Technique Guide. Universal Spinal System (USS). Designed to achieve the goals of scoliosis surgery.

Technique Guide Universal Spinal System (USS). Designed to achieve the goals of scoliosis surgery.

Table of Contents Introduction Universal Spinal System 2 AO ASIF Principles of Internal Fixation 3 Indications 4 Surgical Technique Hook Placement 5 Preparing the Pedicle 7 Inserting the Screw 10 Contouring the Rod 12 Assembling the Construct 14 Distraction and Compression 17 Tightening the Construct 19 Technique Options Attaching Transconnector 22 Attaching Transconnector Clamp to Rod 23 Attaching Transverse Bars 25 Attaching the Open Transverse Bar 26 Attaching the Closed Transverse Bar 28 Reduction Procedure for Spondylolisthesis 30 Anterior Approach 31 Product Information Implants 32 35 Sets 48 Sterilization Parameters 48 Image intensifier control Synthes Spine

Universal Spinal System Goals of Scoliosis Surgery Correct sagittal and coronal alignment Restore balance in the spine Prevent further progression of deformity Fuse the fewest number of vertebral segments Protect the spinal cord The Universal Spinal System is designed to achieve the goals of scoliosis surgery. The system is based upon: Independent anchorage of hooks and/or screws to the spine and independent rod positioning Simple connection between the implant and the rod Segmental correction and stabilization Features and Benefits Low-profile system Side-opening, top-tightening construct Simplifies intraoperative procedure Requires no implant preloading onto rod Single Core Screws offered in titanium and stainless steel (Fig. 1) Dual Core Screws offered in titanium (Fig. 2) Technique adaptability Designed to correct scoliosis by segmental correction or global derotation. Versatile linkage mechanism Allows addition or removal of anchorage points to an assembled construct. Fig. 1 Single Core Fig. 2 Dual Core 2 Synthes Spine Universal Spinal System

AO ASIF Principles of Internal Fixation The AO ASIF Principles of Internal Fixation In 1958, the AO ASIF (Association for the Study of Internal Fixation) formulated four basic principles, 1 which have become the guidelines for internal fixation. They are: Anatomical reduction Stable internal fixation Preservation of blood supply Early, active pain-free mobilization The fundamental aims of fracture treatment in the limbs and fusion of the spine are the same. A specific goal in the spine is returning as much function as possible to the injured neural elements. 2 AO ASIF Principles as Applied to the Spine 3 Anatomical Alignment Restoration of normal spinal alignment to improve the biomechanics of the spine. Stable Internal Fixation Stabilization of the spinal segment to promote bony fusion. Preservation of Blood Supply Creation of an optimal environment for fusion. Early, Pain-Free Mobilization Minimization of damage to the spinal vasculature, dura, and neural elements, which may contribute to pain reduction and improved function for the patient. 1. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger: AO Manual of Internal Fixation, 3rd Edition. Berlin; Springer-Verlag. 1991. 2. Ibid. 3. M. Aebi, J.S. Thalgott, and J.K. Webb. AO ASIF Principles in Spine Surgery. Berlin; Springer-Verlag. 1998. Synthes Spine 3

Indications Posterior Components The Synthes Universal Spinal System (USS) devices are noncervical spinal fixation devices intended for use as posterior pedicle screw fixation systems (T1 S2), a posterior hook fixation system (T1 L5) or as an anterolateral fixation system (T8 L5). Pedicle screw fixation is limited to skeletally mature patients with the exception of the Synthes Small Stature USS. The Synthes USS devices are indicated for all of the following regardless of the intended use: degenerative disc disease (defined as discogenic back pain with the degeneration of the disc confirmed by history and radiographic studies), spondylolisthesis, trauma (i.e. fracture or dislocation), deformities or curvatures (i.e. scoliosis, kyphosis, and/or lordosis), Scheuermann s Disease, tumor, stenosis, pseudoarthrosis, and failed previous fusion. In addition, the Synthes USS is intended for treatment of severe spondylolisthesis (Grades 3 and 4) of the L5 S1 vertebrae in skeletally mature patients receiving fusion by autogenous bone graft, having implants attached to lumbar and sacral spine with removal of the implants after the attainment of solid fusion. When used with the 3.5 mm/6.0 mm parallel connectors, the Synthes USS can be linked to the CerviFix System. Also, the Synthes USS can be interchanged with all USS 6.0 mm rods and transconnectors. Anterior Components The anterior components of the Synthes USS are intended for anterolateral screw and/or staple fixation for the correction of anterolateral lordotic deformities of the spine, lumbar scoliosis, pseudoarthrosis and fracture or dislocation of the thoracolumbar spine (T8 L5). Please refer to product insert GP0001 for complete system description, indications and warnings. 4 Synthes Spine Universal Spinal System

Hook Placement 1 If necessary, prepare lamina for lamina hook Instrument 388.52 Lamina Finder 388.104 Small Lamina Finder (with silicone handle) 388.105 Medium Lamina Finder (with silicone handle) 388.106 Large Lamina Finder (with silicone handle) Use the appropriate Lamina Finder to separate the ligamentum flavum from the underside of the lamina to ensure good bony contact with the lamina hook. The Lamina Finder can be used to prepare for down-going or up-going lamina hooks. 2 If necessary, prepare pedicle for pedicle hook Instrument 388.51 Pedicle Finder 03.622.012 Pedicle Finder (with silicone handle) Use the Pedicle Finder to open the facet capsule and locate the pedicle. Remove a small piece of the inferior articular process to ensure proper seating of the pedicle hook. An osteotome can be used to remove a small piece of the inferior articular process. This allows proper seating of the Pedicle Hook (up-going). Synthes Spine 5

Hook Placement continued 3 Place hook 388.61 Hook or Screw Holder ( Stick ) 388.621 Handle for Hook or Screw Holder 388.63 Hook Positioner 388.110 Hook Positioner (with silicone handle) Align the Hook or Screw Holder ( Stick ) with the appropriate hook, and secure. Snap the Stick into the Handle for Hook or Screw Holder by depressing the button on the handle. Place the hook in the desired location. The Hook Positioner may also be used to facilitate placement of the hook. After the hook is properly seated, remove the handle. The Stick can remain attached to the hook. 388.61 388.621 6 Synthes Spine Universal Spinal System

Preparing the Pedicle for Screw Placement 1 Identify the pedicle The entry point for each lumbar pedicle is at the intersection of a horizontal line bisecting the transverse process and a vertical line drawn along the lateral border of the superior articular process. The point of entry for each thoracic pedicle is at the intersection of a line through the transverse process and a line through the inferolateral edge of the facet joint. Synthes Spine 7

Preparing the Pedicle for Screw Placement continued 2 Prepare the pedicle 03.622.005 Thoracic Pedicle Probe, 3 mm width at tip (with silicone handle) 388.536 Pedicle Probe with Palm Handle for 4.0 mm and 4.2 mm Screws (with silicone handle) 388.539 Pedicle Probe for 7.0 mm, 8.0 mm, and 9.0 mm screws 388.54 Probe for 5.0 mm and 6.0 mm screws 388.544 Pedicle Probe for 4.0 mm and 4.2 mm screws 388.55 Awl (for 5.0 mm 9.0 mm screws) 388.551 Awl, for 4.0 mm and 4.2 mm screws 388.655 Probe with Palm Handle for 5.0 mm 9.0 mm screws (with silicone handle) 388.656 Awl with Palm Handle for 4.0 mm 9.0 mm screws (with silicone handle) Use the appropriate awl to perforate the posterior cortex of the pedicle (Figure 1). Figure 1 Figure 2 Open the pedicle canal using the appropriate probe (Figure 2). Displace the soft cancellous bone by advancing the probe through the pedicle canal into the vertebral body. Use radiographic imaging to check position and orientation. Important: Care should be taken not to perforate the walls of the pedicle. Note: Additionally available Pedicle Markers can be used to confirm position and orientation using radiographic imaging. 8 Synthes Spine Universal Spinal System

3 Select proper screw length 388.545 Straight Ball Tip Probe 388.546 Curved Ball Tip Probe 389.80 Ball Tip Probe Palpate the walls of the pedicle and determine the depth of the pedicle canal using a ball tip probe. This instrument has depth markings at 25 mm, 30 mm, 40 mm, 50 mm, 60 mm and 70 mm. Synthes Spine 9

Inserting the Screw 4 Insert screws 388.61 Hook/Screw Holder ( Stick ) 388.621 Handle for Hook/Screw Holder Insert the Stick into the appropriate side-opening screw and secure with the coupling screw. Snap the Stick into the Handle by depressing the button on the handle. Insert the side-opening screw into the prepared pedicle. After the screw has been inserted, remove the handle by depressing the button, leaving the Stick in place, if desired. 10 Synthes Spine Universal Spinal System

Optional Methods of Screw Insertion 388.33 Screwdriver 388.334 Screwdriver Shaft 388.36 Holding Sleeve for Long Small Hexagonal Screwdriver 388.38 Holding Sleeve (for 388.33, 03.602.001 and 388.334) The Screwdriver for side-opening implants may also be used for screw insertion. The Holding Sleeve may be used with either the screwdriver or the screwdriver shaft to retain the screw during initial insertion into the pedicle. Either the Ratchet Handle and Screwdriver Shaft, or the Handle and the Stick, can be used to facilitate screw insertion. The metal ring on the Ratchet Handle may be positioned in a clockwise, counterclockwise or neutral position: 388.395 2.5 mm Hexagonal Screwdriver, long (with silicone handle) 388.61 Hook or Screw Holder ( Stick ) 388.621 Handle for Hook or Screw Holder 388.652 Ratchet T-Handle 03.602.001 Screwdriver, for side-opening implants (with silicone handle) Position Clockwise Counterclockwise Neutral Function Screw insertion Screw removal Nonratcheting or 388.38 388.334 388.652 Synthes Spine 11

Contouring the Rod 1 Determine rod contour 388.902 Coated Rod Template for 6.0 mm rod, 150 mm 388.905 Coated Rod Template for 6.0 mm rod, 500 mm When the screws and hooks have been placed and their position confirmed radiographically, determine the contour of the rod by using the appropriate 6.0 mm Coated Rod Template. 2 Cut rod to length (if necessary) 388.72 Rod Cutter 388.750 Table Top Rod Cutter 388.751 Handheld Rod Cutter Adjust the rod length using the Rod Cutter, the Table Top Rod Cutter, or the Handheld Rod Cutter. All rod cutting should take place outside the operative field. 12 Synthes Spine Universal Spinal System

3 Contour the rod 388.91 Bending Irons, left and right 388.92 388.112 In Situ Benders, right and left 388.113 388.961 Rod Bender 03.620.020 Rod Bender 03.622.061 Coronal Benders, left and right 03.622.062 388.91, 388.92 388.961 Use the Rod Bender or the Bending Irons to contour the rod to match the rod template. Use the knob on the Rod Bender to adjust the bend radius. Use the Bending Irons, Coronal Benders or In Situ Benders for in situ rod bending. Synthes Spine 13

Assembling the Construct 1 Introduce the rod 388.44 Rod Holding Forceps 388.94 Rod Pusher 388.114 Rod Pusher (with silicone handle) 03.622.081 Rod Holding Forceps with Clamp Grip Position the rod parallel to the side opening of the screws and hooks using the Rod Holding Forceps or Rod Holding Forceps with Clamp Grip. Introduce the rod into the side-opening screw or hook using the Rod Pusher. 2 Apply the collars and the nuts 388.15 Socket Wrench with straight handle, 11 mm 03.602.014 Socket Wrench with Straight Handle, 11 mm (with silicone handle) Stacked nut and collar Load a Collar and Nut into the 11 mm Socket Wrench. Note that the collar can be loaded in only one direction. Place the instrument over the head of the implant and seat both the collar and the nut. Tighten the nut using the Socket Wrench. 14 Synthes Spine Universal Spinal System

Optional Method for Assembling the Construct Assembly using the Persuader 388.50 Rod Introduction Pliers, for side-opening implants ( Persuader ) 388.61 Hook or Screw Holder ( Stick ) Use the Persuader with the Stick for construct assembly. The Persuader has a specialized holding sleeve that enables a collar to be preloaded and retained in the correct orientation. 1 Load collar Load a collar onto the barrel of the Persuader. Note: The collar can be loaded in only one direction. Collar Synthes Spine 15

Optional Method for Assembling the Construct continued 2 Engage rod 388.410 Distraction Forceps, curved (for 6.0 mm rods) 388.605 Distraction Clip Position the barrel of the Persuader over the Stick and advance it downward over the implant. Engage the rod with the jaws opposite the barrel of the Persuader and squeeze the handle to insert the rod into the hook or screw. If biplanar reduction of the rod is necessary, use the Distraction Clip and the Distraction Forceps with the Persuader to guide the rod into the hook or screw opening. The Distraction Forceps allow manipulation of the construct to achieve the desired sagittal-plane contour. Place the Distraction Clip over the Stick to allow reduction. Use the Distraction Forceps against the Distraction Clip while squeezing the Persuader until the rod is seated in the hook or screw. 3 Seat collar 388.110 Hook Positioner (with silicone handle) 388.13 Socket Wrench with L-handle, 11 mm 388.15 Socket Wrench with straight handle, 11 mm 388.63 Hook Positioner 03.602.014 Socket Wrench with Straight Handle, 11 mm (with silicone handle) Use the Hook Positioner to tap the collar onto the implant assembly. Once the collar is pushed down over the implant, remove the Distraction Clip and the Persuader. Place a Nut over the construct and tighten it with the Socket Wrench. 16 Synthes Spine Universal Spinal System

Distraction and Compression 1 Determine point of fixation 388.44 Rod Holding Forceps 298.910 Half Ring 498.910 Titanium Half Ring 03.622.081 Rod Holding Forceps with Clamp Grip Use the Rod Holding Forceps or a Half Ring as a point of fixation, if necessary, against which to distract or compress. 2 If distraction is required 388.118 Parallel Distraction Forceps 388.15 Socket Wrench with straight handle, 11 mm 388.410 Distraction Forceps, curved (for 6.0 mm rods) 03.602.014 Socket Wrench with Straight Handle, 11 mm (with silicone handle) Use the Distraction Forceps and ensure the nut is loose before distracting against the point of fixation. Once in the desired position, tighten the nut using the Socket Wrench. Synthes Spine 17

Distraction and Compression continued 3 If compression is required 388.119 Parallel Compression Forceps 388.15 Socket Wrench with straight handle, 11 mm 388.42 Compression Forceps 03.602.014 Socket Wrench with Straight Handle, 11 mm (with silicone handle) Use the Compression Forceps and ensure the nut is loose before compressing against the point of fixation (Figure 3). Once in the desired position, tighten the nut using the Socket Wrench (Figure 4). Figure 3 Figure 4 4 If derotation is required 388.15 Socket Wrench with straight handle, 11 mm 03.602.014 Socket Wrench with Straight Handle, 11 mm (with silicone handle) 03.622.082 Rod Rotation Wrench, for 6.0 mm hexagonal-end Rods Make certain that all nuts are loose. Grasp the rod with the Rod Holding Forceps and slowly rotate in the proper direction. Alternatively, the Rod Rotation Wrench is available for rotating hex end rods. Once in the desired position, tighten the nut using the Socket Wrench. 18 Synthes Spine Universal Spinal System

Provisional Tightening of the Construct Methods for Provisional Tightening Option 1 Tightening using the screwdriver for countertorque 388.13 Socket Wrench with L-Handle, 11 mm 388.14 Socket Wrench with straight handle, 6 mm 388.33 Screwdriver, for side-opening implants 03.602.001 Screwdriver, for side-opening implants (with silicone handle) 03.602.013 Socket Wrench with Straight Handle, 6 mm (with silicone handle) Place the Screwdriver (without holding sleeve) through the Socket Wrench with L-Handle. Hold the Screwdriver stationary as countertorque while turning the L-handle wrench to secure the nut. Application of countertorque reduces the torque on the bone while tightening the nut. Note: Any distraction or compression must be completed before final tightening. The 10 Nm Torque Wrench must be used for final construct tightening. Synthes Spine 19

Provisional Tightening of the Construct continued Option 2 Tightening using the Internal Counter Torque 388.13 Socket Wrench with L-Handle, 11 mm 388.263 Internal Counter Torque Insert the Internal Counter Torque into the Socket Wrench with L-Handle to reduce torque on the bone while tightening the nut. Hold the Internal Counter Torque stationary and turn the Socket Wrench with L-Handle to secure the nut. Note: Any distraction or compression must be completed before final tightening. The 10 Nm Torque Wrench must be used for final construct tightening. Option 3 Tightening using the 6 mm Socket Wrench with Straight Handle for countertorque 388.13 Socket Wrench with L-Handle, 11 mm 388.14 Socket Wrench with straight handle, 6 mm 388.61 Hook or Screw Holder ( Stick ) 03.602.013 Socket Wrench with Straight Handle, 6 mm (with silicone handle) Place the Socket Wrench with L-Handle over the Hook or Screw Holder and insert the 6 mm Socket Wrench with Straight Handle. Hold the straight handle wrench stationary and turn the L-Handle wrench to secure the nut. Note: Any distraction or compression must be completed before final tightening. The 10 Nm Torque Wrench must be used for final construct tightening. 20 Synthes Spine Universal Spinal System

Final Tightening Option 1 The 10 Nm Torque Wrench must be used for final construct tightening 388.261 10 Nm Torque Wrench, 11 mm width across flats 388.263 Internal Counter Torque Place the Torque Wrench over the nut. Insert the Internal Counter Torque into the wrench. Hold the Internal Counter Torque stationary while turning the Torque Wrench. The wrench will click at the preset torque of 10 Nm. Option 2 The 10 Nm Torque Wrench and Counter Torque Sleeve can also be used for final construct tightening 388.261 10 Nm Torque Wrench, 11 mm width across flats 388.262 Counter Torque Sleeve Place the Counter Torque Sleeve over the screw or hook head. Insert the 10 Nm Torque Wrench into the Counter Torque Sleeve. Hold the Counter Torque Sleeve stationary while turning the 10 Nm Torque Wrench. The wrench will click at the preset torque of 10 Nm. Synthes Spine 21

Technique Options Attaching Transconnector 1 Measure distance between rods Instrument 388.865 Measuring Template, for Low Profile Transconnectors The Low Profile Transconnector is used as a construct stabilizer to reduce rotation. Use the Measuring Template to measure the distance between the two rods and determine the appropriate transconnector length. 2 Secure transconnector to rods 388.31 Long Small Hexagonal Screwdriver 388.395 2.5 mm Hexagonal Screwdriver, long (with silicone handle) Loosen all of the setscrews and place the appropriate length Low Profile Transconnector onto the rods. Use the Hexagonal Screwdriver to secure the transconnector to the rods by tightening the setscrews on each end. When using an adjustable length transconnector, adjust the distance between the rods, if desired, by compressing or distracting. Then, tighten the center setscrew on the rotating shaft using the Hexagonal Screwdriver. Notes: For transconnectors with angular adjustment, tighten the stargrind setscrew to lock the angle between the rods. If any part of the construct requires further adjustment, all transconnector setscrews must be loosened. After final adjustment, retighten the setscrews. 22 Synthes Spine Universal Spinal System

Attaching Transconnector Clamp to Rod 388.31 Long Small Hexagonal Screwdriver 388.36 Holding Sleeve for 388.31 and 388.395 388.395 2.5 mm Hexagonal Screwdriver, long (with silicone handle) Use a USS Preassembled Transconnector Clamp or an Transconnector Clamp (composed of a unassembled clamp body and collar) to provide additional rotational stability. 1 Attach clamp to screwdriver When assembling the transconnector clamp, place the transconnector collar over the holding sleeve on the hexagonal screwdriver. Insert the hexagonal screwdriver into the clamp body setscrew and slide the holding sleeve down to secure the clamp body to the screwdriver. 2 Attach clamp to rod Place the clamp body onto the 6.0 mm rod and slide the collar down to attach the clamp body to the rod. Synthes Spine 23

Technique Options continued 3 Determine length of 3.5 mm bar Instrument 388.902 Coated Rod Template Use the Coated Rod Template to determine the length of the 3.5 mm bar and cut the bar to length with a Rod Cutter. 4 Insert the 3.5 mm bar Instrument 20 388.45 Bar Holding Forceps Use the Bar Holding Forceps to insert the 3.5 mm bar into the bar channel located below the setscrew. Ensure that the bar channel, collar cutout and setscrew allow bar insertion. The 3.5 mm bar can be adjusted ± 20 with respect to the clamp. 20 Repeat the procedure on the contralateral side. 5 Tighten the setscrews Tighten the setscrews in both clamp bodies with the Hexagonal Screwdriver to secure the construct. 24 Synthes Spine Universal Spinal System

Attaching Transverse Bars The Universal Spinal System offers both Open Transverse Bars (Figure 5) and Closed Transverse Bars (Figure 6) for implantto-rod attachment. The transverse bar acts as a lateral extension to the hook or screw in situations where the rod contour or patient anatomy prevents direct hook- or screw-to-rod connection. The transverse bar permits variation in the sagittal angulation of the implant along the 6.0 mm rod (Figure 7). The sagittal and axial alignment can be achieved independently of each other. Figure 5 The transverse bar also allows medial/lateral displacement of the hook or screw from the 6.0 mm rod and rotation of the implant around the 6.0 mm rod (Figure 8). The bar lengths are 15 mm, 20 mm, 25 mm and 30 mm. Figure 6 Figure 7 Figure 8 Synthes Spine 25

Technique Options continued Attaching the Open Transverse Bar 1 Attach clamp to screwdriver 388.31 Long Small Hexagonal Screwdriver 388.36 Holding Sleeve for 388.31 and 388.395 388.395 2.5 mm Hexagonal Screwdriver, long (with silicone handle) The Open Transverse Bar can be used after the construct has already been secured. The Open Transverse Bar consists of two implants: the Clamp for Open Transverse Bar and the Open Transverse Bar. Note: A frontal hook must be used with a transverse bar. Attach the Clamp for Open Transverse Bars to the hexagonal screwdriver with holding sleeve by engaging the setscrew of the clamp with the holding sleeve. 2 Place clamp on rod Place the opening of the Open Transverse Bar on top of the 6.0 mm rod. Position the Clamp for Open Transverse Bars to straddle the Open Transverse Bar. Note: If the transverse bar is placed below the 6.0 mm rod, rotate the clamp to straddle the rod when securing the bar to the rod. 26 Synthes Spine Universal Spinal System

3 Tighten the setscrew 388.31 Long Small Hexagonal Screwdriver 388.36 Holding Sleeve for 388.31 and 388.395 388.395 2.5 mm Hexagonal Screwdriver, long (with silicone handle) 388.49 Rod Crimping Pliers 388.50 Rod Introduction Pliers, for side-opening implants ( Persuader ) 388.395 2.5 mm Hexagonal Screwdriver, long (with silicone handle) Introduce the transverse bar into the frontal hook or sideopening screw with the Rod Crimping Pliers or Persuader. Tighten the setscrew on the clamp with the Long Small Hexagonal Screwdriver. Proceed with step 5 on page 29. Synthes Spine 27

Technique Options continued Attaching the Closed Transverse Bar The Closed Transverse Bar is used when it can be preloaded onto the rod, particularly when the hook or screw cannot be easily aligned with the rod. Note: A frontal hook must be used with a transverse bar. 1 Attach bar to screwdriver 388.31 Long Small Hexagonal Screwdriver 388.36 Holding Sleeve for 388.31 and 388.395 388.395 2.5 mm Hexagonal Screwdriver, long (with silicone handle) Attach the Closed Transverse Bar to the hexagonal screwdriver with holding sleeve by engaging the setscrew of the transverse bar with the holding sleeve. 2 Place bar on rod Place the Closed Transverse Bar on the 6.0 mm rod. 3 Align bar to screw or hook Use the hexagonal screwdriver with holding sleeve to align the transverse bar with the screw or frontal hook. 28 Synthes Spine Universal Spinal System

4 Attach transverse bar 388.49 Rod Crimping Pliers 388.50 Rod Introduction Pliers, for side-opening implants ( Persuader ) Introduce the transverse bar into the frontal hook or sideopening screw with the Rod Crimping Pliers or Persuader. Tighten the setscrew on the transverse bar to secure it in position. 5 Place collar and nut Place the 6 mm Collar with grooves over the screw or frontal hook. Place a Nut over the Stick and tighten using the 11 mm Socket Wrench. Synthes Spine 29

Technique Options continued Reduction Procedure for Spondylolisthesis 388.118 Parallel Distraction Forceps 388.410 Distraction Forceps, curved (for 6.0 mm rods) 388.44 Rod Holding Forceps 388.50 Rod Introduction Pliers ( Persuader ) 388.605 Distraction Clip 03.622.081 Rod Holding Forceps with Clamp Grip Position a Distraction Clip or Rod Holding Forceps on the knurling of the Stick. Place Distraction Forceps between the Distraction Clip or the Rod Holding Forceps and the barrel of the Persuader. Slowly squeeze the Distraction Forceps and the Persuader to reduce the spondylolisthesis. 30 Synthes Spine Universal Spinal System

Anterior Approach Staples and washers can be used to provide secure anchorage for anterolateral constructs. 1 Insert staple 385.805 Staple Impactor 03.602.011 Staple Impactor (with silicone handle) Position the staple on the anterolateral aspect of the thoracolumbar spine to accommodate optimal screw placement. Drive the tips through the cortical bone and seat the staple using the Staple Impactor and a small mallet. 2 Washers Place the washer over the screw. Use the other implants (rod, collars, and nuts) to complete the construct. Synthes Spine 31

Implants Hooks Low-profile design Side-opening design allows rod attachment to side of the hook Multiple designs for use around the lamina, pedicle or transverse process Specialized lamina hooks for thoracic and lumbar applications Frontal hooks for attachment to the transverse bar 13.5 mm Pedicle Hook Lamina Hook Thoracic Lamina Hook Transverse Process Hook Collars and Nuts Secure screws and hooks to the 6.0 mm rod Collars capture the rod, yet allow longitudinal adjustments along the rod before tightening 11 mm nuts secure the construct Screws Low-profile design Side-opening design simplifies intraoperative rod-to-screw assembly Both screw types are self-tapping Available in stainless steel or titanium single core, single lead design of 4.2 mm, 5.0 mm, 6.0 mm, 7.0 mm, 8.0 mm and 9.0 mm diameters, in lengths ranging from 25 mm to 140 mm (Fig.1) Available in titanium dual core, single lead design of 4.0 mm, 5.0 mm, 6.0 mm, 7.0 mm, 8.0 mm and 9.0 mm diameters, in lengths ranging from 25 mm to 100 mm (Fig.2) Dual core screws with rounded tips promote safe screw insertion Fig. 1 Single Core Fig. 2 Dual Core 32 Synthes Spine Universal Spinal System

Rods Available in 6.0 mm diameter Hard and soft rods are available for system versatility 50 mm to 500 mm lengths in 50 mm increments Hex end rod in 500 mm length also available Transverse Bars Provide a lateral extension from the 6.0 mm rod to the hook or screw Eliminate the need for severe rod contouring, which might otherwise be required for direct hook- or screwto-rod connection Used with screws and front-opening hooks Available in lengths of 15 mm, 20 mm, 25 mm and 30 mm Parallel Connectors The 6.0 mm /6.0 mm connector extends USS constructs The 5.0 mm /6.0 mm connector allows attachment to the Small Stature USS. The 3.5 mm /6.0 mm connector allows attachment of the USS to the CerviFix System 6.0 mm /6.0 mm 5.0 mm /6.0 mm 3.5 mm /6.0 mm Synthes Spine 33

Implants continued Low Profile Transconnector Links both rods, providing the construct with rotational stability Clamp body and collar of transconnector assembly allows 20 of angulation Preassembled for ease of placement Available in four fixed lengths (15 mm, 18 mm, 21 mm and 24 mm) and eight adjustable lengths (25.5 mm 83 mm) Stargrind allows attachment to non-parallel rods Adjustable length Center shaft allows 45 rotation about the horizontal axis. Fixed length Stargrind Transconnector Assemblies Links both rods to provide the construct with rotational stability Available in configurations shown to the right Clamp body and collar of the transconnector assemblies permit 20 of angulation Rod available in 3.5 mm diameter, 80 mm and 120 mm length Staples and Washers Provide secure anchorage for anterolateral constructs in the thoracolumbar spine Sizes for use with 5.0 mm, 6.0 mm, 7.0 mm and 8.0 mm screws 34 Synthes Spine Universal Spinal System

for Hook Placement 388.51 Pedicle Finder 388.52 Lamina Finder 388.61 Hook or Screw Holder ( Stick ) 388.63 Hook Positioner Synthes Spine 35

for Hook Placement continued Lamina Finders 388.104 Small 388.105 Medium 388.106 Large 388.110 Hook Positioner 388.621 Handle for Hook or Screw Holder 03.622.012 Pedicle Finder 36 Synthes Spine Universal Spinal System

for Pedicle Preparation 388.551 Awl for 4.0 mm and 4.2 mm screws 388.55 Awl (for 5.2 mm 9.0 mm screws) 388.656 Awl with Palm Handle (for 4.0 mm 9.0 mm screws) 388.544 Pedicle Probe for 4.0 mm and 4.2 mm screws 388.54 Probe (for 5.0 mm and 6.0 mm screws) 388.539 Pedicle Probe for 7.0 mm, 8.0 mm, and 9.0 mm screws 388.536 Pedicle Probe with Palm Handle for 4.0 mm and 4.2 mm screws 388.655 Probe with Palm Handle (for 5.0 mm 9.0 mm screws) 03.622.005 Thoracic Pedicle Probe (3 mm width at tip) Synthes Spine 37

for Pedicle Preparation continued 388.545 Straight Ball Tip Probe 388.546 Curved Ball Tip Probe 389.80 Ball Tip Probe Taps for Dual Core Screws, single lead, 6 mm hex coupling 03.602.004 for 4.0 mm screws 03.602.005 for 5.0 mm screws 03.602.006 for 6.0 mm screws 03.602.007 for 7.0 mm screws 03.620.108 for 8.0 mm screws 03.620.109 for 9.0 mm screws Cannulated Tap for Dual Core Screws, single lead, 6 mm hex coupling 03.602.034 for 4.0 mm screws 03.602.035 for 5.0 mm screws 03.602.036 for 6.0 mm screws 03.602.037 for 7.0 mm screws 311.615 for 8.0 mm screws 311.616 for 9.0 mm screws 38 Synthes Spine Universal Spinal System

for Screw Insertion 388.61 Hook or Screw Holder ( Stick ) 388.621 Handle for Hook or Screw Holder 388.33 Screwdriver, for side-opening implants 388.38 Holding Sleeve (for 388.33, 03.602.001 and 388.334) 03.602.001 Screwdriver, for side-opening implants For alternative method of screw insertion 388.334 Screwdriver Shaft for side-opening screws 388.652 Ratchet T-Handle, 6 mm hex coupling Synthes Spine 39

for Rod Contouring Coated Rod Templates for 6.0 mm rod 388.902 150 mm 388.905 500 mm 388.72 Rod Cutter 388.961 Rod Bender, with bend radius adjustment 388.91 Bending Iron, left 388.92 Bending Iron, right 03.620.020 Rod Bender with radius adjustment and spring opening 40 Synthes Spine Universal Spinal System

03.622.061 Coronal Rod Bender, left 03.622.062 Coronal Rod Bender, right 388.112 In Situ Bender, right 388.113 In Situ Bender, left 388.44 Rod Holding Forceps, for 6.0 mm rods 03.622.081 Rod Holding Forceps, with Clamp Grip Synthes Spine 41

for Construct Assembly 388.94 Rod Pusher, for 6.0 mm rods 388.114 Rod Pusher (with silicone handle) 389.225 Collar Impactor 03.602.016 Collar Impactor (with silicone handle) 388.14 Socket Wrench with straight handle, 6 mm 03.602.013 Socket Wrench with Straight Handle, 6 mm (with silicone handle) 42 Synthes Spine Universal Spinal System

388.15 Socket Wrench with straight handle, 11 mm 03.602.014 Socket Wrench with Straight Handle, 11 mm (with silicone handle) 388.13 Socket Wrench with L-Handle, 11 mm 388.50 Rod Introduction Pliers ( Persuader ), for side-opening implants 388.605 Distraction Clip 388.49 Rod Crimping Pliers, for side-opening implants Synthes Spine 43

for Distraction and Compression 388.410 Distraction Forceps, curved (for 6.0 mm rods) Reinforced instrument jaws provide strength and rigidity for optimal transfer of distraction force to the implants 388.42 Compression Forceps (for 6.0 mm rods) Reinforced instrument jaws provide strength and rigidity for optimal transfer of compression force to the implants 388.118 Parallel Distraction Forceps 388.119 Parallel Compression Forceps 03.622.006 Parallel Compressor with Extended Travel, for 6 mm rods 388.44 Rod Holding Forceps, for 6.0 mm rods Ensures consistent and stable grip on rod with ratchet locking mechanism 44 Synthes Spine Universal Spinal System

03.622.081 Rod Holding Forceps with Clamp Grip 498.910 Titanium Half Ring 298.910 Half Ring 03.622.082 Rod Rotation Wrench, for 6.0 mm hexagonal-end rods Synthes Spine 45

for Tightening of Construct 388.261 10 Nm Torque Wrench, 11 mm width across flats Important: For final tightening of the construct, this wrench must be used to apply the proper amount of torque. 388.263 Internal Counter Torque 388.262 Counter Torque Sleeve 388.61 Hook or Screw Holder ( Stick ) 388.621 Handle for Hook or Screw Holder 388.334 Screwdriver Shaft, for side-opening screws 388.652 Ratchet T-Handle 46 Synthes Spine Universal Spinal System

for Attaching Transconnector 388.31 Long Small Hexagonal Screwdriver 388.36 Holding Sleeve, for Long Small Hexagonal Screwdriver 388.395 2.5 mm Hexagonal Screwdriver, long 388.45 Bar Holding Forceps, for 3.5 mm bar 388.865 Measuring Template, for Low Profile Transconnectors for 6.0 mm rods for anterior approach 385.805 Staple Impactor 03.602.011 Staple Impactor (with silicone handle) Synthes Spine 47

Titanium Dual Core USS Hook, Rod and Clamp Implant Set (01.602.014) Graphic Case 60.602.004 Hook, Rod and Clamp Implant Set Graphic Case Implants Side-Opening Hooks Titanium Description Qty. 498.310 Lamina Hook, small, right 5 498.311 Lamina Hook, small, left 5 498.312 Lamina Hook, small, frontal 2 498.320 Lamina Hook, medium, right 5 498.321 Lamina Hook, medium, left 5 498.322 Lamina Hook, medium, frontal 2 498.330 Lamina Hook, large, right 5 498.331 Lamina Hook, large, left 5 498.332 Lamina Hook, large, frontal 2 498.340 Thoracic Lamina Hook, right 5 498.341 Thoracic Lamina Hook, left 5 498.342 Thoracic Lamina Hook, frontal 2 498.350 Pedicle Hook, right 5 498.351 Pedicle Hook, left 5 498.352 Pedicle Hook, frontal 2 498.380 Transverse Process Hook, right 4 498.381 Transverse Process Hook, left 4 498.382 Transverse Process Hook, frontal, right 2 498.383 Transverse Process Hook, frontal, left 2 6.0 mm Hard Rods Titanium Length (mm) Qty. 498.102 50 2 498.103 75 2 498.104 100 2 498.105 125 2 498.106 150 2 498.108 200 2 498.112 300 2 498.116 400 2 498.119 500 2 6.0 mm Hexagonal-end Rods Titanium Length (mm) Qty. 04.622.317 500 2 Sterilization Parameters for Set (01.602.014) These Synthes sets with all additionally available items, as marked in the case, can be sterilized by the following parameters. For more information, please refer to graphic case package insert. Method Cycle Temperature Exposure Time Steam Prevacuum 132 135 C 10 Minutes (Wrapped) (270 275 F) Steam Gravity Displacement 132 135 C 28 Minutes (Wrapped) (270 275 F) 48 Synthes Spine Universal Spinal System

Implants continued Collar, Nut Titanium Description Qty. 498.011 Collar with grooves 36 498.003 Nut, 11 mm 36 Half Ring Titanium Description Qty. 498.910 Half Ring 4 Low Profile Transconnectors for 6.0 mm Rods Titanium Length (mm) Qty. 497.791 15 2 497.792 18 2 497.793 21 3 497.794 24 3 497.795 25.5 30.5 4 497.796 31.5 34.0 3 04.620.203 33.0 36.5 3 497.797 35.0 41.0 3 04.620.204 38.5 48.0 2 497.798 42.0 55.0 2 04.620.205 49.0 69.0 2 497.799 56.0 83.0 2 3.5 mm Bars, for Transconnector Titanium Length (mm) Qty. 498.120 80 4 498.125 120 4 Clamps Titanium Description Qty. 498.250 Clamp for Open Transverse Bars 4 498.813 USS Preassembled Transconnector Clamp 4 Parallel Connectors Titanium Diameters (mm/mm) Qty. 498.960 3.5 / 6.0 2 498.160 6.0 / 6.0 2 498.162 5.0 / 6.0 2 Closed Transverse Bars Titanium Length (mm) Qty. 498.215 15 2 498.220 20 2 498.225 25 2 04.602.001 30 2 Open Transverse Bars Titanium Length (mm) Qty. 498.251 15 2 498.252 20 2 498.253 25 2 04.602.002 30 2 Instrument 388.365 Measuring Template Synthes Spine 49

Titanium Dual Core USS Screw Implant Set (01.602.013) Graphic Case 60.602.003 Graphic Case for Dual Core USS Screw Implant Set Implants Dual Core USS Screws Thread Diameter Length Titanium (mm) (mm) Qty. 04.602.420 4.0 mm 20 mm 4 04.602.425 4.0 mm 25 mm 8 04.602.428 4.0 mm 28 mm 4 04.602.430 4.0 mm 30 mm 8 04.602.432 4.0 mm 32 mm 4 04.602.435 4.0 mm 35 mm 8 04.602.438 4.0 mm 38 mm 4 04.602.440 4.0 mm 40 mm 6 04.602.445 4.0 mm 45 mm 4 04.602.525 5.0 mm 25 mm 6 04.602.530 5.0 mm 30 mm 8 04.602.535 5.0 mm 35 mm 8 04.602.540 5.0 mm 40 mm 8 04.602.545 5.0 mm 45 mm 8 04.602.550 5.0 mm 50 mm 4 04.602.555 5.0 mm 55 mm 4 04.602.625 6.0 mm 25 mm 2 04.602.630 6.0 mm 30 mm 4 04.602.635 6.0 mm 35 mm 6 04.602.640 6.0 mm 40 mm 8 04.602.645 6.0 mm 45 mm 8 04.602.650 6.0 mm 50 mm 6 04.602.655 6.0 mm 55 mm 4 04.602.660 6.0 mm 60 mm 4 04.602.665 6.0 mm 65 mm 4 04.602.725 7.0 mm 25 mm 2 04.602.730 7.0 mm 30 mm 4 04.602.735 7.0 mm 35 mm 6 04.602.745 7.0 mm 45 mm 8 04.602.750 7.0 mm 50 mm 8 04.602.755 7.0 mm 55 mm 4 04.602.760 7.0 mm 60 mm 2 04.602.765 7.0 mm 65 mm 2 04.602.770 7.0 mm 70 mm 2 Sterilization Parameters for Set (01.602.013) This Synthes set with all additionally available items, as marked in the case, can be sterilized by the following parameters. For more information, please refer to graphic case package insert. Method Cycle Temperature Exposure Time Steam Prevacuum 132 135 C 10 Minutes (Wrapped) (270 275 F) Steam Gravity Displacement 132 135 C 28 Minutes (Wrapped) (270 275 F) 50 Synthes Spine Universal Spinal System

Dual Core USS Screws continued Thread Diameter Length Titanium (mm) (mm) Qty. 04.602.775 7.0 mm 75 mm 2 04.602.780 7.0 mm 80 mm 2 04.602.790 7.0 mm 90 mm 2 04.602.799 7.0 mm 100 mm 2 04.602.825 8.0 mm 25 mm 2 04.602.830 8.0 mm 30 mm 2 04.602.835 8.0 mm 35 mm 2 04.602.840 8.0 mm 40 mm 2 04.602.845 8.0 mm 45 mm 2 04.602.850 8.0 mm 50 mm 2 04.602.855 8.0 mm 55 mm 2 04.602.860 8.0 mm 60 mm 2 04.602.865 8.0 mm 65 mm 2 04.602.870 8.0 mm 70 mm 2 04.602.875 8.0 mm 75 mm 2 04.602.880 8.0 mm 80 mm 2 04.602.890 8.0 mm 90 mm 2 04.602.899 8.0 mm 100 mm 2 04.602.930 9.0 mm 30 mm 2 04.602.935 9.0 mm 35 mm 2 04.602.940 9.0 mm 40 mm 2 04.602.945 9.0 mm 45 mm 2 04.602.950 9.0 mm 50 mm 2 04.602.955 9.0 mm 55 mm 2 04.602.960 9.0 mm 60 mm 2 04.602.965 9.0 mm 65 mm 2 04.602.970 9.0 mm 70 mm 2 04.602.975 9.0 mm 75 mm 2 04.602.980 9.0 mm 80 mm 2 04.602.990 9.0 mm 90 mm 2 04.602.999 9.0 mm 100 mm 2 Washers For screw Outer diameter diameter Titanium (mm) (mm) Qty. 498.035 5 16 2 498.036 6 16 2 498.037 7 16 2 498.045 5 18 2 498.046 6 18 2 498.047 7 18 2 Small Staples Titanium Description Qty. 498.301 for 5 mm screws 4 498.302 for 6 mm screws 4 498.303 for 7 mm screws 4 Synthes Spine 51

Dual Core USS Screw and Hook Instrument Set (01.602.001) Graphic Case 60.602.001 Graphic Case for USS Hook and Screw 388.36 Holding Sleeve for 388.395 388.38 Holding Sleeve for 03.602.001 388.61 Hook or Screw Holder, 16 ea. 388.104 Small Lamina Finder 388.105 Medium Lamina Finder 388.106 Large Lamina Finder 388.110 Hook Positioner 388.334 Screwdriver Shaft, for side-opening implants 388.395 2.5 mm Hexagonal Screwdriver, long, 2 ea. 388.536 Pedicle Probe with Palm Handle, for 4.0 mm and 4.2 mm screws 388.545 Straight Ball Tip Probe 388.546 Curved Ball Tip Probe 388.621 Handle, for Hook or Screw Holder, 2 ea. 388.652 Ratchet T-Handle 388.655 Probe with Palm Handle (for 5.0 mm 9.0 mm screws) 388.656 Awl with Palm Handle (for 4.0 mm 9.0 mm screws) 03.602.001 Screwdriver, for side-opening implants 03.622.005 Thoracic Pedicle Probe, 3 mm width at tip 03.622.012 Pedicle Finder Taps for Dual Core Screws, single lead, 230 mm 03.602.004 for 4.0 mm screws 03.602.005 for 5.0 mm screws 03.602.006 for 6.0 mm screws 03.602.007 for 7.0 mm screws 03.620.108 for 8.0 mm screws 03.620.109 for 9.0 mm screws Cannulated Taps for Dual Core Screws, single lead, 230 mm 03.602.034 for 4.0 mm screws 03.602.035 for 5.0 mm screws 03.602.036 for 6.0 mm screws 03.602.037 for 7.0 mm screws 311.615 for 8.0 mm screws 311.616 for 9.0 mm screws 52 Synthes Spine Universal Spinal System

Dual Core USS Rod Instrument Set (01.602.002) Graphic Cases 60.602.002 Graphic Case for USS Deformity Correction 60.602.005 Graphic Case for USS Rod Bending 60.602.007 Graphic Case for Additional USS Deformity in Graphic Case 60.602.002 388.13 Socket Wrench with L-Handle 388.49 Rod Crimping Pliers 388.50 Rod Introduction Pliers, 2 ea. 388.261 10 Nm Torque Wrench 388.262 Counter Torque Sleeve 388.263 Internal Counter Torque 388.605 Distraction Clip, 2 ea. 03.602.014 Socket Wrench with Straight Handle, 11 mm, 2 ea. in Graphic Case 60.602.005 388.112 In Situ Bender, right 388.113 In Situ Bender, left 388.114 Rod Pusher for 6.0 mm rod 388.902 Coated Rod Template 388.905 Coated Rod Template 03.620.020 Rod Bender with radius adjustment and spring opening 03.622.061 Coronal Rod Bender for 6.0 mm Rod, left 03.622.062 Coronal Rod Bender for 6.0 mm Rod, right 03.622.081 Rod Holding Forceps with Clamp Grip, 2 ea. 03.622.082 Rod Rotation Wrench, for 6.0 mm hexagonal-end rods in Graphic Case 60.602.007 388.118 Parallel Distraction Forceps 388.119 Parallel Compression Forceps 03.602.011 Staple Impactor 03.602.013 Socket Wrench with Straight Handle, 6 mm 03.602.016 Collar Impactor Sterilization Parameters for Sets (01.602.001 and 01.602.002) These Synthes sets with all additionally available items, as marked in the case, can be sterilized by the following parameters. For more information, please refer to graphic case package insert. Method Cycle Temperature Exposure Time Steam Prevacuum 132 135 C 10 Minutes (Wrapped) (270 275 F) Steam Gravity Displacement 132 135 C 28 Minutes (Wrapped) (270 275 F) Synthes Spine 53

Universal Spinal System Hook, Rod and Clamp Sets Stainless Steel (105.855) and Titanium (145.855) Graphic Case 690.061 USS Hook and Rod Set Graphic Case Implants Side-Opening Hooks Stainless Steel Titanium Description Qty. 298.310 498.310 Lamina Hook, small, right 5 298.311 498.311 Lamina Hook, small, left 5 298.312 498.312 Lamina Hook, small, frontal 2 298.320 498.320 Lamina Hook, medium, right 5 298.321 498.321 Lamina Hook, medium, left 5 298.322 498.322 Lamina Hook, medium, frontal 2 298.330 498.330 Lamina Hook, large, right 5 298.331 498.331 Lamina Hook, large, left 5 298.332 498.332 Lamina Hook, large, frontal 2 298.340 498.340 Thoracic Lamina Hook, right 5 298.341 498.341 Thoracic Lamina Hook, left 5 298.342 498.342 Thoracic Lamina Hook, frontal 2 298.350 498.350 Pedicle Hook, right 5 298.351 498.351 Pedicle Hook, left 5 298.352 498.352 Pedicle Hook, frontal 2 298.380 498.380 Transverse Process Hook, right 4 298.381 498.381 Transverse Process Hook, left 4 298.382 498.382 Transverse Process Hook, 2 frontal, right 298.383 498.383 Transverse Process Hook, 2 frontal, left 6.0 mm Hard Rods Stainless Steel Titanium Length (mm) Qty. 298.102 498.102 50 2 298.103 498.103 75 2 298.104 498.104 100 2 298.105 498.105 125 2 298.106 498.106 150 2 298.108 498.108 200 2 298.112 498.112 300 2 298.116 498.116 400 2 298.119 498.119 500 2 Sterilization Parameters for Sets (105.855 and 145.855) These Synthes sets with all additionally available items, as marked in the case, can be sterilized by the following parameters. For more information, please refer to graphic case package insert. Method Cycle Temperature Exposure Time Steam Prevacuum 132 135 C 10 Minutes (Wrapped) (270 275 F) Steam Gravity Displacement 132 135 C 28 Minutes (Wrapped) (270 275 F) 54 Synthes Spine Universal Spinal System

Implants continued Collar, Nut Stainless Steel Titanium Description Qty. 298.011 498.011 Collar with grooves 20 298.003 498.003 Nut, 11 mm 20 Half Ring Stainless Steel Titanium Description Qty. 298.910 498.910 Half Ring 4 Low Profile Transconnectors for 6.0 mm Rods Stainless Steel Titanium Length (mm) Qty. 297.791 497.791 15 2 297.792 497.792 18 2 297.793 497.793 21 3 297.794 497.794 24 3 297.795 497.795 25.5 30.5 4 297.796 497.796 31.5 34.0 3 297.797 497.797 35.0 41.0 3 297.798 497.798 42.0 55.0 2 297.799 497.799 56.0 83.0 2 3.5 mm Bars, for Transconnector Stainless Steel Titanium Length (mm) Qty. 298.120 498.120 80 2 298.125 498.125 120 2 Clamps Stainless Steel Titanium Description Qty. 298.250 498.250 Clamp for Open Transverse Bars 4 298.813 498.813 USS Preassembled Transconnector Clamp 4 Parallel Connectors Stainless Steel Titanium Diameters (mm/mm) Qty. 498.960 3.5/ 6.0 2 298.160 498.160 6.0/ 6.0 2 298.162 498.162 5.0/ 6.0 2 Closed Transverse Bars Stainless Steel Titanium Diameter (mm) Qty. 298.215 498.215 15 2 298.220 498.220 20 2 298.225 498.225 25 2 Open Transverse Bars Stainless Steel Titanium Diameter (mm) Qty. 298.251 498.251 15 2 298.252 498.252 20 2 298.253 498.253 25 2 Instrument 388.365 Measuring Template Synthes Spine 55

Universal Spinal System Screw Sets Stainless Steel (105.856) and Titanium (145.856) Graphic Case 690.060 USS Screw Set Graphic Case Implants Side-Opening Screws Stainless Diameter Length Steel Titanium (mm) (mm) Qty. 298.630 498.630 6.0 30 4 298.635 498.635 6.0 35 6 298.640 498.640 6.0 40 8 298.645 498.645 6.0 45 8 298.650 498.650 6.0 50 6 298.655 498.655 6.0 55 4 298.660 498.660 6.0 60 4 298.730 498.730 7.0 30 4 298.735 498.735 7.0 35 6 298.740 498.740 7.0 40 8 298.745 498.745 7.0 45 8 298.750 498.750 7.0 50 6 298.755 498.755 7.0 55 4 298.760 498.760 7.0 60 4 Washers For screw Outer Stainless diameter diameter Steel Titanium (mm) (mm) Qty. 298.035 498.035 5 16 4 298.036 498.036 6 16 4 298.037 498.037 7 16 4 298.045 498.045 5 18 4 298.046 498.046 6 18 4 298.047 498.047 7 18 4 Small Staples Stainless Steel Titanium Description Qty. 298.301 498.301 for 5 mm screws 4 298.302 498.302 for 6 mm screws 4 298.303 498.303 for 7 mm screws 4 Sterilization Parameters for Sets (105.856 and 145.856) These Synthes sets with all additionally available items, as marked in the case, can be sterilized by the following parameters. For more information, please refer to graphic case package insert. Method Cycle Temperature Exposure Time Steam Prevacuum 132 135 C 10 Minutes (Wrapped) (270 275 F) Steam Gravity Displacement 132 135 C 28 Minutes (Wrapped) (270 275 F) 56 Synthes Spine Universal Spinal System

Universal Spinal System Hook and Screw Instrument Set (105.852) Graphic Case 690.059 USS Hook and Screw Instrument Set Graphic Case 388.31 Long Small Hexagonal Screwdriver, 2 ea. 388.33 Screwdriver, for side-opening implants 388.334 Screwdriver Shaft, for side-opening screws 388.36 Holding Sleeve for 388.31, 2 ea. 388.38 Holding Sleeve for 388.33 388.539 Pedicle Probe, for 7.0 mm, 8.0 mm and 9.0 mm screws 388.54 Probe (for 5.0 mm and 6.0 mm screws) 388.544 Pedicle Probe, for 4.0 mm and 4.2 mm screws 388.545 Straight Ball Tip Probe 388.546 Curved Ball Tip Probe 388.51 Pedicle Finder 388.52 Lamina Finder 388.55 Awl (for 5.0 mm 9.0 mm screws) 388.551 Awl for 4.0 mm and 4.2 mm screws 388.61 Hook or Screw Holder, 16 ea. 388.621 Handle, for Hook or Screw Holder, 2 ea. 388.63 Hook Positioner 388.652 Ratchet T-Handle, 6 mm hex coupling 389.80 Ball Tip Probe Sterilization Parameters for Sets (105.851 and 105.852) These Synthes sets with all additionally available items, as marked in the case, can be sterilized by the following parameters. For more information, please refer to graphic case package insert. Method Cycle Temperature Exposure Time Steam Prevacuum 132 135 C 10 Minutes (Wrapped) (270 275 F) Steam Gravity Displacement 132 135 C 28 Minutes (Wrapped) (270 275 F) Synthes Spine 57

Universal Spinal System Rod Instrument Set (105.851) Graphic Case 690.058 USS Rod Instrument Set Graphic Case 385.805 Staple Impactor 388.13 Socket Wrench with L-handle, 11 mm 388.14 Socket Wrench with straight handle, 6 mm 388.15 Socket Wrench with straight handle, 11 mm, 2 ea. 388.261 10 Nm Torque Wrench, 11 mm 388.262 Counter Torque Sleeve 388.263 Internal Counter Torque 388.410 Distraction Forceps, curved 388.42 Compression Forceps 388.44 Rod Holding Forceps, for 6.0 mm rod, 2 ea. 388.45 Bar Holding Forceps, for 3.5 mm bar 388.49 Rod Crimping Pliers, for side-opening implants 388.50 Rod Introduction Pliers, for side-opening implants 388.605 Distraction Clip 388.902 Coated Rod Template for 6.0 mm rod, 150 mm 388.905 Coated Rod Template for 6.0 mm rod, 500 mm 388.91 Bending Iron, left 388.92 Bending Iron, right 388.94 Rod Pusher, for 6.0 mm Rods 388.961 Rod Bender, with bend radius adjustment 389.225 Collar Impactor 58 Synthes Spine Universal Spinal System

Also Available (Dual Core) For set 01.602.014 Tall Body Lamina Hooks Titanium Description 498.171 Small, left 498.172 Small, right 498.173 Small, frontal 498.174 Medium, left 498.175 Medium, right 498.176 Medium, frontal 498.177 Large, left 498.178 Large, right 498.179 Large, frontal Extended Blade Lamina Hooks 498.181 Small, left 498.182 Small, right 498.183 Small, frontal 498.184 Medium, left 498.185 Medium, right 498.186 Medium, frontal 498.187 Large, left 498.188 Large, right 498.189 Large, frontal Tall Body Extended Blade Lamina Hooks 498.191 Small, left 498.192 Small, right 498.193 Small, frontal 498.194 Medium, left 498.195 Medium, right 498.196 Medium, frontal 498.197 Large, left 498.198 Large, right 498.199 Large, frontal Rectangular Opening Lamina Hooks 498.390 6.5 mm, right 498.391 6.5 mm, left 498.392 8 mm, right 498.393 8 mm, left 498.394 9.5 mm, right 498.395 9.5 mm, left 498.396 11 mm, right 498.397 11 mm, left 6.0 mm Hard Rods Titanium 498.110 250 498.114 350 498.118 450 6.0 mm Soft Rods 498.150 50 498.151 75 498.152 100 498.153 125 498.154 150 498.158 500 Length (mm) 6.0 mm Rods (Ti-6Al-7Nb) 498.290 200 498.292 300 498.294 400 498.296 500 Transconnector Implants Titanium Description 498.810 Transconnector Clamp Body 498.811 Transconnector Collar For set 01.602.013 Washers For screw Outer diameter diameter Titanium (mm) (mm) 498.038 8 16 498.039 9 16 498.048 8 16 498.049 9 18 Staples Titanium Description 498.041 for 5 mm screws 498.042 for 6 mm screws 498.043 for 7 mm screws 498.044 for 8 mm screws Synthes Spine 59