A coupling device for coupling a rod to a bone anchoring element includes a receiving part with a head receiving portion for receiving a head of the bone anchoring element, a rod receiving portion for receiving the rod, a downwardly facing surface, and an upwardly facing surface below and monolithically formed with the downwardly facing surface, and a locking member movable relative to the receiving part from a first position where the head is insertable into the head receiving portion to a second position where the head is prevented from being removed from the head receiving portion. At least part of the locking member is held to the receiving part between the downwardly and upwardly facing surfaces, and wherein the receiving part and the locking member are only separable from one another by permanently deforming or damaging at least one of the receiving part or the locking member.

A load sensing assembly for a spinal implant includes a set screw having a central opening that extends from a first end of the set screw toward a second end of the set screw. The second end of the set screw is configured to engage with an anchoring member. The load sensing assembly includes an antenna, an integrated circuit in communication with the antenna, where the integrated circuit is positioned within the central opening of the set screw, and a strain gauge in connection with the integrated circuit. The strain gauge is located within the central opening of the set screw in proximity to the second end of the set screw.

A device may include an outer sleeve with a hollow interior, and an inner sleeve with a hollow interior to couple axially and slidingly. The outer sleeve may include an outer central body, an outer proximal end part and an outer distal end part integrally connected to one another, and an outer channel extending along the entire outer proximal end part and along a substantial portion of the outer central body. The inner sleeve may include an inner central body, an inner proximal end part and an inner distal end part integrally connected to one another, and an inner channel extending along the entire inner proximal end part and along a substantial part of the inner central body. The inner sleeve may include, in the inner proximal end of the inner sleeve, a lateral engagement element, and an axial engagement element for releasably engaging a surgical screw.

Bone implants and stabilizing rod coupling assemblies to secure a stabilizing rod relative to the bone implant. Bone implants may include a radially recessed collet receiving region that includes a proximal end with an undercut ledge configuration that is sized and configured to interface with and couple to a collet of a tulip assembly.

Interspinous process spacing devices and associated methods are provided. In one embodiment, an interspinous process spacing device includes a first attachment side, a second attachment side, and a spacer. The first attachment side and the second attachment side each include a central portion, a first wing portion, and a second wing portion. The central portion includes an inner surface extending along at least a majority of an anterior-posterior height of the central portion, and the first wing portion includes an inner surface extending along at least a majority of an anterior-posterior height of the first wing portion. The inner surface of the first wing portion extends in a direction transverse to the inner surface of the central portion, and the anterior-posterior height of the first wing portion is less than the anterior-posterior height of the central portion.

A surgical instrument having a first member being engageable with a fastener. A second member includes an expandable portion configured for capturing the fastener. A third member is engageable with the expandable portion to releasably capture the fastener. An actuator connected with the second member and the third member. The actuator includes a threaded inner surface and a threaded coupling member engageable with the threaded inner surface to facilitate axial translation of the second member relative to the third member. Systems, spinal constructs, implants and methods are disclosed.

Surgical tissue retraction systems and methods are described herein. Such systems and methods can be employed in some embodiments to provide medial-lateral tissue retraction to increase access to a surgical site. In one embodiment, a surgical instrument can include a body configured to couple to an implantable anchor, a first tissue manipulating implement coupled to the body and capable of polyaxial movement relative thereto, and a second tissue manipulating implement coupled to the body and capable of polyaxial movement relative thereto. Further, the first and second tissue manipulating implements can be opposed to one another such that they can move any of toward and away from one another.

A method comprises the steps of: fixing a distal end of a first member of a surgical instrument with tissue, the surgical instrument including a second member having a longitudinal passageway configured for disposal of the first member and being connected with a navigation component such that the distal end is disposable with the passageway at a selected distance from the navigation component, the navigation component being positioned relative to a sensor to communicate a signal representative of an orientation of the first member; removing the second member from the first member; and connecting a third member with the first member along the orientation such that a distal end of the third member is fixed with the tissue. Systems, spinal implants, constructs and instruments are disclosed.

Robotic systems and methods include a robotic manipulator and a skin incision tool to be coupled to the robotic manipulator and being configured to create an incision in skin of a patient. A skin tracker is attached to the skin of the patient to track the skin of the patient. A robotic controller controls the robotic manipulator to move the skin incision tool relative to a determined location on the skin of the patient. The robotic controller controls the robotic manipulator to constrain movement of the skin incision tool with a haptic object defined relative to the determined location to guide the skin incision tool to the determined location for making the incision in the skin.

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.