Abstract: A three-prong retractor is disclosed which is inserted into an incision in a patient in order to create an area for surgery. The retractor opens such that two blades move away from a first blade to create an elongated opening. The two blades may then move away from each other in a direction that intersects the direction of the movement of the first blade away from the two blades. The ends of the two blades remote from the retractor body may then move away from the end of the first blade remote from the retractor body to further open the incision. The retractor may also have an elastomeric sheath surrounding the blades in order to create a barrier between the surgical area and the patient's skin.

Abstract: A method of inserting and positioning an intervertebral spacer is provided. The spacer includes a longitudinal axis, an on-axis interface coincident with or parallel to the longitudinal axis, and an off-axis interface angled to the longitudinal axis. The spacer's front end may be curved. The method may include inserting the spacer into the disc space utilizing a tool to engage an on-axis interface and then to engage one or more of the off-axis interfaces, which may be used for further modification of the spacer. The tool is moved substantially along a single insertion direction, which may be substantially parallel to a posterior-anterior axis of the disc space. The method may result in the longitudinal axis of the spacer being perpendicular to the insertion direction, or substantially parallel to a medial-lateral axis of the disc space. The spacer may also be positioned in an anterior aspect of the disc space.

Abstract: A posterior vertebral stabilizer has a resilient member such as a linear spring, which operates in tension and compression. The resilient member may be kept straight by a stabilization rod extending through the spring, or by a telescoping assembly that encases the resilient member. The ends of the stabilizer are attachable to pedicles of adjacent vertebrae so that the stabilizer adds stiffness to control flexion and extension of the vertebrae. Two such stabilizers may be used, and may be connected together by a crosslink designed to limit relative rotation of the stabilizers. Thus, the stabilizers may restrict axial rotation and lateral bending between the vertebrae, while permitting stiffened flexion and extension. Such stabilizers help provide the stiffness of a healthy intervertebral disc. In the event that fusion of the joint becomes necessary, a set screw or other component may be used to further restrict flexion and extension.

Abstract: An expandable intervertebral implant and tool for use in implanting same are disclosed. The tool is useful in retaining the implant in a non-expanded state throughout insert of the implant between adjacent vertebral bodies. Among other elements, the tool includes a rod, a sleeve placed over the rod, and a locking knob attached to the rod and the sleeve to fix them with respect to each other. This construct preferably aids in preventing movement of the various components of the implant, including first and second members and first and second wedges. A method of attaching inserting the implant through the use of the tool and attaching the tool to the implant are also disclosed.

Abstract: A bone plate having at least one screw hole adapted to receive a bone screw, a blocker having a blocking end for blocking a bone screw from further backout of bone the blocker being predisposed in a blocking position wherein the blocking end at least partially overlaps a portion of the screw hole, the blocker being moveable from the blocking position by contact with the bone screw during insertion of the bone screw into the screw hole, and a blocker fixation element having an open orientation at which the blocker can move from the blocking position and a closed orientation preventing substantial movement of the blocker from the blocking position. The blocker fixation element cannot be moved to the closed orientation unless the screw head passes the blocker, thereby revealing that the blocker fixation element is in position to prevent substantial movement of the blocker.

Abstract: A posterior vertebral stabilizer has a resilient member such as a linear spring, which operates in tension and compression. The resilient member may be kept straight by a stabilization rod extending through the spring, or by a telescoping assembly that encases the resilient member. The ends of the stabilizer are attachable to pedicles of adjacent vertebrae so that the stabilizer adds stiffness to control flexion and extension of the vertebrae. Two such stabilizers may be used, and may be connected together by a crosslink designed to limit relative rotation of the stabilizers. Thus, the stabilizers may restrict axial rotation and lateral bending between the vertebrae, while permitting stiffened flexion and extension. Such stabilizers help provide the stiffness of a healthy intervertebral disc. In the event that fusion of the joint becomes necessary, a set screw or other component may be used to further restrict flexion and extension.

Abstract: Anatomic points within the body are projected outside the body through the use of extenders (180, 182, 188). The projected points may then be used for measurement, or to facilitate the selection or configuration of an implant that is positioned proximate the anatomic points using a slotted cannula (143). Such an implant may be a rod (270) for a posterior spinal fusion system. Pedicle screws (140, 142, 148) may be implanted into pedicles of the spine, and may then serve as anchors for the extenders. The extenders (180, 182, 188) may have rod interfaces (214, 216, 218) that receive the rod (270) in a manner that mimics the geometry of the pedicle screws (140, 142, 148) so that the selected or configured contoured rod (270) will properly fit into engagement with the pedicle screws (140, 142, 148).

Abstract: A dynamic subsidence plate is described having a first plate member and a second plate member in sliding engagement that may infinitely subside between a first and second assembled position. The plate includes a lock assembly associated with the first and second plate members. The lock assembly includes a ramp portion, an interference portion, and a bearing member situated between the ramp portion and the interference portion. The lock assembly of the plate is configured to allow movement of the first member with respect to the second member in a first direction in an infinite number of positions between a first assembled position and a second assembled position. Further, the lock assembly alternatively prevents movement of the first member with respect to the second member in an opposite second direction between the first and second assembled positions.

Abstract: An insertion tool for positioning intervertebral spacers into disc spaces. The insertion tool has a proximal end and a distal end, a T-handle secured to the proximal end and a pair of alignment rails extending to the distal end. The insertion tool includes a handle secured to the proximal end of the guide rails, and a shaft that extends through the handle, whereby the shaft has a threaded portion that extends to the T-handle. The insertion tool also includes a blocker that is secured to the distal end of the shaft. The blocker includes stop arms that guide the blocker through the guide rails and toward the distal end of the shaft. The blocker may be provided in a plurality of different sizes corresponding to the sizes of the implants to be inserted into a disc space. A lock is provided for locking the implant to the shaft.

Abstract: An orthopedic bone plate system having a bone plate for placement adjacent one or more vertebral bodies. The bone plate has a first aperture extending along a longitudinal axis and an upper and lower surface. The bone plate system further includes a sliding element having a top portion and a base portion and an aperture extending along a central axis. The sliding element is adapted for being placed adjacent to the bone plate aperture. The system preferably includes a bone fastener having a longitudinal axis which is adapted for connecting the bone plate to a vertebral body. The bone fastener includes a stem and a bone engaging portion. The diameter of the stem may be less than a cross section of the sliding element aperture so that the stem may be oriented within the sliding element aperture at a plurality of angles. The system may further include a stopping element engageable with the sliding element base portion.

Abstract: A spinal plating system for vertebral fixation includes a plate, a compression screw, multiple fixation members and polyaxially adjustable locking rings. The plate is shaped to conform to the curvature of the spine and the surfaces of the vertebral bodies. The compression screw fits through an insert, and together they are guided by the plate as the screw is driven into one of the vertebrae, producing compression between the adjacent vertebrae. A retaining lip on the plate prevents backout of the compression screw. The polyaxial locking rings can be polyaxially pivoted to attain a desired orientation, and are lockable to the plate to maintain the orientation. The fixation members fit through openings in the polyaxial locking rings and the plate to fix the plate to the vertebrae. Locking the polyaxial locking rings fixes the position of the fixation members relative to the plate, and prevents backout of the fixation members.

Abstract: An instrument for spinal rotation that aligns and holds direct vertebral rotation (DVR) lever arms relative to each other to achieve an initial axial alignment of a segment of vertebrae and allows the final DVR rotation by rotating the instrument and lever arms together. A method of direct vertebral rotation that allows rotating the vertebrae to be aligned relative to each other, and collectively rotating the vertebrae to be aligned relative to adjacent spinal segments by rotating the direct vertebral rotation instrument. A system for direct vertebral rotation having at least two pedicle screws. The system also includes at least two levers attachable to the pedicle screws and a clamping instrument configured to clamp the levers.

Abstract: A screwdriver is disclosed including a handle, a shaft, and a gearbox disposed between the handle and the shaft. The gearbox is structured and arranged to cause rotational motion of the shaft at a first rate due to rotational motion imparted on the handle at a second rate. In an embodiment, the first rate is greater than the second rate.

Abstract: An apparatus and method for advancement of a spinal rod in a spinal implant, wherein the apparatus includes a body and a handle attached to the body. A shaft is slidably attached to the body, the shaft is coupled to the handle and has a first end adapted to engage the spinal rod. At least one retractor blade is attached to the body and the spinal implant. The operation of the handle results in the shaft persuading the spinal rod in the spinal implant. The force exerted by the shaft on the spinal rod is limited to a pre-selected force. The apparatus can also be operated in a non-limiting mode when a reduction retractor blade is used.

Abstract: A method of stabilizing bone, such as a spine, includes providing a coupling element having first and second sections that are angled relative to one another, the coupling element having rod receiving openings for securing an elongated member such as an orthopedic rod, and assembling the coupling element with an anchoring element. The method includes securing the anchoring element in bone, moving the coupling element relative to the anchoring element to align the rod receiving openings with the orthopedic rod, securing the orthopedic rod in the rod receiving openings, and after the securing step, locking the coupling element from further movement relative to the anchoring element.

Abstract: The present invention provides a compression and distraction shaft assembly used to apply compression and distraction to bones including vertebrae. Shaft A assembly and shaft B assembly are attached together via a polyaxial fulcrum. The polyaxial fulcrum allows all rotational degrees of freedom between shaft A assembly and shaft B assembly. Such fulcrum, during compression and distraction, does not impart ancillary stresses or motion to vertebrae. A hour glass shaped bore for engaging pliers is formed in approximately middle of both the shaft A assembly and the shaft B assembly. A distraction pliers having cylindrical tips is used to apply distraction to vertebrae. Once handles are pressed to impart appropriate amount of distraction to the vertebrae they are locked in this position. A compression pliers having cylindrical tips is used to apply compression to vertebrae. Once handles are pressed to impart appropriate amount of compression to the vertebrae they are locked in this position.