A polyaxial bone anchoring device includes a receiving part with a rod receiving portion defining a recess for receiving a rod, and a head receiving portion with a wall that defines an accommodation space for accommodating a head of an anchoring element, and a locking member positionable at least partially around the head receiving portion and movable from a first position where the head can pivot in the accommodation space to a second position where an angular position of the head is locked. The wall of the head receiving portion further defines at least one cavity in communication with the accommodation space that reduces a radial thickness of at least part of the wall located between the accommodation space and the locking member, and at least part of the cavity is separated radially from the accommodation space by a portion of the wall.

A polyaxial bone anchoring device includes a receiving part configured to be pivotably connected to a head of an anchoring element, the receiving part having a channel for receiving a rod and an accommodation space having an opening for accommodating the head, and a sleeve-like insert piece having a sleeve axis and a spherical segment-shaped outer surface portion. The insert piece is configured to be positioned around a portion of the head in the receiving part and to pivot in the receiving part, and includes a first part and a separable second part configured to be connected with the first part by a connection structure configured to permit translational movement between the first part and the second part in a direction transverse to the sleeve axis, while preventing movement between the first part and the second part in a direction parallel to the sleeve axis.

A pivotal bone anchor assembly includes a receiver having a cavity with a bottom opening and a first channel for receiving a rod, and a shank having a head positionable into the cavity with the shank extending downward through the bottom opening. The assembly also includes an insert positionable into the central bore above the shank head and having a second channel alignable with the first channel, opposite extensions extending outwardly in the direction of the channels to block rotation between the insert and the receiver, and upward-facing surfaces located laterally outward from and on each side of the second open channel. The upward-facing surfaces are configured for releasable compressive engagement by a compressing tool after the elongate rod is received within the channels and prior to a final locking of the assembly so as to provisionally lock the shank from pivoting with respect to the receiver.

A receiver assembly includes a receiver having a first channel, a through-space with internal recesses beneath a guide and advancement structure, and internal ridges projecting inwardly below the internal recesses. The assembly also includes an insert having a second channel, side structures protruding laterally outward below top surfaces, and opposed lower extensions extending downwardly below the second channel, with the insert being loadable into the through-space with the second channel in non-alignment with the first channel. The insert is the non-threadably rotatable within the through-space to align the second channel with the first channel and to move the side structures into the internal recesses above the internal ridges, with a subsequent forced downward displacement of the insert within the through-space causing the side structures to frictionally engage the internal ridges to inhibit the insert from moving upward within the through-space.

A polyaxial bone anchoring device includes a receiving part with a rod receiving portion defining a recess for receiving a rod, and a head receiving portion with a wall that defines an accommodation space for accommodating a head of an anchoring element, and a locking member positionable at least partially around the head receiving portion and movable from a first position where the head can pivot in the accommodation space to a second position where an angular position of the head is locked. The wall of the head receiving portion further defines at least one cavity in communication with the accommodation space that reduces a radial thickness of at least part of the wall located between the accommodation space and the locking member, and at least part of the cavity is separated radially from the accommodation space by a portion of the wall.

A dynamic fixation medical implant having at least two bone anchors includes a longitudinal connecting member assembly having rigid sleeves for attachment to the bone anchors, at least one spacer engaging the bone anchors and the sleeves, and in some embodiments, an end elastic bumper. A flexible cord is initially slidingly received within the rigid sleeves, the spacer and the bumper. The spacer may include an optional inelastic inner liner, with at least one of the sleeves having an extension slidingly receivable within the liner. Some sleeves include apertures for receiving a closure top portion for locking the cord against the sleeve, or alternatively receiving a closure top that does not extend into the aperture, the slip or grip option provided by the aperture in each sleeve resulting in an overall connector with variable segmental stiffness.

A pivotal bone anchor assembly includes a shank having a head portion and an anchor portion for fixation to the bone of a patient, and a receiver comprising a base defining a lower portion of central bore and a pair of upright arms defining a channel for receiving an elongate rod. The assembly also includes a retaining structure with a central opening configured to capture and pivotally retain and support the head portion of the shank in the retaining structure, and which is slidably movable relative to the receiver so as to provide for increased articulated movement between the shank and the receiver prior to locking the assembly with the elongate rod and a closure. The assembly further includes an insert configured to engage the elongate rod and the head portion of the shank when in use, and to have an overlapping configuration with the retaining structure when the assembly is in the locked configuration.

A pivotal bone anchor assembly includes a receiver comprising a base defining a lower portion of a central bore, a pair of receiver arms extending upward from the base to define a first channel, and a non-threaded curvate tool engagement groove extending horizontally across an outward facing surface of each receiver arm. The assembly also includes a shank comprising an anchor portion and a partially spherical-shaped head configured for positioning into the lower portion of the central bore. The assembly further includes an insert configured for positioning into the central bore above the head of the shank and having a lower body with partially-cylindrical outer surfaces and a pair of insert arms extending upward from the lower body to define a second channel alignable with the first channel and configured to receive the elongate rod, with each of the insert arms having a flared-out upper portion.

A pivotal bone anchor assembly includes a bone screw comprising a screw head and an anchor portion, and a receiver comprising a base defining a central bore and an upper portion defining a first channel, with the central bore extending upward through the first channel to a top of the receiver. The assembly also includes an open ring retainer with a gap that is uploadable into a lower portion of the central bore through a bottom opening for capturing the screw head within receiver, and an insert positionable into the central bore above the screw head with upright arms defining a second channel and opposite extensions extending radially outward into the first channel body for blocking rotation of the insert within the receiver. The insert provides a non-floppy friction fit relationship between the bone screw and the receiver, with top surfaces of the upright arms in overlapping engagement with underside surfaces of opposed abutment structures projecting inwardly into the central bore, prior to an elongate rod being positioned within the first and second channels and locked by a closure top.

According to some embodiments, systems and methods of ultrasonic detection of implantable medical device distraction are provided. The system includes a first elongate member and a second elongate member. The first elongate member has a first end that is configured to be attached to a first location on the skeletal system of a subject, a second end, and at least one landmark identifiable using ultrasound. The second elongate member has a first end that is movably coupled to the second end of the first elongate member, a second end configured to be attached to a second location on the skeletal system, and at least one landmark identifiable using ultrasound. Movement of the first elongate member in relation to the second elongate member causes a corresponding movement of the at least one first landmark in relation to the at least one second landmark which can be detected using ultrasound.