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 s 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.

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 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 pivotal bone anchor assembly includes a receiver with an open channel configured to receive an elongate rod and a central bore having an inwardly protruding interference structure with a discontinuous annular upper surface. The assembly also includes a shank having a head positionable within the central bore and an anchor portion for fixation to the bone of a patient, and an insert positionable into the central bore in an initial position that is constrained from vertical movement in at least one direction by engagement between outer curvate side surfaces of the insert and the discontinuous annular upper surface. The insert is configured for forced downward displacement within the central bore by tooling from the initial position to a lower position in which the outer curvate side surfaces of the insert are wedged against the interference structure to inhibit the insert from moving back up within the central bore.

A tool set for implanting bone screws in a human spine, followed by the implantation of a longitudinal connecting member into the bone screws includes a pair of independently mountable and manipulatable elongate guide tools that form a unitary tool guide when desired. Each guide tool includes attachment structure for independent operable connection of the guide tool to an arm of the bone screw. The bone screw/guide tool attachment includes an undercut and/or recess so as to resist separation of the guide tool member from an attached bone screw. Further tools include a removable stabilizer, a cooperating bone screw driver with an attached stabilizer, a closure starter/reduction tool, a closure driver and a counter torque tool.

A pivotal bone anchor assembly includes a receiver having upright arms defining a receiver channel for receiving an elongate rod, and an axial bore extending downward from the receiver channel to a bottom opening. The upright arms include break-off extensions, outer horizontally extending curvate tool engagement grooves, and side apertures extending inwardly from outer surfaces of the upright arms to deformable crimp wall portions adjacent the axial bore. The assembly also includes a shank having an anchor portion and an integral upper portion that is positionable in the axial bore of the receiver with the shank extending downward through the bottom opening. The assembly further includes an insert with an insert channel positionable within the axial bore and having opposing depressions formed into side surfaces that are configured to cooperate with the crimp wall portions of the receiver to maintain the insert channel in alignment with the receiver channel.

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.

A pivotal uniplanar bone anchor assembly includes a shank having a shank head with a partial spherical shape at a proximal end and an anchor portion opposite the shank head for fixation to the bone of a patient. The assembly also includes a receiver having a top portion defining an open channel for receiving an elongate rod and a base defining a cavity in communication with the open channel and with a bottom surface of the receiver through a distal opening. The assembly further includes a retainer positionable into non-pivotal engagement with an inner surface of the cavity prior to the shank head being received within the cavity, with the retainer having a central passage configured to receive and support the shank head within the cavity while restricting pivotal motion between the shank and the receiver to a single plane.

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.

A tool set for implanting bone screws in a human spine, followed by the implantation of a longitudinal connecting member into the bone screws includes a pair of independently mountable and manipulatable elongate guide tools that form a unitary tool guide when desired. Each guide tool includes attachment structure for independent operable connection of the guide tool to an arm of the bone screw. The bone screw/guide tool attachment includes an undercut and/or recess so as to resist separation of the guide tool member from an attached bone screw. Further tools include a removable stabilizer, a cooperating bone screw driver with an attached stabilizer, a closure starter/reduction tool, a closure driver and a counter torque tool.