Reamer instruments and related methods are disclosed herein, e.g., for reaming bone to facilitate in situ assembly of a bone anchor. In some embodiments, the instrument can include a feedback mechanism configured to alert the user when sufficient bone has been removed to facilitate assembly of the bone anchor. The feedback mechanism can be triggered by a movable shaft of the instrument that is displaced by the shank portion of the bone anchor as the surrounding bone is reamed.

Surgical tissue retraction systems and methods are described herein. Such systems and methods can be employed in some embodiments to provide medial-lateral tissue retraction to increase access to a surgical site. In one embodiment, a surgical instrument can include a body configured to couple to an implantable anchor, a first tissue manipulating implement coupled to the body and capable of polyaxial movement relative thereto, and a second tissue manipulating implement coupled to the body and capable of polyaxial movement relative thereto. Further, the first and second tissue manipulating implements can be opposed to one another such that they can move any of toward and away from one another.

Various implementations include rod reduction instruments, spinal fixation monitoring systems, and related methods. Certain implementations include a rod reduction instrument that is adapted for use with a spinal fixation system and includes a sensor configured to detect a load exerted by a rod reducer on a spinal rod, along with a reduction feedback system that provides an indicator of the load exerted by the rod reducer on the spinal rod.

An apparatus includes a reference array, a bone anchor, a receiver assembly coupled to the bone anchor, and an adapter axially locked with the receiver assembly. The adapter includes a proximal end coupled to the reference array and a distal end coupled to the receiver assembly.

A bone anchoring device includes a receiving part with a rod receiving portion having a first end, a second end, a recess for the rod, an outer surface, and a first engagement structure on the outer surface that extends farther radially outwardly than other parts of the rod receiving portion, and a flexible head receiving portion for inserting and clamping the head. The bone anchoring device also includes a locking ring configured to be arranged around the head receiving portion for locking the head, the locking ring having an outer surface and a second engagement structure on the outer surface that extends farther radially outwardly than the outer surface of the rod receiving portion. The engagement structures are configured to be engaged by an instrument to move the locking ring from a locking position to a position where the inserted head is pivotable.

Described herein is an orthopedic fixation device for use in spinal surgery. The orthopedic device is a pivoting device that comprises one or more hinges. Fixation of multiple vertebrae is accomplished by fixation at the vertebral facet joints. Multiple devices may be further fixed at multiple vertebral levels with the use of a multi-level rod.

A surgical instrument comprises a first portion defining a cavity configured for disposal of a first implant support member. A second portion defines at least one passageway aligned with the cavity and including a guide engageable with a second implant support member to orient the second implant support member with the at least one passageway such that the second implant support member is connectable with the first implant support member. Systems, spinal constructs, spinal implants and methods are disclosed.

An intraoperative monitoring module (IMM) for assessing strength of screw attachments to bone and detecting breaches includes a torque sensor on a rotatable tool receptacle and a variable-output current source. The IMM provides concurrent monitoring of rotational torque applied to a screw and stimulus current passing through the screw into bone for evoked electromyography. A motor housing configured to drive in rotation a tool receptacle on the IMM, a screw driver modified for carrying the stimulus current, and a screw attached to the screw driver are optionally included. Cooperative anti-rotation features on the motor housing and IMM support accurate torque measurements and prevent the outer housing of the IMM from rotating with the tool receptacle while a screw is being driven. The motor housing optionally provides electrical power to the IMM.

Instruments, apparatus and procedures for performing surgical operations are provided. A sleeve for performing surgical procedures may include an elongate main body; a channel extending within a length of the elongate main body; and a retainer configured and dimensioned to releasably retain a fixation member in the sleeve at a predetermined orientation and predetermined distance from a distal end of the sleeve. An assembly for performing surgical procedures may include a sleeve comprising: an elongate main body, a channel extending within a length of the elongate main body; a fixation member having been preloaded in the sleeve; and a bone fastener comprising: a shaft configured to engage bone, a tulip configured to receive a rod, a retention feature and extended tabs extending from the tulip.

A spinal manipulation instrument, system, and method may use a driving rod to move instrument arms toward or away from one another to compress or distract between selected vertebrae to which the arms are connected. Two arms may be coupled to the driving rod. A threaded collar may axially engage one of the arms, to translate that arm along the driving rod with respect to the other arm. The other arm may be at a fixed axial location or driven by another, oppositely-oriented thread. The arms may be highly adjustable to accommodate a wide range of anatomical variation between patients. Attachment members may be modular to interchangeably couple the arms across multiple platforms.