Synthes USS Low Profile User manual

Thoracolumbar posterior fixation system with side-opening
screws and hooks
USS™Low Profile
Spine System
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

Surgical Technique USS™ Low Profile Spine System DePuy Synthes 1
Table of Contents
Introduction AO Spine Principles 2
Surgical Technique Handling Implants with the Stick 3
Insert Pedicle Screws 4
Pedicle Hook Positioning 7
Lamina Hook Positioning 10
Angled Lamina Hook Positioning at
the Transverse Process 11
Rod Contouring 12
Tightening of Construct 13
Introduction of Rods Into Side Openings 15
Distraction or Compression of Adjacent Implants 19
Connecting a Rod to an Implant With a
Rod Connector 20
Indications and Contraindications 22
Bibliography 23
For product catalog contact your local DePuy Synthes representative.

2 DePuy Synthes USS™ Low Profile Spine System 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
AO Spine Principles
Stability
Stabilization to achieve a
specific therapeutic
outcome
Alignment
Balancing the spine in
three dimensions
Biology
Etiology, pathogenesis,
neural protection,
and tissue healing
Function
Preservations and resto-
ration of function to pre-
vent disability
Copyright © 2012 by AOSpine

Surgical Technique USS™ Low Profile Spine System DePuy Synthes 3
Required instruments
388.640 USS Universal Handle
388.641 Sleeve for USS LP
388.616 USS LP Hook and Screw Holder
314.070 Screwdriver, hexagonal, small, length
200 mm
Attaching handle to Stick
Press the button on top of the USS Universal Handle (1)
and simultaneously insert the Stick from below into the
handle (2).
Picking-up of implants
Insert the tip of the Stick into the head of the implant
(1). Tighten the Stick to the implant by rotating the
knurled knob of the USS Universal Handle (2).
Release of Stick
After implant insertion, simultaneously press the button
and remove the handle to release the Stick.
Precaution: If the Stick is required for subsequent
manipulations, make sure that the Stick is rmly
tightened to the implant. To do this, use the small hex-
agonal screwdriver to tighten the stick-implant-thread
connection.
Handling Implants with the Stick
1
2
1
2

4 DePuy Synthes USS™ Low Profile Spine System Surgical Technique
Required instruments
388.551 USS pedicle awl, Ø3.0 mm, length 230
mm, for Ø4.2 mm screws
388.550 USS pedicle awl, length 230 mm, for
Ø5.0, 6.0 and 7.0 mm screws
388.538 Pedicle probe, Ø2.8 mm, length 230
mm, for Ø4.2 mm screws
388.540 Pedicle probe, Ø3.8 mm, length 230
mm, for Ø5.0 and Ø6.0 mm screws
388.539 Pedicle probe, Ø4.8 mm, length 230
mm, for Ø7.0 mm screws
357.789 Length indicator for Pedicle Screws
388.545 Feeler for screw channel, straight,
Ø2.3 mm, length 275 mm
388.546 Feeler for screw channel, curved,
Ø2.3 mm, length 275 mm
Insert Pedicle Screws

Surgical Technique USS™ Low Profile Spine System DePuy Synthes 5
1. Open pedicle
Use the awl that corresponds to the selected screw
diameter and perforate the cortex of the pedicle.
Continue opening the pedicle canal using one of the
USS Pedicle Probes.
Precaution: If the probe resists advancement, use
image intensier control to check the position and
orientation.
2. Probe pedicle channel
Palpate the inner walls of the pedicle screw channel
using the straight or curved Feeler in order to check the
wall for perforations.
Insert Pedicle Screws

2
1
6 DePuy Synthes USS™ Low Profile Spine System Surgical Technique
Insert Pedicle Screws
3. Insert pedicle screw into pedicle
Determine the length of the pedicle screws using the
length indicator. Confirm the position and orientation
with image intensifier control. Pick up the appropriate
pedicle screw from the tray as described on page 3.
Insert the screw into the prepared pedicle until the screw
head is well seated, i.e., the side opening of the implant
head should point in the desired direction and the hori-
zontal position should be aligned with the rod trajectory
(1). In order to disconnect the handle from the Stick,
press the release button (2).
Note: If a rod connector is used, the opening of the
screw must be oriented perpendicular to the rod tra-
jectory.

Surgical Technique USS™ Low Profile Spine System DePuy Synthes 7
Required instruments
388.510 USS Pedicle Feeler, length 260 mm
388.642 USS LP Hook Positioner, length 273 mm
310.190 Drill Bit, Ø2.0 mm, length 102/75 mm
319.060 Depth Gauge for 1.5 to 2 mm screws
314.070 Screwdriver, hexagonal, small, length
200mm
388.381 Holding Sleeve for Fillister Head Screws
388.581 USS Drill Sleeve 2.0
The USS Low Profile Pedicle Hooks can be anchored in
the pedicle with a single Ø 3.2 mm USS Screw for
Pedicle Hook.
1. Prepare seat for pedicle hook
Prepare the pedicle using the USS Pedicle Feeler. Place
the pedicle feeler between the inferior and superior
facet joints.
Precaution: Carefully check that the instrument is
placed in the articular joint space and not in the
bone of the inferior facet.
To facilitate insertion of the pedicle hook, remove a small
portion of the inferior facet with an osteotome (1). The
pedicle feeler has marks. When the last mark in direction
of the tip is reached, sufficient bone has been removed to
accommodate the hook around the pedicle (2).
Check the position of the pedicle feeler by moving it lat-
erally and cranially. The feeler should not move.
Precaution: Do not push medially.
Remove the pedicle feeler.
Pedicle Hook Positioning
1
2

8 DePuy Synthes USS™ Low Profile Spine System Surgical Technique
Pedicle Hook Positioning
2. Position pedicle hook
Pick up a pedicle hook from the tray with the stick as
described on page 3.
Note: Use a front-opening hook if a rod connector is
mounted on the hook.
Insert the hook positioner into the screw hole of the
pedicle hook and move the hook into the previously pre-
pared seat. Check that the pedicle hook is snug around
the pedicle by axial loading of the hook positioner and
also by pushing laterally. The pedicle hook should not
move.
Gently tap the hook positioner with a hammer to firmly
seat the hook. Remove the hook positioner and the han-
dle. The Stick remains attached to the hook.
3. Drill hole for screw Ø3.2 mm
Drill the screw hole with the three-fluted drill bit
together with the USS Drill Sleeve and an oscillating
device. The two components of the drill sleeve (sleeve
and handle) must be screwed together before use.
Warning: Do not start the power drill if the bit does
not hit bone after passing through the drill sleeve.
4. Determine screw length
Remove the drill sleeve and determine the depth with
the Depth Gauge.