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

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

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

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

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

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 14 0 7 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

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

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. 1991. 2. Ibid. 3. M. Aebi, J.S. Thalgott, and J.K. Webb. AO ASIF Principles in Spine Surgery. Berlin: Springer-Verlag. 1998. 6 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

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

Preparation 1 Preparation Required set for Vectra 01.613.001 Vectra Instrument and Titanium Implant Set Required set for Vectra-T 01.613.200 Vectra-T Instrument and Titanium Implant Set Required sets for Vectra-One 01.613.150 Vectra-One Plate Set and 01.613.001 Vectra Instrument and Titanium Implant Set or 01.613.200 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

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 324.06* 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

Implant Selection 1 Select plate Instrument 03.600.004 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 (450.551, 450.552, 450.561, 450.562 and 450.563) 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 (04.613.150 and 04.613.152) is not recommended. 10 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

2 Secure with temporary fixation pins Cranial End Instruments 324.101 Temporary Fixation Pin 324.105 Insertion Screwdriver, self-retaining 352.312* 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 324.105 Alternative techniques a. Using extraction screwdriver 324.101 Temporary Fixation Pin 352.311 352.311 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 324.101 03.600.104* Temporary Fixation Pin Driver 03.613.026* Temporary Fixation Pin 03.600.104 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 03.613.026 Synthes Spine 11

Option 1: Awl and Self-drilling Screws (Variable-angle) 3 Break cortex Instrument 324.111 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 324.105 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

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 03.600.002 Single Barrel Drill Guide, fixed angle 03.600.003 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. 03.600.002 03.600.003 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

Option 2: Drill Guide and Self-tapping Screws (Variable-angle/ Fixed-angle) continued 4 Drill pilot hole Instruments 324.107 Quick Coupling Handle 324.153 2.5 mm Drill Bits with stop 324.157 14 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 324.105 Insertion Screwdriver Optional instruments 311.402* Tap, for 4.0 mm Cancellous Bone Screw 311.404* Tap, for 4.5 mm Cancellous Bone Screw 14 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

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

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 03.613.001 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 03.613.025 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 [03.600.002] DTS Guide [03.613.001] Plate-Holding Drill Guide [03.600.006*] *Also available 16 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

4 Drill Instruments 03.613.001 Drill, Tap and Screw Guide, with post (single barrel) 324.153 2.5 mm Drill Bits with stop 324.157 14 mm 18 mm Optional instruments 311.402* Tap, for 4.0 mm Cancellous Bone Screws 311.404* Tap, for 4.5 mm Cancellous Bone Screws 324.111 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

Option 3: DTS Guide and Self-tapping and Self-drilling Screws continued 4 Drill continued Alternative for Vectra-One Instrument 03.613.025 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

5 Insert screw Instruments 03.613.001 Drill, Tap and Screw Guide, with post, (single barrel) 324.105 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

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

Implant Removal 1 Screwhead cleaning Instrument 324.071 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 352.311 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

Instruments 03.600.002 Single Barrel Drill Guide, fixed angle 03.600.003 Single Barrel Drill Guide, variable angle 03.600.004 Cervical Plate Bender 22 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

03.600.104 Temporary Fixation Pin Driver, for 03.613.026 03.613.001 Drill, Tap and Screw Guide, with post (single barrel) 03.613.025 Plate-holding Drill, Tap and Screw Guide, Vectra-One 03.613.026 Temporary Fixation Pin 324.071 Screw Head Cleaning Tool 324.101 Temporary Fixation Pin Synthes Spine 23

Instruments continued 324.105 Insertion Screwdriver, self-retaining 324.107 Quick Coupling Handle, with swivel cap 324.111 Awl, for self-retaining cervical screws 2.5 mm Drill Bits with stop 324.153 14 mm 324.155 16 mm 324.157 18 mm 352.311 Extraction Screwdriver 24 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

Vectra Instrument and Titanium Implant Set (01.613.001) The Vectra Instrument and Titanium Implant Set (01.613.001) consists of: 01.613.003 Vectra Instrument Set 01.613.004 Titanium Vectra Plate Set 01.613.005 Titanium Vectra Screw Set 690.827 Instruction Label, for Extraction Screwdriver Vectra Instrument Set (01.613.003) Graphic Case 690.160 Graphic Case, for Vectra Instrument and Titanium Implant Set Instruments 03.600.002 Single Barrel Drill Guide, fixed angle 03.600.003 Single Barrel Drill Guide, variable angle 03.613.001 Drill, Tap and Screw Guide, with post (single barrel) 324.071 Screw Head Cleaning Tool 324.101 Temporary Fixation Pin, 3 ea. 324.105 Insertion Screwdriver, self-retaining, 2 ea. 324.107 Quick Coupling Handle, with swivel cap 324.111 Awl, for self-retaining cervical screws 324.153 2.5 mm Drill Bit with stop, 14 mm, 2 ea. 324.155 2.5 mm Drill Bit with stop, 16 mm, 2 ea. 324.157 2.5 mm Drill Bit with stop, 18 mm, 2 ea. 352.311 Extraction Screwdriver 387.684 Universal Plate Bender For additional information, please refer to the package insert. Synthes Spine 25

Vectra Instrument and Titanium Implant Set (01.613.001) continued Titanium Vectra Plate Set (01.613.004) Modules 304.966 Module, for 4-level Titanium Vectra Plates, 60 mm 76 mm 304.967 Module, for 4-level Titanium Vectra Plates, 80 mm 100 mm 304.968 Module, for 3-level Titanium Vectra Plates 304.969 Module, for 1- and 2-level Titanium Vectra Plates Implants Hole pair Total One-Level Titanium Vectra Plates 04.613.012 length (mm) 12 length (mm) 21 Qty. 1 04.613.014 14 23 1 04.613.016 16 25 2 04.613.018 18 27 2 04.613.020 20 29 1 04.613.022 22 31 1 04.613.024 24 33 1 04.613.026 26 35 1 Two-Level Titanium Vectra Plates 04.613.126 26 35 1 04.613.128 28 37 1 04.613.130 30 39 1 04.613.132 32 41 2 04.613.134 34 43 2 04.613.136 36 45 2 04.613.138 38 47 1 04.613.140 40 49 1 04.613.142 42 51 1 04.613.144 44 53 1 04.613.146 46 55 1 Hole pair Total Three-Level Titanium Vectra Plates 04.613.245 length (mm) 45 length (mm) 54 Qty. 1 04.613.248 48 57 1 04.613.251 51 60 1 04.613.254 54 63 1 04.613.257 57 66 1 04.613.260 60 69 1 04.613.263 63 72 1 04.613.266 66 75 1 04.613.269 69 78 1 Four-Level Titanium Vectra Plates Module 1 04.613.360 60 69 1 04.613.364 64 73 1 04.613.368 68 77 1 04.613.372 72 81 1 04.613.376 76 85 1 Four-Level Titanium Vectra Plates Module 2 04.613.380 80 89 1 04.613.384 84 93 1 04.613.388 88 97 1 04.613.392 92 101 1 04.613.396 96 105 1 04.613.400 100 109 1 26 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

Titanium Vectra Screw Set (01.613.005) 304.986 Module, for Titanium Vectra Screws Titanium Variable-angle Screws 4.0 mm Cervical Self-Retaining Screws, self-drilling Length (mm) Qty. 04.613.514 14 12 04.613.516 16 12 04.613.518 18 6 4.0 mm Cervical Self-Retaining Screws, self-tapping Length (mm) Qty. 04.613.614 14 12 04.613.616 16 12 04.613.618 18 6 4.5 mm Cervical Self-Retaining Screws, self-drilling Length (mm) Qty. 04.613.564 14 12 04.613.566 16 12 04.613.568 18 6 4.5 mm Cervical Self-Retaining Screws, self-tapping L ength (mm) Qty. 04.613.664 14 12 04.613.666 16 12 04.613.668 18 6 Titanium Fixed-angle Screws 4.0 mm Cervical Self-Retaining Screws, self-drilling Length (mm) Qty. 04.613.714 14 12 04.613.716 16 12 04.613.718 18 6 4.0 mm Cervical Self-Retaining Screws, self-tapping Length (mm) Qty. 04.613.814 14 12 04.613.816 16 12 04.613.818 18 6 4.5 mm Cervical Self-Retaining Screws, self-drilling Length (mm) Qty. 04.613.764 14 12 04.613.766 16 12 04.613.768 18 6 4.5 mm Cervical Self-Retaining Screws, self-tapping Length (mm) Qty. 04.613.864 14 12 04.613.866 16 12 04.613.868 18 6 For additional information, please refer to the package insert. Synthes Spine 27

Vectra-T Instrument and Titanium Implant Set (01.613.200) The Vectra-T Instrument and Titanium Implant Set (01.613.200) consists of: 01.613.203 Vectra-T Instrument Set 01.613.204 Titanium Vectra-T Plate Set 01.613.005 Titanium Vectra Screw Set 690.827 Instruction Label, for Extraction Screwdriver Vectra-T Instrument Set (01.613.203) Graphic Cases 60.613.200 Graphic Case, for Vectra-T Instrument and Titanium Implant Set 690.812 Label Sheet, for Titanium Vectra Screws 690.860 Label Sheet, for Titanium Vectra Screws Instruments 03.600.002 Single Barrel Drill Guide, fixed angle 03.600.003 Single Barrel Drill Guide, variable angle 03.600.004 Cervical Plate Bender 03.613.001 Drill, Tap and Screw Guide, with post, (single barrel) 324.071 Screw Head Cleaning Tool 324.101 Temporary Fixation Pin, 3 ea. 324.105 Insertion Screwdriver, self-retaining, 2 ea. 324.107 Quick Coupling Handle, with swivel cap 324.111 Awl, for self-retaining cervical screws 324.153 2.5 mm Drill Bit with Stop, 14 mm, 2 ea. 324.155 2.5 mm Drill Bit with Stop, 16 mm, 2 ea. 324.157 2.5 mm Drill Bit with Stop, 18 mm, 2 ea. 352.311 Extraction Screwdriver Note: For Titanium Vectra Screw Set (01.613.005), see page 27 For additional information, please refer to the package insert. 28 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

Titanium Vectra-T Plate Set (01.613.204) Modules 306.981 Module, for Titanium Vectra-T Plates, 4 level, 60 mm 76 mm 306.982 Module, for Titanium Vectra-T Plates, 4 level, 80 mm 100 mm 306.983 Module, for Titanium Vectra-T Plates, 1 and 2 levels 306.984 Module, for Titanium Vectra-T Plates, 3 level Implants One-Level Titanium Vectra-T Plates 450.551 Hole pair length (mm) 14 Total length (mm) 23 Qty. 1 450.552 16 25 2 450.553 18 27 2 450.554 20 29 1 450.555 22 31 1 450.556 24 33 1 450.557 26 35 1 Two-Level Titanium Vectra-T Plates 450.561 28 37 1 450.562 30 39 1 450.563 32 41 2 450.564 34 43 2 450.565 36 45 2 450.566 38 47 1 450.567 40 49 1 450.568 42 51 1 450.569 44 53 1 450.570 46 55 1 Hole pair Total Three-Level Titanium Vectra-T Plates 450.571 length (mm) 45 length (mm) 54 Qty. 1 450.572 48 57 1 450.573 51 60 1 450.574 54 63 1 450.575 57 66 1 450.576 60 69 1 450.577 63 72 1 450.578 66 75 1 450.579 69 78 1 Four-Level Titanium Vectra-T Plates Module 1 450.581 60 69 1 450.582 64 73 1 450.583 68 77 1 450.584 72 81 1 450.585 76 85 1 Four-Level Titanium Vectra-T Plates Module 2 450.586 80 89 1 450.587 84 93 1 450.588 88 97 1 450.589 92 101 1 450.590 96 105 1 450.591 100 109 1 Synthes Spine 29

Vectra-One Instrument and Titanium Implant Set (01.613.151) Module 60.613.150 Module, for Titanium Vectra-One Plates Instrument 03.613.025 Plate-Holding Drill, Tap and Screw Guide, Vectra-One Implants Hole pair Total One-Level Titanium length length Vectra-One Plates (mm) (mm) Qty. 04.613.150 10 19 1 04.613.152 12 21 1 04.613.154 14 23 2 04.613.156 16 25 2 04.613.158 18 27 2 04.613.160 20 29 1 04.613.162 22 31 1 04.613.164 24 33 1 Two-Level Titanium Vectra-One Plates 04.613.176 26 35 1 04.613.178 28 37 1 04.613.180 30 39 1 04.613.182 32 41 1 04.613.184 34 43 1 04.613.186 36 45 1 04.613.188 38 47 1 04.613.190 40 49 1 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

Also Available for Vectra, Vectra-T and Vectra-One 60.613.301 Expanded Graphic Case, for Vectra and Vectra-T (holds Instrument tray and 18 modules) 60.613.321 Module, for Titanium Vectra Screws 22 mm and 24 mm 03.600.104 Temporary Fixation Pin Driver 03.613.020 Outer Sleeve, for Awl, non-engaging 03.613.021 Insertion Screwdriver, self-retaining, short 03.613.026 Temporary Fixation Pin 311.402 Tap for 4.0 mm Cancellous Bone Screws 311.404 Tap for 4.5 mm Cancellous Bone Screws 324.06 Caliper 350.261 Templates, for Anterior Cervical Locking and 350.351 Compression Plates 352.312 Holding Sleeve, for Temporary Fixation Pin 690.812 Label Sheet, for Titanium Vectra Screws (part numbers) (for Vectra System only) 690.827 Instruction Label, for Extraction Screwdriver 690.860 Label Sheet, for Titanium Vectra Screws (for Vectra System only) 03.613.004 Inner Shaft, for Extraction Screwdriver Drill Bits and Stop 2.5 mm Drill Bits with stop 324.151 12 mm 324.152 13 mm 324.154 15 mm 324.156 17 mm 324.158 19 mm 324.159 20 mm 3.0 mm Drill Bits with stop 324.141** 12 mm 324.142** 13 mm 324.143 14 mm 324.144** 15 mm 324.145 16 mm 324.146** 17 mm 324.147** 18 mm 324.148** 19 mm 324.149** 20 mm 03.613.011 2.5 mm Drill Bit, graduated 12 mm 26 mm adjustable depth 03.613.012 Adjustable Drill Stop Guides 03.600.006 Plate Holding Drill Guide, single barrel, fixed angle 03.613.002 Drill, Tap and Screw Guide (without post, single barrel) 03.613.003 Drill, Tap and Screw Guide, with handle, single barrel 03.613.022 Drill, Tap and Screw Guide, double barrel, Vectra 03.613.023 Drill, Tap and Screw Guide, double barrel, Vectra-T 03.614.002 Compression Drill Guide 2.5 mm Drill Bits with stop, short 03.613.112 12 mm 03.613.113 13 mm 03.613.114 14 mm 03.613.115 15 mm 03.613.116 16 mm 03.613.117 17 mm 03.613.118 18 mm 03.613.119 19 mm 03.613.120 20 mm ** Available while supplies last. Synthes Spine 31

Also Available for Vectra, Vectra-T and Vectra-One continued Titanium Variable-angle Screws 4.0 mm Cervical Self-Retaining Screws, self-drilling 04.613.512 12 mm 04.613.513 13 mm 04.613.515 15 mm 04.613.517 17 mm 04.613.519 19 mm 04.613.520 20 mm 4.0 mm Cervical Self-Retaining Screws, self-tapping 04.613.612 12 mm 04.613.613 13 mm 04.613.615 15 mm 04.613.617 17 mm 04.613.619 19 mm 04.613.620 20 mm 4.5 mm Cervical Self-Retaining Screws, self-drilling 04.613.562 12 mm 04.613.563 13 mm 04.613.565 15 mm 04.613.567 17 mm 04.613.569 19 mm 04.613.570 20 mm 4.5 mm Cervical Self-Retaining Screws, self-tapping 04.613.662 12 mm 04.613.663 13 mm 04.613.665 15 mm 04.613.667 17 mm 04.613.669 19 mm 04.613.670 20 mm 4.0 mm Cervical Self-Retaining Cortex Screws, self-tapping 04.614.622 22 mm 04.614.624 24 mm 4.5 mm Cervical Self-Retaining Cortex Screws, self-tapping 04.614.672 22 mm 04.614.674 24 mm Titanium Fixed-angle Screws 4.0 mm Cervical Self-Retaining Screws, self-drilling 04.613.712 12 mm 04.613.713 13 mm 04.613.715 15 mm 04.613.717 17 mm 04.613.719 19 mm 04.613.720 20 mm 4.0 mm Cervical Self-Retaining Screws, self-tapping 04.613.812 12 mm 04.613.813 13 mm 04.613.815 15 mm 04.613.817 17 mm 04.613.819 19 mm 04.613.820 20 mm 4.5 mm Cervical Self-Retaining Screws, self-drilling 04.613.762 12 mm 04.613.763 13 mm 04.613.765 15 mm 04.613.767 17 mm 04.613.769 19 mm 04.613.770 20 mm 4.5 mm Cervical Self-Retaining Screws, self-tapping 04.613.862 12 mm 04.613.863 13 mm 04.613.865 15 mm 04.613.867 17 mm 04.613.869 19 mm 04.613.870 20 mm Titanium Vectra Plates 04.613.012 Titanium Vectra Plate, 1 level, 12 mm (21 mm total length) 04.613.126 Titanium Vectra Plate, 2 level, 26 mm (35 mm total length) 04.613.239 Titanium Vectra Plate, 3 level, 39 mm (48 mm total length) 04..613.242 Titanium Vectra Plate, 3 level, 42 mm (51 mm total length) 32 Synthes Spine Vectra, Vectra-T and Vectra-One Technique Guide

Synthes Spine 1302 Wrights Lane East West Chester, PA 19380 Telephone: (610) 719-5000 To order: (800) 523-0322 Fax: (610) 251-9056 Synthes (Canada) Ltd. 2566 Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) 567-0440 To order: (800) 668-1119 Fax: (905) 567-3185 www.synthes.com 2010 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