Pangea Degenerative Spine System.
Top Loading Preassembled Pedicle
Screw System for Posterior Stabilization
of the Thoracolumbar Spine.
Technique Guide
Contents
Introduction
Product Information
Surgical Technique
AO ASIF Principles
4
Indications and Contraindications
6
Set Configuration
7
Implants
8
Instruments
12
Screw Insertion
18
Posterior Interbody Fusion
23
Rod Insertion
24
Rod Reduction Techniques
26
Close Construct
29
Compress or Distract
32
Apply Final Tightening
34
Additional Techniques
35
Warning
This description is not sufficient for immediate application of
the instrumentation. Instruction by a surgeon experienced in
handling this instrumentation is highly recommended.
Synthes
1
Pangea Degenerative Spine System.
Top Loading Preassembled Pedicle
Screw System for Posterior Stabilization
of the Thoracolumbar Spine.
The Pangea Degenerative Spine System is a posterior pedicle
screw fixation system (T1-S2) intended to provide precise and
segmental stabilization of the spine in skeletally mature patients.
Pangea dual-core screws
Dual-core thread design for optimized bone purchase:
Cortical thread
– Cortical thread engages the pedicle, cancellous thread engages the vertebral body
– Transition zone for core diameter change
– Constant outer diameter
Double-lead thread speeds insertion of 4, 5, 6 and 7 mm
screws
Constant
outer
diameter
Transition
Self-tapping profile
Blunt, threaded tip for safer insertion
Cancellous thread
2
Synthes
Pangea Degenerative Spine System
Technique Guide
Locking cap features
– Quarter turn captures rod
– Ridges under saddle grip the rod
– Self-aligning saddle
– Visual markings for alignement
– Tactile feedback for insertion and 1⁄4 turn engagement
Polyaxial head
Top loading for easy rod introduction
Offers 25° of angulation about the axis of the screw allowing
the implant to adjust readily to the rod
Rod snaps into head to stabilize construct before locking cap
installation
Curved rods
6.0 mm curved rods
35 mm to 85 mm lengths in small increments reduce the
need to contour or cut
Same mechanical properties as straight rods
Synthes
3
AO ASIF Principles
In 1958, the AO ASIF (Association for the Study of Internal
Fixation) formulated four basic principles1, which have become the guidelines for internal fixation. They are:
–
–
–
–
Anatomical reduction
Stable internal fixation
Preservation of blood supply
Early, active pain-free 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 ASIF Principles as Applied to the Spine3
Anatomical reduction
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 pain-free 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 M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger: AO 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.
4
Synthes
Pangea Degenerative Spine System
Technique Guide
Spine principle for
posterior fixation
Technique feature
Clinical importance
Anatomical reduction
Precontoured rods mimic
spinal curvature
Restores normal spinal
curvature
Polyaxial head offers ±25° of
angulation to reduce rod
contouring and provide
optimal rod placement
Restores normal spinal
curvature
Dual-core screw design improves fixation. Cortical
thread engages the pedicle
and cancellous thread
engages the vertebral body
Optimizes pull-out strength
to create a stable segment,
thereby promoting fusion
and/or maintenance of
decompression of neural
elements
Specialized saddle in locking
cap
Resists rod slip. Maximizes
strength of construct
Preservation of blood
supply
Simple quarter-turn locking
cap
Offers ease and speed in
building the construct, leading to shorter operative
times
Early, active pain-free
mobilization
Small head profile and
tapered body
Minimizes trauma to patient
and may lead to pain reduction and improved function
Stable internal fixation
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Indications and Contraindications
The Pangea Degenerative Spine System is a posterior pedicle
screw fixation system (T1–S2) intended to provide precise
and segmental stabilization of the spine in skeletally mature
patients.
Indications
–
–
–
–
–
–
–
Degenerative disc disease
Spondylolisthesis
Trauma (i.e., fracture or dislocation)
Tumour
Stenosis
Pseudoarthrosis
Failed previous fusion
Contraindications
– Fractures and tumours with loss of anterior support
6
Synthes
Pangea Degenerative Spine System
Technique Guide
Set Configuration
68.620.000
Vario Case for Basic Instruments Pangea
Polyaxial, with Lid, without Contents
01.620.015
Pangea Polyaxial Basic Instruments
in Vario Case
68.620.004
Vario Case for Implants Pangea Polyaxial,
with Lid, without Contents
01.620.018
Pangea Polyaxial Implants in Vario Case
Optional
68.620.016
Vario Case for Optional Instruments
Pangea Polyaxial, with Lid, without
Contents
01.620.017
Pangea Polyaxial Optional Instruments in
Vario Case
Synthes
7
Implants
Pangea dual-core screws
–
–
–
–
–
–
Preassembled polyaxial head offers 25° of angulation
Dual-core thread design
Constant outer diameter
Double-lead thread speeds insertion
Self-tapping profile
Blunt, threaded tip for safer insertion
1. Pedicle Screw Pangea Polyaxial, preassembled,
Titanium Alloy (TAN)
Art. No.
Outer
⭋
mm
Cortical
core ⭋
mm
Cancellous
core ⭋
mm
lengths
mm
04.620.420–445
4.0
3.4
3.0
20– 45
04.620.525–555
5.0
4.0
3.6
25– 55
04.620.625–665
6.0
5.0
4.3
25– 65
04.620.725–799
7.0
6.0
5.3
25–100
04.620.825–899
8.0
6.5
5.8
25–100
04.620.930–999
9.0
7.5
6.8
30–100
2. Locking Cap Pangea, Titanium Alloy (TAN)
Art. No.
8
Synthes
04.620.000
Pangea Degenerative Spine System
Technique Guide
3. Rods, Titanium
3.1 6.0 mm rods, curved
Lengths 35 mm to 85 mm in 5 mm increments reduce the
need to contour or cut
Art. No.
Length (mm)
04.620.135
35
04.620.140
40
498.139
45
04.620.150
50
498.140
55
04.620.160
60
498.141
65
04.620.170
70
498.142
75
04.620.180
80
498.143
85
3.2 6.0 mm rods, straight
Art. No.
Length (mm)
498.102
50
498.103
75
498.104
100
498.105
125
498.106
150
498.108
200
498.116
400
Synthes
9
Implants
4. Transverse connectors, low profile, for Rods ⭋ 6 mm,
Titanium Alloy (TAN)
Transverse connector(s) with adjustable length and angle
may be added to the construct.
Art. No.
Length (mm)
497.796
31.5–34
04.620.203
33–36.5
497.797
35–41
04.620.204
38.5–48
497.798
42–55
04.620.205
49–69
497.799
56–83
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Pangea Degenerative Spine System
Synthes
Technique Guide
Synthes
11
Instruments
Taps for dual-core Screws, with 6 mm hex coupling
Art. No
⭋ (mm)
03.620.104
4.0
03.620.105
5.0
03.620.106
6.0
03.620.107
7.0
03.620.108
8.0
03.620.109
9.0
Used with Ratchet T-Handle with Low Toggle with Hexagonal
Coupling 6.0 mm (03.620.005) for tapping a hole for
Pangea screws.
Instruments for screw insertion
03.620.001
Screwdriver Stardrive, T25, with T-Handle,
for Pangea
03.620.006
Screwdriver Stardrive, T25,
with straight handle, for Pangea
An alternate screw insertion method for
Pangea screws.
03.620.002
Screwdriver Shaft Stardrive, T25, long,
with Hexagonal Coupling 6.0 mm,
for Pangea
Used with long Pangea instruments.
03.620.003
Screwdriver Shaft Stardrive, T25,
with Hexagonal Coupling 6.0 mm,
for Pangea
03.620.022
Screwdriver Shaft Stardrive, T25, short,
with Hexagonal Coupling, for Pangea
Can not be used in combination with
other instruments.
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Synthes
Pangea Degenerative Spine System
Technique Guide
Alternate screw insertion methods for Pangea screws
Instrument shafts mate with handles that have 6 mm hexagonal couplings.
03.620.005
Ratchet T-Handle with Low Toggle with
Hexagonal Coupling 6.0 mm
Used with either the 6 mm hexagonal coupling taps for preparing bone or screwdriver shafts for insertion of Pangea screws
and locking caps.
03.620.100
Handle with Ratchet, straight,
with Quick Coupling, for Pangea
An alternate method used with a 6 mm
hexagonal coupling screwdriver shaft
for insertion of Pangea screws and locking
caps.
03.620.023
Retaining Sleeve for
Pangea Polyaxial screws
Used with screwdrivers and screwdriver
shaft (03.620.001, 03.620.006,
03.620.003).
Rigidly couples screwdriver and polyaxial
screw during insertion.
03.620.004
Stabilization Sleeve for
Pangea Polyaxial screws
Optionally used with screwdrivers and
screwdriver shaft (03.620.001,
03.620.006, 03.620.003).
Stabilizes polyaxial head during screw
insertion.
Synthes
13
Instruments
Instruments for rod preparation and insertion
388.902
Bending Template ⭋ 6.0 mm,
length 150 mm, single use
Used to determine the length and contour
of the rod.
03.620.020
Rod Bender for Rods ⭋ 6.0 mm,
with Radius Adjustment
Contours the rod, using the knob to adjust
the bend radius.
388.440
Holding Forceps for Rods ⭋ 6.0 mm,
length 290 mm
Used to place and manoeuvre the rod into
the implant opening.
328.028
Holding Forceps, straight,
for Rods ⭋ 6.0 mm
Used to place the rod into the Pangea
head.
Narrow jaws allow rod insertion into tight
spaces between screws.
03.620.011
Rod Pusher/Counter Torque for Pangea
Helps seat the rod. Provides counter torque
on the rod during final tightening.
14
Synthes
Pangea Degenerative Spine System
Technique Guide
388.114
Rod Pusher for Rods ⭋ 6.0 mm
Assists in placing rod into implant opening.
03.620.008
Rod Persuader for Pangea
Introduces the rod into the Pangea screw
head and facilitates locking cap introduction. Provides 10 mm of reduction.
03.620.009
Rocker Fork Pangea, small, straight shaft
Provides vertical reduction of rod into implant.
03.620.010
Rocker Fork Pangea, small, curved shaft
Provides vertical reduction of rod into implant requiring less rod exposure.
Instruments for construct assembly
03.620.013
Locking Cap Driver with T-Handle,
for Pangea
Used with screwdrivers and screwdriver
shaft (03.620.001, 03.620.006,
03.620.003) to drive Pangea Locking Cap
through 1⁄4 turn lock.
03.620.019
Torque-limiting Handle, 10 Nm, for Pangea
Used with a 6 mm hexagonal coupling
screw driver shaft for final tightening of
the locking cap to apply a torque of 10 Nm
to the locking cap setscrew.
Synthes
15
Instruments
03.620.021
Template for Transverse Connectors low
profile, for Rods ⭋ 6.0 mm
Helps to determine appropriate transverse
connector length.
388.395
Screwdriver, hexagonal, small, ⭋ 2.5 mm,
length 293 mm
Used to secure transconnector.
For distraction and compression
03.620.016
Distractor Pangea, with Hinge
Provides distraction to ease insertion of
interbody implants. Hinged handles allow
greater visibility during interbody fusion
techniques.
03.620.017
Compression Forceps, for Lumbar Spine
Used to apply compression across a
Pangea assembly before final tightening.
03.620.018
Distraction Forceps, for Lumbar Spine
Used to apply distraction across a Pangea
assembly. Wedge shaped tips allow distraction between closely spaced implants.
16
Synthes
Pangea Degenerative Spine System
Technique Guide
Instruments for extraction
03.620.014
Remobilization Tool for Pangea
Remobilizes Pangea screw heads after
setscrew tightening.
03.611.035
Extractor for setscrew ⭋ 4.0 mm
Mates with square tip of Extender, 6 mm
hex coupling (03.611.059) and Ratchet
T-Handle (03.620.005) to remove damaged
Pangea screw or cap.
03.611.059
Extender for No. 03.611.035
Used with Extractor for setscrew
⭋ 4.0 mm (03.611.035).
Synthes
17
Screw Insertion
1
Open pedicles and determine screw lengths
Required instruments
388.656
Pedicle Awl for Screws ⭋ 4.0 to 7.0 mm,
length 255 mm
388.655
Pedicle Probe ⭋ 3.8 mm, straight,
length 240 mm
Optional Instruments
388.552
Pedicle Awl for Screws ⭋ 8.0 and 9.0 mm,
length 255 mm
388.537
Pedicle Probe for Screws ⭋ 8.0 and
9.0 mm, length 240 mm
Locate pedicles as described in AO ASIF Principles in Spine
Surgery1. Use an awl to perforate the outer cortex of
the pedicles. Use a probe to open the pedicle canal. The
markings on the probes yield visual indication of the pedicle
canal depth.
Pangea screws are self-tapping for ease of insertion. Therefore, it is not necessary to tap pedicles. In clinical cases
that require tapping, taps for pedicle screws and a ratchet
T-handle are available.
1 M. Aebi, J.S. Thalgott, and J.K. Webb. AO ASIF Principles in Spine Surgery. Berlin;
Springer-Verlag. 1998. 102
18
Synthes
Pangea Degenerative Spine System
Technique Guide
2
Prepare site for screw head
Required instruments
388.532
Reamer
Insert the tip of the Reamer into the prepared hole. Use rotating movements to remove all interfering bone, and ensure
that enough space exists to allow free mobility of the screw
head.
Repeat for each pedicle site to be instrumented.
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19
3
Insert pedicle screws
Required instruments
03.620.005
Ratchet T-Handle with Low Toggle with
Hexagonal Coupling 6.0 mm
03.620.003
Screwdriver Shaft Stardrive, T25,
with Hexagonal Coupling 6.0 mm
Use the Ratchet T-Handle and the self-retaining Screwdriver
Shaft to pick up a screw from the screw rack.
Place the screwdriver tip firmly into the star recess and pick
up the screw. Insert the screw into the prepared pedicle.
Repeat for each screw site.
Option A: Inserting screw with Stabilizing Sleeve
Required instruments
03.620.004
Stabilization Sleeve for
Pangea Polyaxial screws
If there is soft tissue in the path accessing the pedicle, the
Stabilization Sleeve may be used to stabilize the head and
keep it from rotating during insertion.
Load the Stabilization Sleeve on the Stardrive shaft. Place the
screwdriver tip firmly into the star recess of the screw in
the screw rack and slide the Stabilizing Sleeve down into the
screw head. The sleeve may be held during screw insertion
to prevent the head from turning as the screw advances.
20
Synthes
Pangea Degenerative Spine System
Technique Guide
Option B: Inserting screw with Retaining Sleeve
Required instruments
03.620.023
Retaining Sleeve for
Pangea Polyaxial screws
If it is necessary to exert lateral forces on the screw during insertion, the Retaining Sleeve provides rigid coupling to keep
the screw secure.
Push button and slide sleeve
Push knurled sleeve
To assemble the Retaining Sleeve on the Screwdriver Shaft
press and hold down the assembly button while sliding the
sleeve toward the handle until it stops. Let go off the button
then push the outer knurled sleeve toward the handle. Ensure that the tensioning knob is loosened.
Loosening tensioning knob
Place the screwdriver tip firmly into the star recess of the
screw in the screw rack. Turn the retaining sleeve T-handle to
align the tips with the rod slot. Push the sleeve down to capture the screw and pick up the screw.
After the screw is loaded, if additional screw coupling to the
driver is desired, the tensioning knob may be tightened to
apply more retaining force on the screw.
Tightening tensioning knob
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21
Insert the Pangea screw into the prepared pedicle. The outer
sleeve may be held during screw insertion.
Note: Do not press the assembly button during screw insertion. If this happens, remove the screw, reassemble the
sleeve on the shaft and reload the screw.
To release the sleeve pull up on the outer sleeve and remove
the screwdriver.
Repeat for each screw.
22
Synthes
Pangea Degenerative Spine System
Technique Guide
Posterior Interbody Fusion
Required instruments
03.620.016
Distractor Pangea, with Hinge
If posterior interbody fusion is performed at this time, the
Distractor with Hinge may be placed between Pangea screws
to distract the interbody space.
Position screws at similar height. Engage one distractor leg
below a polyaxial screw head.
Engage second distractor leg below the second screw head.
Fold distractor handle. Distract, and tighten speed nut. Perform interbody procedure.
Remove Distractor and adjust screw heights to final positions.
Synthes
23
Rod Insertion
1
Select and contour rod
Required instruments
388.902
Bending Template ⭋ 6.0 mm,
length 150 mm, single use
03.620.020
Rod Bender for Rods ⭋ 6.0 mm,
with Radius Adjustment
Determine rod length and curvature using the Bending Template. The polyaxial Pangea screw head compensates for
some lateral screw offset.
Select the appropriate length and, if necessary, bend the rod
using the Rod Bender.
Note: Repeated bending can weaken the rod.
24
Synthes
Pangea Degenerative Spine System
Technique Guide
2
Insert rod
Optional Instruments
388.440
Holding Forceps for Rods ⭋ 6.0 mm,
length 290 mm
388.460
Holding Forceps, angled,
for Rods ⭋ 6.0 mm
328.028
Holding Forceps, straight,
for Rods ⭋ 6.0 mm
Insert the rod into the Pangea head using one of the holding
forceps listed above.
Typically a distinct snap is felt when the rod is pushed into
the screw head. The retention feature is designed to provide
temporary hold during assembly.
Note: It is not necessary to feel the snap if the rod is seated.
Synthes
25
Rod Reduction Techniques
The rod must be seated in the Pangea head in order to engage the locking cap. There are three alternative instruments.
a
Rod pushers
Required instruments
03.620.011
Rod Pusher/Counter Torque for Pangea
388.114
Rod Pusher for Rods ⭋ 6.0 mm
Use the Rod Pusher/Counter Torque or the Rod Pusher to
push the rod firmly into the screw head. For constructs with
two or more levels, begin with the central screw.
26
Synthes
Pangea Degenerative Spine System
Technique Guide
b
Rocker forks
Required instruments
03.620.009
Rocker Fork Pangea, small, straight shaft
03.620.010
Rocker Fork Pangea, small, curved shaft
Use the Rocker Fork with straight shaft or Rocker Fork with
curved shaft. Hook the fork under the head’s reduction features from a cranial/caudal approach and rock it away from
the screw to seat the rod into the head. The Rocker Fork
with curved shaft requires less rod exposure, but more access
to engage the head.
Note: Placing the fork on the side where the rod is higher is
more effective at getting the rod seated evenly in the implant.
Synthes
27
c
Persuader
Required instruments
03.620.008
Rod Persuader for Pangea
Use the Rod Persuader and hook the tips of the Persuader
under the head’s reduction features from a cranial/caudal approach.
Centre the Persuader over the head and squeeze the handle
to seat the rod in the head.
Engaging the Persuader
Tip: If necessary the handle on the Persuader may be reversed to allow better access.
Persuading the rod
28
Synthes
Pangea Degenerative Spine System
Technique Guide
Close Construct
1
Attach locking caps
Required instruments
03.620.003
Screwdriver Shaft Stardrive, T25, with
Hexagonal Coupling 6.0 mm, for Pangea
03.620.019
Torque-limiting Handle, 10 Nm, for Pangea
03.620.011
Rod Pusher/Counter Torque for Pangea
03.620.013
Locking Cap Driver with T-Handle,
for Pangea
Cap insertion should be done using guidance through the
Rod Pusher/Counter Torque or with a rocker fork engaged or
through the Persuader.
Attach the Screwdriver Shaft to the Torque-limiting Handle.
Slide the Locking Cap Driver over the Screwdriver Shaft to
the top groove.
Insert the screwdriver tip firmly into a Pangea locking cap
and remove the cap from the module. Align black marks on
the locking cap parallel with the rod. When the cap is in the
correct position, it will drop slightly into the Pangea head.
Push down on the cap to snap it into the head.
Insert cap into head
Synthes
29
Close construct
Rotate the screwdriver 1⁄4 turn to the right to engage the cap
and capture the rod. There is a distinct snap as the cap turns
into place.
The black marks on the locking cap are now perpendicular to
the rod. The rod is free to slide within the head and the head
retains polyaxial mobility.
Note: All locking caps should be in place before tightening
any of the setscrews.
Close construct with 1⁄4 turn
If provisional tightening is desired, turn the screwdriver
further to drive the setscrew down and lock the rod and the
head. Tighten until the Torque-limiting Handle slips.
Tighten construct by releasing setscrew
Repeat for all locking caps.
Note: It is possible to visually identify locking caps that have
had their initial preload disturbed by examining the alignment of the setscrew to the cap. If the etch marks are not
aligned, the setscrew is not ready to carry the cap through
the 1⁄4 turn. The cap driver would be used in this situation.
Set
30
Synthes
Pangea Degenerative Spine System
Technique Guide
Not Set
Alternatively: If the setscrew turns freely within the cap
and/or the locking caps have had their initial preload disturbed as indicated by the alignement of the etch marks, use
the Locking Cap Driver with T-handle to turn the cap.
Required instruments
03.620.013
Locking Cap Driver with T-Handle,
for Pangea
Insert screwdriver tip into setscrew
Thread locking cap driver onto setscrew
Etch parallel to rod, cap inserted
Etch crossing rod, cap closed
Unscrew
Retract
Place the screwdriver tip into the setscrew. Slide the Locking
Cap Driver down onto the top of the setscrew. Thread the
locking cap driver clockwise onto the top of the setscrew until it is snug. Press against a surface to avoid pushing the cap
off the shaft.
Insert locking cap as described in the previous section with
etch mark parallel to the rod.
Turn the Locking Cap Driver clockwise to rotate the cap
⁄4 turn while holding the handle.
1
Note: Unthread the Locking Cap Driver counterclockwise
(holding on to screwdriver handle) and retract it before driving the setscrew further with the Stardrive screwdriver to
avoid locking of the instruments to the locking cap.
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31
Compress or Distract
Controlled compression or distraction is possible by applying
forces at the posterior aspect of the vertebral bodies or
across the entire vertebral body. Lordotic compression will
control the amount of resulting lordosis. Parallel compression will result in more uniform forces across to the anterior
aspect of the vertebral body.
Lordotic compression
Required instruments
03.620.017
Compression Forceps, for Lumbar Spine
03.620.018
Distraction Forceps, for Lumbar Spine
03.620.003
Screwdriver Shaft Stardrive, T25, with
Hexagonal Coupling 6.0 mm, for Pangea
03.620.011
Rod Pusher/Counter Torque for Pangea
Lordotic compression/distraction
Lordotic compression or distraction with mobile Pangea
screw heads is only possible when the locking cap setscrews
have not tightened. Use the Compression Forceps to achieve
compression, or the Distraction Forceps to achieve distraction.
After compression/distraction has been achieved, tighten the
setscrew with the Screwdriver Shaft Stardrive. If final tightening is desired insert the Screwdriver Shaft attached to the
Torque-limiting Handle through the Rod Pusher/Counter
Torque and tighten setscrew.
Note: The Distraction Forceps have narrow wedge tips that
can be pushed between very tightly spaced implants
32
Synthes
Pangea Degenerative Spine System
Technique Guide
Parallel compression
Parallel compression/distraction
Parallel compression or distraction is possible with locked
polyaxiality in the Pangea screw heads where the locking cap
setscrews have been tightened and loosened.
Use the Compression Forceps to achieve compression, or Distraction Forceps to achieve distraction, then tighten the
setscrews by inserting the Screwdriver Shaft through the Rod
Pusher/Counter Torque. Tighten the setscrew while holding
the Rod Pusher/Counter Torque.
Note: Do not use the Torque-limiting Handle to loosen
setscrews.
Repeat as desired for each segment.
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33
Apply Final Tightening
Required instruments
03.620.011
Rod Pusher/Counter Torque for Pangea
03.620.003
Screwdriver Shaft Stardrive, T25, with
Hexagonal Coupling 6.0 mm, for Pangea
03.620.019
Torque-limiting Handle, 10 Nm, for Pangea
Place the Rod Pusher/Counter Torque over the Pangea screw
head. Attach the Screwdriver Shaft to the Torque-limiting
Handle and insert the shaft through the Rod Pusher/Counter
Torque and into the locking cap setscrew. Tighten to the
audible click, which indicates that 10 Nm of torque has been
applied.
Repeat for all locking caps.
Notes:
– The Locking Cap Driver can be used to help center the
Screwdriver Shaft.
– Do not use the Torque-limiting Handle to loosen setscrews.
To facilitate fusion, bone graft is often applied in the lateral
gutters. A suitable bone graft substitute (e.g. chronOS,
DBX, Calceon 6) may be used by itself or in combination
with autograft.
The construct shown is illustrated with chronOS osteoconductive ␤-tricalcium phosphate scaffold, perfused with bone
marrow aspirate.
34
Synthes
Pangea Degenerative Spine System
Technique Guide
Additional Techniques
Adding transverse connectors
Required instruments
03.620.021
Template for Transverse Connectors low
profile, for Rods ⭋ 6.0 mm
388.395
Screwdriver, hexagonal, small, ⭋ 2.5 mm,
length 293 mm
Transverse connector(s) may be added to the construct.
Use the Template for Transverse Connectors to measure the
distance between the two rods. Choose a transverse connector of appropriate length.
Assure that the transverse connector setscrews are not advanced and apply the transverse connector to the rod. Use
the small Screwdriver ⭋ 2.5 mm to tighten the setscrews on
each end.
For transverse connectors with angular adjustment, tighten
the setscrew to lock the angle between the rods.
When using an adjustable length transverse connector, slide
the ends to the appropriate length and tighten the centre
setscrew.
Note: If any part of the construct requires further adjustment, all transverse connector setscrews must be loosened.
After final adjustment, retighten the setscrews.
Synthes
35
Additional techniques
Removal of locking caps
Required instruments
03.620.003
Screwdriver Shaft Stardrive, T25, with
Hexagonal Coupling 6.0 mm, for Pangea
Insert a Stardrive Screwdriver into the setscrew of the locking
cap. Turn the screwdriver counterclockwise until the cap rotates back to its original insert position with the black marks
parallel to the rod. Tilt the shaft along the rod and lift the
cap out.
Note: Do not use the Torque-limiting Handle to remove or
loosen caps or screws.
Remobilization of Pangea screw heads
Required instruments
03.620.014
Remobilization Tool for Pangea
The polyaxial heads can be remobilized with the remobilization tool. After removing the locking caps and the rod, insert
the remobilization tool into the Pangea screw head, and
squeeze the handle completely. Angulate the tool to loosen
angulation.
36
Synthes
Pangea Degenerative Spine System
Technique Guide
Presented by:
036.000.445
0123
SE_038348 AB
51070004
© Synthes
2007
Pangea is a trademark of Synthes
Subject to modifications.