Abstract: An instrument for performing a medical procedure includes a drive shafts a holding clutch, a drive clutch, and an actuator. The holding clutch only allows advancement of the drive shaft, while the drive clutch transfers an advancement force from the actuator to the drive shaft. The dual clutch system allows a lever to be used as the actuator so that a user can generate large actuation forces manually (and optionally remotely) without significant physical effort. This capability can beneficially improve the usability and effectiveness of percutaneous surgical systems, such as those for vertebroplasty or kyphoplasty.

Abstract: An instrument assembly for use in knee joint replacement surgery is provided including a base instrument having a tibial plate, a femoral plate, a tibial arm having a plate end and a control end, a femoral arm having a plate end and a control end, wherein the femoral plate is rotatably fastened to the plate end of the femoral arm. The assembly also includes a distractor mechanism configured to act between the tibial arm and the femoral arm at a point between their respective plate ends and control ends by which the distance between the plate ends of the arms can be adjusted and an ancillary instrument mountable on the base instrument and configured such that the position of the ancillary instrument relative to the tibial plate is fixed during subsequent steps in the knee replacement procedure, while the knee joint is distracted as a result of forces applied across the joint between the tibial plate and the femoral plate.

Abstract: A screw system includes a screw and a washer assembly captive to the screw. The washer assembly is polyaxially pivotable relative to the screw. The screw may be freely rotated in one direction relative to the washer assembly, but frictionally binds with the washer assembly when rotated in a second direction. Various auxiliary fixation features are disclosed.

Abstract: A cranial clamp for attaching a cranial flap to the skull comprises a clamp having a base to be placed against the lamina interna, and a cap acting as a locking member against the lamina externa. The clamp and the cap are linked together by an extension spring within the diploe through a burr hole or along/within the line of a craniotomy.

Abstract: A surgical bone screw (1) and driver (31), and a method for using them for repairing an osteotomy or fracture. The screw has a shaft having a head (5) at its proximal end, screw threads (3) at its distal end and a compression member (7) between the head and the screw threads. In an embodiment, the threads are self-tapping and self-drilling, the head is polygonal, and the sides of the polygon are convex. The driver turns the screw until the threads cross a fracture site and the compression member contacts the proximal bone fragment. The threads and compression member draw the fragments together and leaves the head entirely clear of the bone surface. The screw is removed through a small incision. Tilting the driver to allow the socket to engage an inwardly extending lower portion of the head permits the driver to lift the screw out of the bone.

Abstract: A method of performing vertebral facet fusion by lateral approach and related devices. The lateral approach to facet fusion involves identifying the lateral mass and introducing any of the fixation methods known or described herein laterally at one or more facets through the use of a Kirschner wire guide, a cannulated bone drill and cooperatively cannulated staple guide. A surgical bone staple have a perforated bridge is used across the lateral facet joint where fixation is required. Where fusion is desired, a bone screw have lateral perforations of the shank is inserted through the cannulated staple guide and bridge perforation at the joint to promote fusion. A staple cap and graft container for overlay grafting may be utilized for additional fusion. The method involves less surgical time, reduced blood loss and discomfort for the patient as compared to the posterior approach.

Abstract: A method of replacing a nucleus pulposus material wherein curable nucleus pulposus material is injected into a balloon in an intervertebral space. The balloon has an inlet port and an outlet port that are connected to a pressure-measuring device. After the catheter is placed in the intervertebral space, the balloon is filled with a radio-opaque solution until the desired balloon volume is attained. The nucleus replacement material is then fed into the inlet port of the balloon, while the radiopaque agent is allowed to leave via the outlet port. Once the balloon is completely filled and curing of the curable nucleus replacement material is accomplished, the catheter and ports are removed, and the annular defect can be sealed.

Abstract: A surgical tool includes a pair of pivotally coupled operating handles and working distal ends connected thereto configured to engage bone fixation elements. A toothed ratchet member is arranged across the handles and includes a first and second tooth rack. The first tooth rack includes a plurality of teeth angled in a first direction and the second tooth rack includes a plurality of teeth angled in a second direction. The ratchet member is rotatable with respect to the handles to selectively present the first or second tooth rack to a pawl disposed on one of the handles. The handles are operable for closing or spreading movement via selective engagement of the pawl with the first or second tooth rack, which correspondingly closes or spreads the working distal ends. A method for operating the tool is also disclosed.

Abstract: An endoscopic port that includes an elongate cannula defining a central lumen that extends substantially parallel to a longitudinal axis of the cannula and is sized to receive at least one endoscopic instrument therein. The cannula further defines a first opening that extends through a sidewall of the cannula at an acute angle relative to the longitudinal axis of the cannula. The first opening is sized to receive a suture passer.

Abstract: A medical apparatus including a bar with a first attachment loop, a second attachment and a plurality of hooks, wherein the medical apparatus is an arch bar.

Abstract: A bone fastener includes a fixation portion configured to interface with boney tissue, a connection portion having a longitudinal axis and being configured to interface with an elongated support structure, and a flexible portion disposed between the fixation portion and the connection portion. The flexible portion is configured to permit flexure of the connection portion relative to the fixation portion. The flexible portion has a first set of opposed facing surfaces that mechanically limit the range of flexure in a first direction. It has a second set of opposed facing surfaces that mechanically limit the range of flexure in a second direction. The opposed facing surfaces are substantially transverse to the longitudinal axis.

Abstract: Disclosed is a rib spreader including a stationary arm having a first bent portion; a first hook having a contact surface to contact with one incision plane of a sternum of human, and attached to the stationary arm ahead of the first bent portion so as to be pivotable over a predetermined angular range; a rack fixed to the base end of the stationary arm at a predetermined angle and curved archwise; a movable arm supported at the base end of the movable arm by the rack so as to be movable along the rack, to thereby vary the distance from the stationary arm; and a second hook having a contact surface to contact with the other incision plane, and is attached to the movable arm ahead of the second bent portion so as to be pivotable over a predetermined angular range.

Abstract: A cannulated and possibly fenestrated device for injection of material into bone can be dangerous because large, uncontrolled pressures are introduced during injection into a somewhat closed system, and material may extrude undesirably or emboli may be introduced. Methods and devices are described for providing venting of pressure upon injection of material through cannulated and possibly fenestrated screws. The first method involves a bone screw and/or anchor device that includes multiple channels to allow material to flow in through one channel and out through another channel. The second method involves a plunger that can force material into bone if advanced or lessen pressure if withdrawn. The third method involves usage of two separate screws. Material is alternately injected or withdrawn from each screw to cause material to flow from one screw to the other in a controlled way that creates a uniform or asymmetrical distribution of material as desired.

Abstract: A method for inserting an intervertebral disc prosthesis into a space between two vertebrae involves inserting the prosthesis partway into the space under constraint to prevent endplates of the prosthesis from articulating, releasing the prosthesis from constraint, and inserting the unconstrained prosthesis farther into the space. In some embodiments, the method involves grasping the prosthesis with a grasping device to insert the prosthesis partway under constraint, loosing the grasping device to release the prosthesis from constraint, and pushing the prosthesis farther into the disc space using the grasping device and/or one or more separate pusher devices. A system includes a grasping device, at least one separate pushing device, and optionally a vertebral spreading device and/or a vertebral midline indicator device.

Abstract: An improved access assembly is provided. The access assembly includes a tubular member having a proximal end and a distal end, the tubular member including at least one section extending at least a portion of a length therein. The access assembly further includes a first ring including a plurality of first segments and secured at the proximal end of the tubular member and a second ring including a plurality of second segments and secured at the distal end of the tubular member. At least two segments of the first plurality of segments are independently expandable. At least two sections of the plurality of sections are independently expandable.

Abstract: A bone plate for fixing bone fragments to bone is provided. The bone plate comprises an elongated body portion as well as a hook portion. The elongated body portion comprises an attachment opening configured to receive an attachment element for attaching the bone plate to bone. The hook portion extends from an end of the body portion and comprises one or more hooks configured to grasp a bone fragment. Additionally, at least one guiding opening is provided in the hook portion to receive an elongated guiding member for guiding the bone plate towards the bone fragment.

Abstract: Reciprocating rasps for the surgical preparation of the bone prior to the implantation of a glenoid or acetabular component with complex geometry are disclosed. Surgical methods for the use of such reciprocating rasps are also disclosed.

Abstract: A retraction apparatus and method are disclosed that provide optimized access to a surgical site. In one form, a retraction frame has a retraction opening with two sets of blades operating therein. The blades are used to sequentially retract the tissue from about an incision. The sequential retraction of the blades generates only narrow gaps between the blades so that tissue and blood encroachment during the surgical procedure are minimized.

Abstract: A prosthetic acetabular cup inserter and impactor has an expandable annular cup engaging element to engage the inner surface of a cup to be inserted in the acetabulum. An expander is provided for expanding the cup engaging element which is connected to one end of a handle via a hollow or partly hollow extension portion. The other end of the handle is provided with an anvil. An elongate operator is located within the extension portion and connected to the cup engaging element. A device is provided for moving the elongate operator to pull the cup engaging element towards the expander.

Abstract: Apparatus for the fixed-angle fixation and compression of a fracture site or osteotomy of a bone includes a bone plate having a plurality of holes and bone screws with a threaded head. The bone screws accommodated in the holes are screwed into the bone. At least one of the holes is a combination of two circular holes of different diameter. As screwing of the bone screw into the bone proceeds through a final stage, engagement of the threads on the head with threads in the combination hole effects relative longitudinal displacement between the plate and the bone whereby it is possible to simplify simultaneous fixed angle fixation and compression of the fracture or osteotomy with use of a single screw. Threads on the head of the bone screw engage threads in the hole which is a combination of the two hole to effect relative motions.