POLYAXIAL SPINE SYSTEM D E G E N E R A T I V E

Transcription

1 S U R G I C A L T E C H N I Q U E En POLYAXIAL SPINE SYSTEM D E G E N E R A T I V E

2 LOW PROFILE POLYAXIAL SPINE SYSTEM A Straight spatula A Curved spatula A Bone probe A Tap for ø4.5mm screw A Tap for ø5.5mm screw A Tap for ø6.5mm screw A Tap for ø7.5mm screw A Malleable rod, length 150 mm A T20 screwdriver shaft A Straight ratchet handle A T ratchet handle A Malleable rod, length 350 mm A Palm ratchet handle A Squared awl A Squared awl reamer shaft A Lenke type Spatula A Depth gauge A Rod holder A Rod rotating wrench A Rod pusher shaft A French bender A Compressor A Rod spreader A L-Shaped Jaws A Nutdriver A Nutdriver shaft A Sacral screw gimlet A Sacral screw holder for T20 screwdriver A Flexible guide 2

3 I N S T R U M E N T A T I O N A Pass LP measuring card A Pedicle screwdriver shaft A Nut holder and threaded extension breaker A Counter torque A Counter-torque for rod-plate A Nutdriver shaft for dismantling A Sacral plate holder MS219 Pedicle probe MS227 Connecting clamp releaser MS511 Rod gripper 3

4 LOW PROFILE POLYAXIAL SPINE SYSTEM Section 1 screw Positioning 1. implant selection screw fixation on lumbar and/or thoracic vertebrae...6 Section 2 ROd construct 1. implant selection Rod contouring connector selection rod and connectors insertion tightening final procedure...17 Section 3 ROD to rod linkage 1. implant selection insertion of crosslink...18 Section 4 Sacral plate fixation 1. implant selection insertion of bicortical s1 screw Insertion of bicortical inferior screw into sacrum ala rod and connectors insertion tightening final procedure...23 Section 5 ROD PLate 1. implant selection bending of rod plate insertion of rod plate tighthening of the nut final procedure

5 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E Section 1 screw positioning 1. implant selection Different diameters and lengths available (color code) Please refer to the brochure for the complete range of product. Ø4.5 mm Ø5.5 mm Ø6.5 mm Ø7.5 mm Ø8.0 mm NOTE: The length and the diameter of the pedicle screw are marked on the threaded extension OPTION: Use Offset pedicle screws to block a potential shift (example: spondylolisthesis) in the alignment of the rod on the screw head. The Screw seating is raised by 5 mm. Use the PASS LP measuring card (A ) to check the dimensions. When handling non sterile implants, use the gauge located directly on the implant tray. 5

6 LOW PROFILE POLYAXIAL SPINE SYSTEM 2. Screw fixation on lumbar and/or thoracic vertebrae 2.a. Localization of entry point 2.a.1. On Lumbar vertebrae The technique described below is a free-hand technique. The use of an image intensifier (C-arm) is highly recommended for peroperative control of pedicle screw placement. As an alternative, a surgical navigation system can be used. Facetectomy: Resect the inferior articular process of the overlying vertebra using a gouge chisel. Preparation of the implantation site: Decortication of the superior articular process of the instrumented vertebra using a rongeur. Locate the pedicle entry point and create a pilot hole with the squared awl (A ): this hole is usually located at the intersection of a horizontal line, which bisects the transverse process and a vertical line through the middle of the superior articular process. IMPORTANT: For the superior end of the instrumentation, secure the screw position outside of the facet joint. 6

7 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E 2.a.2. On Thoracic vertebrae The technique described below is a free-hand technique. The use of an image intensifier (C-arm) is highly recommended for peroperative control of pedicle screw placement. As an alternative, a surgical navigation system can be used. Facetectomy: Resect the inferior articular process of the overlying vertebra using a gouge chisel. Preparation of the implantation site: Decorticate both the transverse process and the base of the articular process of the instrumented vertebra using a rongeur. Location of the pedicle entry point and creation of a pilot hole with the squared awl (A ): this hole is usually located at the intersection of a horizontal line which runs through the upper third of the transverse process and a vertical line in the middle of the articular process. 7

8 LOW PROFILE POLYAXIAL SPINE SYSTEM 2.b. Preparation of the pathway Use a spatula (A , A , or A ), with the concave surface of the instrument facing the spinal canal. NOTE: The Straight spatula (A ) can also be used. Test the pathway with the Pedicle probe (MS219). Use the pedicle probe to check that the pedicle wall has not been breached. Enlarge the hole with a curette and test the pathway using the Pedicle probe (MS219). 8

9 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E Determine the appropriate screw length using the laser marks on the spatulas, or the depth gauge (A ). NOTE: Screws are self-tapping, however, if needed, a tap can be used (Ø4.5mm: A , Ø5.5mm: A , Ø6.5mm: A or Ø7.5mm: A ). The taps are undersized by 0.5 mm. RATCHET HANDLES: The handles A , A & A offer 3 settings: F = Forward position for Screw insertion 0 = Neutral position to lock ratchet function R = Reverse position for Screw removal IMPORTANT: Be sure the screw head can sit flush on the bone by leveling the area using the squared awl reamer (A ) 9

10 LOW PROFILE POLYAXIAL SPINE SYSTEM 2.c. Pedicle screw insertion NOTE : This roller can be disassembled for cleaning by unscrewing the small nut on the side of the instrument. Lock the pedicle screw on the pedicle screwdriver (A ) by aligning the prongs of the instrument to the notches of the screw collar, and by turning the roller clockwise as shown above. Attach the preferred ratchet handles (A , A or A ) onto the screwdriver shaft. Insert the pedicle screw. The use of a flexible guide (A ) on top of the post allows for connection to the rod at a distance from the spine. 10

11 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E Section 2 rod construct NOTE : Refer to Section 5 (page 24) if you wish to use a rod-plate. 1. Implant selection 2 rod diameters available: Ø5.5 mm and Ø6 mm : Ø5.5 mm rods are Green Ø6 mm rods are Grey The length is laser marked LL mm Use the malleable rods (A or A ) to select rod length and determine rod contouring. IMPORTANT: For traceability reasons, we recommend NOT TO cut the rods. 2. Rod contouring Rods ranging from 30mm to 100mm length are delivered pre-contoured. For further contouring of short rods or for contouring long rods, use the French bender (A ). 11

12 LOW PROFILE POLYAXIAL SPINE SYSTEM 3. Connector setting Implant selection : The PASS LP system provides 2 types of connectors. The compatible rod diameter is laser marked on the implant to ease identification. 1) Standard connector (Grey) B for Ø5.5 mm rod B for Ø6 mm rod It is symmetrical and thus reversible. 2) Realignment connector (Gold) B for Ø5.5 mm rod B for Ø6 mm rod It is not symmetrical and thus not reversible. Place the laser mark 5.5 or 6.0 facing up. Use this connector to facilitate realignment of the vertebrae in severe spondylolisthesis cases, burst fractures, and compression fractures. After final tightening, the polyaxial screw will be perpendicular to the rod (like a standard monoaxial screw). IMPORTANT: When operating on patients with poor bone quality such as severe osteoporosis the use of realignment connectors (Gold) is not recommended. NOTES: Other implants are available (offset, angulated ). In order to use those connectors, please refer to the additional implants leaflet of the PASS LP Surgical Technique. 12

13 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E 4. Rod and connector insertion Slide the connectors onto the rod. NOTE: If necessary, use the connector releaser (MS227) to slightly re-open the connectors. Drop the assembly over the flexible guide (or directly on the threaded post of the screw) down to the screw head. IMPORTANT: Remove any osteophytes that could prevent the descent of the connectors and rods. If necessary, gently use the rod pusher (A ) to facilitate the rod and connector loading. NOTES: The threaded extensions are completely free during this step and no stress is applied to the anchorage. In most cases, the rods are placed on the median line. 13

14 LOW PROFILE POLYAXIAL SPINE SYSTEM 5. Tightening 5.a. Nut loading The nutholder (A ) is used to load each nut onto the threaded extension of the screw. NOTE: It is not necessary to remove the flexible guides (A ) to start the tightening of the nut. 5.b. Rod Orientation Before final tightening, orientate the rod in the sagittal plane using the rod rotating wrench (A ). 14

15 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E 5.c. Distraction and Contraction Before the final tightening procedure, it may be necessary to use distraction or compression at the instrumented levels. 5.c.1. Distraction To distract, apply the spreader (A ) assembled with the L-shaped jaws (A ). Lock the first screw, then place the tips over the rod by applying directly on the inner side of the connectors (see image), and distract. Lock the second screw with the nutdriver shaft (A ). 5.c.2. Contraction To compress, apply the Compressor (A ) assembled with the L-shaped jaws (A ). Lock the first screw, then place the tips over the rod by applying directly on the outer side of the adjacent connectors (see image), and compress. Lock the second screw with the nutdriver shaft (A ). 15

16 LOW PROFILE POLYAXIAL SPINE SYSTEM 5.d. Final Tightening Remove the flexible guides (A ) to tighten the nuts using the nutdriver (A ). The nut must be tightened until broken off (average value of 12 N.m). While torqueing the nut, exert a downward force to contain the broken part in the instrument. This instrument is cannulated for storage of the broken parts. To empty the instrument, unscrew the plug and turn the instrument upside down to release the broken parts. IMPORTANT: At the end of the tightening, we recommend counting all the broken parts remaining in the nutdriver to be certain no broken parts are left in the incision. If a broken part is blocked in the instrument, use the malleable rod (A ) to push it out. The counter-torque (A ) can be used to stabilize the construct during tightening. This counter torque is not functional with angulated connectors; please refer to the additional implants section of the PASS LP Surgical Technique. If you wish to remove a broken nut, use the nutdriver for dismantling (A ). Align the pins with the holes present on the remaining part of the nut. IMPORTANT: If tightening must be re-executed, it is MANDATORY to re-execute the tightening procedure with a new unbroken nut. 16

17 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E 6. final procedure 6.a. Checking The groove on the threaded extension has to be flush on top of the nut surface. If this is not the case, unscrew the nut using the nutdriver for dismantling (A ) : Check that nothing is preventing the connector from reaching the screw head (osteophytes, etc.) - if necessary, remove with a rongeur. Re-execute the tightening procedure using a new unbroken nut. 6.b. Removal of the threaded extensions After the checking, place the threaded extension breaker (A ) onto the threaded extension of the screw and snap off the upper part along the longitudinal axis of the rod. Repeat this step on each screw. The broken part remains in the instrument. It is necessary to remove each broken part before breaking the next one. IMPORTANT: A count of all the broken parts is recommended to be certain no broken parts are left in the incision. If you wish to use crosslinks, please refer to chapter 3 (page 18). 6.c. Closure of the incision An X-ray control is recommended before the closure in order to assess the positioning of the implants. 17

18 LOW PROFILE POLYAXIAL SPINE SYSTEM Section 3 rod to rod linkage 1. Implant Selection Use the PASS LP measuring card (A ) to measure the distance between the 2 rods and select the implant size accordingly. 2. Insertion of crosslink Check that the rod passage is free in the 2 connectors. If not, release the passage by untightening the central axis using the T20 screwdriver (A ) until the instrument cannot be rotated any further. Once the connector is on the rod, tighten the central axis using the T20 screwdriver until the instrument cannot be rotated any further. The Crosslink can then slide freely along the rod without escaping, and a gentle compression or distraction can be applied between the 2 rods. Lock the crosslink by tightening the locking nuts using the Nutdriver (A ). 18

19 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E Section 4 Sacral plate fixation 1. Implant Selection Choose the implant according to the side of implantation: - Laser mark L for left side. - Laser mark R for right side. 2. Insertion of bicortical S1 screw 2.a. Localization of S1 entry point Facetectomy: Resect the inferior articular process of L5 using a gouge chisel. Identification of the S1 pedicle entry point which is in the inferior part of the S1 articular surface. NOTE: To check the correct positioning of the implant, we recommend the use of a lateral view from an image intensifier (C-arm). Create the pathway through the anterior cortex for a bicortical fixation of the S1 screw using the Straight spatula A Test the pathway with the Pedicle probe (MS219). Enlarge the hole with a curette and perform a second test of the pathway with the pedicle probe (MS219). Determine the appropriate screw length using the depth gauge (A ). 19

20 LOW PROFILE POLYAXIAL SPINE SYSTEM 2.b. Placement of the plate and insertion of S1 screw Assemble the plate on the sacral plate holder (A ) by turning the central roller. Place the drilling guide over the S2 hole (bevelled edge). Position the handle in the right direction and tighten the central roller with the Nutdriver (A ). Assemble the T20 screwdriver (A ) with the desired ratchet handle. Slide the sacral screw holder for T20 screwdriver (A ) onto the T20 screwdriver. Lock the sacral screw onto the assembled instrument (head blocked into the holder). Insert the S1 screw into the prepared hole through the plate positioned on the sacrum. Do not completely seat the S1 screw; leave enough space to facilitate the setting of the second sacral screw. 20

21 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E 3. Insertion of the bicortical inferior screw into the sacrum ala 3.a. Localization of entry point with the guide Position the plate with its lower end lying on the sacral ala, lateral to the first posterior sacral foramen. Use the drilling guide of the sacral plate holder to determine the entry point of the inferior screw (S2) located lateral to the first sacral hole (hole R for a right plate and hole L for a left plate). 3.b. Preparation of the hole 3.b.1. Adjustment of hand drill The desired length of drilling using the sacral screw hand drill (A ) is adjustable. If the drilling guide is used the laser mark WITH DRILLING GUIDE should be facing you. Maintain the external tube with the laser mark facing you, and tighten/untighten the gimlet until the desired length appears in the window. L=50mm NOTE: If the surgeon does not want to use the drilling guide, flip the instrument over so that the laser mark WITHOUT DRILLING GUIDE is showing and adjust the length. 3.b.2. Preparation of the pathway for the inferior screw The drill (A ) is then assembled with one of the ratchet handles and inserted through the drilling guide in the hole corresponding to the side instrumented ( L when using the left sacral plate, and R when using the right sacral plate). Test the pathway with the pedicle probe (MS219). IMPORTANT: If you wish to use an electric drill, the drilling guide is compatible with up to a Ø3.2 mm size drill. 21

22 LOW PROFILE POLYAXIAL SPINE SYSTEM 3.c. Screwing of the inferior screw To assemble the sacral screw on the screwdriver, please refer to Section 2 paragraph 2.b. (page 20). Move the drilling guide onto its side by pulling and rotating the tie to release access to the plate. The screw is then inserted through the plate following the prepared pathway. Remove the sacral plate holder by untightening the central axis. If necessary, complete tightening of the S1 screw. 22

23 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E The sacral screws have intersected trajectories in all 3 planes in order to obtain optimal pull-out resistance. OPTIONAL : Insertion of the cap In order to avoid sacral screw back-out, a cap (B ) can be inserted on top of the plate after the 2 sacral screws have been inserted (before rod insertion). 4. ROD AND CONNECTORS insertion Please refer to Section 2 (page 11 and following). 5.tightening Please refer to Section 2 paragraph 5 (page 14). 6.final procedure Please refer to Section 2 paragraph 6 (page 17). 23

24 LOW PROFILE POLYAXIAL SPINE SYSTEM Section 5 ROD-PLATE 1. Implant selection IMPORTANT: The Rod-plate can be used with standard and offset polyaxial screws, as well as with sacral plates. Measure the distance between the threaded extensions of the anchorages and choose the implant that will fit. 2. Bending of rod-plate The rod-plate is delivered pre-bent. Further bending of the rod-plate is not recommended, as this may cause distortion of the rod-plate holes. 3. Insertion of rod-plate The flexible guide can be loaded on the threaded extension of the anchorages prior to rod-plate insertion. Orientate the rod-plate so that the laser mark is placed on top. NOTE: The single hole should be placed on the cranial part of the construct in order to avoid any conflict with the facets. Drop the rod-plate along the flexible guides, or directly over the threaded extensions. IMPORTANT: In order to allow the connection please be sure to remove any osteophytes that could prevent descent of the implants. 24

25 D E G E N E R A T I V E S U R G I C A L T E C H N I Q U E 4. Tigthening of the nut The 2 inferior scallops allow 3 different positions for nut seating. Be sure to securely fit the threaded extension in one of the designated holes before performing final tightening. For the tightening procedure, please refer to Section 2 paragraph 5 (page 14). Nut setting Final Tightening The Counter-torque for rod-plate (A ) can be used to stabilize the construct during tightening. 5. final procedure Please refer to Section 2 paragraph 6 (page 17). 25

26 LOW PROFILE POLYAXIAL SPINE SYSTEM STANDARDS PEDICLE SCREWS SACRAL IMPLANTS NON STERILE REF. DESIGNATION NON STERILE REF. DESIGNATION B POLYAXIAL PEDICLE SCREW Ø4.5 mm x 25 mm* B RIGHT SACRAL PLATE B POLYAXIAL PEDICLE SCREW Ø4.5 mm x 30 mm B LEFT SACRAL PLATE B POLYAXIAL PEDICLE SCREW Ø4.5 mm x 35 mm B CAP FOR SACRAL PLATE B POLYAXIAL PEDICLE SCREW Ø4.5 mm x 40 mm B SACRAL SCREW Ø6.5 X 25mm B POLYAXIAL PEDICLE SCREW Ø4.5 mm x 45 mm B SACRAL SCREW Ø6.5 X 30mm B POLYAXIAL PEDICLE SCREW Ø4.5 mm x 50 mm* B SACRAL SCREW Ø6.5 X 35mm B POLYAXIAL PEDICLE SCREW Ø4.5 mm x 55 mm* B SACRAL SCREW Ø6.5 X 40mm B POLYAXIAL PEDICLE SCREW Ø5.5 mm x 25 mm* B SACRAL SCREW Ø6.5 X 45mm B POLYAXIAL PEDICLE SCREW Ø5.5 mm x 30 mm B SACRAL SCREW Ø6.5 X 50mm B POLYAXIAL PEDICLE SCREW Ø5.5 mm x 35 mm B SACRAL SCREW Ø6.5 X 55mm B POLYAXIAL PEDICLE SCREW Ø5.5 mm x 40 mm B SACRAL SCREW Ø6.5 X 60mm B POLYAXIAL PEDICLE SCREW Ø5.5 mm x 45 mm B SACRAL SCREW Ø7.2 X 25mm B POLYAXIAL PEDICLE SCREW Ø5.5 mm x 50 mm B SACRAL SCREW Ø7.2 X 30mm B POLYAXIAL PEDICLE SCREW Ø5.5 mm x 55 mm* B SACRAL SCREW Ø7.2 X 35mm B POLYAXIAL PEDICLE SCREW Ø5.5 mm x 60 mm* B SACRAL SCREW Ø7.2 X 40mm B POLYAXIAL PEDICLE SCREW Ø6.5 mm x 25 mm* B SACRAL SCREW Ø7.2 X 45mm B POLYAXIAL PEDICLE SCREW Ø6.5 mm x 30 mm B SACRAL SCREW Ø7.2 X 50mm B POLYAXIAL PEDICLE SCREW Ø6.5 mm x 35 mm B SACRAL SCREW Ø7.2 X 55mm B POLYAXIAL PEDICLE SCREW Ø6.5 mm x 40 mm B SACRAL SCREW Ø7.2 X 60mm B POLYAXIAL PEDICLE SCREW Ø6.5 mm x 45 mm B POLYAXIAL PEDICLE SCREW Ø6.5 mm x 50 mm ROD PLATES B POLYAXIAL PEDICLE SCREW Ø6.5 mm x 55 mm* NON STERILE REF. DESIGNATION B POLYAXIAL PEDICLE SCREW Ø6.5 mm x 60 mm* B ROD-PLATE 1 LEVEL SMALL B POLYAXIAL PEDICLE SCREW Ø7.5 mm x 25 mm* B ROD-PLATE 1 LEVEL LARGE B POLYAXIAL PEDICLE SCREW Ø7.5 mm x 30 mm* B ROD-PLATE 2 LEVELS SMALL B POLYAXIAL PEDICLE SCREW Ø7.5 mm x 35 mm B ROD-PLATE 2 LEVELS LARGE B POLYAXIAL PEDICLE SCREW Ø7.5 mm x 40 mm B B B B B B B B B B B B POLYAXIAL PEDICLE SCREW Ø7.5 mm x 45 mm POLYAXIAL PEDICLE SCREW Ø7.5 mm x 50 mm POLYAXIAL PEDICLE SCREW Ø7.5 mm x 55 mm* POLYAXIAL PEDICLE SCREW Ø7.5 mm x 60 mm* POLYAXIAL PEDICLE SCREW Ø8.0 mm x 25 mm* POLYAXIAL PEDICLE SCREW Ø8.0 mm x 30 mm* POLYAXIAL PEDICLE SCREW Ø8.0 mm x 35 mm* POLYAXIAL PEDICLE SCREW Ø8.0 mm x 40 mm* POLYAXIAL PEDICLE SCREW Ø8.0 mm x 45 mm* POLYAXIAL PEDICLE SCREW Ø8.0 mm x 50 mm* POLYAXIAL PEDICLE SCREW Ø8.0 mm x 55 mm* POLYAXIAL PEDICLE SCREW Ø8.0 mm x 60 mm* *available upon special request NON STERILE REF. B NUT** OTHER IMPLANTS DESIGNATION ** NOTE : Non Sterile polyaxial screws and sacral plates are delivered WITHOUT the nut. Nuts need to be ordered separately. NON STERILE REF. B B B B B B OFFSET PEDICLE SCREWS* DESIGNATION OFFSET PEDICLE SCREW Ø5.5 X 35mm OFFSET PEDICLE SCREW Ø5.5 X 40mm OFFSET PEDICLE SCREW Ø5.5 X 45mm OFFSET PEDICLE SCREW Ø6.5 X 35mm OFFSET PEDICLE SCREW Ø6.5 X 40mm OFFSET PEDICLE SCREW Ø6.5 X 45mm *other lengths available upon special request IMPORTANT : The PASS LP system is also available in STERILE version- simply add a S at the end of each reference in your order. Sterile Polyaxial Screws and Sacral Plates are delivered directly assembled with the nut. 26

27 IMPLANTS IF USE Ø5.5 mm ROD IF USE Ø6 mm ROD Couplers/Connectors (standard/for realignment) Couplers/Connectors (standard/for realignment) NON STERILE REF. DESIGNATION NON STERILE REF. DESIGNATION B STANDARD CONNECTING CLAMP FOR Ø 5.5 mm ROD B STANDARD CONNECTING CLAMP FOR Ø6mm ROD B REALIGNMENT CONNECTOR FOR Ø5.5mm ROD B REALIGNMENT CONNECTOR FOR Ø6mm ROD ROD ROD NON STERILE REF. DESIGNATION NON STERILE REF. DESIGNATION B PRE BENT ROD Ø5.5 X 30 mm B PRE BENT ROD Ø6 X 30 mm B PRE BENT ROD Ø5.5 X 40 mm B PRE BENT ROD Ø6 X 40 mm B PRE BENT ROD Ø5.5 X 50 mm B PRE BENT ROD Ø6 X 50 mm B PRE BENT ROD Ø5.5 X 60 mm B PRE BENT ROD Ø6 X 60 mm B PRE BENT ROD Ø5.5 X 70 mm B PRE BENT ROD Ø6 X 70 mm B PRE BENT ROD Ø5.5 X 80 mm B PRE BENT ROD Ø6 X 80 mm B PRE BENT ROD Ø5.5 X 90 mm B PRE BENT ROD Ø6 X 90 mm B PRE BENT ROD Ø5.5 X 100 mm B PRE BENT ROD Ø6 X 100 mm B ROD Ø5.5 mm x 120 mm B ROD Ø6 mm x 120 mm B ROD Ø5.5 mm x 140 mm B ROD Ø6 mm x 140 mm B ROD Ø5.5 mm x 160 mm B ROD Ø6 mm x 160 mm B ROD Ø5.5 mm x 180 mm B ROD Ø6 mm x 180 mm B ROD Ø5.5 mm x 200 mm B ROD Ø6 mm x 200 mm B ROD Ø5.5 mm x 220 mm B ROD Ø6 mm x 220 mm B ROD Ø5.5 mm x 240 mm B ROD Ø6 mm x 240 mm B ROD Ø5.5 mm x 260 mm B ROD Ø6 mm x 260 mm B ROD Ø5.5 mm x 280 mm B ROD Ø6 mm x 280 mm B ROD Ø5.5 mm x 300 mm B ROD Ø6 mm x 300 mm B ROD Ø5.5 mm x 320 mm B ROD Ø6 mm x 320 mm B ROD Ø5.5 mm x 340 mm B ROD Ø6 mm x 340 mm B ROD Ø5.5 mm x 360 mm B ROD Ø6 mm x 360 mm B ROD Ø5.5 mm x 380 mm B ROD Ø6 mm x 380 mm B ROD Ø5.5 mm x 400 mm B ROD Ø6 mm x 400 mm B ROD Ø5.5 mm x 450 mm B ROD Ø6 mm x 450 mm B ROD Ø5.5 mm x 500 mm B ROD Ø6 mm x 500 mm CROSSLNKS CROSSLNKS NON STERILE REF. DESIGNATION NON STERILE REF. DESIGNATION B CROSSLINK FOR 5.5mm ROD. 22 TO 34mm DISTANCE B CROSSLINK SYSTEM for Ø6mm rod. Distances 22 to 34mm B CROSSLINK FOR 5.5mm ROD. 34 TO 48mm DISTANCE B CROSSLINK SYSTEM for Ø6mm rod. Distances 34 to 48mm B CROSSLINK FOR 5.5mm ROD. 48 TO 62mm DISTANCE B CROSSLINK SYSTEM for Ø6mm rod. Distances 48 to 62mm IMPORTANT : The PASS LP system is also available in STERILE version- simply add a S at the end of each reference in your order. Sterile Polyaxial Screws and Sacral Plates are delivered directly assembled with the nut. 27

28 Headquarters: MEDICREA 24 porte du Grand Lyon NEYRON - FRANCE Tél. +33 (0) Fax +33 (0) customerservice@medicrea.com Manufacturer: MEDICREA Technologies Z.I. Chef de Baie LA ROCHELLE - FRANCE Tel. +33 (0) Fax +33 (0) FDA cleared. Ref. C02D02002 V02 Sept 2009 Medicrea. All rights reserved. Patented products. MEDICREA and PASS are Medicrea registered trademarks RCS La Rochelle SAS au capital de Euros Distributed by: ALMED LISTED NYSE