Abstract: A method of bonding a first object to a second object includes the steps of: providing the first object including thermoplastic material in a solid state, providing the second object including a proximal surface, applying a mechanical pressing force and a mechanical excitation capable to liquefy the thermoplastic material until a flow portion of the thermoplastic material is flowable and penetrates into structures of the second object, and stopping the mechanical excitation and letting the thermoplastic material resolidify to yield a positive-fit connection between the first and the second object. The second object has a region of low density, wherein the protrusion penetrates the region of low density at least partly before the thermoplastic material is made flowable, and wherein the first object includes a protruding portion after the step of letting the thermoplastic material resolidify, the protruding portion at least partly penetrates the region of low density.

Abstract: A graft material injector device and method are disclosed. The injector device includes an elongated injector tube and a side loading aperture for receiving graft material. A graft material loader and a cover for the side loading aperture may optionally be included.

Abstract: A bone graft delivery system for delivering graft material into a surgical site. The delivery system includes an elongate hollow tube constructed to receive the bone graft material and having a hollow interior and indicia formed on an exterior surface of the elongate hollow tube. The delivery system also includes a plunger adapted to extend in the elongate hollow tube and to form a substantially congruent fit with the hollow interior of the elongate hollow tube such that the plunger is precluded from rotating within the elongate hollow tube. The plunger is adapted to urge bone graft material through the elongate hollow tube to deliver bone graft material through an opening thereof.

Abstract: The present disclosure generally pertains to methods and systems for fusing a joint. The disclosure includes mechanically immobilizing the joint by insertion of a bone screw, the bone screw including a screw shaft operatively coupled to a screw head, the screw shaft including a longitudinal axis, a channel extending along the longitudinal axis, a first shaft wall section, a second shaft wall section and a third shaft wall section. Fusing of the joint includes inserting the screw into a first bone, a second bone and a joint formed between the first bone and the second bone. Insertion further includes cutting bone pieces away from the first bone using the third shaft wall section of the bone screw and directing the first bone pieces into a helical depression formed in the third shaft wall section.

Abstract: Disclosed are: a composition for hard tissue repair with excellent penetrability to an adherend such as a cancellous bone and excellent adhesion to an adherend, which comprises a monomer (A), a polymer (B), a polymerization initiator (C) and a contrast medium (X) having a volume mean particle diameter of 3 ?m or more; and a kit for hard tissue repair having members in which the components of the monomer (A), the polymer (B), the polymerization initiator (C) and the contrast medium (X) contained in this composition for hard tissue repair are encased in three or more divided groups in an optional combination.

Abstract: Embodiments discussed herein are directed to devices, systems and methods for effectively treating post endovascular procedure complications such as endoleaks within an aneurysm sac. Some embodiments may include a delivery system with an integral aneurysm sac conduit configured for the introduction of materials which may be useful for treating endoleaks or the like.

Abstract: An ocular implant adapted to be disposed within Schlemm's canal of a human eye with a body extending along a curved longitudinal central axis in a curvature plane, a first strut on one side of the implant and a second strut on an opposite side of the implant, the circumferential extent of the first strut with respect to the plane of curvature being greater than the circumferential extent of the second strut with respect to the plane of curvature. The invention also includes methods of using the implant.

Abstract: Threaded sacro-iliac joint stabilization (e.g., fusion, fixation) implants and methods of implantation and manufacture. Some implants include a threaded distal region, an optionally threaded central region, and an optionally threaded proximal region. The distal, central, and proximal regions have lengths such that when the implant is laterally implanted across a SI joint, the distal region can be positioned in a sacrum, the central region can be positioned across an SI-joint, and the proximal region can be positioned in an ilium.

Abstract: A graft material injector device and method are disclosed. The injector device includes an elongated injector tube and a side loading aperture for receiving graft material. A graft material loader and a cover for the side loading aperture may optionally be included.

Abstract: The present disclosure generally pertains to methods and systems for fusing a joint. The disclosure includes mechanically immobilizing the joint by insertion of a bone screw, the bone screw including a screw shaft operatively coupled to a screw head, the screw shaft including a longitudinal axis, a channel extending along the longitudinal axis, a first shaft wall section, a second shaft wall section and a third shaft wall section. Fusing of the joint includes inserting the screw into a first bone, a second bone and a joint formed between the first bone and the second bone. Insertion further includes cutting bone pieces away from the first bone using the third shaft wall section of the bone screw and directing the first bone pieces into a helical depression formed in the third shaft wall section.

Abstract: The present invention provides a negative pressure guided bone cement injection system comprising a negative pressure system, comprising a negative pressure introduction device, a pushing system for implant bone cement to the target area, a control system for regulating the negative pressure system and the pushing system, and at least one sensing device disposed at any position of the negative pressure system, which can sense at least one environmental parameter for observing the physiological condition of a patient's spinal vertebral body can be monitored immediately, and the result is actively or passively sent back to the system or the operator for adjusting the injection parameters.

Abstract: A liquid container manufacturing method includes: a liquid blow molding step of molding a preform into a liquid container having a shape conforming to an inner surface of a blow-molding mold, by supplying a pressurized liquid to an interior of the preform through a supply path in a state where a blow nozzle is engaged to a mouth of the preform; and a headspace forming step of forming a headspace in the liquid container, by discharging the liquid from an interior of the liquid container through a discharge port in a discharge rod extending to the interior of the liquid container through the blow nozzle, by introducing a pressurized gas to the interior of the liquid container through a gas inflow path in a state where the supply path is closed.

Abstract: A percutaneous minimally-invasive procedure to prevent a potential fracture in an osteoporotic vertebra of an osteoporotic patient who has no history of vertebral fracture is provided by minimally-invasively injecting a non-dispersive, biocompatible and resorbable calcium-based cement paste into the osteoporotic vertebral body.

Abstract: The present invention provides a medical pressurization control device, comprising an outer tube and a threaded push rod inside the outer tube. A movable caliper comprising two arms, a caliper control member connected to the movable caliper, and an operating member connected to the caliper control member are provided in the outer tube; when the operating member moves from a second position to a first position, the operating member drives the caliper control member to move to a locking position, so as to push the two arms of the movable caliper to hold the threaded push rod for locking the threaded push rod; when the operating member moves from the first position to the second position, the operating member drives the caliper control member to move to a release position, so as to push the two arms of the movable caliper to release the threaded push rod for unlocking the threaded push rod.

Abstract: The present invention provides a bone cement composition. The bone cement composition includes a developing particle, an acrylic polymer, and an acrylic monomer, wherein a specific surface area of the developing particle is in a range from about 0.1 m2/g to about 5 m2/g. The present invention further provides a bone cement composition kit. The bone cement composition kit includes a power component and a liquid component, respectively stored in separate containers, wherein the power component includes a developing particle and an acrylic polymer, and the liquid component includes an acrylic monomer. A specific surface area of the developing particle is in a range from about 0.1 m2/g to about 5 m2/g.

Abstract: A device for loading bone graft material into a delivery tube is provided herein. The device includes a housing defining a reservoir for receiving bone graft, a magazine at least partially disposed within the housing, and an actuation member coupled to the housing for discharging the bone graft material into the delivery tube. The magazine defines a first chamber and a second chamber and is moveable between a first position in which the first chamber is in communication with the reservoir and a second position in which the second chamber is in communication with the reservoir. The actuation member includes a plunger configured to slide into the first chamber and the second chamber to discharge bone graft material, when bone graft material is contained therein, into the delivery tube. Methods of loading bone graft material are also provided.

Abstract: The straw includes a tube (11) extending between a first end (16) and a second end (17) and includes a gas-permeable but liquid-impermeable plug (12). The tube (11) is made of a thermochromic material that reversibly changes colour at a pre-set temperature threshold, by virtue of which colour change the tube (11) has a first visual appearance if the temperature thereof is below the preset threshold and a second visual appearance that is different from the first visual appearance if the temperature thereof is above the preset threshold.

Abstract: A system and methods for a safe and efficient distributing of bone graft material into an intervertebral disc space are provided. Systems are provided for receiving, removing, and replacing of preloaded load cartridges in a rapid and repeating manner. The systems can also be designed for rapidly delivering the biologics from a single load cartridge and, to even further facilitate a rapid and repeating delivery of biologics, the load cartridge and cartridge tamp can be adapted so that the cartridge tamp can capture and remove the load cartridge after delivery of fusion promoting material in the load cartridge.

Abstract: A device for reinforcing a femoral neck bone, the femoral neck bone including a cortical bone region and a cancellous bone region, the device including a support structure having an outer surface and including a portion having one or more bores, the one or more bores adapted to allow filler material to be released therefrom to enter directly into the cancellous bone.

Abstract: The embodiments relate to an injectable composition for a bone cement material comprising a dry powder component, a liquid component and a modifier configured to modify a Young's modulus of the bone cement material. The modifier is linoleic acid or a derivative thereof and is present in a concentration of 0.1 to 12 v/v of the liquid component.

Abstract: A shoelace includes a tubular body woven by first threads, second threads, third threads, and fourth threads. Each first thread and each second thread are made of TPU. Each third thread and each fourth thread are made of polyester. Each first thread and each third thread are left-handed helices. Each second thread and each fourth thread are right-handed helices. Each first thread is parallel to each third thread. Each second thread is parallel to each fourth thread. The first threads and the third threads are alternately arranged. The second threads and the fourth threads are alternately arranged and are woven with the first threads and the third threads. Each first thread and each second thread have a smaller denier than that of each third thread and each fourth thread.

Abstract: A bone graft loading system includes a loading funnel, syringe, cannula, plunger, and loading tool. The loading funnel includes an interior passageway to receive the cannula and a syringe docking portion. The syringe may be coupled to the syringe docking portion so that it extends along a longitudinal axis that is transverse to the longitudinal axes of the cannula and the loading funnel. A user may advance bone graft from the syringe to a holding area of the loading funnel. The user may then move the loading tool through the holding area and into the interior space of the cannula to load the cannula with bone graft. This process may be repeated until the cannula is fully loaded with bone graft. The cannula and the plunger inside the cannula may then be removed from the loading funnel and coupled to an injector assembly for use in surgery.

Abstract: Provided are synthetic bone graft substitutes that include bioactive glass and a carrier. Synthetic bone graft substitutes may include bioactive glass, glycerol and polyethylene glycol. Also provided are bone graft substitutes that include collagen and bioactive glass particles. Example bone graft substitutes may include collagen and bioactive glass particles. Other example embodiments may include Type I Bovine Collagen, an angiogenic agent, such as hyaluronic acid, and bioactive glass. Further provided are methods that include administering the present bone graft substitutes to a mammal, e.g., by surgical insertion of the bone graft substitute into the mammal, either alone or in conjunction with one or more implant devices. Further provided are kits that include the present bone grafts.

Abstract: A bone cement mixing and delivery device includes a shaft extending along an axis from a first end to a second end and including a passageway. The first end includes an adapter having a first opening that is in communication with the passageway. The second end includes a second opening that is in communication with the passageway. The shaft includes a mixing portion between the first and second ends. A connector includes a central portion that that is coupled to the adapter. The central portion includes a channel that is in communication with the first opening. The connector includes first and second ports that extend from the central portion. The first port includes a first lumen that is in communication with the channel. The second port includes a second lumen that is in communication with the channel. Methods of use are disclosed.

Abstract: Described herein are medical fluid infusion systems for pumping a fluid to a patient, such as in a hospital environment. In one aspect, disclosed is an infusion system including a drive assembly having a drive fluid reservoir and a drive mechanism configured to apply a force to drive fluid from the drive fluid reservoir through a length of tubing. The infusion system includes a hydraulic assembly having a first fluid chamber having an inlet port configured to be in fluid communication with the length of tubing and a second fluid chamber having an outlet port configured to be in fluid communication with a patient extension set and a flexible movable divider sealing the first fluid chamber from the second fluid chamber. Related apparatus, systems, techniques and articles are also described.

Abstract: A fluid path set includes a first fluid line having a proximal end fluidly connectable to a source of a first fluid and a second fluid line having a proximal end fluidly connectable to a source of a second fluid. A flow mixing device is in fluid communication with distal ends of the first and second fluid lines. The flow mixing device includes a housing, a first fluid port provided for receiving the first fluid, and a second fluid port for receiving the second fluid. A mixing chamber is disposed within the housing and is in fluid communication with the first and second fluid ports. A third fluid port in fluid communication with the mixing chamber for discharging a mixed solution of the first and second fluids. A turbulent flow inducing member is disposed within the mixing chamber for promoting turbulent mixing of the first and second fluids.

Abstract: A bone graft injector device for injecting bone graft material during a surgical procedure includes a barrel defining a channel extending between a first end and a second end. The second end of the barrel defines an opening into the channel. A matter holding section of the channel extending inwardly from the opening has a constant cross-sectional area extending towards the first end. The constant cross-sectional area is equal to an area of the opening. A plunger is positioned in the channel wherein the plunger is configured for urging bone graft material within the matter holding section of the channel out of the second end through the opening.

Abstract: A remotely-activated injection device for use in vertebroplasty is provided to inject a flourescent probe material into a patient. The injection device includes a pump defining an injection chamber having an exit opening; an actuator; and a cable having a first end coupled to the actuator, and a second end remotely engaging the pump. The actuator remotely controls the pump by responsive movement of the cable to thereby cause injection of a flourescent probe material from the injection chamber of the pump through the exit opening to the patient.

Abstract: The present invention relates to minimally invasive graft delivery systems and devices. The systems and devices provide a means to deliver graft material minimally invasively, such as to a spacer within a disc space. A particular system can include a cannula, a syringe and an extrusion tool. The extrusion tool can be used to extrude material from the cannula and syringe, and can have multiple modes of operation to accommodate the extrusion of materials of different viscosities.

Abstract: A surgical instrument includes a first member defining an axis and including an end surface and a passageway. A second member is movably disposed within the passageway and includes a tip and a plurality of spaced apart markings. The second member is movable between a first configuration in which the tip extends parallel to the axis and a second configuration in which the tip extends transverse to the axis. The end surface is aligned with a first one of the markings when the second member is in the first configuration and the end surface is aligned with a second one of the markings when the second member is in the second configuration. Methods are disclosed.

Abstract: A device for storing and mixing bone cement components. The device includes a housing, a safety device, and a vacuum indicator. The housing defines a mixing chamber configured to store a first bone cement component therein. In a first safety position, the safety device prevents contact between the first bone cement component and a second bone cement component in the mixing chamber. In a second safety position, the safety device permits contact between the first and second bone cement components in the mixing chamber. The vacuum indicator restricts movement of the safety device from the first safety position to the second safety position when in a first vacuum indicator position. The vacuum indicator permits movement of the safety device from the first safety position to the second safety position when in a second vacuum indicator position.

Abstract: Two-component bone cement comprising A) a paste as component A, comprising a1) methylmethacrylate; a2) at least one methylmethacrylate-soluble polymer having a number average molar mass of less than 500,000 Dalton; a3) at least one methylmethacrylate-insoluble particulate polymer having a particle size D50 of less than 50 ?m; a4) at least one methylmethacrylate-soluble hydroperoxide; and a5) at least one methylmethacrylate-soluble tertiary amine; and B) a powder as component B, comprising b1) at least one particulate radiopaquer having a particle size D50 of less than 50 ?m; b2) at least one methylmethacrylate-soluble heavy metal salt; and b3) at least one methylmethacrylate-soluble reducing agent. The mixing of paste A and powdered component B immediately generates a tack-free plastically deformable cement dough, without any waiting time, that self-cures by means of radical polymerization.

Abstract: A bone graft delivery system can include an elongate tube and a handle having a trigger and a ratcheting mechanism. The trigger is actuated to deliver bone graft material through the tube. The bone graft delivery system can further include a distal tip at a distal end of the tube. The tip has one or more openings to deliver the bone graft material to a desired location and includes a surface suitable to act as a rasp for decorticating bone. A method for delivering bone graft material to a desired surgical location includes providing a bone graft delivery device, positioning the device adjacent the surgical location, decorticating bone, and delivering bone graft material to the surgical location.

Abstract: The present disclosure provides a retractor including an enclosure extending from a first open end to a second open end to form a lumen extending along an axis therebetween and that is accessible from the first open end and the second open end. The retractor further includes a first aperture formed at first angular position in the enclosure, and a second aperture formed at second angular position in the enclosure and opposing the first aperture to form a passage extending transverse to the axis from the first aperture, through the lumen, and to the second aperture. The first aperture and the second aperture are located proximate to the first open end and sized to arrange the passage along a spine of a patient to receive a trocar for delivering a graft material to the spine.

Abstract: The present invention relates to minimally invasive graft delivery systems and devices. The systems and devices provide a means to deliver graft material minimally invasively, such as to a spacer within a disc space. A particular system can include a cannula, a syringe and an extrusion tool. The extrusion tool can be used to extrude material from the cannula and syringe, and can have multiple modes of operation to accommodate the extrusion of materials of different viscocities.

Abstract: A magazine supporting multiple bone grafts in chambers is coupled to a housing including a barrel. A plunger selectively passes through one of the chambers and along the barrel. A trigger mechanism advances the plunger along the barrel. A selector knob is movable into a plurality of positions, wherein each position employs one of a plurality of stops. One stop prevents the end of plunger from advancing past a predetermined ready position short of the end of the barrel when selected. Another stop prevents the plunger from advancing past a predetermined dispensing position substantially aligned with the end of the barrel when selected. Another stop prevents the plunger from advancing past a predetermined manipulating position beyond the end of the barrel when selected. In the manipulating position, the distal end of the plunger can be used to reposition the bone graft within the spinal disc cavity. Related methods are also provided.

Abstract: Disclosed herein are methods, compositions and tools for repairing an articular joint having a failed implant. The articular repair systems are customizable or highly selectable by or adaptable to individual patients and geared toward providing optimal fit and function. The surgical tools are designed to be customizable or highly selectable by or adaptable to individual patients to increase the speed, accuracy and simplicity of performing total or partial arthroplasty including revision surgeries.

Abstract: A minimally-invasive bone graft harvesting device, kit, and method are provided. The device includes a hollow cutting element and an extraction element. The hollow cutting element may define a longitudinal axis and includes a distal end, a proximal end adapted to be coupled to a powered or manual-operated rotary tool, and an inner lumen extending longitudinally between the distal and proximal ends. The hollow cutting element may also include one or more blades protruding from an outer surface of the cutting element. Each blade may be arranged adjacent to an opening extending between the outer surface and the inner lumen to allow cancellous bone material cut by each blade during use to pass through the opening into the inner lumen. The extraction element may be removably received within the inner lumen of the hollow cutting element to allow withdrawal of the bone material in the inner lumen.

Abstract: A method of stabilizing a first vertebra and a second vertebra includes implanting a first bone anchor into the first vertebra, implanting a second bone anchor into the second vertebra, connecting a first anchor connection instrument to the first anchor, connecting a second anchor connection instrument the second anchor, positioning a cement delivery tube into a passage provided through the first anchor, delivering bone cement from a bone cement delivery system coupled to the bone cement delivery tube through the passage in the first anchor to the first vertebra, removing the cement delivery tube from the first anchor connection instrument and the first anchor, connecting the cement delivery tube to second anchor connecting instrument connected to the second anchor, delivering bone cement through a passage in the second anchor to the second vertebra, connecting a spinal connection element to the first anchor and the second anchor.

Abstract: An apparatus and methods for delivery of reinforcing materials to a weakened or fractured bone is disclosed. An apparatus for delivering a reinforcing mixture to a bone including a tube having a proximal end, a distal end, and a longitudinal axis therebetween, wherein the tube has at least one inner lumen capable of allowing a bone reinforcing mixture to pass therethrough; a balloon engaging the tube wherein the balloon expands from a substantially deflated state to a substantially inflated state upon the bone reinforcing mixture entering the balloon; and at least one light guide extending through the tube into the balloon to guide a light into the balloon.

Abstract: A fixation device, having an elongated element extending along a central axis, having a total length L and including a proximal section formed of a material that is substantially non-absorbent for electromagnetic radiation within a preselected wavelength range and a distal section formed of a material that is substantially nonabsorbent for electromagnetic radiation within the preselected wavelength range in combination with a middle section axially arranged between the proximal and distal sections, the middle section formed of a material that is substantially absorbent for electromagnetic radiation in the preselected wavelength range.

Abstract: Methods and apparatus for treating bones, including, in one or more embodiments, methods and apparatus for treatment of vertebral fractures that include a containment assembly for cement containment and/or a balloon assembly for maintaining vertebral height. Methods for treating a bone comprising: inserting a cannula having an inner lumen into the bone; creating a cavity in the bone; providing a containment assembly, wherein the containment assembly may comprise a tubular member having a proximal end and a distal end, a containment jacket disposed on the distal end of the tubular member, and a guide wire disposed through the tubular member with the guide extending into the containment jacket; inserting the containment jacket through the inner lumen of the cannula and into the cavity; and introducing a filler material into the containment jacket.

Abstract: Implant removal systems and methods for using the system for removing an implant from a bone are disclosed herein. In an embodiment, a method for removing an intramedullary implant from a bone includes navigating a guidewire into an intramedullary cavity of the bone; inserting the guidewire into a lumen of an intramedullary implant located in the intramedullary cavity of the bone; advancing a removal screw over the guidewire to the intramedullary implant; threading the removal screw into the lumen of the intramedullary implant to engage the removal screw to the intramedullary implant; and applying impaction force on the removal screw to remove the intramedullary implant from the intramedullary cavity.

Abstract: The present invention relates to an apparatus and method for near-simultaneous and integrated delivery of bone graft material during the placement of surgical cages or other medical implants in a patient's spine. The integrated fusion cage and graft delivery device according to various embodiments delivers and disperses biologic material through a fusion cage to a disc space and, without withdrawal from the surgical site, may selectably detach the fusion cage for deposit to the same disc space. The integrated fusion cage and graft delivery device is formed such that a hollow tube and plunger selectively and controllably place bone graft material and a fusion cage in or adjacent to the bone graft receiving area.

Abstract: The present invention relates to an apparatus and method for near-simultaneous and integrated delivery of bone graft material during the placement of surgical cages or other medical implants in a patient's spine. The integrated fusion cage and graft delivery device according to various embodiments delivers and disperses biologic material through a fusion cage to a disc space and, without withdrawal from the surgical site, may selectably detach the fusion cage for deposit to the same disc space. The integrated fusion cage and graft delivery device is formed such that a hollow tube and plunger selectively and controllably place bone graft material and a fusion cage in or adjacent to the bone graft receiving area.

Abstract: A manual device, in particular for dental use, for dispensing a pasty filler, may reduce the viscosity of the filler by the introduction of vibrational energy. The device may include a device housing, a detachable container for the pasty filler that includes an outlet nozzle at a front end thereof, a vibration generator with an oscillating body, and pressure generating means for exerting pressure on the pasty filler, wherein the oscillating body is detachably connected to the container in a middle region thereof.

Abstract: A bone grafting delivery device, method and kit is provided. The bone grafting material delivery device may include a needle having a cutting edge located at a distal end of the needle. The needle may be configured to be inserted within a bone via an entry point created through the skin of a patient. Additionally, the bone grafting material delivery device may include a plurality of dilators attachable sequentially to the needle using a swivel assembly. The plurality of dilators may be configured to articulate relative to needle in a plurality of directions via the swivel assembly. Furthermore, a final dilator of the plurality of dilators may include an opening at a distal end of the final dilator for depositing bone grafting material onto the bone or in a void.

Abstract: Described herein are applicators for delivery of a viscous material to a bone surface and methods of use. The applicator includes an elongate handle portion and a tip coupled to a distal location of the handle portion and formed of an elastomeric material configured to conform to the bone surface. The tip includes a bend a distance away from the distal location, a contact surface distal to the bend and including one or more surface features configured to adhere to the viscous material, and a front end having a conic curvature. The bend is between about 20 degrees to about 40 degrees from a longitudinal axis of the tip.

Abstract: A method of stabilizing a first vertebra and a second vertebra includes implanting a first bone anchor into the first vertebra, implanting a second bone anchor into the second vertebra, connecting a first anchor connection instrument to the first anchor, connecting a second anchor connection instrument the second anchor, positioning a cement delivery tube into a passage provided through the first anchor, delivering bone cement from a bone cement delivery system coupled to the bone cement delivery tube through the passage in the first anchor to the first vertebra, removing the cement delivery tube from the first anchor connection instrument and the first anchor, connecting the cement delivery tube to second anchor connecting instrument connected to the second anchor, delivering bone cement through a passage in the second anchor to the second vertebra, connecting a spinal connection element to the first anchor and the second anchor.

Abstract: A method of stabilizing a first vertebra and a second vertebra includes implanting a first bone anchor into the first vertebra, implanting a second bone anchor into the second vertebra, connecting a first anchor connection instrument to the first anchor, connecting a second anchor connection instrument the second anchor, positioning a cement delivery tube into a passage provided through the first anchor, delivering bone cement from a bone cement delivery system coupled to the bone cement delivery tube through the passage in the first anchor to the first vertebra, removing the cement delivery tube from the first anchor connection instrument and the first anchor, connecting the cement delivery tube to second anchor connecting instrument connected to the second anchor, delivering bone cement through a passage in the second anchor to the second vertebra, connecting a spinal connection element to the first anchor and the second anchor.