A tool set for implanting bone screws in a human spine, followed by the implantation of a rod into the bone screws includes end guide tools having flexible back wall flaps that receive opposite ends of the rod and intermediate guide tools that hold the rod in intermediate locations between the end guide tools. Both the end and intermediate guide tools include an attachment structure for operably connecting the guide tool to a bone screw. The attachment structure includes an undercut and/or recess so as to resist splaying and separation of the guide tool from an attached bone screw.

A polyaxial bone screw assembly includes a threaded shank body having an integral upper portion receivable in an integral receiver, the receiver having an upper channel for receiving a longitudinal connecting member and a lower cavity cooperating with a lower opening. The receiver can have crimp tabs, but is devoid of spring tabs and collet-like flexible structures. A down-loadable compression insert (some with lock and release feature), a down-loadable friction fit split retaining ring and an up-loadable shank upper portion cooperate to provide for pop- or snap-on assembly of the shank with the receiver either prior to or after implantation of the shank into a vertebra. The shank and receiver once assembled cannot be disassembled. The receiver and insert include aligned tool receiving apertures for lock and release of the polyaxial mechanism.

A dynamic fixation medical implant having two bone anchors includes a longitudinal connecting member assembly having a transition portion and cooperating outer sleeve, both the transition portion and sleeve being disposed between the two bone anchors. In a first embodiment, the transition portion includes a rigid length or rod having apertures therein for tying or otherwise attaching the rigid length to a second rigid length or to a flexible cord. Slender ties or cords extend through a plurality of apertures in the rigid lengths or are threaded, tied or plaited to the larger flexible cord or cable. In a second embodiment, a transition portion includes slender ties of a cord that are imbedded in a molded plastic of a more rigid member. The sleeve surrounds the transition portion and extends between the pair of bone anchors, the sleeve being compressible in a longitudinal direction between the bone anchors.

A medical implant assembly having at least two bone attachment structures cooperating with a dynamic longitudinal connecting member, the improvement wherein the connecting member includes: a first end, a transition portion, and a second end; a substantially rod portion extending longitudinally from the first end to the transition portion, and including a longitudinal axis and a substantially rigid core running substantially parallel with the longitudinal axis; a substantially cord portion joined with the rod portion and extending from the transition portion to the second end; and a substantially flexible jacket portion covering the rod and cord portions.

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.

A polyaxial bone screw assembly includes a threaded shank body having an integral upper portion receivable in a receiver, the receiver having an upper channel for receiving a longitudinal connecting member and a lower cavity cooperating with a lower opening. The upper portion expands a retaining member in the receiver cavity to capture the shank upper portion in the receiver. In some embodiment either the retaining member or an insert provide for a friction fit of the shank upper portion in the receiver resulting in non-floppy placement of the shank with respect to the receiver. Some retainers and inserts have a lock-and-release feature. Final locking of the polyaxial mechanism is provided by frictional engagement between the shank upper portion and the retaining member. A pre-assembled receiver, retaining member and optional insert may be popped-on or snapped-on to the shank upper portion prior to or after implantation of the shank into a vertebra.

This disclosure describes a variety of transitional or terminal components that may be implanted as part of a spinal fixation construct to decrease the potential for subsequent development of junctional disease. The fixation construct may extend any number of levels from a single level construct to a long construct spanning multiple spinal levels and multiple spinal regions from the lumbosacral to cervical regions, and with any variety of combination of anchors, rods, and connectors. Terminal and/or transitional components maybe utilized at the caudal and or cephalad ends of the fixation construct to reduce stresses endured by the construct adjacent pathology and prevent or reduce incidence and degree of junctional disease.

A medical implant assembly includes a polyaxial bone anchor having a shank, a receiver, a lower compression insert with planar surfaces for closely receiving an elongate connecting member with planar surfaces and a one-piece closure structure. The connecting member is made from a polymer. The closure structure engages both the connecting member and the insert with the engagement between the closure structure and the insert securely locking the polyaxial mechanism even if the connecting member exhibits creep.

A polyaxial bone screw assembly includes a threaded shank body having an integral upper portion receivable in an integral receiver, the receiver having an upper channel for receiving a longitudinal connecting member and a lower cavity cooperating with a lower opening. A down-loadable compression insert has a lower friction fit collet and an outer receiver press fit surface. A down-loadable retaining ring has at least one inner edge and outer tiered surfaces. The ring cooperates with the shank to provide for pop- or snap-on assembly of the shank with the receiver either prior to or after implantation of the shank into a vertebra. The shank and receiver once assembled cannot be disassembled. A uni-planar assembly is included.

Devices, systems and methods for use in spinal surgeries. The system may include a fastener system comprising a fastener, a staple, and a locking cap. A cord may extend along the spine and through at least one fastener system. An instrument may be provided for tensioning the cord. The system may, for example, apply fixation on the convexity of the scoliotic vertebrae to limit growth on the convex side and allow unilateral growth on the concave side.