Vectra, Vectra-T and Vectra-One. Anterior cervical plating for spinal fusion.

Transcription

1 Vectra, Vectra-T and Vectra-One. Anterior cervical plating for spinal fusion. Technique Guide Instruments and implants approved by the AO Foundation

2 Table of Contents Introduction Vectra, Vectra-T and Vectra-One Systems 2 AO Principles 6 Indications 7 Surgical Technique Preparation 8 Implant Selection 10 Option 1: Awl and Self-drilling Screws 12 Option 2: Drill Guide and Self-tapping Screws 13 Option 3: DTS Guide and Self-tapping 16 and Self-drilling Screws Implant Removal 21 Product Information Instruments 22 Set Lists 25 Synthes Spine

3 Vectra, Vectra-T and Vectra-One Systems Vectra, Vectra-T and Vectra-One Plates One-step locking Prelordosed Bend grooves Titanium alloy plates* Integral Elgiloy clips** lock screws to plate Vectra and Vectra-T plates feature large graft visibility windows. Vectra Plate width: 16.5 mm Plate profile: thin medial profile of 2.5 mm Option of toggling screws Vectra-T Plate width: 19 mm Plate profile: thin medial profile of 2.5 mm Option of toggling screws Designed for translation Vectra-One Plate width: 11 mm Plate profile: thin overall profile of 2.5 mm Option of toggling screws Minimized foot print *Ti-6Al-7Nb **40Co-20Cr-16Fe-15Ni-7Mo 2 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

4 Vectra-T Cranial End Allows translation of up to 2 mm at each level. Carriage on cranial end of 3- and 4- level plates allows translation of up to 3 mm. 2 mm 3 mm 2 mm 2 mm 2 mm 2 mm Caudal End Vectra-One Features pyramidal teeth on the underside of the plate to aid in rotational stability. Synthes Spine 3

5 Vectra, Vectra-T and Vectra-One Systems continued Vectra Variable-angle screws Fixed-angle screws 22º -6º 14º -14º 8 offset 28 range 28 range 8 offset offset 14 range Vectra-T Variable-angle screws Fixed-angle screws 22º -6º 8 offset 14º -14º 8 offset 6º 20º 13 offset 28 range Vectra-One 28 range 14 range Variable-angle screw Variable-angle screw Fixed-angle screw 18º -10º 14º -14º 7º -7º 4 offset 28 range 28 range 4 offset 14 range Gold line Blue line Green line Pink line Normal to the plate Fixed angle screw offset Normal to the vertebral bodies Variable angle screw range of angulation 4 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

6 Screws Color code indicates function and diameter Screw color code Variable-angle Variable-angle screws can be oriented from preset trajectories ±14º in the cranial-caudal direction and ±7º in the medial-lateral direction Violet Blue 4.0 mm 4.5 mm Self-drilling Fixed-angle screws have preset trajectories, as shown Fixed-angle Brown 4.0 mm Medium green 4.5 mm Self-drilling screws shown; same color code applies to self-tapping screws. Self-tapping Synthes Spine 5

7 AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation. 1 They are: Anatomic reduction Stable fixation Preservation of blood supply Early, active 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 Principles as Applied to the Spine 3 Anatomic alignment In the spine, this means reestablishing and maintaining the natural curvature and protective function of the spine. By regaining this natural anatomy, the biomechanics of the spine can be improved, and a reduction of pain can be experienced. Stable internal fixation In the spine, the goal of internal fixation is to maintain not only the integrity of a mobile segment, but also maintain the balance and the physiologic three-dimensional form of the spine. 3 A stable spinal segment allows bony fusion at the junction of the lamina and pedicle. Preservation of blood supply The proper atraumatic technique enables minimal retraction or disturbance of the nerve roots and dura, and maintains the stability of the facet joints. The ideal surgical technique and implant design minimize damage to anatomical structures, i.e. facet capsules and soft tissue attachments remain intact, and create a physiological environment that facilitates healing. Early, active mobilization The ability to restore normal spinal anatomy may permit the immediate reduction of pain, resulting in a more active, functional patient. The reduction in pain and improved function can result when a stable spine is achieved. 1. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger: Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag Ibid. 3. M. Aebi, J.S. Thalgott, and J.K. Webb. AO ASIF Principles in Spine Surgery. Berlin: Springer-Verlag Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

8 Indications The Vectra and Vectra-T Systems are intended for anterior plate and screw fixation of the cervical spine (C2 C7) for the following indications: Degenerative disc disease (DDD) (defined as neck pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies) Spondylolisthesis Spinal stenosis Tumors (primary and metastatic) Failed previous fusions Pseudarthrosis Deformity (i.e., kyphosis, lordosis and/or scoliosis) The Vectra-One system is intended for anterior plate and screw fixation of the cervical spine (C2 C7) for the following indications: Degenerative disc disease (DDD) (defined as neck pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies) Contraindications Certain degenerative diseases or underlying physiological conditions such as diabetes or rheumatoid arthritis may alter the healing process, thereby increasing the risk of implant breakage. Mental or physical impairment, which compromises or prevents the patient s ability to comply with necessary limitations or precautions, may place that patient at a particular risk during postoperative rehabilitation. Factors such as the patient s weight, activity level, and adherence to weight-bearing or load-bearing instructions have an effect on the stresses to which the implant is subjected. Contraindications for the use of Synthes Vectra Systems include active systemic infection or infection localized to the site of the proposed implantation. Any entity or condition that totally precludes the possibility of fusion, i.e., cancer, kidney dialysis, or osteopenia are relative contraindications. Other relative contraindications include obesity and foreign body sensitivity. In addition, the patient s activity level or mental capacity may be relative contraindications to this surgery. Warnings/precautions These devices are not approved for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic, or lumbar spine. Synthes Spine 7

9 Preparation 1 Preparation Required set for Vectra Vectra Instrument and Titanium Implant Set Required set for Vectra-T Vectra-T Instrument and Titanium Implant Set Required sets for Vectra-One Vectra-One Plate Set and Vectra Instrument and Titanium Implant Set or Vectra-T Instrument and Titanium Implant Set 2 Preoperative planning All necessary imaging studies should be available to plan cervical plate and screw placement and accommodate varying patient anatomy. 8 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

10 3 Position patient Patient positioning is critical for cervical fusion procedures. The patient should be placed on the operating table in a supine position with the patient s head securely immobilized. Confirm proper patient position by direct visualization before draping, and by radiograph. Always use caution when positioning the patient, as physiological alignment may not be attainable. 4 Approach Make a standard approach, to appropriately expose the cervical levels to be surgically treated. 5 Select and insert graft Instrument * Calipers Following the approach and decompression, insert the appropriately sized graft. Note: For recommended grafting technique, refer to the Synthes ACF Spacer Technique Guide. *Also available Synthes Spine 9

11 Implant Selection 1 Select plate Instrument Cervical Plate Bender Select a plate with appropriate hole spacing. After plate length has been determined, ensure that the prelordosed plate fits the anatomy. The plate contour can be adjusted using the cervical plate bender at the bend grooves of the plate. Caution: Repeated bending may weaken the plate. Do not bend the plate at the holes. Increase lordotic bend Decrease lordotic bend Vectra-T: Bending the shortest 1- and 2-level Vectra-T plates ( , , , and ) may impede the trans lational mechanism and is not recommended. These plates are made with additional lordosis. Vectra-One: Bending the shortest Vectra-One plates ( and ) is not recommended. 10 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

12 2 Secure with temporary fixation pins Cranial End Instruments Temporary Fixation Pin Insertion Screwdriver, self-retaining * Holding Sleeve, for Temporary Fixation Pin When the plate is positioned appropriately, secure it with a temporary fixation pin, using the insertion screwdriver and, if needed, the additionally available holding sleeve. All 3- and 4-level Vectra-T plates are designed with a recommended cranial end the end with the elongated holes. With the Vectra-T System, a stable discectomy-corpectomy combination can be achieved by allowing a corpectomy to be done on the cranial end and the discectomy to be done at the caudal end. Note: If the discectomy is done above the corpectomy, turn the plate around for optimal fixation. Caudal End Alternative techniques a. Using extraction screwdriver Temporary Fixation Pin Extraction Screwdriver To insert the temporary fixation pin, use the extraction screwdriver threaded into the top of the pin. b. Using temporary fixation pin driver * Temporary Fixation Pin Driver * Temporary Fixation Pin After the plate is placed in the appropriate position, secure it with the alternative temporary fixation pin inserted using the temporary fixation pin driver. *Also available Synthes Spine 11

13 Option 1: Awl and Self-drilling Screws (Variable-angle) 3 Break cortex Instrument Awl, for self-retaining screws Insert the awl into the screw hole at the desired screw angle. Push down and twist awl handle. Remove the awl by pulling straight up. Do not angle or lever the awl to either side. 4 Insert variable-angle screw Instrument Insertion Screwdriver, self-retaining Load the appropriate length variable-angle self-drilling screw onto the insertion screwdriver. Advance the screw until the head of the screw is fully seated in the plate and the plate is lagged to the bone. Notes: Vectra-T: Only variable-angle screws are recommended in the elongated holes of 3- and 4-level plates. The screwhead geometry of fixed-angle screws may impede translation. Any screw may be placed in the round screw holes. The total amount of translation can be customized (e.g., for a corpectomy) by removing carriage spacers and moving the carriages within the allowable range before screw placement. The carriage on the cranial end (for 3- and 4- level plates only) can translate 3 mm while all other carriages can translate 2 mm. Intermediate elongated holes allow screws to translate up to 2 mm. Vectra-One: Ensure that the pyramidal teeth are fully seated within the bone. 12 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

14 Option 2: Drill Guide and Self-tapping Screws (Variable-angle/ Fixed-angle) 5 Vectra-T only: Remove carriage spacers Once the Vectra-T construct is complete, use forceps to remove the carriage spacers. Note: All carriage spacers must be removed after screw insertion. The plate is now free to translate. Option 2 Steps 1 and 2 (see pages 10 and 11) 3 Select drill guide Instruments Single Barrel Drill Guide, fixed angle Single Barrel Drill Guide, variable angle 4.0 mm 4.5 mm 4.0 mm 4.5 mm Choose either the fixed- or variable-angle single-barrel drill guide. Color bands on the drill guides correspond to the color of the screws associated with each guide Notes: Insert the tip of the drill guide at an angle, as shown, and rotate the instrument forward until the tip is engaged. The tip of the drill guide snaps into the clip in the plate hole. The awl may be used with either the fixed- or variable-angle single-barrel drill guide to break the cortex. Synthes Spine 13

15 Option 2: Drill Guide and Self-tapping Screws (Variable-angle/ Fixed-angle) continued 4 Drill pilot hole Instruments Quick Coupling Handle mm Drill Bits with stop mm 18 mm Insert the drill guide by rocking it into the screw hole. Use the appropriate length drill bit with stop and quick coupling handle to drill the pilot hole for the screw. The depth stop will contact the drill guide to limit drilling depth. 5 Remove drill guide Remove the drill guide by pulling straight up to disengage it from the clip. Do not angle or lever the guide to either side. 6 Insert screw Instrument Insertion Screwdriver Optional instruments * Tap, for 4.0 mm Cancellous Bone Screw * Tap, for 4.5 mm Cancellous Bone Screw 14 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

16 6 Insert screw continued Load the appropriate length variable-angle or fixed-angle self-tapping screw onto the insertion screwdriver. Advance the screw until the head of the screw is fully seated in the plate and the plate is lagged to the bone. Notes: Vectra-T: Only variable-angle screws are recommended in the elongated holes of 3- and 4-level plates. The screwhead geometry of fixed-angle screws may impede translation. Any screw may be placed in the round screw holes. The total amount of translation can be customized (e.g., for a corpectomy) by removing carriage spacers and moving the carriages within the allowable range before screw placement. The carriage on the cranial end (for 3- and 4- level plates only) can translate 3 mm while all other carriages can translate 2 mm. Intermediate elongated holes allow screws to translate up to 2 mm. Vectra-One: Ensure that the pyramidal teeth are fully seated within the bone. 7 Vectra-T only: Remove carriage spacers Once the Vectra-T construct is complete, use forceps to remove the carriage spacers. Note: All carriage spacers must be removed after screw insertion. The plate is now free to translate. *Also available Synthes Spine 15

17 Option 3: DTS Guide and Self-tapping and Self-drilling Screws Steps 1 and 2 (See pages 10 and 11) 3 Insert drill, tap and screw (DTS) guide, with post Instrument Drill, Tap and Screw Guide, with post (single barrel) Use the DTS guide in the small post holes for fixed-angle screws, or in the diamond window for variable-angle screws. DTS guide post holes indicate the end of the elongated hole where screws must be inserted for translation (Vectra-T only). Note: The awl may be used with the DTS guide to break the cortex. Caution: The DTS guide may only be used for soft tissue protection. If the DTS guide is used for tissue retraction, the DTS guide may break and could potentially harm the patient. Alternative for Vectra-One Instrument Plate-Holding Drill, Tap and Screw (DTS) Guide, Vectra-One 12º 0º Plate-holding drill, tap and screw (DTS) guide (for variable-angle screws only) The Vectra plate-holding DTS guide holds the plate as shown. Two DTS tubes allow preset angulations at +12º and 0º. Use 0º for middle holes on the 2-level plates. Note: Do not place fixed-angle screws with this plate-holding DTS guide. For fixed-angle screws use: Fixed-angle Single Barrel Drill Guide [ ] DTS Guide [ ] Plate-Holding Drill Guide [ *] *Also available 16 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

18 4 Drill Instruments Drill, Tap and Screw Guide, with post (single barrel) mm Drill Bits with stop mm 18 mm Optional instruments * Tap, for 4.0 mm Cancellous Bone Screws * Tap, for 4.5 mm Cancellous Bone Screws Awl, for self-retaining cervical screws Insert the appropriate length drill bit through the barrel of the DTS guide and drill the hole. The depth stop will contact the DTS guide to limit drilling depth. Alternative: Insert the awl through the barrel of the DTS guide, pushing down while twisting the awl handle. *Also available Synthes Spine 17

19 Option 3: DTS Guide and Self-tapping and Self-drilling Screws continued 4 Drill continued Alternative for Vectra-One Instrument Plate-Holding Drill, Tap and Screw (DTS) Guide, Vectra-One Use the plate-holding DTS guide to hold the appropriate size plate. Use the appropriate length drill bit with stop and quick coupling handle to drill the pilot hole for the screw. The depth stop will contact the guide to limit drilling depth. 18 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

20 5 Insert screw Instruments Drill, Tap and Screw Guide, with post, (single barrel) Insertion Screwdriver, self-retaining Insert the appropriate length screw through the barrel of the DTS guide and advance it until the screwhead almost engages the plate (as indicated by the groove on the screwdriver shaft lining up with the top of the DTS guide). Retract the DTS guide by pulling it along the screwdriver shaft, just before the screw seats in the plate hole, to visually confirm that the screw is seating. Advance the screw until it lags the plate to the bone. Notes: Vectra-T: Only variable-angle screws are recommended in the elongated holes of 3- and 4-level plates. The screwhead geometry of fixed-angle screws may impede translation. Any screw may be placed in the round screw holes. The total amount of translation can be customized (e.g., for a corpectomy) by removing carriage spacers and moving the carriages within the allowable range before screw placement. The carriage on the cranial end (for 3- and 4- level plates only) can translate 3 mm while all other carriages can translate 2 mm. Intermediate elongated holes allow screws to translate up to 2 mm. Vectra-One: Ensure that the pyramidal teeth are fully seated within the bone. Synthes Spine 19

21 Option 3: DTS Guide and Self-tapping and Self-drilling Screws continued 6 Vectra-T only: Remove carriage spacers Once the Vectra-T construct is complete, use forceps to remove the carriage spacers. Note: All carriage spacers must be removed after screw insertion. The plate is now free to translate. 20 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

22 Implant Removal 1 Screwhead cleaning Instrument Screw Head Cleaning Tool If access to the screwhead is blocked by tissue, use the screwhead cleaning tool to clean out material. Insert the tool into the screwhead and twist the handle back and forth until material is removed. 2 Screw removal Instrument Extraction Screwdriver To remove the screw, the extraction screwdriver must be used. Insert the driver shaft into the screwhead recess. Thread the inner shaft into the mating thread of the screw by turning the inner shaft knob clockwise until fully tightened. 1 2 Caution: If the inner shaft knob is not fully tightened to the handle, breakage of the driver may occur and could potentially harm the patient. Advance the sleeve downward to contact the upper surface of the plate by turning the sleeve clockwise. While holding the sleeve, turn the handle counterclockwise to extract the screw. Note: After two screw removals from one hole of the plate, the plate must be replaced. 3 4 Caution: The extraction screw driver should only be used for screw removal; use of the extraction screwdriver for screw insertion may lead to driver and/or implant breakage. Synthes Spine 21

23 Instruments Single Barrel Drill Guide, fixed angle Single Barrel Drill Guide, variable angle Cervical Plate Bender 22 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

24 Temporary Fixation Pin Driver, for Drill, Tap and Screw Guide, with post (single barrel) Plate-holding Drill, Tap and Screw Guide, Vectra-One Temporary Fixation Pin Screw Head Cleaning Tool Temporary Fixation Pin Synthes Spine 23

25 Instruments continued Insertion Screwdriver, self-retaining Quick Coupling Handle, with swivel cap Awl, for self-retaining cervical screws 2.5 mm Drill Bits with stop mm mm mm Extraction Screwdriver 24 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

26 Vectra Instrument and Titanium Implant Set ( ) The Vectra Instrument and Titanium Implant Set ( ) consists of: Vectra Instrument Set Titanium Vectra Plate Set Titanium Vectra Screw Set Instruction Label, for Extraction Screwdriver Vectra Instrument Set ( ) Graphic Case Graphic Case, for Vectra Instrument and Titanium Implant Set Instruments Single Barrel Drill Guide, fixed angle Single Barrel Drill Guide, variable angle Drill, Tap and Screw Guide, with post (single barrel) Screw Head Cleaning Tool Temporary Fixation Pin, 3 ea Insertion Screwdriver, self-retaining, 2 ea Quick Coupling Handle, with swivel cap Awl, for self-retaining cervical screws mm Drill Bit with stop, 14 mm, 2 ea mm Drill Bit with stop, 16 mm, 2 ea mm Drill Bit with stop, 18 mm, 2 ea Extraction Screwdriver Universal Plate Bender For additional information, please refer to the package insert. Synthes Spine 25

27 Vectra Instrument and Titanium Implant Set ( ) continued Titanium Vectra Plate Set ( ) Modules Module, for 4-level Titanium Vectra Plates, 60 mm 76 mm Module, for 4-level Titanium Vectra Plates, 80 mm 100 mm Module, for 3-level Titanium Vectra Plates Module, for 1- and 2-level Titanium Vectra Plates Implants Hole pair Total One-Level Titanium Vectra Plates length (mm) 12 length (mm) 21 Qty Two-Level Titanium Vectra Plates Hole pair Total Three-Level Titanium Vectra Plates length (mm) 45 length (mm) 54 Qty Four-Level Titanium Vectra Plates Module Four-Level Titanium Vectra Plates Module Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

28 Titanium Vectra Screw Set ( ) Module, for Titanium Vectra Screws Titanium Variable-angle Screws 4.0 mm Cervical Self-Retaining Screws, self-drilling Length (mm) Qty mm Cervical Self-Retaining Screws, self-tapping Length (mm) Qty mm Cervical Self-Retaining Screws, self-drilling Length (mm) Qty mm Cervical Self-Retaining Screws, self-tapping L ength (mm) Qty Titanium Fixed-angle Screws 4.0 mm Cervical Self-Retaining Screws, self-drilling Length (mm) Qty mm Cervical Self-Retaining Screws, self-tapping Length (mm) Qty mm Cervical Self-Retaining Screws, self-drilling Length (mm) Qty mm Cervical Self-Retaining Screws, self-tapping Length (mm) Qty For additional information, please refer to the package insert. Synthes Spine 27

29 Vectra-T Instrument and Titanium Implant Set ( ) The Vectra-T Instrument and Titanium Implant Set ( ) consists of: Vectra-T Instrument Set Titanium Vectra-T Plate Set Titanium Vectra Screw Set Instruction Label, for Extraction Screwdriver Vectra-T Instrument Set ( ) Graphic Cases Graphic Case, for Vectra-T Instrument and Titanium Implant Set Label Sheet, for Titanium Vectra Screws Label Sheet, for Titanium Vectra Screws Instruments Single Barrel Drill Guide, fixed angle Single Barrel Drill Guide, variable angle Cervical Plate Bender Drill, Tap and Screw Guide, with post, (single barrel) Screw Head Cleaning Tool Temporary Fixation Pin, 3 ea Insertion Screwdriver, self-retaining, 2 ea Quick Coupling Handle, with swivel cap Awl, for self-retaining cervical screws mm Drill Bit with Stop, 14 mm, 2 ea mm Drill Bit with Stop, 16 mm, 2 ea mm Drill Bit with Stop, 18 mm, 2 ea Extraction Screwdriver Note: For Titanium Vectra Screw Set ( ), see page 27 For additional information, please refer to the package insert. 28 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

30 Titanium Vectra-T Plate Set ( ) Modules Module, for Titanium Vectra-T Plates, 4 level, 60 mm 76 mm Module, for Titanium Vectra-T Plates, 4 level, 80 mm 100 mm Module, for Titanium Vectra-T Plates, 1 and 2 levels Module, for Titanium Vectra-T Plates, 3 level Implants One-Level Titanium Vectra-T Plates Hole pair length (mm) 14 Total length (mm) 23 Qty Two-Level Titanium Vectra-T Plates Hole pair Total Three-Level Titanium Vectra-T Plates length (mm) 45 length (mm) 54 Qty Four-Level Titanium Vectra-T Plates Module Four-Level Titanium Vectra-T Plates Module Synthes Spine 29

31 Vectra-One Instrument and Titanium Implant Set ( ) Module Module, for Titanium Vectra-One Plates Instrument Plate-Holding Drill, Tap and Screw Guide, Vectra-One Implants Hole pair Total One-Level Titanium length length Vectra-One Plates (mm) (mm) Qty Two-Level Titanium Vectra-One Plates For compatible screws, see page 32. For additional information, please refer to the package insert. 30 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

32 Also Available for Vectra, Vectra-T and Vectra-One Expanded Graphic Case, for Vectra and Vectra-T (holds Instrument tray and 18 modules) Module, for Titanium Vectra Screws 22 mm and 24 mm Temporary Fixation Pin Driver Outer Sleeve, for Awl, non-engaging Insertion Screwdriver, self-retaining, short Temporary Fixation Pin Tap for 4.0 mm Cancellous Bone Screws Tap for 4.5 mm Cancellous Bone Screws Caliper Templates, for Anterior Cervical Locking and Compression Plates Holding Sleeve, for Temporary Fixation Pin Label Sheet, for Titanium Vectra Screws (part numbers) (for Vectra System only) Instruction Label, for Extraction Screwdriver Label Sheet, for Titanium Vectra Screws (for Vectra System only) Inner Shaft, for Extraction Screwdriver Drill Bits and Stop 2.5 mm Drill Bits with stop mm mm mm mm mm mm 3.0 mm Drill Bits with stop ** 12 mm ** 13 mm mm ** 15 mm mm ** 17 mm ** 18 mm ** 19 mm ** 20 mm mm Drill Bit, graduated 12 mm 26 mm adjustable depth Adjustable Drill Stop Guides Plate Holding Drill Guide, single barrel, fixed angle Drill, Tap and Screw Guide (without post, single barrel) Drill, Tap and Screw Guide, with handle, single barrel Drill, Tap and Screw Guide, double barrel, Vectra Drill, Tap and Screw Guide, double barrel, Vectra-T Compression Drill Guide 2.5 mm Drill Bits with stop, short mm mm mm mm mm mm mm mm mm ** Available while supplies last. Synthes Spine 31

33 Also Available for Vectra, Vectra-T and Vectra-One continued Titanium Variable-angle Screws 4.0 mm Cervical Self-Retaining Screws, self-drilling mm mm mm mm mm mm 4.0 mm Cervical Self-Retaining Screws, self-tapping mm mm mm mm mm mm 4.5 mm Cervical Self-Retaining Screws, self-drilling mm mm mm mm mm mm 4.5 mm Cervical Self-Retaining Screws, self-tapping mm mm mm mm mm mm 4.0 mm Cervical Self-Retaining Cortex Screws, self-tapping mm mm 4.5 mm Cervical Self-Retaining Cortex Screws, self-tapping mm mm Titanium Fixed-angle Screws 4.0 mm Cervical Self-Retaining Screws, self-drilling mm mm mm mm mm mm 4.0 mm Cervical Self-Retaining Screws, self-tapping mm mm mm mm mm mm 4.5 mm Cervical Self-Retaining Screws, self-drilling mm mm mm mm mm mm 4.5 mm Cervical Self-Retaining Screws, self-tapping mm mm mm mm mm mm Titanium Vectra Plates Titanium Vectra Plate, 1 level, 12 mm (21 mm total length) Titanium Vectra Plate, 2 level, 26 mm (35 mm total length) Titanium Vectra Plate, 3 level, 39 mm (48 mm total length) Titanium Vectra Plate, 3 level, 42 mm (51 mm total length) 32 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

34 Synthes Spine 1302 Wrights Lane East West Chester, PA Telephone: (610) To order: (800) Fax: (610) Synthes (Canada) Ltd Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) To order: (800) Fax: (905) Synthes, Inc. or its affiliates. All rights reserved. Vectra and Synthes are trademarks of Synthes, Inc. or its affiliates. Printed in U.S.A. 2/10 J8275-A