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1 Xiapedia 2.0

2 Xiapedia Introduction The Stryker Spine Thoracolumbar Brand Marketing Team is proud to introduce Xiapedia 2.0 the latest one stop resource for comprehensive information on the Xia, Xia 4.5, Radius, Trio and Mantis Spinal Systems. Built on the solid foundation of the original version, Xiapedia 2.0 brings you the following new and exciting sections: Blocker Design Philosophy (Page 3) Screwdriver & Handle Options (Pages 12-13) Tap Options (Page 13) Reduction Options (Page 14) Metal Composition (Page 21) Hooks (Pages 26-29) We hope Xiapedia 2.0 will continue to be a valuable resource for you as you prepare for sales calls, in-services, surgeries, and more. Please do not hesitate to contact the TL Brand Team with questions! Kim Parkins Katie Wright Christine Boehm Jason Coleman Kim.parkins@stryker.com Katie.wright@stryker.com Christine.boehm@stryker.com Jason.coleman@stryker.com O: O: O: O: C: C: C: C: Confidential. For internal use only. Do not distribute.

Core Technology Xia Buttress Thread Blocker Unchanged technology since 1999 Over 2,800,000 Xia-style blockers have been

which is designed to prevent tulip from becoming splayed.

of the blocker axis and has a minimal load in the radial direction.

3 Core Technology Xia Buttress Thread Blocker Unchanged technology since 1999 Over 2,800,000 Xia-style blockers have been implanted Ref #: The Xia 3 blocker when tightened has a greater axial component as a result of the thread flank angle which is designed to prevent tulip from becoming splayed. The Xia blocker is designed with a buttress thread that when loaded provides a greater force component in the axial direction of the blocker axis and has a minimal load in the radial direction. The calculation and free body diagram shows the cross-section of one thread form and the loads acting on the thread during loading. Designed to tolerate up to 7 of misalignment before cross threading occurs. Confidential. For internal use only. Do not distribute. 3

4 Screw Options at a Glance Tulip Head Angulation Monoaxial Xia II (Ti and SS) Stryker Spine Thoracolumbar Screw Systems Xia 3 Xia 4.5 Xia Precision (Cannulated) Radius Radius Rapid (Dual Lead) Radius Precision (Cannulated) Trio+ Mantis D: mm L: mm D: mm L: mm D: mm L: 20-80mm - D: 4.0, mm L: mm Standard Polyaxial D: mm (SS: mm) L: mm D: mm L: mm D: mm L: 20-80mm D: mm L: 35-55mm D: 4.0, mm L: mm D: mm L: mm D: mm L: 35-55mm - D: mm L: 25-60mm Uniplanar D: mm L: 25-50mm (SS only) D: mm L: 20-60mm Monoaxial - D: mm L: mm Closed Polyaxial - D: mm L: mm Monoaxial D: mm L: 25-60mm - D: mm L: 20-60mm Polyaxial Reduction D: mm L: 25-60mm Can use Mantis Redux D: mm L: 20-60mm D: mm L: 25-90mm Uniplanar - D: mm L: 20-60mm RODS 5.5mm (SS) 5.5 or 6.0mm 4.5mm 6.0mm 5.5mm 5.5mm 5.5mm 6.0mm 6.0mm or 6.0mm (Ti) 4 Confidential. For internal use only. Do not distribute.

5mm L: 20-100mm - - - - - - - Polyaxial (Med-Lat) - D: 4.0-9.5mm L: 20-90mm - - - - - - - Post (No Tulip) 50 with Connectors - - - - - - - D: 4.5-8.5mm L: 25-60mm - RODS 5.5mm (SS) 5.5 or 6.0mm 4.

5 Screw Options at a Glance Tulip Head Angulation Monoaxial Xia II (Ti and SS) Stryker Spine Thoracolumbar Screw Systems Xia 3 Xia 4.5 Xia Precision (Cannulated) Radius Radius Rapid (Dual Lead) Radius Precision (Cannulated) Trio+ Mantis - D: mm L: mm Biased Polyaxial (Ceph-Caud) - D: mm L: mm Polyaxial (Med-Lat) - D: mm L: 20-90mm Post (No Tulip) 50 with Connectors D: mm L: 25-60mm - RODS 5.5mm (SS) 5.5 or 6.0mm 4.5mm 6.0mm 5.5mm 5.5mm 5.5mm 6.0mm 6.0mm or 6.0mm (Ti) In General Degenerative Trays will only go up to 7.5 or 7.75mm diameter screws. Ilios Trays will contain or mm diameter screws. Good to Know The 8.5 and 9.5 screws in Xia II are Xia I design - require Xia I screwdriver! The only polyaxial Reduction Screws with a Xia 3 interface are the Mantis Redux screws! When using Xia Anterior, Xia 4.5 Anterior, and Radius Anterior, only monoaxial screws should be used. Xia 3, Xia Precision, and Radius Precision screws all have cutting flutes on the tip to aid in insertion. Mantis, Xia Precision, and Radius Precision are all cannulated screw systems (Mantis and Xia Precision K-Wires: 1.3mm, Radius Precision K-Wires: 1.5mm.) Rod Diameter 4.5mm 5.5mm 6.0mm Material Ti Alloy, Vitallium Ti Alloy, SS Standard, SS Stiff, Vitallium Ti Alloy, CP Ti, Vitallium Confidential. For internal use only. Do not distribute. 5

Screw Terminology Medial Biased-Angle Polyaxial Screws offer 40 of medial-lateral polyaxiality in the biased direction, and 10 in the nonbiased direction, as compared to the

Cephalad-Caudal Biased-Angle Polyaxial Screws offer 40 of cephalad-caudal polyaxiality in the biased direction, and 10 in the nonbiased direction, as compared to the Closed

Once the blocker is locked down, the tabs must be snapped off. Dual-Lead Thread Screws utilize a steeper lead angle while also widening the pitch.

The result is a screw that advances twice the distance with the same number of turns as a standard screw.

Polyaxial Angulation Degrees measured in cephalad/caudal or medial/lateral plane.

Root The bottom surface of the thread Screw Shank Tip Angle Angle the tip of the thread makes to aid insertion into bone Self Tapping Cutting flute to initiate threads into

Thread Angle Angle between the crest and root Pitch Distance from crest to crest Cannulated Screws have a hollowed out bone screw that allows the passage of a K-Wire through

6 Screw Terminology Medial Biased-Angle Polyaxial Screws offer 40 of medial-lateral polyaxiality in the biased direction, and 10 in the nonbiased direction, as compared to the standard polyaxial screw which offers 25 in each direction. Cephalad-Caudal Biased-Angle Polyaxial Screws offer 40 of cephalad-caudal polyaxiality in the biased direction, and 10 in the nonbiased direction, as compared to the standard polyaxial screw which offers 25 in each direction. Closed Head Screws come in both monoaxial and polyaxial heads and have a smoother tulip head. This smooth top of the tulip head helps to hide the hardware construct. These screws are designed to provide equal strength in a smaller profile. Reduction Screws are designed to assist in persuading the rod down the tulip head without the need for an additional persuader instrument. Once the blocker is locked down, the tabs must be snapped off. Dual-Lead Thread Screws utilize a steeper lead angle while also widening the pitch. This allows a second lead to be placed on the screw making it Dual-Lead. The result is a screw that advances twice the distance with the same number of turns as a standard screw. Stryker Spine Screw Definitions Height Distance measuring upward Tulip Run-on-Rod Largest distance the screw takes up on the rod Diameter Distance measuring through the center Polyaxial Angulation Degrees measured in cephalad/caudal or medial/lateral plane. Polyaxial angulation occurs in one plane Major Diameter Diameter measured crest to crest Depth of Thread Major diameter minus minor diameter Crest The top surface of the thread Root The bottom surface of the thread Screw Shank Tip Angle Angle the tip of the thread makes to aid insertion into bone Self Tapping Cutting flute to initiate threads into bone Minor Diameter Diameter measured root to root. Thread Angle Angle between the crest and root Pitch Distance from crest to crest Cannulated Screws have a hollowed out bone screw that allows the passage of a K-Wire through the center. This screw is often used in percutaneous or mini-open procedures and is available with Xia Precision, Radius Precision and Mantis. 6 Confidential. For internal use only. Do not distribute. Xia Cancellous Thread Tapered minor diameter results in deeper thread form at the distal half of the screw which allows for maximum amount of trabecular bone engagement of the vertebral body to improve cancellous bone screw purchase. Xia Cortical Threads Tapered minor diameter results in shallower thread form at the proximal half of the screw which generates greater insertion torque into cortical bone. Once implanted, the shallower minor diameter at the proximal portion of the screw creates optimal compression of the pedicle bone, press fitting the screw into the bone creating solid cortical bone screw fixation.

7 Screw Dimensions Xia Monoaxial Xia II Monoaxial Tulip Dimensions Screw Shank Height Diameter Run-on-Rod Pitch Tip Angle Thread Type Polyaxial Angulation (4.0) (4.0) 12.8mm 14mm 10mm 2.1mm 60 Cortical / Cancellous N/A (4.5) (4.5) 12.8mm 14mm 10mm 2.3mm 60 Cortical / Cancellous N/A (5.0) (5.0) 12.8mm 14mm 10mm 2.5mm 60 Cortical / Cancellous N/A (5.5) (5.5) 12.8mm 14mm 10mm 2.6mm 60 Cortical / Cancellous N/A (6.5) (6.5) 12.8mm 14mm 10mm 3mm 60 Cortical / Cancellous N/A (7.5) (7.5) 12.8mm 14mm 10mm 3mm 60 Cortical / Cancellous N/A (8.5) (8.5) 12.8mm 14mm 10mm 3mm 60 Cortical / Cancellous N/A (9.5) (9.5) 12.8mm 14mm 10mm 3.3mm 60 Cortical / Cancellous N/A Xia Xia II Monoaxial Polyaxial (4.0) 15.3mm 14mm 12.7mm 2.1mm 60 Cortical / Cancellous 50 (4.5) 15.3mm 14mm 12.7mm 2.3mm 60 Cortical / Cancellous 50 (5.0) 15.3mm 14mm 12.7mm 2.5mm 60 Cortical / Cancellous 50 (5.5) 15.3mm 14mm 12.7mm 2.6mm 60 Cortical / Cancellous 50 (6.5) 15.3mm 14mm 12.7mm 3mm 60 Cortical / Cancellous 50 (7.5) 15.3mm 14mm 12.7mm 3mm 60 Cortical / Cancellous 50 (8.5) 16mm 15mm 15mm 3mm 60 Cortical / Cancellous 50 (9.5) 16mm 15mm 15mm 3.3mm 60 Cortical / Cancellous 50 Xia Xia 3 Monoaxial Monoaxial (4.0) 12.8mm 14mm 10mm 2.1mm 60 Cortical/Cancellous N/A (4.5) 12.8mm 14mm 10mm 2.3mm 60 Cortical/Cancellous N/A (5.0) 12.8mm 14mm 10mm 2.5mm 60 Cortical/Cancellous N/A (5.5) 12.8mm 14mm 10mm 2.6mm 60 Cortical/Cancellous N/A (6.0) 12.8mm 14mm 10mm 3.1mm 60 Cortical/Cancellous N/A (6.5) 12.8mm 14mm 10mm 3.1mm 60 Cortical/Cancellous N/A (7.0) 12.8mm 14mm 10mm 3.1mm 60 Cortical/Cancellous N/A (7.5) 12.8mm 14mm 10mm 3.1mm 60 Cortical/Cancellous N/A (8.5) 12.8mm 14mm 10mm 3.1mm 60 Cortical/Cancellous N/A (9.5) 12.8mm 14mm 10mm 3.3mm 60 Cortical/Cancellous N/A (10.5) 12.8mm 14mm 10mm 3.3mm 60 Cortical/Cancellous N/A Confidential. For internal use only. Do not distribute. 7

8 Screw Dimensions 8 Confidential. For internal use only. Do not distribute. Tulip Dimensions Screw Shank Height Diameter Run-on-Rod Pitch Tip Angle Thread Type Polyaxial Angulation Xia 3 Polyaxial (4.0) 15.3mm 14mm 12.7mm 2.1mm 60 Cortical / Cancellous 50 (4.5) 15.3mm 14mm 12.7mm 2.3mm 60 Cortical / Cancellous 50 (5.0) 15.3mm 14mm 12.7mm 2.5mm 60 Cortical / Cancellous 50 (5.5) 15.3mm 14mm 12.7mm 2.6mm 60 Cortical / Cancellous 50 (6.0) 15.3mm 14mm 12.7mm 3.1mm 60 Cortical / Cancellous 50 (6.5) 15.3mm 14mm 12.7mm 3.1mm 60 Cortical / Cancellous 50 (7.0) 15.3mm 14mm 12.7mm 3.1mm 60 Cortical / Cancellous 50 (7.5) 15.3mm 14mm 13mm 3.1mm 60 Cortical / Cancellous 42 (8.5) 16mm 14mm 13mm 3.1mm 60 Cortical / Cancellous 42 (9.5) 16mm 14mm 13mm 3.3mm 60 Cortical / Cancellous 42 (10.5) 16mm 14mm 13mm 3.3mm 60 Cortical / Cancellous 42 Xia 3 Closed Head Monoaxial (6.5) 10.75mm 9mm 9mm 3.1mm 60 Cortical/Cancellous NA (7.5) 10.75mm 9mm 9mm 3.1mm 60 Cortical/Cancellous NA (8.5) 10.75mm 9mm 9mm 3.1mm 60 Cortical/Cancellous NA (9.5) 10.75mm 9mm 9mm 3.3mm 60 Cortical/Cancellous NA Xia 3 Closed Head Polyaxial (6.5) 15mm 11mm 11mm 3.1mm 60 Cortical/Cancellous 42 (7.5) 15mm 11mm 11mm 3.1mm 60 Cortical/Cancellous 42 (8.5) 15mm 11mm 11mm 3.1mm 60 Cortical/Cancellous 42 (9.5) 15mm 11mm 11mm 3.3mm 60 Cortical/Cancellous 42 Xia 4.5 Monoaxial (4.0) 9mm 11mm 8.2mm 2.1mm 60 Cortical / Cancellous N/A (4.5) 9mm 11mm 8.2mm 2.3mm 60 Cortical / Cancellous N/A (5.0) 9mm 11mm 8.2mm 2.5mm 60 Cortical / Cancellous N/A (5.5) 9mm 11mm 8.2mm 2.6mm 60 Cortical / Cancellous N/A (6.5) 9mm 11mm 8.2mm 3mm 60 Cortical / Cancellous N/A

9 Screw Dimensions Thoracolumbar Screw Color Scheme Tulip Dimensions Screw Shank Height Diameter Run-on-Rod Pitch Tip Angle Thread Type Polyaxial Angulation Xia 4.5 Polyaxial (4.0) 12.1mm 11mm 10mm 2.1mm 60 Cortical / Cancellous 50 (4.5) 12.1mm 11mm 10mm 2.3mm 60 Cortical / Cancellous 50 (5.0) 12.1mm 11mm 10mm 2.5mm 60 Cortical / Cancellous 50 (5.5) 12.1mm 11mm 10mm 2.6mm 60 Cortical / Cancellous 50 (6.5) 12.1mm 11mm 10mm 3mm 60 Cortical / Cancellous 50 Mantis (4.5) 15.3mm 16.3mm 12.7mm 2.3mm 40 Cortical / Cancellous 50 (5.5) 15.3mm 16.3mm 12.7mm 2.6mm 40 Cortical / Cancellous 50 (6.5) 15.3mm 16.3mm 12.7mm 3mm 40 Cortical / Cancellous 50 (7.5) 15.3mm 16.3mm 12.7mm 3mm 40 Cortical / Cancellous 50 Radius Standard 4.0, (4.75) - (9.75) 12.2mm 12.75mm 10mm 2.75mm 35 Cortical N/A Radius Multi-Angle 4.0, (4.75) - (9.75) 15.3mm 12.75mm 10mm 2.75mm 35 Cortical 40 Radius Rapid (5.75) - (9.75) 15.3mm 12.75mm 10mm 5.5mm 35 Cortical 40 Orange Gold Light Blue Blue Turquoise Gray Violet Green Fuchsia Turquoise Gray Diameter 4.0mm 4.5mm 5.0mm 5.5mm 6.0mm 6.5mm 7.0mm 7.5mm 8.5mm 9.5mm 10.5mm Mantis Xia II Xia 3 Xia 4.5 Trio Diameter 4.75mm 5.75mm 6.75mm 7.75mm 8.75mm 9.75mm Radius Confidential. For internal use only. Do not distribute. 9

10 Screw Options (Detailed) Monoaxial Xia II Xia II SS Xia 3 Xia 4.5 Radius Mantis 4.0mm (20) - (40) 4.5mm (25) - (45) 5.0mm (25) - (45) 5.5mm (25) - (55) 6.5mm (30) - (00) 7.5mm (30) - (00) 8.5mm (30) - (00) 9.5mm (60) - (00) 4.0mm (20) - (40) 4.5mm (25) - (45) 5.0mm (25) - (45) 5.5mm (25) - (55) 6.5mm (30) - (00) 7.5mm (30) - (00) 8.5mm (30) - (00) 9.5mm (60) - (00) 4.0mm (20) - (45) 4.5mm (20) - (45) 5.0mm (20) - (50) 5.5mm (25) - (55) 6.0mm (25) - (90) 6.5mm (25) - (90) 7.0mm (25) - (90) 7.5mm (25) - (90) 8.5mm (25) - (00) 9.5mm (40) - (00) 10.5mm (40) - (00) 4.0mm (20) - (40) 4.5mm (20) - (45) 5.0mm (20) - (80) 5.5mm (20) - (80) 6.0mm (25) - (80) 6.5mm (30) - (80) 7.0mm (30) - (80) 7.5mm (30) - (80) 4.75mm (25) - (55) 5.75mm (25) - (65) 6.75mm (25) - (00) 7.75mm (25) - (00) 8.75mm (30) - (00) 9.75mm (30) - (00) Standard Polyaxial 4.0mm (20) - (40) 4.5mm (25) - (45) 5.0mm (25) - (45) 5.5mm (25) - (55) 6.5mm (30) - (00) 7.5mm (30) - (00) 8.5mm (30) - (00) 9.5mm (60) - (00) 4.0mm (20) - (40) 4.5mm (25) - (45) 5.0mm (25) - (45) 5.5mm (25) - (55) 6.5mm (30) - (00) 7.5mm (30) - (00) 4.0mm (20) - (45) 4.5mm (20) - (45) 5.0mm (20) - (50) 5.5mm (25) - (55) 6.0mm (25) - (90) 6.5mm (25) - (90) 7.0mm (25) - (90) 7.5mm (25) - (90) 8.5mm (25) - (00) 9.5mm (40) - (00) 10.5mm (40) - (00) 4.0mm (20) - (40) 4.5mm (20) - (70) 5.0mm (25) - (80) 5.5mm (20) - (80) 6.0mm (25) - (80) 6.5mm (30) - (80) 7.0mm (30) - (80) 7.5mm (30) - (80) 4.0mm (15) - (55) 4.75mm (25) - (55) 5.75mm (25) - (65) 6.75mm (25) - (00) 7.75mm (25) - (00) 8.75mm (30) - (00) 9.75mm (30) - (00) 4.5mm (25) - (45) 5.5mm (35) - (55) 6.5mm (30) - (60) 7.5mm (30) - (60) Uniplanar 4.5mm (25) - (45) 5.5mm (30) - (50) 6.5mm (30) - (50) 4.5mm (20) - (45) 5.0mm (20) - (45) 5.5mm (20) - (55) 6.0mm (25) - (60) 6.5mm (25) - (60) 7.0mm (30) - (60) 7.5mm (30) - (60) Closed Polyaxial Monoxial 6.5mm (30) - (00) 7.5mm (30) - (00) 8.5mm (30) - (00) 9.5mm (30) - (00) 6.5mm (30) - (00) 7.5mm (30) - (00) 8.5mm (30) - (00) 9.5mm (30) - (00) 10 Confidential. For internal use only. Do not distribute.

11 Screw Options (Detailed) Monoaxial Xia II Xia II SS Xia 3 Xia 4.5 Radius Mantis 4.5mm (25) - (45) 5.5mm (30) - (55) 6.5mm (30) - (60) 7.5mm (30) - (60) 4.5mm (25) - (45) 5.5mm (30) - (55) 6.5mm (30) - (60) 7.5mm (30) - (60) 4.5mm (20) - (45) 5.5mm (20) - (55) 6.5mm (30) - (60) 7.5mm (30) - (60) Reduction Uniplanar Polyaxial 4.5mm (25) - (45) 5.5mm (30) - (55) 6.5mm (30) - (60) 7.5mm (30) - (60) 4.5mm (25) - (45) 5.5mm (30) - (55) 6.5mm (30) - (60) 7.5mm (30) - (60) Use Mantis 4.5mm (20) - (45) 5.5mm (20) - (55) 6.5mm (30) - (60) 7.5mm (30) - (60) 4.5mm (20) - (45) 5.0mm (20) - (45) 5.5mm (20) - (55) 6.0mm (25) - (60) 6.5mm (25) - (60) 7.0mm (30) - (60) 7.5mm (30) - (60) 4.5mm (25) - (45) 5.5mm (30) - (55) 6.5mm (30) - (60) 7.5mm (30) - (90) 8.5mm (30) - (90) Monoaxial 6.5mm (60) - (00) 7.5mm (60) - (00) 8.5mm (60) - (00) 9.5mm (60) - (00) Biased Polyaxial (Ceph-Caud) 4.0mm (20) - (45) 4.5mm (20) - (45) 5.0mm (20) - (45) 5.5mm (25) - (55) 6.5mm (25) - (90) 7.5mm (25) - (90) 8.5mm (60) - (00) 9.5mm (60) - (00) Polyaxial (Med-Lat) 4.0mm (20) - (45) 4.5mm (20) - (45) 5.0mm (20) - (45) 5.5mm (25) - (55) 6.5mm (25) - (90) 7.5mm (25) - (90) 8.5mm (60) - (90) 9.5mm (60) - (90) Confidential. For internal use only. Do not distribute. 11

Screwdriver Combinations Handle Options Round Handle Regular

T-Handle Ratchet 48231202 Short Round Handle Regular 482397006

Additional Handle Options: Power Options and Components Cordless

Trinkled Reamer 4100-235-000 Xia 3 Power Adaptor 482397012

Universal Driver 6400-099-000 Hudson Modified TPS Handpiece Cord

Power Options are compatible with Xia II, Xia 3, Xia 4.

retrospectively designed to accommodate both Xia 3 and Xia II

12 Screwdriver Combinations Handle Options Round Handle Regular Round Handle Ratchet T-Handle Regular T-Handle Ratchet Short Round Handle Regular Short Round Handle Ratchet Jacob s Chuck Additional Handle Options: Power Options and Components Cordless Driver 3 CD 3 Universal Driver Hudson Modified Trinkled Reamer Xia 3 Power Adaptor Small/Large System 6 Battery / REMB REMB Universal Driver Hudson Modified Trinkled Reamer Xia 3 Power Adaptor TPS Handpiece Cord CORE Motor Controller *The REM B & CD3 Power Options are compatible with Xia II, Xia 3, Xia 4.5, Radius, & Mantis Screwdrivers Note: Xia 3 Handles were retrospectively designed to accommodate both Xia 3 and Xia II shafts. 12 Confidential. For internal use only. Do not distribute.

13 Screwdriver Combinations Complete Screwdrivers (Everything but Handle) Xia 3 Standard Xia 3 Long Xia 3 Short Xia Low Profile* Xia 3 Polyaxial Screwdriver Xia 3 Monoaxial Screwdriver Xia 3 Long Polyaxial Screwdriver L Xia 3 Long Monoaxial Screwdriver L *The Xia 3 Low Profile Screwdriver provides an alternative locking mechanism to the standard Xia 3 Screwdriver. *Cannulated Handles can be found in the Xia Precision, Mantis, or Radius Precision Surgical Techniques. Xia 3 Short Polyaxial Screwdriver S Xia 3 Short Monoaxial Screwdriver S Xia 3 Low Profile Polyaxial Screwdriver Inner Shaft Options Xia 3 Standard Xia 3 Long Xia 3 Short Xia Low Profile* Xia 3 Polyaxial Screwdriver Inner Shaft Xia II Polyaxial Inner Shaft Xia 3 Monoaxial Screwdriver Shaft Xia 3 Long Polyaxial Screwdriver Shaft L Not a Standard Part Xia 3 Long Monoaxial Screwdriver Shaft L *The Xia 3 Low Profile Screwdriver provides an alternative locking mechanism to the standard Xia 3 Screwdriver. *Cannulated Handles can be found in the Xia Precision, Mantis, or Radius Precision Surgical Techniques. Xia 3 Short Polyaxial Screwdriver Inner Shaft S Xia II Short Polyaxial Inner Shaft S Xia 3 Short Monoaxial Screwdriver Shaft S Xia 3 Low Profile Polyaxial Screwdriver Inner Shaft Not a Standard Part Xia 3 Long Monoaxial Screwdriver Shaft L Xia Taps* Xia 3 Xia mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap *Xia Family Taps are compatible with any screw that has a Xia thread pattern Radius Taps mm Tap mm Tap mm Tap mm Tap mm Tap mm Tap mm Tap Radius Rapid Taps mm Rapid Tap mm Rapid Tap mm Rapid Tap Trio Taps mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap mm Modular Tap Mantis Taps mm Cannulated Modular Tap mm Cannulated Modular Tap mm Cannulated Modular Tap mm Cannulated Modular Tap Confidential. For internal use only. Do not distribute. 13

Reduction Options Xia II, Xia 3, Xia 4.5 Persuader Reduction: 20mm Xia II: 48047016 Xia 3: 48237016 Xia 4.

Reduction: 10mm 48237078 Short Suk DVR Clip Reduction: 10mm 48237079 Uniplanar Reduction Screw Reduction: 15mm See Page 11 Radius Trio Mantis Rod

14 Reduction Options Xia II, Xia 3, Xia 4.5 Persuader Reduction: 20mm Xia II: Xia 3: Xia 4.5: One Handed Persuader Reduction: 20mm Lateral Persuader Reduction: 20mm Medialization: 10mm Suk DVR Reduction Tube Reduction: 10mm Short Suk DVR Clip Reduction: 10mm Uniplanar Reduction Screw Reduction: 15mm See Page 11 Radius Trio Mantis Rod Persuader Reduction: 20mm Spondylolisthesis Reduction Instrument Reduction: 20mm Persuader Reduction: 20mm Confidential. For internal use only. Do not distribute.

Rod Terminology Hex vs. Non-Hex A 5mm long hex is placed on the end of some rods for two main reasons. 1. The hex allows for better gripping during rod rotation. 2.

15 Rod Terminology Hex vs. Non-Hex A 5mm long hex is placed on the end of some rods for two main reasons. 1. The hex allows for better gripping during rod rotation. 2. The hex allows for easier insertion through difficult anatomy. Rod Diameter Different diameters are offered for two different reasons. 1. Smaller screw heads such as Xia 4.5 are lower in profile because they accommodate a 4.5mm diameter rod. 2. Different material and diameters provide a wide range of strength and stiffness. Rod Length Different rod lengths are offered for two reasons. 1. Longer rods can be cut to accommodate any length of construct. They are used most often in deformity procedures. 2. Precut rods are designed for use in degenerative procedures involving fewer surgical levels. Rod Material Different rod materials have different degrees of stiffness and strength. (See rod strength comparison charts on pages to see how different rod materials and diameters compare in stiffness and strength.) Prebent Rods Prebent rods are available in both 5.5 and 6.0mm diameters. 1. Ease of use: pre-bent rods are designed to match the natural sagittal curvature of the spine for degenerative procedures. 2. Integrity of the rod: pre-bent rods can provide a consistent, uniform bend, to optimize mechanical performance and reduce intraoperative bending. Laser Markings Rods are marked with laser etching to assist the surgeon with rod rotation and in determining bending planes when contouring the rod. Confidential. For internal use only. Do not distribute. 15

16 Rod Options Line Desc Diameter Material Xia Confidential. For internal use only. Do not distribute. Hex/Non Hex Laser Etched Curve Ref # Length Options (mm) Ti Alloy Hex None Straight ( ) 200, 480 Xia 4.5 Ti Alloy Hex Etched Straight Xia Ti Alloy Hex Etched Rad (30-120) Xia 4.5 Vitallium Non-Hex None Straight Xia 4.5 Vitallium Hex Etched Rad (30-120) Radius Ti Alloy Non-Hex None Straight Radius 5.5 Vitallium Hex Etched Rad (03,53,04,54,05) (06,07,08,09,00,10,20) Radius Ti Alloy Hex None Straight ( ) Radius Ti Alloy Non-Hex Etched Rad (30-50) (60, 70, 80, 90, 00, 10, 20) (5mm increments) (10mm increments) (10mm increments) (20mm increments) (5mm increments) (10mm increments) Radius Ti Alloy Non-Hex Etched Max Rad (50-20) (10mm increments) (30-50) (60,70,80,90,00,10,20) (5mm increments) (10mm increments) Radius Vitallium Non-Hex Etched Rad (80,90,00,10,20) (10mm increments) Radius Vitallium Hex Etched Straight (242, 602) 240, 600 Radius Vitallium Non-Hex Etched Straight (241, 601) 240, 600 Xia II Stainless Steel Non-Hex None Straight Special Feature Xia II Stainless Steel Non-Hex None Straight Stiff Xia II Stainless Steel Hex Etched Straight Stiff Xia II Stainless Steel Hex Etched Straight Stiff Xia II CP Titanium Non-Hex None Straight ( ) 70, 110, 480 Xia 3 CP Titanium Hex Etched Straight ( ), 480, 600 Xia II Ti Alloy Non-Hex None Rad (30-90) (10mm increments) 480, (5mm increments) (10mm increments) Xia II Ti Alloy Non-Hex None Max Rad (50-80) (10mm increments) 6.0 Xia II Vitallium Non-Hex None Straight Xia 3 Vitallium Hex Etched Straight Xia 3 Ti Alloy Hex Etched Straight ( ), 480, 600 Xia 3 Ti Alloy Non-Hex Etched Rad ( ) (10mm increments) 480, (5mm increments) (10mm increments) Standard Stiffness

17 Rod Options Line Desc Diameter Material Xia 3 Hex/Non Hex Laser Etched Mantis Ti Alloy Hex Ends only Straight ( ) 6.0 Curve Ref # Length Options (mm) Ti Alloy Non-Hex Etched Max Rad ( ) (10mm increments) Xia 3 Vitallium None Etched Rad (30-45) (5mm increments) Xia 3 Vitallium Hex Etched Rad ( ) (10mm increments) Mantis Ti Alloy Hex Ends only Rad ( ) (5mm increments) (10mm increments) Mantis Ti Alloy Hex Ends only Max Rad ( ) (10mm increments) Mantis Ti Alloy Hex Ends only Straight Mantis Ti Alloy Hex Ends only Rad ( ) Mantis Ti Alloy Hex Ends only Straight ( ) DIAPASON Ti Alloy Non-Hex None Straight 665 ( ) OPUS Ti Alloy Non-Hex None Straight 671 ( ) (10mm increments) (5mm increments) (10mm increments) (5mm increments) (10mm incrememnts) 480, (10mm increments) 250, 270, 300, 350, 400, (10mm increments) 250, 270, 300, 350, 400, 480 Special Feature New Rod-Inserters Only New Rod-Inserters Only Has hex cut into it Rod Compatibility for Different Stryker Spinal Fixation Systems System Diameter (mm) Xia Xia II 6.0 Xia II Stainless Steel 5.5 Xia 3 5.5/6.0 Radius 5.5 Mantis 6.0 Trio 6.0 (DIAPASON Rods) 6.0 Vitallium Wires Gauge Note: CP Titanium, Titanium and Vitallium rods are compatible with Titanium screws Stainless Steel rods are not compatible with Titanium screws and must only be used with Stainless Steel screws Titanium and Vitallium rods are similarly not compatible with Stainless Steel screws Confidential. For internal use only. Do not distribute. 17

18 Rod Strength Comparison Due to small sample sizes, these values are for comparative purposes only. 4-Point Bend Rod Strength and Stiffness Study Report, Stryker Spine, July 12, 2012, Number: RD , Revision Confidential. For internal use only. Do not distribute.

19 Rod Strength Comparison Due to small sample sizes, these values are for comparative purposes only. 4-Point Bend Rod Strength and Stiffness Study Report, Stryker Spine, July 12, 2012, Number: RD , Revision 00 Confidential. For internal use only. Do not distribute. 19

20 Connecting Different Systems Rod Diameters 3.5mm 4.5mm 5.5mm Stryker s Spinal Fixation Systems (Oasys ) (Xia 4.5) (Radius ) (Xia 3) (Xia II, Mantis ) (Xia 3, Trio ) Multiple Options See Oasys Surgical Technique Axial mm ( ) Parallel mm ( ) Axial mm ( ) Parallel mm ( ) Oasys Saddle Connector ( ) Axial mm ( ) Parallel mm ( ) Multiple Options See Separate Chart on page 23 Axial mm ( ) Parallel mm Large ( ) Parallel mm Small ( ) Axial mm ( ) Parallel mm ( ) Axial mm ( ) Parallel mm Large ( ) Parallel mm Small ( ) Multiple Options* See Separate Chart on page 23 Axial mm ( ) Parallel mm ( ) Oasys Saddle Connector ( ) Axial mm ( ) Parallel mm Large ( ) Parallel mm Small ( ) Multiple Options* See Separate Chart on page 23 Axial mm ( ) Parallel mm ( ) Oasys Saddle Connector ( ) Axial mm ( ) or ( ) Parallel mm Large ( ) Parallel mm Small ( ) Any Xia 3 Connector See Separate Charts on pages Axial mm ( ) Parallel mm ( ) Oasys Saddle Connector ( ) Axial mm ( ) or ( ) Parallel mm Large ( ) Parallel mm Small ( ) Any Xia 3 Connector See Separate Charts on pages mm Axial mm ( ) Parallel mm ( ) Oasys Saddle Connector ( ) Axial mm ( ) or ( ) Parallel mm Large ( ) Parallel mm Small ( ) Multiple Options* See Separate Charts on pages Any Xia 3 Connector See Separate Charts on pages Multiple Options See Separate Charts on pages Multiple Options See Separate Charts on pages *Connectors that have an extending component meant to fit into a Xia Tulip head are 6.0mm in diameter. Therefore, these connectors cannot be used with Radius as the Radius Tulip head can only accommodate a 5.5mm rod or connector. 20 Confidential. For internal use only. Do not distribute.

21 Metal Composition Stiff Stainless Steel Used In: Xia Stainless Steel Rods, Screws, and Cross Connectors Substance Percentage Carbon 0.08% Maximum Silicon 0.75% Maximum Manganese 2-4, 25% Maximum Nickel 9-11% Chromium % Molybdenum 2-3% Niobium % Sulphur 0.01% Phosphorus 0.03% Copper 0.25% Nitrogen % Iron Balance Malleable Stainless Steel Used In: Xia Stainless Steel Rods Substance Percentage Carbon 0.30% Silicon 1% Maximum Manganese 2% Maximum Phosphorus 0.25% Maximum Sulphur 0.01% Maximum Nitrogen 0.1% Maximum Chromium 17-19% Molybdenum % Nickel 13-15% Copper 0.50% Iron Balance Vitallium Used In: Xia II, Xia 3, Xia 4.5, Radius, & Oasys Rods Substance Carbon Percentage 0.14% Maximum Chromium 26-30% Molybdenum 5-7% Nickel Iron Silicon Manganese Nitrogen Colbalt 1% Maximum 0.75% Maximum 1% Maximum 1% Maximum 0.25% Maximum Balance Titanium Alloy Used In: Xia II, Xia 3, Xia 4.5, Oasys Screws, Blockers, Rods, & Cross Connectors Substance Percentage Aluminum % Vanadium 3.5-4% Iron Oxygen Carbon Nitrogen Hydrogen Titanium 0.3% Maximum 0.2% Maximum 0.08% Maximum 0.05% Maximum 0.015% Maximum Balance Commercially Pure (CP) Titanium Used In: Xia 3 Commercially Pure Titanium Rods and Oasys Commercially Pure Titanium Rods Substance Percentage Nitrogen 0.05% Maximum Carbon 0.1% Maximum Hydrogen Iron Oxygen Titanium % Maximum 0.45% Maximum 0.45% Maximum Balance Confidential. For internal use only. Do not distribute. 21

Connector Terminology Top Loading Rod-to-Rod Connectors, often called wedding bands, mimic two

They require a blocker to seat the rod and come in small, large, and angled.

array of shapes such as side-loading, angled, and closed head.

These are offered in both small and large.

This can be beneficial when extending a construct or transitioning from two different rod types

For both parallel and axial connectors, having a straight rod is extremely important.

They require a blocker to seat the rod and come in short, long, and offset.

screw/bolt. Miscellaneous Offset Connectors come in side loading, closed head, and J hook offset.

22 Connector Terminology Top Loading Rod-to-Rod Connectors, often called wedding bands, mimic two Xia tulip heads fused together. They require a blocker to seat the rod and come in small, large, and angled. Miscellaneous Rod-to-Rod Connectors also require a Xia blocker to seat the rod but come in an array of shapes such as side-loading, angled, and closed head. All top-loading and side-loading connectors are most commonly used during revision surgeries or when rods are already in place. Parallel Rod-to-Rod Connectors, often called Dominos, require a hex screwdriver to tighten down. These are offered in both small and large. Axial Connectors connect one end of a rod to the end of another rod. This can be beneficial when extending a construct or transitioning from two different rod types or rod sizes. For both parallel and axial connectors, having a straight rod is extremely important. Top Loading Offset Connectors mimic a Xia tulip head fused together with a short 6.0mm rod. They require a blocker to seat the rod and come in short, long, and offset. These connectors are most commonly used to connect an existing main construct to an Illiac screw/bolt. Miscellaneous Offset Connectors come in side loading, closed head, and J hook offset. Several different options are available to better accommodate the surgical approach and/or connection to a main contruct. These connectors can also be cut and/or contoured. Revision Connectors allow the surgeon to extend or revise already implanted systems. Revision connector screws allow you to extend your construct without skipping a level in tight areas. Sacral Hooks are offered as an alternative to sacral screws. Extended Connectors 22 Confidential. For internal use only. Do not distribute.

23 Connector Options within One System System Type Xia II & Xia 3 Xia 4.5 Radius Axial Parallel Iliac System Type Xia II & Xia 3 Xia 4.5 Radius Side Loading Sacral R Saddle Offset Straight Cross-Connector Monoblock (14)-(26) (12)-(24) Offset Angled Closed or Side Loading Offset Extended M.A.C Revision (40)-(60) (40)-(60) (40)-(60) (40)-(60) Open Closed Radius (22) -(36) *All Xia 3 connectors can be used with Xia II since they can accept a 5.5mm or 6.0mm rod. However, not all Xia II connectors are compatible with 5.5mm rods. Confidential. For internal use only. Do not distribute. 23

Xia II & Xia 3 Connector Compatibility Xia 3 Connectors Work With 5.5mm and 6.

0mm Rods New J-Hook Offset Connector 48230143 100mm Long New Top Loading Side Loading RRC 48235011 11mm Rod-to-Rod New Closed Head Offset

New Parallel Closed RRC 48230141 48235009 7mm Rod-to-Rod 11mm Rod-to-Rod New Open Side Loading Offset Connector 48230144 69mm Long New Revision

24 Xia II & Xia 3 Connector Compatibility Xia 3 Connectors Work With 5.5mm and 6.0mm Rods Xia 3 Connectors Work With 5.5mm and 6.0mm Rods New J-Hook Offset Connector mm Long New Top Loading Side Loading RRC mm Rod-to-Rod New Closed Head Offset Connector mm Long New Revision RRC mm Rod-to-Rod 22mm Rod-to-Rod New Long Offset Connector Open mm Long New Parallel Closed RRC mm Rod-to-Rod 11mm Rod-to-Rod New Open Side Loading Offset Connector mm Long New Revision Axial RRC and Bone Screw (40-60) (40-60) (40-60) (40-60) Axial Rod-to-Rod Connector Ø 6.5 x (40-60) Ø 7.5 (40-60) Ø 8.5 (40-60) Ø 9.5 (40-60) New Angled Loading Side Loading Rod-to-Rod Connector (RRC) mm Rod-to-Rod 24 Confidential. For internal use only. Do not distribute.

Connector 105 bend 03820132 6mm Rod Only Long Offset Connector Neutral 03820133 Offset Screw Connector 03820101 Small Rod-to-Rod Connector 0

25 Xia II & Xia 3 Connector Compatibility Xia II Connectors Work With 5.5mm & 6.0mm Rods 6mm Rod Only Offset Connector 75 bend Offset Connector Neutral New Long Offset Connector mm Long Offset Connector 105 bend mm Rod Only Long Offset Connector Neutral Offset Screw Connector Small Rod-to-Rod Connector Small Rod-to-Rod Connector Axial Connector Large Rod-to-Rod Connector Dual Connector Large Rod-to-Rod Connector Confidential. For internal use only. Do not distribute. 25

26 Hooks Hook Type Design Features Blade Direction Region of Spine Standard Narrow Extended Offset Lumbar Laminar A Lumbar Laminar Hook Blade s geometry is designed to better fit the lumbar lamina, and may obviate the need to remove the ligamentum flavum. A Standard Blade s width distributes forces evenly over a wider aspect of bone. A Narrow Blade s width minimizes metal volume in the spinal canal. An Extended Body Hook can correct anatomic misalignment between two laminae in the dorso-ventral plane. An Offset Hook can be used to medialize or lateralize the rod in the supralaminar or infralaminar position. An Offset Hook can back up a pedicle screw at the same level. An Angled Blade helps align hook saddles in a pediculo-laminar claw construct. T10 - L2 Angled Standard Narrow Offset Thoracic Laminar A Thoracic Supralaminar Hook throat ramp is designed to help prevent blade from pistoning into the spinal canal. A Standard Blade s width distributes forces evenly over a wider aspect of bone. A Narrow Blade s width minimizes metal volume in the spinal canal. An Offset Hook can be used to medialize or lateralize the rod in the supralaminar or infralaminar position. An Offset Hook can back up a pedicle screw at the same level. T1 - T10 Pedicle Pedicle Pedicle Hooks typically have a bifid blade that grasps the thoracic pedicle for increased stability. T1 - T10 26 Confidential. For internal use only. Do not distribute.

27 Hooks Hook Type Design Features Blade Direction Region of Spine Transverse Offset Transverse Process Directed either cephalad or caudally, the blade of a Transverse Process Hook fits between the superior or inferior anterior side of the transverse process and the rib head. When directed caudally, Transverse Process Hooks are often the top portion of a transverse pedicle claw configuration. An Offset Hook can be used to medialize or lateralize the rod in the supralaminar or infralaminar position. An Offset Hook can back up a pedicle screw at the same level. T1 - L5 Lumbar Thoracic Pedicle Reduced Blade Reduced Blade Hooks (RBH) are designed with narrower blades and smaller throat diameters. Reduced Blade Hooks are designed to better match the anatomy of a smaller stature patient. A Reduced Blade Lumbar Laminar Hook Blade s geometry is designed to better fit the lumbar lamina, and may obviate the need to remove the ligamentum flavum. A Reduced Blade Thoracic Supralaminar Hook s throat ramp may prevent the blade from pistoning into the spinal canal. Reduced Blade Pedicle Hooks have a bifid blade that grasps the thoracic pedicle for increased stability. T1 - L2 Lumbar Thoracic Pedicle Reduction Reduction Hooks are designed with an extended tulip head to aid in rod reduction. A Reduction Lumbar Laminar Hook Blade s geometry is designed to better fit the lumbar lamina, and may obviate the need to remove the ligamentum flavum. A Reduction Thoracic Supralaminar Hook s throat ramp may prevent the blade from pistoning into the spinal canal. Reduction Pedicle Hooks have a bifid blade that grasps the thoracic pedicle for increased stability. T1 - L2 Confidential. For internal use only. Do not distribute. 27

28 Hooks Xia II & Xia 3 Xia II Ref # Xia 3 Ref # Lumbar Hooks (Infralaminar) Description Blade Width Throat Diameter Blade Angle Xia Laminar Hook Large, Standard Blade Xia Laminar Hook Large, Narrow Blade Xia Laminar Hook Medium, Standard Blade Xia Laminar Hook Medium, Narrow Blade Xia Laminar Hook Small, Standard Blade Xia Laminar Hook Small, Narrow Blade Blade Length Comments Xia Laminar Hook Offset, Right mm Offset Xia Laminar Hook Offset, Left mm Offset Xia Laminar Hook Large, Angled Blade Xia Laminar Hook Small, Angled Blade Xia Laminar Hook Extended Body Total Height 29.5mm N/A Xia Laminar Hook Extended Body Small Total Height 26.0mm Thoracic Hooks (Supralaminar) Xia Thoracic Laminar Hook Small, Standard Blade Xia Thoracic Laminar Hook Small, Narrow Blade Xia Thoracic Laminar Hook, Small Offset, Right mm Offset Xia Thoracic Laminar Hook, Small Offset, Left mm Offset Xia Thoracic Laminar Hook, Large Offset, Right mm Offset Xia Thoracic Laminar Hook, Large Offset, Left mm Offset Pedicle Hooks Xia Pedicle Hook, Large N/A Xia Pedicle Hook, Medium Xia Pedicle Hook, Small Transverse Process Hooks Xia Transverse Process Hook, Right Lateral Xia Transverse Process Hook, Left Lateral 13.4 N/A Xia Offset Hook Large, Right Angle N/A Xia Offset Hook Large, Left Offset 28 Confidential. For internal use only. Do not distribute.

29 Hooks Xia II & Xia 3 Xia II Ref # Xia 3 Ref # RBH - Reduced Blade Hooks Description Blade Width Throat Diameter Blade Angle Xia RBH Laminar Hook, Narrow Blade Xia RBH Laminar Hook, Standard Blade Xia RBH Laminar Hook Angled Blade Xia RBH Thoracic Laminar Hook, Narrow Blade Xia RBH Pedicle Hook Reduction Hooks N/A Xia Pedicle Hook, Small N/A Xia Thoracic Laminar Hook, Standard Blade N/A Xia Laminar Hook Medium, Standard Blade N/A Xia Laminar Hook Medium, Narrow Blade N/A Xia Laminar Hook Large, Standard Blade Hooks Xia 4.5 Blade Length Comments Xia 4.5 Ref # Description Blade Width Throat Diameter Blade Angle Blade Length Xia Pedicle Hook, Small Xia Pedicle Hook, Large Xia Laminar Hook, Small Xia Laminar Hook, Medium Xia Laminar Hook, Large Xia Laminar Hook, Angled Blade Xia Thoracic Laminar Hook Comments Xia Extended Laminar Hook Total Height Xia Transverse Process Hook, Right Angled Hook Xia Transverse Process Hook, Left Angled Hook Xia Thoracic Laminar Hook, Right mm Offset Xia Thoracic Laminar Hook, Left mm Offset Xia Supralaminar Thoracic Hook, Right Angled Hook Xia Supralaminar Thoracic Hook, Left Angled Hook Xia II Hooks are validated for use with a 6.0mm rod only. Xia 3 Hooks are validated for use with a 5.5 or 6.00mm rod. Xia 4.5 Hooks are validated for use with a 4.5mm rod only. Confidential. For internal use only. Do not distribute. 29

30 This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in surgery. The information presented is intended to demonstrate the breadth of Stryker product offerings. A surgeon must always refer to the package insert, product label and/or instructions for use before using any Stryker product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Stryker representative if you have questions about the availability of Stryker products in your area. Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: OASYS, Mantis, Radius, SR90D, Stryker, Trio, Vitallium, Xia. All other trademarks are trademarks of their respective owners or holders. 2 Pearl Court Allendale New Jersey t: f: Literature Number: TLXIABR12100_US SC/GS 03/13 Copyright 2013 Stryker Printed in USA

Xia 3 Spinal System. AIS surgical technique

Xia 3 Spinal System. AIS surgical technique Xia 3 Spinal System Table of contents Surgical technique Key design features.... 4 Patient positioning.... 8 Hook selection... 9 Hook insertion... 10 Preparing the pedicle.... 14 Screw insertion... 19