Synthes USS II Manual
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Synthes USS II Manual

Synthes USS II Manual

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USS II. Comprehensive posterior and
anterior deformity system with screws
and hooks with dual opening.
Handling technique

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Summary of Contents for Synthes USS II

  • Page 1 USS II. Comprehensive posterior and anterior deformity system with screws and hooks with dual opening. Handling technique...

  • Page 2: Table Of Contents

    Table of Contents Introduction USS II Screws and Hooks with Dual Opening Indications and Contraindications Implant Handling Using the Stick Handling Technique Insert Pedicle Screw* Position Pedicle Hook* Position Lamina Hook* Angled Lamina Hook* Positioning Rod Contouring Locking Implants to Rods...
  • Page 3 USS Universal Spine System. Segmental corrections may be implemented or the spinal column may be realigned along a sagittally positioned rod. Reprocessing, Care and Maintenance of Synthes Instruments For general guidelines, function control and dismantling of multi-part instruments, please refer to: www.synthes.com/reprocessing Synthes...

  • Page 4: Uss Ii Screws And Hooks With Dual Opening

    USS II. Comprehensive posterior and anterior deformity system with screws and hooks with dual opening. Flexible 1 mm Implants accept 5 mm or 6 mm rods and are locked with the same nut (Fig. 1) Bilateral option for fixing the implants to the rod (Fig.
  • Page 5 Controlled implant manipulation using hook- and screwholder (“stick”) with hexagonal coupling and handle. Quick handle assembly Simple to mount and remove Controlled rod-implant assembly with the “Persuader” Immediate fixation with sleeve Counter torque easy to position Secure sleeve purchase Good seat on the rod Synthes...

  • Page 6: Indications And Contraindications

    Indications and Contraindications Intended use The USS II System is a posterior pedicle screw and hook sys- tem (T1–S2), developed for precise and segmental stabiliza- tion of the spine. Anterior cancellous bone screws can also be used in the thoracolumbar spine.

  • Page 7: Implant Handling Using The Stick

    USS Hook and Screwholder, with hexagonal socket 4.0 mm Attach handle to stick Press the knurled release button on the top end of the handle and simultaneously push the USS hook and screwholder, known as the “stick”, into the handle. Synthes...
  • Page 8 Insert stick into implant. Turn release button in a clockwise direction and pick up the implant. Release handle from stick Insert the implant. Press the release button on the handle to detach the handle from the stick. Synthes USS II Handling technique...

  • Page 9: Insert Pedicle Screw

    2.3 mm, length 275 mm 388.622 Handle for USS Hook and Screwholder No. 388.612 388.612 USS Hook and Screwholder, with hexagonal socket 4.0 mm Optional instruments 388.608 Pedicle Marker USS II, with spherical bulges 388.609 Pedicle Marker USS II, with long bulges Synthes...
  • Page 10 Insert the screw at the thoracolumbar junction at an angle of 5 –10° to the midline (5a). Insert the screw at the L2 – L5 level at an angle of 10 –15° (5b). 5–10° 5–10° 10–15° 10–15° Synthes USS II Handling technique...
  • Page 11 10 mm (1). Open the pedicle further using one of the USS pedicle probes with markings at 30, 40 and 50 mm (2). Screw Pedicle Awl Pedicle Probe (mm) 388.551 388.538 ( 2.8 mm) 5.2, 6.2 388.550 388.540 ( 3.8 mm) 388.550 388.539 ( 4.8 mm) Synthes...
  • Page 12 Determine the length of the pedicle screw with the depth gauge for pedicle screws. Probe pedicle channel Use the straight or curved feeler to probe the pedicle screw channel to check the wall for perforations. (1) Synthes USS II Handling technique...
  • Page 13 (2). The bulges show the depth at 10 mm in- tervals (3). The use of pedicle markers with bulges of two dif- ferent shapes facilitates differentiation between the left and right pedicle. 10 mm 10 mm Synthes...
  • Page 14 (1). Press the release button to detach the handle from the stick (2). Note: If using a rod connector, align the screw head such that one of the openings is perpendicular to the rod. Synthes USS II Handling technique...

  • Page 15: Position Pedicle Hook

    Screwdriver, hexagonal, small, 2.5 mm, with groove Optional instruments 388.512 USS II Pedicle Feeler, length 300 mm, for small hooks 388.530 USS Chisel, width 9 mm The special feature of USS pedicle hooks is the fact that they can be anchored securely in the pedicle with a single...
  • Page 16 Move the feeler in a lateral and cranial direction to check for the optimum position. Do not push medially. Remove the pedicle feeler. Synthes USS II Handling technique...
  • Page 17 Note: Use a front-opening hook if a rod connector is re- quired to connect the hook to the longitudinal rod. Insert the hook positioner for USS II into the screw hole of the pedicle hook and move the hook into the prepared posi- tion.
  • Page 18 Note: Do not start the power drill if the bit does not hit bone after passing through the drill sleeve. Remove the drill sleeve and determine the depth of the hole using the depth gauge. Synthes USS II Handling technique...
  • Page 19 Insert screw 3.2 mm Pick up a suitable screw for the pedicle hook with the hold- ing sleeve and the hexagonal screwdriver, and insert it in the pre-drilled hole. The pedicle hook is now firmly attached to the pedicle. Synthes...

  • Page 20: Position Lamina Hook

    388.612 USS Hook and Screwholder, with Hexagonal Socket 4.0 mm 388.632 Hook Positioner for USS II Optional instrument 388.521 USS Small Stature/Paediatric Lamina Feeler Prepare seat for lamina hook The lamina hook can be placed around either the superior or inferior portion of the lamina.
  • Page 21 Note: Use a front-opening hook if a rod connector is needed. Insert the hook positioner for USS II in the positioning hole of the hook and move the lamina hook into the prepared posi- tion. The inferior part of the lamina hook must fit snugly with the lamina.

  • Page 22: Angled Lamina Hook Positioning

    388.612 USS Hook and Screwholder, with hexagonal socket 4.0 mm 388.632 Hook Positioner for USS II Optional instrument 388.521 USS Small Stature/Paediatric Lamina Feeler Prepare seat for angled lamina hook Remove the soft tissue from the transverse process. Place a...
  • Page 23 Pick up the angled lamina hook as described on page 5 and Note: Use a front-opening hook if a rod connector is needed. Insert the hook positioner for USS II in the positioning hole of the hook and move the angled lamina hook into the pre- pared position.

  • Page 24: Rod Contouring

    5.0 mm, length 150/500 mm 388.961 Bending Pliers with Rolls for USS Rods 5.0 mm, with radius adjustment 388.911/922 USS Small Stature/Paediatric Bending Iron for Rods 5.0 mm, left/right 388.441 Holding Forceps for USS Small Stature/Paediatric Rods 5.0 mm Synthes USS II Handling technique...
  • Page 25 In such cases, the dual opening and the offset of the heads of the pedicle screws and the hooks mean that the spacing can be compensated for with- out the rod having to be bent. Synthes...

  • Page 26: Locking Implants To Rods Variation A: Place Sleeve And Nut Consecutively

    Variation A: Place Sleeve and Nut Consecutively Instruments 388.582 Sleeve Pusher for Nos. 388.503, 388.508, 388.583 and 388.161 388.161 Sleeve Positioner for USS II 388.584 Socket Wrench for twelve point nut, with L-handle 388.143 Socket wrench 5.0 mm, with T-handle 388.338...
  • Page 27 If the sleeve cannot be located easily, place it on the implant by tapping lightly on the sleeve pusher. The hook positioner for USS II can be used for this purpose by placing it in the round indentation on the handle of the sleeve pusher.
  • Page 28 T-handle. To tighten the nut further, lift the L-handle of the socket wrench with the right hand and engage it again. Note: If using a 6 mm rod, a few threads will remain visible on the nut. Synthes USS II Handling technique...

  • Page 29: Variation B: Place Sleeve And Nut In A Single Operation

    Socket Wrench, with straight handle, for USS-II nuts and sleeves 388.584 Socket Wrench for twelve point nut, with L-Handle 388.143 Socket Wrench, 5.0 mm, with T-handle 388.338 Screwdriver 4.0 mm, with T-handle 388.612 USS Hook and Screwholder, with hexagonal socket 4.0 m Synthes...
  • Page 30 The sleeve can only be picked up in a specific position. One leg of the holding sleeve is marked with an arrow. This must be located above the narrow-lipped side of the sleeve. (3) Synthes USS II Handling technique...
  • Page 31 T-handle. To tighten the nut further, lift the L-handle of the socket wrench with the right hand and engage it again. Note: If using a 6 mm rod, a few threads will remain visible on the nut. Synthes...

  • Page 32: Variation C: Rod Introduction Pliers ("Persuader")

    With the rod introduction pliers for USS II, the persuader, dual-opening implants can be lifted and drawn on to the rod. Rod and implant are fixed directly with the sleeve.
  • Page 33 Use the attached sleeve pusher to pick up a sleeve from the loading station. The shorter leg of the sleeve pusher must be above the narrow-lipped side of the sleeve (2). The handle of the sleeve pusher must be located on the side of the per- suader with the arrow. Synthes...
  • Page 34 (1). The fork-shaped opening of the counter torque must point upwards. Release the lever so that the fork of the counter torque engages in the hexagonal socket of the stick (2). Synthes USS II Handling technique...
  • Page 35 Remove the counter torque/support for rod introduction pliers. Note: Do not apply too much force on the anchorage of the implant or it will tear out of the bone. Synthes...
  • Page 36 If necessary, a light tap on the sleeve pusher may help. The hook positioner for USS II may be used for this pur- pose: place it in the round indentation on the handle of the sleeve pusher.

  • Page 37: Final Tightening Of Nut

    Instruments 388.145 Socket Wrench, hexagonal, 5.0 mm with T-Handle 03.602.042 Torque-limiting Handle, 12 Nm, for USS II 388.612 USS Hook and Screwholder, with hexagonal socket, 4.0 mm Use the torque limiting handle to tighten the nut firmly. In- sert the hexagonal socket wrench 5.0 mm with T-handle...

  • Page 38: Distraction Or Compression Of Adjacent Implants

    Before tightening the nut on the implant, use the spreader for distraction or the compression forceps for compression. * X = 2 : Stainless Steel X = 4 : TAN Synthes USS II Handling technique...
  • Page 39 The appropriate holding forceps for 5 mm or 6 mm rods may be used instead of a fixation ring. Attach forceps to rod and perform the distraction or compression operation. * X = 2: Stainless Steel X = 4: TAN Synthes...

  • Page 40: Insertion Of Vertebral Body Screws With Washer (Anterior Approach)

    They distribute the force of the screw over the bone. The angled washer forms a fixed angle with the screw and counteracts pull-out of the screw. * For optional long instruments, see page 70. Synthes USS II Handling technique...
  • Page 41 Pick up a vertebral body screw with dual opening according to the description on page 5 and 6. Insert the screw in the prepared vertebral body until the screw head is well seated. Press the release button on the handle to detach the handle from the stick. Synthes...
  • Page 42 5 and 6. Insert the screw in the prepared vertebral body until the screw head is well seated. (3) Press the release button to detach the handle from the stick. Synthes USS II Handling technique...

  • Page 43: Optional: Attach Anterior Connecting Clamp

    Attach the handle to the hook and screwholder and pick up the anterior connecting clamp. Apply the connecting clamp to the 6 mm rod and tighten the set screw finger-tight. Final tightening of the screw is performed at the end. Synthes...
  • Page 44 Pre-drill screw hole Open up the vertebral body with the pedicle awl through the screw hole in the clamp. Insert screw Determine the screw length and insert the screw with the handle and hook and screwholder. Synthes USS II Handling technique...
  • Page 45 Final tightening Tighten the set screw firmly with the handle and the hook and screwholder. Repeat Steps 1 to 4 for the second connecting clamp. Synthes...

  • Page 46: Connecting Rod And Implant Using Rod Connector

    Position the rod connector on the rod, and insert the ribbed part of the rod connector in the hook or the front-opening screw. Screw the set screw of the rod connector tight using the small hexagonal screwdriver. Synthes USS II Handling technique...
  • Page 47 Tighten the nut firmly with the socket wrench for twelve point nut, with L-handle, and apply countertorque using the socket wrench 5.0 mm, with T-handle, mounted on the stick. Note: Use only the toothed, violet sleeve with rod connec- tors. Synthes...

  • Page 48: Connecting Two Rods

    Retract the holding sleeve slightly, place the clamp on the rod and let go of the holding sleeve. Synthes USS II Handling technique...
  • Page 49 Repeat the procedure described in Step 1 for the second clamp on the opposite rod. Pass the cross-link rod 3.5 mm through the hole in the second clamp so that it projects 5 mm above the clamp. Tighten the set screw firmly with the small hexagonal screw- driver. Synthes...
  • Page 50 Distract cross-link assembly (optional) Loosen one of the set screws, place the holding forceps next to the clamp and carry out the distraction with the spreader forceps. Re-tighten the set screw tightly with the small hexagonal screwdriver. Synthes USS II Handling technique...

  • Page 51: Variation B: Connecting Two 6 Mm Rods

    In the case of transverse connectors with variable length, the set screw in the middle must be tightened so that the length remains at the set position. Note: If any of the instrumentation has to be changed, all the set screws in the transverse connector must be loosened. Synthes...

  • Page 52: Variation C: Connecting Two 5 Mm Rods

    Outside the operating field pass a cross-link rod of a suitable length through the two cross-link clamps (1). Either one right and one left clamp (1a) or two identical clamps (1b) can be used depending on the spatial conditions. Synthes USS II Handling technique...
  • Page 53 (1c). Push the rod of the cross-link clamp with rod through the second cross-link clamp. Do not tighten the set screws firmly at this stage. Synthes...
  • Page 54 The 3.5 mm cross-link rod can be angled up to ±15° (3). If the transverse connector cannot be clicked on to the rod, loosen the fixing screws for the rod completely at both cross- link clamps. Synthes USS II Handling technique...
  • Page 55 2.5 mm (2). Distract cross-link assembly (optional) Loosen one of the set screws with the small hexagonal screw driver, place the holding forceps next to the relevant clamp and carry out the distraction with the spreader forceps. Retighten the set screws. Synthes...
  • Page 56 Implants are available in titanium alloy (TAN) and stainless steel (SSt). For titanium alloy, the X in the article number must be replaced with a 4, for stainless steel with a 2. USS II Pedicle Screws with dual opening and dual-core diameter – Rounded tip with thread –...
  • Page 57 Thoracic 499.284/285 Angled, lumbar 499.286/287 Tall body, small 499.288/289 Tall body, medium 499.290/291 Tall body, large USS II Lamina Hooks, angled With dual side opening or front opening (when using rod connectors) X99.280/282 Right X99.281/283 Left USS II Sleeves 499.302 For Rods 6.0 mm, TAN, violet...
  • Page 58 Implants USS II Nuts X99.294 Twelve point USS Rods 6.0 mm For fractures and deformities 498.102–119 Rods, hard, length 50–500 mm, pure titanium, gold 298.102–119 Rods, hard, length 50–500 mm, stainless steel For deformities 498.290–296 Rods, extra-hard, length 200–500 mm, TAN, turquoise...
  • Page 59 498.491–496 Rods, extra-hard, length 150–500 mm, TAN, dark blue 298.491–496 Rods, extra-hard, length 150–500 mm, stainless steel USS II Rod Connectors for Rods 6.0 mm X99.295–297 Rod Connectors, open, length 15–25 mm USS II Rod Connectors for Rods 5.0 mm X98.227–229...
  • Page 60 3.5/6.0 mm, TAN, blue 498.169 Extension Connector 3.5/5.0 mm, TAN, blue X98.159 Parallel Connector 5.0 mm X98.160 Parallel Connector 6.0 mm X98.162 Parallel Connector 5.0/6.0 mm 498.959 Parallel Connector 3.5/5.0 mm 498.960 Parallel Connector 3.5/6.0 mm Synthes USS II Handling technique...
  • Page 61 For 5 mm rods 499.310 Cross-link clamp for rods 5.0 mm, right 499.311 Cross-link clamp for rods 5.0 mm, left 499.306 Cross-link clamp with rod, for rods 5.0 mm X97.871– Transverse Connector, X97.879 low profile for Rods 5.0 mm Synthes...
  • Page 62 Washers for Anterior Vertebral Body Screws 6.2 and 8.0 mm X99.403/404 Flat, external diameter 13.0/15.0 mm X99.401/402 Angled, external diameter 13.0/15.0 mm Anteriore Verbindungsbacke 496.400 Left 496.405 Right 496.420–460 Anterior vertebral body screw 7.0, length 20–60 mm Synthes USS II Handling technique...
  • Page 63 4.8 mm, length 230 mm 388.540 Pedicle Probe 3.8 mm, length 230 mm 388.545 Feeler for Screw Channel, straight, 2.3 mm, length 275 mm 388.546 Feeler for Screw Channel, curved, 2.3 mm, length 275 mm 388.550 Pedicle Awl, 4.0 mm, length 230 mm Synthes...
  • Page 64 3.0 mm, length 230 mm, for screws 4.2 mm 388.608 Pedicle Marker USS II, with spherical bulges 388.609 Pedicle Marker USS II, with long bulges 388.612 USS Hook and Screwholder, with hexagonal socket 4.0 mm 388.622 Handle for USS Hook and Screwholder No.
  • Page 65 1.5 to 2.0 mm, measuring range up to 38 mm 387.060 Handle for Drill Sleeve 2.0 388.381 Holding Sleeve for Fillister Head Screws 388.510 USS Pedicle Feeler, length 300 mm 388.512 USS II Pedicle Feeler, length 300 mm, for small hooks Synthes...
  • Page 66 Instruments 388.520 USS Lamina Feeler, length 300 mm 388.521 USS Small Stature/Paediatric Lamina Feeler 388.530 USS Chisel, width 9 mm 388.581 USS Drill Sleeve 2.0 388.632 Hook Positioner for USS II Synthes USS II Handling technique...
  • Page 67 5.0 mm, with T-handle 388.145 Socket Wrench, hexagonal 5.0 mm, with T-handle 388.159 Socket Wrench with straight handle, for USS II Nuts and Sleeves 388.161 Sleeve Positioner for USS II 388.163 Holding Sleeve for No. 388.159, for Rods 5.0 and 6.0 mm 388.338...
  • Page 68 Compression Forceps for USS Small Stature/Paediatric 388.440 Holding Forceps with broad tip for Rods 6.0 mm, length 290 mm 388.441 Holding Forceps 5.0 mm for USS Small Stature/Paediatric Rods 388.508 Rod Introduction Pliers for Rods 6.0 mm Synthes USS II Handling technique...
  • Page 69 388.584 Socket Wrench for twelve point nut, with L-Handle 388.615 Counter Torque for Rod Introduction Pliers 388.750 USS Rod Cutting and Bending Device 388.870/880 Trial Rod 6.0 mm, length 150/400 mm 388.906/907 Trial Rod 5.0 mm, length 150/500 mm Synthes...
  • Page 70 USS Small Stature/Paediatric Bending Iron for Rods 5.0 mm, right 388.960 Bending Pliers with Rolls for USS Rods 6.0 mm, length 300 mm 388.961 Bending Pliers with Rolls for USS Rods 5.0 mm, with radius adjustment Synthes USS II Handling technique...
  • Page 71 3.5/4.5 mm, length 295 mm 385.807 Inserter for Angled Washers 6.0 to 8.0 mm 388.360 USS Holding Sleeve for No. 314.070 388.363 Holding Sleeve with Catches, for No. 314.070 03.620.021 Template for Transverse Connectors low profile, for Rods 6.0 mm Synthes...
  • Page 72 4.0 mm, long, with T-Handle 388.379 USS Holding Sleeve, long, for No. 388.339 388.148 Socket Wrench, long, with straight handle, for USS II Nuts and Sleeves 388.164 Holding Sleeve, long, for No. 388.148 388.143 Socket Wrench 5.0 mm, with T-handle 314.070...
  • Page 73 Synthes...
  • Page 74 II System, can be found in the Chapter entitled “Modular Stabilization System: The Universal Spine System”, in Aebi M, Thalgott JS, Webb JK (1998) AO ASIF Principles in Spine Surgery. Springer Berlin, Heidelberg, 123, et seq. Synthes USS II Handling technique...
  • Page 76 Ö036.000.212öABWä Synthes GmbH Eimattstrasse 3 All technique guides are available as PDF files at CH-4436 Oberdorf 0123 www.synthes.com/lit www.synthes.com...

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