In some embodiments, a spinal stabilization system may be formed in a patient using quick-connect sleeve assemblies. Each quick-connect sleeve assembly can be coupled to a bone fastener assembly in a fast and intuitive way. In one embodiment, a quick-connect sleeve assembly has a detachable member and a movable member. Both members engage a collar of the bone fastener assembly. In one embodiment, the engagement can be locked via one or more locking features to facilitate screwing a bone fastener of the bone fastener assembly onto a vertebral body in a minimally invasive surgical procedure. Each quick-connect sleeve assembly has a low profile and is particularly shaped for minimally invasive entry.

Systems, devices, and methods suitable for use with procedures performed at least partially percutaneously are provided. In some procedures, two or more access devices for providing access to adjacent surgical locations within a patient are used. Certain embodiments of the access device comprise an elongate body having a distal end with one or more cutouts. The cutouts on adjacent access devices are generally aligned with each other to permit passage of a portion of a fixation element from one access device to the other access device. A fastener with an elongated removable head may be delivered to the surgical site through the access device. After a distal end of the fastener is secured to the surgical site, a portion of the elongated housing is detached from the remainder of the fastener and removed from the patient.

A guide assembly includes a spinal screw assembly having a bone screw and a spinal rod holder; and a spinal rod guide having first and second elongated arc portions defining a pair of longitudinal slots extending along the first and second arc portions, each of the first and second arc portions further defining at least one recess extending transversely from each of the longitudinal slots, the at least one recess configured to receive at least a portion of a reduction tool to enable reduction of a spinal rod received within the spinal rod holder.

An articulating rod inserter is configured for use in delivering a fixation rod to an orthopedic fixation system through a cannula or tower. The articulating rod inserter is releasably coupled to a rod and can move the rod from a generally aligned configuration, wherein the longitudinal axes of the rod and rod inserter are generally aligned, to an angled configuration, wherein the longitudinal axis of the rod is at an angle to the longitudinal axis of the rod inserter. The rod is inserted into the patient through a first tower and then articulated to a second tower such that the rod extends between two or more fixation devices.

A system, a method, and instruments for manipulating a surgical cord into spinal implants to assist in correcting a spinal deformity are described. The system may include a tensioner, a tensioner extension, and a counter tensioner. One of the instruments can include an elongate body, a dual coupler, and a nose member. The elongate body has a flexible cylindrical member adapted to carry tension along a longitudinal axis, where the flexible cylindrical member is sized to receive a surgical cord through a lumen within the flexible cylindrical member. The dual coupler is disposed on a proximal end of the elongate body, and include a bore for receiving a nose portion of a tensioner and for guiding the surgical cord into the tensioner. The nose member is disposed on a distal end of the elongate body, and be adapted to discharge the surgical cord from the elongate body.

A bone anchoring device includes a receiving part with a head receiving portion defining a seat for pivotably receiving a head of a bone anchor, and a rod receiving portion defining a recess for receiving a rod, the recess forming two legs each having an engagement surface for engaging a locking device to lock the rod in the recess, and an expansion limiting member having a surface configured to engage a portion of the receiving part spaced apart from the engagement surfaces of the legs. When the legs are urged radially outwardly, the head receiving portion is urged radially inwardly to compress and lock the head. The expansion limiting member is adjustable from a first configuration relative to the receiving part where the head receiving portion is expandable to permit the insertion of the head, to a second configuration where expansion of the head receiving portion is restricted.

A bone fixation system with variable z-axis translation is provided. The bone fixation system includes an outer tulip coupled to a bone fastener. An inner tulip, which provides a seat for an elongate fixation rod, is located inside the outer tulip. The inner tulip together with a seated rod is permitted to translate along the z-axis in an unlocked position. Also in the unlocked position, the bone fastener is free to angulate relative to the outer tulip. The bone fixation system includes a locked position in which the z-axis position of the inner tulip and rod relative to the outer tulip is fixed. Also in the locked position, the bone fastener is locked with respect to the outer tulip. The system may be adjusted between the locked and unlocked positions by way of a set screw or independently by rotation of the inner tulip relative to the outer tulip.

A rod reduction tool assembly includes an outer tube with outer tangs for engaging a bone anchor, an inner partially tubular pin support and a threaded cap mated to the outer tube and engaging the inner pin support.

Implementations described herein may include a system for manipulating implants coupled by a cord. The system may include a tensioner and a counter tensioner. The tensioner may include a nose assembly and a cord lock assembly for applying tension to the cord. The nose assembly may include a piston having a lumen extending therethrough for receiving the cord and a spring positionable in contact with an indicator region of the piston. The counter may be releasably coupleable to a head of an implant at a proximal end thereof and may guide the cord to a port proximate the distal end thereof, the port for receiving the nose assembly. The counter tensioner may enable translation of the implant relative to another implant implanted in an adjacent or nearby vertebrae. The indicator region of the piston may be visible through a window in a tensioner main body and may indicate cord tension when the nose assembly of the tensioner is coupled to the port of the counter tensioner and engaged with the cord.

A surgical instrument for correcting spinal deformities includes a tubular body adapted to receive a second instrument through the tubular body. The tubular body forms a transverse passage adapted to receive a longitudinal fixation element through the tubular body. The tubular body further includes first and second arms for connecting the surgical instrument to a vertebral anchor. The first and second arms include one or more anti-splaying features adapted to mate with anti-splaying features on the second instrument to prevent the first and second arms from splaying as the second instrument is inserted into the tubular body.