Abstract: Vertebral column manipulation systems include spinal derotation instrumentation to affect one or more derotation maneuvers on a scoliotic spine or on a spine having one or more displaced, misaligned or curved vertebral levels. Derotation instrumentation is attached to at least one vertebral body, with the instrumentation including at least two elongated extensions mounted to and extending proximally from the at least one vertebral body. A linking assembly extends between and links proximal ends of the extensions to one another. The linking assembly includes first and second mounting assemblies movably engaged to an elongate link member extending transversely to the extensions. Each of the mounting assemblies includes a movable joint for receiving the proximal end of a respective one of the extensions and a cam assembly for securing the mounting assembly in position relative to the link member and to fix the joint around the extension.

Abstract: A spinal implant for stabilizing two adjacent vertebrae having a damaged disc therebetween is assembled in situ. An elongated tool is used to insert a flat U-shaped distractor in the disc space through a low profile incision with both legs of the U-shaped distractor contacting both end plates of the adjacent vertebrae. The tool is rotated 90 degrees rotating the distractor 90 degrees so that each leg of the distractor contacts one end plate of the adjacent vertebrae, respectively, to restore intervertebral space. An elliptical bone tray is slid along the tool to seat within the U-shaped distractor. The tool is removed and a retainer replaces it to lock the bone tray and the distractor together. A screw is used to lock the bone tray to the distraction device, the screw slides down the cannula which is the tool inserted over the rod that the distraction implant is attached to.

Abstract: A system for implantation of a spinal stabilization system includes a vertebral anchor having a top portion. The top portion has a perimeter and a first engaging element. The first engaging element has a first longitudinal axis that is generally parallel to a second longitudinal axis of the top portion. The perimeter extends around the second longitudinal axis. The system also includes a driving tool that has a second engaging element that is configured to cooperate with the first engaging element to substantially restrict rotation of the driving tool relative to the top portion about the second longitudinal axis. The first engaging element is configured to slidably receive the second engaging element in a direction along the first longitudinal axis, and the second engaging element is configured to extend substantially within the perimeter of the top portion.

Abstract: A spinal surgical system includes at least one extender mounted to an anchor engaged to the spinal column. The extender extends proximally away from the anchor to a proximal end outside the patient. The extender is configured to receive a connecting member from an approach that is generally parallel or along the longitudinal axis of the extender so that the connecting member can be positioned from the proximal end of the extender to the anchor at the distal end of the extender without requiring an additional incision or puncture to accommodate the connecting member insertion.

Abstract: Instrumentation and methods for reduction of a spinal deformity, including a plurality of elongate alignment elements and first and second reduction elements engaged to the alignment elements. Each of the alignment elements extends generally along a longitudinal axis and includes a proximal portion adapted for coupling to a corresponding vertebra and a distal portion. The first reduction element extends along a first transverse axis and is engaged with the distal portions of the alignment elements to maintain the distal portions in general alignment along the first transverse axis. The second reduction element extends along a second transverse axis and is movably engaged with the alignment elements wherein the proximal portions are positioned in general alignment along the second transverse axis as the second reduction element is displaced in a proximal direction to thereby reduce the spinal deformity.

Abstract: Template systems and methods of use are disclosed herein for use in conjunction with corresponding spinal fusion plates. Preferred templates are slotted to allow for use with distractor pins and a distractor. Additionally preferred templates include windows to allow the operating surgeon to have more visibility of the intervertebral area, including the graft. After the appropriate sized template has been placed against the targeted vertebrae, holding pins can be placed into the vertebral bodies to help guide the fusion plate and to compress the intervertebral space.

Abstract: An inserter for implanting an intervertebral spacer into a spinal disc space is disclosed. The inserter comprises a jaw assembly connected to a shaft assembly that is connected to a handle assembly. The user operates the handle assembly to open and close the jaw assembly to thereby connect to and release from the intervertebral spacer. Furthermore, the handle assembly is operable to lock and unlock rotation of the jaw assembly while still connected thereto to permit angulation of the jaw assembly relative to the shaft assembly without losing hold of the intervertebral spacer.

Abstract: Embodiments of the present invention provide apparatus for guiding medical instruments, including a handle with a handle shaft, an alignment stand configured to interface with a receptacle of a cervical plate, an instrument guide tube coupled to the alignment stand and having a lumen therethrough, such that when the alignment stand is in communication with the receptacle, the instrument guide tube is positioned over a bone screw receiving hole in the cervical plate and an axial centerline of the instrument guide tube passes through the bone screw receiving hole. Instrument guide tube may swivel about the alignment stand via a rotational coupling, or may be one of two fixed instrument guide tubes. Alignment stand may include an angle-limiting post to interface with the receptacle to permit ranges of tilting, or a stem and optional bone pin for holding the alignment stand at a substantially constant angle in the receptacle.

Abstract: Systems for positioning a connecting element adjacent the spinal column in minimally invasive procedures include installation instruments that guide the connecting element from a location remote from one or more anchors to a location proximate to the one or more anchors. The installation instruments include extensions mountable to anchors engageable to the spinal column or other bony structure, and inserters mountable to the anchor extensions for positioning the connecting element adjacent the anchors.

Abstract: Instruments for inserting an implant in a space between adjacent bony portions include upper and lower guide members and a drive assembly between the spreaders with an implant positioned forwardly of the drive assembly. The drive assembly is coupled to a handle assembly, and the handle assembly is operable to move the implant forwardly between the guide members to position the implant in a space between the bony portions. The handle assembly includes a mounting portion to which the drive assembly is mounted and an actuating portion operable to effect linear movement of the drive assembly.

Abstract: A spinal implant provides support for desired parts of the spine. The implant can provide support in fusion situations. The spinal implant includes a pair of elongated members and a variable length cross-link. A variable length cross-link apparatus may couple to the first and second elongated members. Each variable length cross-link device may include a fixed portion having a receiver portion for attachment to a first elongated member. Each variable length cross-link may include a transverse portion. Each variable length cross-link may include an adjustable portion having a receiver portion for attachment to a second elongated member and a transverse portion engaging member. Inserting the transverse portion of the fixed portion into the engaging portion of the adjustable portion may form a cross-link for stabilizing motion between two elongated members. Engaging the adjustable portion at a selected point on the transverse portion establishes a length selected by the surgeon.

Abstract: The disclosure relates generally to embodiments of systems and methods of spinal stabilization. Embodiments include methods that use a dilator to displace tissue proximate to a sleeve. An embodiment of a surgical system can comprise a dilator that may define a working channel from a first opening to a second opening. The dilator can be positioned to displace tissue proximate to the sleeve. The dilator may be shaped to allow a first end of an elongated member to enter the working channel through the first opening and exit the dilator through the second opening to be percutaneously moved to another assembly.

Abstract: Devices and methods for immobilizing adjacent vertebrae are disclosed including the utilization of one or more implants inserted between adjacent vertebrae and having protrusions thereon for substantially fixedly securing with the vertebrae. In one form, an implant may be inserted in a first orientation and then rotated to a second orientation having a larger profile. A second implant may also be inserted in the same vertebral space in the same manner. A trial spacer may be used to determine the proper implant size. In another form, an implant may be inserted already in the fusion orientation. The implants and trial spacer, as well as a spreader and/or a scraper for preparing the intervertebral space, may be inserted in the vertebral space with the same insertion tool. The inserter tool may include a threaded member for attachment with the implants or other devices.

Abstract: A system for implantation of a spinal stabilization system includes a vertebral anchor having a top portion. The top portion has a perimeter and a first engaging element. The first engaging element has a first longitudinal axis that is generally parallel to a second longitudinal axis of the top portion. The perimeter extends around the second longitudinal axis. The system also includes a driving tool that has a second engaging element that is configured to cooperate with the first engaging element to substantially restrict rotation of the driving tool relative to the top portion about the second longitudinal axis. The first engaging element is configured to slidably receive the second engaging element in a direction along the first longitudinal axis, and the second engaging element is configured to extend substantially within the perimeter of the top portion.

Abstract: A method of operating a rod reducer includes connecting a cam coupling rod reducer to a screw head of a pedicle screw assembly, wherein spaces in between prongs at a second end of an inner tube of the rod reducer are positioned parallel to a rod of the pedicle screw assembly, and wherein the connection of the cam coupling rod reducer to the screw head indicates a first position of operation; rotating a lever cam of the cam coupling rod reducer until an indication line marked on an outer body of the cam coupling rod reducer moves to a second position of operation; and rotating the lever cam to a third position of operation, wherein the third position of operation indicates that the rod is optimally seated in the pedicle screw assembly, and that the pedicle screw assembly is ready to accept a blocker screw.

Abstract: A spinal stabilization system may be formed in a patient. In some embodiments, a minimally invasive procedure may be used to form a spinal stabilization system in a patient. Bone fastener assemblies may be coupled to vertebrae. Each bone fastener assembly may include a bone fastener and a collar. The collar may be rotated and/or angulated relative to the bone fastener. Detachable members may be coupled to the collar to allow for formation of the spinal stabilization system through a small skin incision. The detachable members may allow for alignment of the collars to facilitate insertion of an elongated member in the collars. An elongated member may be positioned in the collars and a closure member may be used to secure the elongated member to the collars.

Abstract: A method and device are provided for reducing abnormal vertebral orientation using a fixation plate that is used in conjunction with a positioning tool to reduce spinal deviation and properly position and secure adjacent vertebrae for fusion of the spine. The disclosed embodiments are particularly useful in minimally invasive surgical techniques such as laterally performed anterolisthesis and retrolisthesis.

Abstract: A lordotic guard and method for guiding a bone removal device to form an implantation space in the human spine and, if desired, for inserting a spinal implant into the implantation space.

Abstract: A surgical instrument for insertion of an interbody fusion implant between adjacent vertebral bodies. The surgical instrument comprises a frame member, and a first and a second arm coupled to the frame member. Each arm includes a distal end region and a proximal end region, whereby the proximal end region of at least one arm is pivotably coupled to the frame member, and the distal end region of each arm defines a distractor plate. The distractor plate of each arm is configured to be positioned in direct contact with a vertebral body. A wedge is positioned between the first and second arms, and is configured to translate the interbody fusion implant along an axis between the proximal end region and the distal end region of the arms while adjusting a distance between the distractor plates of the arms via a rack and pinion.

Abstract: Instruments and methods for preparing a spinal disc space to receive an implant include an annulus template, a footprint template, a distractor for distracting adjacent vertebrae, and a guide member for guiding a chisel. The instruments and methods can be employed in an oblique approach to the spinal disc space.

Abstract: A rod inserter and method of inserting a rod into a vertebral body, wherein the rod inserter holds a rod in a vertical or semi-vertical position from one end and allows the rod to be inserted and then rotated into its final horizontal position inside a wound. The device comprises a longitudinal member comprising holes located at distal ends of the longitudinal member; and a holder comprising a tip end comprising a first and second portion any of which comprise a prong tip. The holder also includes a handle end located distally away from the tip end, wherein the handle end comprises a first gripping arm and a second gripping arm; and an engaging member comprising tooth-like features connecting the first gripping arm to the second gripping arm, wherein the tooth-like features engage the second gripping arm, and wherein the prong tip fits into a hole of the longitudinal member.

Abstract: Interspinous process implants are disclosed. Also disclosed are systems and kits including such implants, methods of inserting such implants, and methods of alleviating pain or discomfort associated with the spinal column.

Abstract: A method for performing minimally invasive surgery to reduce lumbar scoliosis in a patient is disclosed. The method involves performing an orthopedic exercise or maneuver on a patient to reduce scoliosis, and anchoring the ilioposoas muscles to a region of the femur to permanently reduce the scoliosis. During the exercise or maneuver, a lumbar x-ray is taken on both sides of the patient to determine which side the scoliosis reduction is greatest. The side with the greatest reduction is the side where the surgery takes place.

Abstract: A surgical instrument has an elongate guide member and a reciprocable member. The elongate guide member provides a protected path of travel for an implant from outside the body to a position near a damaged tissue site. The reciprocable member is movable along the elongate guide member to push the implant along its path of travel. The reciprocable member can include an implant carrier. The implant can be an orthopaedic implant for repair or regeneration of soft tissue at a damaged joint site. The implant can be larger than the transverse dimension of the elongate guide member and folded or rolled to fit within the elongate guide member. Use of this instrument protects the implant from damage as it is delivered to the damaged joint site. The invention also includes a surgical method for delivering an implant to a damaged tissue site.

Abstract: Instrumentation for implanting an artificial intervertebral disc includes static trials and a dynamic trial for determining the appropriate size of disc to be implanted, static trial holders for manipulating the static trials, inserter/impactors for inserting and removing the static trials and for inserting the artificial intervertebral discs, repositioners/extractors for repositioning and extracting the static trials or the artificial intervertebral discs, and a leveler for setting the proper position of the artificial intervertebral disc. Methods for using the same are also disclosed. Features for artificial intervertebral discs and intervertebral spacer devices useful for manipulation by the instrumentation are also disclosed.

Abstract: An apparatus and method for distracting, in a given direction, and supporting two tissue surfaces. A plurality of wafers are consecutively inserted between the two tissue surfaces to create a column of wafers. The column of wafers is oriented between the tissue surfaces so as to expand in the given direction as the wafers are consecutively added to the column.

Abstract: Stabilization systems for stabilizing one or more vertebral levels are provided. The systems include anchors engageable to the vertebrae and at least one connecting member that includes a window to receive the anchors and mounting portions extending from opposite ends of the connecting member into the window for engagement with the anchors. The connecting member can flex in response to spinal loading to provide dynamic stabilization, although rigid engagement relationships are also contemplated.

Abstract: Derotation instrument assemblies and systems are provided to facilitate positioning one or more vertebrae of a spinal column into a desired alignment. The instrument assemblies and systems include implant holders engageable to respective implants engaged to vertebrae of the spinal column, transverse bridges to connect implant holders associated with a particular vertebra, and inter-level linking assemblies to connect instrument assemblies associated with different vertebrae. Derotation handles can be provided to facilitate application of the alignment forces, while the assemblies distribute the corrective forces to the connected implants and vertebrae.

Abstract: An apparatus and method for distracting, in a given direction, and supporting two tissue surfaces. A plurality of wafers are consecutively inserted between the two tissue surfaces to create a column of wafers. The column of wafers is oriented between the tissue surfaces so as to expand in the given direction as the wafers are consecutively added to the column.

Abstract: A surgical guiding instrument for use with a chisel and an implant body for insertion into an intervertebral space, included is a shaft with a stop device for delimiting a depth of insertion of the implant body into the intervertebral space. The shaft has a distal end and a proximal end, the implant body being arranged at the distal end of the shaft and defining two bearing surfaces positionable against the adjacent vertebral bodies, the stop device having at least one stop movably mounted at the distal end of the shaft or on the implant body, the stop having a stop surface pointing in distal direction transversely or substantially transversely to at least one of the bearing surfaces, so that an insertion depth for a surgical machining tool can be set in a simple way.

Abstract: An electronically guided spinal rod system for the placement of a spinal rod into the heads of pedicle screws and other types of bone fixation systems includes a bone screw inserter having rod access slots extending longitudinally for a length along the screw inserter, a rod detection system coupled to the rod access slots and a rod pusher for inserting a spinal rod through the rod access slots. The electronically guided spinal rod system insures that the spinal rod will be accurately positioned while allowing the operator complete freedom to choose its specific path into the screw inserter rod access slots.

Abstract: Systems for positioning a connecting element adjacent the spinal column in minimally invasive procedures include installation instruments that guide the connecting element from a location remote from one or more anchors to a location proximate to the one or more anchors. The installation instruments include extensions mountable to anchors engageable to the spinal column or other bony structure, and inserters mountable to the anchor extensions for positioning the connecting element adjacent the anchors.

Abstract: The present invention provides a robotic surgical tool for use in a robotic surgical system to perform a surgical operation. The robotic surgical tool includes a wrist mechanism disposed near the distal end of a shaft which connects with an end effector. The wrist mechanism includes a distal member configured to support the end effector, and a plurality of rods extending generally along an axial direction within the shaft and movable generally along this axial direction to adjust the orientation of the distal member with respect to the shaft. Advancement or retraction of a first rod generally along the axial direction tips the base through a first angle. The addition of a second angle allows the distal member to direct the end effector in essentially a compound angle. The robotic surgical tool may also include provisions for roll movement.

Abstract: A spinal stabilization system may be formed in a patient. In some embodiments, a minimally invasive procedure may be used to form a spinal stabilization system in a patient. Bone fastener assemblies may be coupled to vertebrae. Each bone fastener assembly may include a bone fastener and a collar. The collar may be rotated and/or angulated relative to the bone fastener. Detachable members may be coupled to the collar to allow for formation of the spinal stabilization system through a small skin incision. The detachable members may allow for alignment of the collars to facilitate insertion of an elongated member in the collars. An elongated member may be positioned in the collars and a closure member may be used to secure the elongated member to the collars.

Abstract: Derotation instrument assemblies and systems are provided to facilitate positioning one or more vertebrae of a spinal column into a desired alignment. The instrument assemblies and systems include implant holders engageable to respective implants engaged to vertebrae of the spinal column, transverse bridges to connect implant holders associated with a particular vertebra, and inter-level linking assemblies to connect instrument assemblies associated with different vertebrae. Derotation handles can be provided on the implant holders to facilitate application of the alignment forces, while the assemblies distribute the corrective forces to the connected implants and vertebrae.

Abstract: Instrumentation for implanting an artificial intervertebral disc includes static trials and a dynamic trial for determining the appropriate size of disc to be implanted, static trial holders for manipulating the static trials, inserter/impactors for inserting and removing the static trials and for inserting the artificial intervertebral discs, repositioners/extractors for repositioning and extracting the static trials or the artificial intervertebral discs, and a leveler for setting the proper position of the artificial intervertebral disc. Methods for using the same are also disclosed. Features for artificial intervertebral discs and intervertebral spacer devices useful for manipulation by the instrumentation are also disclosed.

Abstract: In one embodiment, there is disclosed a surgical instrument for inserting an implant, the surgical instrument including an inserter assembly and a distractor assembly.

Abstract: A cam coupling rod reducer and method of operation comprises an inner tube comprising a first end having a hole and a second end having a plurality of prongs extending therefrom. The rod reducer further includes a lever cam connected to the first end, wherein the lever cam comprises a base and a pair of semicircular arms extending from the base, wherein each of the arms comprise a hole configured to align with the hole of the first end of the inner tube. The rod reducer also includes an outer extension tube connected to the inner tube, wherein the outer extension tube comprises positional markings on the body of the outer extension tube; a top end having a concave opening; and a bottom end comprising an opening configured to permit the prongs of the inner tube to extend therethrough; and a pair of pegs extending from the bottom end.

Abstract: There is shown a system and method for reducing the difficulty in percutaneous placement of a spine stabilization brace. A medical implant system has a first bone anchor having a longitudinal axis, a second bone anchor and a brace. The brace couples the first bone anchor to the second bone anchor. A the distal end of the brace may be pivotally coupled to the first bone anchor and also adapted to slide in a generally transverse direction in relation to the longitudinal axis of the first bone anchor.

Abstract: A spinal stabilization system may be formed in a patient. In some embodiments, a minimally invasive procedure may be used to form a spinal stabilization system in a patient. Bone fastener assemblies may be coupled to vertebrae. Each bone fastener assembly may include a bone fastener and a collar. The collar may be rotated and/or angulated relative to the bone fastener. Detachable members may be coupled to the collar to allow for formation of the spinal stabilization system through a small skin incision. The detachable members may allow for alignment of the collars to facilitate insertion of an elongated member in the collars. An elongated member may be positioned in the collars and a closure member may be used to secure the elongated member to the collars.

Abstract: Minimally invasive methods and devices for introducing a spinal fixation element into a surgical site in a patient's spinal column are provided. In general, the method involves advancing a spinal fixation element in a first, lengthwise orientation along a pathway extending from a minimally invasive percutaneous incision to a spinal anchor site. As the spinal fixation element approaches the spinal anchor site, the fixation element can be manipulated to extend in a second orientation, which is preferably substantially transverse to the first orientation, to position the fixation element in relation to one or more spinal anchors.

Abstract: Instrumentation for implanting an artificial intervertebral disc includes static trials and a dynamic trial for determining the appropriate size of disc to be implanted, static trial holders for manipulating the static trials, inserter/impactors for inserting and removing the static trials and for inserting the artificial intervertebral discs, repositioners/extractors for repositioning and extracting the static trials or the artificial intervertebral discs, and a leveler for setting the proper position of the artificial intervertebral disc. Methods for using the same are also disclosed. Features for artificial intervertebral discs and intervertebral spacer devices useful for manipulation by the instrumentation are also disclosed.

Abstract: A spinal stabilization system may be formed in a patient. In some embodiments, a minimally invasive procedure may be used to form a spinal stabilization system in a patient. Bone fastener assemblies may be coupled to vertebrae. Each bone fastener assembly may include a bone fastener and a collar. The collar may be rotated and/or angulated relative to the bone fastener. Detachable members may be coupled to the collar to allow for formation of the spinal stabilization system through a small skin incision. The detachable members may allow for alignment of the collars to facilitate insertion of an elongated member in the collars. An elongated member may be positioned in the collars and a closure member may be used to secure the elongated member to the collars.

Abstract: A system for reduction of vertebral bodies (or vertebrae) in various embodiments includes a reducer, and extender, and a hollow tube. The reducer couples to the extender, which in turn couples to an elongated member, such as a rod, and to a bone fastener assembly. The reducer allows reduction of the vertebral body incrementally, and by a desired amount. The reducer may include or may be used in conjunction with a holding device or holder in order to hold or keep the amount of reduction constant or steady once the desired amount of reduction has been obtained. The reducer may use one of several embodiments, including embodiments that use threaded assemblies or members, inclining members or wedges, offset cams, scissor jacks, and/or levers.