An instrument includes an outer sleeve and an inner sleeve positioned in the outer sleeve. The inner sleeve defines a cavity. The shaft extends through the inner sleeve and includes a drive. A latch is positioned in the cavity. An inner sheath extends through an outer sheath and has a proximal end positioned between the inner sleeve and the shaft and a distal end comprising a threaded surface. The proximal end of the inner sheath includes a groove. The inner sleeve is movable relative to the outer sleeve to move the instrument between a first orientation in which the latch is positioned in the groove and the sheaths are prevented from translating relative to the outer sleeve and a second orientation in which the latch is spaced apart from the groove and the sheaths are translatable relative to the outer sleeve. Systems, implants and methods are disclosed.

A pivotal bone anchor assembly includes a shank having an anchor portion and a head with a partially spherical outer surface, a drive socket, an annular planar top surface surrounding the drive socket, and a frusto-conical surface between the planar top surface and the partially spherical outer surface. The assembly further includes a receiver having a base defining an axial bore and an upper portion defining a channel configured to receive a rod, and an insert positionable within the axial bore having an upper surface engageable with the rod, a lower surface for transferring a downwardly-directed force toward the head, and a central aperture for accessing the drive socket, with the rod extending across the central aperture when the fixation rod is engaged by the upper surface. After the head, the insert, and the rod are positioned in the receiver, the frusto-conical surface remains spaced apart from the rod to provide for increased articulation of the shank relative to the receiver.

A dynamic stabilization assembly includes a core, typically in the form of a tensioned cord, at least one pair of bone anchors, a spacer surrounding the core located between the bone anchors, at least one elastic bumper and at least one fixing or blocking member. The core is slidable with respect to at least one of the bone anchors, the spacer and the bumper. The bumper is compressed. Bone screws of the assembly include closure structures that lock against the bone screw independent of any fixing or sliding of the core with respect to the bone screw.

A method comprises the steps of: imaging a patient anatomy; selecting an implant strategy for at least one bone fastener having a first member; registering the imaging of the patient anatomy with imaging of at least a portion of a robot; engaging the first member with tissue of the patient anatomy via robotic guidance according to the implant strategy; and subsequently, manipulating the patient anatomy. Systems, spinal constructs, implants and surgical instruments are disclosed.

A system for flexibly stabilizing a vertebral motion segment of the facet joint by connecting a first vertebra and a second vertebra is disclosed. The system includes an elongate connection element with end portions interconnected by a flexible coupling member. The system includes first and second attachment portions for connecting the connection element to the vertebrae. A first resilient member is positioned between the first end portion and the first attachment portion, and a second resilient member is positioned between the first attachment portion and the second attachment portion.

A bone fastener comprises a first member defining an implant cavity and a plurality of adjacent grooves. A first band is configured for disposal within the grooves. A second band is configured for disposal within the grooves. A second member is configured to penetrate tissue and includes a head engageable with the first band to provisionally connect the members. The second band is moveable for disposal adjacent the first band to fix connection of the members. Implants, systems, instruments and methods are disclosed.

An instrument includes an outer sleeve defining a passageway and extending along an axis between proximal and distal ends. A knob sleeve is positioned in the passageway and defines a bore and a sleeve cavity. A latch is positioned in the sleeve cavity. A shaft is positioned in the bore. An inner sleeve is positioned between the knob sleeve and the shaft. A proximal end of the inner sleeve defines a notch. The knob sleeve is movable relative to the outer sleeve to move the instrument between a first orientation in which the latch is positioned in the notch and the inner sleeve is prevented from translating along the axis and a second orientation in which the latch is spaced apart from the notch and the inner sleeve is translatable along the axis. Systems, implants and methods are disclosed.

A pivotal bone anchor assembly includes a receiver defining a cavity with an upper expansion region and a lower locking region, and a shank having a partial spherical head that is up-loadable into the cavity through a bottom opening. The assembly also includes a resiliently expandable retainer that is positionable within the upper expansion region with a discontinuous partial spherical internal surface and an inwardly facing surface above the discontinuous partial spherical internal surface, and a compression insert having a lower outwardly facing surface configured for side-to-side engagement with the inwardly facing surface and a downwardly facing partial spherical surface for frictionally engaging the head of the shank. The compression insert is positionable in overlapping engagement with the retainer within the receiver with the discontinuous partial spherical internal surface extending above and below a hemisphere of the head of the shank to capture the head within the retainer.

A pivotal bone anchor assembly includes a receiver having a cavity for receiving the head of a shank, a first channel for receiving an elongate rod, and an axial bore extending upward from a bottom opening of the receiver to a discontinuous thread adjacent a top of the receiver with opposed alignment members protruding inwardly beneath the discontinuous thread. The assembly also includes a pressure insert having a second channel for receiving the underside of the elongate rod, a lower surface for applying downward pressure on the shank head, and an outer cylindrical surface with opposite elongate recesses. The pressure insert is loaded into a first position within the axial bore and then rotated into a second position in which the opposed alignment members become positioned within the opposite elongate recesses to hold the second channel of the pressure insert in alignment with the first channel of the receiver.

A pivotal spinal fixation system includes bone anchors comprising capture portions having a partial spherical shape with flat side surfaces, multi-planar receivers with continuous interior circumferential engagement surfaces proximate their bottom openings, and uni-planar receivers with non-continuous interior circumferential engagement surface proximate their bottom openings. The system also includes circular retainers, each having a non-continuous outer circumferential surface configured for non-pivotal engagement with the interior circumferential engagement surfaces of both the multi-planar receivers and the uni-planar receivers, and an inner surface configured to expand and contract around the capture portion and flat side surfaces of a bone anchor so as to capture the bone anchor within a multi-planar or uni-planar receiver. The system provides for pivotal motion of the bone anchors in any of a plurality of angular directions relative to the vertical centerline axes of the multi-planar receivers while limiting pivotal motion to a single pivot plane relative to the vertical centerline axes of the uni-planar receivers.