Spinal implant system and method

An interspinous implant comprises a first member and a second member. The members define a pathway. A third member is movable along the pathway relative to the first member and the second member. Systems and methods are disclosed.

TECHNICAL FIELD

The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical system that includes a spinal implant and method for treating a spine.

BACKGROUND

Spinal disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including pain, nerve damage, and partial or complete loss of mobility. For example, after a disc collapse, severe pain and discomfort can occur due to the pressure exerted on nerves and the spinal column.

Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes decompression, discectomy, laminectomy, laminoplasty, fusion, fixation and implantable prosthetics. For example, spinal stabilization treatments may employ implants, which may include interbody devices, plates and bone fasteners to stabilize vertebrae and facilitate healing. This disclosure describes an improvement over these technologies.

SUMMARY

In one embodiment, an interspinous implant is provided. The interspinous implant comprises a first member and a second member. The members define a pathway. A third member is movable along the pathway relative to the first member and the second member. In some embodiments, systems and methods are provided.

DETAILED DESCRIPTION

The exemplary embodiments of the surgical system and related methods of use disclosed are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of a surgical system including a spinal implant and a method for treating a spine. In some embodiments, the systems and methods of the present disclosure are employed with a spinal joint fusion, for example, with a cervical, thoracic, lumbar and/or sacral region of a spine. In some embodiments, the spinal implant includes an interbody device, interspinous implant and/or bone fasteners. In some embodiments, the systems and methods of the present disclosure are employed with decompression, discectomy, laminectomy, laminoplasty, fusion, fixation and implantable prosthetic procedures.

In some embodiments, the surgical system includes a spinal implant comprising a facet fixation interspinous process implant. In some embodiments, the surgical system includes a spinal implant comprising a fixation implant having a curved surface to conform to the spinous process and provide a stable implant. In some embodiments, the spinal implant includes openings for disposal of screws. In some embodiments, the screws are placed through the facet joints at angles that are stable and offer less risk to adjacent neural structures.

In some embodiments, the surgical system includes a spinal implant comprising an interspinous spacer having outer portions and an intermediate portion. In some embodiments, the surgical system includes a spinal implant comprising an interspinous spacer having outer portions and an intermediate, movable portion. In some embodiments, the intermediate portion is a central movable portion that is translatable relative to the outer portions. In some embodiments, the outer portions include screw holes. In some embodiments, the outer portions comprise wings that include screw holes. In some embodiments, the central portion of the implant is configured for translation in a cranial-caudal direction relative to the outer portions to conform to the patient anatomy at one or more vertebral levels. In some embodiments, one or more of the outer portions include a bump stop to resist and/or prevent the intermediate portion from sliding entirely out of the track of the outer portions. In some embodiments, a medial surface of each of the outer portions includes a groove disposed for clearance with an inferior lamina. In some embodiments, the intermediate portion mates with an inferior spinous process more posterior than the superior spinous process such that an inferior surface of the spacer does not project inside the spinal canal. In some embodiments, one or more of the outer portions include a mating element that matingly engages a mating element of the intermediate portion to resist and/or prevent non-desirable assembly orientation of the portions of the spinal implant.

In some embodiments, the surgical system includes a spinal implant comprising an anatomical curve and a bottom surface that is contoured to match and/or mate with anatomy. In some embodiments, the surgical system includes a spinal implant having a plate comprising an anatomical contour surface that engages flush with a patient anatomy to provide stability and an effective screw trajectory.

In some embodiments, the surgical system includes a spinal implant comprising a lamina notch. In some embodiments, the lamina notch facilitates engagement of the spinal implant with a spinous process/laminar intersection. In some embodiments, the spinal implant includes an inferior portion and/or a foot configured to provide stability when disposed with an inferior lamina. In some embodiments, the spinal implant comprises a superior notch of one or more of the member. In some embodiments, the spinal implant comprises a notch on a superior surface of the intermediate portion and an inferior notch that provide for stabilization and centering of the spinal implant with spinous processes.

In some embodiments, the surgical system includes a spinal implant comprising openings, such as, for example, screw holes. In some embodiments, the screw holes are disposed at an angular orientation. In some embodiments, the angular orientation is 40 degrees. In some embodiments, the screw holes comprise insertion holes. In some embodiments, the spinal implant includes a facet screw plate having a mating curvature. In some embodiments, the spinal implant includes a screw trajectory oriented through a facet and a pedicle. In some embodiments, the spinal implant comprises a trans-facet joint screw assembly, which includes at least one trans-facet screw trajectory. In some embodiments, the outer portions include one or more central holes for attachment with an implant inserter.

In some embodiments, the surgical system includes a spinal implant comprising a modular plate. In some embodiments, the plate includes a middle interspinous portion. In some embodiments, the interspinous portion is modular. In some embodiments, the plate is adjustable to conform to a patient anatomy. In some embodiments, the spinal implant includes a plurality of interspinous portions having alternate heights and widths to conform and/or adjust to a patient anatomy. In some embodiments, the interspinous portion is movable relative to the screw holes to accommodate a patient anatomy at different spinal levels. In some embodiments, the interspinous portion optimizes an implant plate height and width and the screw trajectory for each spinal level.

The following discussion includes a description of a surgical system and related methods of employing the surgical system in accordance with the principles of the present disclosure. Alternate embodiments are also disclosed. Reference is made in detail to the exemplary embodiments of the present disclosure, which are illustrated in the accompanying figures. Turning toFIGS. 1-5, there are illustrated components of a surgical system, such as, for example, a spinal implant system10.

Various components of spinal implant system10may have material composites, including the above materials, to achieve various desired characteristics such as strength, rigidity, elasticity, compliance, biomechanical performance, durability and radiolucency or imaging preference. The components of spinal implant system10, individually or collectively, may also be fabricated from a heterogeneous material such as a combination of two or more of the above-described materials. The components of spinal implant system10may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein. In one embodiment, a spinal implant, as described herein, may be formed substantially of a biocompatible metal, such as titanium and selectively coated with a bone-growth promoting material, such as HA. In one embodiment, a spinal implant, as described herein, may be formed substantially of a biocompatible polymer, such as PEEK, and selectively coated with a biocompatible metal, such as titanium, or a bone-growth promoting material, such as HA. In some embodiments, titanium may be plasma sprayed onto surfaces of the spinal implant to modify a radiographic signature of the spinal implant and/or improve bony ongrowth to the spinal implant by application of a porous or semi-porous coating of titanium.

Spinal implant system10may be employed, for example, with minimally invasive procedures, including percutaneous techniques, mini-open surgical techniques and/or open surgical techniques to deliver and introduce instrumentation and/or spinal implants, such as, for example, an interspinous implant at a surgical site within a body of a patient, which includes, for example, vertebrae. One or more of the components of surgical system10including an interspinous implant can be employed, for example, in decompression, discectomy, laminectomy, laminoplasty, fusion, fixation and implantable prosthetic procedures to treat patients suffering from a spinal disorder to provide stabilization and decompression. In some embodiments, one or more of the components of spinal implant system10is employed with a method for implanting an interspinous process spacer between two adjacent vertebrae, which includes introducing the interspinous spacer adjacent a superior and an inferior spinous processes.

Spinal implant system10includes an interspinous implant, such as, for example, a plate12. In some embodiments, plate12is modular and comprises end members, as described herein, to facilitate selective adjustability with a patient anatomy. In some embodiments, one or more of the components and/or portions of plate12may have various cross-section configurations, such as, for example, flat, cylindrical, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, one or more of the components and/or the overall geometry of plate12may have various configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. Plate12defines a longitudinal axis X1.

End member14includes a surface30that defines a slot32having an arcuate configuration. Slot32defines a portion of a pathway, such as, for example, a track34, as described herein. Slot32is configured for disposal of an intermediate member90, as described herein, and surface30is engageable with intermediate member90in a keyed connection. Surface30includes a retention member, such as, for example, opposing flanges36disposed along slot32and configured to engage a portion of intermediate member90to retain intermediate member90with end member14. As intermediate member90translates relative to end member14, flanges36retain intermediate member90with end member14.

End member14includes an inner surface40that defines opening42. In some embodiments, opening42is oriented along a direct facet-pedicle pathway44, as shown inFIGS. 9 and 10. In some embodiments, opening42is oriented along a direct posterior-anterior pathway. In some embodiments, opening42is oriented along a pathway aligned with a plane disposed in substantially parallel relation to a sagittal plane of vertebrae. Pathway44is configured for disposal of a fastener46, as described herein. In some embodiments, pathway44is disposed at an angular range a relative to axis X1, as shown inFIGS. 8 and 10. In some embodiments, angular range a includes an angle in a range of 0 to 40 degrees relative to axis X1.

Plate12includes an end member50, which includes an anterior surface52and a posterior surface54. Surface52is configured to engage tissue, such as, for example, vertebrae, as described herein. End member50includes a surface, such as, for example, an end surface56. In some embodiments, surface56includes an undulating profile. In some embodiments, surface56may have alternate configurations, such as, for example, arcuate, irregular, uniform, non-uniform, variable and/or tapered. Surface56extends between surfaces52,54.

End member50includes a surface66that defines a slot68having an arcuate configuration. Slot68defines a portion of track34. Slot68is configured for disposal of an intermediate member90, as described herein, and surface66is engageable with intermediate member90in a keyed connection. Slot68includes a retention member, such as, for example, opposing flanges70disposed along slot68and configured to engage a portion of intermediate member90to retain intermediate member90with end member50. As intermediate member90translates relative to end member50, flanges70retain intermediate member90with end member50.

End member50includes an inner surface72that defines opening74. In some embodiments, opening74is oriented along a direct facet-pedicle pathway76, as shown inFIGS. 9 and 10. In some embodiments, opening74is oriented along a direct posterior-anterior pathway. In some embodiments, opening74is oriented along a pathway aligned with a plane disposed in substantially parallel relation to a sagittal plane of vertebrae. In some embodiments, pathway76is disposed at an angular range a relative to axis X1, similar to pathway44.

Intermediate member90is configured for movable disposal within slots32,68along track34for selective adjustability of plate12with a patient anatomy and/or positioning for attachment and/or implantation with tissue. Track34facilitates translation of intermediate member90relative to end members14,50along a cranial-caudal trajectory, as shown by arrows A inFIG. 2, for selective adjustment to engage vertebrae and/or orient an openings42,74, as described herein. In some embodiments, intermediate member90is translatable relative to end members14,50to facilitate engagement with vertebrae, as described herein. In some embodiments, intermediate member90is translatable along track34in a range of slidable movement relative to end members14,50between a superior vertebral limit, as shown inFIG. 4, and an inferior vertebral limit, as shown inFIG. 5.

In some embodiments, intermediate member90is translatable along track34relative to openings42,74to facilitate engagement of fasteners46with vertebrae, such as, for example, facets/pedicles and accommodate variation in patient anatomies and/or different spinal levels of a patient. In some embodiments, end member14is movable relative to end member50and/or intermediate member90. In some embodiments, end member50is movable relative to end member14and/or intermediate member90.

Intermediate member90is configured to connect end member14with end member50to form a modular plate12to facilitate selective adjustability of plate12relative to adjacent vertebrae. In some embodiments, surgical system10comprises a kit including a plurality of alternate intermediate members90having varying width and/or height to facilitate engagement with varied patient anatomy. Intermediate member90includes an anterior surface92and a posterior surface94. Intermediate member90extends between an end96and an end98.

Surface94includes a protrusion100. Protrusion100extends between an end102and an end104. Protrusion100extends a distance from surface94and is configured for disposal between vertebrae, such as, for example, spinous process'. In some embodiments protrusion100comprises a handle to facilitate translation of intermediate member90and/or positioning of plate12.

End102includes a surface106engageable with vertebrae, such as, for example, a spinous process and/or a lamina/spinous process intersection. End104includes a surface108engageable with vertebrae, such as, for example, a spinous process and/or a lamina/spinous process intersection. End104includes an arcuate portion110engageable with vertebrae and contoured to a shape of a spinous process.

Intermediate member90includes an edge, such as, for example, a keyed portion112disposable with slot32during translation of intermediate member90relative to member14. Portion112includes an enlarged portion114that extends between ends96,98. Portion114is disposed with slot32and engageable with opposing flanges36in a movably locked orientation with member14to retain and prevent removal of intermediate member90from slot32during relative translation. Intermediate member90includes an edge, such as, for example, a keyed portion120disposable with slot68during translation of intermediate member90relative to member50. Portion120includes an enlarged portion122that extends between ends96,98. Portion122is disposed with slot68and engageable with opposing flanges70in a movably locked orientation with member50to retain and prevent removal of intermediate member90from slot68during relative translation.

Surfaces22,106,58define a cavity124. Cavity124is configured for disposal of vertebrae, such as, for example, a spinous process and/or a lamina/spinous process intersection. In some embodiments, cavity124is arcuate in shape. In some embodiments, cavity124may have alternate configurations, such as, for example, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, the configuration and dimension of cavity124is adjustable via translation of intermediate member90relative to end members14,50.

Surfaces24,108,60define a cavity128. Cavity128is configured for disposal of vertebrae, such as, for example, a spinous process and/or a lamina/spinous process intersection. In some embodiments, cavity128includes a trapezoid profile. In some embodiments, cavity128may have alternate configurations, such as, for example, angled, arcuate, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, the configuration and dimension of cavity128is adjustable via translation of intermediate member90relative to end members14,50.

Surfaces16,52,92define a tissue mating curvature130of plate12, as shown inFIG. 3. Curvature130includes a profile P1that matches and/or mates with a profile P2of vertebrae V. As such, curvature130is configured for selective engagement with vertebrae, such as, for example, a spinous process, lamina, tissue adjacent a lamina/spinous and/or tissue adjacent facet joints. In some embodiments, curvature130includes an undulating profile. In some embodiments, curvature130is adjustable via translation of intermediate member90relative to end members14,50.

For example, curvature130is contoured and engages flush with tissue to mate profile P1with profile P2of vertebrae V such that plate12conforms with the anatomy of adjacent facet joints FJ1, FJ2and/or other adjacent tissue. Curvature130facilitates stability between plate12and vertebrae. In some embodiments, curvature130may have alternate configurations, such as, for example, arcuate, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, profile P1mates with profile P2to provide stability and an effective screw trajectory.

In assembly, operation and use, surgical system10, similar to the systems and methods described herein, is employed to treat a selected section of vertebrae V, as shown inFIGS. 6-10. A medical practitioner obtains access to a surgical site including vertebrae V in any appropriate manner, such as through incision and retraction of tissues. In some embodiments, surgical system10can be used in any existing surgical method or technique including open surgery, mini-open surgery, minimally invasive surgery and percutaneous surgical implantation, whereby vertebrae V is accessed through a mini-incision, or sleeve that provides a protected passageway to the area. Once access to the surgical site is obtained, the particular surgical procedure can be performed for treating a spine disorder. In some embodiments, one or all of the components of surgical system10can be delivered or implanted as a pre-assembled device or can be assembled in situ. The components of surgical system10may be completely or partially revised, removed or replaced.

An incision is made in the body of a patient and a cutting instrument (not shown) creates a surgical pathway for implantation of components of surgical system10with a portion of vertebrae V including spinous process SP1, spinous process SP2, facet joint FJ1and facet joint FJ2. A preparation instrument (not shown) can be employed to prepare tissue surfaces of vertebrae V, as well as for aspiration and irrigation of a surgical region.

Pilot holes are made in vertebrae V1, V2for receiving fixation elements, such as, for example, fasteners46. Pilot holes are oriented along facet-pedicle pathways44,76, as described herein. Plate12, as described herein, is delivered and introduced to the surgical site adjacent spinous process SP1, spinous process SP2, facet joint FJ1and facet joint FJ2. Spinous process SP1is disposed with cavity124and spinous process SP2is disposed with cavity128.

Intermediate member90and end members14,50are slidably and selectively adjusted, as described herein, such that plate12conforms to the anatomy of spinous process SP1, spinous process SP2, facet joint FJ1and facet joint FJ2. Intermediate member90is translated relative to end members14,50along track34and a cranial-caudal trajectory, as shown by arrows A inFIG. 6.

Surface106engages spinous process SP1and surface108engages spinous process SP2. This configuration provides for selective adjustment of plate12to engage vertebrae and orient openings42,74, as described herein. Intermediate member90and end members14,50are slidably and selectively adjusted to align openings42,74with the pilot holes to accommodate variation in anatomy at different vertebral levels. Fasteners46are disposed with openings42,74and engaged with vertebrae V to fasten plate12with vertebrae V1, V2.

Upon selective orientation of plate12with the anatomy of spinous process SP1, spinous process SP2, facet joint FJ1and facet joint FJ2, curvature130engages flush with tissue to mate profile P1with profile P2, as described herein. Plate12conforms with the anatomy of spinous process SP1, spinous process SP2, facet joint FJ1and facet joint FJ2, and/or adjacent tissue.

In one embodiment, as shown inFIG. 11, spinal implant system10comprises a kit including a plurality of alternate interspinous implants comprising a plurality of modular plates12, similar to that described herein. The modular plates12can be of alternate configuration and dimension and include end members14,50described herein, and one of a plurality of alternately configured and dimensioned intermediate members90a,90b, similar to intermediate member90described herein. A superior oriented plate12includes intermediate member90ahaving a smaller width to conform with the anatomy of vertebrae V1, V2, similar to that described herein. An inferior oriented plate12includes intermediate member90bhaving a larger width to conform with the anatomy of vertebrae V2, V3, similar to that described herein.

In some embodiments, spinal implant system10can include one or a plurality of fasteners such as those described herein and/or fixation elements, which may be employed with a single vertebral level or a plurality of vertebral levels. In some embodiments, fasteners46may be engaged with vertebrae in various orientations, such as, for example, series, parallel, offset, staggered and/or alternate vertebral levels. In some embodiments, fasteners46may be configured as multi-axial screws, sagittal angulation screws, pedicle screws, mono-axial screws, uni-planar screws, fixed screws, anchors, tissue penetrating screws, conventional screws, expanding screws. In some embodiments, fasteners46may be employed with wedges, anchors, buttons, clips, snaps, friction fittings, compressive fittings, expanding rivets, staples, nails, adhesives, posts, connectors, fixation plates and/or posts.

In one embodiment, spinal implant system10includes an agent, which may be disposed, packed, coated or layered within, on, adjacent or about the components and/or surfaces of spinal implant system10, and/or disposed with tissue. In some embodiments, the agent may include bone growth promoting material, such as, for example, bone graft to enhance fixation of the components and/or surfaces of spinal implant system10with vertebrae. In some embodiments, the agent may include one or a plurality of therapeutic agents and/or pharmacological agents for release, including sustained release, to treat, for example, pain, inflammation and degeneration.

Upon completion of a procedure, as described herein, the surgical instruments, assemblies and non-implanted components of spinal implant system10are removed and the incision(s) are closed. One or more of the components of spinal implant system10can be made of radiolucent materials such as polymers. Radiopaque markers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. In some embodiments, the use of surgical navigation, microsurgical and image guided technologies may be employed to access, view and repair spinal deterioration or damage, with the aid of spinal implant system10.

In one embodiment, as shown inFIGS. 12-15, spinal implant system10, similar to the systems and methods described herein, includes a plate212, similar to plate12described herein. Plate212defines a longitudinal axis X2. Plate212includes an end member214, which includes an anterior surface216and a posterior surface218. Surface216is configured to engage spinous process SP1, spinous process SP2, facet joint FJ1, facet joint FJ2and/or adjacent tissue, similar to surface16described herein. End member214includes an end surface220that extends between surfaces216,218.

End member214includes a tissue engaging surface222engageable with spinous process SP1and extending between surfaces216,218. End member214includes a surface224configured for engagement with spinous process SP2. Surface224extends between surface216,218. In some embodiments, surfaces222,224may be rough, textured, porous, semi-porous, dimpled, knurled, toothed, grooved and/or polished to facilitate engagement with tissue.

End member214includes an inner surface240that defines an opening242, similar to opening42described herein, which is oriented along a pathway, similar to pathway44described herein.

Plate212includes an end member250, which includes an anterior surface252and a posterior surface254. Surface252is configured to engage spinous process SP1, spinous process SP2, facet joint FJ1, facet joint FJ2and/or adjacent tissue, similar to surface52described herein. End member250includes an end surface256that extends between surfaces252,254.

End member250includes a tissue engaging surface258engageable with spinous process SP1and extending between surfaces252,254. End member250includes a surface260configured for engagement with spinous process SP2and extending between surfaces252,254. In some embodiments, surfaces258,260may be rough, textured, porous, semi-porous, dimpled, knurled, toothed, grooved and/or polished to facilitate engagement with tissue.

End member250includes an inner surface272that defines opening274, similar to opening74described herein, which is oriented along a pathway, similar to pathway76described herein.

An intermediate member290connects and is monolithically formed with end members214,250. Intermediate member290includes an anterior surface292and a posterior surface294. Intermediate member290extends between an end296and an end298. Surfaces222,296,258define a cavity324. Cavity324is configured for disposal of spinous process SP1. Surfaces224,298,260define a cavity328. Cavity328is configured for disposal of spinous process SP2.

Surfaces216,252,292define a tissue mating curvature330, similar to curvature130described herein. Curvature330includes a profile that matches and/or mates with a profile of vertebrae V, as shown inFIG. 13. For example, curvature330is contoured and engages flush with tissue to mate with vertebrae V such that plate212conforms with the anatomy of adjacent facet joints FJ1, FJ2and/or other adjacent tissue. Curvature330facilitates stability between plate212and vertebrae. In some embodiments, curvature330includes an inferior portion and/or a foot configured to provide stability when disposed with an inferior lamina.

In one embodiment, as shown inFIGS. 16-18, spinal implant system10, similar to the systems and methods described herein, includes a plate412, similar to plate12described herein. In some embodiments, plate412is modular and comprises end members, as described herein, to facilitate selective adjustability with a patient anatomy. Plate412defines a longitudinal axis X3.

Plate412includes an end member414, which includes an anterior surface416and a posterior surface418. Surface416is configured to engage tissue, such as, for example, vertebrae, as described herein. End member414includes an end surface420. In some embodiments, surface420includes an undulating profile.

End member414includes a tissue engaging surface422engageable with vertebrae. End member414includes a surface424configured for engagement with tissue, such as, for example, a spinous process. In some embodiments, surface422and/or surface424can be disposed for clearance with an inferior lamina.

End member414includes a surface430that defines a slot432. Slot432defines a portion of a pathway, such as, for example, a track434, similar to track34, as described herein. Slot432is configured for disposal of an intermediate member490, as described herein. Surface430includes opposing flanges436disposed along slot432and configured to engage a portion of intermediate member490to retain intermediate member490with end member414. Surface430includes a protrusion, such as, for example, a bump stop438. In some embodiments, bump stop438resists and/or prevents intermediate member490from sliding entirely out of track434. In some embodiments, the protrusion may have various configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered.

End member414includes an inner surface440that defines an opening442, similar to opening42described herein, configured for disposal of a fastener, as described herein. End member414includes an inner surface444that defines a central opening446configured for engagement with a surgical instrument, such as, for example, an insertion tool to facilitate insertion of plate412with a surgical site.

Plate412includes an end member450, which includes an anterior surface452and a posterior surface454. Surface452is configured to engage tissue, such as, for example, vertebrae, as described herein. End member450includes an end surface456. In some embodiments, surface456includes an undulating profile.

End member450includes a tissue engaging surface458engageable with vertebrae. End member450includes a surface460configured for engagement with tissue, such as, for example, a spinous process. In some embodiments, surface458and/or surface460can be disposed for clearance with an inferior lamina.

End member450includes a surface466that defines a slot468. Slot468defines a portion of track434. Slot468is configured for disposal of intermediate member490, as described herein. Slot468includes opposing flanges470disposed along slot468and configured to engage a portion of intermediate member490to retain intermediate member490with end member450. Surface466includes a protrusion, such as, for example, a bump stop471, similar to stop438. In some embodiments, bump stop471resists and/or prevents intermediate member490from sliding entirely out of track434.

End member450includes an inner surface472that defines opening474, similar to opening74described herein, configured for disposal of a fastener, as described herein. End member450includes an inner surface476that defines a central opening478configured for engagement with a surgical instrument, such as, for example, an insertion tool to facilitate insertion of plate412into a surgical site.

Intermediate member490is configured for movable disposal within slots432,468along track434for selective adjustability of plate412with a patient anatomy and/or positioning for attachment and/or implantation with tissue, as described herein. Track434facilitates translation of intermediate member490relative to end members414,450along a cranial-caudal trajectory, as described herein, for selective adjustment to engage vertebrae and/or orient openings442,474, similar to that described herein. In some embodiments, intermediate member490is translatable relative to end members414,450to facilitate engagement with vertebrae, as described herein. In some embodiments, intermediate member490is translatable along track434in a range of slidable movement relative to end members414,450between a superior vertebral limit and an inferior vertebral limit, as described herein.

Intermediate member490is configured to connect end member414with end member450to form a modular plate412to facilitate selective adjustability of plate412relative to adjacent vertebrae, similar to that described herein. Intermediate member490includes an anterior surface492and a posterior surface494. Intermediate member490extends between an end496and an end498. In some embodiments, intermediate member490mates with an inferior spinous process more posterior than the superior spinous process such that an inferior surface of plate412does not project inside the spinal canal.

End496includes a surface500engageable with vertebrae, such as, for example, a spinous process and/or a lamina/spinous process intersection. End496includes a portion502engageable with vertebrae and contoured to a shape of a spinous process. End498includes a surface508engageable with vertebrae, such as, for example, a spinous process and/or a lamina/spinous process intersection. End498includes a portion510engageable with vertebrae and contoured to a shape of a spinous process. In some embodiments, portion502comprises a notch on a superior surface of intermediate member490and portion510comprises an inferior notch that provide for stabilization and centering of plate412with spinous processes.

Intermediate member490includes an edge, such as, for example, a keyed portion512, similar to portion112, disposable with slot432during translation of intermediate member490relative to member414. Intermediate member490includes an edge, such as, for example, a keyed portion520, similar to portion120, disposable with slot468during translation of intermediate member490relative to member450.

Surfaces422,500,458define a cavity524, similar to cavity124, configured for disposal of vertebrae, such as, for example, a spinous process and/or a lamina/spinous process intersection. Surfaces424,508,460define a cavity528. Cavity528is configured for disposal of vertebrae, such as, for example, a spinous process and/or a lamina/spinous process intersection. Surfaces416,452,492define a tissue mating curvature530, similar to cavity130, of plate412, as shown inFIG. 17. Curvature530includes a profile that matches and/or mates with a profile of vertebrae, as described herein.