Abstract: A specialized spinous process retractor surgical instrument comprises a pair of opposing proximal handles coupled to a pair of opposing distal jaws through a joint such that when the handles are compressed the jaws spread apart, the handles defining a plane when viewed from the side. The jaws curve downwardly from the plane distally from the joint, then curve back upwardly before terminating in end portions configured for spreading. The instrument defining a centerline when viewed from above, with the jaws distally from the joint diverging outwardly from the centerline, then curving back toward the centerline before terminating in the end portions. The end portions may include opposing, outwardly facing textured or roughened bone-contacting surfaces. The end portions of the jaws when viewed from the sides may define a plane that is substantially parallel to the plane defined by the handles.

Abstract: A device for the detection of slippage of magnetic coupling between an implanted medical device having a magnet and an externally applied magnetic field includes at least one external magnet configured to apply the externally applied magnetic field, an induction coil disposed external to the subject and between the at least one external magnet and the implanted medical device, and a detection circuit operatively coupled to the induction coil and configured to detect slippage between the rotational orientation of the magnet of the implanted device and the externally applied magnetic field based at least in part on the varying frequency components of the voltage waveform across the induction coil.

Abstract: A mandibular distractor can include an elongated main body having a central longitudinal axis extending in the elongate direction between a first end and a spaced apart second end. A first bone mount can be secured to the main body and a second bone mount can be positioned on the main body. A drive mechanism configured to selectively move the second bone mount longitudinally along the main body can also be included. A third bone mount configured to be moved longitudinally along the main body can also be included.

Abstract: A method of treating a patient's joint having opposing joint surfaces includes providing an elongate member having a proximal end, a distal end and an expandable member near the distal end. The expandable member is positioned in the joint between the joint surfaces and expanded so as to separate the joint surfaces away from one another into a distracted position. The joint is manipulated while in the distracted position so that the joint is distracted and in flexion. A diagnostic or therapeutic procedure is then performed on the joint while maintaining the joint in the flexed and distracted position.

Abstract: Systems and methods for stabilizing or adjusting the position of at least one spinal motion segment, such as a posterior element distraction system. The system includes an implantable member having at least one of a lateral member and a transverse member. The lateral member may be expandable in at least one dimension, for example, in a direction along the axis of the spine. The expandable member may be an inflatable balloon, expandable scaffolding, strut, or combination thereof and may provide stability and anchoring to the implantable member. The transverse member is configured to engage the spinous process and may extend from the lateral member or may extend between two laterally-opposed members. For example, the transverse members may be configured to engage an outer surface of the spinous process, and as such, act as a saddle or cradle.

Abstract: A laterally deflectable asymmetric implant for implanting into a body may comprise a deflectable piece having distal and proximal ends and assuming a straightened insertion state. The backbone may abut or interconnect with said deflectable piece at the distal end of the deflectable piece. In a fully deflected state the implant may define an asymmetric shape, e.g. a D-shaped loop, defining an at least partially enclosed volume. The deflectable piece may comprise a sequence of segments interconnected at effective hinges. Longitudinal pressure applied to the proximal end of the deflectable piece (or applied to the backbone in an opposite direction) may cause relative longitudinal movement between the backbone and the proximal end of the deflectable piece and may generate outward horizontal movement of the deflectable piece away from the backbone. In one embodiment, the implant is implanted using lateral access into an anterior zone of a vertebra and deployed posteriorly.

Abstract: A bone graft delivery system includes a bone graft injector and an access portal. The access portal may include a handle having a first arm pivotably connected to, and biased away from, a second arm. A ratchet including a pawl may extend from the second arm. A delivery tube may be configured to mate with the first arm and be configured to store a bone graft material therein. A plunger including a shaft and a plunger tip at the distal end thereof may be configured to move through the delivery tube. At least a portion of the shaft may include teeth, the pawl of the ratchet being configured to iteratively contact the teeth. A user may hold the access portal with a first hand and the bone graft injector with a second hand, iteratively squeezing the handle to iteratively eject amounts of bone graft material into a patient.

Abstract: Techniques and systems for distracting a spinal disc space and supporting adjacent vertebrae are provided. Trial instruments are insertable into the disc space to determine a desired disc space height and to select a corresponding implant. Implants can be also be self-distracting and the implant providing the desired disc space height can be implanted in the spinal disc space.

Abstract: Methods and devices for sculpting bones, particularly in preparation for implanting prosthetic devices to replace articulating bone joint surfaces. Improved bone removal devices including burr mills driven by gears and loop drives are provided. Reciprocating cutters and belt cutters are also provided. Some devices have either integral or removable expandable portions to vary the force and bone resection depth. Devices can have irrigation ports and plenums to remove bone fragments. Some cutters are dual cutters, adapted to remove bone in two or more regions, such as the knee joint, simultaneously.

Abstract: A joint balancing insert with sensors and an actuated mechanism is disclosed. The joint balancing insert is used to balance a joint during arthroplasty surgery, as the sensors provide force, position and angular data relating to the movement of the joint, while the actuated mechanism allows for highly accurate and dynamic adjustments of the joint based on the data from the sensors. Various configurations of actuated mechanisms and sensors may be implemented in the insert to provide for manual or real time control of the insert, and customized interfaces are provided for visualized feedback of adjustments. Sensor data may also be collected and compared with expected or preferred data sets to provide adjustment recommendations and achieve better outcomes based on historical data.

Abstract: An instrument assembly for use in knee joint replacement surgery is provided including a base instrument having a tibial plate, a femoral plate, a tibial arm having a plate end and a control end, a femoral arm having a plate end and a control end, wherein the femoral plate is rotatably fastened to the plate end of the femoral arm. The assembly also includes a distractor mechanism configured to act between the tibial arm and the femoral arm at a point between their respective plate ends and control ends by which the distance between the plate ends of the arms can be adjusted and an ancillary instrument mountable on the base instrument and configured such that the position of the ancillary instrument relative to the tibial plate is fixed during subsequent steps in the knee replacement procedure, while the knee joint is distracted as a result of forces applied across the joint between the tibial plate and the femoral plate.

Abstract: A system for assessing an intervertebral disc space comprises an elongated catheter with proximal and distal ends and an expandable body carried at the distal end of the elongated catheter. The expandable body includes a distal cap portion. The system further includes a mandrel extending through the elongated catheter and the expandable body and attached to the distal cap portion. The mandrel is movable within the elongated catheter and the expandable body to reposition the distal cap portion relative to the distal end of the elongated catheter while the expandable body is positioned within the intervertebral disc space.

Abstract: A surgical tool includes a pair of pivotally coupled operating handles and working distal ends connected thereto configured to engage bone fixation elements. A toothed ratchet member is arranged across the handles and includes a first and second tooth rack. The first tooth rack includes a plurality of teeth angled in a first direction and the second tooth rack includes a plurality of teeth angled in a second direction. The ratchet member is rotatable with respect to the handles to selectively present the first or second tooth rack to a pawl disposed on one of the handles. The handles are operable for closing or spreading movement via selective engagement of the pawl with the first or second tooth rack, which correspondingly closes or spreads the working distal ends. A method for operating the tool is also disclosed.

Abstract: The subject disclosure is directed to systems, apparatuses, devices and methods for vertebral and spinal correction. In some embodiments, an expandable implant is provided which may be inserted inside the vertebral body and/or between two vertebrae, for instance, for maintenance and/or restoration of a space therein or there between. In certain embodiments, the implant includes a mechanical resistance that prevents the expandable implant from contracting once it has been expanded. Methods of treatment and methods of use of such implants for the alleviation of back pain (for example) are also provided herein.

Abstract: A method of treating a patient's joint having opposing joint surfaces includes providing an elongate member having a proximal end, a distal end and an expandable member near the distal end. The expandable member is positioned in the joint between the joint surfaces and expanded so as to separate the joint surfaces away from one another into a distracted position. The joint is manipulated while in the distracted position so that the joint is distracted and in flexion. A diagnostic or therapeutic procedure is then performed on the joint while maintaining the joint in the flexed and distracted position.

Abstract: Modular medical instruments and kits are provided, having, a tool body portion with a first mating element at one end. A removable and replaceable modular end effector having a second mating element is matable with the first mating element. The instrument further includes a selectively engageable locking mechanism having a lever arm with a first portion associated with the body portion and a claw portion matingly engageable with a portion of the second mating element of the end effector, the locking mechanism being effective to secure the end effector to the body portion of the modular medical instrument. The invention can be particularly useful for providing a secure connection between the modular end effector and the body portion, yet provide ease of interchangeability between modular end effectors.

Abstract: The present disclosure provides for a system for mandibular distraction which includes a rod and a first pin clamp assembly coupled adjacent a first end of the rod. Furthermore, the first pin clamp assembly includes a first clamp. The system further includes a second pin clamp assembly which includes an advancement mechanism that moveably couples the second pin clamp assembly to the rod and a second clamp. Furthermore, a swivel joint is disposed between the advancement mechanism and the second clamp whereby the second clamp is enabled to rotate relative to the advancement mechanism.

Abstract: A surgical tool includes a pair of pivotally coupled operating handles and working distal ends connected thereto configured to engage bone fixation elements. A toothed ratchet member is arranged across the handles and includes a first and second tooth rack. The first tooth rack includes a plurality of teeth angled in a first direction and the second tooth rack includes a plurality of teeth angled in a second direction. The ratchet member is rotatable with respect to the handles to selectively present the first or second tooth rack to a pawl disposed on one of the handles. The handles are operable for closing or spreading movement via selective engagement of the pawl with the first or second tooth rack, which correspondingly closes or spreads the working distal ends. A method for operating the tool is also disclosed.

Abstract: Devices, systems and methods for minimally open orthopedic spine surgery are disclosed. A first flexible screw-based retractor is designed to be coupled to each pedicle screw inserted into adjacent vertebral bodies. A retractor system is provided in which a first retractor blade is mounted to one of the screws and a second movable retractor blade is moved away from the first blade, in a medial direction, to create a working channel through which the disc space may be accessed for passing instruments and implants. Light may be incorporated into the device to illuminate the surgical field. One or all of the retractor blades may be made of a sterilizable plastic or metal and be disposable or reusable.

Abstract: A bone elevator system includes: a bone hook; a first coupling device; an elevator arm member including a substantially straight first elongate arm and a substantially straight second elongate arm which is offset from and fixedly coupled with the first elongate arm, the first coupling device coupling the first elongate arm with the bone hook, the second elongate arm configured for being coupled, by way of a second coupling device, with an anchoring post.

Abstract: An implant for orthopedic surgery includes an impaling member (101,102), which is separable into portions (102a, 102b) for impaling and attaching to tissue, for example, bone. Once the portions (102a, 102b) of the impaling member (101,102) are separated and attached to the requisite tissue, they may accommodate stabilizing members for fixation, or other instrumentation for procedures such as fusion.

Abstract: A spinal distraction system includes a distraction rod having a first end and a second end, the first end being configured for affixation to a subject's spine at a first location, the distraction rod having a second end containing a recess having a threaded portion disposed therein. The system further includes an adjustable portion configured for affixation relative to the subject's spine at a second location remote from the first location, the adjustable portion comprising a housing containing a magnetic assembly, the magnetic assembly affixed at one end thereof to a lead screw, the lead screw operatively coupled to the threaded portion. A locking pin may secure the lead screw to the magnetic assembly. An o-ring gland disposed on the end of the housing may form a dynamic seal with the distraction rod.

Abstract: An apparatus and method is provided for interbody fusion including distracting, in a given direction, and supporting opposing vertebral bodies. A plurality of wafers are consecutively inserted between the vertebral bodies to create a column of wafers. The column of wafers is oriented between the vertebral bodies so as to expand in the given direction as the wafers are consecutively added to the column.

Abstract: Devices and methods are disclosed for providing access to a central compartment of a hip joint. The devices can access the central compartment by distracting all or a portion of the labrum. The labrum can be distracted by advancing a device underneath the bottom edge of the labrum, and using the device to further distract the labrum. Some devices can move underneath the labrum to provide a gap for other devices to access the central compartment.

Abstract: Devices and methods for implantation of an orthopedic device between skeletal segments using limited surgical dissection. The implanted devices are used to adjust and maintain the spatial relationship(s) of adjacent bones. Depending on the implant design, the motion between the skeletal segments may be increased, limited, modified, or completely immobilized.

Abstract: A conic retractor for retraction of tissue of a mammal may comprise an at least partially hollow first truncated cone (20); a second truncated cone (30), having a similar apex angle and whose opening is wider than the first truncated cone, may be configured to at least partially enter the first truncated cone and to dilate at least a distal end of the first truncated cone as it is pushed to the distal end of the cone. A third truncated cone (40) can be inserted into the second truncated cone, etc. Cones can be dilated by having a longitudinal slit (29) or overlapping longitudinal wall surface edges, or by the nature of the material the cones are made of.

Abstract: Method and apparatus are disclosed for distracting tissue and particularly spinal tissue. The device and method may include insertion of at least one elongated member and an augmenting member to form a structure between the tissues to be distraction, such that a dimensional aspect of the structure is augmented upon movement of the augmenting structure.

Abstract: A joint distraction device for use in an arthroscopic surgery is provided. The device has a joint distraction mechanism, situated in between two bone fixation surfaces, and is capable of changing the relative distance between these two surfaces. The force generated by the mechanism should be sufficient to insert bone spikes affixed to the surfaces into bone, as well as distract the joint to create a sufficient enough gap to allow the intended procedure. With the surfaces and spikes engaged to bone at opposite sites of a joint, an increase in distraction force results in an increase in the relative distance results, hence increasing the space within the joint. Embodiments of this invention, compared to fracture table approaches, effectively eliminate the risk of pudendal nerve injury, allow for longer surgical times, and allow for much more controllable joint distraction.

Abstract: A joint-spacing balloon catheter comprising: a shaft having a distal end and a proximal end; first and second balloons mounted to the distal end of the shaft, the first balloon being disposed distal to, and spaced from, the second balloon, with the portion of the shaft between the first and second balloons being flexible; and a handle attached to the proximal end of the shaft.

Abstract: A positioning device for aligning at least one support on at least one structure includes a positioning tool configured to interface with a part of the structure, and a positioning element coupled to said positioning tool. The positioning element includes at least one holding part, wherein the at least one support is releasably coupled to said at least one holding part.

Abstract: A spine alignment system is provided to assess load forces on the vertebra in conjunction with overall spinal alignment. The system includes a spine instrument having an electronic assembly and a sensorized head. The sensorized head can be inserted between vertebra and report vertebral conditions such as force, pressure, orientation and edge loading. A GUI is therewith provided to show where the spine instrument is positioned relative to vertebral bodies as the instrument is placed in the inter-vetebral space. The system can distract vertebrae to a first height and measure the load applied by the spine region. The GUI can indicate that the load is outside a predetermined range. The spine region can be distracted to a second height where the load is measured within the predetermined load range.

Abstract: A flexible obturator configured to dilate soft tissue without abrading the adjacent bone surface area. The flexible obturator consists of at least one flexible strand (for example, flexible wire, suture or similar malleable flexible material) that is overmolded with a material that allows the device to bend/flex in multiple planes. The overmolded material has an increasing taper to provide graduated dilation through soft tissue.

Abstract: An instrument includes a distraction mechanism having a proximal end and an opposed distal end. The distal end includes opposed first and second end members. A first vertebral endplate spreader includes a proximal spreader section mounted to the first end member of the distraction mechanism. The first spreader also includes a distal spreader section operatively connected to the proximal spreader section for lateral movement relative to the proximal spreader section. A second vertebral endplate spreader is mounted to the second end member of the distraction mechanism. The distraction mechanism is configured and adapted to distract the spreaders apart and to retract the spreaders together along a distraction axis. The distal spreader section of the first spreader is configured to move relative to the second spreader in a lateral direction relative to the distraction axis for correction of vertebral alignment, as in treatment of spondylolisthesis, scoliosis, and the like.

Abstract: The invention relates to a knee spacer for temporary replacement of an artificial knee joint, whereby the knee spacer comprises a tibial component (11) and a separator (12), whereby the tibial component (11) comprises a running surface (14) by means of which the tibial component (11), in the patient-inserted state, can be placed against a femoral component (28) in mobile manner, and whereby the separator (12) comprises a contact surface (15) for placing on the tibia (22) and the contact surface (15) is adjustable at a variable distance from the running surface (14) of the tibial component (11).

Abstract: At least one embodiment is directed to an insert for measuring a parameter of the muscular-skeletal system. The insert can be temporary or permanent. In one embodiment, the insert is prosthetic component for a single compartment of the knee. The insert comprises a support structure and a support structure respectively having an articular surface and a load bearing surface. The height of the insert is less than 10 millimeters. At least one internal cavity is formed when support structures are coupled together for housing electronic circuitry, sensors, and the power source. The cavity is sterilized through a port. A membrane is between the port and the cavity. A sterilization gas permeates the membrane for sterilizing cavity. The membrane prevents ingress of solids and liquids to the cavity.

Abstract: In some embodiments, an apparatus includes an elongated member, an expandable member coupled to the elongated member, and an outer sheath. The outer sheath, which can be constructed from a different material than the expandable member, is disposed about the expandable member such that an outer surface of the expandable member is in discontinuous contact with an inner surface of the outer sheath. The expandable member and the outer sheath are configured to cooperatively displace a bone structure when moving between a collapsed configuration and an expanded configuration.

Abstract: A bone distractor assembly configured to distract first and second bone segments on opposite sides of a bone gap is provided. In one embodiment the distractor assembly includes a distractor having a first coupler and a second coupler, a first footplate releasably coupled to the first coupler, a second footplate releasably coupled to the second coupler, and a locking mechanism releasably coupling the first and second footplates to the first and second couplers. The first and second footplates releasably are each configured to attach to bone. The locking mechanism includes a tube, wherein removal of the tube releases the first and second footplates from the first and second couplers.

Abstract: A fluid joint spacer comprising a body having means for receiving a pressurized fluid from an external source and applying that pressurized fluid against a joint element so as to create a flowing fluid bearing within the joint.

Abstract: A central inflatable distractor and a perimeter balloon are inserted into the disc space in uninflated configurations. The central inflatable distractor is then expanded, thereby distracting the vertebral endplates to the controlled height of the central inflatable distractor. The perimeter balloon is then inflated with a curable substance. The perimeter balloon expands as it is filled with the curable substance and conforms to the void remaining in the disc space around the central inflatable distractor, thereby creating a horseshoe shape. Once the flowable material in the perimeter balloon has cured, the central inflated distractor can be deflated and removed. The remaining void (or inner space) is then packed with graft for fusion.

Abstract: A device for accessing and distending a joint comprises a distraction structure having a generally tapered distal portion adapted to penetrate a tissue region and create an access space within a joint. The distraction structure also includes a lumen extending from a proximal surface to a distal portion. The device further includes a distention structure deployable through the lumen and adapted to exert a force between a first joint surface and a second joint surface and create a working space. The distention structure may, in some embodiments, include an elongate member having a proximal end, a distal end, and a lumen extending along at least a portion of the length of the elongate member, a first expandable region deployable from a first substantially collapsed position to a second substantially expanded position, the first expandable region adapted to exert a force between the first joint surface from the second joint surface.

Abstract: A robotic surgical system includes a master controller with an input handle and robotic manipulator assemblies including a surgical end effector and an endoscopic camera. The input handle is translatable to provide a position and rotatable to provide an orientation. A control system couples the master controller to the first and second manipulator assemblies. The control system moves the surgical end effector in response to the position and orientation of the input handle. The control system moves the input handle to orient the input handle to correspond to an orientation of the surgical end effector from a viewpoint of the endoscopic camera during the repositioning of at least one of the input handle position, the end effector, or the endoscopic camera. The control system may move the surgical end effector only in a first mode and orients the input handle only in a second mode.

Abstract: An instrument for compression and distraction of a vertebral segment and reducing a surgical rod includes a first arm, a second arm, a coupler, and a reducer. The first arm includes a first aperture for receiving a first screw extender that attaches to a first vertebra. The second arm pivotably couples to the first arm and includes a second aperture for receiving a second screw extender that attaches to a second vertebra. The coupler links the first arm to the second arm to position the first arm relative to the second arm for compression and distraction of the first vertebra relative to the second vertebra. The reducer is received within the second aperture for reducing a surgical rod within the second screw extender.

Abstract: At least one embodiment is directed to a dynamic distractor (1 00) for distracting bones of a muscular-skeletal system. The dynamic distractor (100) includes at least one sensor (108, 110) which can provide loading, loading differential and position information as well as other measured parameters, a handle (112, 804), a lift mechanism (302), and one or more alignment aid (502, 802). The position and measurement sensors (108, 110) communicate with the processing unit (406) to display, process, and store measured data. A rod (604) couples a cutting block (602) to the distractor (100). The rod (604) also fixes a position of a cutting block (602) in relation to the distractor (100). The cutting block (602) is coupled to the distractor (100) to stabilize and align the muscular-skeletal system while shaping a bone.

Abstract: A set of instruments configured to deliver a therapy to a bone can include a cannulated syringe. The cannulated syringe can extend along a longitudinal axis between a proximal and a distal end. The cannulated syringe can have an inner tube and an outer tube that are interconnected at the distal end as a single fixed unit. A first cannulation can be formed along the longitudinal axis of the cannulated syringe within the inner tube and a second cannulation can be formed within an annular space between the inner and outer tubes. The outer tube can define an opening through a sidewall thereof. The cannulated syringe can be closed from fluid communication between the inner and outer tubes.

Abstract: A surgical distraction apparatus is disclosed. The surgical distraction apparatus includes a tissue distraction device adapted for implantation, the tissue distraction device including a plurality of distraction members, one or more actuators adapted for implantation and operatively coupled to the tissue distraction device, the one or more actuators being configured to drive the tissue distraction device and adjust the alignment of the plurality of distraction members, and an activator adapted to deliver one or more pulses to at least one actuator in the one or more actuators.

Abstract: A method for creating space in a joint, the method comprising: applying force to a body part so as to distract the joint and create an intrajoint space; inserting an expandable member into the intrajoint space while the expandable member is in a contracted condition; expanding the expandable member within the intrajoint space; and reducing the force applied to the body part so that the joint is supported on the expandable member.

Abstract: A method of performing vertebral facet fusion by lateral approach and related devices. The lateral approach to facet fusion involves identifying the lateral mass and then introducing any of the fixation methods known or described herein laterally at one or more facets through the use of a hollow cannula. A surgical bone staple have a perforated bridge is used across the lateral facet joint where fixation is required. Where fusion is desired, a bone screw have lateral perforations of the shank is inserted through the bridge perforation at the joint to promote fusion. The staple and screw may be used in conjunction with one another or individually. The facet joint may be distracted prior to fixation to increase the foraminal space and decompress the neural structures to relieve pain. The method involves less surgical time, reduced blood loss and discomfort for the patient as compared to the posterior approach.

Abstract: Apparatus and method for a shoulder implant, for example, for the glenohumeral joint. The implant is expandable and deflatable during implantation. The implant is sized for the glenoid fossa. In an exemplary embodiment of the invention, the selection and/or implantation of the implant include adapting the implant by size and function to a particular patient's need.

Abstract: A spinal surgery retractor with a slotted keyway for integrating a keyed spinal distractor. This retractor and distractor combination slide together to displace a portion of the intervertebral disk space to restore or maintain intervertebral spacing and facilitate retraction of surrounding soft tissues while disk space surgery is performed. The distractor head and mating portion of the retractors have matching profiles that enable the retractor to maintain distraction of the vertebra after removal of the distractor portion of the tool, permitting access to increase at the operating site. The retractor has convex curved surfaces that interface with a majority of retracted soft tissues during progression of the retraction process, which enhance retractor safety. In addition, the retractor portion of the tool has a proximally located section that is laterally flexible, which provides further progression in the retraction process while increasing relative access to the operating site.

Abstract: An installation tool that is useful for the efficient and effective placement of an article, such as an artificial disc, between adjacent vertebral bodies is provided. The installation tool can be provided as a kit having modular components which allow the surgeon to select from among a variety of components to assemble an installation tool that is optimized for its intended use. The installation tool of the invention generally includes a pair of opposed levers, each of which has a proximal handle portion and a distal portion. A fulcrum is disposed between the two levers to enable proper operation of the tool. The tool further includes a pusher block that is positioned between the two levers and is selectively movable between an initial location distal of the fulcrum and a final location adjacent the distal end of the levers. The pusher block includes a proximal end, a distal end, and a bore extending at least partially therethrough.