standard



03.616.050 Polyaxial Head Alignment Tool


03.632.036 Retaining Sleeve, long, for Matrix 5.5

Also available


0x6.001.190_AB 26.11.12 11:18 Seite 69

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

03.616.059 Compression Instrument, mini-open

03.616.058 Distraction Instrument, mini-open

03.616.003 Template for Rod Length

03.632.017 Rod Bender with Silicone Handle

03.616.055 Rod Pusher

MATRIX MIS standard instruments 2


Instruments

0x6.001.190_AB 26.11.12 11:18 Seite 70

03.616.035 Retraction Blade, percutaneous

03.616.036 Retraction Blade, mini-open

03.616.039 Retraction Blade Removal Instrument


MATRIX MIS instruments short

03.616.037 Retraction Blade, percutaneous, long

03.616.038 Retraction Blade, mini-open, long

03.616.040 Retractor Removal Instrument, long


MATRIX MIS instruments, long


0x6.001.190_AB 26.11.12 11:18 Seite 71

03.616.044 Centering Sleeve for Rod Holder,No. 03.616.048, long

03.616.047 Centering Sleeve for Rod HolderNo. 03.616.048



MIS rod holders


Instruments

0x6.001.190_AB 26.11.12 11:18 Seite 72






03.620.225 Protection Sleeve 7.2 /5.3, for No. 03.620.205, violet

03.620.226 Protection Sleeve 8.2 /6.3, for No. 03.620.206, blue

03.620.227 Protection Sleeve 9.2 /7.3, for No. 03.620.207, green

03.620.228 Protection Sleeve 10.2 /8.3, for No. 03.620.208, pink

03.620.229 Protection Sleeve 11.2 /9.3, for No. 03.620.209, turquoise

Also available


0x6.001.190_AB 26.11.12 11:18 Seite 73

03.611.035 Extractor for Set Screw � 4.0 mm

03.611.059 Extender for No. 03.611.035

03.632.072 Screwdriver Shaft Stardrive, T25, long,for Matrix


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

03.632.099 Counter Torque, long, for Matrix 5.5

MATRIX MIS additional instruments


Instruments

0x6.001.190_AB 26.11.12 11:18 Seite 74

0x6.001.190_AB 26.11.12 11:18 Seite 75

0x6.001.190_AB 26.11.12 11:18 Seite 76

0x6.001.190_AB 26.11.12 11:18 Seite Cvr3

0123

Synthes GmbH Eimattstrasse 3 CH-4436 Oberdorf www.synthes.com

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

Ö036.001.190öAB(ä

036.

001.

190

vers

ion

AB

11

/201

250

1477

71

© S

ynth

es, I

nc. o

r its

aff

iliat

es

Subj

ect

to m

odifi

catio

n Sy

nthe

s an

d St

ardr

ive

are

trad

emar

ks o

f Sy

nthe

s, In

c. o

r its

aff

iliat

es

0x6.001.190_AB 26.11.12 11:18 Seite Cvr4

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

Documents

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