Enzymatic and non-enzymatic detectors and associated membrane apparatus, and methods of use, such as within a fully implantable sensor apparatus. In one embodiment, detector performance is controlled through selective use of membrane configurations and enzyme region shapes, which enable accurate detection of blood glucose level within the solid tissue of the living host for extended periods of time. Isolation between the host's tissue and the underlying enzymes and reaction byproducts used in the detectors is also advantageously maintained in one embodiment via use of a non-enzyme containing permeable membrane formed of e.g., a biocompatible crosslinked protein-based material. Control of response range and/or rate in some embodiments also permits customization of sensor elements. In one variant, heterogeneous detector elements are used to, e.g., accommodate a wider range of blood glucose concentration within the host. Methods of manufacturing the membranes and detectors, including methods to increase reliability, are also disclosed.

The present disclosure includes a polyaxial bone fixation element for use in spinal fixation to interconnect a longitudinal spinal rod with a patient's vertebra. The polyaxial bone fixation element preferably includes a bone anchor, a collet, a body, and a locking cap. The polyaxial bone fixation element preferably enables in-situ assembly. That is, the polyaxial bone fixation element is preferably configured so that in use, the bone anchor may be secured to the patient's vertebra prior to being received within the body. Accordingly, the polyaxial bone fixation element enables a surgeon to implant the bone anchor without the body to maximize visibility and access around the anchoring site. Once the bone anchor has been secured to the patient's vertebra, the body can be snapped-onto the bone anchor. The bone anchor preferably also includes a second tool interface so that a surgical instrument can be directly coupled to the bone anchor.

An instrument for spinal procedures is a vertebral endplate spreader device having a vertebral endplate spreader and a driver handle. The vertebral endplate spreader includes a linkage with a drive sprocket operatively connected for rotation relative thereto and with a secondary sprocket. The secondary sprocket is operatively connected for rotation relative to the linkage. The vertebral endplate spreader includes a belt operatively connected to the drive sprocket and the secondary sprocket to be driven about a belt axis. The driver handle has a distal end and a proximal end. The distal end is operatively connected to the drive sprocket to actuate rotation of the belt.

Tools and techniques are described that are useful for trauma correction of anterior compression, chance, or burst fractures, particularly where the posterior longitudinal ligament and posterior arch anatomy is still intact. The described tools can be used to reduce fracture and provide additional distraction for ligamentum taxis through a posterior approach that is compatible with both open and minimally invasive methodologies.

A transverse coupling for connecting multiple implant extensions includes at least a first sleeve and a second sleeve. The first sleeve defines a first aperture adapted to axially receive a first implant extension through the first aperture. The second sleeve defines a second aperture adapted to axially receive a second implant extension through the second aperture. The transverse coupling also includes a central housing. A first shaft connects the first sleeve to the central housing, and a second shaft connects the second sleeve to the central housing. The central housing includes at least one joint for connecting the central housing to at least one of the first and second shafts in a movable arrangement that allows the shaft(s) to move through one or more degrees of freedom relative to the central housing.

Methods of applying a locking cap to a bone anchor assembly. The bone anchor assembly includes a bone anchor and an elongate rod. The bone anchor includes a body that defines a channel and has a tissue retractor coupled thereto that defines a partial pathway to the channel.

Devices and methods for aligning the components of polyaxial screws are described herein. In one embodiment, an alignment instrument includes an elongate frame having a longitudinal axis and a plurality of connection caps slidably disposed along the elongate frame. Each connection cap can removably couple to a polyaxial screw extension tube and selectively lock relative to the elongate frame such that a distance between the plurality of connection caps and an angular orientation of each connection cap relative to the elongate frame is maintained. The instrument can also include a transverse angle indicator to indicate an angular orientation of the elongate frame in a plane transverse to the longitudinal axis of the elongate frame. The device can, for example, capture the orientation of a plurality of polyaxial screws during spinal surgery such that the screws can be returned to the same orientation after manipulation to correct a spinal deformity, etc.

Some embodiments provide systems, assemblies, and methods of analyzing patient anatomy, including providing an analysis of a patient's spine, and also analyzing the biomechanical effects of implants. In some embodiments, the systems, assemblies, and/or methods can include obtaining initial patient data, acquiring spinal alignment and contour information, acquiring flexibility and/or biomechanical information, registering patient anatomical landmarks of interest relative to fiducial markers, analyzing databases of measurements and patient data to predict postoperative patient outcomes. Further, in some embodiments, the systems, assemblies, and/or methods can assess localized anatomical features of the patient, and obtain anatomical region data. In some embodiments, the systems, assemblies, and/or methods can also analyze the localized anatomy and therapeutic device location and contouring. Further, the systems, assemblies, and/or methods can output localized anatomical analyses and therapeutic device contouring data and/or imagery on a display according to some embodiments.

A bone fastener includes a receiver defining a longitudinal axis and extending between a proximal end and a distal end, the proximal end including a first wall and a second wall that define an implant cavity, each wall having a proximal face. At least one of the first wall and the second wall include an extension extending proximally from the proximal face along the longitudinal axis, the extension having a distal end integral with the proximal face and a proximal end including a first locking part configured for fixation with a second locking part of an instrument. A bone penetrating member has a proximal end and a distal end, the proximal end of the bone penetrating member being connected with the distal end of the receiver.

A spinal implant comprises an implant body extending between an anterior surface and a posterior surface, and including a first vertebral engaging surface and a second vertebral engaging surface. The implant body includes an inner surface that defines at least a first cavity and a second cavity. The cavities are oriented to implant fasteners in alignment with an oblique surgical pathway relative to a bilateral axis of a subject body and adjacent an anterior portion of an intervertebral space of the subject body. Systems and methods are disclosed.