The present disclosure relates to an apparatus and method for near-simultaneous and integrated delivery of bone graft material and 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 detach the fusion cage for deposit. 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. In certain embodiments, the integrated fusion cage is an expandable integrated fusion cage.

Techniques and systems for distracting a spinal disc space and supporting adjacent vertebrae are provided. Trial instruments are insertable into the disc space to determine a desired disc space height and to select a corresponding implant. Implants can be also be self-distracting and the implant providing the desired disc space height can be implanted in the spinal disc space.

A surgical instrument comprises a member being engageable to a spinal implant configured for connection to a bone fastener shaft. An actuator is connected to the member. A latch is connected to the actuator and the connection is configured to change between at least one non-locked orientation such that the actuator is movable relative to the member and a locked orientation such that the actuator is fixed relative to the member. Systems, spinal constructs, implants and methods are disclosed.

A spinal cage with a wall extending in a longitudinal direction defining an interior space is disclosed. There is also provided a deployable element in movable relation to the spinal cage.

Provided are methods and systems for enlarging a spinal canal of a vertebra. Using the methods and systems disclosed the spinal canal of the vertebra is enlarged by cutting the posterior arch portion of the vertebra to create one or two implant receiving spaces in the posterior arch portion. The cutting of the posterior arch portion is completed through a minimally invasive approach. Once cut, the detached portion of the posterior arch portion is repositioned and an implant is positioned in the implant receiving space of the posterior arch portion to thereby enlarge the spinal canal such that the spinal cord is no longer compressed. The insertion of the implant is also completed through a minimally invasive approach.

A total artificial expansile disc and a method for posterior insertion between a pair of vertebral endplates are disclosed. The total artificial expansile disc includes at least one pair of substantially parallel plates that move apart along a first axis, in order to occupy a space defined by the vertebral endplates. In another embodiment, each of substantially parallel plates includes a first plate and a second sliding plate. An expansion device or tool is used to move the substantially parallel pair of plates apart along the first axis. A core is disposed between the pair of plates, and the core permits the vertebral endplates to move relative to one another. A ball limiter or ball extender prevents the core from being extruded from between the substantially parallel plates.

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.

A method of inserting and positioning an intervertebral spacer is provided. The spacer includes a longitudinal axis, an on-axis interface coincident with or parallel to the longitudinal axis, and an off-axis interface angled to the longitudinal axis. The spacer's front end may be curved. The method may include inserting the spacer into the disc space utilizing a tool to engage an on-axis interface and then to engage one or more of the off-axis interfaces, which may be used for further modification of the spacer. The tool is moved substantially along a single insertion direction, which may be substantially parallel to a posterior-anterior axis of the disc space. The method may result in the longitudinal axis of the spacer being perpendicular to the insertion direction, or substantially parallel to a medial-lateral axis of the disc space. The spacer may also be positioned in an anterior aspect of the disc space.

An extraction tool for removing an installed artificial disc from a spine is provided. The extraction tool is impacted between the artificial disc and the vertebrae and engages the artificial disc to allow a surgeon to remove the artificial disc from the spine.

An apparatus for extracting a medical implant from bone includes: a housing; a coupler carried by the housing and configured to be mechanically connected to a medical implant; and a forcing mechanism carried by the housing and operable to apply a cyclic excitation force with a specified amplitude, frequency, and vector to the coupler. Methods are described for using the apparatus to remove and/or implant medical implants.