Abstract: An instrument for breaking off and retaining the tab of a reduction screw is provided. The instrument includes a breaking arm and a retaining mechanism. The breaking arm is configured to break off an excess portion of the tab of the reduction screw about a weakened section. The retaining mechanism is configured to retain the broken off tab and preventing the tab from falling into a surgical site. The retaining mechanism is further configured to allow the instrument to engage another tab while simultaneously holding a predetermined number of previously broken off tabs. Accordingly, the instrument reduces surgical time as the surgeon may simply move from one reduction screw to another while breaking off the tabs until the instrument can no longer retain additional broken off tabs.

Abstract: An instrument system, associated milling or drilling guide and method include use of a trial implant of a size corresponding to an actual implant for the intervertebral space, with a milling guide mounted on the trial implant. The system also includes a cutting tool which is used to form a cutout in an adjacent vertebra.

Abstract: A method for reducing a fixation rod is provided. The method minimizes the surgical corridor by performing fixation within the surgical corridor defined by the screw extender. The screw extender is attached to the spinal implant. The method includes the steps of coupling the proximal end of a first cannulated body with the screw extender and rotating a second cannulated body within the first cannulated body. The method proceeds to the step of actuating a rod pusher with a first driving feature so as to engage the rod pusher with the fixation rod. The rod pusher includes a bore. The method proceeds to the step of rotating an inserter shaft within first cannulated body, second cannulated body and bore of the rod pusher, the inserter shaft including a proximal end with a second driving feature and a distal end with a setscrew attachment feature.

Abstract: A rod reducer including a housing defining an opening, a body member defining an opening and a slot, a shaft disposed through the opening of the housing and coupled to the opening of the body member, an anvil including a linkage extending therefrom, the linkage coupled to the body member and the anvil, a plurality of arm members, and a biasing element disposed between the body member and the anvil. A pin of the linkage is slidably disposed within the slot, and the biasing element is configured to bias the anvil distally with respect to the body member. Rotation of the shaft translates into linear movement, relative to the housing, of the shaft, the body member, and the anvil. The arm members are coupled to the housing and movable towards a parallel configuration as the anvil is advanced away from the housing to engage a bone screw.

Abstract: An orthopedic prosthesis for use in a hip replacement surgery. The orthopedic prosthesis includes an elongated stem component that has a proximal body, a neck extending superiorly and medially from the proximal body and a tapered stem extending inferiorly from the proximal body. An anchor is positioned on the neck and is configured to be engaged by a surgical instrument. A system for use in assembling the orthopedic prosthesis and a method of assembly are also disclosed.

Abstract: An intervertebral spacer inserter includes a sleeve having a longitudinal axis, a hollow sleeve bore extending through the sleeve along the longitudinal axis, a sleeve tip end and an opening of a passage disposed in the sleeve tip end. The passage extends into the sleeve to the sleeve shaft along a passage axis that intersects the longitudinal axis at an angle less than about 90°. A sliding tip with an elongated slot is in contact with the sleeve tip end and is moveable with respect to the sleeve tip end between a first position with the opening accessible through the elongated slot and disposed adjacent a first end of the elongated slot and a second position with the opening accessible through the elongated slot and disposed adjacent a second end of the elongated slot opposite the first end.

Abstract: A hip joint apparatus is described. The apparatus has an acetabular cup designed for both seated engagement within a patient's acetabulum, and articulatory reception of a matingly shaped femoral component, wherein the dome of the acetabular cup has holes configured for accepting wires and variable angle locking screws to facilitate attachment of the acetabular cup to the acetabulum, and wherein the rim of the acetabular cup has holes configured for accepting wires to provide provisional stability to the acetabular cup. The apparatus also has an insertion handle with a graspable portion and a mating portion, the mating portion attached to the graspable portion and configured for engaging with the rim of the acetabular cup, thereby coupling the insertion handle to the acetabular cup.

Abstract: An orthopedic device for implanting between adjacent vertebrae comprising: an arcuate balloon and a hardenable material within said balloon. In some embodiments, the balloon has a footprint that substantially corresponds to a perimeter of a vertebral endplate. An inflatable device is inserted through a cannula into an intervertebral space and oriented so that, upon expansion, a natural angle between vertebrae will be at least partially restored. At least one component selected from the group consisting of a load-bearing component and an osteobiologic component is directed into the inflatable device through a fluid communication means.

Abstract: A system for reducing deformities of the vertebrae in the spine includes a first reduction assembly, a second reduction assembly, and a reduction drive assembly. The first reduction assembly is configured for attachment to a first reduction tower that attaches to a first vertebra. The second reduction assembly is configured for attachment to a second reduction tower that attaches to a second vertebra. The reduction drive assembly includes an arcuate rack gear operably coupling the first reduction assembly to the second reduction assembly to translate the first reduction assembly relative to the second reduction assembly along an arcuate path in a first plane.

Abstract: A device for guiding a surgical instrument having one end for coupling to the head of a bone anchor element and a longitudinal channel, the head of the bone anchor element having a tapped longitudinal recess intended for receiving a screw cap, said longitudinal recess leading into a transverse channel capable of receiving a link rod, characterized in that said guiding device includes a rod for guiding the surgical instrument, with a longitudinal axis A, having one end comprising two semi-tubular tabs in which the outer section matches the inner section of said longitudinal recess and in which the inner section is at least equal to the diameter of the link rod, the cross-section of the guiding device being always smaller than the section of the longitudinal channel of the surgical instrument in order to allow the insertion and the removal of said device in the distal direction.

Abstract: An artificial replacement disc includes a pair of substantially parallel plates formed to occupy a space defined by vertebral endplates, each of the plates including a plurality of spikes on a first surface and a concave trough formed on a second surface opposite of the first surface. A mobile core includes a core rim with opposing convex surfaces extending from opposite sides of the core rim, the mobile core being capable of being disposed between the pair of plates to permit the vertebral endplates to move relative to one another. The spikes on each of the plates extend substantially away from the mobile core and the convex surfaces are formed to integrally fit within the concave trough of at least one of the plates. The core rim limits lateral movement of the mobile core relative to the parallel plates. One or more insertion tools for inserting and implanting the replacement disc are also described.

Abstract: A surgical instrument for use in an orthopaedic arthroplasty procedure includes a shaft having a first end and a second end and an impactor head disposed at the second end of the shaft. The impactor head includes first and second spaced ends, two spaced impaction surfaces disposed at the second end, and a cavity disposed between the impaction surfaces. The cavity is adapted to accommodate posterior-stabilizing spines of at least a first tibial implant component and a second tibial implant component having a size different than a size of the first tibial implant component. Each of the impaction surfaces includes a first section with a contour that conforms to a contour of a bearing surface of the first tibial implant component and a second section with a contour that conforms to a contour of a bearing surface of the second tibial implant component.

Abstract: An intervertebral implant assembly includes and inserter tool and an implant having a U-shaped body shaped and dimensioned to be placed between two adjacent vertebras. The U-shaped body comprises a rounded front end, an open back end, first and second elongated components extending from the rounded front end, forming the U-shaped body and ending at the open back end and at least one rigid strut extending from and connecting opposite inner side surfaces of the first and second elongated components. A first through-opening is formed in the space between the front end, the rigid strut and the opposite inner side surfaces of the front portions of the first and second elongated components and a second through-opening is formed in the space between the open back end, the rigid strut and the opposite inner side surfaces of the back portions of the first and second elongated components. The inserter tool comprises a shaft, a middle sleeve and an outer sleeve that work together to attach and lock to the implant.

Abstract: An intervertebral insert member and an instrument for positioning the insert in a space between vertebral bodies in vivo. The insert member is advanced by the instrument into a prepared site located between adjacent vertebral bodies. Upon reaching the appropriate insertion point, the sleeve is retracted and a pivotal motion is imparted to the insert. The insert member is pivotally attached to the distal end of the delivery instrument such that it can be articulated about a pivot point that is located on the insert member until it is properly positioned. The positioning instrument is then released from the insert member and removed from the space between the vertebral bodies. An adjustment screw is available to expand the surfaces of the insert member by displacement of a wedge member within the insert.

Abstract: A surgical blade (180) designed for use with an acetabular cup remover (30). The blade includes a body (182) from which teeth (190) extend distally forward. The body and teeth are disposed around the section of a sphere. On each side of the longitudinal axis of the blade body there is an outer tooth and at least two inner teeth. The teeth are further shaped so that one each side of the longitudinal axis through the blade body there are at least two adjacent inner teeth that have rake surfaces located along axes that, extending from the outer surface of the blade body to the inner surface of the blade body, do not intersect.

Abstract: A composite interbody bone implant device is provided including a body having a non-bone composition, such as a polymer, formed into a shape and including one or more cavities. An osteoinductive material, such as bone allograft tissue, may be retained in the one or more cavities of the body. The body is formable via injection molding and/or machining into a shape and size adapted for implantation at a surgical site. The dimensions of the body include a length, a width and a thickness, and the thickness of the body may be less than at least one of the length and width.

Abstract: A method of treating a facet joint of a patient. The facet joint has a superior facet with a superior articular face and an inferior facet with an inferior articular face. An implant delivery cannula is used to position a superior resurfacing implant and an inferior resurfacing implant between the superior articular face and the inferior articular face.

Abstract: An intervertebral insert member and an instrument for positioning the insert in a space between vertebral bodies in vivo. The insert member is advanced by the instrument into a prepared site located between adjacent vertebral bodies. Upon reaching the appropriate insertion point, the sleeve is retracted and a pivotal motion is imparted to the insert. The insert member is pivotally attached to the distal end of the delivery instrument such that it can be articulated about a pivot point that is located on the insert member until it is properly positioned. The positioning instrument is then released from the insert member and removed from the space between the vertebral bodies. An adjustment screw is available to expand the surfaces of the insert member by displacement of a wedge member within the insert.

Abstract: The present invention provides a surgical impactor that includes an impact head, an impacting portion connected to the impact head and a load-transmitting stem connecting the impacting portion to the impact head. The impact head has an impact surface that can be struck by a tool such as a mallet. The load-transmitting stem includes at least one load-limiting resistor. The load-limiting resistor is configured to lock to the impact head and unlock from the impact head when an overload force is applied to the impact surface of the impact head.

Abstract: A surgical instrument for reducing a rod into a saddle of a fixation member includes a distal end for engaging the saddle and a proximal end. A reducing device is disposed between the distal end and the proximal end. The reducing device is operative to reduce the rod into the saddle. The reducing device defines a throughbore. The throughbore provides access there through by a first drive member to secure a plug to the saddle.

Abstract: An expandable sizer instrument for distracting and spacing opposing vertebral bodies of a spine comprises an elongate hollow shaft defining a longitudinal axis and having opposed distal and proximal ends. An actuator is provided at the proximal end and an expandable distractor is provided at the distal end. An elongate push rod extends within the shaft, a proximal end of the push rod being coupled to the actuator and a distal end being coupled to the expandable distractor. The distractor comprises a lower plate immovably attached to the shaft, and an upper plate coupled to the lower plate by a linkage mechanism fully contained within the perimeter of the distractor and operable to move the upper plate away from the lower plate in an expansion direction substantially parallel to the lower plate. The linkage mechanism comprises two laterally spaced linkage pairs with a middle link disposed therebetween.

Abstract: A method of loading an implant inserter with an implant tab and an intramedullary orthopedic implant includes placing the intramedullary orthopedic implant engaged with the implant tab in an implant tab press tool. The implant tab press tool closes the implant tab, which is then moved to a locked position. The implant press tool opens, and the implant tab coupled with the intramedullary orthopedic implant is removed therefrom. The implant tab coupled with the intramedullary orthopedic implant and the implant inserter are placed in an inserter press tool. The inserter press tool closes the implant inserter, which is then moved to a locked position. The inserter press tool opens, and the implant inserter loaded with the implant tab and the intramedullary orthopedic implant coupled therewith is removed from the inserter press tool.

Abstract: A spinal joint distraction system for treating a facet joint including articular surfaces having a contour is disclosed and may include a delivery device including a generally tubular structure adapted to engage a facet joint, an implant adapted to be delivered through the delivery device and into the facet joint, the implant comprising two members arranged in opposed position, and an implant distractor comprising a generally elongate member adapted to advance between the two members of the implant causing separation of the members and distraction of the facet joint, wherein the implant is adapted to conform to the shape of the implant distractor and/or the articular surfaces of the facet upon being delivered to the facet joint. Several embodiments of a system, several embodiments of an implant, and several methods are disclosed including a method for interbody fusion.

Abstract: An insertion device for deploying an implant includes an elongated main body having a distal locking portion for coupling to the implant and a proximal handle portion. The main body defines a central passage and the distal locking portion has outer ridges and slots to allow the outer ridges to flex radially inward when mounting to the implant. A plunger slides in the central passage for movement between an unlocked position for mounting the implant on the distal locking portion, a locked position for locking the implant on the distal locking portion, and an insertion instrument deployed position for deploying the actuation plunger to move the blades from the stowed position to the deployed position. A spike cap drive rotatably mounts on the main body having a socket end for engaging a drive nut on the implant to, in turn, move the spike cap.

Abstract: This present invention concerns a transforaminal intersomatic cage for an intervertebral fusion graft, and an instrument and method for implanting the cage, an embodiment of the cage having a body in the shape of a circular arc and comprising a lateral concave surface, a lateral convex surface, a straight upper surface, a straight lower surface and an end wall having at least one hole, called the end hole, designed to receive a rod of an instrument for implanting the cage between the vertebrae, wherein: the end hole has an orientation that is more or less tangential to the circular arc described by the body; the extremity opposite the end wall of the body includes a return part extending the body toward the center of the circle on which the circular arc described by the body lies.

Abstract: Instruments, kits, and methods are disclosed for installing an implant spacer through an incision and down a surgical corridor. The instruments also serve to align a drill guide and align and insert a spacer stabilizer for stabilization of adjacent bone portions. The instrument comprises an elongated guide bar body, an inserter face at a distal end of said guide bar body for abutting an instrument attachment portion of a spacer, a connection tip portion for securing a spacer against an inserter face, and a guide portion of said elongated guide bar body for aligning instruments with said spacer and for introducing a stabilizer to secure the spacer in a predetermined position between the bone portions. Included is a retractable graft block for securing graft material within an aperture of said spacer during insertion of the spacer.

Abstract: A prosthesis system comprises plates that can be positioned against vertebrae and a selected resilient core that can be positioned between the plates to allow the plates to articulate. The selected resilient core can be chosen from a plurality of cores in response to patient characteristics, such as age and/or intervertebral mobility, such that the prosthesis implanted in the patient is tailored to the needs of the patient. The plurality of cores may comprise cores with different resiliencies, and one of the cores can be selected such that the upper and lower plates articulate with the desired shock absorbing resiliency and/or maximum angle of inclination when the one selected core is positioned between the plates.

Abstract: An insertion tool for positioning intervertebral spacers into disc spaces. The insertion tool has a proximal end and a distal end, a T-handle secured to the proximal end and a pair of alignment rails extending to the distal end. The insertion tool includes a handle secured to the proximal end of the guide rails, and a shaft that extends through the handle, whereby the shaft has a threaded portion that extends to the T-handle. The insertion tool also includes a blocker that is secured to the distal end of the shaft. The blocker includes stop arms that guide the blocker through the guide rails and toward the distal end of the shaft. The blocker may be provided in a plurality of different sizes corresponding to the sizes of the implants to be inserted into a disc space. A lock is provided for locking the implant to the shaft.

Abstract: A bi-directional mechanically deployed rod mechanism utilizes non-parallel cam surfaces with a unique engagement, entrapment, and release methodology. The instrument utilizes a unique spring loading pivot point and lockout mechanisms to prevent early release of the pivot point and bi-directional cam surfaces.

Abstract: An implanting apparatus and an operating method thereof are provided. An implanting apparatus used for implanting an intervertebral cage into a location between two adjacent vertebral bodies, wherein the implanting apparatus comprises a sleeve and an extension member. The extension member has a rod and a coupling column, wherein the rod is screwed inside the sleeve, the coupling column is connected to one end of the rod and exposed outside the sleeve, and the axial direction of the coupling column is substantially perpendicular to that of the rod. When one end of the coupling column is disposed on an inner arc surface of a connecting portion of the intervertebral cage and the rod is rotated with respect to the sleeve, the distance between the coupling column and the sleeve is decreased so as to clamp the connecting portion of the intervertebral cage between the coupling column and the sleeve.

Abstract: A segmented disc nucleus replacement prosthesis and system for its implantation wherein the segments are made of a compliant, homogeneous material throughout. The prosthesis comprises a plurality of modular segments that mate together in a rail-and-slot arrangement. The rails and slots are configured to interlock and hold together under load despite being formed of compliant materials. In one embodiment, insertion tools and stabilizers are utilized for manipulation of the modular segments, the insertion tools and stabilizers being designed to accommodate for handling the compliant modular segments.

Abstract: Insertion tool assemblies for positioning an implant at a target location in a patient. Insertion tool assemblies that comprise first and second jaw portions configured to engage an implant; a sleeve assembly coupled to the first and second jaw portions; and a handle coupled to the sleeve assembly.

Abstract: An inserter can be used to implant a distractible intervertebral body fusion device into a disc space and expand the device. The inserter includes a shaft frame and a drive shaft assembly for expanding the device and a support shaft assembly for stabilizing the device extending distally from the shaft frame. A drive housing can be operably connected to the shaft frame and extend outwardly from shaft frame distal of a proximal end of the shaft frame. Drive housing can have an internal passage that provides access into the shaft frame to a proximal end of the drive shaft assembly. An actuation tool can be disposed with the drive housing with a distal end extending through the access into the shaft frame to interface with the proximal end of the drive shaft assembly such that activation of the actuation tool rotates the drive shaft assembly to expand the device.

Abstract: A surgical apparatus includes an orientation sensor that detects an actual orientation of a surgical tool. The apparatus also includes a tactile orientation feedback device that selectively provides a tactile orientation feedback signal. Moreover, the apparatus includes a controller that causes the tactile orientation feedback device to provide the tactile orientation feedback signal when the actual orientation of the surgical tool detected by the orientation sensor is substantially equal to a predetermined target orientation of the surgical tool.

Abstract: A modular acetabular cup assembly (10, 100, 200, 300, 350) for use with multiple bearing liners (32, 110, 212, 310, 354) is disclosed. The acetabular cup assembly includes a shell (12) having a tapered inner wall (28) and two circumferential grooves (24, 26). The shell (12) may be used with polyethylene, ceramic, metal, and other types of liners.

Abstract: A surgical instrument handle assembly configured for rigid and releasable connection to orthopedic devices including orthopedic shaping or cutting members such as a broaches, reamers and/or osteotomes adapted to prepare the intramedullary canal of a femur in total hip arthroplasty procedures.

Abstract: An extender comprises an inner member including a wall defining a thread form and at least one extension defining a first axial cavity and a second axial cavity, each cavity including first, second and third portions. An outer member includes an actuator and at least one arm having projections disposable with the portions of the axial cavities. The actuator is rotatable to axially translate the inner member such that the projections are disposable between a first position, a second position and a third position. Methods of use are disclosed.

Abstract: Provided is a surgical instrument having an adjustable distal end that can securely engage an interbody for introduction of the interbody into an intervertebral space, can be adjusted before and during the surgical procedure to vary the angle of the distal end of the device and the angle of introduction of the interbody, and after positioning that interbody at the surgical site, can be easily disengaged and removed.

Abstract: A handling apparatus for automated or robot-supported contact tasks is disclosed. The handling apparatus has the following components: a mechanical interface for releasably or fixedly connecting the handling apparatus to a manipulator; a holder, which is movable in relation to the interface, for holding a tool; at least one static-frictionless adjusting element for positioning the holder in relation to the interface to the manipulator; a sensor device for directly or indirectly measuring the force acting on the at least one adjusting element; and a closed-loop controller which is configured to regulate the contact force depending on a predefinable force profile when there is contact between the handling apparatus and a surface.

Abstract: An apparatus for inserting an implant between vertebrae includes a body having a through bore, a central shaft movable within the through bore, the central shaft having a proximal end and a distal end. The apparatus includes a pair of distractor arms having proximal portions and distal portions, the proximal portions pivotally coupled to the body and distal portions for engagement between the vertebrae. Tracking slots are formed in and extend through surfaces of and along a longitudinal axes of the distractor arms and an attachment tip is operably connected to the central shaft, the attachment tip is configured to grip the implant. The apparatus includes a single guide member projecting outward from the attachment tip and the attachment tip is removably connectable to the central shaft in multiple configurations.

Abstract: An apparatus for use in spinal interbody fusion comprises, in combination, a spinal interbody fusion implant and an inserter releasably attached thereto. The implant comprises a hollow interior through which the inserter extends, the inserter having a tapered distal tip projecting exteriorly beyond the distal end of the implant to initially distract opposing tissue surfaces and to facilitate insertion of the implant into the intradiscal space between the vertebral bodies.

Abstract: Implants, tools and methods for performing unilateral posterior lumbar interbody fusion are provided. An interbody implant includes a body having a top and bottom surface extending along a length thereof; and first and second side surfaces extending between the top and bottom surfaces on opposite sides of the body. The height of the first side surface is greater than the height of the second side surface.

Abstract: A surgical instrument is disclosed that facilitates the implantation of one of a number of differently sized or differently configured hip stem prostheses into a proximal end of a femur while also providing a surgeon with a substantial amount of rotational control over the prosthesis during the implantation. A suitable hip stem prosthesis is selected from a family of hip stem prostheses of varying sizes and dimensions. The surgical instrument attaches to the selected hip stem prosthesis via first and second spaced engagement portions such that the instrument is operable to exert rotational control over the selected hip stem prosthesis. The first engagement portion is an impaction portion configured to engage a corresponding impaction feature on a proximal body portion of the hip stem prosthesis. The second engagement portion is an adjustable clamping portion configured to clampingly receive the neck of the hip stem prosthesis, regardless of the prosthesis size.

Abstract: An intervertebral disc prosthesis designed to be substituted for fibrocartilaginous discs ensures a connection between the vertebra of the vertebra column or the end of the latter. The prosthesis includes a pair of plates spaced from each other by a nucleus. The prosthesis has increased stability by providing the nucleus with a translation or rotation stop, or by inducing an angular correction between its plates contacting vertebra, or a combination of these characteristics. The stop includes parts external to the nucleus and contact surfaces perpendicular to their contact directions. Surgical methods and instrumentation for implanting the prosthesis are also described.

Abstract: A number of orthopaedic surgical instruments are disclosed. A method, apparatus, and system for fabricating such instruments are also disclosed.

Abstract: An end effector assembly for use with an electrosurgical instrument is provided. The end effector assembly has a pair of opposing jaw members. One or more of the jaw members includes a support base, an electrical jaw lead, and a sealing plate coupled to the electrical jaw lead. The sealing plate has a stainless steel layer and one or more piezoelectric sensors. The jaw member also includes an insulative plate disposed between the support base and the sealing plate.

Abstract: Bone anchors and surgical instruments (e.g., bone taps, drivers, etc.) are disclosed herein that include integrated guide tips. Use of these anchors or instruments can eliminate one or more of the steps in a conventional bone anchor installation procedure, improving surgical efficiency and safety. For example, a surgical instrument can include a guide projection configured for insertion through a cannulation formed in a bone anchor when the surgical instrument is coupled to the bone anchor. The surgical instrument can also include various mechanisms for adjusting the position of the guide projection relative to the bone anchor. The guide projection can replace the needle, stylet, and guidewire used in typical insertion procedures. The bone anchor can also include integrated tapping features to eliminate the need for a separate bone tap instrument. Thus, in some embodiments, targeting, tapping, and driving the bone anchor can be performed in a single step.

Abstract: A spinal rod persuader, system and method can include an outer tube, an inner tube, and a locking element. A first actuation mechanism can be movable in a linear fashion along a longitudinal axis direction to cause the locking element to move in a linear fashion over the inner tube and to lock the inner tube onto a pedicle screw. A second actuation mechanism can be rotated to cause the outer tube to move in a longitudinal axis direction with respect to the inner tube to push the spinal rod into a final position with respect to the pedicle screw while the pedicle screw is locked to the inner tube. A slot and/or tab structure can be provided in the outer tube such that actuation of the slot/tab will allow disassembly of the inner tube, outer tube and locking element with respect to each other.

Abstract: A spinal fixation element fixation reduction system is provided herein. In general, the system can include a cap element with a bore having a central axis extending therethrough wherein the cap element is configured to releasably engage any type of surgical device (e.g., an access sleeve, a vertebral body rotator, etc.). Further, the system can include a driver configured to be slidably and removably positioned through the cap element. The system can also include an actuator configured to apply a force to the driver substantially along the central axis of the cap element thereby moving the driver in a distal direction so as to effect reduction of a spinal fixation element into a bone anchor. Additionally, a method of reducing a spinal fixation element into a bone anchor is also provided wherein the method can be performed as a minimally invasive surgical procedure or as an open procedure.

Abstract: An instrument system, associated milling or drilling guide and method include use of a trial implant of a size corresponding to an actual implant for the intervertebral space, with a milling guide mounted on the trial implant. The system also includes a cutting tool which is used to form a cutout in an adjacent vertebra.