Abstract: The present disclosure relates to a spinal fusion impactor tool that includes an attachment means for securing an implant device to the distal end of the tool, a means for adjusting the angle of the distal head relative to the handle to better position the implant for introduction into the implant site, means for remotely releasing the implant device at the distal end and a clamp device on the shaft of the tool to secure tabs, attachments and other devices. The impactor tool is preferably used in conjunction with implantation of an intervertebral fusion cage that is equipped with shims having tabs or other removing means, but may also be used to introduce, for example, an implant, graft, fusion device, wedge or distractor device into any joint space or bony region in preparation for implantation.

Abstract: A vaginal manipulator includes a shaft, a handle connected to a first end of the shaft, and a head connected to a second end of the shaft. The head includes a rigid anterior surface that moves independently from a rigid posterior surface of the head. When the vaginal manipulator is inserted into a vagina, the rigid anterior surface is movable to displace an anterior wall of the vagina and the rigid posterior surface is movable to displace a posterior wall of the vagina. A light source is provided on the head.

Abstract: Minimally invasive surgical techniques including techniques and implants for provision of therapy to a spine from a lateral approach. Implants that may be used with other approaches to the spine are disclosed. Minimally invasive surgical techniques using one or more extended retractors to create an extended access route such as the non-limiting example of lateral access to the spine. Minimally invasive surgical techniques using internal retractors that may be reversibly expanded with a removable retractor inserter to create an extended access route. A linkage jack to expand a set of two or more extended retractors to create an extended access route.

Abstract: A device (1) for use in the surgical treatment of a patient suffering from funnel chest characterized in that it comprises a plate adapted to be fitted underneath the skin of the patient, and further characterized in that, in use, said plate can be attached to the patient's sternum and the curvature, length and width of the plate being such that the plate extends on both sides of the sternum and on the outside of the patient's thorax and is supported by the ribs to hold up the sternum.

Abstract: Various methods and devices for minimally invasive treatment and prevention of conditions of the fascia are provided. In one aspect, a method includes providing an acoustic wave source effective to deliver a focused acoustic wave to a target site within a patient's body, and focusing an acoustic wave through a patient's skin such that at least one location in the patient's fascia is fenestrated in a desired pattern.

Abstract: A Lisfranc injury between a second metatarsal and medial cuneiform is repaired by gaining access to the injury site and placing two arm members of a novel drill guide around the two neighboring bones at the injury site, drilling a guide wire through the two bones guided by the drill guide to a desired depth, measuring the depth of the guide wire to determine the proper length for a bone screw for securing the two bones, drilling a cannulated drill bit into the two bones to a drill depth using the guide wire as a guide, and threading a bone screw into the two bones.

Abstract: A tool is disclosed for use in distracting and compressing fractures of any of a variety of bones. In particular, the tool has a pair of engaging arms, one arm having a hook element to engage a bone plate connected to one side of a fracture, and the other arm having at least one recess for engaging a head of a bone screw or guide wire connected to the other side of the fracture. Actuation of the tool causes the opposing bone segments of the fracture to be pushed apart or drawn together, depending on whether the tool handles are squeezed together or pulled apart. The tool may have a scissors joint that allows the ends of the tool to maintain a parallel alignment during operation, thus reducing the chances for misalignment of the bone segments during operation.

Abstract: A device for early stabilizing of distracted tissue that includes a first implant, a second implant, a sliding expansion mechanism and a stabilizer. The first implant is capable of being attached to a first tissue region. The second implant is capable of being attached to a second tissue region. The sliding expansion mechanism engages the first implant and the second implant for distracting the first implant away from the second implant to create a distraction space for formation of the distracted tissue. The stabilizer rigidly fixes the first implant and the second implant after disengagement of the sliding expansion mechanism to rigidly stabilize the distracted tissue. The stabilizer includes in whole or in part a biodegradable, bioerodible or bioresorbable material.

Abstract: A surgical distance adjusting assembly for a distractor has a base having a first connecting portion configured to hold a first bone attachment member and a carrier having a second connecting portion configured to hold a second bone attachment member. The base and the carrier are movable relative to each other, wherein the first and second connecting portions provide a releasable mechanical coupling to the first and second bone attachment members. The releasable mechanical coupling comprises a hook member at one or both of the first and second connecting portions and configured to engage the respective bone attachment member. Alternatively, the releasable mechanical coupling comprises an opening at one or both of the first and second connecting portions. The opening has a thread for a fixation screw configured to releasable couple the respective bone attachment member to the respective connecting portion.

Abstract: An orthopedic device for compressing or distracting bone parts includes an elongated body with two arms extending transversely away from the body. One arm is a stationary arm affixed to one end of the body and a second arm is a longitudinally movable. The two arms extend from the elongated body in the same direction and parallel to each other. The orthopedic device also includes a locking sleeve hingeably connected to the outer end of each of the first and second arms by a hinge joint, where each locking sleeve is configured for lockably receiving an elongated pin using a collet and a captured collet nut.

Abstract: Assemblies for implantation across one or more spinal motion segments to allow for control of the distance between bone anchors. Control of distance between bone anchors may be provided by one inter-anchor element pushing the pair of bone anchors apart and a second inter-anchor element pulling the pair of bone anchors together. Control of distance between bone anchors may be provided through use of dissimilar thread pitch. Compression of intervertebral disc space through controlled movement of a pair of anchored bone anchors towards one another.

Abstract: A bone fixation system that may be configured to move at least one of a first bone segment and a second bone segment relative to the other, is disclosed. The system may include a first lever and a second lever pivotally coupled to the first lever. The first lever may include a first handle, a first jaw extending from the first handle, and an aperture extending through the first jaw. The aperture may be configured to receive a fixation element to thereby fixedly couple the first lever to a bone plate. The second lever may include a second handle, a second jaw extending from the second handle, and an aperture extending through the second jaw. The aperture may be configured to receive a temporary fixation element to operatively couple the second lever to the second bone segment.

Abstract: First and second bone segments separated by a fracture line or joint can be fixated or fused by creating an insertion path through the first bone segment, through the fracture line or joint, and into the second bone segment. An anchor body is introduced through the insertion path. The distal end of the anchor body is anchored in the interior region of the second bone segment. An elongated implant structure is passed over the anchor body to span the fracture line or joint between the bone segments. The proximal end of the anchor body is anchored to an exterior region of the first bone segment to place, in concert with the anchored distal end, the anchor body in compression, to thereby compress and fixate the bone segments relative to the fracture line or joint.

Abstract: A surgical device includes a rigid shaft connected between a handle and a head. The head of the surgical device is sized for insertion into an organ such as a vagina, a uterus, a rectum, or an esophagus. The head includes an expansion plate and a door coupled to a central plate. The central plate has a distal end connected to the rigid shaft, an anterior surface, and a recess formed in a posterior side of the central plate that provides a posterior surface opposite the anterior surface. The expansion plate is coupled to and movable relative to the anterior surface of the central plate. The door is coupled disposed within the recess of the central plate and movable relative to the posterior surface of the central plate. The expansion plate is movable independently of the door to allow the head to expand and move the organ.

Abstract: Methods and apparatus for treating bones, including, in one or more embodiments, methods and apparatus for treatment of vertebral fractures that include an inflation device for cavity creation and an inflation and containment device for maintaining vertebral height and cement containment. Methods for treating a bone comprising: creating a cavity in the bone; inflating a containment jacket in the cavity; inflating a balloon within the containment jacket so that the balloon occupies a first portion of the containment jacket; introducing a first filler material into a second portion of the containment jacket, wherein the second portion of the containment jacket is not occupied by the balloon; removing the balloon from the containment jacket; and introducing a second filler material into the first portion of the containment jacket.

Abstract: A distraction system includes a distraction rod having one end configured for affixation to at a first location on patient. The system further includes an adjustable portion configured for placement in the patient at a second location, the adjustable portion comprising a housing containing a magnetic assembly comprising a magnet, the magnetic assembly secured to a threaded element that interfaces with an opposing end of the distraction rod. The system includes a magnetically permeable member in proximity to the magnetic assembly and covering an arc of less than 360° of the adjustable portion.

Abstract: A clamp applicable to both temporary and definitive orthopaedic external fixation systems comprising a first coupling element having a pair of opposite jaws defining one or more seats to house a first component of the orthopaedic external fixation system. A second coupling element comprises a pair of opposite jaws defining one or more seats to house a second component of the orthopaedic external fixation system. An interconnection pin passes through and connects the first and second coupling elements along an axis of rotation. A fastening means is arranged to bring the clamp from a slack configuration. The first and second coupling elements are relatively rotatable along the axis of rotation to a locked configuration, and are relatively rotatable with each other. These fastening means include manually operable temporary fastening means to temporarily lock the clamp, and definitive fastening means operable with a fastening tool, to definitively lock the clamp.

Abstract: The present invention provides a bone plate that includes a sliding mechanism that allows for both static and dynamic loading and the associated stabilization or partial or whole immobilization of two or more adjacent bone fragments or vertebral bodies of the spine. This sliding mechanism is designed such that as bone resorbs or the like, the sliding mechanism maintains axial compression in a collinear manner across the bone segments.

Abstract: A system for applying a treatment to a defect in one bone of two bones forming a joint that comprises a bladder for delivering a reduced pressure to the defect and for providing a positive pressure as bracing between the two bones of the joint is disclosed. A method for applying such treatment is also disclosed. A bladder for applying such treatment that comprises a reduced-pressure chamber and a bracing chamber is also disclosed.

Abstract: Surgical anchoring systems and methods are employed for the correction of bone deformities. The anchoring system and its associated instrument may be suitable for surgical repair of hallux valgus, tarsometatarsal sprains, ankle ligament reconstruction, spring ligament repair, knee ligament reinforcement, acromioclavicular sprains, coracoclavicular sprains, elbow ligament repair, wrist and hand ligamentous stabilization or similar conditions. The anchoring system may include a fixation system for anchoring two or more sections of bone or other body parts and a system for aligning of one section relative to another section.

Abstract: A collapsible bone screw for healing bone fragments across a bone fracture includes an externally threaded inner screw member and an externally threaded outer screw member. The inner screw member is initially screwed into an inner bone portion. An unthreaded portion of the outer screw member is movably joined to the inner screw member. The outer screw member is screwed until it gains purchase in an outer bone portion. As impaction occurs over time, the collapsible bone screw apparatus may shorten in length as the two screw members slide, telescope or otherwise axially move toward each other to shorten the overall length, thereby preventing any portion of the screw apparatus from protruding out of the bone. A bone screw kit of multiple inner and outer screw members are provided as well as a method of surgically fastening bone fragments.

Abstract: In one aspect, an apparatus for correcting osseous development deficiencies at orbital level in persons includes a halo-like structure for fixing to a cranium, a union plate between the halo-like structure and the distractor, and the orbital distractor itself, which is supported by the halo-like structure and fixed to the orbit.

Abstract: A distraction screw includes a proximal portion secured to a first vertebra, a distal portion secured to a second vertebra and an intermediate portion. The intermediate portion is coupled to the proximal and distal portions and is positioned in an intervertebral space. The intermediate portion is configured and adapted to enable distraction of the first vertebra relative to the second vertebra.

Abstract: A pair of clamps are attached to a damaged linear or non-linear bone one each side of a fracture site during a surgical reduction, one clamp on each side of the fracture site, after which the two clamps are slidably engaged to a pivotal alignment bar, with the clamps then being adjusted to properly align the linear or non-linear bone for a surgical attachment using a bone plate. The pivotal alignment bar provides at least one pivotal ball joint which may be aligned as a straight bar for a linear bone or adjusted to an angle for non-linear bones to achieve optimal alignment of the bone. Each clamp provides axially adjustable plate retainers which slides along a track on the end of each segment of the each clamp to position the retainers at a location where the bone plate is to be attached to the bone.

Abstract: The present invention relates to an expandable prosthetic implant device for engagement between vertebrae generally comprising an inner member, outer member, and gear member positioned coaxial with respect to each other such that the inner and outer members are moveable relative to each other along an axis. The gear member is axially fixed to the outer member and freely rotatable with respect to the outer member and the gear member threadedly engages a threaded portion of the inner member to translate inner member along the axis. The implant is configured to engage the vertebrae in a predetermined alignment and the gear member includes gear teeth exposed to the exterior and configured to be accessible by a tool member at a plurality of angular positions around the perimeter of the implant device.

Abstract: An expansion device is disclosed which, when mounted on an appropriate support, can make controlled advancement relative to the support in response to activation from a remote site. The device comprises first (6) and second (8) elements coupled for relative movement along an axis defined on a support 2. An expandable chamber is defined between the elements, in which chamber is a flexible and elastic membrane (24). A resilient mechanism urges the two elements towards each other to define a minimum volume for the chamber. The chamber can be expanded to separate the elements, and hold mechanisms typically in the form of latches, are provided for selectively restricting movement on the respective elements relative to the support.

Abstract: A feeler gauge and alignment device comprises a first outer shim having a first end, a second end, and an alignment aperture disposed between the first end and the second end, a second outer shim having a first end, a second end, and an alignment aperture disposed between the first end and the second end, and one or more inner shims disposed between the first outer shim and the second outer shim, each of the one or more inner shims having a first end, a second end, and an alignment aperture disposed between the first end and the second end. The first outer shim, the second outer shim, and the one or more inner shims are rotatably coupled about the first ends.

Abstract: Treatment of spinal irregularities, including, in one or more embodiments, derotation apparatus and systems that can be used to reduce the rotation of vertebral bodies. Derotation apparatus that may comprise a tube assembly comprising an inner sleeve and an outer sleeve disposed over the inner sleeve. The inner sleeve may have a distal end for attachment to an implant. The tube assembly may further comprise a handle assembly. The tube assembly may further comprise a ball joint assembly disposed between the tube assembly and the handle assembly. The ball joint assembly may comprise a ball joint configured for attachment to a coupling rod.

Abstract: The various embodiments disclosed herein relate to implantable devices for the treatment of structural bone and joint deformity, including hallux valgus. More specifically, the various embodiments include systems, devices, and methods for implantation of a flexible or tension band for treating such deformity.

Abstract: This invention is an implantable device that enables non-invasive post-operative adjustment of the motion dynamics between two members of the human skeletal system. It may be used for dynamic stabilization of the spine. This device includes: a flowable substance; a reservoir implanted into the human body that contains this flowable substance wherein movement of moving portions of this reservoir causes the flowable substance to flow; and an energy-transducing mechanism wherein this mechanism transduces energy from a flow of the flowable substance into changes in the motion dynamics between the two members of the human skeletal system. This device may be used for: (1) non-invasive post-implantation customization of the device to reduce back pain for a particular patient; (2) non-invasive gradual adjustment of the device to correct spinal deformities; and (3) real-time adjustment to optimize spinal motion dynamics as the patent engages in different activities.

Abstract: An introducer can be used to implant a distractible intervertebral body fusion device into a patient's disc space and expand the device. Introducer includes a body 100 including a handle and a sleeve. Handle includes a slot for containing an actuation tool. A drive shaft and a securing shaft can extend through sleeve between a proximal end of the sleeve adjacent slot and a distal end of the device. At proximal end, actuation tool can connect to drive shaft where drive shaft extends through an opening in body. Drive shaft can extend out of an opening at distal end to engage a worm gear, drive shaft, or other actuation member of distractible device. Securing shaft can engage the device to stabilize the device during distraction. Activation of the actuation member rotates the drive shaft, which expands the distractible device.

Abstract: The invention relates to a resetting tool (1a), for the axial displacement of a Kirschner wire (2a), in particular, for application with bone plates, which may be implanted for the fixing of fractures. The above comprises a Kirschner wire (2a), comprising a thread in at least a part region and at least one guide tube (4a, 4b), by means of which the Kirschner wire may be positioned. A nut (3a) is provided, which is slotted and contains an internal drilling, such that the nut may be placed over the Kirschner wire and may be supported on the guide tube, whereby the Kirschner wire may be displaced in the axial direction by means of rotation of the nut.

Abstract: The invention relates to a systems, devices and methods of delivering and deploying a stent into a curvilinear cavity within a vertebral body or other bony or body structure. In some instances, a system can include an elongate shaft for delivering a self-expanding, cement-directing stent. The elongate shaft can include at least one of an inner shaft, an outer shaft, a tubular sheath, a flexible guidewire, and an internal polymer extrusion. A rotational handle can be used to control movement of the elongate shaft. The rotational handle can incorporate one or more pins in slots associated with each of the components (e.g., inner shaft, outer shaft, and tubular sheath), such that upon rotation of the handle, the pins are forced to move in the direction of their respective slots.

Abstract: A bone fixation device (1) for internal fixation of bone fragments with a longitudinal axis (2) and comprising: A) a first and a second plate (3, 4) each having a lower surface (5), an upper surface (6), two lateral surfaces (22, 23), a front surface (7) axially intermediate between said first and second plate (3, 4), an axially terminal surface (8) and at least one screw hole (17) extending from said upper surface (6) to said lower surface (5) and intended to receive a bone screw; B) a first and a second guide rail (13, 14) arranged parallel with respect to said longitudinal axis (2) and uniaxially slideably connecting said first and second plate (3, 4); and C) at least one resilient member (15, 16) arranged between said first and second plate (3, 4) acting as a compression spring.

Abstract: A device to space vertebral members that may include a deploying device with a first member with an elongated first shaft and a first body at an end of the first shaft, a second member with an elongated second shaft that extends around the first shaft and a second body at an end of the second shaft, and a third member with an elongated third shaft that extends around the second shaft and a third body at an end of the second shaft. The device may include a first plate positioned on a first side of the deploying device, and a second plate positioned on a second side of the deploying device. First, second, and third jointed linkages may be spaced apart along the deploying device and each having a pair of links and each having a first end attached to the first plate, a second end attached to the second plate, and an intermediate joint connecting the pair of links together and being attached to the deploying device.

Abstract: An orthopaedic surgical device comprises a first sensor component and a second sensor component. Each sensor component includes a paddle set to contact a proximal tibia and a distal femur of a patient. The first sensor component and the second sensor component being movable with respect to one another to extend one paddle set beyond the other paddle set, and each paddle set includes cutouts for the clearance of the patellar tendon to avoid the need to evert the patella during use.

Abstract: A device for use as an implant for surgical displacement of vertebrae, and that is comprised of two parts co-working in a sliding way: a sliding part with an internal thread and a carrier part, and also a driving element with an external thread which is located between the parts, is described. The driving element includes a head and the sliding part of the device includes a threaded guideline cooperating with the driving element and a seat of a diameter corresponding with the head's diameter and length greater than the head's length, and the carrier part has a seat of a diameter and length corresponding with the head's diameter and length.

Abstract: A method of treating a vertebra, comprising: (a) accessing an interior of a vertebra; and (b) introducing a sufficient amount of artificial biocompatible material which does not set to a hardened condition in storage, into said bone, with sufficient force to move apart fractured portions of said bone.

Abstract: An embodiment of a method includes selecting a countersink depth setting with a linear countersink adjustment mechanism of a distractor-inserter, positioning distal ends of blades of the distractor-inserter between the two vertebral bodies to be separated, driving a head block assembly of the distractor-inserter forward until the retraction members of the distractor-inserter engages respective outer faces of the vertebral bodies, and retracting the distal ends of the blades and the tip from between the vertebral bodies, wherein the vertebral bodies compress the disc implant and hold the disc implant between the vertebral bodies at the countersink depth. A distractor-inserter includes first and second retraction members disposed within channels of the blades, and a countersink adjustment mechanism configured to linearly adjust a distance between a tip and the retraction members to thereby linearly adjust a countersink depth of an implantable element inserted between two distracted elements.

Abstract: According to one representative embodiment, a method for distracting a segment of bone from a source bone includes providing a bone distractor that has a first end portion and a second end portion movable relative to each other. The method further includes coupling the first end portion to the segment of bone and coupling the second end portion to an anchor bone opposing the source bone. Additionally, the method includes actuating the bone distractor to move the first and second end portions closer to each other and pull the segment of bone toward the anchor bone. The method can also include fixing the source bone relative to the anchor bone. Further, the method can include positioning the bone distractor to the sides of the source bone, anchor bone, and a gingival layer covering the bones.

Abstract: Spinal surgical systems include a compressor mountable to a first vertebra and positionable relative to a fulcrum mountable to a second vertebra. The compressor and fulcrum are manipulated relative to one another to compress the first and second vertebrae. The systems further include a distractor mountable to a first vertebra and positionable relative to a fulcrum mountable to a second vertebra. The distractor and fulcrum are manipulated relative to one another to distract the first and second vertebrae.

Abstract: A compression and distraction shaft assembly applies compression and distraction to bones including vertebrae. Shaft A assembly and shaft B assembly are attached together via a polyaxial fulcrum. The polyaxial fulcrum allows all rotational degrees of freedom between shaft A assembly and shaft B assembly. Such fulcrum, during compression and distraction, does not impart ancillary stresses or motion to vertebrae. An hourglass-shaped bore for engaging pliers is formed in approximately middle of both the shaft A assembly and the shaft B assembly. Distraction pliers having cylindrical tips are used to apply distraction to vertebrae. Once handles are pressed to impart an appropriate amount of distraction to the vertebrae, they are locked in this position. Compression pliers having cylindrical tips are used to apply compression to vertebrae. Once handles are pressed to impart an appropriate amount of compression to the vertebrae, they are locked in this position.

Abstract: A device and method for treating bone fractures/lesions using an inflatable body is provided. The inflatable body includes a balloon having a substantially flat horizontal surface for quick easy insertion into bone beneath the fracture so as to align misaligned fragments of the fracture and/or to collapsed bone. The body has a shape and size to compress at least a portion of the cancellous bone to form a cavity in the cancellous bone and/or to restore the original position of the outer cortical bone, if fractured or collapsed. The inflatable body has a stylet attached to it's distal end so that once the inflatable body is deflated it can be twisted about the stylet to have a smaller profile so as to be easily withdrawn from the bone.

Abstract: An instrument for engaging a bone anchor may include a first implant engaging member having a proximal end and a distal end and a second implant engaging member having a proximal end and a distal end. The second implant engaging member may be integrally connected to the first implant engaging member by a pair of opposed integral spring members located proximal to the distal ends of the first and second implant engaging members. Manipulation of the proximal ends of the first and second implant engaging member can cause each of the distal ends to rotate about the pair of opposed spring members to engage at least a portion of a bone anchor. A rod adjusting tool may be connectable to the bone anchor engaging tool and may be axially adjustable relative to the bone anchor tool to adjust a spinal rod relative to the bone anchor.

Abstract: Systems are provided for reducing the complexity and invasiveness of spinal stabilization procedures and provide an expandable device deliverable to a spinal implantation location. The expandable device can be delivered through a minimally invasive access portal and expanded at the implantation location to manipulate one or more bony structures or maintain a configuration of one or more bony structures.

Abstract: The present invention discloses a securing device that is used to secure a fixation device to two bone portions to promote healing between the two bone portions. The bone portions commonly include a skull bone portion and a skull bone flap or implant, and the fixation device is commonly a cranial clamp. The securing device provides for securing the fixation device in a uniform, single movement as opposed to currently available products. The securing device has two handles pivotably connected, and a gripping means moveably associated with one handle. As the handles are activated, the gripping means travels proximally along the one handle and grips an elongated section of the fixation device and exerts a tensioning force along the shaft of the elongated section prior to the cutting means cutting the elongated shaft to secure the fixation device in place.

Abstract: Alignment clamps, extension caps, and systems, with associated methods, for pedicle screw extension alignment in an orthopedic patient are described. An alignment clamp for alignment of pedicle screw extensions includes a clamp having a hollow interior. The clamp can receive a pedicle screw extension through the hollow interior. The clamp includes opposing open ends in communication with the hollow interior. A straightening rod receptacle is on a side of the clamp. The straightening rod receptacle is oriented to receive a straightening rod therethrough. The straightening rod receptacle can be substantially perpendicular to a direction of the clamp through which the pedicle screw extension is receivable.

Abstract: A bone prosthesis device is comprised of an upper and lower abutment surfaces and an intervening malleable member. The device is sufficiently small so that implantation into an inter-vertebral disc space can be performed from a substantially posterior approach without significant impingement upon the neural elements.

Abstract: A surgical instrument for assembling a spinal rod to a plurality of anchoring members includes first and second levers that are pivotally, and optionally removably, connected for rotation about a pivot axis. The first lever has a hollow guide tube forming a first handle section and a first distal end section, with a first longitudinal bore extending therethrough. The second lever has a second handle section, a second distal end section, and an intervening second intermediate section that interconnects the two in offset fashion. The second distal end section has a second longitudinal bore. The longitudinal bores accept bone anchor heads. Pivoting of the levers relative to each other about the pivot axis causes the bone anchors to move toward or away from each other. The first and second bores may be configured to mate with bone screw assemblies having extended tabs.

Abstract: Treatment of spinal irregularities, including, in one or more embodiments, derotation apparatus and systems that can be used to reduce the rotation of vertebral bodies. Derotation apparatus that may comprise a tube assembly comprising an inner sleeve and an outer sleeve disposed over the inner sleeve. The inner sleeve may have a distal end for attachment to an implant. The tube assembly may further comprise a handle assembly. The tube assembly may further comprise a ball joint assembly disposed between the tube assembly and the handle assembly. The ball joint assembly may comprise a ball joint configured for attachment to a coupling rod.