Synthes USS Universal User manual

Side-opening screws and hooks for thoracolumbar spine
USS™Universal
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™ Universal Spine System DePuy Synthes 1
Table of Contents
Introdution AO Spine Principles 2
Surgical Technique Picking up implants 3
Pedicle screw positioning (posterior instrumentation) 4
Pedicle screw positioning with washers
(anterior instrumentation only) 5
Pedicle hook positioning 7
Lamina hook positioning 9
Angled lamina hook positioning 10
Rod contouring 11
Introducing rods into side-opening implants 12
Distraction or compression of adjacent implants 15
Locking side-opening implants to a rod 16
Connecting a rod to an implant with closed rod
connectors 17
Connecting two rods with cross-link clamps 18
Indications and Contraindications 20
Bibliography 21
For product catalog contact your local DePuy Synthes representative.

2 DePuy Synthes USS™ Universal 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
specic 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™ Universal Spine System DePuy Synthes 3
Picking up implants
The side-opening pedicle screws have the same head as
the hooks. Therefore, the following handling instructions
apply to both pedicle screws and hooks (called side-
opening implants in the following).
1. Attach handle to stick
Attach the USS Handle (388.640) to the Hook and Screw
Holder, the “stick” (388.610).
2. Pick up implant
Connect the side-opening implant to the stick by rotat-
ing the cog-wheel of the handle.
3. Release handle from stick
Insert the implant. To release the handle from the stick,
press the release mechanism on top of the handle.

4 DePuy Synthes USS™ Universal Spine System Surgical Technique
Pedicle screw positioning
(posterior instrumentation)
1. Open pedicle and determine screw
length
Use the Pedicle Awl (1) (388.550) to open the cortex of
the pedicle to a depth of 10 mm. Continue opening the
pedicle using the USS Pedicle Probe Ø 3.8 mm (2)
(388.540) with markings at 30, 40 and 50 mm.
Determine the length of the pedicle screw using the
Depth Gauge for Screws (319.100).
Note: For Ø4.0 mm or Ø5.0 mm pedicle screws use
the Pedicle Probe Ø2.8 mm (388.538).
2. Insert pedicle screw into pedicle
Pick up a side-opening pedicle screw as described on
page 3.
Note: If a rod connector is needed, align the screw
head by turning it 90°. The opening has to be perpen-
dicular to the rod.
Insert the pedicle screw into the prepared pedicle until
the screw head is well seated (1). To disassemble the
stick from the handle press the button on the handle (2).
1 2
1
2

Surgical Technique USS™ Universal Spine System DePuy Synthes 5
Pedicle screw positioning with washers
(anterior instrumentation only)
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. Open pedicle and determine screw
length
Determine the entry point for the screw, preferably at
the junction of the pedicle and the vertebral body.
Use the Pedicle Awl (1) (388.550) to prepare the screw
hole, directing it perpendicularly to the contralateral
side. Enlarge the screw hole using the USS Pedicle Probe
(2) (388.540), until it penetrates the contralateral cortex.
Determine the length of the pedicle screw using the
Depth Gauge for Screws (3) (319.100). The actual length
of the screw is chosen 5 mm longer than measured in
order to enable the positioning of a washer.
2a. Insert screw and flat washer
Place at washers with the convex side down onto the
concavity of the vertebral body.
Pick up a side-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 disas-
semble the stick from the handle press the button on
the handle.
1
1
2
3
2

6 DePuy Synthes USS™ Universal Spine System Surgical Technique
Pedicle screw positioning with washers
(anterior instrumentation only)
2b. Insert angled washer
a. Pick up screw and washer
Slide an appropriate-size pedicle screw into a washer
and pick it up with a stick. Insert the screw until the
washer slightly touches the bone surface.
Leave a space of 8–10 mm between the angled washer
and the screw for the USS Pusher (388.691).
b. Place pusher onto stick
Pull the cannulated guide of the pusher backwards until
the ringmark appears (1). Place the tip of the pusher
onto the washer and the cannulation of the pusher over
the stick (2). Push down the cannulated guide to lock
the stick in place (3).
c. Insert screw and washer
Tap onto the end of the pusher to introduce the angled
washer into the bone. When tapping the pusher, the
force is transmitted to the angled washer and not to the
screw (4). Once the washer is firmly seated, remove the
pusher. Using the USS Handle (388.640), insert the
screw further until the screw head is well seated (5).
1
2
8–10 mm
3
4

Surgical Technique USS™ Universal Spine System DePuy Synthes 7
Pedicle hook positioning
The USS 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 (1)
(388.510). Place the pedicle feeler between the inferior
and superior facet joints.
Precaution: Make sure to place it in the articular
space and not into the bone of the inferior facet.
To facilitate the insertion of the pedicle feeler, a small
portion of the inferior facet is removed with an osteo-
tome (2). The pedicle feeler has six lines on the blade.
When the last line is reached, sufficient bone has been
removed to accommodate the hook around the pedicle.
Check the optimal position of the pedicle feeler by mov-
ing it laterally and cranially (3).
Precation: Do not push medially.
Remove the pedicle feeler.
2. Position pedicle hook
Pick up a pedicle hook from the tray with the hook and
screw holder as described on page 3.
Note: Use a front-opening hook if a rod connector is
needed.
Insert the USS Hook Positioner (388.630) into the screw
hole of the hook and ease the pedicle hook into the pre-
viously prepared seat. Check if the pedicle hook is snug
around the pedicle by axial loading of the hook posi-
tioner 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 USS handle. The
stick remains attached to the hook.
1
2
3
3
3– 4 mm

8 DePuy Synthes USS™ Universal Spine System Surgical Technique
Pedicle hook positioning
3. Drill hole for Ø 3.2 mm screw
To anchor the pedicle hook to the pedicle screw, a
Ø 3.2 mm cortical screw can be inserted through the
hole at the back of the pedicle hook.
Use a three-uted drill bit Ø 2.0 mm (315.190) together
with the USS drill sleeve 2.0 and an oscillating drill to
drill the screw hole. The drill sleeve consists of two com-
ponents, the drill sleeve (388.581) and the handle
(387.060). These two components must be screwed
together before use. Advance the tip of the drill until it
passes through the vertebral endplate.
Warning: Do not start the power drill if the drill 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 for Screws Ø 1.5 to 2.0 mm (319.060).
5. Insert Ø 3.2 mm screw
Pick up an appropriate length USS Screw for Pedicle
Hooks using the Holding Sleeve (314.060) using the
Holding Sleeve (314.060) and Screwdriver (314.070) and
insert it into the previously prepared drill hole. The pedi-
cle hook is now attached to the pedicle and the
endplate.