Patent Publication Number: US-2016242819-A1

Title: Spinal implant system and method

Description:
TECHNICAL HELD 
     The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical system and method for correction of a spine disorder. 
     BACKGROUND 
     Spinal pathologies and disorders such as scoliosis and other curvature abnormalities, kyphosis, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, 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 deformity, pain, nerve damage, and partial or complete loss of mobility. 
     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 correction, fusion, fixation, discectomy, laminectomy and implantable prosthetics. Correction treatments used for positioning and alignment may employ implants, such as vertebral rods, bone screws and sub-laminar wire, for stabilization of a treated section of a spine. This disclosure describes an improvement over these prior art technologies. 
     SUMMARY 
     In one embodiment, a spinal construct comprises a member extending between a first end and a second end defining an opening configured for movement of the first end therethrough and disposal of the longitudinal member about spinal tissue. A malleable element is disposed with the first end. In some embodiments, systems and methods are disclosed. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present disclosure will become more readily apparent from the specific description accompanied by the following drawings, in which: 
         FIG. 1  is a perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 2  is a side view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 3A  is a cross section view of the components shown in  FIG. 2 ; 
         FIG. 3B  is a cross section view of the components shown in  FIG. 2 ; 
         FIG. 4  is a perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 5  is a perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 6  is a perspective view of the components shown in  FIG. 2 ; 
         FIG. 7  is a plan view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 8  is a plan view of the components shown in  FIG. 7  with parts separated; 
         FIG. 9  is a plan view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 10  is a plan view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 11  is a break away plan view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure: 
         FIG. 12  is a break away plan view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 13  is a break away plan view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 14  is a break away plan view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 15  is a perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 16  is a perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 17  is a perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 18  is a break away plan view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 19  is a break away plan view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 20  is a break away perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 21  is a break away perspective view of the components and vertebrae shown in  FIG. 20 ; 
         FIG. 22  is a break away perspective view of the components and vertebrae shown in  FIG. 20 ; 
         FIG. 23  is a break away perspective view of the components and vertebrae shown in  FIG. 20 ; 
         FIG. 24  is a break away perspective view of the components and vertebrae shown in  FIG. 20 ; 
         FIG. 25  is a perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 26  is a perspective view of the components shown in  FIG. 25  with parts separated; 
         FIG. 27  is a cross section view of the components shown in FIG,  25 ; 
         FIG. 28  is a side view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 29  is a side view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 30  is a cross section view of the components shown in  FIG. 29 ; 
         FIG. 31  is a side view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 32  is a side view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 33  is a side view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 34  is a perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; and 
         FIG. 35  is a perspective view of the components shown in  FIG. 34 . 
     
    
    
     DETAILED DESCRIPTION 
     The exemplary embodiments of a surgical system and related methods of use are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of a surgical system and method for correction of a spine disorder. In some embodiments, the surgical system may be employed in applications for correction of deformities, such as scoliosis and kyphosis. 
     In some embodiments, the surgical system includes a spinal implant including a connector and a tether attached to a front portion of the connector. In one embodiment, the surgical system includes a set screw configured to apply a force to the spinal rod and the tether. In one embodiment, the set screw is configured to apply a force to the spinal rod causing the spinal rod to translate over the tether and fix the tether to the connector at two separate locking surfaces and/or points of contact. In one embodiment, the surgical system includes a tether having a loop that is configured for attachment to the connector and a loop configured for attachment with laminae. 
     In one embodiment, the surgical system includes a connector having two or more planar surfaces, such as, for example, flats and/or even surfaces configured to engage and/or retain the spinal rod. In one embodiment, the flats and/or even surfaces provide two or more separate locking surfaces and/or points of contact to facilitate gripping of a spinal rod. In one embodiment, the flats and/or even surfaces define one or more reliefs configured to prevent a spinal rod from undesirably engaging and/or pinching a tether at a sharp edge such that the tether is damaged and/or cut. In one embodiment, the connector includes four locking surfaces and/or points of contact with a spinal rod to facilitate fixation of the spinal rod and the tether with the connector. 
     In one embodiment, the surgical system includes a two piece connector. In one embodiment, the two piece connector facilitates clearance of a spinal rod. In one embodiment, the two piece connector includes a round edge and/or pin for attachment with a tether. 
     In some embodiments, the surgical system includes a connector configured for disposal of a spinal rod and a tether such that the spinal rod compresses the tether between the spinal rod and the connector to form a rigid connection by tightening of a set screw with the connector. In some embodiments, the surgical system includes a connector that allows for simultaneous contact of a spinal rod to the connector and is configured as a damp for a tether. In some embodiments, an angle of tether openings and contact areas can be varied during manufacture. 
     In one embodiment, the surgical system includes a multi-piece connector that includes a cover plate and fasteners. In one embodiment, the cover plate is configured to cover slots in the connector to facilitate capture of a tether. In one embodiment, the cover plate is attached to the connector during manufacture. In one embodiment, the surgical system includes a connector body having a threaded throughhole for a set screw, an upper tether slot, a middle portion to receive a spinal rod and a lower tether slot. In some embodiments, the surgical system is employed with a method that includes the steps of threading a tether from a top of the connector, into a middle portion of the connector and through a lower slot of the connector and passed out a bottom opening of the connector. In some embodiments, the method includes the steps of looping the tether around the spine, such as, for example, laminae and threading the tether in a reverse manner from the bottom of the connector. In one embodiment, the method includes the steps of looping a tether around the spine and ends of the tether are threaded into the connector through a lower tether slot, through a mid-portion of the connector and through an upper tether slot. 
     In one embodiment, the surgical system includes a set screw configured to capture a spinal rod by pressing the spinal rod against a tether such that tether presses against a portion of a wall of a connector. In one embodiment, a spinal rod is pressed against a second portion of a wall of a connector to rigidly capture the spinal rod and a tether to the connector. In one embodiment, the set screw provisionally fixes a tether allowing the tether to translate within slots in a connector for tensioning. 
     In one embodiment, the surgical system includes a connector having a first slot and a second slot disposed at a relative angular orientation. In some embodiments, the slots are disposed in an orientation to vary an amount of rod to connector body contact and tether to connector body contact. In some embodiments, the first and second slots are not in an in-line alignment or parallel relative to each other. In some embodiments, this configuration facilitates manufacture by cutting slots from a side portion of the connector and a cover plate is configured to cover an open side of the connector to capture the tether. 
     In one embodiment, the surgical system includes a sub-laminar tether configured for attachment with laminae and secures a vertebral body to a spinal rod, In some embodiments, an end of the tether, such as, for example, a paddle is configured for being passed safely and effectively about vertebrae. In some embodiments, the sub-laminar tether includes a malleable insertion paddle with a silicone coating. In some embodiments, the paddle may include an engagement element, such as, for example, a hole, knot or loop configured for attachment to a surgical instrument or nerve hook to engage the tether once passed under laminae. 
     In some embodiments, the tether includes a malleable insert configured to slide into the tether. In some embodiments, the malleable insert allows for flexibility and facilitates shaping and contouring. In some embodiments, the tether includes a metal insert attached to the tether via stitching, adhesive or heat sealing. In some embodiments, an end of the tether is coated with silicone to facilitate passage through patient anatomy. In some embodiments, the silicone coating is colored. 
     In some embodiments, the surgical system includes a tether that allows passing of the tether under the lamina without compromising the dura. In one embodiment, a magnetic tether paddle is provided to facilitate capture of the tether without using an invasive instrument. In one embodiment, a magnet is disposed with the tether paddle and connected with an instrument containing a ferro-magnetic metal. In one embodiment, the instrument includes a magnet and the tether paddle includes a ferro-magnetic metal. In one embodiment, the surgical system is employed with a method including the steps of passing the tether under laminae, positioning the instrument near a tip of the paddle, capturing the paddle with the instrument and pulling the paddle through an intervertebral space without interfering with the dura. 
     In some embodiments, the surgical system includes a connector that can be configured to selectively position an intersection of the tether slots relative to the contact surfaces in the throat of the connector to select the amount of surface contact area of the rod and the tether with the connector. In some embodiments, the intersection position is selectively oriented to affect system performance as the connector tightens the tether to prevent the tether from slipping and facilitates gripping the rod to resist and/or prevent the components of the system from slipping along the rod. In some embodiments, an increased surface contact area of the components results in an increased gripping performance between the components of the system. 
     In some embodiments, the surgical system includes a connector having a slot for disposal of the tether centrally positioned along a flat surface allowing surface contact with the tether and the rod. In some embodiments, the slot is disposed at a back edge of a flat surface allowing for rod contact and no tether contact. 
     In some embodiments, the surgical system includes a connector having a slot positioned along an upper portion of a flat surface providing for more tether surface contact and no rod contact. In some embodiments, the surgical system includes a connector having a slot disposed along an upper portion of a flat surface allowing for tether contact surface and a slot disposed along a bottom flat surface oriented to allow for more tether contact surface area and less rod contact. 
     In some embodiments, the surgical system is used with surgical navigation, such as, for example, fluoroscope or image guidance. In one embodiment, one or all of the components of the spinal implant system are disposable, peel-pack, pre-packed sterile devices. One or all of the components of the surgical system may be reusable. The surgical system may be configured as a kit with multiple sized and configured components. 
     In one embodiment, the present disclosure may be employed to treat spinal disorders such as, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor and fractures. In one embodiment, the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. In some embodiments, the disclosed surgical system and methods may be alternatively employed in a surgical treatment with a patient in a prone, supine position, lateral and/or employ various surgical approaches to the spine, including anterior, posterior, posterior mid-line, direct lateral, postero-lateral, and/or antero-lateral approaches, and in other body regions. The present disclosure may also be alternatively employed with procedures for treating the lumbar, cervical, thoracic, sacral and pelvic regions of a spinal column. The system and methods of the present disclosure may also be used on animals, bone models and other non-living substrates, such as, for example, in training, testing and demonstration. 
     The present disclosure may be understood more readily by reference to the following detailed description of the embodiments taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this application is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting. Also, in some embodiments, as used in the specification and including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” or “approximately” one particular value and/or to “about” or “approximately” another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. It is also understood that all spatial references, such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure. For example, the references “upper” and “lower” are relative and used only in the context to the other, and are not necessarily “superior” and “inferior”. 
     As used in the specification and including the appended claims, “treating” or “treatment” of a disease or condition refers to performing a procedure that may include administering one or more drugs to a patient (human, normal or otherwise or other mammal), employing implantable devices, and/or employing instruments that treat the disease, such as, for example, micro discectomy instruments used to remove portions bulging or herniated discs and/or bone spurs, in an effort to alleviate signs or symptoms of the disease or condition. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, treating or treatment includes preventing or prevention of disease or undesirable condition (e.g., preventing the disease from occurring in a patient, who may be predisposed to the disease but has not yet been diagnosed as having it). In addition, treating or treatment does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes procedures that have only a marginal effect on the patient. Treatment can include inhibiting the disease, e.g., arresting its development, or relieving the disease, e.g., causing regression of the disease. For example, treatment can include reducing acute or chronic inflammation; alleviating pain and mitigating and inducing re-growth of new ligament, bone and other tissues; as an adjunct in surgery; and/or any repair procedure. Also, as used in the specification and including the appended claims, the term “tissue” includes soft tissue, ligaments, tendons, cartilage and/or bone unless specifically referred to otherwise. 
     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 exemplary embodiments of the present disclosure, which are illustrated in the accompanying figures. Turning to  FIGS. 1-6 , there are illustrated components of a surgical system, such as, for example, a spinal implant system  10 . 
     The components of spinal implant system  10  can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics and bone material and/or their composites. For example, the components of spinal implant system  10 , individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade  5  titanium, super-elastic titanium alloys, cobalt-chrome alloys, stainless steel alloys, superelastic metallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUM METAL® manufactured by Toyota Material Incorporated of Japan), ceramics and composites thereof such as calcium phosphate (e.g., SKELITE™ manufactured by Biologix Inc.), thermoplastics such as polyaryletherketone (PAEK) including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO 4  polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers, elastomeric composites, rigid polymers including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone material including autograft, allograft, xenograft or transgenic cortical and/or corticocancellous bone, and tissue growth or differentiation factors, partially resorbable materials, such as, for example, composites of metals and calcium-based ceramics, composites of PEEK and calcium based ceramics, composites of PEEK with resorbable polymers, totally resorbable materials, such as, for example, calcium based ceramics such as calcium phosphate such as hydroxyapatite (HA), corraline HA, biphasic calcium phosphate, tricalcium phosphate, or fluorapatite, tri-calcium phosphate (TOP), HA-TCP, calcium sulfate, or other resorbable polymers such as polyaetide, polyglycolide, polytyrosine carbonate, polycaroplaetohe and their combinations, biocompatible ceramics, mineralized collagen, bioactive glasses, porous metals, bone particles, bone fibers, morselized bone chips, bone morphogenetic proteins (BMP), such as BMP-2, BMP-4, BMP-7, rhBMP-2, or rhBMP-7, demineralized bone matrix (DBM), transforming growth factors (TGF, e.g., TGF-4), osteoblast cells, growth and differentiation factor (GDF), insulin-like growth factor 1, platelet-derived growth factor, fibroblast growth factor, or any combination thereof. 
     Various components of spinal implant system  10  may 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 system  10 , 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 system  10  may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein. 
     Spinal implant system  10  comprises a spinal implant, such as, for, example, a connector  12 . Connector  12  includes a body  14  having a surface  16  that defines a cavity, such as, for example, an opening  18  configured for disposal of a member, such as, for example, a tether  20 , as described herein. In some embodiments, opening  18  may have various cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, surface  16  may include gripping elements or surfaces, such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured to facilitate engagement with tether  20 . 
     Body  14  includes a surface  22  that includes extensions  24   a,    24   b,  Extensions  24   a,    24   b  define a cavity, such as, for example, an opening  26  configured for disposal of tether  20 . In some embodiments, opening  26  is disposed in alignment with opening  18 . In some embodiments, opening  26  is disposed offset or staggered from opening  18 . In some embodiments, opening  18  may have various cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, surface  22  may include gripping elements or surfaces, such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured to facilitate engagement with tether  20 . 
     Extension  24   a  includes a surface  28  that defines a cavity  30 . Cavity  30  is configured to receive a pin  32 , as described herein. Extension  24   b  includes a surface  34  that defines a cavity  36 . Cavity  36  is aligned with cavity  30 . Cavity  36  is configured to receive pin  32 , as described herein. 
     Pin  32  extends between an end  38  and an end  40 . End  38  is disposed with cavity  30  and end  40  is disposed with cavity  36 . Pin  32  has a cylindrical configuration and includes a surface  42  configured for attachment with tether  20 , as described herein. In some embodiments, pin  32  may have alternate cross section configurations, such as, for example, oval, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. 
     Body  14  includes a surface  50  that defines a passageway  52 . Passageway  52  has an oblong configuration and extends through body  14 . In some embodiments, passageway  52  may have alternate cross section configurations, such as, for example, oval, cylindrical, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. Passageway  52  is configured for disposal of a longitudinal element, such as, for example, a spinal rod  54 , as described herein, such that connector  12  can be mounted with spinal rod  54 , as described herein. 
     Surface  50  includes a wall  60  comprising a plurality of adjacent planar surfaces. Wall  60  includes a planar surface, such as, for example, a flat  62 . Flat  62  defines an engagement surface and/or a lock surface  68  such that, with tether  20  disposed between spinal rod  54  and flat  62 , spinal rod  54  is translated into engagement with tether  20 . Spinal rod  54  engages tether  20  with flat  62  to fix tether  20  with connector  12  via compressive forces, applied at least in the direction shown by arrows A in  FIGS. 3A and 3B . In some embodiments, the compressive forces applied adjacent surface  68  may be directed in various orientations, such as, for example, perpendicular, transverse and/or at angular orientations, such as acute or obtuse. 
     Wall  60  includes a planar surface, such as, for example, a flat  64  disposed adjacent flat  62 . Fiat  64  defines an engagement surface and/or a lock surface  70  such that, with tether  20  disposed between spinal rod  54  and flat  64 , spinal rod  54  is translated into engagement with tether  20 . Spinal rod  54  engages tether  20  with flat  64  to fix tether  20  with connector  12  via compressive forces, applied at least in the direction shown by arrows B in  FIGS. 3A and 38 . In some embodiments, the compressive forces applied adjacent surface  70  may be directed in various orientations, such as, for example, perpendicular, transverse and/or at angular orientations, such as acute or obtuse. 
     Wall  60  includes a planar surface, such as, for example, a flat  66  disposed adjacent flat  64 . Flat  66  defines an engagement surface and/or a lock surface  72  such that, with tether  20  disposed between spinal rod  54  and flat  66 , spinal rod  54  is translated into engagement with tether  20 . Spinal rod  54  engages tether  20  with flat  66  to fix tether  20  with connector  12  via compressive forces, applied at least in the direction shown by arrows C in  FIGS. 3A and 3B . In some embodiments, the compressive forces applied adjacent surface  72  may be directed in various orientations, such as, for example, perpendicular, transverse and/or at angular orientations, such as acute or obtuse. In some embodiments, surface  50  may include gripping elements or surfaces, such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured to facilitate engagement. In some embodiments, wall  60  includes a single planar surface. In some embodiments, wall  60  includes a combination of planar and arcuate surfaces. 
     In some embodiments, wall  60  defines a plurality of cavities between and adjacent flats  62 ,  64 ,  66  that prevent spinal rod  54  from undesirably engaging and/or pinching tether  20 . Wall  60  includes a cavity, such as, for example, an arcuate relief  80  disposed adjacent flat  62 . Relief  80  is recessed from surface  50  such that damage to tether  20  is resisted and/or prevented during engagement of tether  20  between spinal rod  54  and wall  60 . Wall  60  includes a cavity, such as, for example, an arcuate relief  82  disposed adjacent and between flats  62 ,  64 . Relief  82  is recessed from surface  50  such that damage to tether  20  is resisted and/or prevented during engagement of tether  20  between spinal rod  54  and wall  60 . Wall  60  includes a cavity, such as, for example, an arcuate relief  84  disposed adjacent and between flats  64 ,  66 . Relief  84  is recessed from surface  50  such that damage to tether  20  is resisted and/or prevented during engagement of tether  20  between spinal rod  54  and wall  60 . In some embodiments, wall  60  can include one or more reliefs. 
     Body  14  includes a mating surface  90  that defines cavities, such as, for example, mating capture elements  91  configured to mate with a surgical instrument (for example, as shown in  FIG. 16 ) to facilitate implant and manipulation of connector  12  and/or components of spinal implant system  10 . In some embodiments, spinal implant system  10  may include one or a plurality of implant connectors spaced apart and disposed along spinal rod  54 , which may be relatively disposed in a side by side, irregular, uniform, non-uniform, offset and/or staggered orientation or arrangement, along one or a plurality of spinal rods. In some embodiments, spinal rod  54  extends along one or a plurality of vertebra, as described herein, In some embodiments, spinal implant system  10  may include one or a plurality of spinal rods  54 , which may be relatively disposed in a side by side, irregular, uniform, non-uniform, offset and/or staggered orientation or arrangement. 
     Body  14  includes a surface  92  that defines a cavity, such as, for example, an opening  94 . Surface  92  is threaded and configured for disposal of a locking dement, such as, for example, a set screw  96 . Set screw  96  extends between an end  98  and an end  100 . End  98  is configured for engagement with a surgical instrument. In one embodiment, end  98  includes a hexagonal geometry configured for engagement with a similarly shaped tool, such as, for example, a driver. In some embodiments, end  98  has a cruciform, phillips, square, hexalobe, polygonal or star cross sectional configuration for disposal of a correspondingly shaped portion of a driver. End  100  includes a surface  102  configured for engagement with spinal rod  54 . Surface  102  is tapered for engaging spinal rod  54 . In some embodiments, as set screw  96  translates through opening  94 , surface  102  translates spinal rod  54  into engagement with tether  20  to fix spinal rod  54  and tether  20  with connector  12 , as described herein. 
     Set screw  96  is disposable between a non-locking orientation, as shown in  FIG. 3A , such that spinal rod  54  and/or tether  20  are translatable relative to body  14  and a locked orientation, as shown in  FIG. 3B , such that surface  102  translates spinal rod  54  into engagement with tether  20  to fix tether  20  with body  14 . Engagement of surface  102  with spinal rod  54  at an engagement surface and/or a lock surface  103  causes translation of spinal rod  54  into engagement with tether  20 , Tether  20  is compressed between spinal rod  54  and wall  60  including flats  62 ,  64 ,  66 , as described herein, such that spinal rod  54  and tether  20  are locked and/or disposed in a fixed orientation with body  14  and relative to connector  12 . In some embodiments, reliefs  80 ,  82 ,  84  prevent spinal rod  54  from pinching and/or cutting tether  20 . 
     Tether  20  is a flexible longitudinal element that extends between an end  106  and an end  108 , as shown in  FIG. 5 . Tether  20  is configured for engagement with connector  12 , as described herein. In some embodiments, end  106  and end  108  form a loop  110  configured to surround all or a portion of tissue, such as, for example, laminae and/or spinal rod  54 , as described herein. Tether  20  is configured for tensioning about a targeted portion of an anatomy of a body for attachment of tether  20  with the targeted portion of the anatomy, as described herein. In some embodiments, the targeted portion of the anatomy may include laminae, transverse process and/or pedicle regions of a vertebral level. In some embodiments, spinal implant system  10  may include one or a plurality of tethers  20 , each tether being configured for disposal about a single and separate vertebral level. In some embodiments, a single vertebral level may include one or a plurality of tethers  20 . 
     Tether  20  has a flexible configuration and may be fabricated from materials, such as, for example, fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers and elastomeric composites. In one embodiment, the flexibility of tether  20  includes movement in a lateral or side to side direction and prevents expanding and/or extension in an axial direction upon tensioning and attachment with a targeted portion of the anatomy. In some embodiments, all or only a portion of tether  20  may have a semi-rigid, rigid or elastic configuration, and/or have elastic properties, similar to the material examples described above, such that tether  20  provides a selective amount of expansion and/or extension in an axial direction. In some embodiments, tether  20  may be compressible in an axial direction. Tether  20  can include a plurality of separately attachable or connectable portions or sections, such as bands or loops, or may be monolithically formed as a single continuous element. 
     Tether  20  can have a uniform thickness/diameter. In some embodiments, tether  20  may have various surface configurations, such as, for example, smooth and/or surface configurations to enhance fixation, such as, for example, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. In some embodiments, the thickness defined by tether  20  may be uniformly increasing or decreasing, or have alternate diameter dimensions along its length. In some embodiments, tether  20  may have various cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, the surface of tether  20  may include engaging structures, such as, for example, barbs, raised elements and/or spikes to facilitate engagement with tissue of the targeted anatomy. 
     In some embodiments, tether  20  may have various lengths. In some embodiments, tether  20  may be braided, such as a rope, or include a plurality elongated elements to provide a predetermined force resistance. In some embodiments, tether  20  may be made from autograft and/or allograft, and be configured for resorbable or degradable applications. In one embodiment, tether  20  is a cadaver tendon. In one embodiment, tether  20  is a tendon that may be harvested, for example, from a patient or donor. In some embodiments, a tendon harvested from a patient may be affixed in remote locations with the patient&#39;s body. 
     In one embodiment, as shown in  FIGS. 4-6 , end  106  includes a loop  112  having an inner surface that defines an opening  114 . An end most portion of end  106  is folded, wrapped and/or bent to connect with the surface of tether  20  to form loop  112 . Opening  114  is configured for disposal of pin  32  such that tether  20  is attached with pin  32  and connector  12 . In one embodiment, loop  114  is monolithically formed with end  106 . In one embodiment, end  106  is stitched to a portion of tether  20  to form loop  112 . In one embodiment, end  106  is connected to the surface of tether  20  with adhesive to form loop  112 . In some embodiments, connector  12  is employed during a surgical treatment with tether  20  pre-attached. In some embodiments, end  106  and/or end  108  include non-looped, free ends. 
     In some embodiments, as shown in  FIGS. 7-10 , a tether  120 , similar to tether  20  described herein, includes an inner surface  122  that defines a cavity  124 . Cavity  124  is configured for disposal of a metal insert  126 , which is slid into tether  120  to form a malleable tether  120  such that tether  120  can be deformed into one or a plurality of alternate selected configurations. As such, tether  120  can be passed and/or guided through cavities defined by spinal tissue. As such, tether  120  resists and/or prevents non-desirable and/or harmful engagement with selected and/or sensitive anatomy of the spinal tissue. In some embodiments, insert  126  is attached to tether  120  via stitching  128 , as shown in  FIG. 9 . In some embodiments, insert  126  is attached to tether  120  via adhesive and/or heat sealing. In one embodiment, as shown in  FIG. 11 , malleable tether  120  includes a malleable lead, such as, for example, a paddle  123  that can be deformed and/or contoured into one or a plurality of alternate selected configurations so that tether  120  can be passed and/or guided through cavities defined by spinal tissue. 
     In some embodiments, paddle  123  includes a malleable configuration such that paddle  123  can be passed and/or guided through cavities of spinal tissue to resist and/or prevent non-desirable and/or harmful engagement with selected and/or sensitive anatomy of the spinal tissue. In some embodiments, paddle  123  is configured for manipulation with a surgical instrument. In some embodiments, paddle  123  is soft and flexible and configured to pass through a sub-laminar cavity of vertebrae without adhering to dura matter of a spinal cord and/or surfaces of a lamina of a vertebral level. In some embodiments, all or only a portion of paddle  123  is fabricated from a low-friction material, such as, for example, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers and elastomeric composites. In some embodiments, all or only a portion of paddle  123  is fabricated from a semi-rigid, rigid or elastic configuration and/or have elastic properties, such as the elastic properties corresponding to the material examples described above. In some embodiments, all or only a portion of paddle  123  is fabricated from a material having a durometer in the range of approximately 30 A to 60 A under the ASTM D2240 type A scale. In one embodiment, paddle  123  comprises silicone having a durometer of 30 A to 60 A. 
     Paddle  123  includes an outer surface having an average surface roughness such that paddle  123  can be passed through the cavities of the spinal tissue and resist and/or prevent non-desirable and/or harmful adherence with selected and/or sensitive anatomy of the spinal tissue, for example, a lamina of a vertebral level and/or the dura matter. In some embodiments, all or only a portion of the surface of paddle  123  has an average surface roughness in a range of approximately 4 to 32 micro inches. In some embodiments, all or only a portion of the surface of paddle  123  has an average surface roughness in a range of approximately 4 to 16 micro inches. In some embodiments, all or only a portion of the surface of paddle  123  contacts spinal tissue, such as, for example, a lamina of a vertebral level and/or dura matter of a spinal cord, and the coefficient of kinetic friction of the surface of paddle  123  is in a range of approximately 0.04-0.50, such that the surface of paddle  123  slides along selected and/or sensitive anatomy of the spinal tissue with minimal resistance, adherence and/or sticking to the lamina and/or dura matter. 
     In some embodiments, paddle  123  has a length of approximately 40 mm to 60 mm so that paddle  123  can be passed under lamina of a particular vertebral level, In some embodiments, paddle  123  includes a tip having a blunt shape to resist and/or prevent non-desirable and/or harmful engagement with selected and/or sensitive anatomy of the spinal tissue. In some embodiments, paddle  123  has an arcuate configuration. In some embodiments, paddle  123  can have various shape configurations, such as, for example, oval, oblong, polygonal, irregular, uniform, non-uniform, variable and/or tapered. 
     In some embodiments, paddle  123  includes a substantially uniform thickness. In some embodiments, paddle  123  is variously shaped, such as, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. In some embodiments, paddle  123  may have various cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable, tubular and/or tapered. 
     In some embodiments, paddle  123  includes a cavity configured for disposal of a longitudinal member, such as, for example, tether  120 . In one embodiment, paddle  123  is permanently molded with tether  120 . In some embodiments, paddle  123  is detachably or removably engaged with tether  120 . In some embodiments, paddle  123  can be variously connected with tether  120 , such as, for example, monolithic, integral connection, frictional engagement, threaded engagement, mutual grooves, screws, adhesive, nails, barbs and/or raised element. 
     In some embodiments, paddle  123  includes a uniform width. In one embodiment, paddle  123  has a width of approximately 6 mm. In some embodiments, paddle  123  includes a substantially even face and being oriented in a first direction and a substantially even face and being oriented in a second direction opposite the first direction. In some embodiments, paddle  123  has a substantially uniform thickness along its length. In some embodiments, the thickness of paddle  123  may be non-uniform, uniformly increasing or uniformly decreasing. In some embodiments, paddle  123  has a thickness of approximately 2 mm. In some embodiments, one of the faces of paddle  123  is concavely curved and the opposite faces is convexly curved such that paddle  123  is arcuate along its length. In some embodiments, paddle  123  has an arcuate configuration having a radius of curvature. In some embodiments, paddle  123  has a radius of curvature in a range of approximately 20 mm to 100 mm. In some embodiments, tether  120  is substantially flexible relative to paddle  123 . 
     In one embodiment, as shown in  FIG. 12 , all or only a portion of a tether  220 , similar to tether  20  described herein, includes a coating  222 . In some embodiments, coating  222  may include polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers and/or elastomeric composites. In some embodiments, coating  222  includes visual indicia, such as, for example, coloration for identification during selection, a treatment and/or to facilitate manipulation. 
     In one embodiment, as shown in  FIG. 13 , a tether  320 , similar to tether  20  described herein, includes a paddle  322  having an opening  324  configured for connection to a portion of tether  320 , a separate tether and/or spinal implant, and/or a surgical instrument. In some embodiments, opening  324  connects with a surgical instrument, such as, for example a nerve hook. In one embodiment, as shown in  FIG. 14 , tether  320  includes a knot  326  configured for connection to a portion of tether  320 , a separate tether and/or spinal implant, and/or a surgical instrument. In one embodiment, as shown in  FIG. 15 , tether  320  includes a loop  328  configured for connection to a portion of tether  320 , a separate tether and/or spinal implant, and/or a surgical instrument. 
     In assembly, operation and use, spinal implant system  10 , similar to the systems and methods described herein, is employed with a surgical procedure, such as, for example, a correction treatment of an affected portion of a spine, for example, a correction treatment to treat adolescent idiopathic scoliosis and/or Scheuermann&#39;s kyphosis of a spine. In some embodiments, one or all of the components of spinal implant system  10  can be delivered or implanted as a pre-assembled device or can be assembled in situ. Spinal implant system  10  may be completely or partially revised, removed or replaced. 
     In use, to treat a selected section of vertebrae V, as shown in  FIG. 16 , 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, spinal implant system  10  can 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 a 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 the spine disorder. 
     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 spinal implant system  10 . 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. 
     Tether  20  is attached with connector  12 , as described herein. Loop  112  is connected with pin  32 . Connection of tether  20  with pin  32  causes tether  20  to extend from opening  26 . Tether  20  is delivered along the surgical pathway to a surgical site adjacent vertebrae V. Tether  20  is disposed with vertebrae V and threaded with the openings and passageways of connector  12 , as described herein, to capture selected spinal tissue of vertebrae V. 
     In one embodiment, loop  110  is disposed about a transverse process of a vertebra V 2  by passing end  108  continuously about the transverse process. End  108  is inserted into opening  26  to form loop  110 . Loop  110  is fixed and/or attached with the transverse process and/or lamina. Tether  20  is threaded through opening  26 , passageway  52  and opening  18 . Spinal rod  54  is disposed with passageway  52  such that tether  20  is disposed between spinal rod  54  and wall  60 , as described herein, and reduced with connector  12  to vertebrae V. Set screw  96  is engaged with opening  94 . End  98  is engaged with a surgical instrument, such as, for example, a driver to advance set screw  96  into opening  94  in a non-locking orientation, as described herein, such that tether  20  is translatable relative to body  14  to tension tether  20  about vertebra V 2 . 
     A surgical instrument, such as, for example, a tensioner T is disposed adjacent connector  12 . Tensioner T is aligned and engaged with mating capture elements  91  for releasable fixation and/or provisional fixation of tensioner T with connector  12 . Tensioner T is actuated to tension tether  20  about vertebra V 2  for connecting spinal rod  54  with vertebrae V. In some embodiments, the tension and/or tensile force applied to tether  20  and/or corrective forces applied to vertebrae V can be increased and/or decreased by tensioner T. 
     As set screw  96  is rotated for translation to a locked orientation, as described herein, such that surface  102  engages spinal rod  54 . Surface  102  translates spinal rod  54  into engagement with tether  20 , which is disposed between spinal rod  54  and wall  60 . Tether  20  is compressed between spinal rod  54  and wall  60  including flats  62 ,  64 ,  66 , as described herein, such that spinal rod  54  and tether  20  are locked and/or disposed in a fixed orientation with body  14  and relative to connector  12  adjacent vertebra V 2 . Reliefs  80 ,  82 ,  84  prevent spinal rod  54  from pinching and/or cutting tether  20 . This configuration tensions tether  20  about vertebra V 2  and tensions the spinal construct for attachment with vertebrae V and/or to apply corrective treatment to vertebrae V. 
     In some embodiments, spinal implant system  10  includes a second spinal rod (not shown) delivered along the surgical pathway to the surgical site adjacent a contra-lateral side of vertebrae V. The second spinal rod is connected with the contra-lateral side of vertebrae V via one or more tethers  20 , similar to spinal rod  54  described herein. Spinal rod  54  and the second spinal rod are fixed with vertebrae V in a side by side orientation and/or a bi-lateral arrangement to stabilize vertebrae V and affect growth for a correction treatment to treat spine pathologies, as described herein. 
     Upon completion of the procedure, the surgical instruments, assemblies and non-implanted components of spinal implant system  10  are removed from the surgical site and the incision is closed. One or more of the components of spinal implant system  10  can be made of radiolucent materials such as polymers. Radiomarkers 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 system  10 . 
     In some embodiments, spinal implant system  10  includes an agent, which may be disposed, packed, coated or layered within, on or about the components and/or surfaces of spinal implant system  10 . In some embodiments, the agent may include bone growth promoting material, such as, for example, bone graft to enhance fixation of the bone fasteners with 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. 
     In some embodiments, the components of spinal implant system  10  may be employed to treat progressive idiopathic scoliosis with or without sagittal deformity in either infantile or juvenile patients, including but not limited to prepubescent children, adolescents from 10-12 years old with continued growth potential, and/or older children whose growth spurt is late or who otherwise retain growth potential. In some embodiments, the components of spinal implant system  10  may be used to prevent or minimize curve progression in individuals of various ages. 
     In some embodiments, as shown in  FIGS. 17-19 , paddle  322  includes a magnet  330 . Paddle  322  is employed with a surgical instrument  334 , as shown in  FIG. 19 , for guiding tether  320  during a surgical treatment, as described herein. In some embodiments, paddle  322  is disposed with cavities of spinal tissue, for example, adjacent laminae. Surgical instrument  334  includes a ferro-magnetic portion  332  that is disposed adjacent paddle  322  and magnetically attracts magnet  330  to draw paddle  322  via magnetic attraction along a selected pathway adjacent the spinal tissue. As such, paddle  322  is selectively drawn through tissue so that tether  320  can be passed and/or guided through cavities defined by spinal tissue. Surgical instrument  334  draws paddle  322  along the selected pathway such that non-desirable and/or harmful engagement of tether  320  with selected and/or sensitive anatomy of the spinal tissue is resisted and/or prevented. 
     In use, as shown in  FIGS. 20-24 , spinal implant system  10  including tether  320  having magnet  330 , similar to the systems and methods described herein, is employed with a surgical procedure, as described herein. For example, as shown in  FIGS. 20 and 21 , paddle  322  including magnet  330  is passed under a lamina L of vertebrae V. Portion  332  is positioned adjacent the tip of paddle  322  including magnet  330 , as shown in  FIG. 22 . Portion  332  magnetically attracts magnet  330  into contact and instrument  334  captures paddle  322 , as shown in  FIG. 23 . Instrument  334  draws paddle  322  and tether  320  through an intervertebral space I of vertebrae V, as shown in  FIG. 24 . In some embodiments, paddle  322  includes a ferro-magnetic metal portion and surgical instrument  334  includes a magnet. 
     In one embodiment, as shown in  FIGS. 25-28 , spinal implant system  10 , similar to the systems and methods described herein, comprises a connector  412 , similar to connector  12  described herein. Connector  412  includes a body  414  having a surface  416  that defines a cavity, such as, for example, an opening  418  configured for disposal of tether  20 , as described herein. 
     Body  414  includes a surface  422  that defines a cavity, such as, for example, an opening  426  configured for disposal of tether  20 . Opening  418  is oriented at an angle a relative to opening  426 , as shown in  FIG. 27 . In some embodiments, angle a can be altered to vary the amount of spinal rod  54  to connector  412  contact and/or tether  20  to connector  412  contact. In some embodiments, angle a may include an angle in a range of 0 through 270 degrees. 
     Body  414  includes a surface  450  that defines a passageway  452 . Passageway  452  has an oblong configuration and extends through body  414 . Passageway  452  is configured for disposal of spinal rod  54 , as described herein, such that connector  412  can be mounted with spinal rod  54 , as described herein. 
     Surface  450  defines a wall  460 , similar to wall  60  described herein. Wall  460  includes planar surfaces, such as, for example, flats  462 ,  464 , similar to flats  62 ,  64  described herein. Body  414  includes a surface  492  that defines an opening  494 . Surface  492  is threaded and configured for disposal of a set screw  496 . Set screw  496  extends between an end  498  and an end  500 . End  498  is configured for engagement with a surgical driver. End  500  includes a lock surface  502  configured for engagement with spinal rod  54 . 
     Set screw  496  is disposable between a non-locking orientation such that tether  20  is translatable relative to body  414  and a locked orientation such that lock surface  502  of set screw  496  translates spinal rod  54  into engagement with tether  20  to selectively fix tether  20  with body  414 , similar to connector  12  described herein. 
     Body  414  includes a surface  504  that defines openings  506 . Openings  506  are configured for engagement with locking elements, such as, for example, fasteners  508 , as described herein. Openings  506  are disposed equidistant about surface  504 . In some embodiments openings  506  are disposed offset and/or staggered about surface  504 . 
     A capture element, such as, for example, a plate  510  includes a surface  512  aligned with a lateral surface  514  of body  414 . Plate  510  includes a wall  516  configured to align with wall  460 . Alignment of surfaces  512 ,  514  and walls  516 ,  460  forms connector  412 . Plate  510  includes a surface  518  that defines openings  520 . Openings  520  are configured to align with openings  506  for engagement with fasteners  508 . Plate  510  is configured to cover openings  418 ,  426  to fix tether  20  to body  414 . Each of fasteners  508  includes a head portion  530  and a shaft portion  532 . Shaft portion  532  is configured for disposal with openings  506 ,  520 . Head portions  530  engage plate  510  to secure plate  510  with body  414 . In some embodiments, plate  510  captures tether  20  with connector  414  such that tether  20  can be fixed with connector  412 , as described herein. In some embodiments, plate  510  is assembled with connector  412  during manufacture and prior to threading of tether  20  with body  414 , as described herein. 
     In use, as shown in  FIG. 28 , spinal implant system  10  including tether  20  and connector  412 , similar to the systems and methods described herein, is employed with a surgical procedure, as described herein. End  106  of tether  20  is threaded through opening  418  into passageway  452  and through opening  426  such that end  106  extends past surface  422  of opening  426 . End  106  is looped around lamina, as described herein, and then threaded in a reverse manner through opening  426 , through passageway  452  and through opening  418 . In some embodiments, tether  20  can be threaded through connector  412  in a reverse configuration. In some embodiments, connector  412  includes a pin, similar to pin  32  described herein, and tether  20  includes a loop, similar to loop  112  described herein, such that the tether loop is attached to connector  412  and tether  20  is connected with the lamina and threaded through opening  426 , passageway  452  and opening  418 . 
     Tether  20  extends past surface  416  of opening  418  for attachment to an instrument for tensioning of tether  20 , as described herein. Plate  510  captures tether  20  within openings  418 ,  426 . In some embodiments, body  414  includes mating capture elements, similar to mating capture elements  91  described herein, configured to mate with a surgical instrument, as described herein. 
     Set screw  496  is rotated for translation to a locked orientation, as described herein, such that surface  502  engages spinal rod  54 . Surface  502  translates spinal rod  54  into engagement with tether  20 , which is disposed between spinal rod  54  and wall  460 . Tether  20  is compressed between spinal rod  54  and wall  460  including flats  462 ,  464 , similar to that described herein, such that spinal rod  54  and tether  20  are locked and/or disposed in a fixed orientation with body  414  and relative to connector  412 . 
     In one embodiment, as shown in  FIGS. 29 and 30 , spinal implant system  10 , similar to the systems and methods described herein, comprises a connector  412   a,  similar to connector  412  described herein. Connector  412   a  includes a body  414   a  having an opening  418   a  configured for disposal of tether  20 , as described herein. Body  414   a  includes an opening  426   a  configured for disposal of tether  20 . Opening  418   a  is oriented at an angle α1 relative to opening  426   a,  as shown in  FIG. 30 . In some embodiments, angle α1 can be altered to vary the amount of spinal rod  54  to connector  412   a  contact and/or tether  20  to connector  412   a  contact. In some embodiments, angle α1 may include an angle in a range of 0 through 270 degrees. 
     Body  414   a  includes a surface  428  that defines an opening  430  configured for disposal of tether  20 . End  106  of tether  20 , as described herein, is folded, wrapped and/or bent to connect with surface  428 . End  106  includes a loop  112  having an inner surface that defines an opening  114 . Opening  114  is configured for disposal of surface  428  such that tether  20  is attached with connector  412   a.    
     Body  414   a  includes a surface  450   a  that defines a passageway  452   a.  Passageway  452   a  has an oblong configuration and extends through body  414   a.  Passageway  452   a  is configured for disposal of spinal rod  54 , as described herein, such that connector  412   a  can be mounted with spinal rod  54 , as described herein. 
     Surface  450   a  defines a wall  460   a,  similar to wall  60  described herein. Wall  460   a  includes planar surfaces, such as, for example, flats  462   a,    464   a,  similar to flats  62 ,  64  described herein. Body  414   a  includes a surface  492   a  that defines an opening  494   a.  Surface  492   a  is threaded and configured for disposal of a set screw  496   a,  similar to set screw  96 , described herein. 
     In one embodiment, as shown in  FIG. 31 , spinal implant system  10 , similar to the systems and methods described herein, comprises a connector  612 , similar to connector  412  described herein. Connector  612  includes a body  614  having a surface  616  that defines an opening  618  configured for disposal of tether  20 , as described herein. 
     Body  614  includes a surface  622  that defines an opening  626  configured for disposal of tether  20 . Opening  618  is oriented at an angle α2 relative to opening  626 . Body  614  includes a surface  628  that defines an opening  630  configured for disposal of tether  20 . End  106  of tether  20 , as described herein, is folded, wrapped and/or bent to connect with surface  628 . End  106  includes a loop  112  having an inner surface that defines an opening  114 . Opening  114  is configured for disposal of surface  628  such that tether  20  is attached with connector  612 . 
     Body  614  includes a surface  650  that defines a passageway  652 . Passageway  652  has an oblong configuration and extends through body  614 . Passageway  652  is configured for disposal of spinal rod  54 , as described herein, such that connector  612  can be mounted with spinal rod  54 , as described herein. 
     Surface  650  defines a wall  660 , similar to wall  60  described herein. Wall  660  includes planar surfaces, such as, for example, flats  662 ,  664 , similar to flats  62 ,  64  described herein. Opening  618  is disposed at a midpoint M of flat  662 . Positioning opening  618  at midpoint M provides surface contact with tether  20  and contact with spinal rod  54 . Opening  626  is positioned at a point P oriented towards a back edge of fiat  664 . Orienting opening  626  towards the back edge of flat  664  provides an increased surface contact with tether  20  and decreases the surface contact with spinal rod  54 . The intersection of openings  618 ,  626  with flats  663 ,  664  alters the surface contact area of spinal rod  54  and tether  20  to connector  612 . Increased surface contact between spinal rod  54  and tether  20  area facilitates gripping with connector  612 . 
     Set screw  696  is disposable between a non-locking orientation such that tether  20  is translatable relative to body  614  and a locked orientation to selectively fix tether  20  with body  614 , similar to connector  12  described herein. 
     In one embodiment, as shown in  FIG. 32 , spinal implant system  10 , similar to the systems and methods described herein, comprises a connector  712 , similar to connector  412  described herein. Connector  712  includes a body  714  having a surface  716  that defines an opening  718  configured for disposal of tether  20 , as described herein. 
     Body  714  includes a surface  722  that defines an opening  726  configured for disposal of tether  20 . Opening  718  is oriented at an angle α3 relative to opening  726 . Body  714  includes a surface  728  that defines an opening  730  configured for disposal of tether  20 . End  106  of tether  20 , as described herein, is folded, wrapped and/or bent to connect with surface  728  connector  612 . End  106  includes a loop  112  having an inner surface that defines an opening  114 . Opening  114  is configured for disposal of surface  728  such that tether  20  is attached with connector  712 . 
     Body  714  includes a surface  750  that defines a passageway  752 . Passageway  752  has an oblong configuration and extends through body  714 . Passageway  752  is configured for disposal of spinal rod  54 , as described herein, such that connector  712  can be mounted with spinal rod  54 , as described herein. 
     Surface  750  defines a wall  760 , similar to wall  60  described herein. Wall  760  includes planar surfaces, such as, for example, flats  762 ,  764 , similar to flats  62 ,  64  described herein. Opening  718  is disposed at a point P 1  of flat  762 . Point P 1  is oriented at an upper portion of flat  762  providing an increased surface contact with tether  20 . Opening  726  is positioned at a point P oriented towards a back edge of flat  764  to prevent surface contact with spinal rod  54 . 
     Set screw  796  is disposable between a non-locking orientation such that tether  20  is translatable relative to body  714  and a locked orientation to selectively fix tether  20  with body  614 , similar to connector  12  described herein. 
     In one embodiment, as shown in  FIG. 33 , spinal implant system  10 , similar to the systems and methods described herein, comprises a connector  812 , similar to connector  412  described herein. Connector  812  includes a body  814  having a surface  816  that defines an opening  818  configured for disposal of tether  20 , as described herein. 
     Body  814  includes a surface  822  that defines an opening  826  configured for disposal of tether  20 . Opening  818  is oriented at an angle α4 relative to opening  826 . Body  814  includes a surface  828  that defines an opening  830  configured for disposal of tether  20 . End  106  of tether  20 , as described herein, is folded, wrapped and/or bent to connect with surface  828 . End  106  includes a loop  112  having an inner surface that defines an opening  114 . Opening  114  is configured for disposal of surface  828  such that tether  20  is attached with connector  812 . 
     Body  814  includes a surface  850  that defines a passageway  852 . Passageway  852  has an oblong configuration and extends through body  814 . Passageway  852  is configured for disposal of spinal rod  54 , as described herein, such that connector  812  can be mounted with spinal rod  54 , as described herein. 
     Surface  850  defines a wall  860 , similar to wall  60  described herein. Wall  860  includes planar surfaces, such as, for example, flats  862 ,  864 , similar to flats  62 ,  64  described herein. Opening  818  is disposed at a point P 1  of flat  862 . Point P 1  is oriented at an upper portion of flat  862  providing an increased surface contact with tether  20 . Opening  826  is positioned at a point P 2  oriented towards a forward edge of flat  864  allowing for increased surface contact with tether  20 . 
     Set screw  896  is disposable between a non-locking orientation such that tether  20  is translatable relative to body  814  and a locked orientation to selectively fix tether  20  with body  814 , similar to connector  12  described herein. 
     In one embodiment, as shown in  FIGS. 34 and 35 , spinal implant system  10 , similar to the systems and methods described herein, comprises a connector  912 , similar to connector  12  described herein. Connector  912  includes a body  914  having a surface  916  that defines an opening  918  configured for disposal of a member, such as, for example, a tether  20 , as described herein. 
     Body  914  includes a surface  922  that defines an opening  924  configured for disposal of tether  20 . A portion of surface  922  includes a groove, such as, for example, a cutout  928 . Cutout  928  is configured to provide a flush engagement between tether  20  and surface  922  when tether  20  is disposed with opening  924 . 
     Body  914  includes a surface  930  that defines a passageway  932 . Passageway  932  has an oblong configuration and extends through body  914 . Passageway  932  is configured for disposal of a longitudinal element, such as, for example, a spinal rod  54 , such that connector  912  can be mounted with spinal rod  54 , as described herein. 
     Surface  930  includes a wall  960  comprising a plurality of adjacent planar surfaces. Wall  960  includes planar surfaces, such as, for example, flats  962 ,  964 ,  966 , similar to flats  62 ,  64 ,  66  described herein. Flats  962 ,  964 ,  966  define an engagement surface and/or a lock surface  968 . In some embodiments, wall  960  defines a plurality of cavities between and adjacent flats  962 ,  964 ,  966  that prevent spinal rod  54  from undesirably engaging and/or pinching tether  20 . Wall  60  includes a cavity, such as, for example, arcuate reliefs  980 ,  982 ,  984 , similar to arcuate reliefs  80 ,  82 ,  84  as described herein. 
     Body  914  includes a mating surface  990  that defines cavities, such as, for example, mating capture elements  991  configured to mate with a surgical instrument to facilitate implant and manipulation of connector  912  and/or components of spinal implant system  10 . Body  914  includes a surface  992  that defines an opening  994 . Surface  992  is threaded and configured for disposal of a set screw  96 , as described herein. 
     It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplification of the various embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.