Abstract: A bellows shaped spinal implant, comprising an upper plate, a lower plate and a bellows shaped shell extending between and joining the upper and lower plates. The bellows shaped shell is formed of titanium or an alloy comprising titanium and includes a wall extending therearound that defines a hollow interior. The wall has a thickness in the range of 0.5 mm to 1.0 mm to provide for radiographic imaging through the wall. The wall is angled or curved inwardly or outwardly between the upper and lower plates to provide stiffness mimicking the stiffness properties of a similarly sized polyetheretherketone (PEEK) implant. The upper and lower plates each comprise porous contact regions including a three-dimensional gyroid lattice structure defined by a plurality of struts and pores in communication with the hollow interior. The outer surfaces of at least a portion of the struts may comprise a laser ablated textured surface.

Abstract: An expandable interbody fusion device and an associated instrument for inserting the device into an intervertebral disc space, expanding the device and for use in delivering graft material into the device once expanded in the disc space. The device is small enough to fit through Kambin's triangle yet is capable of expanding both in the vertical direction to accommodate spinal lordosis and in the lateral direction to provide sufficient structural support for opposing vertebral bodies laterally within the disc space. A process of forming textured top and bottom surfaces of the device by initially laser ablating each surface with a nano-second pulsed laser followed by laser ablating those surfaces with a femto-second pulsed laser.

Abstract: An expandable interbody fusion device and an associated instrument for inserting the device into an intervertebral disc space, expanding the device and for use in delivering graft material into the device once expanded in the disc space. The device is small enough to fit through Kambin's triangle yet is capable of expanding both in the vertical direction to accommodate spinal lordosis and in the lateral direction to provide sufficient structural support for opposing vertebral bodies laterally within the disc space. A process of forming textured top and bottom surfaces of the device by initially laser ablating each surface with a nano-second pulsed laser followed by laser ablating those surfaces with a femto-second pulsed laser.

Abstract: An expandable interbody fusion device and an associated instrument for inserting the device into an intervertebral disc space, expanding the device and for use in delivering graft material into the device once expanded in the disc space. The device is small enough to fit through Kambin's triangle yet is capable of expanding both in the vertical direction to accommodate spinal lordosis and in the lateral direction to provide sufficient structural support for opposing vertebral bodies laterally within the disc space. A process of forming textured top and bottom surfaces of the device by initially laser ablating each surface with a nano-second pulsed laser followed by laser ablating those surfaces with a femto-second pulsed laser.

Abstract: A medical implant has a textured tissue contact surface comprising a roughened surface that includes a plurality of macroscale and microscale projections and recesses and a plurality of nanostructures on the projections and within the recesses. The nanostructures comprise a plurality of spaced elongated waves, each wave having a crest and a trough. Each wave and recess comprise a plurality of individual polygonal structures, some of which comprise pyramidical-type shapes. The textured tissue contact surface is formed by initially laser ablating a tissue contact surface on the implant with a nanosecond pulsed laser followed by laser ablating the initially ablated surface with a femto-second pulsed laser.

Abstract: A bellows shaped spinal implant, comprising an upper plate, a lower plate and a bellows shaped shell extending between and joining the upper and lower plates. The bellows shaped shell is formed of titanium or an alloy comprising titanium and includes a wall extending therearound that defines a hollow interior. The wall has a thickness in the range of 0.5 mm to 1.0 mm to provide for radiographic imaging through the wall. The wall is angled or curved inwardly or outwardly between the upper and lower plates to provide stiffness mimicking the stiffness properties of a similarly sized polyetheretherketone (PEEK) implant. The upper and lower plates each comprise porous contact regions including a three-dimensional gyroid lattice structure defined by a plurality of struts and pores in communication with the hollow interior. The outer surfaces of at least a portion of the struts may comprise a laser ablated textured surface.

Abstract: An inserter for attaching a modular yoke to a bone screw and for providing an indication of attachment, comprises a tubular body having a central lumen, distal and proximal ends, and an attachment portion for releasable attachment to a yoke having a bottom opening for receipt of a head of said bone screw. The inserter includes an inner shaft having a distal end configured to be received into the yoke, the shaft being axially movable within the lumen from first to second axial positions in response to the introduction of the bone screw head into the yoke bottom opening. An indicator button supported by the body is movable in response to axial movement of the shaft from a first indicator position indicating the first axial position of the shaft relative to the body to a second indicator position indicating the second axial position of the shaft relative to the body.

Abstract: A medical implant has a textured tissue contact surface comprising a roughened surface that includes a plurality of macroscale and microscale projections and recesses and a plurality of nanostructures on the projections and within the recesses. The nanostructures comprise a plurality of spaced elongated waves, each wave having a crest and a trough. Each wave and recess comprise a plurality of individual polygonal structures, some of which comprise pyramidical-type shapes. The textured tissue contact surface is formed by initially laser ablating a tissue contact surface on the implant with a nanosecond pulsed laser followed by laser ablating the initially ablated surface with a femto-second pulsed laser.

Abstract: A system for delivering bone graft material into an interbody fusion device (IBFD) in an intradiscal space of a spine, the IBFD having an open-frame with a hollow interior and an opening through its proximal end communicating with the interior. Included is an elongate channel having a lumen extending therethrough, the distal end being in engagement with the IBFD to align the lumen with the opening through the proximal end of the IBFD. An adjustable block is movably attached to the channel, the block having plural chambers containing bone graft material, the chambers being individually sequentially alignable with the lumen. A plunger pushes graft material from each chamber, through the lumen and into the IBFD. A distal end of a tamper is configured to be inserted through each chamber and the lumen and into the IBFD interior for tamping graft material deposited into the interior of the IBFD.

Abstract: A system for delivering bone graft material into an interbody fusion device (IBFD) in an intradiscal space of a spine, the IBFD having an open-frame with a hollow interior and an opening through its proximal end communicating with the interior. Included is an elongate channel having a lumen extending therethrough, the distal end being in engagement with the IBFD to align the lumen with the opening through the proximal end of the IBFD. An adjustable block is movably attached to the channel, the block having plural chambers containing bone graft material, the chambers being individually sequentially alignable with the lumen. A plunger pushes graft material from each chamber, through the lumen and into the IBFD. A distal end of a tamper is configured to be inserted through each chamber and the lumen and into the IBFD interior for tamping graft material deposited into the interior of the IBFD.

Abstract: A modular apparatus for extending a rod in an existing spinal construct comprises a modular rod connector for attachment to the existing rod and a modular rod extender that may be selectively attached to the rod connector. Each rod connector includes a spherical head that is formed to have the same size and configuration such that any selected modular rod extender may be attached to a selected rod connector. Each rod connector comprises an attachment portion having an opening for receipt of a portion of the rod of an existing spinal construct. Each modular rod extender comprises an extender body including a common modular attachment feature at one end for receipt of the spherical head of the selected rod connector, and an extension rod extending from an opposite end to extend the existing spinal rod.

Abstract: A bellows shaped spinal implant, comprising an upper plate, a lower plate and a bellows shaped shell extending between and joining the upper and lower plates. The bellows shaped shell is formed of titanium or an alloy comprising titanium and includes a wall extending therearound that defines a hollow interior. The wall has a thickness in the range of 0.5 mm to 1.0 mm to provide for radiographic imaging through the wall. The wall is angled or curved inwardly or outwardly between the upper and lower plates to provide stiffness mimicking the stiffness properties of a similarly sized polyetheretherketone (PEEK) implant. The upper and lower plates each comprise porous contact regions including a three-dimensional gyroid lattice structure defined by a plurality of struts and pores in communication with the hollow interior. The outer surfaces of at least a portion of the struts may comprise a laser ablated textured surface.

Abstract: A disc preparation instrument for use in fusing spinal vertebrae comprises a modular scoring trial and a depth stop releasably attached to the scoring trial. The trial includes an elongate stem supporting a trial device at its distal tip. The trial device is insertable into a disc space and includes a rotatable rasp for scoring opposing vertebral endplates at a scored location. A stop, sized to engage an exterior surface of the vertebrae, is movable on the depth stop stem by rotation of an adjustment knob to a plurality of selectable distances between the proximal end of the trial device and the movable stop. An actuator releasably attached to the trial is operable to rotate the rasp. A plurality of modular trials, each having a trial device of different heights may be provided in a kit. Each scoring trial is selectively releasably attachable to a single depth stop.

Abstract: A modular inserter assembly for use in inserting an interbody fusion cage into the disc space between opposing vertebrae comprises a depth stop and a modular inserter tip releasably attached thereto. The modular inserter assembly includes a cage attachment surface for releasable attachment to an interbody fusion cage, the depth stop including a movable stop axially movable relative to the inserter tip and being sized and configured to engage an exterior surface of one of the vertebrae to establish the depth to which the interbody fusion cage is to be inserted in the disc space. A plurality of modular inserter tips, each being configured for selective releasable attachment to differently sized interbody fusion cages are provided in a kit with the depth stop.

Abstract: An apparatus is provided herein for dilating bodily tissue and for monitoring neural activity in the distracted bodily tissue. In one aspect of the invention, the apparatus includes a first dilator having a tubular body with a distal end, a proximal end, and at least one electrode mounted about a circumference thereof; and, a second dilator having a tubular body of electrically-insulative material, the tubular body having a distal end, a proximal end, and a lumen extending therebetween sized to permit the second dilator to subsequently telescopically slide over the first dilator and come into overlapping coaxial alignment with the first dilator. A discrete window is formed through the tubular body, at or near the distal end, in communication with the lumen.

Abstract: A spinal rod reducer for reducing a rod into a rod-receiving opening of a bone anchor comprises an elongate tubular body having a lumen extending therethrough and a pair of spaced flexible anchor attachment members at the distal end of the tubular body. A threaded rod reduction member having a rod contacting surface is supported for axial movement within the lumen. A threaded rotatable reduction knob is threadably engaged with the rod reduction member rotation of which causes the rod reduction member with the rod contacting surface to move axially distally toward the bone anchor. A locking sleeve is configured to axially slide on the tubular body over the attachment members, the locking sleeve including a locking element for releasably coupling the locking sleeve and the rod reduction member for selective independent and joint movement relative to the tubular body.

Abstract: A bellows shaped spinal implant, comprising an upper plate having an upper opening therethrough, a lower plate having a lower opening therethrough, and aa bellows shaped shell extending between and joining the upper plate and the lower plate. The bellows shaped shell is formed of titanium or an alloy comprising titanium and includes a wall extending continuously therearound that defines a hollow interior in communication with the upper opening and the lower opening. The wall has a thickness in the range of 0.5 mm to 1.0 mm to provide for radiographic imaging through the wall. The wall is angled or curved inwardly or outwardly between the upper plate and the lower plate to provide stiffness that mimics the stiffness properties of a similarly sized polyetheretherketone (PEEK) implant.

Abstract: Apparatus and devices for percutaneously extending an existing spinal construct ipsilaterally with an additional spinal construct in a patient are disclosed. The additional spinal construct comprises a rod connector that includes an elongate additional rod integrally attached thereto. The additional rod is placed through an access port in a first orientation generally parallel to the longitudinal axis of the access port and rotated to a different second orientation generally transverse to the longitudinal axis of the access port. During such rotation the additional rod is moved subcutaneously beneath the skin of the patient from the existing spinal rod to an additional bone engaging implant. In another arrangement, the extension of an existing spinal construct in a minimally invasive procedure comprises a rod connector having an offset support for receiving an additional spinal rod that may be placed laterally interiorly or exteriorly of the existing spinal construct.

Abstract: An inserter for attaching a modular yoke to a bone screw and for providing an indication of attachment, comprises a tubular body having a central lumen, distal and proximal ends, and an attachment portion for releasable attachment to a yoke having a bottom opening for receipt of a head of said bone screw. The inserter includes an inner shaft having a distal end configured to be received into the yoke, the shaft being axially movable within the lumen from first to second axial positions in response to the introduction of the bone screw head into the yoke bottom opening. An indicator button supported by the body is movable in response to axial movement of the shaft from a first indicator position indicating the first axial position of the shaft relative to the body to a second indicator position indicating the second axial position of the shaft relative to the body.

Abstract: An access system for spinal surgery through a lateral approach comprises a tissue retractor including a center body supporting a centering guide having an elongate opening defining an alignment axis. A pair of retractor blades are movably supported by the center body one blade each on either side of said the centering guide, each retractor blade having a proximal end and a distal end, the distal ends of each retractor blade being configured for placement adjacent a spinal column of a patient. A plurality of elongate disc anchors is provided, each disc anchor being sized for individual removable receipt through the centering guide opening. Each disc anchor has a length such that the distal end of each disc anchor extends distally beyond the distal ends of the retractor blades when each disc anchor is respectively disposed in the centering guide opening.