USS II Ilio-Sacral. Modular System for Stable Fixation in ... - Synthes

Technique Guide 

USS II Ilio-Sacral. Modular System 

for Stable Fixation in the Sacrum and 

Illium.

Table of Contents 

Introduction 

Product Information 

Surgical Technique 

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 

Indications and Contraindications 5 

Implants 6 

Instruments 8 

Iliac Fixation with Iliac Connector 10 

S2 Fixation with S2 connector 19 

a Insertion S2 connector left/right 22 

b Insertion S2 connector for rod end 24 

Remobilisation of the Polyaxial Connection 

for Implant Removal 27 

Synthes 1

USS II Ilio-Sacral. Modular System for 

Stable Fixation in the Sacrum and Ilium. 

USS II Ilio-Sacral is intended for an additional 

rod fixation in the ilium and in S2. 

It is an add-on to USS II Polyaxial and 

combined with the USS systems enables 

a construct from the thoracolumbar 

spine to the pelvis. 

USS II Ilio-Sacral 

– Add-on to USS II Polyaxial 

– Uses the same bone screws 

(extra long up to 140 mm) 

– Low profile 

There are different connectors available 

for the linkage to the ilium and to the 

S2 pedicle. All connectors are combined 

with the USS II Polyaxial bone 

screws. 

USS II nut 

Fixed length iliac connector (1) 

Telescopic iliac connector (2) 

Clamp for fixed length/ 

telescopic iliac connector 

Collet 

2 Synthes USS II Ilio-Sacral Technique Guide 

Dual-core cancellous bone 

screws 

S2 connector, left/right 

S2 connector, for rod end 

Pelvic connectors 

Pelvic rod 

Secure working over sticks, 

for both USS II Ilio-Sacral and 

USS II Polyaxial. 

1 

6.2 7.0 8.0 

S2 fixation 

2

4 Synthes USS II Ilio-Sacral Technique Guide

Indications and Contraindications 

Notes 

– The iliac connectors provide additional stabilization for an 

S1 screw fixation. It is recommended to always combine an 

iliac connector with an S1 screw. 

– For degenerative diseases, it is recommended to use an S2 

fixation where possible in addition to the S1 screw. 

Indications 

USS II Ilio-Sacral is indicated for fixation of long posterior rod 

constructs in the ilium and in S2, both in combination with 

an S1 fixation. 

S1 fixation combined with iliac fixation: 

– Severe scoliosis (e.g. neuromuscular) 

S1 fixation combined with S2 fixation: 

– Degenerative diseases (e.g. spondylolisthesis) 

Contraindications 

– Fractures and tumours with insufficient anterior support 

– USS II Ilio-Sacral should not be used where no fixation in 

S1 is possible. 


Implants 

Iliac connectors, fixed length 

04.621.112–145* Iliac connectors in fixed lengths from 

12 to 45 mm (in 3 mm steps) 

04.621.275* Clamp for iliac connector with fixed length 

Iliac connector, telescopic 

04.621.171* Iliac connector, telescopic, neutral, 

length 17–27 mm 

04.621.270* Clamp for telescopic iliac connector 

S2 connectors 

04.621.260/261* S2 connector, left/right, 

for rods � 6.0 mm 

04.621.262* S2 connector for rod end, 

for rods � 6 mm 

Collet for iliac connector and S2 connector 

04.621.190* Collet for iliac connector and S2 connector, 

for all sizes 

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


USS II nut 

499.294** USS II nut 

USS II Polyaxial cancellous bone screws with dual core 

Art. Nos. � Lengths Colour 

04.607.232–239** 6.2 mm 30– 65 mm light blue 

04.607.252–269** 7.0 mm 30–140 mm turquoise 

04.607.272–289** 8.0 mm 30–140 mm blue 

Optionally USS II Polyaxial pedicle screws can be used. 

Pelvic connectors* 

0X.300.000** L-connector 

0X.300.001** Claw-connector 

0X.300.002** T-connector, small 

0X.300.003** T-connector, large 

Pelvic rods* 

0X.306.010** Pelvic rod, left 

0X.306.012** Pelvic rod, right 

*X=4 Titanium Alloy (TAN) 

X=2 Stainless Steel 

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


Instruments 

The USS General Instruments (187.200) are recommended 

for use as basic instrument set. 

USS II Polyaxial instruments needed for 

USS II Ilio-Sacral 

03.607.001 Screwdriver, bihexagonal, � 3.0 mm, 

with T-Handle 

03.607.003 USS II Polyaxial Holding Sleeve for 

No. 03.607.001 

03.607.002 Screwdriver Shaft for USS II Polyaxial 

cancellous bone screws with 

lengths �70 mm 

388.622 Handle for Screw Holder 

or 

03.607.006 USS II Polyaxial Handle for Screw Holder 

03.607.055 

03.607.000 USS II Polyaxial Reamer 


03.607.005 USS II Polyaxial Screw Holder 

388.584 Socket Wrench for twelve point nut, 

with L-Handle 

USS II Ilio-Sacral instruments 

03.621.011 Clamp Holder 

(for clamps 04.621.270 and 275) 

03.621.031-33 Templates for Iliac Connectors 

(short, medium, long) 

03.621.012 Socket Wrench, cannulated, with Straight 

Handle for USS-II Nut 

Additional instruments 

319.011 Depth Gauge for Pedicle Screws, 

measuring range up to 110 mm 

388.143 Socket Wrench � 5.0 mm, with T-Handle 

314.070 Screwdriver, hexagonal, small, � 2.5 mm, 

with Groove 


Iliac Fixation with Iliac Connector 

1 

Instrument spine down to S1 

Instrument the spine with a rod construct down to S1 according 

to the surgical technique of the implant system used 

(e.g. USS II Polyaxial). In S1, it is recommended to use a 

USS II Polyaxial cancellous bone screw for easy rod introduction. 

Note: Leave at least 3 cm excess rod caudally to the S1 

screw for later placement of the iliac connector. 

Alternative 

Instead of applying the iliac connectors to the rod as the last 

step in the surgery, it is also possible to insert all screws and 

iliac connectors first, and then apply the rod. 

2 

Determine size of iliac connector 

Required instruments 

03.621.031–33 Templates (short, medium, long) 

Use the templates to determine the proper implant size. 

Either the telescopic or the fixed-length iliac connector may 

be used. 

Notes 

– Fixed length connector: The distances indicated on the 

template correspond to the implant size (mm). 

– Telescopic connector: The distance varies between 

17 and 27 mm. 


3 

Attach clamp 



Pick up the corresponding clamp for the telescopic or 

fixed-length connector from the tray using the Clamp 

Holder. 

Note: The Clamp Holder is approx. twice as long as the 

USS II Polyaxial Screw Holder. 

Attach the clamp to the rod from the midline. If necessary, 

remove excessive bone below the rod to create enough 

space for the clamp. 

Clamp for fixed-length iliac connector 

Clamp for telescopic iliac connector 

Note: To prevent possible tissue irritation remove enough 

bone on the ilium so that the iliac connector will be seated 

below the original iliac crest. 



4 

Place iliac connector and create screw entry point 



Drop the iliac connector over the Clamp Holder. With the implant 

in place, verify that the correct implant size has been 

chosen. 

Use a pedicle probe to drill the screw hole in the center of 

the opening of the iliac connector. This ensures that 

the screw will be placed at the correct distance to the rod. 

After drilling the screw hole, remove the iliac connector. 

Alternative screw placement in the ilium: The screw may be 

placed from the inner side of the iliac crest in order to reduce 

the extent of soft tissue exposure. 


5 

Insert bone screw 



with T-Handle 

03.607.003 USS II Polyaxial Holding Sleeve 

Optional instruments 

03.607.002 Screwdriver Shaft for screws �70 mm 

03.607.006 USS II Polyaxial Handle 

Pick up the appropriate screw from the screw rack using the 

Screwdriver and the Holding Sleeve. Insert the screw into the 

prepared ilium until the screw is well seated. 

Note: For cancellous bone screws with a length of 70 mm or 

longer, use the Screwdriver Shaft 03.607.002 attached to 

the USS II Polyaxial Handle. 



6 

Expose screw head 




with T-Handle 

Place the Reamer guided by the Screwdriver over the screw 

head. Ream away excessive bone by moving the reamer back 

and forth until the red mark on the screwdriver shaft becomes 

visible. 

Note: If more bone that may block the connector has to be 

removed, use a chisel or gauge pliers. 


7 

Click on the collet 




(388.622) (Handle for Screw Holder) 

Use the USS II Polyaxial Screw Holder to pick up a collet from 

the tray. Optionally, attach the Handle for a better hold. 

Click on the collet and orient the notch on the collet in direction 

of the screw angulation to achieve larger angles. Afterwards 

release the Handle leaving the Screw Holder attached 

to the collet. 

Note: Make sure that no tissue is stuck between the screw 

head and the collet. 



8 

Insert iliac connector 



Attach the clamp to the rod from the midline. 

Slide the iliac connector over both the Clamp Holder and the 

Screw Holder. 


9 

Lock iliac connector 


03.621.012 Socket Wrench, cannulated, with Straight 

Handle for USS-II Nut 


with L-Handle 

388.143 Socket Wrench � 5,0 mm, with T-Handle 

Pick up a nut using the Socket Wrench with Straight Handle 

(black), place it over the collet of the iliac screw and tighten 

it slightly. (1) 

Notes 

– Always first place a nut on the collet (iliac screw) 

and then one on the clamp (rod). 

– Pre-tighten the nut on the iliac screw at least 

2 revolutions. This is how the iliac connector is firmly 

attached to the bone screw while the polyaxiality is still 

maintained. Pull on the Screw Holder to check if the 

collet has been attached correctly. 

Secondly, apply a nut on the clamp, and tighten it slightly. (2) 

For final tightening, change the Socket Wrench with black 

handle to the one with L-Handle. Use the Socket Wrench 

with T-Handle as counter-torque. 

1 

2 



Optional: Lock the clamp of the connector with the 

Spreader Forceps 


388.410 Spreader Forceps 

388.615 Support for Rod Introduction Pliers 

(Clip for Persuader) 

In some cases, the iliac connector may not be properly 

seated on the rod, and the nut cannot be tightened. In this 

case, use the technique described below. 

With the Socket Wrench with L-Handle in place, attach the 

Clip for Persuader at the distal end of the Clamp Holder. 

Press the Spreader Forceps. This will pull up the clamp. At 

the same time, turn the Socket Wrench until the nut engages. 


S2 Fixation with S2 Connector 

1 

Instrument spine down to S1 

Place the pedicle screws according to the surgical technique 

of the system used (e.g. USS II Polyaxial) 

2 

Prepare hole for the S2 pedicle screw 


388.540 Pedicle probe � 3,8 mm 

with Canevasit Handle 

388.539 Pedicle probe � 4,8 mm 

with Canevasit Handle 

Open the pedicle using a pedicle probe. 



3 

Insert S2 screw 



with T-Handle 

03.607.003 USS II Polyaxial Holding Sleeve 

Pick up the appropriate screw from the screw rack using the 

Screwdriver and the Holding Sleeve. Insert the screw into 

the prepared pedicle until the screw is well seated. Ideally, 

the screw is placed bicortically. 

4 

Expose screw head 


03.607.001 Screwdriver, bihexagonal, 

� 3.0 mm, with T-Handle 


Place the Reamer guided by the Screwdriver over the screw 

head. Ream away excessive bone by moving the reamer 

back and forth until the red mark on the screwdriver shaft 

becomes visible. 


5 

Click on the collet 



388.622 Handle for Screw Holder 

(03.607.006) (USS II Polyaxial Handle) 

Use the USS II Polyaxial Screw Holder to pick up a collet from 

the tray. Optionally, attach the Handle for a better hold. 

Click on the collet and orient the notch on the collet in direction 

of the screw angulation to achieve larger angles. Afterwards 

release the Handle leaving the Screw Holder attached 

to the collet. 

Notes 

– Make sure that no tissue is stuck between the screw head 

and the collet. 

– Alternately a USS II Polyaxial 3-D head may be clicked on 

the screw instead of using the S2 connector. 



a Insertion S2 connector left/right 

6a 

Insert S2 connector (left or right) 



with L-Handle 


Slide the connector over the Screw Holder onto the collet. 

Pick up a nut using the Socket Wrench with L-Handle, and 

place it over the collet of the S2 screw. 

Pre-tighten the nut on the S2 screw at least 2 revolutions. 

This is how the S2 connector is firmly attached to the bone 

screw while the polyaxiality is still maintained. Check for a 

secure seat by pulling on the Screw Holder. 


7a 

Insert rod and lock nuts 




with L-Handle 

388.143 Socket Wrench � 5.0 mm with T-Handle 


with T-Handle 

Insert the rod into the connector. 

Connect the rod to the remaining screws according to the 

surgical technique of the implant system used (e.g. USS II 

Polyaxial). 

Use the Screwdriver to lock the set screw on the 

S2 connector. 

Use the Socket Wrench with T-Handle as counter-torque for 

final tightening. 



b Insertion S2 connector for rod end 

6b 

Insert connector for rod end 


314.070 Screwdriver, hexagonal, small, � 2.5 mm, 

with Groove 

Insert contoured rod into the connector and lock the set 

screw with the 2.5 mm Screwdriver. Slide the connector over 

the Screw Holder onto the collet. 

Pick up a nut using the Socket Wrench with L-Handle and 

place it over the collet of the S2 screw. 

Pre-tighten the nut on the S2 screw at least 2 revolutions. 

This is how the S2 connector is firmly attached to the bone 

screw while the polyaxiality is still maintained. Check for a 

secure seat by pulling on the Screw Holder. 


7b 

Connect rod to remaining screws and lock nuts 




with L-Handle 

388.143 Socket Wrench � 5.0 mm with T-Handle 

Connect the rod to the remaining screws according to the 

surgical technique of the implant system used (e.g. USS II 

Polyaxial). 

Use the Socket Wrench with T-Handle as counter-torque for 

final tightening. 



Remobilisation of the Polyaxial 

Connection for Implant Removal 



with L-Handle 



After removing the nuts, move the collet back and forth using 

the Screw Holder. The collet will come loose. 



Ö036.000.791öACpä 

AC 

Synthes GmbH 

Eimattstrasse 3 

CH-4436 Oberdorf All technique guides are available as PDF files at 

www.synthes.com www.synthes.com/lit 

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0123 

50147192 © 04/2010 Synthes, Inc. or its affiliates All rights reserved Synthes is a trademark of Synthes, Inc. or its affiliates

USS II Ilio-Sacral. Modular System for Stable Fixation in ... - Synthes

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