Abstract: A bone screw extension assembly for use in placing a connecting rod percutaneously into tissue of a patient comprises a multi-axial bone screw and a screw extension releasably coupled to yoke of the bone screw. The screw extension includes coaxially disposed outer sleeve and inner sleeves that are rotatable relative to each other. A screw engaging member projects radially from the distal end of the inner sleeve and is configured to engage an extension coupling surface on the outer sleeve upon relative rotation of the inner and outer sleeves. A securement member including cooperative surfaces is defined adjacent the distal end of the inner and outer sleeves that is operable upon relative rotation of the inner sleeve and outer sleeve to radially secure the sleeves together to thereby maintain the engagement of the screw engaging member and the bone screw.

Abstract: A device (20) used during a medical procedure to engage a cross-section of a bone is disclosed herein. The device is selectively expandable to correspond to the cross-section of the bone. Once the device is properly sized, the device is used as a sizing tool to select the proper size of an implant or as a surgical guide for preparing the bone with a surgical instrument, for example.

Abstract: The present invention features new methods, apparatuses and devices for fixing adjacent bone segments, segments of a bony structure and adjacent vertebrate of a spine. The methods, apparatuses and devices utilize an apparatus for forming a channel in a surface of the bone or bony structure segments or adjacent vertebra or a channel submerged within the bone or bony structure segments or adjacent vertebra. In more particular embodiments such apparatuses and methods including forming an arcuate channel and which channel can receive therein a curved rod or implant member. Also featured are systems, apparatuses and methods for removably suspending a spacer in the intervertebral space while forming such a channel as well as systems, apparatuses and methods for use of dynamized implant members.

Abstract: A bone cutting assembly. The bone cutting assembly includes a guide pin having a distal tip that may be securely inserted into a bone to define a cutting axis and a housing having a cam surface and features which allow the housing to be temporarily secured to the bone. The bone cutting assembly further includes a burr mounting arm which can be fitted on to the guide pin so that it can swing around the cutting axis and also translate up and down the guide pin. The burr mounting arm is configured to act against the cam surface as it is swung around the guide pin, so that the arm is caused to move up or down relative to the guide pin by the action of the cam surface.

Abstract: An orthopedic surgical instrument set is disclosed herein. The instrument set includes (i) at least one tamp, the tamp including a substantially cylindrical body portion; (ii) at least one trephine, the trephine having a first end and a second end, the second end of the trephine having a plurality of teeth disposed thereon, the trephine being provided with a cylindrical passageway disposed therethrough for receiving the substantially cylindrical body portion of the tamp; and (iii) a guide stand having a base portion and an upper portion disposed above the base portion, the upper portion of the guide stand being provided with a guide aperture disposed therein for receiving the at least one trephine. A method of fabricating a bone plug, which utilizes the orthopedic surgical instrument set, is also disclosed herein.

Abstract: Methods and apparatus for performing knee arthroplasty, including, but not limited to, bicruciate retaining knee arthroplasty, are described herein. Methods and apparatus for preparing a distal femur for a femoral implant as well as methods and apparatus for preparing a proximal tibia for a tibial implant are described. These methods and apparatus, in at least some embodiments and uses, facilitate decreasing the complexity of knee arthroplasty procedures such as bicruciate retaining procedures, while maintaining, if not improving on, the safety, accuracy and/or effectiveness of such procedures.

Abstract: An apparatus and method for dispensing bone cement includes a cartridge for containing the bone cement. The apparatus also includes a plunger insertable into the cartridge. An impedance sensor is coupled to the plunger and configured to produce an output signal indicative of an impedance of bone cement contained in the cartridge. The apparatus may also include a processing circuit configured to determine an impedance value of bone cement contained within the cartridge based on the sensor signal. The processing circuit may activate a visual indicator based on the impedance value to indicate that the dough time, the end-of-work time, and/or setting-time of bone cement contained in the cartridge has been reached.

Abstract: A device for mixing, dispensing and applying a paste, such as bone cement, has a housing (1), a cylinder (4) for receiving the paste, and a piston (13) associated with a piston rod (7). A mixing paddle (12) is provided with ridges (23) for engagement with grooves (24) on the piston (13). By this engagement, the paddle-piston assembly (12-13) can be rotated after removal of a safety pin (9) and interconnected by a jamming mechanism (25). After this interconnection, the paddle-piston assembly (12-13) is used to push the paste inside the cylinder (4) and out thereof for dispensing. A low-friction piston rod locking mechanism (14) is provides as well.

Abstract: Apparatus and methods for use in the performance of minimally invasive orthopaedic procedures, including apparatus and methods for use in the performance of such procedures under the visualization of an endoscope, are herein disclosed. Such procedures include a minimally invasive intramedullary nailing procedure, a minimally invasive bone graft harvesting procedure, a minimally invasive pelvic osteotomy procedure, an orthopaedic implant revision procedure, and a minimally invasive percutaneous bone plating procedure.

Abstract: A tool for implantation of a rod into a bone screw implanted in a human spine includes a guide member having a laterally opening channel disposed along an entire length thereof for side loading and receiving an implant fastener. A rod pushing member and a handle with a laterally opening channel are coaxial with the guide member, with the rod pushing member being rotatingly mateable to the guide member and the handle having a spring attachment mechanism for attaching the handle to the guide member. The guide member includes spring tabs for attachment to a bone screw, the tabs biased away from the bone screw. The rod pushing member includes a sleeve that extends substantially about the guide member, pressing the spring tabs toward the bone screw and into apertures on the bone screw arms. The rod pushing member sleeve also operatively functions as a rod pusher that abuts a rod as the sleeve is translated along the guide member and toward the bone screw.

Abstract: Setting instrument (10) for a hip socket or shoulder socket inlay, having a handle part (11) and a suction element (12) that can be brought into sealing contact with the joint surface. The suction element (12) comprises a flexible molded part (13) matched to the joint surface, which molded part is deformable by a pulling element (14) in such a way that, when applied to the joint surface, an (increased) partial vacuum is formed between the joint surface and the flexible molded part (13).

Abstract: An impacting device including a head having a longitudinal axis, a lateral surface and a base surface. The impacting device also includes a recess positioned in the head having a first channel and a second channel, the first and second channels being operably connected to each other. The first and second channels are at an angle with respect to each other when viewed in a plane parallel to the longitudinal axis.

Abstract: Apparatus, methods, systems, and kits related to surgical procedures and instruments are disclosed. In one aspect, a method for securing a fixation device to a driver for use in a surgical procedure is disclosed. The method comprises engaging a first portion of the driver with the fixation device to limit rotational movement of the fixation device relative to the driver; and engaging a second portion of the driver with the fixation device to limit axial movement of the fixation device relative to the driver; wherein engaging the second portion of the driver with the fixation device comprises actuating an actuator of the driver to cause the second portion of the driver to move relative to the first portion of the driver. In other aspects, surgical drivers, surgical kits, and surgical procedures are disclosed.

Abstract: The invention provides a forceps system comprising a pair of forceps members and force measurement means operable to measure compressive and traction forces exerted by the forceps when in use, and to output measurement signals indicative of such forces. Also provided is a method of measuring the compressive and traction forces exerted by a forceps system when in use.

Abstract: A scaled head frame positioner and tabletop adapter are provided. The positioner may be employed for any neurosurgical procedure that requires fixed positioning of the stereotactic head frame or ring onto a patient's skull. The positioner employs a generally triangular shaped member with Velcro tapes fixed at each corner. The tapes have measurement markings, such as measurement tapes. The positioner supports the head frame with the tapes engaging means on the frame and fastened back to themselves, with markings indicating distances to adjust the position of the frame about the patient's head. Furthermore, the tabletop adapter clamps the patient with a stereotactic head frame onto a CT or treatment table. The tabletop adapter includes a generally U-shaped bracket secured to a support to be placed on the tabletop. The bracket is attachable to the head frame of the patient to hold his head in a desired position.

Abstract: A system is provided to align a surgical guide instrument over a burr hole in a patient's body. Adjustments of a surgical instrument can be made in x, y, z, and angular directions using the system. An instrument guide unit can include an instrument guide for guiding a surgical instrument into the body of a patient and a base unit operative to be secured to the body near an area in which surgery is to occur. The base unit is coupled to the instrument guide. An adjustment mechanism, coupled to the base unit and the instrument guide, is operative to adjust the instrument guide in lateral directions with respect the surface of the area.

Abstract: Devices and methods provide accurate targeting, placement, and/or stabilization of an electrode or other instrument(s) into the brain or other body organ, such as to treat severe tremor or other neurological disorders. Targeting is performed using any form of image-guidance, including real-time MRI, CT, or frameless surgical navigation systems.

Abstract: A surgical support apparatus is disclosed, including an elongate member, a first tissue penetrating member, and a second tissue penetrating member. The second tissue penetrating member includes two segments hingably attached to each other. A distal portion of the second segment of the second tissue penetrating member includes an engagement surface. The first tissue penetrating member has a distal portion including a receiving surface. The engagement surface radially approaches the receiving surface causing the secure engagement of the first and second tissue penetrating members. Surgical objects can be attached to the surgical support apparatus and supported within an internal body cavity. Also disclosed is a method of assembling the surgical support apparatus in an internal body cavity.

Abstract: A clipping device includes (a) a shaft defining a lumen therethrough from a proximal end which, during a procedure remains outside the body accessible to a user and a distal end including a distal opening which, during a procedure is inserted into the body to a position adjacent to target tissue; (b) a flexible clip deployable from the distal opening, when in an unconstrained state, the clip assuming a shape selected to clip tissue and prevent a flow of fluid therethrough wherein, while residing within the lumen the clip is held substantially straight by an inner diameter of the lumen; (c) a control wire extending through the lumen from the proximal end to the distal end thereof; and (d) a release mechanism connecting the control wire to the clip during deployment of the clip and disconnecting the control wire from the clip after deployment thereof.

Abstract: An apparatus for application of surgical clips to body tissue is provided and includes a handle assembly and a shaft assembly. The handle assembly includes a drive assembly; and a trigger operatively connected to the drive assembly. The shaft assembly extends from the handle assembly and includes an articulating neck assembly; and an end effector assembly supported on a distal end of the articulating neck assembly and being configured to form a surgical clip in place on the body tissue.

Abstract: The invention relates to a surgical repair article, comprising a structural member of high performance polyethylene (HPPE) filament(s). The invention also relates to a method of making such a surgical repair article, and to a kit of parts comprising the article. The surgical repair article comprises a structural member of high performance polyethylene (HPPE) filament(s), and a biodegradable coating applied to the surface of the structural member, wherein the coating comprises a sol/gel produced inorganic oxide and a biologically active compound incorporated therein. The article combines high tensile strength, biocompatibility and favorable bioactive compound delivery characteristics.

Abstract: An anastomotic device, particularly a positioning device (24) extending along a longitudinal axis (30) comprises a first component, or proximal component (26) and a second component, or distal component (28). The proximal and distal components are suitable to lock an elastic ring (52) in a deformed configuration therebetween. The proximal component (26) has a substantially cylindrical outer structure with a cavity (32) for receiving a proximal end (52a) of the elastic ring (52). The distal component (28) comprises a head (42) and a stem (44) developing along the longitudinal axis (30). The head (42) has a cone or truncated-cone shape.

Abstract: A vascular anastomosis device of an aspect of the presently disclosed subject matter can include: a head portion that is provided on a distal side of an insertion portion and is capable of projecting a joining member and a cutting member from a distal surface thereof; an anvil configured to deform the joining member projecting from the head portion at a position where the anvil faces the distal surface of the head portion; and a connection member that can be installed so as to be able to project from and retract into the head portion. The anvil can be connected to the distal end of the connection member. The connection member can be configured to allow, along an axial direction, a portion thereof to be separated and ends of the remaining portion to be joined together.

Abstract: A stent and a method for implanting a stent for decompression and anastomosis formation are provided. The stent includes a non-expandable, generally tubular body having a proximal portion and a distal portion, a lumen extending through at least a portion of the body, a distal opening in the distal portion in fluid communication with the lumen and a proximal opening in the proximal portion in fluid communication with the lumen. The stent further includes a first magnetic element positioned on the distal portion of the tubular body and a second magnetic element movably positionable on the proximal portion of the tubular body. The second magnetic element is configured to surround and move over the proximal portion of the tubular body towards the first magnetic element.

Abstract: A uterine clamp for stemming or stopping bleeding of a hemorrhagic uterus. A pair of inflatable bladders are nested in a pair of rigid shells shaped and sized to fit the anterior and posterior of a uterus without impinging on the uterine horn on placement of the shells nesting the bladders in mirrored spaced opposition to one another in front of and behind the uterus and the broad ligament supporting the uterus. At least one latch on an upper end of one shell and at least one latch catch in the upper end of the other shell provide an interlock for releasably interlocking the opposed shells in front of and behind the broad ligament anteriorly and posteriorly against the uterus for inflation of the bladders to compress the uterus to stem or stop hemorrhage.

Abstract: An electro-mechanical surgical device, system and/or method may include a housing, at least two opposing jaw, and at least one electrical contact associated with at least one of the jaws. The electrical contact may include at least one of a bipolar electrical contact and an ultrasonic electrical contact. The electrical contact may be a row of electrodes located on one or all of the jaws. A sensor may also be associated with any tissue located between the jaws to sense and report the temperature of that tissue. A piercable ampulla containing fluid may also be placed on at least one of the jaws so that the fluid is releasable when the jaws are in closed position and the electrode(s) pass through the tissue into the piercable ampulla.

Abstract: Vitrectomy probes and system related thereto are disclosed herein. The disclosure describes various example vitrectomy probes having an adjustable cutting port size. Various example features are described for adjusting the size of the cutting port. Further, the disclosure provides examples for adjusting the size of the cutter port while the vitrectomy probe is in operation.

Abstract: A surgical tool such as a grasper or a pair of surgical scissors includes a hinge portion that spans between a handle proximal portion and a distal working portion to communicate mechanical actions of the handle proximal portion to the distal working portion. A programmable rotary module is coupled to the hinge portion and includes a sensor, an actuator, and a controller. The sensor, actuator, and controller may be enclosed in a common housing. The sensor measures rotation of the distal working portion and the actuator generates haptic effects to the proximal handle portion. A controller is electrically connected to the sensor and to the actuator. The controller receives the rotation measurements from the sensor and, based upon the rotation measurements, outputs a control signal to the actuator relating to the generation of haptic effects. The haptic effects may include force sensations such as detents and barriers.

Abstract: An apparatus, system and method are presented by which certain surgical procedures normally done by powered surgical handpieces may be accomplished by powered arthroscopic handpieces, thus obviating the need to use powered surgical handpieces.

Abstract: A lancet magazine for use in a lancing aid is described comprising a plurality of lancets each having a lancet body at the proximal end of the lancet and a lancet tip at the distal end of the lancet, where the proximal end of the lancet points in the direction of the proximal end of the housing of the lancet magazine and the distal end of the lancet is aligned in the direction of the distal end of the housing and the lancets in the unused state are completely surrounded by the housing. Furthermore, an extension unit is movably connected to the housing in such a manner that the housing can be extended by movement of the extension unit in the direction of the distal end of the housing such that the lancet is prevented from emerging from the lancet magazine.

Abstract: An obturator for use in penetrating tissue includes an elongate member defining a longitudinal axis, and having a proximal end and a distal end, and a penetrating member adjacent the distal end of the elongate member. The penetrating member has a distal penetrating tip dimensioned to pass through tissue. The penetrating member defines an external wall leading toward the penetrating tip. The external wall includes a plurality of raised elements extending at least radially outwardly relative to the longitudinal axis and being in general longitudinal alignment. Adjacent raised elements are spaced along the longitudinal axis to thereby accommodate tissue displaced during passage of the penetrating member through tissue. The raised elements are dimensioned to be generally atraumatic to tissue. The raised elements may define an arcuate profile.

Abstract: A method and apparatus for preparing an access site on a patient for insertion of a catheter into one of the patient's veins. The method includes the steps of: providing a tract forming assembly having a leading cutting edge and a dilating body defining a trailing dilating portion, with the cutting edge and dilating body together defining a tract forming unit; advancing the tract forming unit into skin at the access site so that: a) the cutting edge progressively forms a tract through the patient's skin and subcutaneous tissue towards the one vein; and b) the dilating body follows the cutting edge and dilates the tract; and removing the tract forming unit from the dilated tract so that no component resides in the dilated tract to allow a catheter to be directed through the dilated tract and into the one vein.

Abstract: A medical system for the treatment of morbid obesity comprising an inflatable balloon implanted in a gastric cavity, a percutaneous fillant delivery tube and a control module connected to the tube for regulating the inflation and deflation of the balloon. The balloon may be individually contoured and inflated to occupy a large volume of the gastric cavity to provide a feeling of satiety. The balloon may also be deflated to give the gastric cavity lining a rest during less critical time.

Abstract: Described herein are bioerodible, biodegradable, or digestible self-deploying intragastric implants that may be swallowed. Once swallowed, the implants undergo self-expansion in the stomach and apply a suitable pressure against the stomach wall to provide a feeling of satiety to the individual. The implants then dissolve or are disassembled perhaps using gastric liquids and pass out of the stomach. Methods of using the devices, perhaps for an individual participating in a dietary control regimen, are described.

Abstract: An implant configured for ingestion by a patient. After the implant has been swallowed by the patient and is disposed within the target location, e.g. the patient's stomach, an inflation subcomponent causes the implant to expand from a compact delivery state to an expanded, volume-occupying, deployed state. In the deployed state the implant creates a sensation of satiety in the patient stomach and thereby aids in limiting food intake and obesity. After a predetermined time a deflation subcomponent is actuated and the implant reduces in size so as to allow it to pass through the remainder of the patient's digestive track. The device may further incorporate tracking and visualization subcomponents, as well as pharmaceutical delivery subcomponents.

Abstract: The present invention is a catheter device that includes a disruptable guidewire channel. The guidewire channel is configured to provide necessary trackability of the catheter along the guidewire during introduction of the catheter to a treatment site. Once treatment is completed, the guidewire channel can then be disrupted so as to free the guidewire from the catheter in situ. The apparatus of the present invention provides distinct advantages over existing over-the-wire and rapid exchange catheter introduction methods, including the ability to achieve much faster treatment implement exchanges, the ability to rapidly deliver multiple treatment implements in series, and the ability to maintain multiple treatment implements simultaneously at a treatment site using a single guidewire.

Abstract: The invention relates to a device for the implantation of microcoils (3, 7, 11, 12) into body cavities and blood vessels, in particular aneurysms, with said microcoils (3, 7, 11, 12) comprising wires forming a plurality of windings (4), at least one microcoil serving as occlusion helix (3) for the occlusion of the body cavity or blood vessel, and the device consisting of a catheter, one or several microcoils (3, 7, 11, 12) movably arranged in longitudinal direction within the catheter and at least one securing means (10) passing at least partially through the lumen (9) of the occlusion helix (3), with said securing means (10) being fixed in its end areas inside the microcoils (3, 7, 11, 12). Such a fixation of the securing means (10) is achieved in at least one end area by providing a frictional connection with the microcoil (3, 7, 11, 12) in such a manner that this connection is detachable from the microcoil (3, 7, 11, 12) when a certain tensile force acting on the securing means (10) is exceeded.

Abstract: A retrievable device for treatment of a stenotic lesion in a body vessel is disclosed. The device comprises a reticulation portion including a plurality of struts connected together in a singly staggered configuration distally along a longitudinal axis. The plurality of struts of the reticulation portion is configured to fold along the longitudinal axis defining a collapsed state of the device for retrieval. The device further includes an expandable body distally extending from the reticulation portion along an outer diameter for treatment of the stenotic lesion. The expandable body is configured to expand in the open state and collapsed in the collapsed state of the reticulation portion for retrieval. The device further comprises a retrieval stem extending proximally from the reticulation portion for retrieval of the device in the collapsed state.

Abstract: Vascular treatment and methods include a plurality of self-expanding bulbs and a hypotube including interspersed patterns of longitudinally spaced rows of kerfs. Joints between woven structures and hypotubes include solder. Woven structures include patterns of radiopaque filaments measurable under x-ray. Structures are heat treated to include at least shapes at different temperatures. A catheter includes a hypotube including interspersed patterns of longitudinally spaced rows of kerfs. Heat treating systems include a detachable flange. Laser cutting systems include a fluid flow system.

Abstract: Vascular treatment and methods include a plurality of self-expanding bulbs and a hypotube including interspersed patterns of longitudinally spaced rows of kerfs. Joints between woven structures and hypotubes include solder. Woven structures include patterns of radiopaque filaments measureable under x-ray. Structures are heat treated to include at least shapes at different temperatures. A catheter includes a hypotube including interspersed patterns of longitudinally spaced rows of kerfs. Heat treating systems include a detachable flange. Laser cutting systems include a fluid flow system.

Abstract: A radial artery compression device configured to be secured to a wrist or other portion of a patient to provide adjustable and consistent compression pressure in the area of a radial artery access site or other physiological portion of a patient to achieve hemostasis either during or after a medical procedure such as a percutaneous coronary procedure. The radial artery compression device includes a rotatable member and a compression pad adapted such that rotation of the rotatable member does not affect the rotational orientation of the compression pad. According to one embodiment of the present invention, a single rotation of the rotatable member results in complete extension or retraction of the radial artery compression device. According to another embodiment of the present invention, the rotation of the rotatable member results in a compounding of the extension or retraction of the compression pad relative to the body of the radial artery compression device.

Abstract: The present invention is a device having a rigidly linked jaw that is decoupled from an articulating wrist. The device provides for articulating motion as well as actuation that may be used in grasping, cutting, suturing or the like.

Abstract: Vasculature closure devices, and systems and methods for their use, are provided. In one embodiment, the vasculature closure device includes an expandable support frame deployable within a vessel and a sealing membrane at least partially supported by the expandable support frame. Upon expanding the support frame, the vasculature closure device is configured to intraluminally position the sealing membrane against a puncture site existing in a vessel wall.

Abstract: A device for sealing a puncture in a patient includes a sealing component including an elongate control member configured to pass through a puncture in skin of a patient. The sealing component also includes an expandable member disposed near a distal end of the control member, and a tip releasably attached to the elongate control member distal to the expandable member. The device also includes a sealing material delivery component including a delivery tube through which the control member of the sealing component is configured to extend. The delivery tube is configured to deliver sealing material through an opening in a distal end of the delivery tube.

Abstract: A tissue closure device includes a main body, a sheath, and a biasing member. The main body has a plurality of resilient arms that each extend from a proximal end to a distal tip. The resilient arms are movable between an open configuration in which the distal tips are radially spaced apart from the longitudinal axis of the main body and from each other and a closed configuration in which the distal tips abut one another at or near the longitudinal axis. The sheath is longitudinally slideable on the main body to move the arms between the open and closed configurations. The biasing member causes the sheath to bias the arms toward the closed configuration.

Abstract: A flexible member securing assembly to secure a flexible member relative to tissue is provided and includes a shaft, an arm, an anchor, and a flexible member grasper. The shaft extends along a longitudinal axis from a first end and a second end. The arm is extendable from the shaft second end and the flexible member grasper is adjacent to a distal end of the arm to position the flexible member in relation to the anchor. The anchor is removably positioned at the shaft second end and can retain the flexible member in the tissue. Methods of securing a flexible member are also provided.

Abstract: A surgical suture system, suture, and tissue engaging member for tissue repair and reattachment of torn tissue to a tissue substrate, medical prosthesis or medical implant. The system includes the elongated flexible suture member having a plurality of longitudinally spaced protuberances along a length thereof and one or a plurality of the tissue engaging members each of which include two closely spaced apart locking apertures sized and configured to receive one of the suture members passed therethrough or a unique single locking aperture to allow longitudinal tensioning and/or restraining movement of the suture member in only one direction through the locking apertures for suture member tightening.

Abstract: An anchor, formed of at least two different materials, for securing a suture relative to bone. The anchor includes a generally cylindrical body portion having a leading end configured to facilitate insertion of the body portion into the bone; a passage which is oriented transverse to the longitudinal axis of the body portion and proximate the leading end of the body portion; and bone engaging projections to secure the anchor in the bone.

Abstract: A spinal implant device includes a spacer region and an attachment region. The spacer region is adapted to be positioned between first and second spinous processes of first and second vertebral bodies to limit movement of the first spinous process and the second spinous process toward one another. The attachment region attaches to the first spinous process via a fastener that extends substantially along a long axis of the spinous process.

Abstract: Disclosed are embodiments of a dynamic stabilizer system for dynamically stabilizing the sacrum and at least lumbar vertebra L5. The dynamic stabilizer system may comprise two anchoring members that can be implanted at distinct locations in the sacrum, a mechanical fastener element having two ends and a flexible portion that can be securely fastened on the spinous process of a lumbar vertebra, and two distinct rods, each securing onto the anchoring members and the mechanical fastener element. In some embodiments, the dynamic stabilizer system may further comprise one or more spacers, each interposed between two spinous processes. The mechanical fastener element further comprises features for securing the one or more spacers.