Johnson & Johnson DePuy Synthes MATRIX User manual

A Solution for Simple and Complex Spine Pathology
MATRIX Spine System–
Degenerative
Surgical Technique

Image intensifier control
This description alone does not provide sufficient background for direct use
of DePuy Synthes products. Instruction by a surgeon experienced in handling
these products is highly recommended.
Processing, Reprocessing, Care and Maintenance
For general guidelines, function control and dismantling of multi-part
instruments, as well as processing guidelines for implants, please contact your
local sales representative or refer to:
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
For general information about reprocessing, care and maintenance of Synthes
reusable devices, instrument trays and cases, as well as processing of Synthes
non-sterile implants, please consult the Important Information leaflet
(SE_023827) or refer to:
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

MATRIX Spine System – Degenerative Surgical Technique DePuy Synthes 1
Introduction MATRIX Spine System – Degenerative 2
AO Spine 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
Biomaterial Implants 81
Table of Contents

2 DePuy Synthes MATRIX Spine System – Degenerative Surgical Technique
MATRIX Spine System – Degenerative
The Synthes MATRIX Spine System is a set ofinstruments
and implants that cover degenerative disorders (open
or minimally invasive access), deformities and trauma
indications.
Dual Core / Double Lead Screw Design
• Designed for fast and controlled insertion
• Designed for increased pull-out resistance due to
enhanced bone purchase
• Designed for improved handling thanks to atraumatic
tip and self tappingthread
PrimeLock – Screwdriver – ScrewInterlock
• Toggle free screw insertion
• Designed for precise and controlled screw placement
• Direction of screw insertion possible

MATRIX Spine System – Degenerative Surgical Technique DePuy Synthes 3
Modularity – Click-on and
Preassembled Screws
• Designed for better visualization of the
anatomical structure
• Multiple screw head removal and
replacement without removing the
bone screw from the pedicle
• Customized inventory possible
Snap-on Swiveling Transverse
Connector
• Designed to provide fast in-situ
placement
• Anatomical adjustment possible

15 mm
50° 50°
4 DePuy Synthes MATRIX Spine System – Degenerative Surgical Technique
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
• Designed for increased visual access to the anatomical
structures
• Designed to allow 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 Surgical Technique DePuy Synthes 5
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 reduces cross threading under
high reduction loads
• T25 Stardrive recess designed to reduce the risk of
damage at high loads
• 1-step locking cap designed to allow 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 reduces
drive stripping while fi nal tightening
Instruments
• Ergonomically designed handles
• Intuitive, ease of use
• Convenient, interchangeable options

coronal
axial
sagittal
6 DePuy Synthes MATRIX Spine System – Degenerative Surgical Technique
The four principles to be considered as the foundation for
proper spine patient management underpin the design
and delivery of the Curriculum: Stability – Alignment–
Biology – Function.1,2
Stability
Stabilization to achieve
a specifi c therapeutic
outcome
Biology
Etiology, pathogenesis,
neural protection,
and tissue healing
Alignment
Balancing the spine in
three dimensions
Function
Preservations and resto-
ration of function to
prevent disability
AO Spine Principles
Copyright © 2012 by AOSpine
1Aebi M, Arlet V, Webb JK, (2007): AOSPINE Manual
(2 vols), Stuttgart, New York: Thieme.
2Aebi M, Thalgott JS, Webb JK (1998): AO ASIF Principles
in Spine Surgery. Berlin: Springer.

MATRIX Spine System – Degenerative Surgical Technique DePuy Synthes 7
Indications and Contraindications
Intended use
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
column reconstruction is required

8 DePuy Synthes MATRIX Spine System – Degenerative Surgical Technique
Surgical Technique
1. Prepare pedicles and determine
screw lengths
Instruments
388.656 Pedicle Awl B4.0 mm with Silicone
Handle, length 255 mm, for Pedicle
Screws B5.0 to 7.0 mm
388.655 Pedicle Probe B 3.7 mm
with Silicone Handle, length 240 mm,
for Pedicle Screws B 5.0 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 Surgical Technique 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 B 3.8 mm, curved,
with Silicone Handle, length 290 mm,
for Pedicle Screws B 5.0 to 7.0 mm
388.536 Pedicle Probe for Screws B 4.2 mm,
length 240 mm
388.545 Feeler for Screw Channel, straight,
B 2.3 mm, length 275 mm
388.546 Feeler for Screw Channel, curved,
B 2.3 mm, length 275 mm
388.549 Feeler, straight, with rounded tip
388.551 Pedicle Awl B3.0 mm, length 230 mm,
for Screws B4.0 and 4.2 mm
03.632.103 Tap for Pedicle Screws B 3.5 mm,
length 180 mm
03.632.104 Tap for Pedicle Screws B 4.0 mm,
length 180 mm
03.632.105 Tap for Pedicle Screws B 5.0 mm,
length 180 mm
03.632.155 Tap for Pedicle Screws B 5.5 mm,
length 180 mm
03.632.106 Tap for Pedicle Screws B 6.0 mm,
length 180 mm
03.632.107 Tap for Pedicle Screws B 7.0 mm,
length 180 mm
03.632.108 Tap for Pedicle Screws B 8.0 mm,
length 180 mm
03.632.109 Tap for Pedicle Screws B 9.0 mm,
length 180 mm
388.654 Ratchet with Handle,
with Hexagonal Quick Coupling 6.0 mm

10 DePuy Synthes MATRIX Spine System – Degenerative Surgical Technique
Surgical Technique
2. Assemble screwdriver
Instruments
03.632.036 Retaining Sleeve, long, for Matrix 5.5
03.632.072 Screwdriver Shaft Stardrive, T25, long,
for Matrix
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
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 Surgical Technique DePuy Synthes 11
3. Pick up screw
Instruments
03.632.036 Retaining Sleeve, long, for Matrix 5.5
03.632.072 Screwdriver Shaft Stardrive, T25, long,
for Matrix
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
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

12 DePuy Synthes MATRIX Spine System – Degenerative Surgical Technique
Surgical Technique
4. Insert screw
Instruments
03.632.036 Retaining Sleeve, long, for Matrix 5.5
03.632.072 Screwdriver Shaft Stardrive, T25, long,
for Matrix
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 Surgical Technique DePuy Synthes 13
Optional Instruments
03.616.043 Retaining Sleeve, locking, long
03.632.074 Screwdriver Stardrive, T25, long,
with T-Handle, for Matrix
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 Surgical Technique
Surgical Technique
5. Select, cut and bend rod
Instruments
03.632.007 Alignment Tool for polyaxial Screw
Head, for Matrix 5.5
388.906 Trial Rod B 5.0 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 sufcient pressure to re-
lease the lock.
When connecting rods 3.5 mm/5.5 mm and
4.0 mm/5.5 mm are used, MATRIX can be linked to the
Synapse, Axon and CerviFix 3.5 mm and 4.0 mm system,
respectively. When 5.5 mm/6.0 mm connecting rods are
used, the Synthes 6.0 mm rod systems can be linked to
the MATRIX System.

MATRIX Spine System – Degenerative Surgical Technique DePuy Synthes 15
Optional instruments
03.632.017 Rod Bender with Silicone Handle
388.750 USS Rod Cutting and Bending Device
388.720 Bolt Cutter
Precautions:
• 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 Surgical Technique
Surgical Technique
6. Insert rod
Instrument
03.632.081 Rod Holding Forceps for Rods B 5.5 mm
Insert the rod using the rod holding forceps.
Optional instrument
03.632.202 Holding Forceps for Rods B 5.5 and
B 6.0 mm
Note: When using a connecting rod, it is important
not to position the transition taper within the head
of a screw or hook.

MATRIX Spine System – Degenerative Surgical Technique DePuy Synthes 17
7. Reduce 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 B 5.5/6.0 mm,
for Matrix
03.632.000 Distraction Fork
Precaution:
If signicant reduction forces are encountered,
consider
• screw height adjustments
• rod placement to reduce muscle entrapment.

18 DePuy Synthes MATRIX Spine System – Degenerative Surgical Technique
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 mm
Medium Rocker Fork = 13.5 mm
Footed Rocker Fork = 7.5 mm
Technique tip: Use the footed MATRIX rocker fork
to aid in reducing the rod into adjacent screw heads.
Precaution:
If signicant reduction forces are encountered,
consider
• screw height adjustments
• rod placement to reduce muscle entrapment.