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4. APPENDIX

Titanium Alloy

ELEMENT

MINIMUM %

MAXIMUM %

Nitrogen

—

0.05

Carbon

—

0.08

Hydrogen

—

0.012

Iron

—

0.25

Oxygen

—

0.13

Aluminum

5.5

6.5

Vanadium

3.5

4.5

Titanium

Balance

Cobalt Chromium Alloy

ELEMENT

MINIMUM %

MAXIMUM %

Carbon

—

0.14

Aluminum

—

—

Lanthanum

—

—

Chromium

26

30

Molybdenum

5

7

Nickel

—

1

Iron

—

0.75

Silicon

—

1

Manganese

—

1

Nitrogen

—

0.25

Cobalt

Balance

DePuy Synthes Companies

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EXPEDIUM VERSE System

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System Guide

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Summary of Contents for EXPEDIUM VERSE

Page 1: ...SYSTEM GUIDE EXPEDIUM VERSE Spinal System...

Page 2: ......

Page 3: ...gnment Devices 16 Residual Cement Removal 16 ROD INSERTION 17 Rod Contouring 17 Rod Placement 18 POLYAXIAL TO MONOAXIAL CONVERSION 19 CORRECTION MANEUVERS 20 Segmental Translation 20 Set Screw Inserti...

Page 4: ...gn The EXPEDIUM VERSE Pedicle Screw serves as a powerful instrument to facilitate correction maneuvers The result is a significant reduction in the number of instruments required for fusion procedures...

Page 5: ...favored angle provides up to 84 of angulation providing the benefits of a side loading implant with the ease of use of a top tightening system X25 Drive Feature For the first time in an EXPEDIUM 5 5 P...

Page 6: ...nd 8mm Available in screw lengths 30 80mm in 5mm increments 6 fenestrations for screws 45mm and longer 3 fenestrations for screws 40mm and shorter FIGURE 4 The benefits of Polyaxial Screw plus Instrum...

Page 7: ...lated design Cortical Fix Thread Form Doubles the number of contact points within the cortical wall of the pedicle and increases the resistance to axial pull out forces compared to standard EXPEDIUM a...

Page 8: ...hin the pedicle and increases the resistance to pull out ultimately enhancing fixation within the pedicle If more fixation is required the fenestrated tip of the Fenestrated Cortical Fix Polyaxial Scr...

Page 9: ...ures With fewer cases when compared to a traditional instrument based system the EXPEDIUM VERSE System reduces the costs associated with reprocessing and offers the potential to shorten the surgical s...

Page 10: ...hallenge of complex pathologies EXPEDIUM VERSE Implants are available in an extensive range of sizes providing surgeons thoracolumbar and pelvic fixation options for adolescent and adult pathologies A...

Page 11: ...uired for cement delivery For set content details please refer to the product catalogue at the end of this document Pedicle Preparation and Screw and Rod Delivery Reduction Derotation Compression and...

Page 12: ...0 Curved Thoracic Pedicle Probe 2997 04 115 Straight Lumbar Pedicle Probe 2997 04 120 Curved Lumbar Pedicle Probe 2997 04 125 130 Ball Tip Feeler Straight Curved Identify screw entry point and penetra...

Page 13: ...urgeon preference Clear surrounding soft tissue and bony anatomy to allow for full screw angulation Choose appropriate tap size per table Start with a smaller tap diameter and complete sequential tapp...

Page 14: ...e by depressing the button and then removing the tap SCREW DELIVERY Equipment Polyaxial Driver Assembly Comprised of 2997 04 152 Poly Driver Handle 2997 04 155 Poly Driver Shaft 2997 04 160 Poly Drive...

Page 15: ...equired the Ratcheting T Handle can be used Once the pedicle screw is inserted make sure the polyaxial head does not interfere with the bony anatomy so that the polyaxiality of the head is retained To...

Page 16: ...ylet 2797 26 511 Mini Cleaning Stylet If enhanced fixation in the pedicle and the vertebral body is desired the EXPEDIUM VERSE Fenestrated Polyaxial Screw provides a fenestrated screw shank will accom...

Page 17: ...the V Max Mixing and Delivery System and the Vertebroplastic Radiopaque Resinous Material the CONFIDENCE System Luer Adapter 2839 99 001 is screwed onto the cannula before attaching those systems onto...

Page 18: ...amount of cement has been introduced stop cement introduction as indicated per the respective bone cement technique Disengage the cannula from the alignment guide by depressing the tabs on each side o...

Page 19: ...voir from the cannula and proceed with plunger insertion REMOVAL OF ALIGNMENT DEVICES After the cement introduction the alignment devices can be unthreaded from the screw head RESIDUAL CEMENT REMOVAL...

Page 20: ...the rod A French Rod Bender and in situ sagittal and coronal benders are available in the set for rod contouring Caution Do not reverse bend rods Reverse bending may produce internal stresses which m...

Page 21: ...e which allows for alignment of the screw head positioning facilitating rod insertion Use the Rod Clamp to insert the rod into the openings of the EXPEDIUM VERSE Implants Place the rod into the openin...

Page 22: ...ick FIGURE 31 There are two ways to engage the Facilitator or Quick Stick instruments First the open end of the Counter Torque Handle can be used to engage the flats on the proximal end of the tubular...

Page 23: ...ring the spine to the contoured rod allowing for coronal correction to occur 1 2 11 The EXPEDIUM VERSE Spinal System provides extended tabs with 17mm of reduction The combination of the reduction tabs...

Page 24: ...rallel compression and distraction and derotation maneuvers If dual stage locking is not required the Unitized Set Screw 1997 21 001 is also provided for one step locking of the screw head and rod For...

Page 25: ...the Rod Lock advances beyond the Poly Lock prior to final tightening Independent poly and rod locking is not achievable The Key Inserter Tightener may not properly engage the implant If the inner set...

Page 26: ...formed by aligning the sagittal contour of the rod with the sagittal plane of the patient This technique will further translate the spine to the rod Either the Rod Clamp or the Double End 5 5 Rod Hex...

Page 27: ...means to obtain derotational correction with a single implant type FIGURE 46 By tightening the Correction Key Poly Lock and using Facilitators or Quick Sticks vertebral body derotation VBD can be perf...

Page 28: ...ick Tube With the Quick Stick Sleeve in the retracted position align the slots of the Quick Stick with the rod slot of the implant Holding only the Quick Stick Tube press the instrument onto the impla...

Page 29: ...one simultaneously to distribute stress at the bone screw interface The rotation of the concave screws will help decrease the torsion and will lift the concavity out of the chest Derotation will bring...

Page 30: ...t these levels FIGURE 51 Apply facilitators to the distal anchors of the neutral segment Place another two facilitators on the next proximal level A Quick Stick must be attached to the concave screw a...

Page 31: ...k to the contralateral concave side The Facilitator Quick Stick on the neutral level must be used to apply a counter force as the rotated segment is corrected to a neutral position The EXPEDIUM Derota...

Page 32: ...been reduced on the concave side Once the concave side is fully reduced convert all screws to monoaxial implants by final tightening the Poly Lock Using a counter torque instrument final tighten the P...

Page 33: ...locking the outer portion of the Correction Key it is possible to apply parallel compression distraction between vertebral levels this can be used to level the most proximal and distal level of the co...

Page 34: ...ngage the drive feature of the Poly Lock While applying a counter torque to the Poly Lock loosen the Rod Lock with the X25 Inserter Tightener Selectively loosen or tighten the Rod Lock and apply compr...

Page 35: ...th pedicle screw head and the Correction Keys remaining proud When final tightening revisit set screws at every level starting with the outer portion of the Correction Key working away from the levels...

Page 36: ...Poly Lock Rod Lock or Unitized Set Screw Tighten until there is a tactile release which indicates that the required 80in lb 9Nm of torque has been applied Repeat this process for all levels If require...

Page 37: ...E 62 Do not twist the instrument during tab removal Following reduction tab breakage the instrument can immediately be applied to the next tab This instrument has been designed to hold up to 40 tabs T...

Page 38: ...P NOTCH Feature slight rotational or pulling forces should not displace the instrument Next grasping the hex end of the Threaded Insert insert it into the Flex Clip Rotating the Threaded Insert in the...

Page 39: ...DePuy Synthes EXPEDIUM VERSE System Guide 30...

Page 40: ...997 04 140 Tear Drop Handle Ratcheting x2 ITEM NUMBER DESCRIPTION 2997 04 040 4 35mm Double Lead Tap 2997 04 050 5mm Double Lead Tap 2997 04 060 6mm Double Lead Tap 2997 04 070 7mm Double Lead Tap 299...

Page 41: ...97 04 152 Poly Driver Handle x2 2997 04 155 Poly Driver Shaft x2 2997 04 160 Poly Driver Sleeve x2 2997 04 165 Head Adjuster 2997 04 180 Double End 5 5 Rod Hex Wrench 2997 04 175 Rod Clamp 5 5 x2 2997...

Page 42: ...omprised of 2997 04 270 Flex Clip Reducer Flex Clip 2997 04 272 Flex Clip Reducer Threaded Insert 2 piece 2997 04 275 Flex Clip Reducer Handle ITEM NUMBER DESCRIPTION 2997 04 220 Correction Key Insert...

Page 43: ...Torque Handle Adapter 10mm Hex EXPEDIUM Tab Breaker Assembly Comprised of 2997 04 310 EXPEDIUM Tab Breaker Body 2997 04 315 EXPEDIUM Tab Breaker Cap 2997 04 250 Distractor 5 50mm 2997 04 255 Counter...

Page 44: ...04 200 Sagittal In Situ Bender Right 2997 04 170 French Rod Bender CEMENT DELIVERY Contents ITEM NUMBER DESCRIPTION 2997 04 285 Alignment Device Open 2997 04 295 Alignment Sleeve Open 2797 26 402 Plu...

Page 45: ...er Straight 2997 04 130 Ball Tip Feeler Curved Modular Taps ITEM NUMBER DESCRIPTION 2997 04 040 4 35mm Double Lead Tap 2997 04 050 5mm Double Lead Tap 2997 04 060 6mm Double Lead Tap 2997 04 070 7mm D...

Page 46: ...T Handle Ratcheting 2997 04 140 Tear Drop Handle Ratcheting 2997 04 145 Pencil Handle 2997 04 320 Torque Limiting Handle 80in lb Adapters ITEM NUMBER DESCRIPTION 2997 04 325 Torque Handle Adapter 10m...

Page 47: ...30 X25 Inserter Tightener 2997 04 255 Counter Torque Handle 2997 04 355 Tab Ring ROD REDUCTION AND DEROTATION ITEM NUMBER DESCRIPTION 2997 04 205 Facilitator Quick Stick Assembly Comprised of 2997 04...

Page 48: ...97 04 185 Coronal In Situ Bender Left 2997 04 190 Coronal In Situ Bender Right 2997 04 195 Sagittal In Situ Bender Left 2997 04 200 Sagittal In Situ Bender Right Compression and Distraction ITEM NUMBE...

Page 49: ...eaker Cap CEMENT DELIVERY INSTRUMENTS ITEM NUMBER DESCRIPTION 2997 04 285 Alignment Device Open 2997 04 295 Alignment Sleeve Open 2797 26 500 Open Cannula pre packed sterile single use 2797 26 402 Plu...

Page 50: ...2997 04 801 Instrument 1 Pedicle Prep 2997 04 802 Instrument 1 Screw Rod Insertion 2997 04 805 Graphic Case Instrument 2 2997 04 806 Instrument 2 Reduction Derotation 2997 04 807 Instrument 2 Compress...

Page 51: ...nt 3 Rod Bending 2997 04 815 Graphic Case Implant 1 2997 04 816 Implant 1 Rods Keys and Unitized Set Screws 2997 04 825 Screw Measuring Template 2997 04 830 Key and Unitized Set Screw Caddy 2797 92 10...

Page 52: ...2997 04 835 Graphic Case Fenestrated Instruments 2997 04 840 Generic Outer Half Lid 2997 04 845 Graphic Case Fenestrated Implant 1 2797 92 109 Generic Outer Lid 49 DePuy Synthes Companies EXPEDIUM VE...

Page 53: ...CR 4 35X70 199723475 5 5 EXP VERSE FEN SCR 4 35X75 199723480 5 5 EXP VERSE FEN SCR 4 35X80 199723530 5 5 EXP VERSE FEN SCR 5 0X30 199723535 5 5 EXP VERSE FEN SCR 5 0X35 199723540 5 5 EXP VERSE FEN SCR...

Page 54: ...70 199723675 5 5 EXP VERSE FEN SCR 6 0X75 199723680 5 5 EXP VERSE FEN SCR 6 0X80 199723730 5 5 EXP VERSE FEN SCR 7 0X30 199723735 5 5 EXP VERSE FEN SCR 7 0X35 199723740 5 5 EXP VERSE FEN SCR 7 0X40 19...

Page 55: ...P VERSE FEN SCR 8 0X45 199723850 5 5 EXP VERSE FEN SCR 8 0X50 199723855 5 5 EXP VERSE FEN SCR 8 0X55 199723860 5 5 EXP VERSE FEN SCR 8 0X60 199723865 5 5 EXP VERSE FEN SCR 8 0X65 199723870 5 5 EXP VER...

Page 56: ...1997 21 460 5 5 Ti EXP VERSE SCREW 4 35X60 1997 21 465 5 5 Ti EXP VERSE SCREW 4 35X65 1997 21 520 5 5 Ti EXP VERSE SCREW 5 0X20 1997 21 525 5 5 Ti EXP VERSE SCREW 5 0X25 1997 21 530 5 5 Ti EXP VERSE S...

Page 57: ...7 21 660 5 5 Ti EXP VERSE SCREW 6 0X60 1997 21 665 5 5 Ti EXP VERSE SCREW 6 0X65 1997 21 720 5 5 Ti EXP VERSE SCREW 7 0X20 1997 21 725 5 5 Ti EXP VERSE SCREW 7 0X25 1997 21 730 5 5 Ti EXP VERSE SCREW...

Page 58: ...SCREW 8 0X65 1997 21 870 5 5 Ti EXP VERSE SCREW 8 0X70 1997 21 875 5 5 Ti EXP VERSE SCREW 8 0X75 1997 21 880 5 5 Ti EXP VERSE SCREW 8 0X80 1997 21 885 5 5 Ti EXP VERSE SCREW 8 0X85 1997 21 890 5 5 Ti...

Page 59: ...Oxygen 0 13 Aluminum 5 5 6 5 Vanadium 3 5 4 5 Titanium Balance Cobalt Chromium Alloy ELEMENT MINIMUM MAXIMUM Carbon 0 14 Aluminum Lanthanum Chromium 26 30 Molybdenum 5 7 Nickel 1 Iron 0 75 Silicon 1 M...

Page 60: ...ortant information DePuy Spine Spinal System components should not be used with components from other manufacturers Stainless steel components may interfere with the quality of imaging obtained using...

Page 61: ...de the use of this or any other spinal instrumentation system Any entity or condition that totally precludes the possibility of fusion i e cancer kidney dialysis or osteopenia is a relative contraindi...

Page 62: ...tion Forces Measured During Scoliotic Instrumentation Using Two Different Screw Designs Spine Deformity 94 101 7 F Geiger 2009 September More options in scoliosis patients with the Dual Innie Favored...

Page 63: ...DePuy Synthes EXPEDIUM VERSE System Guide 42 DePuy Synthes Companies EXPEDIUM VERSE System System Guide 60...

Page 64: ...ous fusion in skeletally mature patients When used for posterior non cervical pedicle screw fixation in pediatric patients the EXPEDIUM VERSE System metallic implants are indicated as an adjunct to fu...

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