A pivotal bone anchor assembly for securing an elongate rod to patient bone includes a shank having a head and an anchor portion, a receiver having an axial bore and a channel for receiving the elongate rod, a collet insert top loaded into a first position within the axial bore and having a collet pocket for receiving the shank head, and a pressure ring uploadable into the collet pocket prior to the shank head and having an upper surface for engaging the rod. After receiving the shank head within the collet pocket, the collet insert and pressure ring are downwardly deployable with the shank head into a second position to capture the shank head in the assembly, the pressure ring being operable to transfer pressure from the elongate rod in the channel to the shank head to lock an angular position of the shank relative to the receiver.

A surgical kit includes a shield for covering a portion of the spine of a subject. The shield can include an attachment portion adapted to engage a bone fixation assembly which is adapted to be fixed on multiple vertebra bones of the subject. The bone fixation assembly can include a vertebra joining member secured between two bone anchors. Each bone anchor can include a fastener portion adapted to be implanted into a vertebra bone and a head coupling portion adapted to secure the vertebra joining member. The shield can be coupled to the bone fixation assembly via separate coupling elements, such as a clip or an adjustable link secured between two vertebra joining members of the bone fixation assembly. Alternatively, the shield can include an integral attachment portion configured to engage the bone fixation assembly directly.

Systems, methods, and devices for securing a spinal rod are provided. A clamp assembly comprises a tulip comprising an opening comprising an inner surface, wherein the inner surface is threaded; and a threaded locking cap disposed in the opening, wherein threads of the locking cap and the inner surface include various geometries.

A bone fixation apparatus includes an insert and a bone anchor. The insert has open ends defining a lumen. A first thread is disposed on an outer surface of the insert and a second thread is disposed in the lumen. The insert is configured for threadably engaging bone. A driving tool is releasably attachable to the insert. The bone fixation apparatus also includes a bone anchor with a bone screw member and a housing. The bone screw member extends from the housing and has a third thread along a shank of the bone screw member. The third thread of the shank is engageable with the second thread of the lumen such that the bone anchor is coupled to the insert.

A bone anchoring device includes a receiving part for coupling a rod to a bone anchoring element, the receiving part having a first end, a second end, a recess at the first end for receiving the rod, and a compressible head receiving portion at the second end for accommodating a head of the bone anchoring element, a pressure member positionable in the receiving part to exert pressure on the head, and a clamping ring positionable around the head receiving portion and movable towards the first end of the receiving part to a locking position where the clamping ring exerts force on and compresses the head receiving portion. In the locking position, at least part of the clamping ring that faces the first end of the receiving part is exposed to the outside to facilitate movement of the clamping ring away from the first end of the receiving part.

A fastener configured for spinal applications includes a head having a channel adapted to receive a spinal rod and a shaft extending from the head to a distal tip and having a thread, at least a portion of the thread being serrated. The serrated portion of the thread includes peaks and troughs and can extend along about 35 percent of a length of the thread.

A vertebral anchor device comprising a bone anchor screw having a screw body and a screw head for coupling a link element to the screw body, the screw head being mounted to move on the screw body; the screw body comprising a threaded shank of a longitudinal axis AA for anchoring the screw body in a vertebra, and provided at one of its ends with a coupling head for coupling the screw body to the screw head; the screw head comprising a head body of a longitudinal axis BB and through which a channel passes longitudinally that is suitable for receiving, in the head body bottom portion, the coupling head; said vertebral anchor device further comprising assembly means for assembling together the coupling head and the screw head, the coupling head having a portion of cylindrical shape and of axis perpendicular to the threaded shank.

Spinal fixation apparatus with a first end for selectively flexing to expand in diameter when receiving a head of an engagement member, the engagement member for coupling to a portion of a spine and a flexible sidewall between the first end and a second end, the flexible sidewall to selectively expand in length, between the first end and the second end, when the first end is not in receipt of the head of an engagement member and alternatively to contract in length when the first end is in receipt of the head of the engagement member.

A polyaxial bone anchoring device includes a receiving part with two legs defining a recess for receiving a rod and a pressure member for exerting pressure on a head of a bone anchoring element in the receiving part, the pressure member having an engagement portion. The engagement portion can extend at least partially into a leg and is directly engageable from outside the bone anchoring device to move the engagement portion axially for adjusting the pressure member from a non-locking position where the head is pivotable to a locking position where the head is clamped. When the pressure member is in the locking position and the engagement portion is free from any outside axial forces, a first contact surface of the receiving part cooperates with a second contact surface of the pressure member to hold the pressure member in the locking position.

A spinal construct comprises a first member engageable with a receiver of a first fastener having a shaft fixed with tissue. A second member is engageable with a receiver of a second fastener having a shaft fixed with the tissue. A longitudinal element connects the members. At least one of the members includes a mating element that is releasably engageable with a surgical instrument to manipulate the tissue such that movement of the receivers relative to the shafts is resisted and/or prevented. Surgical instruments, implants, systems and methods are disclosed.