A system includes a bone anchor including a shank having a first end, a second end, a channel extending through the shank with a channel axis, and an internal advancement structure having at least a portion being closer axially to the second end than to the first end, and an elongate instrument configured to extend through the channel, with a tip portion and an external advancement structure configured to cooperate with the internal advancement structure. Engagement between the advancement structures facilitates holding of the tip portion at a first axial position relative to the bone anchor and movement of the tip portion from the first axial position towards both the first and second ends of the shank. The tip portion and the external advancement structure of the elongate instrument are insertable into and removable from the channel via the first end of the shank.

Systems, instruments, and methods for advancing a set screw in an object. The methods comprise: disposing a shank tip of a set screw reducer in a socket of the set screw; causing a sleeve integrated with the set screw reducer to slidingly engage a shank of the set screw reducer and move in a direction towards the shank tip; transferring torque from the set screw reducer to the set screw such that the set screw is advanced in a threaded hole of the object; and using the sleeve of the set screw reducer to substantially prevent splaying of at least one sidewall of the object while the torque is being transferred from the set screw reducer to the set screw.

An anchor can be coupleable to a bone, where the anchor includes a head, a shank, a first extension, and a second extension. The head can include a distal head portion and a proximal head portion, where the proximal head portion can be open at a proximal end of the head. The shank can extend distally from the distal head portion, where the shank including a threaded portion configured to engage the bone. The second extension can be opposing the first extension, and the second extension can include a second proximal support coupled to a second end of a first elongate portion, where a first proximal support can extend transverse to the longitudinal axis, and the first proximal support portion and the second proximal support portion can be separated in a first condition and can be engaged to transfer forces there between in a second.

Systems and methods for reducing the risk of PJK, PJF, and other conditions are disclosed herein. In some embodiments, a longitudinal extension can be added to a primary fixation construct to extend the construct to one or more additional vertebral levels. The extension can be attached to a first attachment point, such as a bone anchor implanted in a vertebra that is superior to the primary construct. The extension can also be attached to a second attachment point, such as a component of the primary construct or an anatomical structure disposed inferior to the first attachment point. The extension can be more flexible than the primary construct and/or can limit motion to a lesser degree than the primary construct, thereby providing a more-gradual transition from the instrumented vertebrae to the natural patient anatomy adjacent thereto. The extension can be placed with little or no soft tissue disruption.

A surgical expandable implant includes a bolt, a movable member, and a support body. The bolt has a bolt body and a fixing member. The movable member is configured to be slidably sleeved on the bolt body. The support body has a first end configured to extend through the fixing member and a second end configured to extend through the movable member. The movable member is configured to slide along the length of the bolt body so as to move the support body from an initial shape to a deformed shape.

An attachment apparatus is disclosed to secure a medical alignment device to align a tool. The attachment apparatus may include a base wall providing a base alignment surface for abutting or positioned adjacent a first portion or first surface of the medical alignment device. The medical alignment device operable to provide an alignment of a tool, such as a three-dimensional alignment angle of the tool, and to provide a notification when the medical alignment device aligned with the tool as desired. The attachment apparatus may include a first side wall providing a side alignment surface for abutting or adjacent a second portion or surface of the medical alignment device; and an alignment support configured to align with a portion of the tool. A method is disclosed for aligning a tool or object using an attachment apparatus.

An adapter device for connecting an instrument to a bone anchor includes an elongate main portion having a longitudinal axis, a first end with a surface that is directly engageable with a head of the bone anchor, an opposite second end, and a channel that extends longitudinally through the main portion, and a holding member having an inner surface forming a seat for the head. The holding member is movable over a majority of the main portion, and is configured to be held at a position where a first portion of the seat is directed towards the second end of the main portion to hold the head in the seat against the first end of the main portion, while the holding member engages another part of the adapter device to keep the first portion of the seat spaced apart axially from the first end of the main portion.

Disclosed herein are stylet control handles and related methods for extending and retracting a stylet during insertion of a bone anchor, and for providing a visual indication of the extent of extension of the stylet.

A surgical instrument comprises an outer sleeve including an inner surface that defines a cavity. An inner shaft is fixed with the outer sleeve and extending within the cavity. The inner shaft includes a drive engageable with a first mating surface of a bone fastener. An inner sleeve is disposed between the inner shaft and the outer sleeve. The inner sleeve is rotatable relative to the outer sleeve and includes an element connectable with a second mating surface of the bone fastener. Systems, spinal implants and methods are disclosed.

A screw driving instrument is provided with a stylet holder able to retain a head of a stylet at one of multiple discrete locations. A user may vary a distance that a point of the stylet extends from a distal end of the instrument by choosing which of the discrete locations to insert the stylet head into before coupling the stylet holder to the instrument. The instrument may include a ratcheting handle capable of rotation in one direction about a central axis of the instrument relative to other components of the instrument. The stylet holder may be engageable with the handle.