Synthes EXPEDIUM VERSE Parts list manual

SYSTEM GUIDE
EXPEDIUM VERSE®
Spinal System

CONTENTS
1. PRODUCT OVERVIEW 1
FEATURES AND BENEFITS 1
IMPLANT DESIGN 5
INSTRUMENT DESIGN AND SET CONFIGURATION 6
SET CONTENTS 7
2. SURGICAL TECHNIQUE 9
SCREW BED PREPARATION 9
•Cannulation 9
•Tapping 10
SCREW DELIVERY 11
•Poly Driver Assembly 11
•Loading the EXPEDIUM VERSE®Screw 12
•Delivering the EXPEDIUM VERSE Screw 12
•Adjusting the Polyaxial Screw Head 12
CEMENT DELIVERY (OPTIONAL) 13
•Assembly of the Alignment Drive 13
•Alignment of the Screw 13
•Cement Preparation 14
•Connection of Cannula to the Cement Reservoir 14
•Attachment of Cement Cannula
to Alignment Guide 14
•Cement Delivery 15
•Removal of Delivery Cannula 15
•Subsequent Level Augmentation 16
•Removal Of Alignment Devices 16
•Residual Cement Removal 16
ROD INSERTION 17
•Rod Contouring 17
•Rod Placement 18
POLYAXIAL TO MONOAXIAL CONVERSION 19
CORRECTION MANEUVERS 20
•Segmental Translation 20
– Set Screw Insertion and Rod Capture 21
•Rod Rotation 23
•Vertebral Body Derotation 24
– Quick Stick Assembly and Attachment 25
– En Bloc Vertebral Body Derotation
with the EXPEDIUM VERSE System 26
– Segmental Vertebral Body Derotation
with the EXPEDIUM VERSE System 27
•Compression and Distraction 30
FINAL TIGHTENING 32
TAB REMOVAL 34
REDUCTION WITH FLEX CLIP REDUCER 35
3. PRODUCT CATALOG 37
TRAY CONTENTS 37
INSTRUMENTS 42
HANDLES & ADAPTORS 43
SCREW INSTRUMENTS 44
ROD REDUCTION AND DEROTATION 44
ROD INSTRUMENTS 45
TAB REMOVAL 46
CEMENT DELIVERY INSTRUMENTS 46
CASES AND TRAYS 47
IMPLANTS 50
4. APPENDIX 56
5. USAGE 57
6. POSTOPERATIVE MOBILIZATION 58
7. CONTRAINDICATIONS 58
8. REFERENCES 59

1. PRODUCT OVERVIEW
The EXPEDIUM VERSE SPINAL SYSTEM has two configurations. The first configuration utilizes the classic solid shank,
double lead threadform found on Expedium 5.5: in this document we will be referring to the classic solid screw version as
the EXPEDIUM VERSE Polyaxial Screw. The second is a more advanced, feature rich configuration which adds a fully
cannulated shank with fenestrations and the Cortical Fix threadform at the proximal end of the screw: this version is
known as the EXPEDIUM VERSE Fenestrated Cortical Fix Polyaxial Screw.
FEATURES AND BENEFITS
EXPEDIUM®Pedigree
The EXPEDIUM VERSE System builds upon the more than ten years of clinical experience with the comprehensive
EXPEDIUM 5.5 System. Each implant component has been scrutinized and refined to deliver the features and performance
needed to address complex spine pathologies.
Simplicity through Design
The EXPEDIUM VERSE Pedicle Screw
serves as a powerful instrument to
facilitate correction maneuvers. The
result is a significant reduction in the
number of instruments required for
fusion procedures, potentially
simplifying the back table and reducing
the costs associated with reprocessing.
Speed and Versatility
The EXPEDIUM VERSE Pedicle Screw
combines the attributes of multiple
screw types, offering intraoperative
flexibility by allowing the surgical staff
to address unplanned circumstances
with one versatile implant, ultimately
delivering a more predictable
intraoperative experience.
Easier Rod Capture with Powerful
and Controlled Correction
The “hypermobility” or increased
angulation of the polyaxial head in
combination with the reduction tabs
simplify rod capture while providing a
powerful threaded reduction
mechanism that accommodates
controlled approximation of the spine
to the rod.
EXPEDIUM VERSE Spinal System
enables surgeons to perform
multiple correction maneuvers
with one versatile implant.
FIGURE 1
1DePuy Synthes Companies |EXPEDIUM VERSE System |System Guide

Unitized Set Screw
One-step locking of the polyaxial head
and rod can be achieved with the
Unitized Set screw when independent
locking is not required.
Correction Key
The Correction Key delivers independent
locking of the polyaxial head and rod,
providing the benefit of
a polyaxial screw with the correction
control of a monoaxial screw.
Rod Lock
Poly Lock
EXPEDIUM VERSE Polyaxial
Pedicle Screw
TOP NOTCH®Feature
The Top Notch Feature helps
various instruments easily connect
to the implant and simplifies
intraoperative maneuvers.
Head Drag
A drag mechanism enables the
implant head to retain alignment,
simplifying rod capture
Hypermobile Head with a
Favored Angle
The favored angle provides up to 84°
of angulation,* providing the benefits of
a side loading implant with the ease
of use of a top tightening system.
X25 Drive Feature
For the first time in an EXPEDIUM 5.5
Pedicle Screw, the EXPEDIUM VERSE
System provides an X25 Drive Feature
which allows for 43%** more torque
to be delivered compared to the
T20 Drive Feature provided in the
EXPEDIUM 5.5 System.
Fully Threaded Dual-Lead Shank
The double-lead thread, self-tapping and
self-centering shank is designed to
provide faster screw insertion, enhanced
bone purchase, and help ensure
accurate placement within the pedicle.
FIGURE 2
FIGURE 3
Extended Tabs with Loading Zone
Powerful integrated reduction with an
alignment feature.
The black line on the tab indicates the side
of the Favored Angle.
* DVA-106873-TA
** DVA-102149-TP Rev 4
DePuy Synthes Companies |EXPEDIUM VERSE System |System Guide 2

EXPEDIUM VERSE Fenestrated Cortical Fix Polyaxial Pedicle Screw
• The Fenestrated Cortical Fix
Polyaxial Screw is a fully cannulated
screw with fenestrations at the
distal end.
• The cannulation and fenestrations
allow for the injection of bone
cement through the screw.
• Earlier thread start compared to
standard EXPEDIUM, VIPER, and
Screws
• Cortical Fix thread form is designed
to engage the pedicle wall.
• Available in screw diameters:
4.35, 5, 6, 7, and 8mm
• Available in screw lengths:
30-80mm (in 5mm increments)
• 6 fenestrations for screws 45mm
and longer
• 3 fenestrations for screws 40mm
and shorter
FIGURE 4
The benefits of Polyaxial Screw plus…
Instruments for Cement Delivery
The EXPEDIUM VERSE cement delivery
instruments consist of alignment devices and
cement delivery cannulas which rigidly attach
to the alignment devices.
These instruments allow cement injection
through the screw shank while staying clear of
the fluoroscopy field.
Open Alignment
Sleeve
Open Alignment
Device
Open Cement
Cannula
Plunger Stylet Mini Stylet
3DePuy Synthes Companies |EXPEDIUM VERSE System |System Guide

FIGURE 5
Cannulation is 1.75mm in diameter
Standard Double-Lead Thread
Integrates with the cancellous
bone in the vertebral body.
Advances twice as far with each
rotation (as compared to single lead
screws).
Fully cannulated design
Cortical Fix Thread Form
Doubles the number of contact points
within the cortical wall of the pedicle
and increases the resistance to axial
pull-out forces (compared to standard
EXPEDIUM and VIPER screws).*
*Test data on file with DePuy Synthes Spine
Optimized Tip
Self-tapping and self-centering tip
allows for insertion with or without
tapping.
DePuy Synthes Companies |EXPEDIUM VERSE System |System Guide 4

IMPLANT DESIGN
The EXPEDIUM VERSE System represents the next “verse”
in posterior fixation. The EXPEDIUM VERSE Pedicle Screw
combines three proven technologies into one versatile implant.
Benefiting from the clinically proven design of the EXPEDIUM
5.5 and EXPEDIUM Favored Angle Screw Systems, each
pedicle screw component and feature has been scrutinized
and refined. The result is an implant which provides the
features of polyaxial, monoaxial, and side loading screw
technologies within a single screw type.
The “hypermobility” of the polyaxial head in combination
with 17mm of reduction provides the surgeon with the
tools necessary to capture the rod during complex spine
deformity procedures while obviating the need for complex
reduction instrumentation.
The pedicle screw is available in two versions. The Polyaxial
Screw incorporates the EXPEDIUM double-lead, solid shank
which has more than the years of clinical use globally. The
Fenestrated Cortical Fix Polyaxial Screw is designed to meet the
needs of challenging cases, building upon the feature set of
the Polyaxial Screw and adding a fully cannulated Cortical Fix
thread form with fenestrations. The Cortical Fix thread form
doubles the number of contact points within the pedicle and
increases the resistance to pull out*, ultimately enhancing
fixation within the pedicle. If more fixation is required, the
fenestrated tip of the Fenestrated Cortical Fix Polyaxial Screw
enables cement augmentation.
Using the EXPEDIUM VERSE System as a standalone system
provides reduction capabilities at each operative level,
accommodating techniques which promote the distribution
of correction forces. The result is a reduction of stresses at
the bone screw interface and a decrease in the potential for
intraoperative screw migration.4,5,6
The Correction Key adds independent polyaxial head and rod
locking, providing intraoperative polyaxial to monoaxial screw
conversion at any time during the procedure and at any
location within the polyaxial head’s range of motion.7With the
EXPEDIUM VERSE Pedicle Screw, the implant is a polyaxial
screw during rod capture when mobility is required and a
monoaxial screw when correction forces need to be applied.
The EXPEDIUM VERSE Unitized Set Screw provides one-step
locking of the polyaxial head and rod should independent
locking not be required.
The result is a versatile system which enables surgeons to
leverage their technique when correcting spinal deformity
with fewer implant types and instruments while delivering a
more predictable intraoperative experience.
FIGURE 6
* LWR-012411-01 Rev C.
5DePuy Synthes Companies |EXPEDIUM VERSE System |System Guide

INSTRUMENT DESIGN AND SET CONFIGURATION
The EXPEDIUM VERSE Spine System has been developed in
close collaboration with spine surgeons with an aim to
improve operating room efficiency by leveraging the unique
combination of features of the EXPEDIUM VERSE Implant.
The EXPEDIUM VERSE Instruments have been designed to
enhance the capabilities of the implant while reducing the
dependence on complex instrumentation. The “Implant
Based Operating Room” reduces the set footprint and
requires fewer instruments to treat complex spinal
pathologies. As a result, the EXPEDIUM VERSE System
reduces reprocessing and sterilization costs when compared
to traditional instrument based procedures. With fewer cases
when compared to a traditional, instrument based system,
the EXPEDIUM VERSE System reduces the costs associated
with reprocessing and offers the potential to shorten the
surgical staff’s learning curve without compromising the
utility of the instrumentation.
Thoughtful instrument design allows surgeons to do more
with less and the versatility of the system enables surgeons
to apply many of the fundamental correction maneuvers,
leveraging their correction technique while benefiting from
a more optimized surgical flow and predictable
intraoperative experience.
FIGURE 7
Deformity
Instruments
Instruments
Extra Degen &
Specialty Implants
Specialty Implants
Monoaxial,
Uniplanar,
Reduction
Uni/Reduction
Implants
Standard Degen Implants
Instrument Based Operating Room
Implant Based Operating Room
DePuy Synthes Companies |EXPEDIUM VERSE System |System Guide 6

SET CONTENTS
The EXPEDIUM VERSE Instruments build upon more
than ten years clinical experience of EXPEDIUM 5.5
System. They improve upon the design of these
established instruments while retaining the intuitive
features which help surgeons to meet the challenge of
complex pathologies.
EXPEDIUM VERSE Implants are available in an extensive range
of sizes providing surgeons thoracolumbar and pelvic fixation
options for adolescent and adult pathologies.
Available EXPEDIUM VERSE Screw Sizes
Diameter Lengths
4.35mm 20-65mm
5mm 20-65mm
6mm 20-65mm
7mm 20-65mm
8mm 30-100mm
* Fenestrated screw shanks available in lengths of 30–80mm (in 5mm increments).
7DePuy Synthes Companies |EXPEDIUM VERSE System |System Guide