MATRIX Spine System – Degenerative. The total solution ... - Synthes

Technique Guide 

MATRIX Spine System – 

Degenerative. The total solution for 

simple and complex spine pathology.

Table of Contents 

Introduction 

Surgical Technique 

Product Information 

Biomaterials Implants 78 

Image intensifier control 

Warning 

This description alone does not provide sufficient background for direct use of 

the instrument set. Instruction by a surgeon experienced in handling these 

instruments is highly recommended. 

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 

MATRIX Spine System – Degenerative 2 

AO Principles 6 

Indications and Contraindications 7 

Surgical Technique 8 

Optional Technique 29 

Screw Insertion with Retaining Sleeve, Locking 29 

Unassembled Pedicle Screw Insertion 31 

Polyaxial Head Removal 33 

Reduction Screws 34 

Adding Transverse Connectors 36 

Distraction for Posterior Interbody Fusion 37 

Locking Cap Removal 40 

How to Disassemble Instruments for Cleaning 45 

Implants 49 

Instruments 64 

MATRIX Spine System – Degenerative Technique Guide Synthes 1

MATRIX Spine System – 

Degenerative. The total solution for 

simple and complex spine pathology. 

The Synthes MATRIX Spine System is a universal set 

of instruments and implants that cover degenerative 

disorders (open or minimally invasive access), deformities 

and trauma indications. 

Unique Dual Core / 

Double Lead Screw Design 

– Fast and controlled insertion 

– Increased pull-out resistance due to optimal bone 

purchase 

– Safe handling thanks to atraumatic tip and self 

tapping thread 

PrimeLock – Screwdriver – 

Screw Interlock 

– Toggle free screw insertion 

– Precise and controlled screw placement 

– Direction of screw insertion possible 

2 Synthes MATRIX Spine System – Degenerative Technique Guide

Modularity – Click-on and 

Preassembled Screws 

– For better visualization of the anatomical 

structure 

– Multiple screw head removal and replacement 

without removing the bone screw from the 

pedicle 

– Customized inventory possible 

Snap-on Swiveling 

Transverse Connector 

– Offers fast and simple in-situ placement 

– Simple anatomical adjustment possible 


MATRIX Spine System – Degenerative. The total solution for 

simple and complex spine pathology. 

Implants 

Preassembled Polyaxial and 

Reduction Pedicle Screw 

– Allows up to 50° of angulation to ease in situ connection 

to the longitudinal rod 

– The rod reduction features are located at the top of the 

polyaxial head 

– Dual Core/Double Lead thread designed to securely 

anchor the screw in cortical and cancellous bone 

– Threaded T25 Stardrive recess designed to deliver torque 

effectively 

Pedicle Screw 

– Increased visual access to the anatomical structures 

– Allows for improved access to the surgical field 

– Dual Core/Double Lead thread designed to securely 

anchor the screw in cortical and cancellous bone 

– Threaded T25 Stardrive recess designed to deliver torque 

effectively 

Click-on Polyaxial and Reduction 

Screw Head 

– The polyaxial head of the implant is designed for rod 

reduction 

– To ease intraoperative planning, the polyaxial heads can 

be removed and replaced without removing the pedicle 

screw from the pedicle 

– The reduction head allows for 15 mm rod reduction 

4 Synthes MATRIX Spine System – Degenerative Technique Guide 

50° 50° 

15 mm

Rods 

– Available in three material strengths: Hard pure titanium, 

extra-hard titanium alloy (TAN), and extra-hard cobaltchromium 

alloy, diameter 5.5 mm 

– A choice of straight and curved rods to facilitate intraoperative 

construct assembly and technique maneuvers 

Locking Cap 

– Square thread design minimizes cross threading under 

high reduction loads 

– T25 Stardrive recess designed to reduce the risk of 

damage at high loads 

– 1-step locking cap allows for complete fixation in one step 

(polyaxiality and run on rod) 

Transverse Connector 

– The snap-on transverse connector is preassembled and 

requires only final positioning and tightening 

– The jaws of the transverse connector swivel and are 

spring loaded 

– Telescoping body is arched to accommodate grafts and 

anatomical structures and is available in a range of 

lengths 

– The locking screws use a T15 Stardrive which minimizes 

drive stripping while final tightening 

Instruments 

– Ergonomically designed handles 

– Intuitive, easy to use 

– Convenient, interchangeable options 


AO Principles 

In 1958, the AO formulated four basic principles, which have 

become the guidelines for internal fixation. 1 They are: 

– Anatomic reduction 

– Stable internal 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 

Restoration of normal spinal alignment to improve the 

biomechanics of the spine. 

Stable internal fixation 

Stabilization of the spinal segment to promote bony fusion. 

Preservation of blood supply 

Creation of an optimal environment for fusion. 

Early, active mobilization 

Minimization of damage to the spinal vasculature, dura, and 

neural elements, which may contribute to pain reduction and 

improved function for the patient. 

1 Müller ME, Allgöwer M, Schneider R, Willenegger H (1995) Manual of Internal 

Fixation. 3rd, expanded and completely revised ed. 1991. Berlin, Heidelberg, 

New York: Springer 

2 Ibid. 

3 Aebi M, Arlet V, Webb JK (2007). AOSPINE Manual (2 vols.), Stuttgart, New York: 

Thieme 


Indications and Contraindications 

The MATRIX Spine System is a posterior pedicle screw and 

hook fixation system (T1 – S2) intended to provide precise 

and segmental stabilization of the spine for use in skeletally 

mature patients. 

Indications 

– Degenerative disc disease 

– Spondylolisthesis 

– Trauma (i.e. fracture or dislocation) 

– Tumor 

– Stenosis 

– Pseudarthrosis 

– Failed previous fusion 

– Deformities (i.e. scoliosis, kyphosis and/or lordosis) 

Contraindications 

– Osteoporosis 

– In fractures and tumors with severe anterior vertebral 

body disruption, an additional anterior support or column 

reconstruction is required 



1 

Prepare pedicles and determine screw lengths 

Instruments 

388.656 Pedicle Awl 4.0 mm 

with Silicone Handle, length 255 mm, 

for Pedicle Screws 4.0 to 7.0 mm 

388.655 Pedicle Probe 3.7 mm 



Locate pedicles and use the awl to perforate the cortex. Use 

the probe to open the pedicle canal. Using radiographic 

imaging, confirm pedicle location, orientation and depth by 

inserting the probe. When selecting the appropriate length 

screw, use the markings on the probe to determine the 

pedicle depth. 

All MATRIX pedicle screws are self-tapping; however, if tapping 

is preferred, use the appropriate tap and tap handle. 


Optional instruments 

03.632.057 Pedicle Marker for Matrix 

03.632.058 Inserter for Pedicle Marker, for Matrix 

388.657 Pedicle Probe 3.8 mm, curved, 



388.536 Pedicle Probe for Screws 4.2 mm, 

length 240 mm 

388.545 Feeler for Screw Channel, straight, 

2.3 mm, length 275 mm 

388.546 Feeler for Screw Channel, curved, 


388.549 Feeler, straight, with rounded tip 

03.632.103 Tap for Pedicle Screws 3.5 mm, 

length 180 mm 


length 180 mm 


length 180 mm 


length 180 mm 


length 180 mm 


length 180 mm 


length 180 mm 


length 180 mm 

388.654 Ratchet with Handle, 

with Hexagonal Quick Coupling 6.0 mm 



2 

Assemble screwdriver 

Instruments 

03.632.036 Retaining Sleeve, long, for Matrix 5.5 

03.632.072 Screwdriver Shaft Stardrive, T25, long, 

for Matrix 5.5 

03.620.061 T-Handle with Ratchet Wrench and 

with Torque Limiter, 10 Nm 

Slide retaining sleeve on the screwdriver shaft and attach the 

ratchet handle. 


03.616.043 Retaining Sleeve, locking, long 

03.632.074 Screwdriver Stardrive, T25, long, 

with T-Handle, for Matrix 5.5 


with straight handle, for Matrix 

03.616.042 Retaining Sleeve, locking 

03.632.001 Retaining Sleeve, standard, for Matrix 5.5 

03.632.002 Screwdriver Shaft Stardrive, T25, standard, 


03.632.004 Screwdriver Stardrive, with T-Handle, 

standard, for Matrix 5.5 

03.632.005 Screwdriver Stardrive, T25, with straight 

handle, standard, for Matrix 5.5 


3 

Pick up screw 

Instruments 






Choose the appropriate screw diameter and length based on 

pedicle probe feedback. 

Insert the screwdriver tip into the recess of the pedicle screw 

and rotate the green knob of the retaining sleeve clockwise 

until the tip of the sleeve is firmly attached to the pedicle 

screw. 

Verify the screw length with the template provided in the 

screw module. 

Note: Set the ratchet to the neutral position before picking 

up a screw. 

















4 

Insert screw 

Instruments 






Insert the screw. Hold the black part of the retaining sleeve 

during screw insertion. 

To disengage the retaining sleeve, rotate the green knob 

counterclockwise and remove screwdriver. 

Notes: 

– Do not grasp the green knob during screw insertion as 

this will cause the retaining sleeve to disengage from the 

screw. 

– Ensure that the polyaxial screw head remains free to adapt 

its position and is not restricted by, or does not rest on, 

bony structures. If necessary, adjust the screw height 

and/or ream space for the screw head. 

– When countersinking, care should be taken in reaming 

the most superior (and inferior) level to protect the facet 

joints. 

– If pedicle screws with separate polyaxial heads are used, 

follow the optional technique described on page 29. 


Optional Instruments 













handle, standard, for Matrix .5.5 



5 

Select, cut and bend rod 

Instruments 

03.632.007 Alignment Tool for polyaxial Screw Head, 


388.906 Trial Rod 5.0 mm, length 150 mm 

03.632.017 Rod Bender with Silicone Handle 

Use the head alignment tool to rotate and align the screw 

heads. 

Use the trial rod to determine contour and length of the rod. 

Select precontoured rod, or use rod bender to form rod 

according to the template. 

Notes: 

– The screw height must be adjusted to the rod. If necessary, 

adjust the screw height using a screwdriver without retaining 

sleeve. 

– To restore polyaxiality of a screw head that has already 

been tightened, insert the alignment tool in the screw 

head and apply sufficient pressure to release the lock. 




388.750 USS Rod Cutting and Bending Device 

388.720 Bolt Cutter 

Notes: 

– The USS rod cutting and bending device must be used to 

cut cobalt chromium rods. 

– Do not reverse bend rods. Reverse bending may produce 

internal stresses, which may become the focal point for 

eventual breakage of the implant. 



6 

Insert rod 

Instrument 

03.632.081 Rod Holding Forceps for Rods 5.5 mm 

Insert the rod using the rod holding forceps. 

Optional instrument 

03.632.202 Holding Forceps for Rods 5.5 and 

6.0 mm 


7 

Reduce rod 

Option A: Reduce rod with a rod pusher 

Instruments 

03.632.006 Rod Pusher/Counter Torque, standard, 


03.632.080 Handle, detachable, for Matrix 

Connect detachable handle to the octagonal end of the rod 

pusher/counter torque. 

Advance rod into the screw head using the rod pusher/ 

countertorque. 


03.632.076 Rod Pusher/Counter Torque, long, 


03.632.169 Rod Pusher for Rods 5.5/6.0 mm, 

for Matrix 

03.632.000 Distraction Fork 



Option B: 

Reduce rod with a rocker fork 

Instruments 

03.632.010 Rocker Fork, small, for Matrix 5.5 

03.632.012 Rocker Fork, medium, for Matrix 5.5 

03.632.011 Rocker Fork, footed, for Matrix 5.5 

Use a rocker fork to lever the rod into the head of the 

pedicle screw. 

Reduction travels: 

Small Rocker Fork = 8.5 mm 

Medium Rocker Fork = 13.5 mm 

Footed Rocker Fork = 7.5 mm 

Technique tip: Use the footed MATRIX rocker fork to aid in 

reducing the rod into adjacent screw heads. 


Option C: 

Reduce rod with a rod persuader 

Instrument 

03.632.009 Rod Persuader, standard, for Matrix 5.5 

Ensure that the ratchet handle is fully open. Place the rod 

persuader over rod and onto the screw head. Press down 

firmly until the tips engage the head of the screw. Squeeze 

the handle to seat the rod into the head of the pedicle screw. 

Reduction travel: 

15 mm 

Note: The rod persuader can be used as counter torque 

for final tightening of the locking cap. 


03.632.079 Rod Persuader, long, for Matrix 5.5 



Option D: Reduce rod with a reduction instrument 

for Spondylolisthesis 

Instruments 

03.632.408 Reduction Instrument for Spondylolisthesis, 


388.654 Ratchet with Handle, with 

Hexagonal Quick Coupling 6.0 mm 

03.620.091 Socket, hexagonal 6.0 mm 

To assemble the instrument, slide the inner tube through the 

outer tube. Insert the black nut and press down firmly until 

audible feedback. Push the inner tube up towards the black 

nut and turn the black nut clockwise until the black line is 

visible at the 30 line. 

Place the reduction instrument over the screw head. Press 

down firmly until the tips engage. Load the hexagonal socket 

into the ratchet handle and insert it into the top of the 

reduction instrument. 

Rotate the ratchet handle clockwise to reduce the rod into 

the screw head. Full reduction is achieved when the black 

line on the side of the instrument is visible at the 0 line. 

Remove the hexagonal sockel to insert a locking cap through 

the instrument. 

To remove the instrument from the screw head, turn the 

palm handle counter-clockwise until the line on the side of 

the instrument is visible at the 30 line. 

Reduction travel: 

30 mm 


Parallel reduction can be achieved by the simultaneous use 

of two reduction instruments on the same vertebral body. 

Note: The reduction instrument for spondylolisthesis can be 

used as counter torque for final tightening of the locking cap. 


03.632.409 Reduction Instrument for 

Spondylolisthesis, long, for Matrix 5.5 



8 

Insert 1-step locking cap 

Instruments 








Insert the tip of the screwdriver shaft into the T25 recess of 

the locking cap. Press down firmly. The screwdriver shaft is 

self-retaining. 

To ensure optimal cap alignment, insert the locking cap 

through the rod pusher/counter torque. Thread the locking 

cap clockwise into the implant head. 

Apply a light torque to provisionally tighten the locking cap 

and maintain the desired rod position. Place the remaining 

caps and provisionally tighten. 


Note: 

Confirm that the rod is fully aligned to the polyaxial head. (1) 

Examples of misalignment: 

– The rod is sitting high in the polyaxial head. (2) 

– The rod is not perpendicular to the polyaxial head.(3) 

– A severe bend is positioned within the polyaxial head. 

(4a, 4b) 

1 2 

 

3 

4a 

4b 

 

 

 


9 

Distract 

Instruments 

388.410 Spreader Forceps for Pedicle Screws, 

length 330 mm 


straight tip, with Hexagonal Coupling, 

for Matrix 



03.632.049 Counter Torque, standard, for Matrix 5.5 

Precaution: Ensure all locking caps are fully reduced and 

provisionally tightened (see “Insert 1-step locking cap”). Failure 

to do so could potentially lead to a misalignment. 

Finally tighten one locking cap completely to create a fixed 

point for distraction (see “Perform final tightening”). Reverse 

the locking cap of the screw to be relocated a quarter of a 

turn. 

Use the distraction forceps to distract the construct. Once in 

the desired position, tighten the locking caps with the screwdriver. 

The holding forceps can be used as a temporary point of 

distraction when adjacent pedicle screws are too distant 

from each other. 


Note: Always fully seat the counter torque on the rod. The 

instrument must be perpendicular to the rod during tightening. 



6.0 mm 


for Matrix 

03.632.074 Screwdriver Stardrive, T25, long, with 

T-Handle, for Matrix 5.5 


straight handle, for Matrix 



for Matrix 






handle, standard, for Matrix .5.5 

Correct 

 

Incorrect 



10 

Compress 

Instruments 

388.422 Compression Forceps, length 335 mm, 

for Pedicle Screws 



for Matrix 







Finally tighten one locking cap completely to create a fixed 

point for distraction (see “Perform final tightening”). Reverse 

the locking cap of the screw to be relocated a quarter of a 

turn. 

Use the compression forceps to compress the construct. 

Once in the desired position, tighten the locking caps with 

the screwdriver. 

The rod holding forceps can be used as a temporary point of 

compression when adjacent pedicle screws are too distant. 

Note: Always fully seat the counter torque on the rod. The 

instrument must be perpendicular to the rod during tightening. 


03.632.202 Holding Forceps for Rods 5.5 

and 6.0 mm 


Correct 

 

Incorrect

11 

Perform final tightening 

Instruments 





for Matrix 






Note: The handle of the counter torque must be oriented 

laterally or medially. Do not orient the handle of the countertorque 

in line with the rod. This action could cause misalignment 

of the rod with the implant. 

Place the counter torque over the head of the screw. Attach 

the screwdriver shaft T-handle with ratchet wrench and with 

torque limiter. Insert the instrument through the counter 

torque cannula into the drive recess of the locking cap. Ensuring 

that the polyaxial head is perpendicular to the rod, 

tighten until there is a tactile release. This indicates that the 

required 10 Nm of torque has been applied. Repeat for all 

locking caps. 

After initial final tightening of all screws, sequentially revisit 

all locking caps. Start at the caudal left screw of the construct 

and proceed clockwise to systematically repeat final 

tightening of all locking caps of the construct. 

Warning: Final tightening of the locking caps should only 

be performed with a Synthes 10 Nm torque handle. MATRIX 

screw implants achieve performance standard only when 

tightened to the required 10 Nm tightening torque. 

 

Correct 

Incorrect 



Notes: 

– Alternatively, the reduction instrument for spondylo - 

listhesis and the rod persuader can be used as counter 

torque for final tightening of the locking cap. 

– Always fully seat the rod pusher/counter torque on the 

rod. The instrument must be perpendicular to the rod 

during final tightening. 





Spondylolisthesis, standard, for Matrix 5.5 





Spondylolisthesis, long, for Matrix 5.5 

03.632.079 Rod Introduction Pliers, long, 


03.632.099 Counter Torque, long, for Matrix 5.5 


Correct 

 

Incorrect

Optional Technique 

Screw Insertion with Retaining 

Sleeve, Locking 

Insert screw with retaining sleeve, locking 

Instruments 



03.616.043 Retaining Sleeve, locking, long, 


To assemble the screwdriver and the retaining sleeve, depress 

the loading collar on the proximal end of the retaining sleeve 

(1). 

Then slide the sleeve toward the handle on the shaft until it 

stops (2). 

Release the loading collar and verify that the retaining sleeve 

is firmly attached to the screwdriver (3). 

Retract the green locking ring towards the handle (4). 

Place the screwdriver tip securely into the T25 StarDrive 

recess of the pedicle screw (5). 

1 

2 

3 

4 

5 



Screw Insertion with Retaining Sleeve, Locking 

When using a ratchet handle, make sure to set it to neutral 

setting. 

Rotate the grey knob of the retaining sleeve clockwise. Firmly 

tighten to secure the implant, using the handle as countertorque 

(6). 

Push the green locking ring toward the grey knob (7). If 

required, set the ratchet handle to the forward setting to 

insert the screw. 

To release the screw from the retaining sleeve, retract the 

grey locking ring towards the handle, rotate the silver knob 

counterclockwise and remove the screwdriver (8) 

Notes: 

– Polyaxial screwheads need to remain free and mobile after 

insertion to allow accurate alignment to the rod during 

locking cap insertion and final tightening. 

– The mobility of the screwhead cannot be assessed while 

the holding sleeve is attached. 



for Matrix 



03.632.042 Retaining Sleeve, locking, standard, 


03.632.004 Screwdriver Stardrive, T25, standard, 

with T-Handle, for Matrix 






6 

7 

8


Unassembled Pedicle Screw Insertion 

1 

Insert unassembled pedicle screw 

Instruments 



03.632.046 Reamer for Pedicle Screws, for Matrix 5.5 

Prepare the pedicle and insert unassembled pedicle screws as 

recommended in steps 1 to 4 of the surgical technique 

(pages 8 –13). 

Slide reamer over screwdriver shaft. Engage tip of screwdriver 

in unassembled pedicle screw. Ream until the black 

line is visible on the shaft. This indicates that there is enough 

room for the implant head. 

Note: When reaming the most superior and inferior levels 

take care to protect the facet joints. 


03.620.061 T-Handle with Ratchet Wrench and with 

Torque Limiter, 10 Nm 


for Matrix 


straight handle, for Matrix 



03.632.002 Screwdriver Shaft Stardrive, T25, 


03.632.005 Screwdriver Stardrive, T25, with 

straight handle, standard, for Matrix 5.5 



Unassembled Pedicle Screw Insertion 

2 

Assemble polyaxial head 

Instruments 

03.632.037 Positioning Instrument for 

Polyaxial Screw Heads, for Matrix 5.5 

68.632.125 Loading Station for Matrix 5.5 

Insert the inner shaft of the positioning instrument into the 

handle and tighten in the clockwise direction. 

To pick up a screwhead, align the positioning instrument for 

polyaxial screw heads to the rod slot features on the poly - 

axial head implant and press down. 

Position the placement tool with the polyaxial head over the 

unassembled pedicle screw and press down. To ensure the 

polyaxial head is securely attached to the unassembled pedicle 

screw, gently lift up on the placement tool and angulate 

the polyaxial head. 

To release the head placement tool, press the button located 

at the distal end of the instrument. 

Notes: 

– If the polyaxial head does not successfully attach to the 

head of the unassembled pedicle screw, additional reaming 

or screw height adjustment may be required to ensure 

sufficient space exists to allow free mobility of the head. 

– Polyaxial screw heads can be removed a maximum of 

three times without removing the pedicle screw; a new 

head must be used for each assembly. 



Polyaxial Head Removal 

Instruments 

03.632.045 Removal Instrument 

for Polyaxial Screw Heads, for Matrix 5.5 



If required, the polyaxial head can be removed from the 

pedicle screw intraoperatively. 

Remove any existing locking cap and the rod. 

Connect the inner shaft of the removal tool for polyaxial 

screw heads to the ratchet and insert into the handle of the 

removal tool. 

Ensure that the black line is visible on the inner shaft of the 

head removal tool. 

Press the tip of the head removal tool into the polyaxial head. 

A tactile feedback may be felt as the tip of the head removal 

tool mates with the collet of the polyaxial head. While holding 

the handle, thread the inner shaft clockwise until it stops. 

Lift to remove the head. 

To remove the implant head from the instrument, turn the 

ratchet counter-clockwise until the black line is visible. Pull 

the head off the instrument. 

Notes: 

– The head removal tool can be used to remove the polyaxial 

head of both unassembled as well as preassembled 

screws. 

– To remove the polyaxial reduction head, the tabs must 

first be broken off. 



Reduction Screws 

Instruments 



03.632.042 Rod Pusher / Counter Torque 

for Reduction Screw, for Matrix 5.5 


03.632.026 Rod Pusher / Counter Torque 

for Reduction Screws, for Matrix 5.5 

03.632.030 Tab Remover for Reduction Screws, 


Reduction screws are available in preassembled form or as 

click-on versions for subsequent assembly. 

Follow the technique for preassembled polyaxial screw 

(page 10) or unassembled pedicle screw (page 30) to insert 

screw. 

Pick up a locking cap from the screw module with a T25 

screwdriver shaft. The screwdriver shaft is self-retaining. 

Place the rod pusher/counter torque for reduction screws 

(03.632.042) over the screw head. Insert the locking cap 

through the counter torque. Turning the locking cap will 

reduce the rod into the screw head. 


03.620.061 T-Handle with Ratchet Wrench and with 

Torque Limiter, 10 Nm 



03.632.005 Screwdriver Stardrive, T25, with 

straight handle, standard, for Matrix 5.5 

03.632.025 Counter Torque for Reduction Screws, 



T-Handle, for Matrix 


15 mm 

Reduction

To break off the reduction screw tabs, place the rod 

pusher/counter torque for reduction screws (03.632.026) 

with the handle over the screw head. Gently rock the tab 

removal tool medial then lateral to break the tab wall free 

from the polyaxial head. 

Alternative technique for locking cap insertion 

Instrument 

03.632.029 Holding Crown for Reduction Screws, 


The holding crown for reduction screws can be used instead 

of the counter torque to provide guidance for the locking 

cap insertion. 



Adding Transverse Connectors 

Instruments 

03.632.053 Measuring Device for Transverse 

Connectors, Snap-on, for Matrix 

03.632.204 Torque-limiting Handle, 3 Nm 

03.632.052 Screwdriver Stardrive, T15, short, 

for Matrix 

03.632.050 Retaining Sleeve for Transverse 


Use the measuring device for transverse connectors to estimate 

the distance between the two rods. On the crossbar of 

the measuring device note the size of the appropriate transverse 

connector (1 – 8). 

The transverse connectors are marked with sizes 1 – 8, 

matching the figures on the measuring device. Select the 

appropriate transverse connector. 

The ends of the transverse connector can be clicked onto the 

rod to secure it at the desired point. 

Use the screwdriver and the torque limiting handle to secure 

the transverse connector to the rods. When tightening the 

setscrews a tactile release is felt. 

Note: Always use retaining sleeve when tightening the 

setscrew. 

Warning: The MATRIX transverse connector contains Nitinol 

components. Implants that contain nitinol should not be 

used in patients with nickel sensitivities or allergies. 



Distraction for Posterior Interbody 

Fusion 

Instruments 



03.632.085 Retaining Sleeve, detachable, 


03.632.083 Distractor Tip, for Bone Screws, 


03.632.087 Toothed Rack Retractor, for Matrix 

Slide detachable retaining sleeve over long T25 screw driver. 

Slide the distractor tip over the screwdriver tip and press 

firmly into the detachable retaining sleeve. 

Insert the tip of the screwdriver shaft into the screw head. 

Make sure that the tip of the screwdriver is fully seated in the 

recess of the screw head. Turn the green knob clockwise. 

Insert two pedicle screws. 

To release the detachable retaining sleeve from the distractor 

tip, pull the green knob towards the handle. Remove the 

screwdriver and retaining sleeve and repeat the procedure 

for the second pedicle screw. 



Distraction for Posterior Interbody Fusion 

Insert both posts of the distractor into the distractor tips. 

Lock the angular position of the rotatable distractor arm (1) 

by turning the lever. Switch the rocker lever (2) to the distraction 

position (D) and rotate the wing nut screw clockwise until 

the desired distraction is achieved. 

Perform discectomy and interbody fusion. 

Turn the rocker lever (2) to neutral (N) to unlock the angular 

position and remove the distractor. 

Reattach the screwdriver/detachable retaining sleeve and 

turn the green knob counterclockwise. 

Note: Do not allow the assembled tips to cross over otherwise 

the distractor will not work correctly. If necessary, use a 

different type of tip (see page 37). 


2 

1

Alternative instruments 



03.632.084 Distractor Tip, for Screw Heads, 


03.632.089 Distractor Tip, with Hook End, 


Alternative distractor tips and techniques 

Three different distractor tips are available, which can be 

used in a variety of combinations. 

The distractor tip for screws (1) can be used with pedicle, 

polyaxial, and polyaxial reduction screws. Parallel distraction 

can be performed. 

The distractor tip with screw heads (2) can be used with 

polyaxial, polyaxial reduction, and monoaxial screws. They 

are attached to the polyaxial screw head after insertion of 

the pedicle screw. If firmly tightened the screw becomes 

monoaxial, parallel distraction can be performed. These tips 

are particularly suitable for cases where the tips for bone 

screws would cross over as a result of pronounced lordotic 

curvature of the spine. 

The distractor tip with hook end (3) can be used with pedicle, 

polyaxial, and polyaxial reduction screws. Distraction can be 

performed. 

1 

2 

3 



Locking Cap Removal 

Loosen locking cap 

Instruments 





for Matrix 


03.632.080 Handle, detachable, for Matrix 5.5 

To remove a locking cap, slide the counter torque with detachable 

handle over the screwhead. Place the ratchet of the 

torque limiting handle in the neutral position, engage a T25 

screwdriver with the Stardrive recess of the locking cap and 

turn counter-clockwise. 

Note: Locking caps are designed to lock the construct safely 

and minimize the chance of post-operative loosening and 

rod-push-through. Therefore, in certain cases, the loosening 

torque may be higher than 10 Nm. In such cases, use the 

following techniques to remove a locking cap. 


Sequentially turn clockwise and then immediately counterclockwise. 

Turn until tactile or audible feedback from the 

implant is experienced. Repeat the steps until the locking cap 

is loose. 

Notes: 

– For this technique, always use the torque limiting handle 

(03.620.061) to reduce risk of damage to the T25 screwdriver 

shaft. 

– If this method does not produce the desired result, follow 

the technique according to Option A (page 42) or Option 

B (page 44). 






for Matrix 


for Matrix 




If after multiple attempts to loosen the locking cap the 

torque is still excessive, following techniques should be used: 

Option A: Counter torque on a adjacent screw 

Instruments 




straight tip, with Hexagonal 

Coupling, for Matrix 





Place the rod pusher / counter torque with detachable handle 

over an adjacent screw on the same rod (i.e. one level higher 

or lower). Simultaneously place the countertorque over the 

locking cap to be loosened and engage the screwdriver shaft 

and torque limiting handle with the stardrive recess of the 

locking cap. Place the ratchet of the torque limiting handle in 

the neutral position and begin to sequentially turn clockwise 

and then immediately counter-clockwise. Turn until tactile or 

audible feedback from the implant is experienced. Repeat 

the steps until the locking cap is loose. 


Notes: 



shaft. 

– Retighten the locking cap on which the counter torque 

was applied to 10 Nm. 

– To loosen the last locking cap, replace the counter torque, 

consisting of rod pusher/counter torque and handle, with 

a rod persuader. 


the technique according to Option B (page 44). 







for Matrix 


for Matrix 






Option B: 

Apply a downward force to the rod 

Instruments 





for Matrix 



Apply a downward force to the rod. Place the Rod Persuader 

on the screw and firmly squeeze the handles. Place the 

ratchet of the torque limiting handle in the neutral position. 

With the reduction load applied begin to sequentially turn 

clockwise and then immediately counter-clockwise. Turn until 

tactile or audible feedback from the implant is experienced. 

Repeat the steps until the locking cap is loose. 

Notes: 



shaft. 


the technique according to Option A (page 42). 

Optional Instruments 


for Matrix 



for Matrix 





How to Disassemble Instruments 

for Cleaning 

Screwdriver with retaining sleeve 

1 

Screwdriver with detachable retaining sleeve 

1 

4 

2 

2 

5 

3 

3 


How to Disassemble Instruments for Cleaning 

Counter torque 

1 

Positioning instrument for polyaxial screw heads 

1 


1 

2 

2 

2

Head removal tool 

1 2 

Torque limiting handle 

1 2 

2 

1 


How to Disassemble Instruments for Cleaning 

Reduction instrument for spondylolisthesis MATRIX 

1 

Rod persuader MATRIX 

1 


2 3 

2 3

Implants* 

Pedicle Screw Matrix 5.5 Polyaxial 4.0 mm, 

preassembled, Titanium Alloy (TAN) 

length (mm) 

04.632.420 20 

04.632.425 25 

04.632.430 30 

04.632.435 35 

04.632.440 40 

04.632.445 45 



length (mm) 

04.632.520 20 

04.632.525 25 

04.632.530 30 

04.632.535 35 

04.632.540 40 

04.632.545 45 



length (mm) 

04.632.120 20 

04.632.125 25 

04.632.130 30 

04.632.135 35 

04.632.140 40 

04.632.145 45 

04.632.150 50 

04.632.155 55 

04.632.160 60 

*All implants are also available sterile packed. Add suffix “S” to article number. 


Implants* 



length (mm) 

04.632.620 20 

04.632.625 25 

04.632.630 30 

04.632.635 35 

04.632.640 40 

04.632.645 45 

04.632.650 50 

04.632.655 55 

04.632.660 60 

04.632.665 65 



length (mm) 

04.632.725 25 

04.632.730 30 

04.632.735 35 

04.632.740 40 

04.632.745 45 

04.632.750 50 

04.632.755 55 

04.632.760 60 

04.632.765 65 

04.632.770 70 

04.632.775 75 

04.632.780 80 

04.632.785 85 

04.632.790 90 

04.632.795 95 

04.632.799 100 





length (mm) 

04.632.825 25 

04.632.830 30 

04.632.835 35 

04.632.840 40 

04.632.845 45 

04.632.850 50 

04.632.855 55 

04.632.860 60 

04.632.865 65 

04.632.870 70 

04.632.875 75 

04.632.880 80 

04.632.885 85 

04.632.890 90 

04.632.895 95 

04.632.899 100 



length (mm) 

04.632.930 30 

04.632.935 35 

04.632.940 40 

04.632.945 45 

04.632.950 50 

04.632.955 55 

04.632.960 60 

04.632.965 65 

04.632.970 70 

04.632.975 75 

04.632.980 80 

04.632.985 85 

04.632.990 90 

04.632.995 95 

04.632.999 100 


Implants* 

Reduction Screw Matrix 5.5, 4.0 mm, preassembled, 

Titanium Alloy (TAN) 

length (mm) 

04.634.420 20 

04.634.425 25 

04.634.430 30 

04.634.435 35 

04.634.440 40 

04.634.445 45 



length (mm) 

04.634.520 20 

04.634.525 25 

04.634.530 30 

04.634.535 35 

04.634.540 40 

04.634.545 45 

04.634.550 50 

04.634.555 55 



length (mm) 

04.634.120 20 

04.634.125 25 

04.634.130 30 

04.634.135 35 

04.634.140 40 

04.634.145 45 

04.634.150 50 

04.634.155 55 

04.634.160 60 





length (mm) 

04.634.620 20 

04.634.625 25 

04.634.630 30 

04.634.635 35 

04.634.640 40 

04.634.645 45 

04.634.650 50 

04.634.655 55 

04.634.660 60 

04.634.665 65 



length (mm) 

04.634.725 25 

04.634.730 30 

04.634.735 35 

04.634.740 40 

04.634.745 45 

04.634.750 50 

04.634.755 55 

04.634.760 60 

04.634.765 65 



length (mm) 

04.634.825 25 

04.634.830 30 

04.634.835 35 

04.634.840 40 

04.635.845 45 

04.635.850 50 

04.635.855 55 

04.635.860 60 

04.635.865 65 


Implants* 

Pedicle Screw Matrix 5.5 4.0 mm, 


length (mm) 

04.639.420 20 

04.639.425 25 

04.639.430 30 

04.639.435 35 

04.639.440 40 

04.639.445 45 



length (mm) 

04.639.520 20 

04.639.525 25 

04.639.530 30 

04.639.535 35 

04.639.540 40 

04.639.545 45 

04.639.550 50 

04.639.555 55 



length (mm) 

04.639.120 20 

04.639.125 25 

04.639.130 30 

04.639.135 35 

04.639.140 40 

04.639.145 45 

04.639.150 50 

04.639.155 55 

04.639.160 60 




length (mm) 

04.639.620 20 

04.639.625 25 

04.639.630 30 

04.639.635 35 

04.639.640 40 

04.639.645 45 

04.639.650 50 

04.639.655 55 

04.639.660 60 

04.639.665 65 



length (mm) 

04.639.725 25 

04.639.730 30 

04.639.735 35 

04.639.740 40 

04.639.745 45 

04.639.750 50 

04.639.755 55 

04.639.760 60 

04.639.765 65 

04.639.770 70 

04.639.775 75 

04.639.780 80 

04.639.785 85 

04.639.790 90 

04.639.795 95 

04.639.799 100 


Implants* 



length (mm) 

04.639.825 25 

04.639.830 30 

04.639.835 35 

04.639.840 40 

04.639.845 45 

04.639.850 50 

04.639.855 55 

04.639.860 60 

04.639.865 65 

04.639.870 70 

04.639.875 75 

04.639.880 80 

04.639.885 85 

04.639.890 90 

04.639.895 95 

04.639.899 100 




length (mm) 

04.639.930 30 

04.639.935 35 

04.639.940 40 

04.639.945 45 

04.639.950 50 

04.639.955 55 

04.639.960 60 

04.639.965 65 

04.639.970 70 

04.639.975 75 

04.639.980 80 

04.639.985 85 

04.639.990 90 

04.639.995 95 

04.639.999 100 

Also available: 

– Pedicle Screw Matrix 5.5, polyaxial, cannulated 

– Pedicle Screw Matrix 5.5, perforated 

– Intermediate lengths available upon request 

Screw heads 

04.632.001 Screw Head, polyaxial, for Matrix 5.5, 


04.634.002 Reduction Head, polyaxial, for Matrix 5.5, 



Implants* 

Curved rods 

Rods 5.5 mm, hard, curved, Pure Titanium (TiCP) 

04.636.030 30 

04.636.035 35 

04.636.040 40 

04.636.045 45 

04.636.050 50 

04.636.055 55 

04.636.060 60 

04.636.065 65 

04.636.070 70 

04.636.075 75 

04.636.080 80 

04.636.085 85 

04.636.125 125 

length (mm) 

Rods 5.5 mm, extra-hard, curved, 

Cobalt-Chrome Alloy (CoCrMo) 

length (mm) 

09.636.030 30 

09.636.035 35 

09.636.040 40 

09.636.045 45 

09.636.050 50 

09.636.055 55 

09.636.060 60 

09.636.065 65 

09.636.070 70 

09.636.075 75 

09.636.080 80 

09.636.085 85 

09.636.125 125 


Straight rods 

Rods 5.5 mm, hard, straight, Pure Titanium (TiCP) 

04.634.230 30 

04.634.235 35 

04.634.240 40 

04.634.245 45 

04.634.250 50 

04.634.255 55 

04.634.260 60 

04.634.265 65 

04.634.270 70 

04.634.275 75 

04.634.280 80 

04.634.285 85 

04.634.290 90 

04.634.295 95 

04.633.290 100 

04.634.325 125 

04.633.291 150 

04.633.292 200 

04.633.293 300 

04.633.294 400 

04.633.500 500 

04.633.700* 700 

length (mm) 

*Available nonsterile packed only 


Implants* 

Straight rods 

Rods 5.5 mm, extra-hard, straight, 


length (mm) 

04.616.130 30 

04.616.135 35 

04.616.140 40 

04.616.145 45 

04.616.150 50 

04.616.155 55 

04.616.160 60 

04.616.165 65 

04.616.170 70 

04.616.175 75 

04.616.180 80 

04.616.185 85 

04.616.190 90 

04.616.195 95 

04.633.279 100 

04.616.225 125 

04.633.281 150 

04.616.275 175 

04.633.282 200 

04.633.283 300 

04.633.284 400 

04.633.285 500 

04.616.700* 700 



Straight rods 

Rods 5.5 mm, hard, straight, 

Cobalt-Chrome Alloy (CoCrMo) 

length (mm) 

09.631.030 30 

09.631.035 35 

09.631.040 40 

09.631.045 45 

09.631.050 50 

09.631.055 55 

09.631.060 60 

09.631.065 65 

09.631.070 70 

09.631.075 75 

09.631.080 80 

09.631.085 85 

09.631.090 90 

09.631.095 95 

09.633.100 100 

09.631.125 125 

09.633.150 150 

09.631.175 175 

09.633.190 200 

09.633.191 300 

09.633.192 400 

09.633.193 500 

09.631.700* 700 



Implants* 

Connecting rods 

Connecting Rod, length 500 mm, 

Pure Titanium (TiCP) 

diameter (mm/mm) 

04.633.187 5.5/6.0 

Connecting Rods, length 500 mm, 



04.633.190 5.5/3.5 

04.633.191 5.5/4.0 

04.633.188 5.5/6.0 

Connecting Rod, length 500 mm, Cobalt-chrome alloy 

(CoCrMo) 


09.633.187 5.5/6.0 

Also available: 

– Pelvic Rods 5.5 mm, prebent 

For an overview, please refer to www.synthes.com/e-catalog. 


Locking cap 

04.632.000 Locking Cap, one-step, for Matrix 5.5 


Snap-On Transverse Connector 

length size 

04.633.317 17 – 22 mm 1 









Instruments 

For pedicle preparation 

03.632.057 Pedicle Marker for Matrix 

03.632.058 Inserter for Pedicle Marker, for Matrix 

Awls and probes with palm handle 

388.656 Pedicle Awl 4.0 mm with 

Silicone Handle, length 255 mm, 


388.536 Pedicle Probe for Screws 4.2 mm, 

length 240 mm 

388.655 Pedicle Probe 3.7 mm 



388.657 Pedicle Probe 3.8 mm, curved, 




Ball tip feelers 

388.545 Feeler for Screw Channel, straight, 


388.546 Feeler for Screw Channel, curved, 


388.549 Feeler, straight, with rounded tip 

Tap for Pedicle Screws, 

length 180 mm 

03.632.103 3.5 mm 

03.632.104 4.0 mm 

03.632.105 5.0 mm 

03.632.155 5.5 mm 

03.632.106 6.0 mm 

03.632.107 7.0 mm 

03.632.108 8.0 mm 

03.632.109 9.0 mm 


Instruments 

For screw insertion 

Retaining Sleeves 





Screwdriver Shafts Stardrive T25 






straight tip, with Hexagonal 

Coupling, for Matrix 



for Matrix 

Screwdrivers Stardrive T25 with T-Handle 






Screwdrivers Stardrive T25 with straight handle 

03.632.005 Screwdriver Stardrive, T25, 

with straight handle, standard, 



with straight handle, for Matrix 5.5 

Handles with hexagonal coupling 

03.620.019 Torque-limiting Handle, 10 Nm, for Pangea 

03.636.008 T-Handle with Hexagonal Coupling 6.0 mm 

03.632.090 T-Handle with Ratchet Wrench, with 

Hexagonal Coupling 6.0 mm 

03.632.091 Handle with Ratchet Wrench, straight, 

with Hexagonal Coupling 6.0 mm 


Instruments 

For assembly and removal of polyaxial screw heads 

03.632.007 Alignment Tool for polyaxial Screw Head, 


03.632.037 Positioning Instrument for Polyaxial Screw 

Heads, for Matrix 5.5 

03.632.045 Removal Instrument for Polyaxial Screw 

Heads, for Matrix 5.5 

03.632.046 Reamer for Pedicle Screws, for Matrix 5.5 

68.632.125 Loading Station for Matrix 5.5 


For rod cutting and bending 

388.906 Trial Rod 5.0 mm, length 150 mm 


388.750 USS Rod Cutting and Bending Device 

388.720 Bolt Cutter 


Instruments 

For rod insertion 

03.632.081 Rod Holding Forceps for Rods 5.5 mm 


6.0 mm 

03.632.169 Rod Pusher for Rods 5.5 / 6.0 mm, 

for Matrix 


For distraction and compression 

03.632.000 Distraction Fork 

388.410 Spreader Forceps for Pedicle Screws, 

length 330 mm 

03.620.018 Distraction Forceps, for Lumbar Spine 

388.422 Compression Forceps, length 335 mm, 

for Pedicle Screws 

03.620.017 Compression Forceps, for Lumbar Spine 


Instruments 

Instruments for toothed rack retractor 



03.632.084 Distractor Tip, for Screw Heads, 


03.632.089 Distractor Tip, with Hook End, 


03.632.085 Retaining Sleeve, detachable, 


03.632.087 Toothed Rack Retractor, for Matrix 


For cap introduction and tightening 



Rod Pusher/Counter Torques 






03.632.099 Counter Torque, long, for Matrix 5.5 



Instruments 

For transverse connectors 

03.632.050 Retaining Sleeve for Transverse 


03.632.052 Screwdriver Stardrive, T15, short, 

for Matrix 

03.632.053 Measuring Device for Transverse 


03.632.204 Torque-limiting Handle, 3 Nm 


For rod reduction 

Reduction instruments 




long, for Matrix 5.5 



03.620.091 Socket, hexagonal 6.0 mm 


Instruments 

Rod persuader/ Rod introduction pliers 




Rocker forks 

03.632.010 Rocker Fork, small, for Matrix 5.5 

03.632.012 Rocker Fork, medium, for Matrix 5.5 

03.632.011 Rocker Fork, footed, for Matrix 5.5 


Instruments for reduction screws 

03.632.042 Rod Pusher / Counter Torque for Reduction 

Screw, for Matrix 5.5 

03.632.025 Counter Torque for Reduction Screws, 


03.632.029 Holding Crown for Reduction Screws, 


03.632.026 Rod Pusher / Counter Torque for Reduction 

Screws, for Matrix 5.5 

03.632.030 Tab Remover for Reduction Screws, 



Biomaterial Implants 

To facilitate fusion, bone graft is often applied in the lateral 

gutters. A suitable bone graft substitute (e.g. chronOS, DBX) 

may be used by itself or in combination with autograft. 

The construct shown is complemented with chronOS Strip 

precast, which optimally integrates with patient anatomy 

and implanted hardware. Perfusion of Strip with bone 

marrow aspirate provides a favorable environment for bony 

ingrowth. 

chronOS Strip, precast, sterile 

07.801.200.02S 47 mm18 mm3 mm 

pack of 2 implants 

Volume of bone marrow or blood: 5 –10 cc 


length thickness length thickness

Ö036.001.185öACcä 

All technique guides are available as PDF files at 

www.synthes.com/lit 

0123 

036.001.185 version AC 09/2012 50147645 © Synthes, Inc. or its affiliates Subject to modifications Synthes and Stardrive are trademarks of Synthes, Inc. or its affiliates

MATRIX Spine System – Degenerative. The total solution ... - Synthes

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