Abstract: A minimally invasive dilation device includes a plurality of rigid arms radially arrayed about a center and a dilating member positioned between the arms. A stylus may occupy the center. An outer flexible sleeve may be circumferentially secured to the arms, lying within or without the plurality of arms. An inner mesh may surround the stylus and dilating member. The device may be introduced into tissue toward a targeted area, while in a closed configuration. The dilating member may be a balloon, wherein upon inflation of the balloon, the arms are pushed radially outward, expanding the device and dilating the surrounding tissue. The dilating member may be a tube, wherein upon insertion of the tube, the arms are pushed radially outward. A cannula may be inserted inside the plurality of arms to keep the arms in an open configuration, and the dilating member may be withdrawn, providing an open passageway through the device to the targeted area. The device may be used with a neural monitoring system.

Abstract: Instrument handles are adjustable relative to an end effector of the instrument. The handles may be releasably locked in selected positions and/or orientations relative to the end effector. When the lock is released, the handles may be moved to a different position and/or orientation relative to the end effector, and locked in place. The handles may pivot relative to the end effector around one or more joints. The handles may pivot about an axis of a hinge joint or a point of a ball and socket joint. The axis of the hinge joint may be aligned parallel or perpendicular to a center longitudinal axis of the end effector, or of a shaft between the handles and the end effector.

Abstract: An apparatus is designed to attach an implant to bone in a manner that permits rotational adjustment of the implant about multiple axes prior to securement via the apparatus. The apparatus includes separate rotational and translational fasteners that can be individually locked to independently restrict rotation and translation of the implant relative to the bone. The rotational fastener includes an interpositional member, an expandable engagement member, and a rotational locking member that urges the expandable engagement member to advance along the interpositional member. The resulting expansion of the engagement member causes it to engage the implant. The rotational fastener is slidable along a fixation member implanted in the bone until the translational fastener is applied to restrict relative translation between the rotational fastener and the bone.

Abstract: A facet joint replacement system includes an inferior implant with an inferior articular surface, a superior implant with a superior articular surface, and an optional crossbar. The inferior implant and the superior implant are each polyaxially adjustably connected to fixation elements which anchor the implants to adjacent vertebrae. The optional crossbar may be polyaxially adjustably connected to bilateral implants. The system components may be provided in kits which provide components of various sizes and shapes. A set of surgical instruments may facilitate implantation of the facet joint replacement system by providing tools for bone preparation, trialing, implant insertion, implant alignment, and lock-out of modular interconnections.

Abstract: Superior and/or inferior facets of one or more facet joints may be replaced by superior and/or inferior facet joint prostheses. In one embodiment, a kit of superior or inferior prostheses is provided, in which the prostheses have at least two dimensions that vary among members of the kit independently of each other. Each prosthesis may have a bone engaging surface having a surface that is polyaxially rotatable against a corresponding resection of a vertebra. Each prosthesis may also have an articulating surface shaped such that, after attachment to the spine, the replaced or partially replaced facet joints provide a larger medial-lateral range of motion when the spine is flexed than when the spine is extended. Crosslinks may be used to connect left and right prosthesis together in such a manner that they are stabilized in a position in which they are seated directly against the vertebra.

Abstract: An apparatus is designed to attach an implant to bone in a manner that permits rotational adjustment of the implant about multiple axes prior to securement via the apparatus. The apparatus includes separate rotational and translational fasteners that can be individually locked to independently restrict rotation and translation of the implant relative to the bone. The rotational fastener includes an interpositional member, an expandable engagement member, and a rotational locking member that urges the expandable engagement member to advance along the interpositional member. The resulting expansion of the engagement member causes it to engage the implant. The rotational fastener is slidable along a fixation member implanted in the bone until the translational fastener is applied to restrict relative translation between the rotational fastener and the bone.

Abstract: A catheter tip designed to reduce the outflow velocity and/or directional momentum of fluid being infused by a catheter having such a tip. In one variation, a plurality of channels is provided at the distal portion of the catheter to increase the outflow cross-sectional area. In another variation, the diameter of the catheter at its distal portion where the fluid exits is increased. In yet another variation, a bullet-shaped nose is implemented which may decrease turbulence at the distal end of catheter tip. The low velocity outflow catheter tip may also be implemented on a dual lumen catheter, such as a hemodialysis catheter, to reduce recirculation rate. Various device configurations and methods for such implementations are also disclosed.

Abstract: Superior and/or inferior facets of one or more facet joints may be replaced by superior and/or inferior facet joint prostheses. In one embodiment, a kit of superior or inferior prostheses is provided, in which the prostheses have at least two dimensions that vary among members of the kit independently of each other. Each prosthesis may have a bone engaging surface having a surface that is polyaxially rotatable against a corresponding resection of a vertebra. Each prosthesis may also have an articulating surface shaped such that, after attachment to the spine, the replaced or partially replaced facet joints provide a larger medial-lateral range of motion when the spine is flexed than when the spine is extended. Crosslinks may be used to connect left and right prosthesis together in such a manner that they are stabilized in a position in which they are seated directly against the vertebra.

Abstract: Superior and/or inferior facets of one or more facet joints may be replaced by superior and/or inferior facet joint prostheses. In one embodiment, a kit of superior or inferior prostheses is provided, in which the prostheses have at least two dimensions that vary among members of the kit independently of each other. Each prosthesis may have a bone engaging surface having a surface that is polyaxially rotatable against a corresponding resection of a vertebra. Each prosthesis may also have an articulating surface shaped such that, after attachment to the spine, the replaced or partially replaced facet joints provide a larger medial-lateral range of motion when the spine is flexed than when the spine is extended. Crosslinks may be used to connect left and right prosthesis together in such a manner that they are stabilized in a position in which they are seated directly against the vertebra.

Abstract: A fixation system is designed to lock an elongated member within a housing member, permitting positional and/or orientational adjustment of the elongated member prior to locking. The system includes a housing member, a slotted spherical collet, an elongated member, and may include a tapered wedge, which may be a discrete component or formed as part of the elongated member. The housing member and/or elongated member may be implantable. The elongated member may be positioned in the wedge, the wedge in the collet, and the collet in the housing such that when compression force is applied to the wedge and the collet, the wedge contracts about the elongated member and the collet expands to engage the housing, thus locking the elongated member relative to the housing. The collet may have a tapered channel with a degree of taper equal to the tapered wedge. The collet may have multiple slots to allow uniform radial expansion and compression.

Abstract: A facet joint replacement system includes an inferior implant with an inferior articular surface, a superior implant with a superior articular surface, and an optional crossbar. The inferior implant and the superior implant are each polyaxially adjustably connected to fixation elements which anchor the implants to adjacent vertebrae. The optional crossbar may be polyaxially adjustably connected to bilateral implants. The system components may be provided in kits which provide components of various sizes and shapes. A set of surgical instruments may facilitate implantation of the facet joint replacement system by providing tools for bone preparation, trialing, implant insertion, implant alignment, and lock-out of modular interconnections.

Abstract: External fixation systems, and methods for immobilizing joints or fractured bones. An external fixation system may include one or more clamp assemblies connected to one or more rod assemblies at polyaxial joints. Each rod assembly may be length adjustable, and may include a one-way locking mechanism to provisionally lock the length of the rod assembly, and additional locking mechanisms to permanently lock the length of the rod assembly. The system may be deployed pre-assembled as a unit to immobilize a joint or fracture. Another external fixation system further includes a spanning member extending transverse to the rod assemblies. Two or more external fixation systems may be deployed in a stacked configuration on one set of bone pins to immobilize two joints and/or fractures. The systems may be provided in kits including guiding instrumentation, bone pins and pin clamping assemblies for connecting the bone pins to the external fixation systems.

Abstract: A needle assembly including a positive flush mechanism for use with a vascular access port. The needle assembly is configured to supply fluid to the port and to provide a positive flush to overcome negative pressures in the port that can potentially occur during withdrawal of the needle from the port.

Abstract: Facet joint replacement implants may be designed for use on multiple adjacent vertebral levels. Each superior implant may have a substantially semispherical concave surface, and each inferior implant may have a cooperating semispherical convex surface that is deformable to enable it to be pressed into the superior implant concave surface to fix the relative orientations of the superior and inferior implants. Thus, the inferior implant may be attached to the same pedicle as the superior implant, but may also be oriented independently of the superior implant and then fixed in position. Similar mounting structures may be used to attach one or more fusion implants to a level adjacent to that of a facet joint replacement implant.

Abstract: A crosslink is provided for securing orthopedic implants, such as facet joint replacement implants, together. The crosslink has a pair of implant coupling components, a pair of rod coupling components, a rod, and a pair of fasteners. Each facet joint implant may include a semicylindrical interface received in a resilient member of the corresponding implant coupling component to permit relative cephalad/caudal adjustment between the crosslink and the implants. The resilient members grip the semicylindrical interface of the implant to enable at least temporary attachment of the implant coupling components to the implants independently of the rod. Clocking features on the semicylindrical interfaces and on the interfacing areas of the implant coupling components and rod coupling components may limit assembly of the crosslink to discrete relative orientations and prevent play after assembly. The fasteners secure the rod coupling components to the rod at the desired positions along the rod.

Abstract: A needle assembly including a positive flush mechanism for use with a vascular access port. The needle assembly is configured to supply fluid to the port and to provide a positive flush to overcome negative pressures in the port that can potentially occur during withdrawal of the needle from the port.

Abstract: A bone plate assembly including at least one bone plate, polyaxially adjustable fixation elements and a polyaxially adjustable locking mechanism. A first plate includes at least one polyaxial element for lockable connection with a fixation pad, and a connection feature which allows the plate to translate and polyaxially rotate relative to the locking mechanism. A second plate includes at least one polyaxial element for connection with a fixation pad and a connection feature for non-rotatable connection with the locking mechanism. The locking mechanism allows translation and polyaxial adjustment of the first plate relative to the second plate and locks the first and second plates via a taper lock. The fixation pad includes a deflectable spacer configured to prevent premature locking of the pad. Methods for implantation of the bone plate assembly between bone structures are disclosed. Instrumentation for implantation, compression and locking of the bone plate assembly is disclosed.

Abstract: A bone plate assembly including at least one bone plate, polyaxially adjustable fixation elements and a polyaxially adjustable locking mechanism. A first plate includes at least one polyaxial element for lockable connection with a fixation pad, and a connection feature which allows the plate to translate and polyaxially rotate relative to the locking mechanism. A second plate includes at least one polyaxial element for connection with a fixation pad and a connection feature for non-rotatable connection with the locking mechanism. The locking mechanism allows translation and polyaxial adjustment of the first plate relative to the second plate and locks the first and second plates via a taper lock. The fixation pad includes a deflectable spacer configured to prevent premature locking of the pad. Methods for implantation of the bone plate assembly between bone structures are disclosed. Instrumentation for implantation, compression and locking of the bone plate assembly is disclosed.

Abstract: Facet joint replacement implants may be designed for use on multiple adjacent vertebral levels. Each superior implant may have a substantially semispherical concave surface, and each inferior implant may have a cooperating semispherical convex surface that is deformable to enable it to be pressed into the superior implant concave surface to fix the relative orientations of the superior and inferior implants. Thus, the inferior implant may be attached to the same pedicle as the superior implant, but may also be oriented independently of the superior implant and then fixed in position. Similar mounting structures may be used to attach one or more fusion implants to a level adjacent to that of a facet joint replacement implant.

Abstract: A crosslink is provided for securing orthopedic implants, such as facet joint replacement implants, together. The crosslink has a pair of implant coupling components, a pair of rod coupling components, a rod, and a pair of fasteners. Each facet joint implant may include a semicylindrical interface received in a resilient member of the corresponding implant coupling component to permit relative cephalad/caudal adjustment between the crosslink and the implants. The resilient members grip the semicylindrical interface of the implant to enable at least temporary attachment of the implant coupling components to the implants independently of the rod. Clocking features on the semicylindrical interfaces and on the interfacing areas of the implant coupling components and rod coupling components may limit assembly of the crosslink to discrete relative orientations and prevent play after assembly. The fasteners secure the rod coupling components to the rod at the desired positions along the rod.