The Synex cage is an expanding titanium implant designed for reconstruction of the anterior column in injury, post-traumatic kyphosis or tumour of the thoracolumbar spine. It is supplemented by a stabilizing implant. As it is expandable in situ it therefore can be inserted via a relatively small exposure. The design enables good purchase of the endplates and reduces the possibility of secondary displacement. Surgery for anterior reconstruction is usually performed via an anterior approach, however, there are incidences were a posterolateral approach is indicated. The Synex cage is useful in these circumstances, as being expandable, posterolateral insertion with preservation of the nerve roots is possible. The Synex cage is then supplemented with a posterior construct. The cage can be inserted via a left or right posterolateral approach. A specially designed angled screwdriver is now available to release the ratchet mechanism and if necessary collapse the cage. We present, what is, to the best of our knowledge and that of the manufacturer, the first two patients where a Synex cage has been inserted using the posterolateral approach.
