One or more tethers for use with fastener assemblies and a method for use of the one or more tethers with the fastener assemblies is provided. The one or more tethers can be attached between a first fastener assembly positioned with respect to a first vertebrae adjacent a first side of a spinous process of a second vertebrae and a second fastener assembly positioned with respect to the vertebrae adjacent a second side of the spinous process of the second vertebrae. The one or more tethers can be tensioned against the spinous process of the second vertebrae to mitigate stresses on an uninstrumented level of the spine.

Implementations described herein may include a system for manipulating implants coupled by a cord. The system may include a tensioner and a counter tensioner. The tensioner may include a nose assembly and a cord lock assembly for applying tension to the cord. The nose assembly may include a piston having a lumen extending therethrough for receiving the cord and a spring positionable in contact with an indicator region of the piston. The counter may be releasably coupleable to a head of an implant at a proximal end thereof and may guide the cord to a port proximate the distal end thereof, the port for receiving the nose assembly. The counter tensioner may enable translation of the implant relative to another implant implanted in an adjacent or nearby vertebrae. The indicator region of the piston may be visible through a window in a tensioner main body and may indicate cord tension when the nose assembly of the tensioner is coupled to the port of the counter tensioner and engaged with the cord.

A system for securing a flexible member to a vertebra includes a flexible member, a fixation member, and an inserter. The flexible member includes two ends. The fixation member includes a head and a shank that defines a longitudinal axis of the fixation member. The head defines a slot that passes through the head orthogonal to the longitudinal axis. The slot receives a portion of the flexible member. The inserter includes a handle and a tubular member that has proximal and distal end portion. The proximal end portion is attached to the handle and the distal end portion extends from the handle. The tubular member defines a passage between the proximal and distal end portions. The distal end portion includes a couple for receiving the head of the fixation member with the portion of the flexible member received in the slot of the flexible member.

A method for treating a spine comprising the steps of: connecting at least one first fastener that defines an implant cavity with at least one vertebral level of a first portion of vertebrae; connecting at least one second fastener with at least one vertebral level of a second portion of the vertebrae; manipulating the vertebrae; manipulating a spinal rod to a selected configuration; connecting the spinal rod with the at least one first fastener such that the spinal rod is disposed at a selected position with the implant cavity; connecting a tether to a second fastener and the spinal rod; and reducing the spinal rod to a selected position relative to the second fastener with the tether. Systems, spinal constructs and surgical instruments are disclosed.

Methods for clamping a tether about a spinal or other anatomical feature. In some implementations, a tether may be extended in a loop around an anatomical feature of a spine. A spinal fixation rod may be coupled with an inner coupling piece of a clamping assembly, such as by way of a slot formed in the inner coupling piece. The inner coupling piece may be nestably coupled within an outer coupling piece of the clamping assembly. A first end of the tether may be passed through a passage of the clamping assembly, the passage being is at least partially defined by an outer surface of the inner coupling piece and an inner surface of the outer coupling piece. The loop may be tightened about the anatomical feature with the tether clamped between the inner coupling piece and the outer coupling piece.

A spinal construct comprises a member extending between a first end and a second end and includes a first layer and a second layer. The first layer includes a plurality of interlaced strands that define a first angle. The second layer includes a plurality of interlaced strands that define a second angle. The first angle is smaller than the second angle. Systems, implants, surgical instruments and methods are disclosed.

A spinal correction system includes a tensioning member and a fulcrum tensioner device including a housing defining a chamber having a biasing member therein and a camming pin operatively coupled with the biasing member. The tensioning member is configured to be received in the biasing member and looped around the camming pin, such that a first end of the tensioning member is oriented in a first direction and a second end of the tensioning member is oriented in a second direction. The camming pin is transitionable between an extended position in which the biasing member applies tension to the tensioning member and a retracted position in which the biasing member is compressed to inhibit application of tension to the tensioning member.

Methods and apparatus for coupling two or more bones together with a flexible connector.

A method of inserting a spinal stabilization system into a patient generally comprises inserting a first positioning tool through a first location on a patient's skin and along a path generally toward a first vertebral anchor, coupling an end of the first positioning tool to the first vertebral anchor, positioning at least a portion of a delivery device over a connecting element, and inserting the delivery device and the connecting element through the patient's skin at the first location and along at least a portion of the first positioning tool. The first positioning tool is configured to facilitate directing the delivery device and connecting element generally toward a second vertebral anchor within the patient's body.

Implantable devices for dynamic interconnection between bones, and especially between vertebrae. The devices provide for various types of manipulation of a flexible connection such as a tether, such as by providing an aperture through which the flexible connection is passed and guided, or a post to which a loop of the flexible connection can be attached, or a groove in which a loop of the flexible connection can be placed.