Abstract: Described here are closure devices and methods for ligating tissue, such as the left atrial appendage. The closure devices may comprise a snare loop assembly comprising a snare and a suture loop releasably attached thereto. The snare may be releasable from an elongate body of the closure device. In some instances, the closure device may comprise one or more markers to allow a user to determine whether the snare loop assembly is twisted.

Abstract: An occlusive device comprising a braided component which can be inserted into a blood vessel and a delivery system for delivering said occlusive device is described.

Abstract: Vascular compression devices with an inflatable chamber are disclosed. The inflatable chamber of the vascular compression devices can be inflated and then deflated with a liquid with ultrasound properties similar to biological tissues. Ultrasound waves may be applied to the vascular compression device and may propagate through the vascular compression device and into the biological tissue of the patient to produce an ultrasound image to determine the patency of the vessel.

Abstract: A tourniquet includes: a baseplate with first and second ends; a strap having first and second ends, the strap having a first portion adjacent its first end, and a second portion adjacent its second end; a lever with proximate and distal ends, wherein the proximate end is pivotally connected to the baseplate, and the distal end is free; wherein the first end of the strap is pivotally connected to the lever intermediate to the proximal and distal ends; and a connector assembly operable to selectively connect the second portion of the strap to the baseplate, so as to form a closed loop, the connector assembly operable to permit a length of the closed loop to be adjusted; and wherein the baseplate includes an integral lever anchor disposed between the first and second ends of the baseplate, the lever anchor receiving the proximate end of the lever.

Abstract: A medical device comprising a rotatable cutter head having a center longitudinal rotation axis; the rotatable cutter head comprising a mandrel and a plurality of elongated cutters disposed on the mandrel; each of the elongated cutters rotatable about a cutter rotation axis, respectively, wherein rotation of each of the elongated cutters about the cutter rotation axis changes a cutting diameter of the rotatable cutter head; each cutter rotation axis having a length which simultaneously extends both longitudinally along the center longitudinal rotation axis and circumferentially around the center longitudinal rotation axis; and each cutter rotation axis parallel with a first imaginary plane, respectively, which is at an angle with a second imaginary plane which is parallel to the center longitudinal axis, respectively.

Abstract: Various exemplary methods, systems, and devices for instability repair are provided. In general, a surgical device can be configured to drill a hole in bone and to deliver a suture anchor into the hole. In this way, a single surgical device can drill the hole and deliver the anchor into the hole for securing soft tissue to the bone. The anchor can be configured to allow the soft tissue to be secured to the bone using a suture coupled to a suture anchor without the need to knot or otherwise tie the suture to secure the soft tissue in place relative to the bone.

Abstract: An adjustable femoral pin guide assembly includes a base and a femoral extension rod assembly. The base may be rotated to align with the femoral shaft axis while the femoral extension rod assembly aligns with the leg mechanical axis. An adjustable distal femoral cut guide assembly may be adjusted to provide a range of varus/valgus angles for the distal femoral resection. An adjustable, single-use, disposable four-in-one cut guide may be adjusted to position saw slots for the anterior and posterior femoral resections and the anterior and posterior chamfer cuts for various size femoral components, then locked. A foot holder assembly includes an anterior tibial target that may be adjusted in three dimensions relative to the tibia. A femoral sizing guide includes a sliding drill guide to position a pin in the distal femur in a specific orientation relative to the leg mechanical axis.

Abstract: Surgical drill guides have modular configurations and are adapted to accommodate a wide range of anatomy. The surgical drill guides are adapted to be removed while leaving a guide wire in its intended location in human bone. The distal end of the drill guide acts as a safety stop for the guide wire by preventing the guide wire from penetrating too far past the far side of the bone.

Abstract: Provided herein are devices related to the removal of uroliths, including kidney, ureteral and/or bladder stones. In one embodiment, the device comprises a mesh or sponge that is removably connected to a catheter, adapted for the removal of urolith fragments of the size 2 mm or less. In one embodiment, the device includes a catheter that is either solid or hollow, the latter for the irrigation of various types of fluid (either standard irrigation fluid (e.g. saline or water) or a material (e.g. blood, fibrin glue, etc.) that would form a clot like substance within the interstices of the device thereby increasing its ability to entrap fragments within the interstices of the basket or nearby.

Abstract: A medical device includes a handle with a proximal arm and a distal arm. The proximal arm and the distal arm are pivotable via a joint. The medical device also includes a tube coupled to the distal arm and a drive wire. A distal portion of the drive wire includes an expandable end effector. A portion of the drive wire is positioned within the tube, and a different portion of the drive wire extends proximally of the distal arm and is coupled to the proximal arm.

Abstract: An ultrasonic surgical instrument is disclosed. The ultrasonic surgical instrument includes a housing, an ultrasonic transducer assembly to selectively generate ultrasonic motion, a motor within the housing, an outer sheath coupled to the housing, and a blade operably coupled to the ultrasonic transducer assembly and rotatably supported within the outer sheath for rotation with the ultrasonic transducer assembly. The ultrasonic transducer assembly is rotatably supported within the housing. The motor is configured to selectively apply a rotary motion to the ultrasonic transducer assembly. The outer sheath comprises a distal tip portion defining a tip cavity. The blade includes a tissue-cutting distal end rotatably supported within the tip cavity. A portion of the tissue-cutting distal end is configured to apply the ultrasonic motion to tissue.

Abstract: An apparatus includes an elongate shaft, a dilation balloon, and a fitting member. The elongate shaft includes an inflation lumen, an irrigation lumen, and at least one irrigation opening. The at least one irrigation opening is in fluid communication with the irrigation lumen. The dilation balloon is at the distal portion of the shaft. The dilation balloon is in fluid communication with the inflation lumen. The fitting member is at the proximal end of the shaft. The fitting member includes an inflation fluid port, an irrigation fluid port, and a blocking structure. The inflation fluid port is in fluid communication with the inflation lumen. The irrigation fluid port is in fluid communication with the irrigation lumen. The blocking structure is adjacent to the irrigation fluid port and defines a gap around the irrigation fluid port.

Abstract: Thrombus evacuator devices are provided. A cystothrombus provides an aspirator tube fluidly communicating to a suction intake, wherein a maceration blade is provided within the aspirator tube adjacent to the suction intake. A rotational element us operatively associated to the maceration blade for morcellating blood clots urged through the suction intake, wherein the aspirator tube is dimensioned to slidably nest in a cystoscope sheath adapted to be inserted into a human urethra. In another embodiment, a gastroentro-thrombus evacuator includes a double lumen tube having non-fluidly connected first and second lumens terminating into a coupling cavity of a coupling device removably attached to a distal end of the double lumen tube. The coupling device provides a suction intake and a flushing outlet fluidly communicating with the coupling cavity. A rotating maceration blade is operational adjacent to the suction intake, while a suction is urged through the first lumen.

Abstract: Surgical devices and methods are described herein that provide improved motor control and feedback, thereby combining advantages of manually-operated and powered surgical devices. In one embodiment, a surgical device includes a proximal handle portion that includes a motor, a distal end effector coupled to the handle portion, and a cutting element configured to cut tissue engaged by the end effector, wherein the motor is configured to supply power that moves the cutting element. The device also includes a motor control mechanism configured to cause the amount of the power to dynamically change in response to a manual user input when the cutting element is moving.

Abstract: A thrombectomy system may include an elongate shaft that defines a high pressure lumen and a low pressure lumen. The high pressure lumen may terminate near an end of the low pressure lumen. An expandable capture basket may be disposed near the end of the low pressure lumen. A thrombectomy apparatus may include an elongate shaft, an evacuation lumen extending within the elongate shaft and a high pressure lumen extending within the elongate shaft. A capture apparatus may be disposed within a wire lumen that extends within the elongate shaft such that the capture apparatus extends distally from the wire lumen.

Abstract: A method of controlling the temperature of an ultrasonic blade includes applying a power level to an ultrasonic transducer to achieve a desired temperature at an ultrasonic blade coupled to the transducer via an ultrasonic waveguide, inferring a temperature of the blade based on a voltage Vg(t) signal and a current Ig(t) signal applied to the transducer, comparing the inferred temperature of the blade to a predetermined temperature; and adjusting the power level to the transducer based on the comparison. In some aspects, the method includes measuring a phase angle ? between the voltage Vg(t) and the current Ig(t) and inferring the temperature of the blade from the phase angle ?. In some aspects, the method includes measuring an impedance Zg(t) equal to a ratio of the voltage Vg(t) to the current Ig(t) and inferring the temperature of the blade from the impedance Zg(t).

Abstract: Various aspects of a generator, ultrasonic device, and method for estimating and controlling a state of an end effector of an ultrasonic device are disclsoed. The ultrasonic device includes an electromechanical ultrasonic system defined by a predetermined resonant frequency, including an ultrasonic transducer coupled to an ultrasonic blade. A control circuit measures a complex impedance of an ultrasonic transducer, wherein the complex impedance is defined as Z g ? ( t ) = V g ? ( t ) I g ? ( t ) . The control circuit receives a complex impedance measurement data point and compares the complex impedance measurement data point to a data point in a reference complex impedance characteristic pattern. The control circuit then classifies the complex impedance measurement data point based on a result of the comparison analysis and assigns a state or condition of the end effector based on the result of the comparison analysis.

Abstract: An ultrasonic device may include an electromechanical ultrasonic system having a resonant frequency, the system including a transducer coupled to an ultrasonic blade. A method of driving the blade may include determining a tissue type contacting the blade, setting current delivered to the transducer to achieve a desired blade temperature, and setting a desired period during which the desired temperature is applied to the tissue. The tissue type may be determined by measuring an impedance of the transducer, comparing an impedance measurement data point to a reference data point, and classifying the impedance measurement data point based on a result of the comparison.

Abstract: An ultrasonic device may include an electromechanical ultrasonic system defined by a predetermined resonant frequency, the electromechanical ultrasonic system including an ultrasonic transducer coupled to an ultrasonic blade. A method of controlling energy delivered to the ultrasonic device may include determining an impedance of the ultrasonic transducer during a transection process, analyzing the impedance of the ultrasonic transducer, profiling the ultrasonic blade based on the impedance, and adjusting a power delivered to the transducer during the transection process based on the profile of the blade. The method may further include pulsing, the power delivered to the ultrasonic transducer, determining changes in tissue characteristics of tissue located in an end effector, wherein the changes in tissue characteristics is determined between pulses, and adjusting power delivered to the ultrasonic transducer based on the tissue changes throughout the transection.

Abstract: A method of controlling the temperature of an ultrasonic blade between two temperature set points includes applying a first power level to an ultrasonic transducer to set an ultrasonic blade temperature to a first target temperature T1, monitoring a phase angle ? between voltage Vg(t) and current Ig(t) signals applied to the transducer, inferring the temperature of the blade based on the phase angle ?, determining that a transection process is complete, and applying a second power level to the transducer to set the blade temperature to a second target temperature T2. The transducer may be coupled to the blade via an ultrasonic waveguide. The first target temperature may be optimized for vessel sealing and the second target temperature may be optimized for clamp arm pad life. The control circuit may determine that transection is complete by determining that the ultrasonic blade contacts the clamp arm pad.

Abstract: An ultrasonic device may include an electromechanical ultrasonic system defined by a predetermined resonant frequency, the electromechanical ultrasonic system further including an ultrasonic transducer coupled to an ultrasonic blade. A method of delivering energy to the ultrasonic device may include measuring a complex impedance of the ultrasonic blade coupled to the ultrasonic transducer, comparing the measured complex impedance to stored values of complex impedance patterns associated with ultrasonic blade functions, and applying, an algorithm to control a power output to the ultrasonic transducer based on the comparison. The method may further include delivering energy to the ultrasonic device based on a state or condition of an end effector, in which the state or condition of the end effector corresponds to a state of only sealing a tissue or of spot coagulating the tissue.

Abstract: An ultrasonic device may include an electromechanical ultrasonic system that includes an ultrasonic transducer coupled to an ultrasonic blade. A method of delivering energy to the ultrasonic device may include sensing a vessel type in contact with the blade, determining that the vessel type is either a vein or an artery, and delivering power to the transducer based on the vessel type. Power may be applied to the transducer at a power level P that differs from a nominal power level Pn for a period T that differs from a nominal period Tn based on the vessel. The power level P may be lower than Pn for a period T that is longer than Tn when the vessel is a vein. Alternatively, the power level P my be greater than Pn for a period T that is shorter than Tn when the vessel is an artery.

Abstract: A method of determining instability of an ultrasonic blade includes monitoring a phase angle ? between voltage Vg(t) and current Ig(t) signals applied to an ultrasonic transducer, coupled to an ultrasonic blade via an ultrasonic waveguide, inferring the blade temperature based on the phase angle ?, comparing the inferred temperature to an ultrasonic blade instability trigger point threshold, and adjusting a power level applied to the ultrasonic transducer to modulate the temperature of the blade. The method may also include determining a frequency/temperature relationship of an ultrasonic blade that exhibits a displacement or modal instability and compensating for a thermal induced instability of the ultrasonic blade. The method may be implemented in an ultrasonic surgical instrument or by a control circuit in a power generator for the ultrasonic surgical instrument.

Abstract: An ultrasonic device may include an ultrasonic system including a transducer coupled to an ultrasonic blade, A method of delivering energy to the device may include sensing a vessel contacting the blade, identifying that the vessel is calcified, and generating a warning. In some aspects, the method further includes disabling one or more activation functions of the blade. In another aspect, the method further includes generating a message to apply compression to the vessel for a predetermined period, disabling activation functions of the blade during compression, and enabling activation functions after the expiration of the compression period. In yet another aspect, the method includes applying a compressive clamp force to the calcified vessel by driving a clamp arm toward the blade, disabling activation functions of the blade during compression, and enabling the activation functions after adjusting the compressive force. An ultrasonic surgical instrument may effect the method.

Abstract: An ultrasonic device may include an electromechanical system defined by a resonant frequency and further include an ultrasonic transducer coupled to an ultrasonic blade. The device may be composed of two or more components, one of which is reusable and one of which is disposable. A method of detecting a proper installation of the components may include determining a spectroscopy signature of the blade coupled to the transducer, comparing the signature to a reference signature, determining an installation state of the components based on the comparison, and controlling a delivery of power to the transducer based on the comparison. The method may include enabling an operation of the device when the installation state of components is proper. The method may further include disabling the device when the installation state is not proper and generating a warning. The warning may be visible, audible, or tactile.

Abstract: A grasping treatment instrument includes a grasping piece, and a supporting member opening and closing relative to the grasping piece. A clamp member is provided between the supporting member and the grasping piece in open and close directions of the supporting member, and the clamp member includes an opposed surface opposed to the grasping piece, and a back surface facing to an opposite side of the opposed surface. The grasping treatment instrument includes a cover member made of a material having lower thermal conductivity than the clamp member, and the cover member covers the clamp member from the back surface side in a part on a distal side with respect to a position where the clamp member is pivotally supported.

Abstract: Various systems and methods for determining the state of an end effector of an ultrasonic surgical instrument are disclosed. A control circuit can be configured to measure a complex impedance of an ultrasonic electromechanical system including an ultrasonic blade and compare the measured complex impedance to reference complex impedance patterns that each correspond to a state of the end effector. Accordingly, the control circuit can further be configured to determine the state of the end effector according to which of the plurality of reference complex impedance patterns the measured complex impedance corresponds.

Abstract: A generator, ultrasonic device, and method for controlling a temperature of an ultrasonic blade are disclosed. A control circuit coupled to a memory determines an actual resonant frequency of an ultrasonic electromechanical system comprising an ultrasonic transducer coupled to an ultrasonic blade by an ultrasonic waveguide. The actual resonant frequency is correlated to an actual temperature of the ultrasonic blade. The control circuit retrieves from the memory a reference resonant frequency of the ultrasonic electromechanical system. The reference resonant frequency is correlated to a reference temperature of the ultrasonic blade. The control circuit then infers the temperature of the ultrasonic blade based on the difference between the actual resonant frequency and the reference resonant frequency.

Abstract: A method of ultrasonic sealing includes activating an ultrasonic blade temperature sensing, measuring a first resonant frequency of an ultrasonic electromechanical system that includes a transducer coupled to the blade via a waveguide, making a first comparison between the measured first resonant frequency and a first predetermined resonant frequency, and adjusting a power level applied to the transducer based on the first comparison. The first predetermined frequency may correspond to an optimal tissue coagulation temperature. The method may further include measuring a second resonant frequency of the system, making a second comparison between the measured second frequency and a second predetermined frequency, and adjusting the power level based on the second comparison. The second predetermined frequency may correspond a melting point temperature of a clamp arm pad. An ultrasonic instrument and a generator may implement the method.

Abstract: An ultrasonic device may include an electromechanical ultrasonic system defined by a predetermined resonant frequency, in which the system may include an ultrasonic transducer coupled to an ultrasonic blade. A method of estimating a state of an end effector of the ultrasonic device may include applying a drive signal defined by a magnitude and a frequency to the ultrasonic transducer, sweeping the frequency of the drive signal from below a first resonance to above the first resonance of the electromagnetic ultrasonic system, measuring and recording, impedance/admittance circle variables Re, Ge, Xe, and Be, comparing, the measured impedance/admittance circle variables Re, Ge, Xe, and Be to reference impedance/admittance circle variables Rref, Gref, Xref, and Bref, and determining, a state or condition of the end effector based on the result of the comparison. An electromechanical ultrasonic system may include a control circuit to effect the method.

Abstract: A method of determining an initial temperature of an ultrasonic blade may include measuring a resonant frequency of an ultrasonic blade prior to activating an ultrasonic transducer, in which the ultrasonic transducer is coupled to the blade via an ultrasonic waveguide, comparing the measured resonant frequency to a baseline resonant frequency, determining an initial temperature of the ultrasonic blade based on a difference between the measured resonant frequency and the baseline resonant frequency, and applying a power level to the blade based on the initial temperature of the blade. The method may further include applying a high power level to the transducer when the initial temperature of the ultrasonic blade is low or applying a low power level to the transducer when the initial temperature of the blade is high. The baseline resonant frequency may be stored in a memory look up table.

Abstract: Instruments, systems and methods are provided for performing submucosal medical procedures in a desired area of the digestive tract using endoscopy. Instruments include a safe access needle injection instrument, a submucosal tunneling instrument, a submucosal dissection instrument, a mucosal resection device. Systems include a combination of one or more of such instruments with or without injectable agents. Embodiments of various methods for performing the procedures are also provided.

Abstract: A valved sheath introducer for venous cannulation, including a valve, sheath, handle and cap. The valve is configured to permit safe introduction and removal of medical instruments through the sheath introducer. The valve may have one or more anchoring members and a thickened central portion through which a slit is formed. The central portion may have one or more concave surfaces and the slit can be angled with respect to the top surface of the valve. The cap is attached to the handle, compressing a portion of the valve therebetween.

Abstract: Surgical devices having a plurality of outwardly-biased flexible fins capable of inward movement such that the fins converge to provide both a passageway for surgical instruments to traverse towards a surgical site, and provide a substantially impermeable seal, thus providing for fluid retention during the surgical procedure. The outwardly-biased flexible fins provide for soft tissue compression, decreasing the length of the lumen or passageway through which instruments pass, allowing for a wider range of movement of instruments and better access to the surgical site, especially in patients with greater amounts of fat tissue that would otherwise require longer lumen lengths in prior art endoscopic cannulas.

Abstract: Disclosed herein are multiple cannulas defining a lumen sized and dimensioned to receive one or more medical instruments, an inflatable outer membrane attached to an outer surface of the cannula, and at least one activator that reversibly activates the cannulas to push a fluid contained in the cannulas into the outer membrane to fill or pressurize the outer membrane. Also disclosed are methods for operating these cannulas.

Abstract: Disclosed herein are multiple cannulas defining a lumen sized and dimensioned to receive one or more medical instruments, an inflatable outer membrane attached to an outer surface of the cannula, and at least one activator that reversibly activates the cannulas to push a fluid contained in the cannulas into the outer membrane to fill or pressurize the outer membrane. Also disclosed are methods for operating these cannulas.

Abstract: An obturator sleeve for a trocar assembly and method of its use are disclosed for infiltrating a liquid medication such as a local anesthetic into the tissue walls of a port site wound during a laparoscopic procedure. The sleeve includes an internal flow passage for receiving the liquid medication. A diffusion polymer, located within the internal flow passage, first absorbs the liquid medication and then releases the liquid medication through a plurality of apertures in the sleeve. When port site wound tissue contacts the diffusion polymer, the diffusion polymer within the sleeve steadily releases the absorbed medication through the plurality of apertures. The obturator sleeve provides a means to adequately infiltrate medication into the tissues of the port site wound, and can be used to block the free nerve endings of the port site wound as well as nearby sensory and motor nerves.

Abstract: A gasket for creating a fluid seal in a medical device includes a flexible base, a flexible hollow body, and a multi-leaflet valve. The flexible hollow body extends along an axis from a hole defined in the flexible base. The flexible hollow body is configured to have a relaxed state in which a cross section of the flexible hollow body has a first shape and a compressed state in which the cross section of the flexible hollow body has a second shape. The multi-leaflet valve is disposed in the flexible hollow body. The compressed state causes the multi-leaflet valve to close to increase (a) a first threshold force or a first threshold pressure differential needed to open the multi-leaflet valve in a distal direction and (b) a second threshold force or a second threshold pressure differential needed to open the multi-leaflet valve in a proximal direction.

Abstract: An expanding surgical dilator for access to the spine and associated method of use is presented. The method has several steps associated with utilizing the expanding surgical dilator to facilitate the placement of objects, optionally implants and/or instrumentation, through the expanding surgical dilator that exceed the expanding surgical dilator's diameter in its compressed form. The expanding surgical dilator comprises an elastic sheath that can stretch and accommodate and link blades forming the rigid bodies of the sheath.

Abstract: Disclosed herein are multiple cannulas defining a lumen sized and dimensioned to receive one or more medical instruments, an inflatable outer membrane attached to an outer surface of the cannula, and at least one activator that reversibly activates the cannulas to push a fluid contained in the cannulas into the outer membrane to fill or pressurize the outer membrane. Also disclosed are methods for operating these cannulas.

Abstract: A device and method are disclosed for an elastic strip with a first fixed end and a second movable end, the elastic strip configured to be in at least one of a tense state and an elastic state. A release mechanism is configured to maintain the elastic strip in a tense state when the release mechanism is in a holding state, and configured to release the elastic strip when in a release state. A needle path with a first bend is provided. A rigid needle is configured to traverse a first portion of the needle path when the elastic strip is in the elastic state and a cannula is located in the needle path and configured to traverse a second portion of the needle path when the rigid needle traverses the first portion of the needle path.

Abstract: A tool for use in fixing the position of an implanted item beneath skin, comprises: a main body, a channel in the main body, the channel defining at least two gripping interfaces for engagement with the skin and around the implanted item, wherein the interfaces are positioned such that, when engaged with the skin, the interfaces retain the implanted item in a known position relative to the engaged skin. Methods of using the tool are also described.

Abstract: The present disclosure relates to a tool for a closed reduction of a fracture. The tool includes at least: a winding portion having a winding shape; a support extending from the winding portion in a normal direction relative to a plane of the winding shape; and a handle extending from the support in the normal direction, and configured to be gripped.

Abstract: The present application provides external bone and tissue fixation systems and related methods. The fixation systems may include an elongate beam element defining an axis with an axially extending threaded track portion. The systems may also include at least one drivable fixation clamp assembly comprising a housing with a central bore, a driving housing rotatably coupled to the housing, a threaded driving member, and a clamp assembly rotatably coupled to the housing configured to clamp to at least one fixation member. The elongate beam element may extend axially through central bore of the housing. The driving member may be movable with respect to the central bore via rotation of the driving housing between engaged and disengaged states with the threaded track portion. Rotation of the driving member in the engaged state may axially translate the clamp assembly along the beam element.

Abstract: Open implant closure structures include a helically wound guide and advancement flange form having splay control surfaces. Multi-start closures and closures with inner set screws have splay control contours for interlocking with cooperating flange forms of bone anchor receivers. Flange form heights, thicknesses and other geometry, such as splay control ramp angle may be varied.

Abstract: A vertebral assist device for monitoring, supporting, stabilizing, and adjusting vertebrae. An embodiment of the vertebral assist device includes: a plurality of vertebral support sections, each of the plurality of vertebral support sections configured to support a respective vertebra of a patient; an actuating system for interconnecting each adjacent pair of the plurality of vertebral support sections, the actuating system dynamically controlling an alignment of the plurality of vertebral support sections; and a control system for actively monitoring the alignment of the plurality of vertebral support sections and for directing the actuating system to dynamically adjust the alignment of the plurality of vertebral support sections until an alignment goal is achieved.

Abstract: A medical implant assembly includes a polyaxial bone anchor having a shank, a receiver, a lower compression insert with planar surfaces for closely receiving an elongate connecting member with planar surfaces and a one-piece closure structure. The connecting member is made from a polymer. The closure structure engages both the connecting member and the insert with the engagement between the closure structure and the insert securely locking the polyaxial mechanism even if the connecting member exhibits creep.

Abstract: A polyaxial bone anchoring device includes a receiving part with an upper member having a first end, a second end, and a recess at the first end for receiving a rod, and a lower member connectable around the second end of the upper member, and a pressure member positionable in the upper member to exert pressure on a head of a bone anchoring element. The lower member is movable from a first position where the head is pivotable, to a second position closer to the first end of the upper member where an angular position of the head is locked while the recess remains vacant or unobstructed. When the lower member is at the second position, at least part of the lower member is aligned axially with at least part of an end face at the second end of the upper member.

Abstract: The invention relates to a polyaxial pedicle screw (2) comprising a screw anchor (4), which has a threaded shaft (6) and a head (8), and comprising a fork head (10), which is U-shaped in side view and has a receiving opening (16) for a corrective element, in particular a correcting rod, and two arms (12), wherein the head is polyaxially pivotably mounted in a distal end region (14) of the fork head and the fork head can be fixed in a pivoted position intended by the surgeon relative to the head, and also comprising a pressure piece (18) which can be arranged in the fork between the head and the corrective element which, on the one hand, rests on the head and, on the other hand, can be loaded by the corrective element, wherein the region of one arm of the fork head the pressure piece is supported by means of a pivot bearing (54) against this arm in the axial direction (20), and that diametrically opposite the pressure piece has a receiving region (42) for a positioning force (44) acting in the axial direction,

Abstract: A coupling device is provided for coupling a rod to a bone anchoring element. The coupling device includes a receiving part having a first end, a second end, a central axis extending through the first end and the second end, and a channel for receiving a rod. The receiving part defines an accommodation space for accommodating a head of a bone anchoring element, the accommodation space having an opening for inserting the head. The coupling device further includes a pressure element arranged at least partially in the accommodation space, the pressure element having a flexible portion to clamp an inserted head, and a clamping element extending at least partially around the flexible portion of the pressure element. The clamping element is configured to move from a first position to a second position in which the clamping element exerts a clamping force onto the pressure element, where the movement includes rotating the clamping element around the central axis.