SYNFRAME RL AND SYNFRAME

Transcription

1 SYNFRAME RL AND SYNFRAME Modular approach ach and retraction system Instruments and implants approved by the AO Foundation. This publication is not intended for distribution in the USA. SURGICAL TECHNIQUE

2 Image intensifier control This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to:

3 Table of Contents Introduction SynFrame RL and SynFrame 2 Set Overview 4 AO Spine Principles 6 Surgical Technique Mounting the Basic System 7 Mounting Soft Tissue Retractors/Muscle Retractors 13 Mounting Bone Levers 15 Mounting Rib Retractors 17 Mounting Light-transmitting Rod and Optics Holder 19 Removal 21 Product Information Sets 23 Bibliography 37 SynFrame RL and SynFrame Surgical Technique DePuy Synthes 1

4 SynFrame RL and SynFrame Modular approach and retraction system The SynFrame family is composed of several modules, allowing for either a lumbar or a cervical set up. In addition to the Stainless Steel blades (SST), blades made out of radiolucent aluminium alloy (Alu) are also available. Semi-transparent bone levers made out of Titanium Alloy (TAV) complete the system. Optimizing minimally invasive surgery Exposure in the depth of the operating field by Distal expansion capability allows surgeon to work through a small skin incision Enhanced illumination by means of the polyaxial holder for optics and endoscope Stable operating field System attached to both sides of the operating table Precise fixation of the retractors Soft Tissue and Muscle Retractors Alu SST Alu SST 2 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

5 Enhanced visibility Unobstructed view of the operating field: Modules can be positioned freely on the frame Comprehensive overview of the operating field Aluminium and titanium alloy components allow for improved fluoroscopic viewing in comparison to stainless steel components. Broad range of applications All retractors can be combined Different lumbar approaches (anterior, lateral, posterior) Anterior cervical approach Atraumatic retraction Traction forces can be individually adjusted Exact and rapid fixation: Constant traction to protect critical structures Bone Levers Rib Retractors Holder for Optics SST Light-transmitting Rod TAV SST SynFrame RL and SynFrame Surgical Technique DePuy Synthes 3

6 Set Overview Vario Case for SynFrame Basic System (Fixation Components for OR Table), with Lid, without Contents SynFrame Basic System SynFrame Basic System in Vario Case Vario Case for SynFrame Basic System (Fixation Components for Ring), with Lid, without Contents 4 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

7 Set SynFrame RL, lumbar Set SynFrame RL, cervical SynFrame RL (radiolucent) Optional Retractors for SynFrame RL, without Vario Case SynFrame Soft Tissue Retractors in Vario Case SynFrame Bone Levers in Vario Case SynFrame (Stainless Steel) SynFrame Muscle Retractors in Vario Case Optional Retractors for SynFrame, without Vario Case SynFrame RL and SynFrame Surgical Technique DePuy Synthes 5

8 AO Spine Principles The four principles to be considered as the foundation for proper spine patient management underpin the design and delivery of the Curriculum: Stability Alignment Biology Function. 1,2 Stability Stabilization to achieve a specific therapeutic outcome axial sagittal coronal Alignment Balancing the spine in three dimensions Biology Etiology, pathogenesis, neural protection, and tissue healing Function Preservations and restoration of function to prevent disability Copyright 2012 by AOSpine 1 Aebi et al (1998) 2 Aebi et al (2007) 6 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

9 Mounting the Basic System SynFrame is a surgical approach and retraction system. It consists of a basic system (basic construction) and modules that are specially designed for the respective requirements and needs of various indications and/or approach techniques (eg. anterior lumbar approach for total disc replacement). For further details and indications please refer to the corresponding technique guides. The illustrations for the assembly technique of the SynFrame basic system will be described with reference to a supine patient (anterior lumbar approach in this case). In other patient positions, the SynFrame basic system is always constructed in the same sequence following the same principles. Assembly on the operating table and over the surgical approach needs to be adapted to the patient position. Sterile assembly of SynFrame To separate the sterile area from the unsterile area on the operating table, sterile cover tubing or a corresponding cover with special fenestrated drapes is recommended. Since the insulated holding base ( ) can be sterilized, it can also be used in the covered area (for example over the sterile cover). Note: During assembly, check if the holding base is firmly affixed to the guide rails of the operating table and does not move. The clamping mechanism for the holding base can damage special cover materials (such as Goretex) in certain circumstances. SynFrame RL and SynFrame Surgical Technique DePuy Synthes 7

10 Mounting the Basic System 1 Mount the holding base Tightly screw an insulated holding base ( ) to the guide rails, diagonally to each other. Offset the insulated holding base to the side so that: a. The retaining ring B 300 mm ( ) can be affixed cranially and caudally between the holding base on the operating table (required space: at least 400 mm), b. The retaining ring can be positioned laterally and cranially or caudally between the angled rods ( ) held in the holding bases depending on the planned surgery, c. The freedom of movement and the work area of the surgeon and assistants are not restricted. If this construction is not possible due to the patient s position, the approach or the design of the operating table, always assemble the basic system so that it, and the retaining ring in particular, is held securely. Note: The SynFrame holding base for the operating table insulates the entire SynFrame system from the grounded operating table and meets safety standards IEC and 2-2, VDE 0750 part 2, and VDE 0753 for ground-free patient positioning. Ground-free patient positioning with the SynFrame is only guaranteed by the manufacturer when original SynFrame holding bases are used. Damaged holding bases or those with an expired product expiration date may not be used. 8 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

11 2 Insert the guiding tubes into the holding base Insert both guiding tubes ( ) into the holding bases at the same height in relation to the positioned patient, and clamp them with the clamp (1). The outer diameter of the bottom part of the guiding tube mates with the guide of the holding bases. The larger outer diameter of the top part of the guiding tube acts as a stop so that the tightening bar (2) of the guiding tube does not touch the metal parts of the operating table or the insulated parts of the holding base which would eliminate the effects of the insulation Fix the angled rods in the guiding tubes Insert the angled rods ( ) into the guiding tubes on both sides of the operating table, and affix them approximately 5 10 cm from the patient. 4 Affix tube-to-tube clamps on the angled rods Loosely insert the tube-to-tube clamps ( ) onto the two angled rods. SynFrame RL and SynFrame Surgical Technique DePuy Synthes 9

12 Mounting the Basic System 5 Mount retaining ring The retaining ring ( ) consists of the two half-rings ( ). To mount the retaining ring, insert the two halfrings over the guide pins. Tighten the side set screws with the large hexagonal screwdriver ( ). Alternative Mount the retaining ring with an extension The round retaining ring B 300 mm can be enlarged to form an oval retaining ring 400 mm long. Insert the extensions ( ) over the guide pins onto the half rings on both sides, and tighten them with the large hexagonal screwdriver. 6 Mount the connection rods on the retaining ring Open the clamps of the two connecting rods ( ). Insert the retaining ring into the two clamps, and screw on the clamps with the large hexagonal screwdriver so that the connecting rods can still freely slide on the retaining ring. The retaining ring can thereby be optimally adapted to the placement of the positioned patient. 11 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

13 7 Affix the retaining ring over the patient Insert the retaining ring with the connecting rods into the tube-to-tube clamps on both sides, and affix it over the operative field. Move the retaining ring as close as possible to the operative field so that the distance between the instruments later placed on the retaining ring and the operative field is as small as possible. If necessary, lower the angled rods further into the guiding tube. Adjust the optimum position, and tighten the tube-to-tube clamps (1) and screws in the clamps of the connecting rods (2). Check the stability of the connecting elements to prevent undesirable movement during surgery. Precaution: Do not lean against the basic SynFrame system. This could overload the construction, move individual parts of the SynFrame, and displace soft tissue and/or blood vessels. When moving the patient, monitor the position of the instruments in situ to avoid potential harm or dislocation of soft tissue and/or vessels Alternative way to mount the basic system The sequence of the steps can also be varied as follows: 1. First affix the connecting rods to the tube-to-tube clamps. 2. Then insert the mounted retaining ring into the opening of the connecting rods. (see steps 5 7) SynFrame RL and SynFrame Surgical Technique DePuy Synthes 11

14 Mounting the Basic System 8 Mount the clamp on the retaining ring The clamps ( ) serve as a holder for the different SynFrame instruments on the retaining ring. They are construction elements of the basic system. Check if the clamp is completely open before snapping it on. Snap the clamp with the larger of the two slotted openings onto the retaining ring without tightening it. Make sure that the clamp is affixed from the outside since the holding force of the clamp is greatest there given its construction. 11 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

15 Mounting Soft Tissue Retractors/ Muscle Retractors Soft tissue retractors are for retraction of soft tissues and blood vessels. Muscle retractors are for retraction of muscles of the sub cutaneous tissues and the skin. 1 Insert the retractor in the guide rod From the side, insert the selected retractor into the adjustable clamp of the guide rod ( ) and rotate it 90 in the retaining ring. This holds the retractor in the guide, but the retractor remains fully movable. Soft tissue retractor Muscle retractor 2 Position the retractor Position the retractor in the operative site, and clamp the guide rod of the retractor in the smaller slotted opening of the clamp. Make sure that the clamp is completely opened. The retractor is freely moveable on the retaining ring in every plane as long as the clamp is not screwed tight. After the retractor is definitively positioned, stably affix the clamp by screwing tight. Precaution: The retractors can apply a relatively large force to the soft tissue and vessels. For this reason, loosen the retractors from time to time to prevent pressure necrosis. Precaution: Always align the retractor directly with the direction of pull of the guide rod so that the entire width of the retractor serves as a seat for the soft tissue (a). The pointed edge of the retractor may never contact the soft tissue (b); this can cause pressure necrosis and cause burns if it unintentionally contacts the coagulation device. a b SynFrame RL and SynFrame Surgical Technique DePuy Synthes 11

16 Mounting Soft Tissue Retractors/Muscle Retractors 3 Enlarging the work area Loosen the setscrew in the adjustable clamp of the guide rod with socket wrench 6.0 mm ( ). The adjustable tip of the affixed retractor can then be pivoted on its axis, and the visible working area can be enlarged. Precaution: If the socket wrench is used as a lever, there is a danger of too much force being transmitted to the retractor. This can damage the retracted structures (overstretching the vessels and soft tissue). It is therefore recommendable to guide the moveable retractor with your finger. The tension can be adjusted and distributed safely for soft tissue. 4 Retraction For retraction, release the clamps until the guide rod can be moved. Carefully pull the guide rod and the retractor until the desired retraction is achieved. Then screw the clamp tight in this position. 11 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

17 Mounting Bone Levers For retracting soft tissue, blood vessels and muscular structures. 1 Anchor the bone lever in the bone Position and anchor the bone lever in the bone with the aid of a hammer. Warning: Carefully insert the bone lever into the operative site and hammer it in under visual observation. The sharp tip can cause tissue damage. 2 Affix the bone lever to the holder Enlarge the operative site by pulling back the bone lever, and hang the lever over the ball of the holder ( ). Patient movement can be compensated by the ball joint and the flexible end of the holder. SynFrame RL and SynFrame Surgical Technique DePuy Synthes 11

18 Mounting Bone Levers 3 Clamp the bone lever holder in the clamp Clamp the bone lever holder in the smaller slotted opening of the clamp. As long as the clamp is not screwed tight, the holder for the bone lever can still be freely moved. 4 Retraction Carefully pull the holder for the bone lever in the not-fullytightened clamp together with the retractor until the desired retraction is achieved. Then screw the clamp tight in this position. 11 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

19 Mounting Rib Retractors For retracting ribs for a thoracic approach. 1 Position the rib retractor Place the rib retractor into the desired position. 2 Clamp the rib retractor in the clamp Clamp the rib retractor in the smaller slotted opening of the clamp. As long as the clamp is not screwed tight, the rib retractor can still be freely moved. SynFrame RL and SynFrame Surgical Technique DePuy Synthes 11

20 Mounting Rib Retractors 3 Retraction Carefully pull the rib retractor in the not-fully-tightened clamp until the desired retraction is achieved. Then screw the clamp tight in this position. 11 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

21 Mounting Light-transmitting Rod and Optics Holder Mount the light-transmitting rod The light-transmitting rod ( ) is equipped with an ACM connection. Use the required adapter (Storz or Wolf) depending on the available fiber-optic cable system. Following the same procedure as with the guide rods for retractors, clamp the light-transmitting rod in the small slotted opening of the clamp. As with the guide rods, it is recommended to position the light-transmitting rod so that the working area is directly illuminated deep in the operative site without hindering surgery. Stably fix the light-transmitting rod on the frame by tightening the clamp. Precaution: Together with the high-power light sources, temperatures can arise at the light-source end and instrument end of the light-transmitting rod that can cause burns. In addition, high- energy light can increase the tissue temperature. For this reason, avoid direct contact with tissue, and maintain a distance between the tissue and distal end of the rod of at least 10 mm when affixing the SynFrame light-transmitting rod. Do not place the light-transmitting rod on flammable objects such as textiles (surgical drapes). Never look into the end of the connected light-transmitting rod (blinding hazard). SynFrame RL and SynFrame Surgical Technique DePuy Synthes 11

22 Mounting Light-transmitting Rod and Optics Holder Mount the optics holder Tighten the set screw to affix the holder for optics ( ) facing outward on the ring so that the operative field remains free. Fix the polyaxial mechanism of the optics holder in the desired position using the central adjusting screw. The optics holder is designed for optics with a diameter of 4 mm or 10 mm. 22 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

23 Removal Remove SynFrame SynFrame is removed in reverse sequence. The entire construction (retaining ring and connecting rods) above the patient can be quickly removed from the operative area by completely screwing out from the clamp the locking screws of the tube-to-tube clamps ( ) on the angled rods. SynFrame RL and SynFrame Surgical Technique DePuy Synthes 22

24 Removal Using SynFrame with devices from other manufacturers Precaution: If SynFrame is used with high-frequency or electromedical surgical equipment, make sure that this equipment does not contact the metal parts of the SynFrame. The SynFrame manufacturer refers to the guidelines and instructions associated with the high-frequency or electromedical surgical device manufacturers but also recommends the use of insulating and grounding techniques. 22 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

25 Sets SynFrame Basic System SynFrame Basic System in Vario Case Vario Case for SynFrame Basic System 1 (Fixation Components for OR Table), with Lid, without Contents Vario Case for SynFrame Basic System 1 (Fixation Components for Ring), with Lid, without Contents Content of SynFrame Holding Base, insulated, 2 for OR Table, dark blue SynFrame Guiding Tube, 2 for Angled Rod No , for Basic System SynFrame Angled Rod, 2 for Basic System SynFrame Tube-to-Tube Clamp, 2 for Basic System Content of SynFrame Connecting Rod, 2 for Holding Rings Nos and , for Basic System SynFrame Retaining Ring B 300 mm, 1 two-part, complete, for Basic System SynFrame Clamp for Holding Ring 8 No , dark blue SynFrame Guide Rod 6 with adjustable clamp, for Soft Tissue and Muscle Retractors Screwdriver, hexagonal, large, 1 B 3.5 mm, with Groove, length 245 mm Socket Wrench 6.0 mm, 1 with straight handle SynFrame RL and SynFrame Surgical Technique DePuy Synthes 22

26 Sets Optional for SynFrame Half-Ring, for Holding Ring 1 No , for Basic System SynFrame Extension, 2 for Nos and SynFrame Guide Rod 6 with adjustable clamp, with Snap-in Locking, for Soft Tissue and Muscle Retractors SynFrame Light-transmitting Rod Holder for Optics B 10.0 and 4.0 mm, 1 polyaxial, for SynFrame Basic System Included in Adapter type Storz, for No Adapter type Wolf, for No DePuy Synthes SynFrame RL and SynFrame Surgical Technique

27 SynFrame RL Set SynFrame RL, lumbar Vario Case Vario Case For SynFrame, radiolucent, lumbar, without Contents 1 Bone Levers SynFrame Bone Lever, semi-transparent, 2 width 8 mm, length 160 mm SynFrame Bone Lever, semi-transparent, 2 width 8 mm, length 190 mm SynFrame Bone Lever, semi-transparent, 2 width 18 mm, length 160 mm SynFrame Bone Lever, semi-transparent, 2 width 18 mm, length 190 mm Holder for SynFrame Bone Lever 6 Retractors SynFrame Soft Tissue Retractor, 4 radiolucent, blunt, width 25 mm, length 60 mm, Aluminium SynFrame Soft Tissue Retractor, 4 radiolucent, blunt, width 25 mm, length 80 mm, Aluminium SynFrame Soft Tissue Retractor, 4 radiolucent, blunt, width 25 mm, length 100 mm, Aluminium SynFrame Soft Tissue Retractor, 4 radiolucent, blunt, width 25 mm, length 120 mm, Aluminium SynFrame Soft Tissue Retractor, 4 radiolucent, blunt, width 25 mm, length 140 mm, Aluminium SynFrame Soft Tissue Retractor, 4 radiolucent, blunt, width 25 mm, length 160 mm, Aluminium SynFrame RL and SynFrame Surgical Technique DePuy Synthes 22

28 Sets Set SynFrame RL, cervical Vario Case Vario Case for SynFrame, radiolucent, 1 cervical, with Lid, without Contents SynFrame Extension, with Joint SynFrame Extension, with Joint, 1 with Snap-in Locking SynFrame Holding Ring B 240 mm, 1 two-part, complete Bone Levers SynFrame Bone Lever, semi-transparent, 2 width 8 mm, length 100 mm SynFrame Bone Lever, semi-transparent, 2 width 8 mm, length 130 mm SynFrame Bone Lever, semi-transparent, 2 width 18 mm, length 100 mm SynFrame Bone Lever, semi-transparent, 2 width 18 mm, length 130 mm Holder for SynFrame Bone Lever 6 22 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

29 Retractors Blunt/slim SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 15 mm, length 40 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 15 mm, length 60 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 15 mm, length 80 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 15 mm, length 100 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 15 mm, length 120 mm, Aluminium Blunt/normal SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 40 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 60 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 80 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 100 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 120 mm, Aluminium SynFrame RL and SynFrame Surgical Technique DePuy Synthes 22

30 Sets Small teeth/slim SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 15 mm, length 40 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 15 mm, length 60 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 15 mm, length 80 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 15 mm, length 100 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 15 mm, length 120 mm, Aluminium Small teeth/normal SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 25 mm, length 40 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 25 mm, length 60 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 25 mm, length 80 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 25 mm, length 100 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 25 mm, length 120 mm, Aluminium 22 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

31 Big teeth/slim SynFrame Muscle Retractor, radiolucent, 2 width 15 mm, length 40 mm, Aluminium SynFrame Muscle Retractor, radiolucent, 2 width 15 mm, length 60 mm, Aluminium SynFrame Muscle Retractor, radiolucent, 2 width 15 mm, length 80 mm, Aluminium SynFrame Muscle Retractor, radiolucent, 2 width 15 mm, length 100 mm, Aluminium SynFrame Muscle Retractor, radiolucent, 2 width 15 mm, length 120 mm, Aluminium Big teeth/normal SynFrame Muscle Retractor, radiolucent, 2 width 25 mm, length 40 mm, Aluminium SynFrame Muscle Retractor, radiolucent, 2 width 25 mm, length 60 mm, Aluminium SynFrame Muscle Retractor, radiolucent, 2 width 25 mm, length 80 mm, Aluminium SynFrame Muscle Retractor, radiolucent, 2 width 25 mm, length 100 mm, Aluminium SynFrame Muscle Retractor, radiolucent, 2 width 25 mm, length 120 mm, Aluminium SynFrame RL and SynFrame Surgical Technique DePuy Synthes 22

32 Sets Optional for SynFrame RL Lumbar retractors Blunt/normal SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 50 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 70 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 180 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 200 mm, Aluminium 33 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

33 Blunt/wide SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 40 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 50 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 60 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 70 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 80 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 100 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 120 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 140 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 160 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 180 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 50 mm, length 200 mm, Aluminium SynFrame RL and SynFrame Surgical Technique DePuy Synthes 33

34 Sets Cervical retractors Blunt/slim SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 15 mm, length 50 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 15 mm, length 70 mm, Aluminium Blunt/normal SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 50 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, blunt, width 25 mm, length 70 mm, Aluminium Small teeth/slim SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 15 mm, length 50 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 15 mm, length 70 mm, Aluminium Small teeth/normal SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 25 mm, length 50 mm, Aluminium SynFrame Soft Tissue Retractor, 2 radiolucent, small teeth, width 25 mm, length 70 mm, Aluminium 33 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

35 Big teeth/slim SynFrame Muscle Retractor, radiolucent, 2 width 15 mm, length 50 mm, Aluminium SynFrame Muscle Retractor, radiolucent, 2 width 15 mm, length 70 mm, Aluminium Big teeth/normal SynFrame Muscle Retractor, radiolucent, 2 width 25 mm, length 50 mm, Aluminium SynFrame Muscle Retractor, radiolucent, 2 width 25 mm, length 70 mm, Aluminium SynFrame RL and SynFrame Surgical Technique DePuy Synthes 33

36 Sets SynFrame (Stainless Steel) SynFrame Soft Tissue Retractors in Vario Case, Stainless Steel Vario Case Vario Case for SynFrame Soft Tissue 1 Retractors, Stainless Steel, with Lid, without Contents Content of SynFrame Soft Tissue Retractor, 4 width 23 mm, length 60 mm SynFrame Soft Tissue Retractor, 4 width 23 mm, length 80 mm SynFrame Soft Tissue Retractor, 4 width 23 mm, length 100 mm SynFrame Soft Tissue Retractor, 4 width 23 mm, length 120 mm SynFrame Soft Tissue Retractor, 4 width 23 mm, length 140 mm SynFrame Soft Tissue Retractor, 4 width 23 mm, length 160 mm 33 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

37 SynFrame Bone Levers in Vario Case, Stainless Steel Vario Case Vario Case for SynFrame Bone Levers, 1 Stainless Steel, with Lid, without Contents Content of Holder for SynFrame Bone Lever SynFrame Bone Lever, width 8 mm, 3 length 100 mm SynFrame Bone Lever, width 8 mm, 3 length 130 mm SynFrame Bone Lever, width 8 mm, 3 length 160 mm SynFrame Bone Lever, width 18 mm, 3 length 130 mm SynFrame Bone Lever, width 18 mm, 3 length 150 mm SynFrame Bone Lever, width 18 mm, 3 length 170 mm SynFrame Bone Lever, width 18 mm, 3 length 190 mm SynFrame RL and SynFrame Surgical Technique DePuy Synthes 33

38 Sets SynFrame Muscle Retractors in Vario Case, Stainless Steel Vario Case Vario Case for SynFrame Muscle 1 Retractors, Stainless Steel, with Lid, without Contents Content of SynFrame Muscle Retractor, 2 width 23 mm, length 20 mm SynFrame Muscle Retractor, 2 width 23 mm, length 40 mm SynFrame Muscle Retractor, 4 width 23 mm, length 60 mm SynFrame Muscle Retractor, 4 width 23 mm, length 80 mm SynFrame Muscle Retractor, 4 width 23 mm, length 100 mm SynFrame Muscle Retractor, 2 width 23 mm, length 120 mm Optional Rib Retractors for SynFrame (Stainless Steel) SynFrame Rib Retractor, 2 width 30 mm, length 40 mm SynFrame Rib Retractor, 2 width 40 mm, length 50 mm Optional Muscle Retractors for SynFrame (Stainless Steel) SynFrame Muscle Retractor, 2 width 23 mm, length 140 mm SynFrame Muscle Retractor, 2 width 23 mm, length 160 mm Optional Soft Tissue Retractor for SynFrame (Stainless Steel) SynFrame Soft Tissue Retractor, 4 width 23 mm, length 180 mm 33 DePuy Synthes SynFrame RL and SynFrame Surgical Technique

39 Bibliography Aebi M, Thalgott JS, Webb JK (1998): AO ASIF Principles in Spine Surgery. Berlin: Springer. Aebi M, Arlet V, Webb JK (2007): AOSpine Manual (2 vols), Stuttgart, New York: Thieme SynFrame RL and SynFrame Surgical Technique DePuy Synthes 33

40 DSEM/SPN/0616/ /16 Synthes GmbH Eimattstrasse 3 Not all products are currently available in all markets Oberdorf Switzerland This publication is not intended for distribution in the USA. Tel: Fax: All surgical techniques are available as PDF files at DePuy Synthes Spine, a division of Synthes GmbH All rights reserved