阅读说明：本技术 脊柱植入物系统和方法 (Spinal implant system and method ) 是由 C·伊塔利艾 M·R·格里扎德 M·T·马拉波德 于 2019-10-17 设计创作，主要内容包括：一种植入物支撑盖包括限定空腔和至少一个纵向通道的壁。所述壁包含可与植入物支撑构件接合的引导件,以使用所述至少一个通道定向所述植入物支撑构件,使得所述植入物支撑构件可与所述壁连接。公开了系统、手术器械、脊柱构造、植入物和方法。(An implant support cap includes walls defining a cavity and at least one longitudinal channel. The wall includes a guide engageable with an implant support member to orient the implant support member using the at least one channel so that the implant support member can be connected with the wall. Systems, surgical instruments, spinal constructs, implants, and methods are disclosed.)

1. An implant support cap, comprising:

a wall defining a cavity and at least one longitudinal channel,

the wall includes a guide engageable with an implant support member to orient the implant support member using the at least one channel such that the implant support member is connectable with the wall.

2. The implant support cap of claim 1, wherein said guide comprises a distal surface of said wall, said distal surface in communication with said at least one channel.

3. The implant support cap of claim 2, wherein said distal surface is arranged in a transverse orientation with respect to said at least one channel.

4. The implant support cap of claim 1, wherein the at least one channel includes a first longitudinal channel and a second longitudinal channel, the guide including a first opening in communication with the first channel and a second opening in communication with the second channel.

5. The implant support cap of claim 4, wherein the first opening is disposed in a transverse orientation with respect to the first channel and the second opening is disposed in a transverse orientation with respect to the second channel.

6. The implant support cap of claim 1, wherein the at least one channel includes a first longitudinal channel and a second longitudinal channel, the guide including an extension of the wall having a first slot arranged coaxially with the first channel and a second slot arranged coaxially with the second channel.

7. The implant support cap of claim 1, wherein the at least one channel comprises first and second longitudinal channels, the wall comprising a mating groove defining the channel and engageable with spaced apart extender tabs of the implant support member.

8. The implant support cap of claim 7, wherein the mating recess defines a pocket surface engageable with a proximal spring tip of the implant support member.

9. The implant support cap of claim 1, wherein the wall and the implant support member are engageable in a snap-fit assembly.

10. The implant support cap of claim 1, wherein the wall includes a lock engageable with the implant support member.

11. The implant support cap of claim 10, wherein the lock is releasably engaged with the implant support member.

12. The implant support cap of claim 1, wherein the wall includes a flange oriented to abut the implant support member.

13. The implant support cap of claim 1, wherein said wall includes at least one corner.

14. The implant support cap of claim 1, wherein said at least one channel includes a first axial slot and a second axial slot arranged in a relatively parallel orientation.

15. The implant support cap of claim 14, wherein the wall includes a plurality of longitudinal rails defining the slot.

16. An implant support cap, comprising:

a wall defining a cavity and containing a mating recess defining a first longitudinal channel and a second longitudinal channel,

the wall includes an angled distal surface engageable with an implant support member including spaced-apart extender tabs, the distal surface including a first opening in communication with the first channel and a second opening in communication with the second channel to orient the tabs using the channels so that the implant support member can be connected with the wall.

17. The implant support cap of claim 16, wherein the wall includes an extension having a first slot arranged coaxially with the first channel and a second slot arranged coaxially with the second channel.

18. The implant support cap of claim 16, wherein said wall and said tabs are engageable in a snap-fit assembly.

19. The implant support cap of claim 16, wherein said wall includes a lock releasably engageable with said tab.

20. A spinal implant system, comprising:

an implant support cap defining a cavity and including a mating recess defining a first longitudinal channel and a second longitudinal channel, the cap including an angled distal surface having a first opening in communication with the first channel and a second opening in communication with the second channel;

an implant support member including spaced-apart extender tabs engageable with the distal surface in a configuration that guides the tabs into channels such that the implant support member is connectable with the cap; and

an implant receiver connected to the tab.

Technical Field

The present disclosure relates generally to medical devices for treating musculoskeletal disorders, and more particularly to spinal implant systems and methods for treating the spine.

Background

Spinal pathologies and disorders such as kyphosis, scoliosis and other curvature abnormalities, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, tumors, and fractures can be caused by factors including trauma, disease, and degenerative conditions resulting from injury and aging. Spinal disorders often result in symptoms that include deformity, pain, nerve damage, and partial or complete loss of mobility.

Non-surgical treatments, such as drug treatment, rehabilitation, and exercise, may be effective, however, may not alleviate the symptoms associated with these conditions. Surgical treatment of these spinal disorders includes correction, fusion, fixation, discectomy, laminectomy, and implantable prosthesis. As part of these surgical treatments, spinal constructs such as vertebral rods are often used to provide stability to the treated area. The rod redirects the stresses away from the damaged or defective area as healing occurs to restore proper alignment and generally support the vertebral members. During surgical treatment, one or more rods and bone fasteners may be delivered to the surgical site. The rod may be attached to the exterior of two or more vertebral members via fasteners. Surgical treatments may use surgical instruments and implants that are manipulated for engagement with vertebrae to position and align one or more vertebrae. The present disclosure describes improvements over these prior art techniques.

Disclosure of Invention

In one embodiment, an implant support cap is provided. The implant support cap includes walls defining a cavity and at least one longitudinal channel. The wall includes a guide engageable with an implant support member to orient the implant support member with the channel so that the implant support member can be connected with the wall. In some embodiments, systems, surgical instruments, spinal constructs, implants, and methods are disclosed.

In one embodiment, the implant support cap includes a wall defining a cavity and including a mating recess. The mating recess defines a first longitudinal channel and a second longitudinal channel. The wall includes an angled distal surface engageable with an implant support member including spaced-apart extender tabs. The distal surface includes a first opening in communication with the first channel and a second opening in communication with the second channel to orient the tab with the channel such that the implant support member can be connected with the wall.

In one embodiment, a spinal implant system is provided. The spinal implant system includes an implant support cap defining a cavity and including a mating recess defining a first longitudinal channel and a second longitudinal channel. The cap includes an angled distal surface having a first opening in communication with the first channel and a second opening in communication with the second channel. The implant support member includes spaced-apart extender tabs engageable with the distal surface in a configuration that guides the tabs into the channels such that the implant support member is connectable with the cap. An implant receiver is connected to the tab.

Drawings

The disclosure will become more apparent from the detailed description set forth below when taken in conjunction with the drawings in which:

FIG. 1 is a side view of components of one embodiment of a surgical system according to the principles of the present disclosure;

FIG. 2 is another side view of the component shown in FIG. 1;

FIG. 3 is an isolated perspective view of the components shown in FIG. 1;

FIG. 4 is a perspective view of a first step of assembling components of one embodiment of a surgical system according to the principles of the present disclosure;

FIG. 5 is a perspective view of a second step of assembling components of one embodiment of a surgical system according to the principles of the present disclosure; and

fig. 6 is a perspective view of a third step of assembling components of one embodiment of a surgical system according to the principles of the present disclosure.

Detailed Description

Exemplary embodiments of the disclosed surgical systems and associated methods of use are discussed in terms of medical devices for treating musculoskeletal disorders, and more particularly, in terms of spinal implant systems and methods for treating the spine. In some embodiments, the systems and methods of the present disclosure include medical devices including surgical instruments and implants for use in surgical treatment of, for example, the cervical, thoracic, lumbar and/or sacral regions, as described herein.

In some embodiments, the present surgical system includes a surgical instrument, such as an extender cap, configured to guide and/or align one or more components of an implant support, implant, and/or spinal construct into engagement for connection and/or assembly of the components. In some embodiments, the surgical instrument includes a guide to align an implant support, e.g., at least one extender tab, with the at least one longitudinal channel for connection with the extender cover. In some embodiments, the guide comprises at least one opening arranged to communicate with the at least one channel to facilitate connection with the implant support. In some embodiments, the guide includes an angled surface configured to facilitate handling of the extender tab with the extender cover.

In some embodiments, the surgical instrument includes a guide engageable with the at least one extender tab to guide and/or align the at least one extender tab into the at least one axial channel, e.g., axial slot. In some embodiments, the slot is configured to arrange the extender tab with the cavity of the extender cover.

In some embodiments, the extender tabs are configured to align an implant, such as a bone fastener, with various instruments and provide an access path for a set screw and rod. In some embodiments, the extender tab may be coupled with a bone fastener.

In some embodiments, the surgical systems of the present disclosure can be used to treat spinal disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumors, and bone fractures. In some embodiments, the surgical systems of the present disclosure may be used with other bone and bone related applications, including those associated with diagnosis and therapy. In some embodiments, the disclosed surgical system may alternatively be used in surgical treatment of patients in prone or supine positions, and/or to reach the spine using various surgical approaches (including anterior, posterior midline, direct lateral, posterolateral, and/or anterolateral approaches), as well as to reach other body regions. The surgical system of the present disclosure may also alternatively be used in conjunction with surgical procedures for treating the lumbar, cervical, thoracic, sacral and pelvic regions of the spine. The surgical systems of the present disclosure may also be used with animals, bone models, and other non-biological substrates, for example, in training, testing, and demonstration.

The surgical system of the present disclosure may be understood more readily by reference to the following detailed description of the embodiments taken in conjunction with the accompanying drawings, which form a part of the disclosure. It is to be understood that this application is not limited to the specific devices, methods, conditions or parameters described and/or illustrated herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting. In some embodiments, as used in the specification, including the appended claims, the singular forms "a," "an," and "the" include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from "about" or "approximately" one particular value, and/or to "about" or "approximately" another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent "about," it will be understood that the particular value forms another embodiment. It should also be understood that all spatial references (e.g., horizontal, vertical, top, upper, lower, bottom, left, and right) are for illustrative purposes only and may be varied within the scope of the present disclosure. For example, references to "upper" and "lower" are relative and only used in context with one another, and not necessarily "upper" and "lower".

As used herein and including the appended claims, "treating" a disease or condition refers to performing a procedure that may include administering one or more drugs to a patient (normal or abnormal human, or other mammal), applying an implantable device, and/or applying a device for treating the disease, such as a minimally invasive discectomy device for removing a herniated or herniated disc portion and/or bony spurs, in an attempt to alleviate the disorder or symptom of the disease or condition. Remission may occur before as well as after the onset of signs or symptoms of the disease or condition. Thus, treatment includes preventing a disease or an adverse condition (e.g., preventing the disease from occurring in a patient who may be predisposed to the disease but has not yet been diagnosed with the disease). Furthermore, treatment does not require complete relief of signs or symptoms, does not require a cure, and specifically involves surgery that has only a marginal effect on the patient. Treatment may comprise inhibiting the disease, e.g. arresting its development, or alleviating the disease, e.g. causing regression. For example, treatment may include reducing acute or chronic inflammation; relief of pain and reduction and induction of regrowth of new ligaments, bone and other tissues; as an aid to surgery; and/or any revision surgery. In some embodiments, the term "tissue" as used in the specification and including the appended claims includes soft tissue, ligaments, tendons, cartilage and/or bone, unless other meanings are explicitly indicated.

The following discussion includes a description of a surgical system (including surgical instruments, related components) and methods of using the surgical system in accordance with the principles of the present disclosure. Alternative embodiments are also disclosed. Reference will now be made in detail to the exemplary embodiments of the present disclosure that are illustrated in the accompanying drawings. Turning to fig. 1-6, components of a surgical system, such as a spinal implant system 10, are illustrated. Embodiments of the system 10 are shown in fig. 4-6. Fig. 1-3 illustrate some components of the system.

The components of the spinal implant system 10 may be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics, and bone materials and/or composites thereof. Example (b)For example, the components of the spinal implant system 10 may be individually or collectively fabricated from, for example: stainless steel alloys, aluminum, commercially pure titanium, titanium alloys, grade 5 titanium, superelastic titanium alloys, cobalt-chromium alloys, superelastic metal alloys (e.g., Nitinol), superelastic metals, such as GUM) Ceramics and composites thereof (e.g., calcium phosphates (e.g., SKELITE)^TM) Thermoplastics (e.g., Polyaryletherketones (PAEKs) including Polyetheretherketones (PEEK), Polyetherketoneketones (PEKK), and Polyetherketones (PEK), carbon-PEEK composites, PEEK-BaSO₄Polymeric rubber, polyethylene terephthalate (PET)), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubber, polyolefin rubber, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers, elastomer composites, rigid polymers (including polyphenylenes, polyamides, polyimides, polyetherimides, polyethylenes, epoxies), bone materials (including autografts, allografts, xenografts, or transgenic cortical and/or cortical spongiosa bone and tissue growth or differentiation factors), partially resorbable materials (e.g., composites of metals and calcium-based ceramics, PEEK and resorbable polymers), fully resorbable materials (e.g., calcium-based ceramics, such as calcium phosphate, calcium oxide, or combinations thereof, calcium oxide, and combinations thereof, Tricalcium phosphate (TCP), Hydroxyapatite (HA) -TCP, calcium sulfate, or other absorbable polymers, such as polylactide, polyglycolide, polytyrosine carbonate, polycaprolactone), and combinations thereof.

The various components of the spinal implant system 10 can be provided with composite materials, including the materials described above, to achieve various desired characteristics, such as strength, rigidity, flexibility, compliance, biomechanical properties, durability and radiolucency or imaging preference. The components of the spinal implant system 10 may also be fabricated, individually or collectively, from heterogeneous materials, such as from a combination of two or more of the foregoing materials. The components of the spinal implant system 10 may be integrally formed, integrally connected, or incorporate fastening elements and/or instruments as described herein.

Spinal implant system 10, for example, is used for fully open surgical procedures, minimally invasive surgical procedures including percutaneous techniques, and micro-open surgical techniques for delivering and introducing instruments and/or spinal implants (e.g., bone fasteners) at a surgical site (including, for example, the spine) of a patient. In some embodiments, spinal implants may comprise one or more components of one or more spinal constructs (e.g., intervertebral devices, intervertebral cages, bone fasteners, spinal rods, tethers, connectors, plates, and/or bone grafts), and may be used with various surgical procedures, including surgical treatment of the cervical, thoracic, lumbar, and/or sacral regions of the spine.

The spinal implant system 10 includes an implant support cap, such as an extender cap 12. The cap 12 is configured to guide and/or align implant support members, such as extender tabs 152, 152a, into engagement with the cap 12 for connection and/or assembly of components of an extender connected with the bone fastener assembly 150. In some embodiments, the cover 12 includes guides 40 configured to facilitate connection of the extender tabs 152, 152a with the cover 12.

The cover 12 extends between an end 14 and an end 16 defining an axis X1. The lid 12 includes a wall 24. Wall 24 includes portions 24a, 24b, 24c, and 24 d. Wall 24 includes an inner surface 26 that extends along portions 24a, 24b, 24c, and 24 d. The surface 26 defines a cavity 28 configured for seating the extender tab 152, 152 a. The cavity 28 comprises a generally rectangular configuration. In some embodiments, the cavity 28 has various configurations, including, for example, circular, oval, polygonal, irregular, uniform, variable, uniform, and non-uniform.

The portions 24a, 24b, 24c and 24d meet at a corner 30, respectively, along the inner surface of the wall 24. In some embodiments, the inner surfaces of portions 24a, 24b, 24c, and 24d include curved, rounded, or partially rounded or partially curved surfaces that form corners 30, as shown by example in fig. 3. In some embodiments, the corners 30 may have various configurations, including irregular, uniform, variable, uniform, and non-uniform, for example. The corner 30 extends axially along the wall 24. In some embodiments, the corners 30 extend along the wall 24 in alternative orientations, such as transverse, perpendicular, and/or other angular orientations, such as acute or obtuse, and/or may be offset or staggered relative to the axis X1.

As shown in fig. 3, the projection 34 is arranged with portions 24b, 24 d. The tab 34 is configured to abut the extender tab 152, 152a to retain the extender tab 152, 152a within the cavity 28. For example, when the extender tabs 152, 152a are translated into engagement with the cover 12, the tabs 34 impede and/or prevent the extender tabs 152, 152a from passing through the cavity 28 during insertion.

As described herein, the portion 24a includes a surface 41 that can be connected with a portion of the extender tab 152, 152a, such as the spring tip 178 or the spring tip 176. As shown in FIG. 1, surface 41 defines at least one recess, such as pocket 42. Portion 24a includes a pair of pockets 42. As described herein, the pocket 42 is configured for mating engagement with the spring tip 178. As described herein, surface 41 is configured as a lock 44 to inhibit and/or prevent disengagement of spring tip 178 from pocket 42.

As described herein, the portion 24c includes a surface 50 similar to the surface 41 that may be connected with a portion of the extender tab 152, 152a, such as the spring tip 178 or the spring tip 176. As shown in FIG. 2, surface 50 defines at least one recess, such as pocket 52. As shown in fig. 2, portion 24c includes a pair of pockets 52. As described herein, the pocket 52 is configured for mating engagement with the spring tip 176. Pocket 52 is aligned with pocket 42, as shown in FIG. 1, to facilitate engagement of spring tip 176. As described herein, the surface 50 is configured as a lock 54 to inhibit and/or prevent the spring tip 176 from disengaging from the pocket 52.

As shown in fig. 6, the pockets 42, 52 are configured to engage with the spring tips 176, 178. The arrangement of the spring tips 176, 178 with the pockets 42, 52 is configured to resist and/or prevent the extender tabs 152, 152a from disengaging from the lid 12. In some embodiments, the pockets 42, 52 are arranged parallel to the axis X1. In some embodiments, pockets 42, 52 are arranged in alternating orientations with respect to axis a, e.g., arranged in a transverse, perpendicular, and/or other angular orientation, e.g., acute or obtuse, and/or may be offset or staggered. In some embodiments, the locks 44, 54 are configured to provide an audible and/or tactile indication, such as an audible click indicating engagement of the spring tips 176, 178 with the lid 12.

Wall 24 includes longitudinal rails 60a, 60b, 60c, and 60d extending along axis X1. The track 60a includes a surface 64. Track 60b includes a surface 66. The surfaces 64, 66 define a channel, for example, an axial groove 68. The slot 68 extends along an axis X1. As described herein, the slot 68 is configured to facilitate engagement of the extender tab 152 with the lid 12. In some embodiments, all or only a portion of the surfaces 64, 66 may have alternative configurations, such as irregular, uniform, non-uniform, offset, staggered, tapered, arcuate, or wavy. The surfaces 64, 66 index and/or guide the insertion of the extender tab 152 into the cavity 28.

Track 60c includes a surface 70. Track 60d includes a surface 72. The surfaces 70, 72 define a channel, for example, an axial groove 74. The slot 74 extends along an axis X1. As described herein, the slot 74 is configured to facilitate engagement of the extender tab 152a with the lid 12. In some embodiments, all or only a portion of the surfaces 70, 72 may have alternative configurations, such as irregular, uniform, non-uniform, offset, staggered, tapered, arcuate, or wavy. The surfaces 70, 72 direct and/or guide the insertion of the extender tab 152a into the cavity 28.

As described herein, the extender tabs 152, 152a are configured to slide and/or translate along the slots 68, 74 to position the extender tabs 152, 152a within the cavity 28 and into locking engagement with the lid 12. The slots 68, 74 are configured to open the extender tabs 152, 152a to facilitate engagement of the spring tips 176, 178 with the pockets 42, 52.

The guide 40 is configured to guide and/or direct the extender tab 152, 152a into the cavity 28. As shown in fig. 2, guide 40 includes a distal surface 80 of wall 24 and an extension 82 extending from portion 24 c. Surface 80 includes an opening 84 disposed in communication with slot 68. Surface 80 includes an opening 86 disposed in communication with slot 74. The surface 80 is configured to guide and/or index the extender tab 152, 152a into the slot 68, 74.

As shown in fig. 2 and 3, surface 80 is disposed at an angle relative to axis X1 such that surface 80 is disposed in a transverse orientation relative to grooves 68, 74 to define ramp 81. The ramp 81 is selectively sloped to facilitate translation and/or guiding of the extender tabs 152, 152a into the slots 92, 94 and/or the slots 68, 74. In some embodiments, the surfaces 80 are arranged in alternative orientations with respect to the axis X1, such as transverse, perpendicular, and/or other angular orientations, such as acute or obtuse angles, and/or may be offset or staggered. In some embodiments, the surface 80 is selectively sloped to facilitate translation and/or disengagement of the extender tabs 152, 152a from the lid 12.

The extension 82 includes a slot 92 and a slot 94. As shown in fig. 1, the slot 90 is arranged coaxially with the slot 68. The groove 92 is arranged coaxially with the groove 74. The extender tabs 152, 152a are guided, oriented and/or aligned by sliding translation along the slots 90, 92 into the slots 68, 74. This configuration facilitates alignment of the extender tabs 152, 152a for assembly with the lid 12.

Bone fastener assembly 150 includes bone fastener 100. Bone fastener 100 includes a receiver 102. The receiver 102 is connected to extender tabs 152, 152a extending along axis X1. The receiver 102 includes a pair of spaced apart arms 104, 106 defining an implant cavity configured for placement of a component of a spinal construct, such as a spinal rod (not shown). The receiver 102 includes a socket configured for engagement with a surgical instrument. The receiver 102 includes an inner surface having a thread form located adjacent to the arm 104 and a thread form located adjacent to the arm 106. The threaded form of the arms 104, 106 is configured for engagement with a coupling member. The bone fastener 100 includes a threaded shaft 116. The shaft 116 is configured to penetrate tissue, e.g., bone.

The arm 104 includes a breakaway tab 120 frangibly connected to the arm 104 such that manipulation of the tab 120 relative to the arm 104 can break the tab 120 and separate the tab from the arm 104 at a predetermined force and/or torque limit, as described herein. The arm 106 includes a breakaway tab 130 frangibly connected to the arm 106 such that manipulation of the tab 130 relative to the arm 106 can break the tab 130 and separate the tab from the arm 106 at a predetermined force and/or torque limit, as described herein. In some embodiments, for example, the predetermined torque and force limits are approached as force and/or torque is applied to the tabs 120, 130 and the resistive force increases.

In some embodiments, the tabs 120, 130 can break and separate at a predetermined force or torque limit, which can range from about 2 newton meters (N-m) to about 8N-m. In some embodiments, the tabs 120, 130 and arms 104, 106 may have the same or alternative cross-sectional configurations, may be made of a homogenous material or heterogeneously made of different materials, and/or alternatively formed of a material having a greater degree of plastic deformability, frangible characteristics, and/or fracture properties, characteristics, or attributes to facilitate fracture and separation of the tabs 120, 130.

Bone fastener assembly 150 includes extender tabs 152, 152a that are connected to bone fastener 100. The extender tabs 152, 152a extend between the proximal end 172 and the distal end 174. As shown in fig. 4, the proximal end 172 includes spring tips 176, 178. As described herein, the spring tips 176, 178 may be interchangeably attached with the pockets 42, 52 of the cap 12 to resist and/or prevent the spring tips 176, 178 from disengaging. Distal end 174 is configured for slidably seating a portion of bone fastener 100, e.g., tabs 120, 130. In some embodiments, the tabs 120, 130 are configured to releasably secure the extender tabs 152, 152a with the bone fastener 100.

In assembly, operation and use, the spinal implant system 10 similar to the systems and methods described herein is used in conjunction with a surgical procedure, such as the treatment of an affected section of the spinal column and adjacent areas within the body of an applicable condition or injury. In some embodiments, one or all of the components of the spinal implant system 10 can be delivered or used as a pre-assembled device or can be assembled in situ. The spinal implant system 10 may be fully or partially modified, removed, or replaced.

In use, to treat a vertebra (not shown), a practitioner accesses the surgical site in any suitable manner, such as by incision and retraction of tissue. In some embodiments, the spinal implant system 10 may be used with any existing surgical method or technique, including open surgery, mini-open surgery, minimally invasive surgery, and percutaneous surgical implantation, whereby the vertebrae are accessed through a small incision or sleeve that provides a protected channel to the area. Once the surgical site is accessed, a specific surgical procedure may be performed to treat the spinal disorder.

An incision is made in the patient and a cutting instrument (not shown) forms a surgical pathway for implanting the components of the spinal implant system 10. Preparation instruments (not shown) may be used to prepare the tissue surfaces of the vertebrae and for aspiration and irrigation of the surgical field.

A guide hole (not shown) is made in the selected level of the vertebra for receiving shaft 116 of bone fastener assembly 150. A surgical instrument, such as a driver, is coupled to bone fastener 100 and bone fastener 100 is engaged with the vertebra. Extender tabs 152, 152a are connected to bone fastener 100 as described herein.

As shown in fig. 4, the extender tabs 152, 152a are positioned adjacent the lid 12. The extender tabs 152, 152a are aligned with the guide 40 such that the ramp 81 guides the extender tabs 152, 152a into the slots 92, 94 of the extension 82. The extender tabs 152, 152a slide and/or translate along the slots 92, 94. The slots 92, 94 guide and/or align the extender tabs 152, 152a into the slots 68, 74 through the openings 84, 86.

In some embodiments, the extender tabs 152, 152a are positioned with the slots 92, 94 of the extension 82 such that the extender tabs 152, 152a slide and/or translate along the slots 92, 94. The slots 92, 94 guide and/or align the extender tabs 152, 152a through the openings 84, 86 for placement into the slots 68, 74. The ramp 81 helps guide and/or align the extender tabs 152, 152a into the slots 92, 94 of the extension 82.

As shown in fig. 6, surfaces 64, 66 of slot 68 and surfaces 70, 72 of slot 74 are configured to spread the extender tabs 152, 152a apart for disposal with the pockets 42, 52. In some embodiments, the spring tips 176, 178 engage the surfaces 44, 54 and an audible and/or tactile indication, such as a click indicating engagement of the spring tips 176, 178 with the cap 12. During insertion of the extender tabs 152, 152a, the tabs 34 resist and/or prevent the cover 12 from disengaging from the cavity 28.

In some embodiments, the surgical procedure includes delivering a spinal rod along a surgical path for connection with one or more bone fasteners 100. A reduction instrument (not shown) engages the spinal rod for reducing and securing the spinal rod with the receiver 102. In some embodiments, the tab disruptor is engaged with the extender tab 152, 152a and manipulated to apply a force to the extender tab 152, 152a and/or the tab 120, 130. As the applied force reaches a selected torque limit, the tab disruptor separates the extender tabs 152, 152a and/or tabs 120, 130 from the bone fastener 100.

At the completion of the procedure, the surgical instruments, components, and non-implanted components of the spinal implant system 10 are removed, and one or more incisions are closed, as described herein. One or more of the components of the spinal implant system 10 may be made of a radiolucent material such as a polymer. Radioactive labels may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. In some embodiments, the spinal implant system 10 may include one or more of spinal rods, plates, connectors, and/or bone fasteners for a single vertebral level or multiple vertebral levels.

In some embodiments, one or more bone fasteners can be engaged with tissue in various orientations (e.g., in tandem, parallel, offset, staggered, and/or alternate vertebral levels), as described herein. In some embodiments, the bone fastener may comprise a polyaxial screw, sagittal adjustment screw, pedicle screw, monoaxial screw, uniplanar screw, facet screw, fixation screw, tissue penetrating screw, conventional screw, expansion screw, wedge, anchor, button, clamp, snap, friction fitting, compression fitting, expansion rivet, staple, nail, adhesive, post, fixation plate, and/or post.

In one embodiment, the spinal implant system 10 includes an agent that can be disposed, packaged, coated, or layered within, on, or about a component and/or surface of the spinal implant system 10. In some embodiments, the agent may comprise a bone growth promoting material, such as a bone graft, to enhance fixation of the components and/or surfaces of the spinal implant system 10 to the vertebrae. In some embodiments, the agent may comprise one or more therapeutic and/or pharmacological agents for release, including sustained release, to treat, for example, pain, inflammation, and degeneration.

It should be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplifications of the various embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.