Tensioner instruments, systems, and methods of tensioning flexible bands in-situ. The tensioner instrument may include first and second pivoting arms with a base for pinching and pulling the flexible band to provide tension. The tensioner instrument system may include a clip inserter and a ratcheting tensioner for tensioning the band through an implant. The instruments may be configured to apply and maintain tension to the flexible band, thereby providing the desired correction to the spine.

A bone anchoring device includes a receiving part including a rod receiving portion with a first end, a second end, and a U-shaped recess for receiving a rod, the recess defining two free legs, and a head receiving portion at the second end for introducing and clamping the head, and a locking ring configured to be arranged around the head receiving portion, the locking ring including an engagement structure for engagement with a tool, the engagement structure defining a width of the locking ring that is greater than a greatest width of the rod receiving portion, wherein the locking ring can assume a locking position exerting a greatest compressive force on the head receiving portion of the receiving part to lock an inserted head, and wherein the locking ring is movable out of the locking position towards the first end of the rod receiving portion.

A surgical instrument enables dispensing of a series of fasteners within a patient's body. The device includes a magazine sized and dimensioned to hold a series of fasteners, the series of fasteners insertable through an opening at the end of the magazine. A splined guide bore is rotatably supported within the magazine, and slidingly supports a shaft having an external surface mateable with the splined guide bore to restrict radial rotation of the shaft with respect to the support about said longitudinal axis. A biasing element is connected between the support and the shaft, to urge the shaft along a longitudinal axis towards a distal end of the instrument. A ratchet is connected to the shaft and engages the magazine to permit sliding of the shaft in a direction for dispensing fasteners only, unless disengaged with the magazine.

A method comprises the steps of: fixing a distal end of a first member of a surgical instrument with tissue, the surgical instrument including a second member having a longitudinal passageway configured for disposal of the first member and being connected with a navigation component such that the distal end is disposable with the passageway at a selected distance from the navigation component, the navigation component being positioned relative to a sensor to communicate a signal representative of an orientation of the first member; removing the second member from the first member; and connecting a third member with the first member along the orientation such that a distal end of the third member is fixed with the tissue. Systems, spinal implants, constructs and instruments are disclosed.

A bone anchoring device includes a receiving part including a rod receiving portion with a first end, a second end, and a U-shaped recess for receiving a rod, the recess defining two free legs, and a head receiving portion at the second end for introducing and clamping the head, and a locking ring configured to be arranged around the head receiving portion, the locking ring including an engagement structure for engagement with a tool, the engagement structure defining a width of the locking ring that is greater than a greatest width of the rod receiving portion, wherein the locking ring can assume a locking position exerting a greatest compressive force on the head receiving portion of the receiving part to lock an inserted head, and wherein the locking ring is movable out of the locking position towards the first end of the rod receiving portion.

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.

A clamp assembly for orthopedic use having a housing that includes a top surface, a recess, a distal base and a bottom surface, the recess defining a longitudinal axis and extending through the housing from the top surface through the distal base and toward the bottom surface, and at least two through slots, each one of being disposed at a bottom or a side a surface of the housing. The assembly including a securement assembly positionable within the recess in a co-axial relationship to a mating surface on the recess, and a band sized for travel along a predetermined path defined in part by the through slots in the housing, wherein at least one of the through slots is a starting point for travel of the band along the predetermined path.

A bone anchoring device includes a receiving part with a head receiving portion defining a seat for pivotably receiving a head of a bone anchor, and a rod receiving portion defining a recess for receiving a rod, the recess forming two legs each having an engagement surface for engaging a locking device to lock the rod in the recess, and an expansion limiting member having a surface configured to engage a portion of the receiving part spaced apart from the engagement surfaces of the legs. When the legs are urged radially outwardly, the head receiving portion is urged radially inwardly to compress and lock the head. The expansion limiting member is adjustable from a first configuration relative to the receiving part where the head receiving portion is expandable to permit the insertion of the head, to a second configuration where expansion of the head receiving portion is restricted.

The present disclosure describes a device and methods for safely and accurately placing screws into bones with a powered driving device. By employing multiple layers of fail-safe features and image-guidance systems, the powered driving device provides safe, accurate, and efficient screw placement. That is, the powered driving device may continuously monitor a screw advancement and placement and may automatically shutdown when improper placement is detected. Monitoring placement may be conducted by a microcurrent-monitoring system, by an image-guidance system, or by any other appropriate sensory system. Additionally, upon detecting that screw insertion is complete, the powered driving device may be automatically shutdown. As screw placement is continuously simulated by image-guidance in real time, multiple redundant verification steps are eliminated, providing highly accurate screw placement while decreasing clinician error, device contamination, and surgical time, the decreased surgical time associated with decreased patient-recovery time and associated medical costs.

A surgical instrument comprises a first member including a lateral projection having a locking surface that defines an elongated cavity. The locking surface is engageable with a longitudinal member to fix the longitudinal member with the first member. A second member includes at least one mating element being engageable with a spinal construct. The first member is axially translatable relative to the second member in a first direction to tension the longitudinal member and in a second direction to release tension from the longitudinal member. Systems and methods are disclosed.