A spine alignment system is disclosed. The spine alignment system includes a pedicle screw having a longitudinal axis, the pedicle screw having a screw head. The screw head includes a slot having a longitudinal axis that is substantially perpendicular to the longitudinal axis of the pedicle screw. An extension shaft is secured to the pedicle screw, such that a longitudinal axis of the extension shaft is substantially coaxial with the longitudinal axis of the pedicle screw. The spine alignment system also includes a cap having a slot that forms a substantially cylindrical passage with the slot of the pedicle screw head. The substantially cylindrical passage is configured to receive an alignment rod such that alignment of the spine occurs as the rod is translated along the extension shaft to the pedicle screw.

A rod reducer includes a housing, an anvil, a locking anvil configured to engage a locking plug of a bone screw assembly, an arm assembly, a reducing screw extending through the housing and rotatably coupled with the anvil, and a locking screw extending through the housing and rotatably coupled with the locking anvil. The arm assembly includes an arm hingedly coupled to the housing, and first and second grasping members configured to engage the bone screw assembly. The first and second grasping members are hingedly coupled to the housing and extend through the anvil. Rotation of the reducing screw transitions the arm assembly between an open position, in which, distal portions of the arm and the first and second grasping members are radially expanded, and a closed position, in which, the distal portions of the arm and the first and second grasping members are radially contracted.

Modular surgical instruments and related methods are disclosed herein, e.g., for performing rod reduction, derotation, and/or set screw insertion during spinal surgery. An exemplary system can include an instrument body configured to couple to a bone anchor assembly to provide a modular platform for carrying out various steps of a surgical procedure. For example, the instrument body can receive a reduction instrument therethrough for reducing a spinal rod into the bone anchor assembly. A derotation instrument can be attached to the reduction instrument for performing derotation maneuvers or applying other manipulation forces. A modular driver or handle adapter can be attached to the reduction instrument and/or to the derotation instrument to facilitate rod reduction. Any of the instrument body, the reduction instrument, and the derotation instrument can include a working channel therethrough. A set screw or closure mechanism, and a driver instrument for applying the set screw or closure mechanism to the bone anchor assembly, can be inserted through the working channel.

A tool set for implanting a rod in a human spine in conjunction with bone screws includes a pair of end guide tools that receive opposite ends of the rod in channels and under manipulation by a surgeon facilitate transport of the rod toward the bone screws attached to the guide tools. Each end guide tool includes a laterally extending, rigid, rod holding structure located near a bottom surface thereof. Intermediate guide tools having pass-through slots are utilized to guide the rod to the bone screws at intermediate locations. For bone screw implantation, the end guide tools and intermediate guide tools are assembled with a driver. The driver is coaxial with the respective guide tool and rotatingly mateable thereto. The driver includes a stem and a nut-type fastener, the stem receivable in the guide tool. The fastener allows for rotation of the bone screw without rotating the attached guide tool. For reducing a rod into the bone screw, a rod pusher is deployed that is coaxial with a respective guide tool and includes an outer sleeve that abuts the rod as the sleeve is translated along the guide tool and toward the bone screw. A method utilizing the tool set allows a surgeon to percutaneously implant the bone screws and the rod in the patient.

Systems and methods for a guide assembly for introducing a bone anchor to an operative target site. The guide includes an outer sleeve and an inner sleeve. The outer sleeve has a distal anchor engaging end, a proximal end, and a central passage extending from the distal end to the proximal end. The inner sleeve may be situated in the central passage of the outer sleeve. The inner sleeve is movable being between a first position and a second position. The first position permits insertion of the bone anchor in the central passage. The second position releasably fixes the bone anchor to the guide assembly.

Treatment of spinal irregularities, including, in one or more embodiments, derotation apparatus and systems that can be used to reduce the rotation of vertebral bodies. Derotation apparatus that may comprise a tube assembly comprising an inner sleeve and an outer sleeve disposed over the inner sleeve. The inner sleeve may have a distal end for attachment to an implant. The tube assembly may further comprise a handle assembly. The tube assembly may further comprise a ball joint assembly disposed between the tube assembly and the handle assembly. The ball joint assembly may comprise a ball joint configured for attachment to a coupling rod. The ball joint assembly further may comprise a reducing extension below the ball joint, the reducing extension being sized to fit in a central bore of the inner sleeve. Orthopedic fixation devices comprising a ball joint are also disclosed.

A bone anchoring device includes a receiving part with a rod receiving portion having a first end, a second end, a recess for the rod, an outer surface, and a first engagement structure on the outer surface that extends farther radially outwardly than other parts of the rod receiving portion, and a flexible head receiving portion for inserting and clamping the head. The bone anchoring device also includes a locking ring configured to be arranged around the head receiving portion for locking the head, the locking ring having an outer surface and a second engagement structure on the outer surface that extends farther radially outwardly than the outer surface of the rod receiving portion. The engagement structures are configured to be engaged by an instrument to move the locking ring from a locking position to a position where the inserted head is pivotable.

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.

Surgical instruments and devices including drivers, inserters, and reducers. The driver includes a ratcheting mechanism configured to provide uni-directional motion when engaged. The inserter includes a rack, pinion, and cam system designed to secure an implant and release an implant in-situ. The reducer includes a geared system for persuading together surgical components and aligning misaligned vertebrae.

A surgical tool adaptor includes a distal interface member and a proximal holder. The surgical tool adaptor is formed with a lumen through the distal interface member and the proximal holder for passing a guiding element (e.g., K-wire) distally through the distal interface member. The proximal holder includes a locking element for locking the guiding element in the lumen and the distal interface member includes a connecting element for connecting to a surgical tool. The proximal holder is movable relative to the distal interface member so that the proximal holder is movable to a position wherein the guiding element does not protrude proximally out of the proximal holder.