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 screw assembly includes a receiver having a base defining a lower portion of a central bore, and an upper portion extending upward from the base to define a channel configured to receive an elongate rod. The upper portion further includes a guide and advancement structure proximate a top end configured for engagement with a closure top, and side outer surfaces with tool engagement grooves extending horizontally and circumferentially to the front and back faces of the receiver. The assembly further includes a shank having a head and an anchor portion configured for attachment to the bone, with the head being positionable into the central bore of the receiver with the shank extending downward through the lower opening. The lower opening is configured to provide for increased pivotal movement of the shank with respect to the receiver in at least one direction.

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.

An improved dynamic longitudinal connecting member includes a rod portion joined with a tensioned cord portion, for use in a medical implant assembly having at least two bone attachment structures, a spacer covering the join of the rod and cord portions and extending between the at least two bone attachment structures, a sleeve, a bumper and a cord blocker. The spacer and bumper are compressed. The cord portion is slidable with respect to at least one of the bone attachment members.

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 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, a down-loadable friction fit split retaining ring having inner and outer tangs 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.

An implantable growing rod assembly adapted to be secured along a length of a spine for treating deformities of the spine. The assembly includes a housing, a fixed rod extending along a longitudinal axis away from the housing, and an expansion rod extendible from the housing along the longitudinal axis. A driver assembly is fixed to the housing and adapted to translate the expansion rod along the longitudinal axis.

A pivotal bone screw assembly includes a receiver having a base defining a lower portion of a central bore, and a pair of upright arms extending upward from the base to define an open channel configured to receive an elongate rod. The uprights arms include opposed internal surfaces with a guide and advancement structure configured for engagement with a closure top, and side outer surfaces opposite the internal surfaces with tool engagement grooves extending horizontally and circumferentially to the front and back faces of the receiver. The assembly further includes a shank having a head and an anchor portion configured for attachment to the bone, with the head being positionable into the central bore of the receiver with the shank extending downward through the lower opening. The lower opening is configured to provide for increased pivotal movement of the shank with respect to the receiver in at least one direction.

A pivotal bone anchor assembly includes a receiver having upright arms defining an channel for receiving an elongate rod and an axial bore extending downward from the channel to a bottom opening, and a shank having an anchor portion and an integral upper portion that is positionable in the axial bore with the shank extending downward through the bottom opening. The upright arms include break-off extensions and outer horizontally extending tool engagement grooves. The assembly further includes an insert positionable within the axial bore and into an overlapping engagement with a downward-facing abutment surface that is configured to inhibit movement of the insert.

A method of assembling a pivotal bone anchor assembly includes positioning a retaining structure into a central bore of a receiver having a planar seating surface above a lower opening, the retaining structure being operably slidably coupled with the planar seating surface and having a central opening, the receiver including upright arms defining an open channel configured to receive a rod and exterior surfaces comprising opposite cylindrical upper side surfaces defining a first width and opposite lower side surfaces below the upper side surfaces defining a second width. The method also includes positioning a partially spherical head of a shank into the central opening of the retaining structure, with the retaining structure being slidably movable along the planar seating surface of the receiver to provide for increased articulated movement between the shank and the receiver in at least one direction relative to a vertical centerline axis of the receiver prior to locking the assembly with a closure.