PHOENIX Spinal Fixation System Operative Technique

TA BL E O F CON T E N T S

Pre-Operative Planning • Patient Positioning • Pedicle Identification and Incision Planning Operative Technique • Incision and Guide Wire Insertion • Pedicle Preparation and Tissue Dilation • Multi-Axial Screw Placement • Rod Insertion • Set Screw Insertion and Rod Reduction • Compression/Distraction • Final Tightening • Tab Removal • Removal Procedure Part Numbers Implant Inserter Assembly and Disassembly Indications for Use

The surgical technique shown is for illustrative purposes only. The technique(s) actually employed in each case will always depend upon the medical judgment of the surgeon exercised before and during surgery as to the best mode of treatment for each patient. Please see Instructions for Use for the complete list of indications, warnings, precautions, and other important medical information.

1 1 2 4 4 5 8 10 12 14 15 15 16 18 20

PRE-OPERATIVE PLANNING

Fig. 1

1. PATIENT POSITIONING Position the patient in the prone position. A/P and lateral fluoroscopy should be used to provide proper imaging. (Fig. 1)

1

2

PRE-OPERATIVE PLANNING

Fig. 2a

Fig. 2b

2. PEDICLE IDENTIFICATION AND INCISION PLANNING Attain an A/P fluoro with spinous process aligned and end plates parallel to each other. (Fig. 2a) Verify the lateral edge of the pedicle ovals are close to the lateral edge of the vertebral body. (Fig. 2b) The top of the ovals for both pedicles should be parallel and equidistant from the end plate. (Fig. 2c)

Fig. 2c

PRE-OPERATIVE PLANNING

Incision for Mini on both sides using TLIF

Incision for Mini on both sides using PLIF

Incision placement will depend on the surgical approach and minimally invasive technique used to place the rod. The four figures provide common options when performing a single level fusion.

Incision for Mini on left side and percutaneous on right using TLIF

Incision for Mini on left side using TLIF and percutaneous on right

3

4

OPERATIVE TECHNIQUE

Fig. 3a

Fig. 3b

Fig. 3c

3. INCISION AND GUIDE WIRE INSERTION Locate and make the first incision as defined in the incision planning step. The incision is approximately 14mm in length to match the diameter of the Phoenix Screw Body. (Fig. 3a) Insert the Pedicle Targeting Needle into the pedicle entry point and advance under AP fluoro to ensure that the Pedicle Targeting Needle is not medial to the medial border of the pedicle prior to the entrance into the vertebral body. Multiple Pedicle Targeting Needles can be placed in succession prior to switching to lateral fluoro to check superior/inferior angulation. (Fig. 3b)

Remove the inner stylet of the pedicle targeting needle. Insert the Guide Wire (20-0123, 20-0124) through the Pedicle Targeting Needle and place the Guide Wire into the mid portion of the vertebral body on the lateral view. (Fig. 3c)

OPERATIVE TECHNIQUE

Fig. 4a

4. PEDICLE PREPARATION: TISSUE DILATION AND PEDICLE TAPPING Assembly of Dilator/Awl/Tap Instrument Choose the appropriate diameter Tap, 4.5, 5.5, 6.5 or 7.5mm (20-0145, 20-0155, 20-0165, 20-0175) based on surgeon preference and bone quality. Each Tap has a color band on the proximal end that corresponds the Tap diameter to the same color of the Screw. Assemble the T-Handle (52-1011) or a Straight Handle (52-1013) onto Tap. Next, assemble the Tap Sleeve Dilator (20-0275) onto the Tap until it lines up with the zero mark on the Tap. Advance the Tap Dilator until it engages the first groove on the Tap, this is your starting position for insertion into the incision. The Dilator will be retained in this position until the Release Button is depressed. A visual inspection is recommended to confirm the awl portion of the Tap thread is protruding through the tip of the Tap sleeve. (Fig. 4a)

NOTE: If pedicle screw monitoring is to be performed, there is a non-conductive dilator (20-0218) that should be placed over Dilator/Awl/ Tap instrument prior to use.

5

6

OPERATIVE TECHNIQUE

Fig. 4d

Fig. 4b

Fig. 4c

4. PEDICLE PREPARATION: TISSUE DILATION AND PEDICLE TAPPING CONT. Tissue Dilation Place Tap with assembled Dilator over the Guide Wire (Fig. 4b) and advance through the tissue using a twisting motion. (Fig. 4c) Once the Tap engages the bone, push the Release Button to allow the Tap Sleeve Dilator to move freely so the Awl and tapping can occur. (Fig. 4d) The Tap Sleeve Dilator has measurements to indicate the appropriate length of Phoenix Screw Bodies to be used. (Fig. 4e) Generally, the Short is used for the thoracic region and Standard and Long are used in the lumbar region based on patient size. Sometimes a longer size may be preferred in a longer construct to reach the anterolisthesed segment of a spondylolisthesis.

Skin Surface Level

It is ideal to have approximately 50% of the reduction head visible above the surface of the skin as indicated in the figure. (Fig. 4e) A Non-Conductive Dilator (20-0218) can be placed on the Tap Sleeve Dilator if stimulation of the Tap is desired. Fig. 4e

OPERATIVE TECHNIQUE

Fig. 4g

Fig. 4f

Awl The instrument has a sharp tip design functioning as a Bone Awl to perforate the pedicle bone so tapping can occur. Use a clockwise twisting motion to break through the cortex. (Fig. 4f) Tapping Continue a clockwise motion for tapping the bone while maintaining a straight trajectory to avoid bending the tap. (Fig. 4g) Use periodic fluoroscopy to check on depth and proper alignment. When the Tap is at the desired depth, the screw length is measured by reading the scale on the Tap. (Fig. 4h) The Dilator must be in contact with the pedicle bone surface to achieve accurate measurement. Remove the Tap Assembly leaving Guide Wire and Dilator (non-conductive) if desired behind.

Fig. 4h

7

8

OPERATIVE TECHNIQUE

E C

B

D

A Fig. 5a

Fig. 5b

5. MULTI-AXIAL SCREW PLACEMENT Implant Selection There are two Phoenix Body styles to accommodate different rod passing techniques. (Fig. 5a) The closed (magenta) Phoenix Bodies are only used at the end of a construct and are optional based on surgeon preference. The closed style can also be used to guide the Rod into place for mini-open techniques. The open (green) Phoenix Bodies are used in multi-level constructs and can also be used at the end of constructs based on surgeon preference. See Step 4 – The Dilator has measurements to indicate the appropriate length of Phoenix Bodies to be used. Generally, the Short is used for thoracic region and Standard and Tall are used for lumbar based on patient size. Sometimes a longer size may be preferred in a longer construct to reach the anterolisthesed segment of a spondylolisthesis. It is ideal to have approximately 50% of the reduction head visible above the surface of the skin. (Fig. 4e and 5b)

Phoenix Screw Body Styles

Dimension A Height of Saddle

Dimension B From Top of Saddle to Bottom of Tab

Dimension C Height of Tab

Dimension D Overall Phoenix Length

Dimension E Diameter

Short

16mm

70mm

18mm

104mm

14mm

Standard

16mm

90mm

18mm

124mm

14mm

Tall

16mm

120mm

18mm

154mm

14mm

Fig. 5b chart

OPERATIVE TECHNIQUE

Knob

Fig. 5c

Fig. 5d

Fig. 5e

Screw Driver Assembly Attach the appropriate modular Phoenix Screw Body onto the desired Firebird® Modular Screw. Confirm a secure connection by pulling on the Screw. Insert the Screwdriver (20-0200) with either the Straight Handle (52-1013) or the T-Handle (52-1011) into Phoenix Screw Body and engage the tip of the Screwdriver with square of the Modular Screw. (Fig. 5c) Rotate the knob on a Screwdriver in a clockwise direction to assemble the Head of the Screw onto the Screwdriver Tip. (Fig. 5d) Confirm the Screw is solidly attached to the Screwdriver and do not overtighten. Using the Screwdriver, drive the Multi-Axial Screw of appropriate length over the Guide Wire into the prepared Pedicle. Remove the Guide Wire after the Screw enters the vertebral body. (Fig. 5e) Periodically check with fluoro to ensure proper Screw placement based on surgeon preference. Over-insertion of Screw may limit poly-axial motion of the Reduction Head. Once the Screw is seated to the appropriate level, turn the Knob in a counter-clockwise direction and remove the Screwdriver. (Fig. 5d)

NOTE: If for any reason the Phoenix Screw needs to be adjusted after the Screwdriver is removed, there is modular Multi-Axial Adjustment Screw Driver (20-0201) that mates with the Straight Handle (52-1013) to easily advance or withdraw the Screw. Place the remaining Screws using the same techniqueby repeating Steps 3 to 5. NOTE: Preparation of disc space may occur before or after Screw placement based on surgeon preference. NOTE: Optional sterile packed HA coated bone screws are available upon request.

9

10

OPERATIVE TECHNIQUE

Fig. 6a

Fig. 6c

Fig. 6b

6. ROD INSERTION – ROD LENGTH Determination

Rod Inserter Assembly

The Rod Sizing Tool (20-0205) is inserted into the most proximal and distal Phoenix Screw Body and the reading is taken from the markings on the scale. (Fig. 6a) This is a direct measurement and no additional numeric addition is necessary to determine proper length. Example: if the measurement tool reads 100mm, then select a 100mm Lordotic or Straight Hex Rod. Both ends of the Caliper must be inserted until they contact the screw head to ensure an accurate measurement. This technique works up to a maximum of 150mm. The option exists to cut and bend Rods as required.

Align the Hex end of the Rod with the Hex mating features of the Rod Holder (20-0214). Attach rod to holder to allow for insertion while maintaining the desired curvature of the rod. Firmly push the Hex into the Rod Inserter until it is fully seated. (Fig. 6b) Rotate the knob on the Inserter in a clockwise motion to draw the Rod upwards until the front surface of the tip aligns and is engaged in the undercut feature of the Rod. (Fig. 6c) This will prevent the Rod from becoming disengaged during insertion.

WARNING: Excessive or repeated bending of rods may reduce strength and result in construct failure.

OPERATIVE TECHNIQUE

Fig. 6d

11

Fig. 6g

Fig. 6e

Fig. 6f

Option: Creating a Tunnel for Rod

Percutaneous Rod Passing

The Tissue Dissector (20-0283) may be used to create a tunnel for passing the Rod into position. The distal tip of the Tissue Dissector is passed through the end of the construct with the hook facing up away from the spine. (Fig. 6d) Advance the instrument through each Phoenix Screw Saddle until it passes to the opposite end of the construct. Slowly pull the instrument back which will dissect the tissue with distal hook of the instrument.

This technique requires use of the open body for the end of the construct where the Rod is to be introduced. Align the openings of the Phoenix Bodies by hand to facilitate easy passing of the Rod. A Body Alignment Tool (20-0212) is available to align the openings if tissue or bone prevents positioning by hand. The leading tapered end of the Rod is passed through the open channel in the Phoenix Screw Body until it passes below the fascia and into the Screw Head. The Rod Inserter handle will be almost parallel to the patient during this phase of Rod passage. (Fig. 6e) When distal tip of Rod enters the Screw Head, begin to rotate the Rod Inserter handle which will push the Rod through to the adjacent levels. Once the Rod is seated, the Rod Inserter handle will be approximately perpendicular to the patient. (Fig. 6f) Excessive forces should not be required to pass the Rod through the tissue. If Rod passage is difficult, remove the Rod Inserter and utilize the tissue dissector (Fig. 6d). The Rod Pusher (20-0210) can be inserted down the Phoenix Screw Body to seat the Rod into position. (Fig. 6g)

12

OPERATIVE TECHNIQUE

Fig. 6h

Fig. 7a

ALTERNATIVE - HOOK ROD INSERTER Hook Rod Inserter (70-3208) can be used in mini-open procedures by attaching the hook to the rod, and dropping down between Phoenix Bodies. (Fig. 6h)

Fig. 7b

7. SET SCREW INSERTION AND ROD REDUCTION The Rod is brought into correct position and is stabilized with Rod Holder. The Set Screws are assembled onto the Set Screw Holders (20-0250, 20-0260) and held in place by depressing the button on the top of the handle. The Set Screws are inserted into each Phoenix Screw Body and are used to seat the Rod into the Impant Saddle. The Set Screw is fully seated when the Set Screw Holder’s corresponding laser mark (Short, Standard, Tall) reaches the top of the Screw Body. (Fig. 7a) The instrument set contains two long Set Screw Holders and one short Set Screw Holder. The two different lengths of Inserters allow for simultaneous tightening of the Set Screws in tight working spaces as shown in figure. The round handle design eliminates the issues with the interference of using T-Handles side-by-side. A/P and lateral fluoroscopic views can be used to ensure proper Rod positioning and the extent of reduction. (Fig. 7b) There are two Round Handles (20-0211) that can be placed on the existing set screw handle, if a larger grip surface is desired. They can also be used to provide greater force when reducing a spondylolisthesis.

OPERATIVE TECHNIQUE

Fig. 7c

Fig. 7d

7b. ALTERNATIVE STEP FOR TREATMENT OF SPONDYLOLISTHESIS: SET SCREW INSERTION AND ROD REDUCTION The built-in reduction capability is also useful for reducing a spondylolisthesis by first provisionally tightening one Set Screw followed by tightening of the anterolisthesed segment to establish deformity correction. Fully seat the set screws in the Phoenix Screw Bodies on either side of the vertebrae with the spondylolisthesis. Then insert the Set Screw on the vertebrae with spondylolisthesis. (Fig. 7c) Advancing the Screw provides the reduction force to align the vertebrae. Make sure the black lines on the set screw holder shaft indicate the set screw is fully seated. (Fig. 7d) There are two Round Handles (20-0211) that can be placed on the existing set screw handle, if a larger grip surface is desired. They can also be used to provide greater force when reducing a spondylolisthesis.

13

14

OPERATIVE TECHNIQUE

Compression

Fig. 8a

Distraction

Fig. 8b

8. COMPRESSION/DISTRACTION Compression

Distraction

Slide the Torque Wrench Cannulas (20-0226) over each Phoenix Screw Body to which you are going to apply compression forces. Application of compression forces without use of the cannulas in not recommended. The slot in the end of the Cannula is aligned and engages the rod. Slide the Alignment Tool (70-3221) over the top of the cannulas and draw the cannulas together with either upward or downward force on the handle of the alignment tool. Alternative method – The compression/distraction fixture (20-0220) can be used in place of the alignment tool (70-3221). Adjust the fixture to the desired width and lock the adjustment nut on the fixture.

Slide the Torque Wrench Cannulas (20-0226) over each Phoenix Screw Body to which you are going to apply distraction forces. Application of distraction forces without use of the cannulas is not recommended. The slot in the end of the Cannula is aligned and engages the rod. Slide the compression/ distraction fixture (20-0220) over the top of the cannulas. Adjust the fixture to the desired width and lock the adjustment nut on the fixture. Assemble the distraction tips (left 70-3220 & right 70-3222) on distraction instrument (70-3219) and attach to the holes in the cannulas closest to the level of the skin. Distract the Cannulas to the desired level and proceed to final tightening of set screws. (Fig. 8b)

Attach the compression instrument (70-3218) to the holes in the cannulas closest to the level of the skin. Compress the Cannulas to the desired level and proceed to final tightening of Set Screws. (Fig. 8a)

OPERATIVE TECHNIQUE

Fig. 9

Fig. 10a

Fig. 10b

9. FINAL TIGHTENING

10. TAB REMOVAL

The Torque Wrench Cannula slides over the Phoenix Screw Body and has two distal openings to engage the Rod. The Counter Torque Wrench Handle (20-0225) slides over the hex end of the Cannula. The Torque T-Handle (52-1512) attached to the Set Screw Driver (52-1061) is passed down the Phoenix Screw Body and mates with the Set Screw. ALTERNATIVE – When the use of compression or Distraction is not desired, then a one piece Counter Torque Wrench (20-0224) can be used in place of the modular instruments. Turn the Torque T-Handle (55-1068) clockwise to tighten the Set Screw to 100 in/lbs. The handle will reach its maximum torque and release at 100 in/lbs. (Fig. 9)

Position the three claws on the small end of the Implant Tab Removal Tool (20-0280) below one of the small tabs on the Phoenix Screw Body and use an upward motion to engage the claws of the tool onto the tab. Rotate the handle downward causing the small end to rotate up and the small tab will break free of the Phoenix Screw Body. Perform the same steps on the opposite side. (Fig. 10a) The small tabs can be discarded or recycled. Slide the large opening of the Implant Tab Removal tool over the large tab on one side of the Phoenix Screw. Move the handle away from the midline and then back to midline until the large tab dissociates from the Phoenix Screw Head. Perform the same steps on the remaining tab. (Fig. 10b) The larger tabs can be discarded or recycled.

11. REMOVAL PROCEDURE Removal of implants should be performed as outlined in the Firebird Spinal Fixation Operative Technique.

15

16

PART NUMBERS

PHOENIX IMPLANT CASE, 20-0017 Part Numbers Part #

Description

Part Numbers Qty

Phoenix Implant Case Implant Case (Empty) 20-0111

1

Phoenix Bodies Phoenix™ Open Body, Short 20-2070 Phoenix™ Open Body, Standard 20-2090 Phoenix™ Open Body, Tall 20-2120 Phoenix™ Closed Body, Short 20-3070 Phoenix™ Closed Body, Standard 20-3090 Phoenix™ Closed Body, Tall 20-3120

18 18 18 * * *

Firebird Set Screws Set Screw 44-2001

30

Firebird Cannulated Modular Screw/Self Tapping 4.5mm / 20mm 77-8420 4.5mm / 25mm 77-8425 4.5mm / 30mm 77-8430 4.5mm / 35mm 77-8435 4.5mm / 40mm 77-8440 4.5mm / 45mm 77-8445 4.5mm / 50mm 77-8450 4.5mm / 55mm 77-8455 5.5mm / 35mm 77-8535 5.5mm / 40mm 77-8540 5.5mm / 45mm 77-8545 5.5mm / 50mm 77-8550 5.5mm / 55mm 77-8555 6.5mm / 35mm 77-8635 6.5mm / 40mm 77-8640 6.5mm / 45mm 77-8645 6.5mm / 50mm 77-8650 6.5mm / 55mm 77-8655 7.5mm / 40mm 77-8740 7.5mm / 45mm 77-8745 7.5mm / 50mm 77-8750 7.5mm / 55mm 77-8755 8.5mm / 40mm 77-8840 8.5mm / 45mm 77-8845

* * * * * * * * 6 8 8 6 4 4 10 12 10 4 4 6 6 4 2 2

* By Request Only, Not Standard in Set

Part #

Description

Qty

Firebird Lordotic Rods with Hex Pre-Lordosed Rod w/hex and taper, 35mm 20-4035 Pre-Lordosed Rod w/hex and taper, 40mm 20-4040 Pre-Lordosed Rod w/hex and taper, 45mm 20-4045 Pre-Lordosed Rod w/hex and taper, 50mm 20-4050 Pre-Lordosed Rod w/hex and taper, 55mm 20-4055 Pre-Lordosed Rod w/hex and taper, 60mm 20-4060 Pre-Lordosed Rod w/hex and taper, 65mm 20-4065 Pre-Lordosed Rod w/hex and taper, 70mm 20-4070 Pre-Lordosed Rod w/hex and taper, 75mm 20-4075 Pre-Lordosed Rod w/hex and taper, 80mm 20-4080 Pre-Lordosed Rod w/hex and taper, 90mm 20-4090 Pre-Lordosed Rod w/hex and taper, 100mm 20-4100 Pre-Lordosed Rod w/hex and taper, 110mm 20-4110 Pre-Lordosed Rod w/hex and taper, 120mm 20-4120 Pre-Lordosed Rod w/hex and taper, 130mm 20-4130 Pre-Lordosed Rod w/hex and taper, 140mm 20-4140 Pre-Lordosed Rod w/hex and taper, 150mm 20-4150

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

Phoenix Straight Rods with Hex Straight Rod w/hex and taper, 40mm 20-5040 Straight Rod w/hex and taper, 50mm 20-5050 Straight Rod w/hex and taper, 60mm 20-5060 Straight Rod w/hex and taper, 70mm 20-5070 Straight Rod w/hex and taper, 80mm 20-5080 Straight Rod w/hex and taper, 90mm 20-5090 Straight Rod w/hex and taper, 100mm 20-5100 Straight Rod w/hex and taper, 110mm 20-5110 Straight Rod w/hex and taper, 120mm 20-5120 Straight Rod w/hex and taper, 140mm 20-5140 Straight Rod w/hex and taper, 160mm 20-5160 Straight Rod w/hex and taper, 180mm 20-5180 Straight Rod w/hex and taper, 200mm 20-5200 Straight Rod w/hex, 450mm 20-5450

2 2 2 2 2 2 2 2 2 2 2 2 2 2

PART NUMBERS

PHOENIX INSTRUMENT CASE 1, 20-0015

PHOENIX INSTRUMENT CASE 2, 20-0016

INSTRUMENTS

INSTRUMENTS

Part # 20-0101 20-0123 20-0124 20-0145 20-0155 20-0165 20-0175 20-0200 20-0201 20-0205 20-0210 20-0211 20-0212 20-0214 20-0218 20-0224 20-0250 20-0251 20-0260 20-0261 20-0275 20-0280 20-0283 52-1011 52-1013 52-1061 70-3208

Description Instrument Case 1 (Empty) Guide Wire Nitinol, 21 inch - Blunt (1.57mm Dia) Guide Wire Nitinol, 21 inch - Sharp (1.57mm Dia) 4.5mm Tap 5.5mm Tap 6.5mm Tap 7.5mm Tap Screw Driver Modular Multi-axial Adjustment Screw Driver Rod Sizing Tool Rod Pusher Round Set Screw Inserter Handle Body Alignment Instrument Rod Holder/Inserter Non-Conductive Dilator Counter Torque Wrench Set Screw Holder Long Set Screw Holder Long Insert Set Screw Holder Short Set Screw Holder Short Insert Tap Sleeve Dilator Implant Tab Removal Tool Tissue Dissector Cannulated Firebird T-handle Straight Ratcheting Handle, Small Set Screw Driver (adapter) Proview Rod Inserter

* By Request Only, Not Standard in Set

Qty 1 10 10 * 1 1 1 2 1 1 1 2 1 1 2 1 2 2 1 1 2 1 1 2 2 2 1

Part # 20-0120 20-0220 20-0225 20-0226 52-1512 70-3218 70-3219 70-3220 70-3221 70-3222

Description Instrument Case 2 (Empty) Compression/Distraction Fixture Counter Torque Wrench Handle Counter Torque Cannula Torque T-Handle Parallel Compressor Parallel Distractor Distractor Tip Left Alignment Tool Distractor Tip Right

17

Qty 1 1 1 2 1 1 1 1 1 1

OTHER INSTRUMENTS Part # 21-5000 21-5011

Description Bone Marrow Aspiration Needle Kit, 8 gauge Bone Marrow Aspiration Needle Kit, 11 gauge

Qty 1 1

18

IMPLANT INSERTER ASSEMBLY/DISSASEMBLY INSTRUCTIONS

Instructions for Assembly/Disassembly of the Multi-Axial Screw Driver (20-0200) There are three parts to the Multi-Axial Screw Driver: 1) Inner Shaft, 2) Screwdriver Shaft, and 3) Extender Shaft.. 1

2

3

The Multi-Axial Screw Driver requires disassembly prior to cleaning using the following steps.

(Fig. 1)

Assembly/Inspection of the Multi-Axial Screw Driver (20-0200) a. Insert inner shaft completely into screwdriver shaft. Large end of inner shaft should be on the same side as the threaded tip of screwdriver shaft. not, reverse inner shaft insertion. (Fig. 1 & 2)

If

(Fig. 2)

b. While holding inner shaft and screwdriver shaft in place, align D-cut on inner shaft with D-shaped hole on extender shaft. (Fig. 3) c. With slotted knob on the extender shaft pulled back (away from threads), slide extender shaft and inner shaft together until it clicks. (Fig. 4 & 5) d. Push slotted knob on extender shaft forward and turn until threads are fully engaged. (Fig. 6)

(Fig. 3)

e. After assembly, ensure that turning extender shaft smoothly rotates inner shaft within the screwdriver. (Fig. 7) f. If inner shaft does not rotate smoothly or extender shaft knob will not fully seat, disassemble instrument and check for debris. g. If debris is found, repeat cleaning and attempt assembly. Disassembly of the Multi-Axial Screw Driver (20-0200)

(Fig. 4)

a. Turn slotted knob at back of screwdriver until knob completely unthreads. (Fig. 5) b. Slide slotted knob back to the stop on extender shaft. (Fig. 4) c. Remove extender shaft from inner shaft by pulling axially until extender shaft is free. (Fig. 3) d. Pull inner shaft out of screwdriver shaft. (Fig. 1)

(Fig. 5)

Once disassembly is complete there will be three parts to the Multi-Axial Screw Driver. Note: To avoid components falling, it is suggested to hold the assembly horizontal and/or perform the assembly over a table.

(Fig. 6)

(Fig. 7)