Abstract: Bottom-loading bone anchor assemblies and components thereof are disclosed that have a reduced profile and can be utilized with bone screws of various size. Bone anchor assemblies of the present disclosure can include a receiver member, a drag retaining ring, and a shank. The retaining ring and shank can be inserted proximally into a bore of the receiver member. The drag ring can have a base and a walled portion extending proximally therefrom. The drag retaining ring can be disposed in a groove of the receiver member with the base forming a seat for the shank head that can hold the shank within the receiver. The walled portion of the drag retaining ring can impart a drag force on the shank head seated in the base to prevent unintended movement between the shank and the receiver member.

Abstract: Example instruments disclosed herein can include a bar that can engage a rod slot of a hook or other implant. A user can tighten a setscrew to make a rigid connection between the instrument and the implant. The bar can prevent the need for counter-torque on the implant during engagement and disengagement by virtue of its rigid connection to the implant. The instrument can also include a handle and a shaft extending at an angle from a distal end of the instrument. The handle can be used to both hold and manipulate the implant into place. A mallet can be applied to the handle to transmit insertion forces to the implant to facilitate insertion thereof. Example instruments can include a setscrew captured in a distal housing by one or more pins that allow translation of the setscrew within the distal housing but prevent removal of the setscrew from the housing.

Abstract: Surgical instruments and related methods are disclosed for performing rod reduction, derotation, and/or setscrew insertion during spinal surgery. One example instrument that can accommodate performing all of these functions can include an inner sleeve having a proximal threaded portion, a distal portion configured to rotate relative to the proximal threaded portion, an inner channel, and a modular drive interface disposed at a proximal end of the threaded portion. The instrument can further include an intermediate sleeve having an inner channel with a threaded proximal portion configured to receive the inner sleeve, the intermediate sleeve terminating in a pair of extensions at a distal end thereof. The instrument can further include an outer sleeve having an inner channel configured to receive the intermediate sleeve, the outer sleeve terminating in a pair of extensions at a distal end thereof.

Abstract: Modular surgical instruments or components that utilize a magnetic coupling to more securely attach to other surgical instruments and components are disclosed. The devices can be modular drivers for use with surgical instruments that utilize an actuation force, such as a spinal rod reducer. In one example, a surgical instrument driver can include a non-magnetic body having a proximal end and a distal end with a distal-facing recess configured to receive a portion of a surgical instrument. The recess can include a surface configured to contact the portion of the surgical instrument disposed in the recess to impart torque thereto. The driver can further include a magnet disposed within the body such that the magnet is configured to extend proximal to a proximal end of a surgical instrument disposed within the recess and radially outward beyond the proximal end of the surgical instrument disposed within the recess.

Abstract: Bottom-loading bone anchor assemblies and components thereof are disclosed that have a reduced profile and can be utilized with bone screws of various size. Bone anchor assemblies of the present disclosure can include a receiver member, a drag retaining ring, and a shank. The retaining ring and shank can be inserted proximally into a bore of the receiver member. The drag ring can have a base and a walled portion extending proximally therefrom. The drag retaining ring can be disposed in a groove of the receiver member with the base forming a seat for the shank head that can hold the shank within the receiver. The walled portion of the drag retaining ring can impart a drag force on the shank head seated in the base to prevent unintended movement between the shank and the receiver member.

Abstract: Various implant holding systems are provided herein that include an outer tube, an inner tube, and a holder. The implant holding systems can be designed to hold various implants, such as bone anchors used in spinal operations. For example, one embodiment of an implant holding system can have an outer tube, an inner tube that can be disposed within the outer tube, and an implant holder that can be disposed within the inner tube. An individual bone anchor that has various configurations and sizes can be disposed within the holder, and the holder can engage the bone anchor to assist in maintaining an orientation of the bone anchor relative to the holder.

Abstract: Surgical instruments that are configured to couple to a bone anchor assembly to provide a modular platform for carrying out various steps of a surgical procedure, such as spinal rod reduction and derotation, are provided. For example, in one embodiment a surgical instrument can include an outer sleeve terminating in a pair of extensions, an inner sleeve having a proximal threaded portion and a distal translating portion configured to pass through the outer sleeve, and a pair of pivoting arms received in the extensions of the outer sleeve. The pivoting arms can be configured to extend into a channel of the outer sleeve to couple a bone anchor to the outer sleeve, and a proximal end portion of the outer sleeve can include one or more flats configured to engage with another instrument.

Abstract: A method of providing access to an intervertebral disc has been developed that involves using the patient's bony pedicle as an anchoring spot for a pedicle screw that temporarily attaches to the access port. Because this new procedure eliminates the need for the surgical table as an anchor, it also eliminates the assembly components extending from the table to the port at the access site, thereby unencumbering the surgeon's view and workspace while providing minimally invasive access.

Abstract: Surgical instruments that are configured to couple to a bone anchor assembly to provide a modular platform for carrying out various steps of a surgical procedure, such as spinal rod reduction and derotation, are provided. For example, in one embodiment a surgical instrument can include an outer sleeve terminating in a pair of extensions, an inner sleeve having a proximal threaded portion and a distal translating portion configured to pass through the outer sleeve, and a pair of pivoting arms received in the extensions of the outer sleeve. The pivoting arms can be configured to extend into a channel of the outer sleeve to couple a bone anchor to the outer sleeve, and a proximal end portion of the outer sleeve can include one or more flats configured to engage with another instrument.

Abstract: Surgical instruments for cutting surgical components either in situ or ex situ are disclosed. The surgical instruments can include a translating anvil that can be driven relative to an outer sleeve by a rotating an inner sleeve relative to the outer sleeve. The outer sleeve can be separable into a distal tip and a proximal base tube that can be modularly coupled to one another and selectively locked against separation. A distal portion of the outer sleeve can include a hooked shape with an opening to receive a rod or other component therein that can be selectively closed by a pivoting capture arm. Actuation of the instrument can occur by manual user power or by powered instrument, such as a driver. The outer sleeve can interface with additional instruments or components, such as a counter-torque handle, to prevent rotation thereof during actuation of the inner sleeve relative thereto.

Abstract: This disclosure relates generally to surgical instruments used to deliver locking or set screws to secure a rod or spinal fixation element relative to an implanted bone anchor or other spinal fixation construct during spine surgery. In one embodiment, the inserter instrument can include an inner driver shaft, a ratcheted outer sleeve, and a handle configured to receive the shafts therein. The inner driver shaft can receive a plurality of set screws on a distal end thereof. A side latch, pawl, or button can engage with the ratcheted outer sleeve to facilitate step-wise advancement of the sleeve relative to the driver shaft for set screw delivery. Step-wise advancement can be controlled using another button that causes movement of the side latch.

Abstract: Bearing assemblies for selectively coupling to surgical instruments are disclosed. In one embodiment, a bearing assembly can include a housing with a cavity, a first race in the cavity that translates but does not rotate relative to the housing, bearing elements disposed in the first race that move radially in and out of a central passage of the first race, and a second race that is fixed in the cavity. The first race can be biased toward an opening of the cavity, the second race can surround the first race with an inner surface having a tapered diameter configured to contact the bearing elements as the first race moves distally relative to the second race and urge the plurality of bearing elements radially inward to selectively lock the bearing assembly to a surgical instrument disposed within the central passage of the first race.

Abstract: Bone anchor assemblies and related instrumentation are disclosed herein. In some embodiments, a modular bone anchor assembly allows for a bone anchor to be driven into bone and a head or receiver member to be attached thereto at some later point in time. The bone anchor can have a smaller footprint than the complete assembly, which can improve visualization and anatomical spatial awareness during insertion of the bone anchor and during other surgical steps performed prior to attaching the head or receiver member to the bone anchor. A variety of modular head types are disclosed, as are various instruments for driving a bone anchor, attaching a head to a bone anchor, removing a head from a bone anchor, and making a unilateral attachment to a head of a bone anchor assembly. Drive interfaces for driving a bone anchor are disclosed, as are features that allow a bone anchor to act as a fixation point for soft tissue retraction, disc space distraction, derotation, and the like.

Abstract: Example rocker reducer instruments securely engage a receiver that is implanted in a vertebra of the spine and move a spinal fixation element, such as a rod, into a channel formed in the receiver. Example instruments pivot around their contact point with the receiver and a cross-pin or foot feature on the instrument makes contact with the spinal rod and applies a downward force to reduce the rod into the receiver. Further, example instruments can contain a stopping mechanism to limit the amount of compressing force applied to the receiver while maintaining the instrument in a rigid, closed position.

Abstract: This disclosure relates generally to surgical instruments used to deliver locking or set screws to secure a rod or spinal fixation element relative to an implanted bone anchor or other spinal fixation construct during spine surgery. In one embodiment, the inserter instrument can include an inner driver shaft, a ratcheted outer sleeve, and a handle configured to receive the shafts therein. The inner driver shaft can receive a plurality of set screws on a distal end thereof. A side latch, pawl, or button can engage with the ratcheted outer sleeve to facilitate step-wise advancement of the sleeve relative to the driver shaft for set screw delivery. Step-wise advancement can be controlled using another button that causes movement of the side latch.

Abstract: Bearing assemblies for selectively coupling to surgical instruments A bearing assembly can include a housing with a cavity, a first race in the cavity that translates but does not rotate relative to the housing, bearing elements disposed in the first race that move radially in and out of a central passage of the first race, and a second race that is fixed in the cavity. The first race can be biased toward an opening of the cavity, the second race can surround the first race with an inner surface having a tapered diameter configured to contact the bearing elements as the first race moves distally relative to the second race and urge the plurality of bearing elements radially inward to selectively lock the bearing assembly to a surgical instrument disposed within the central passage of the first race.

Abstract: Bone anchor assemblies and related instrumentation are disclosed herein. In some embodiments, a modular bone anchor assembly allows for a bone anchor to be driven into bone and a head or receiver member to be attached thereto at some later point in time. The bone anchor can have a smaller footprint than the complete assembly, which can improve visualization and anatomical spatial awareness during insertion of the bone anchor and during other surgical steps performed prior to attaching the head or receiver member to the bone anchor. A variety of modular head types are disclosed, as are various instruments for driving a bone anchor, attaching a head to a bone anchor, removing a head from a bone anchor, and making a unilateral attachment to a head of a bone anchor assembly. Drive interfaces for driving a bone anchor are disclosed, as are features that allow a bone anchor to act as a fixation point for soft tissue retraction, disc space distraction, derotation, and the like.

Abstract: Instruments and methods for selectively coupling to an object are provided, for example surgical instruments that can form a rigid connection with an object and also be disassembled for cleaning, sterilization, etc. One embodiment includes an elongate shaft with a longitudinal groove, a first partial circumferential groove that intersects with a distal end of the longitudinal groove, and a second at least partial circumferential groove formed distal to the first partial circumferential groove. The instrument also includes a sleeve disposed over the elongate shaft that includes a protrusion extending from an internal wall that is received within the longitudinal groove to constrain movement of the sleeve relative to the elongate shaft. The sleeve further includes a lock that interfaces with the second at least partial circumferential groove when the protrusion is disposed in the first partial circumferential groove to further selectively constrain axial and rotational movement of the sleeve.

Abstract: Instruments and methods for delivering bone cement are disclosed herein. In one exemplary embodiment, the instrument includes a cannulated bone screw having a head that is configured to be received within a rod receiver and a shank extending distally from the head and configured to extend distally from the rod receiver, a cannulated shaft having a distal end configured to extend into the shank of the cannulated bone screw and a proximal end configured to couple to a bone cement delivery system, and a retaining sleeve disposed around at least a portion of the cannulated shaft. The head of the bone screw has proximal and distal recesses therein, and a distal end of the retaining sleeve is configured to couple to the proximal recess.

Abstract: Reamer instruments and related methods are disclosed herein, e.g., for reaming bone to facilitate in situ assembly of a bone anchor. In some embodiments, the instrument can include a feedback mechanism configured to alert the user when sufficient bone has been removed to facilitate assembly of the bone anchor. The feedback mechanism can be triggered by a movable shaft of the instrument that is displaced by the shank portion of the bone anchor as the surrounding bone is reamed.