Synthes USS Small Stature/Paediatric Spine System User manual

Thoracolumbar fixation with dual opening pedicle screws and hooks
USS™Small Stature /
Paediatric Spine System
Surgical Technique

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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™ Small Stature/Paediatric Spine System DePuy Synthes 1
Table of Contents
Introduction AO Spine Principles 2
Surgical Technique Handling the Implants with a Stick 3
Insert Pedicle Screws (Posterior Approach) 4
Insert Pedicle Screws with Washers
(Only for Anterior Approach) 6
Position Pedicle Hook 8
Position Lamina Hook 11
Angled Lamina Hook Positioning 12
Rod Contouring 13
Locking Implants to Rods 14
Introducing Rods into Dual-Opening Implants 15
Distraction or Compression of Adjacent Implants 18
Connecting a Rod to an Implant with
Rod Connectors 19
Connecting Two Rods with Cross-Link
Connectors 20
Indications and Contraindications 22
Bibliography 23
For product catalog contact your local DePuy Synthes representative.

2 DePuy Synthes USS™ Small Stature/Paediatric 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™ Small Stature/Paediatric Spine System DePuy Synthes 3
The dual-opening pedicle screws have the same head as
the pedicle, lamina and angled hooks. The following
handling instructions hence refer to both the pedicle
screws and all three hook types (termed “implants” in
the following).
1. Attach handle to stick
Press the knurled release button on the upper end of the
handle (388.622), and simultaneously attach the hook
and screw holder with hexagonal 4.0 mm (388.612)
(also termed the ”stick”) to the handle.
2. Pick up implant
Pick up the dual-opening implant with the stick and
handle by rotating the release button on the handle.
3. Release handle from stick
Insert the implant. To release the handle from the stick,
press the release button on the handle.
Handling the Implants with a Stick
05_02 USS Paediatric
05_01 USS Paediatric –
von 06_01 Ped.Hooks
05_03 USS Paediatric

4 DePuy Synthes USS™ Small Stature/Paediatric Spine System Surgical Technique
1. Open pedicle and determine screw
length
Use one of the pedicle awls (1) (388.551 for screws
Ø 4.2 mm, 388.550 for larger screws) to open the cortex
of the pedicle to a depth of 10 mm. Continue opening
the pedicle using one of the pedicle probes (2) with
markings at 30, 40 and 50 mm.
• 388.538 for Ø 4.2 mm screws;
• 388.540 for Ø 5.0 and 6.0 mm screws;
• 388.539 for Ø 7.0 mm screws.
Determine the length of the pedicle screws with the
depth gauge for pedicle screws (357.789).
2. Probe pedicle channel
Using the straight feeler Ø 2.3 mm (388.545) or the
curved feeler Ø 2.3 mm (388.546), probe the pedicle
screw channel in order to check for perforations in the
walls.
Insert Pedicle Screws
(Posterior Approach)
Pedicle 8
30
40
50
09_02 USS II von 07_02 USS Paediatric –
von 08_02 Ped.Hooks
12
09_03 USS II von 07_03 USS Paediatric

Surgical Technique USS™ Small Stature/Paediatric Spine System DePuy Synthes 5
3. Insert pedicle screw into pedicle
Pick up the pedicle screw as described on page 3.
Insert the pedicle screw into the prepared pedicle until
the screw head is well seated and one of the openings
points towards the rod that is to be subsequently
inserted (1). To disconnect the stick from the handle,
press the release button on the handle (2).
Note: If using a rod connector, align the screw head
such that one of the openings is perpendicular to the
rod.
Insert Pedicle Screws
(Posterior Approach)
10_04 USS II von 08_04 USS Paediatric
1
2

6 DePuy Synthes USS™ Small Stature/Paediatric Spine System Surgical Technique
Flat (1) and angled (2) washers can be used with anterior
fixation constructs to distribute the force of the screw
over the bone. The angled washers form a fixed angle
with the screw.
1. Prepare screw hole and determine
screw length
Determine the entry point for the screw, preferably at
the junction of the pedicle and the vertebral body.
Align the pedicle awl (1) (388.550 or 388.551) perpen-
dicular to the contralateral side, and prepare the screw
hole. Enlarge the screw hole using the pedicle probe (2)
(388.538, 388.539 or 388.540) until it penetrates the
contralateral cortex.
Determine the length of the pedicle screw using the
depth gauge for pedicle screw (357.789) (3).
2a. Insert flat washer and screw
Place a flat washer with the convex side facing down
onto the concavity of the vertebral body.
Pick up a dual-opening pedicle screw as described on
page 3. Insert the pedicle screw into the prepared verte-
bral body until the screw head is well seated. To release
the stick from the handle, press the release button on
the handle.
Insert Pedicle Screws with Washers
(Only for Anterior Approach)
09_02a USS Paediatric
1 2 3
1 2

Surgical Technique USS™ Small Stature/Paediatric Spine System DePuy Synthes 7
2b. Insert angled washer and screw
While pressing the release button, load an angled
washer in the inserter (385.807) (1). Anchor the washer
in the bone by gently tapping the inserter (2).
Once the washer is firmly seated, remove the inserter by
pressing the release button (3). Pick up a dual-opening
pedicle screw as described on page 4. Insert the pedicle
screw into the prepared vertebral body until the screw
head is well seated (4). To disconnect the stick from the
handle, press the release button on the handle.
Insert Pedicle Screws with Washers
(Only for Anterior Approach)
10_02b_1 USS Paediatric
1
10_02b_2 USS Paediatric
2
10_02b_3 USS Paediatric
3
10_04 USS Paediatrics
4

8 DePuy Synthes USS™ Small Stature/Paediatric Spine System Surgical Technique
The USS Small Stature/Paediatric 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 pedicle feeler (388.511)
(1). Place the pedicle feeler between the inferior and
superior facet joints.
Precaution: Ensure that the feeler is placed in the
articular space and not in the bone of the inferior
facet.
To facilitate the insertion of the pedicle hook, remove a
small portion of the inferior facet with an osteotome (2).
The pedicle feeler has a mark. As soon as the mark is
reached, sufficient bone has been removed to accommo-
date the hook around the pedicle.
Check the optimal position of the pedicle feeler by mov-
ing it laterally and cranially (3).
Precaution: Do not push medially.
Remove the pedicle feeler.
Position Pedicle Hook
Haken 03 S11
13_01 USS II = 11_01b Ped.Hooks
3
3
Haken 02 S11s
13_01a USS II = 11_01a Ped.Hooks
2
1
3 mm