Patent Publication Number: US-10327913-B2

Title: Pivotable interbody implant system

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a divisional application of U.S. patent application Ser. No. 13/283,915, filed Oct. 28, 2011, which is incorporated herein by reference, in its entirety. 
    
    
     TECHNICAL FIELD 
     The present disclosure generally relates to medical devices, systems and methods for the treatment of musculoskeletal disorders, and more particularly to an interbody implant system and method that facilitates implant positioning for treating a vertebral column. 
     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 are 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 fusion, fixation, discectomy, laminectomy and implantable prosthetics. These treatments may employ interbody implants. This disclosure describes an improvement over these prior art technologies. 
     SUMMARY OF THE INVENTION 
     Accordingly, an interbody implant system and method is provided that facilitates implant positioning for treating a vertebral column. It is further contemplated that the implant system and method may be employed for an arthrodesis treatment using minimally invasive and percutaneous techniques. 
     In one embodiment, an interbody implant system is provided. The interbody implant system includes an implant having an engagement surface and an instrument including a first member and a second member that is movable relative to the first member. The first member is configured to capture the implant and the second member includes an interface configured to engage the engagement surface to releasably lock the implant in at least one orientation relative to the second member. The at least one of the engagement surface and the interface include at least one planar face. 
     In one embodiment, the interbody implant system includes an implant having a first end and a second end having an engagement surface including at least one planar face and a catch. An instrument extends between a first end and a second end. The instrument is movable relative to the first member. The first member includes a proximal end and a distal end. The distal end includes a capture surface configured to engage the catch. The capture surface is movable between an open position to release the catch and a closed position to capture the catch such that the implant is movable to a plurality of orientations. The second member includes a proximal end and a distal end. The distal end includes a planar interface configured to engage the at least one planar face of the engagement surface to releasably fix the implant relative to the distal end of the second member in one of the plurality of orientations between a first configuration such that the distal end of the second member is movable relative to the implant and a closed position to capture the catch such that the implant is movable relative to the second member to a plurality of orientations. 
     In one embodiment, the interbody implant system includes an implant including an engagement surface having a smooth arcuate configuration that defines a first radius of curvature. The system also includes an instrument having a first member and a second member that is movable relative to the first member. The first member is configured to capture the implant and the second member includes an interface having a smooth, arcuate configuration that defines a second radius of curvature. The second radius of the curvature is less than the first radius of curvature such that the interface engages the engagement surface in an interference fit to releasably lock the implant in at least one orientation relative to the second member. 
     In yet another embodiment, an interbody implant is provided having a body defining a longitudinal axis extending between a proximal end and a distal end. The proximal end including an inner surface having opposing transverse surfaces and defining an inner cavity having a proximal facing opening configured to receive an instrument. The proximal end further including a catch configured for disposal within the inner cavity and disposed in an orientation transverse to said longitudinal axis so that the catch is configured to be captured by the instrument. The proximal end of the interbody implant may also include opposing lateral faces that are disposed at an angular orientation relative to a longitudinal axis of the implant. The proximal end of the implant may also have at least one planar face that includes a proximal face disposed in a perpendicular orientation relative to a longitudinal axis of the implant, and a first lateral face that converges with the proximal face to form a first angle. The interbody implant may also have a second lateral face that converges with the proximal face to form a second angle, so that the implant is pivotable relative to the instrument via engagement of the instrument with at least one of said first and second angles. 
    
    
     
       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 an implant of a system in accordance with the principles of the present disclosure; 
         FIG. 2  is a perspective view of the implant shown in  FIG. 1  and a break away view of an instrument of the system; 
         FIG. 3  is a top, break away view of the instrument shown in  FIG. 2 ; 
         FIG. 4  is a perspective view of the instrument shown in  FIG. 2 ; 
         FIG. 5  is an enlarged side, cutaway view of the instrument shown in  FIG. 4 ; 
         FIG. 6  is a top, break away view of the implant and the instrument shown in  FIG. 2 ; 
         FIG. 7  is a top, break away view of the implant and the instrument shown in  FIG. 2 ; 
         FIG. 8  is a top, break away view of the implant and the instrument shown in  FIG. 2 ; 
         FIG. 9  is a top, break away view of an instrument in accordance with the principles of the present disclosure; 
         FIG. 10  is a top view of an implant in accordance with the principles of the present disclosure and a break away view of the instrument shown in  FIG. 2 ; 
         FIG. 11  is a top, break away view of an implant and an instrument in accordance with the principles of the present disclosure; 
         FIG. 12  is a top, break away view of an implant and an instrument in accordance with the principles of the present disclosure; 
         FIG. 13  is an enlarged detail view of the implant and instrument shown in  FIG. 12 ; 
         FIG. 14  is a perspective view an instrument implant and an instrument; 
         FIG. 15  is an enlarged side, cutaway view of the instrument shown in  FIG. 14 ; 
         FIG. 16  is a perspective view of an implant in accordance with the principles of the present disclosure; 
         FIG. 17  is a perspective view of the implant shown in  FIG. 16  and a break away view of an instrument of the system; 
         FIG. 18  is a cross-sectional perspective view of the implant and instrument shown in  FIG. 17 ; 
         FIG. 19  is a perspective view of the implant and instrument shown in  FIG. 17 ; 
         FIG. 20 . is a top view of the implant and a break away view of the instrument shown in  FIG. 17 ; 
         FIG. 21  is a side view of the implant and a break away view of the instrument shown in  FIG. 17 ; 
         FIG. 22  is a side view of the implant and a break away view of the instrument shown in  FIG. 17 ; 
         FIG. 23  is a break away perspective view of the implant and the instrument shown in  FIG. 17 ; 
         FIG. 24  is a perspective view of the implant and a break away perspective view of the instrument shown in  FIG. 17 ; 
         FIG. 25  is a side view of the implant and a side break away perspective view of the instrument shown in  FIG. 17 ; 
         FIG. 26  is a perspective view of an implant of a system in accordance with the principles of the present disclosure and a break away view of an instrument of the system; 
         FIG. 27  is a side view of a portion of the instrument shown in  FIG. 26 ; 
         FIG. 28  is a plan view of a portion of the instrument shown in  FIG. 26 ; 
         FIG. 29  is a cross-sectional perspective view of the instrument shown in  FIG. 26 ; and 
         FIG. 30  is a perspective view of the instrument shown in  FIG. 26 . 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The exemplary embodiments of the interbody implant 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 an interbody implant system that facilitates implant positioning for treating a vertebral column. It is envisioned that the interbody implant system, in general, may be employed for fusion and fixation treatments to provide decompression and/or restoration of lordosis. It is further envisioned that the interbody implant system and methods of use disclosed can be employed to obtain fusion of vertebrae through a minimally invasive or percutaneous technique. It is contemplated that the interbody implant is removable and/or may be repositioned. In one embodiment, the disclosed interbody implant system and methods of use can provide for manipulation of an interbody implant, which includes pivoting of the implant in an intervertebral space. In one embodiment, the system allows a practitioner to control the amount of pivot and relocate the implant after the implant is pivoted to a particular orientation. 
     It is envisioned that 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. It is contemplated that the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. It is further contemplated that the disclosed interbody implant system may be alternatively employed in a surgical treatment with a patient in a prone or supine position, and/or employ various surgical approaches to the spine, including anterior, posterior, posterior mid-line, medial, 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 and pelvic regions of a spinal column. The interbody implant 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 invention may be understood more readily by reference to the following detailed description of the invention taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this invention 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 of the claimed invention. Also, 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 “superior” and “inferior” are relative and used only in the context to the other, and are not necessarily “upper” and “lower”. 
     Further, 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 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 components of the interbody implant system can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics and bone material and/or their composites, depending on the particular application and/or preference of a medical practitioner. For example, the components of the interbody implant system, 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, super elastic 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, tri-calcium phosphate (TCP), hydroxyapatite (HA)-TCP, calcium sulfate, or other resorbable polymers such as polyaetide, polyglycolide, polytyrosine carbonate, polycaroplaetohe and their combinations. Various components of the interbody implant system 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 the interbody implant system, 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 following discussion includes a description of an interbody implant system and related methods of employing the interbody implant system in accordance with the principles of the present disclosure. Alternate embodiments are also disclosed. Reference will now be made in detail to the exemplary embodiments of the present disclosure, which are illustrated in the accompanying figures. Turning now to  FIGS. 1-29 , illustrated are components of an interbody implant system in accordance with the principles of the present disclosure. 
     As shown in  FIGS. 1-2 , the interbody implant system includes a spinal implant  30  employed as a stabilization device in fusion and fixation procedures, for example, for patients suffering from a spinal disorder to provide height restoration between vertebral bodies, decompression and/or restoration of lordosis. The components of the interbody implant system may be monolithically formed, integrally connected or include fastening elements and/or instruments, for example, as described herein. Implant  30  is configured to be inserted between adjacent vertebrae and includes a first end, such as proximal end  32 , and a second end, such as distal end  34 , opposite proximal end  32 , upper and lower surfaces  40 ,  42 , and side surfaces  44 ,  46 . Implant  30  has a height defined by the distance between upper and lower surfaces  40 ,  42  which is approximately the distance between two adjacent vertebrae and a width defined by the distance between proximal end  32  and distal end  34 . The width of implant  30  is approximately the width of at least one of the vertebrae implant  30  is positioned between. 
     Proximal end  32  includes a proximal face  36 , while distal end  34  includes a distal face  38 . Upper and lower surfaces  40 ,  42  are configured to interface with load bearing endplates of adjacent vertebrae, while side surfaces  44 ,  46 , proximal end  32  and distal end  34  extend between upper and lower surfaces  40 ,  42 . In one embodiment, proximal face  36  is planar while distal face  38  is convexly curved between upper and lower surfaces  40 ,  42  and is configured to allow at least a portion of distal face  38  to be inserted into a collapsed, undistracted disc space. However, it is envisioned that distal face  38  may also be pointed, planar or concavely curved between upper and lower surfaces  40 ,  42 . 
     Proximal end  32  includes at least one recess  54  disposed in a parallel orientation relative to transverse axis a. Recess  54  is sized and configured to receive at least a portion of an insertion instrument, such as instrument  130 . In addition to or alternatively to recess  54 , any other suitable structure or configuration for engagement by an insertion tool is contemplated, including one or more grooves, slots and/or holes in proximal end  32  that are threaded or unthreaded. In one embodiment, recess  54  is rectangular, however it is envisioned that recess  54  may have a polygonal shape including triangular, square, pentagonal, hexagonal, or may have a round or oval shape. 
     Recess  54  extends through side surfaces  44 ,  46 . However, it is envisioned that recess  54  may be disposed within proximal end  32  of implant  30  without extending through side surfaces  44 ,  46 , such that recess  54  is disposed between side surfaces  44 ,  46 . Alternatively, recess  54  may be disposed within proximal end  32  of implant  30  while extending through only side surface  44  or side surface  46  and terminating between side surfaces  44 ,  46 . Recess  54  is disposed equidistant between upper and lower surfaces  40 ,  42 , however, it is envisioned that recess  54  may be disposed in proximal face  36  such that the top of recess  54  is closer to upper surface  40  than the bottom of recess  54  is from lower surface  42 , or vice versa. Recess  54  has a depth extending longitudinally along longitudinal axis a 1  of implant  30  from proximal face  36  toward distal face  38  and terminates before distal face  38 . 
     Recess  54  may include a catch  56 , such as a cylindrical pin, which is configured to be captured by an instrument that facilitates positioning of spinal implant  30 , such as instrument  130 . In one embodiment, catch  56  is disposed through upper and lower surfaces  40 ,  42  in proximal end  32  of implant  30 . However, it is envisioned that catch  56  may also be disposed in proximal end  32  of implant  30  without extending through upper and lower surfaces  40 ,  42 . Alternatively, catch  56  may extend through upper surface  40  without extending through lower surface  42 , or catch  56  may extend through lower surface  42  without extending through upper surface  40 . In one embodiment, catch  56  is disposed in implant  30  in a perpendicular orientation relative to longitudinal axis a 1  of implant  30  such that implant  30  can be pivoted about catch  56  in an axial plane. Catch  56  is disposed a distance from proximal end  32  sufficient to allow an instrument, such as instrument  130 , to engage catch  56  of implant  30  and pivot implant  30  axially about catch  56 . Catch  56  is disposed equidistant between side surfaces  44 ,  46  such that catch  56  is the same distance from side surface  44  as side surface  46 . It is also envisioned that catch  56  may be positioned such that the catch is closer to side surface  44  than side surface  46 , or vice versa. Catch  56  is fabricated of a rigid material(s) such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, stainless steel alloys, man-made materials and combinations thereof that can withstand the torque associated with maneuvering implant  30 . 
     Implant  30  further includes at least one engagement surface  58  configured to engage the engaging portion of an insertion instrument, such as instrument  130 , to lock the rotation of implant  30  within instrument  130 . That is, once the instrument engages catch  56 , engagement surface  58  contacts the engaging portion of the instrument so as to prevent further pivoting of implant  30  about catch  56 . In one embodiment, engagement surface  58  includes at least a portion of proximal face  36  above and below recess  54 . Engagement surface  58  is planar and is disposed in a parallel orientation relative to transverse axis a of spinal implant  30 . Alternatively, as described further below, engagement surface  58  can be angled relative to transverse axis a. The size and shape of engagement surface  58  corresponds to the size and shape of the corresponding portion of instrument  130  that engages engagement surface  58 , further details of which will be provided below. 
     In one embodiment, side surfaces  44 ,  46  are parallel to one another and are both planar. However, it is envisioned that side surfaces  44 ,  46  may also be convexly curved between upper and lower surfaces  40 ,  42  and/or proximal end  32  and distal end  34  such that at least a portion of side surfaces  44 ,  46  have a rounded portion to facilitate insertion of implant  30  into a collapsed, undistracted disc at a variety of angles, leading with the rounded portion of side surfaces  44 ,  46 . 
     Upper and lower surfaces  40 ,  42 , side surfaces  44 ,  46 , proximal end  32  and distal end  34  include at least one aperture  48  that may receive anchor members for attachment of implant  30  to vertebrae, engage a surgical instrument and/or receive a bone graft. In one embodiment, aperture  48  is a cylindrical bore extending through side surfaces  44 ,  46  and is disposed in a parallel orientation relative to a transverse axis a of implant  30 . Aperture  48  may assume a variety of shapes depending upon the function of aperture  48 . For example, if aperture  48  is used to receive bone graft, aperture  48  may have a size and shape corresponding to the size and shape of the bone graft and/or an instrument used to insert the bone graft within aperture  48 . Aperture  48  may be oval, triangular, polygonal, square or rectangular, for example. 
     A hollow center  50  opening at upper and lower surfaces  40 ,  42  allows for placement of materials, such as bone growth materials, to promote bonding and/or fusion of implant  30  to adjacent vertebrae. In one embodiment, hollow center  50  has an oval shape and is disposed along the longitudinal axis a 1  of implant  30 . It is also envisioned that hollow center  50  may be disposed through side surfaces  44 ,  46  and may assume a variety of shapes depending upon, for example, the shape of the vertebrae implant  30  is inserted between and/or the type of material placed therein. That is, hollow center  50  may have a shape that corresponds to the shape of the vertebrae implant  30  is inserted between. Hollow center  50  may be in communication with aperture  48 . 
     Upper and lower surfaces  40 ,  42  of implant  30  include bone engaging features  52  configured to reduce slipping or movement relative to the vertebrae implant  30  is placed between. In one embodiment, bone engaging features  52  are on the entire area of upper and lower surfaces  40 ,  42 , but can also be provided on a portion of these surfaces. In one embodiment, bone engaging features  52  are angled teeth that permit introduction into the disc space, but also restrict removal. It is contemplated that bone engaging features  52  may include other features such as protrusions or keels, which may or may not restrict removal of implant  30 . It is further contemplated that the upper and lower surfaces  40 ,  42  of implant  30  may be free of bone engaging features  52 , such that the upper and lower surfaces  40 ,  42  of implant  30  are relatively smooth. In one embodiment, upper surface  40  includes bone engaging features  52  to engage an adjacent vertebra, while lower surface  42  is smooth to permit another of the adjacent vertebra to be moved along and in contact with the smooth surface of lower surface  42  as corrective forces are applied to manipulate the other of the adjacent vertebrae into alignment. 
     In addition to implant  30 , as mentioned above, the system of the present invention also includes instrument  130 . Instrument  130  is configured to engage implant  30 , pivot implant  30  relative to instrument  30 , lock implant  30  at a particular angle relative to instrument  130  and insert implant  30  at the desired angle. Instrument  130  includes a first member  132  and a second member  134  that is movable relative to first member  132 . Second member  134  is a sleeve configured to fit about first member  132  and has an opening in a distal end  144 . It is envisioned that first member  132  and/or second member  134  and may be rectangular, cylindrical or, in the alternative, and may have other cross section shapes such as square, hexagonal or octagonal, for example. 
     First member  132  includes a proximal end  136  and a distal end  138  having a capture surface  140 , shown in  FIG. 3 , configured to engage catch  56  of implant  30 . Capture surface  140  is offset from the bottom of recess  54  so as to prevent friction between implant  30  and instrument  130 . Distal end  138  of first member  132  is bifurcated longitudinally into a top portion  151  and a bottom portion  153 , bottom portion  153  is moveable relative to top portion  151 . The distal end of top portion  151  forms a hook  152  having a cavity  150 , while the distal end of bottom portion  153  forms a gate  154  which translates relative to hook  152  to cover at least a portion of cavity  150 . Hook  152  and gate  154  each have a length which is less than the depth of recess  54  such that when capture surface  140  is inserted into recess  54 , capture surface  140  may engage catch  56  and pivot about catch  56  without contacting the sides of recess  54 , thus allowing instrument  130  to freely pivot about catch  56 . Cavity  150  has a size and shape that corresponds to that of catch  56 , such that implant  30  will be permitted to pivot about catch  56  when engaged with instrument  130 . In one embodiment, cavity  150  includes top and right portions that are curved, a left portion that is angled and a bottom portion that is planar. This configuration facilitates capture of a cylindrical pin, such as catch  56 , while providing space for catch  56  to pivot within cavity  150 . Catch  56  may be positioned within cavity  150  when capture surface  140  is in an open position. Gate  154  then translates relative to hook  152  to capture catch  56  within cavity  150 , thus moving capture surface  140  to a closed position. 
     Second member  134  includes a proximal end  142  and a distal end  144  having an interface  146  configured to engage engagement surface  58  to releasably lock implant  30  in at least one orientation relative to second member  134 . Interface  146  and engagement surface  58  each include at least one planar face such that interface  146  could be positioned perpendicarly against engagement surface  58 , when capture surface  140  engages catch  56 , to lock implant  30  at an angle relative to instrument  130  by preventing implant  30  from pivoting about catch  56 . In one embodiment, interface  146  includes a distal face  148  of distal end  144 , wherein distal face  148  is disposed in a perpendicular orientation relative to a longitudinal axis a 2  of instrument  130 . It is envisioned that distal face  148  may be disposed at multiple angles ranging from 0 to 90° and from 0 to −90° relative to a longitudinal axis a 2  of instrument  130 . To lock implant  30  in a particular orientation relative to second member  134 , interface  146  of second member  134  is advanced toward proximal face  36  of implant  30  until interface  146  engages proximal face  36 , thereby preventing implant  30  from pivoting or rotating about catch  56 . 
     Instrument  130  may include a handle having a transverse dimension greater than that of second member  134  to permit ease of gripping by a surgeon during use. The handle may be formed of stainless steel, for example, and may have a shape corresponding to that of second member  134 . For example, it is envisioned that the handle could be cylindrical or, in the alternative, may have other cross section shapes such as square or rectangle, for example. The handle may also have flattened surfaces for receiving hammer blows used to manipulate instrument  130  to pivot and/or position an implant  30  into the intervertebral disc space. 
     As shown in  FIGS. 4 and 5 , capture surface  140  may be translated from an open position to a closed position via a spring mechanism. Capture surface  140  includes a hook and gate mechanism, as shown in  FIG. 3 . Second member  134  includes at least one first recess  156  disposed within second member  134  in a parallel orientation relative to longitudinal axis a 2  of instrument  130 . First recess  156  includes a first spring  158  inserted therein and disposed in a parallel orientation relative to longitudinal axis a 2  of instrument  130 . Second member  134  further includes a second recess  160  disposed in a perpendicular orientation relative to longitudinal axis a 2  of instrument  130  extending from the center portion of second member  134  through a bottom surface of second member  134 . Second recess  160  includes a second spring  162  inserted therein and disposed in a perpendicular orientation relative to longitudinal axis a 2  of instrument  130 . Second member  134  also includes a notch  164  disposed in a perpendicular orientation relative to longitudinal axis a 2  of instrument  130  extending from the center portion of second member  134  through a bottom surface of second member  134 . Notch  164  is proximal to first recess  156  and first spring  158 . An arm  166  extends between first recess  156  and notch  164 . At least a portion of a distal end  170  of arm  166  is configured to fit within notch  164  such that distal end  170  covers at least a portion of notch  164 , and at least a portion of the proximal end  172  of arm  166  is configured to fit within second recess  160  such that proximal end  172  covers at least a portion of second recess  160 . Arm  166  includes a pivot point  168  positioned between notch  164  and second recess  160 . Pivot point  168  is disposed through second member  134  such that pivoting arm  166  about pivot point  168  allows distal end  170  of arm  166  to be removed from notch  156  with proximal end  172  inserted into second recess  160  or proximal end  172  of arm  166  to be removed from second recess  160  with distal end  170  inserted into notch  164 . Distal end  170  contacts at least a portion of second spring  162  to maintain second spring  162  in its compressed configuration. When second spring  162  is decompressed, distal end  170  moves perpendicularly relative to longitudinal axis a 2  of instrument  130  such that distal end  170  moves away from a bottom portion of second member  134 . Proximal end  172  of arm  166  is inserted into at least a portion of notch  164  and contacts at least a portion of first spring  158  within first recess  156  to maintain first spring  158  in its compressed configuration. Pivoting arm  166  about pivot point  168  toward distal end  170  of arm  166  causes second spring  162  to compress, which in turn causes proximal end  172  of arm  166  to be removed from notch  164  as first spring  158  decompresses. Decompressing first spring  158  allows bottom portion  153  of first member  132  with gate  154  fixed to the distal end thereof to move distally, translating gate  154  over at least a portion of cavity  150  within hook  152  and capturing catch  56  within cavity  150 . To move capture surface  140  to an open position, a handle  174  may be moved toward a proximal end of instrument  130  causing first spring  158  to compress. As first spring  158  is compressed, arm  166  is pivoted about pivot point  168  toward proximal end  172 , causing second spring  162  to decompress, which in turn inserts proximal end  172  of arm  166  into second recess  164 . Distal end  144  of second member  134  may be advance to engage engagement surface  58  of implant  30  using a thread mechanism, a ratcheting mechanism, or a latch mechanism. 
     Implant  30  may be locked to instrument  130  in a straight orientation where it is desirable to insert implant  30  between two adjacent vertebrae leading with distal face  38  of implant  30 . As shown in  FIG. 6 , engagement surface  58  is proximal face  36  of implant  30  and is planar, as is interface  146 . To insert implant  30  into an intervertebral space with implant  30  locked to instrument  130  in a straight orientation, capture surface  140  is inserted into recess  54  of implant  30  in an open position and is positioned to engage catch  56  within cavity  150 . Capture surface  140  is then moved to a closed position, which captures catch  56  within cavity  150 . To lock implant  30  in a straight orientation, interface  146  of second member  134  is advanced toward proximal face  36  of implant  30  until interface  146  engages proximal face  36 , thereby preventing implant  30  from pivoting about catch  56 . Implant  30  may then be inserted into an intervertebral space in a straight orientation, leading with distal face  38  of implant  30 . 
     Implant  30  may be unlocked from instrument  130  by disengaging interface  146  of instrument  130  from engagement surface  58  of implant  30 , while catch  56  remains captured by capture surface  140 , allowing implant  30  to pivot about catch  56 . It may become necessary to apply force to pivot implant  30 . Indeed, because implant  30  is compressed between two vertebrae, it may be difficult to pivot using instrument  130 . It is therefore desirable to apply a force directly to implant  30  to pivot the same to a desired angle or position. Applying force directly to the outside surface of implant  30  avoids the pivot force being applied directly to catch  56 , which may have limited strength. To pivot implant  30  to the desired angle or position, capture surface  140  of instrument  130  is first inserted into recess  54  of implant  30  in an open position and is positioned to engage catch  56  within cavity  150 . Capture surface  140  is then moved to a closed position, which captures catch  56  within cavity  150 . Instrument  130  may be pivoted at multiple angles relative to a longitudinal axis a 2  of instrument  130  by applying a force to a surface of implant  30 , such as side surface  44  or side surface  46  such that implant  30  pivots about catch  56 . As shown in  FIG. 7 , engagement surface  58  of implant  30  is positioned on a corner of implant  30  between proximal face  36  and side surface  46 ; and implant  30  is pivoted approximately 45° relative to longitudinal axis a 2  defined by instrument  130 . After implant  30  is pivoted to a desired orientation, interface  146  is moved distally relative to instrument  130  until interface  146  contacts engagement surface  58  of implant  30 . After contacting implant  30 , distal face  148  may push implant  30  such that implant  30  pivots about catch  56  in the axial plane to a desired angle or position. 
     As shown in  FIG. 8 , engagement surface  58  may be located on a side surface such as side surface  46 , where side surface  46  is planar. Implant  30  may be locked to instrument  130  in a 90° orientation relative to a longitudinal axis a 2  of instrument  130  such that implant  30  may be inserted between two adjacent vertebrae leading with a side surface, such as side surface  44 . To insert implant  30  into an intervertebral space with implant  30  locked to instrument  130  in a 90° orientation relative to a longitudinal axis a 2  of instrument  130 , capture surface  140  is inserted into recess  54  of implant  30  in an open position and is positioned to engage catch  56  within cavity  150 . Capture surface  140  is then moved to a closed position, which captures catch  56  within cavity  150 . Implant  30  may then be pivoted 90° such that side surface  46  is perpendicular to interface  146 . To lock implant  30  in a 90° orientation relative to a longitudinal axis a 2  of instrument  130 , distal face  148  of second member  134  is advanced toward side surface  46  of implant  30  until interface  146  of second member  134  engages side surface  46  to releasably lock implant  30  in a 90° orientation, thereby preventing implant  30  from rotating within instrument  130 . Implant  30  may then be inserted into an intervertebral space in a 90° orientation, leading with side surface  44 . 
     In one embodiment, shown in  FIG. 9 , the interbody implant system includes an instrument  330  which has a similar configuration to instrument  130  and includes a first member  332  and a second member  334  that is movable relative to first member  332 . First member  332  includes a capture surface  340  at the distal end thereof configured to engage a catch, such as catch  56  of implant  30 . The distal end of first member  332  is bifurcated longitudinally into opposing claws  358 ,  360  that define a cavity  350  for receiving catch  56  and are movable to fix catch  56  in cavity  350 . Opposing claws  358  and  360  extend from the distal end of second member  332  a first distance, which is less than the depth of recess  54  such that when capture surface  340  is inserted into recess  54 , capture surface  340  may engage catch  56  and pivot about catch  56  without contacting the sides of recess  54 , thus allowing instrument  330  to freely pivot about catch  56 . Cavity  350  is cylindrical to facilitate capture of a cylindrical pin, such as catch  56 , while providing space for catch  56  to pivot within cavity  350 . Catch  56  may be positioned within cavity  350  when capture surface  340  is in an open position. Capture surface  340  then moves to a closed position by converging opposing claws  358 ,  360 , which allows implant  30  to pivot about catch  56  to a plurality of orientations. Second member  334  includes a distal end  344  having an interface  346  configured to engage engagement surface  58  of implant  30  to releasably lock implant  30  in at least one orientation relative to second member  334 . 
     As discussed above, the system of the present invention allows pivoting of an implant in an intervertebral space. Indeed, when surgeons perform an interbody fusion via a posterior approach, some like to pivot an implant in the axial plane so that a side surface of the implant faces anteriorly. This approach allows the surgeon to avoid areas of the spinal column, such as the spinal cord, as desired, while performing posterior spinal fusion. In one embodiment, shown in  FIG. 10 , the interbody implant system includes an implant  230  configured to be inserted between adjacent vertebrae which is similar in configuration to implant  30  and includes a proximal end  232 , a distal end  234  opposite proximal end  232 , an upper surface  240 , a lower surface (not shown), and side surfaces  244 ,  246 . Proximal end  232  includes a proximal face  236 , while distal end  234  includes a distal face  238 . Upper and lower surfaces  240 ,  242  are configured to interface with load bearing endplates of adjacent vertebrae, while side surfaces  244 ,  246 , proximal end  232  and distal end  234  extend between upper and lower surfaces  240 ,  242 . Upper and lower surfaces  240 ,  242  include bone engaging features  252  configured to reduce slipping or movement relative to the vertebrae implant  230  is placed between. A hollow center  250  opening at upper and lower surfaces  240 ,  242  allows placement of materials, such as bone growth materials, to promote bonding and/or fusion of implant  230  to adjacent vertebrae. Implant  230  includes at least one recess (not shown) in proximal end  232  disposed in a parallel orientation relative to a transverse axis a 3  of implant  230  that extends along side surfaces  244 ,  246  configured to receive at least a portion of an insertion instrument, such as instrument  130 . The recess includes a catch  256 , such as a cylindrical pin, which is configured to be captured by instrument  130 . Implant  230  further includes at least one surface configured to engage instrument  130 , to lock the rotation of implant  230  within instrument  130 . Proximal face  236  includes a first lateral face  260  that converges with proximal face  236  to form a first angle and a second lateral face  262  that converges with proximal face  236  to form a second angle. Either proximal face  236 , first lateral face  260 , or second lateral face  262  may act as an engagement surface to engage an engaging portion of an instrument, such as interface  146  of instrument  130 . Implant  230  is pivotable relative to second member  234  via engagement of second member  234  with at least one of the first and second angles. As shown in  FIG. 10 , first lateral face  260  and second lateral face  262  are each disposed at an angle relative to proximal face  236 . It is envisioned that lateral faces  260 ,  262  may each be disposed at a variety of angles (from 0 to 90° and from 0 to −90°) relative to proximal face  236 . 
     To insert implant  230  into an intervertebral space at the first angle, capture surface  140  of instrument  130  is inserted into the recess in proximal end  232  of implant  230  in an open position and is moved to engage catch  256 . Capture surface  140  is then moved to a closed position, which captures catch  256  within cavity  150  such that implant  230  may pivot about catch  256 . Implant  30  is then pivoted about catch  256  until second lateral face  262  and interface  146  of instrument  130  are substantially parallel to one another. Implant  230  may be locked to instrument  130  by advancing interface  146  of instrument  130  toward second lateral face  262  of implant  230  until interface  146  engages second lateral face  262  to releasably lock implant  230 , thereby preventing implant  230  from pivoting about catch  256 . Implant  30  may then be inserted into an intervertebral space at an angle equal to the first angle. Likewise, to insert implant  230  into an intervertebral space at the second angle, capture surface  140  of instrument  130  is inserted into the recess in proximal end  232  of implant  230  in an open position and is moved to engage catch  256 . Capture surface  140  is then moved to a closed position, which closes catch  256  within cavity  150  in a manner that permits implant  230  to pivot about catch  256 . Implant  30  is then positioned at the second angle by pivoting implant  230  about catch  256  until first lateral face  260  and interface  146  of instrument  130  are substantially perpendicular to one another. Implant  230  may be locked to instrument  130  at the second angle by advancing interface  146  toward first lateral face  260  until interface  146  engages first lateral face  260  to releasably lock implant  230 , thereby preventing implant  230  from pivoting about catch  256 . Implant  30  may then be inserted into an intervertebral space at an angle equal to the second angle. 
     An alternative way to insert implant  230  into an intervertebral space comprises locking implant  230  in a straight orientation with the inserting tool so that the implant  230  can be inserted into the disc space. The implant  230  is then unlocked form the straight orientation in which it was inserted by moving the capture surface  140  to a closed position, which closes catch  256  within cavity  150  in a manner that permits implant  230  to pivot about catch  256 . Implant  230  is then positioned at the second angle by pivoting implant  230  about catch  256 . Once in the second position the implant  230  is re-locked by advancing interface  146  toward first lateral face  260  until interface  146  engages first lateral face  260  to releasably lock implant  230 , thereby preventing implant  230  from pivoting about catch  256 . The implant  230  can then be positioned into the desired location and orientation. 
     In one embodiment, shown in  FIG. 11 , the interbody implant system includes an implant  430 , which is similar to implant  30  and implant  230 , having a proximal end  432 , a distal end  434  opposite proximal end  432 , an upper surface  440 , a lower surface  442  (not shown) opposite upper surface  440  and having a configuration similar to upper surface  440 , and side surfaces  444 ,  446 . Implant  430  assumes a generally annular kidney-shape, corresponding to the annular kidney-shape of the anterior aspect of the vertebra. Proximal end  432  includes a proximal face  436 , while distal end  434  includes a distal face  438 . Upper and lower surfaces  440 ,  442  are configured to interface with load bearing endplates of adjacent vertebrae, while side surfaces  444 ,  446 , proximal end  432  and distal end  434  extend between upper and lower surfaces  440 ,  442 . Upper and lower surfaces  440 ,  442  include bone engaging features  452  configured to reduce slipping or movement relative to the vertebrae implant  430  is placed between. Implant  430  includes a hollow center  450  disposed in a perpendicular orientation relative to longitudinal axis a 4  of implant  430  and configured to allow placement of materials, such as bone growth materials, to promote bonding and/or fusion of implant  430  to adjacent vertebrae. As shown in  FIG. 11 , implant  430  includes a stabilizer  451  extending between side surfaces  444 ,  446  and bisecting hollow center  450  to provide stability to implant  430 . Implant  430  further includes at least one engagement surface  458  configured to engage instrument  530 , to lock the rotation of implant  430  within instrument  530 . Engagement surface  458  has a smooth arcuate configuration that defines a first radius of curvature. Proximal face  436  includes at least one protrusion, such as an angled tooth. 
     In addition to implant  430 , the system of the present invention also includes an instrument  530  is configured to engage implant  430 , pivot implant  430  relative to instrument  530 , lock implant  430  at a particular angle relative to instrument  530  and insert implant  430  at the desired angle. Instrument  530  includes a second member  534  having an interface  546  with a smooth, arcuate configuration that defines a second radius of curvature and is configured to capture implant  430 . The second radius of the curvature is less than the first radius of curvature such that interface  546  engages engagement surface  458  in an interference fit to releasably lock implant  430  in at least one orientation relative to first member  532 . The at least one protrusion  447  on proximal face  436  is/are constructed of a first material while instrument  530  is constructed of a second material, the second material being harder than the first material such that protrusions  447  deform when pressed into interface  546  to lock implant  430  in place at a particular angle relative to instrument  530 . In one embodiment, engagement surface  458  has a plurality of protrusions  447  which resemble gear teeth extending from the proximal end of side surface  444  across proximal face  436  and the proximal end of side surface  446 . Any of the protrusions  447  along side surface  444 , proximal face  436  or side surface  446  may be used to engage interface  546  of instrument  530  to attach implant  430  to instrument  530  along side surface  444 , proximal face  436  or side surface  446 , thus permitting implant  430  to attach to instrument  430  at many different angles, which in turn permits implant  430  to be implanted between two adjacent vertebrae at many different angles, using different approaches. In one embodiment, instrument  530  includes gear teeth  547  on interface  546  configured to engage protrusion(s)  447  of implant  430  such that gear teeth  547  mesh with at least one protrusion  447  to lock the rotation of implant  430  within instrument  530  at a particular angle relative to first member  532 . 
     In one embodiment illustrated in  FIGS. 12 and 13 , instrument  530  may have at least one locking protrusion  544  that is configured to engage a corresponding recess  458  in implant  430  to maintain implant  430  at a particular angle relative to instrument  530  by preventing implant  430  from rotating within instrument  530 . It is envisioned that locking protrusion  544  may be larger than recess  458  to which it corresponds. Instrument  530  may be made of a material that is harder than the material implant  430  is made of, such that locking protrusion  544  will deform the softer recess  458  to lock implant  430  in place via an interference fit. Locking protrusion  544  has a convexly curved cross-sectional profile and recess  458  has a concave cross-sectional profile that corresponds to the curve of locking protrusion  544 . Locking protrusion  544  may have a polygonal cross-sectional profile such as a triangular, rectangular (including square), heptagonal, hexagonal, etc. cross-sectional profile. Likewise, recess  458  may have a cross-sectional profile which corresponds to the polygonal cross-sectional profile of locking protrusion  544  such that at least a portion of locking protrusion  544  fits within recess  458  to maintain implant  430  at a particular angle by preventing implant  430  from rotating within instrument  530 . Locking protrusion  544  may be an angled tooth that engages a corresponding recess  458  such that implant  430  may be rotated in one direction only. 
     As illustrated in  FIGS. 12 and 13 , proximal face  436  has a portion that is convexly curved, as well as, a portion that is planar. Instrument  530  includes interface  546  which corresponds to the convexly curved portion of proximal face  436  so as to engage implant  430  with instrument  530  rotates implant  430  within recess  558  in one direction only. That is, when implant  430  is rotated within recess  558  such that the portion of the proximal face  436  that is convexly curved mates with concavely configured interface  536  of the instrument  530 , implant  430  moves freely within recess  558 . However, moving the implant  430  in the opposite direction engages the planar portion of the proximal face  436  with the concavely configured interface  536  and since the planar portion of the proximal face  436  of the implant cannot move freely against the concavely configured interface  536 , movement of the implant  430  in restricted to one direction only. Instrument  530  may have a plurality of locking protrusions  544  configured to engage corresponding recesses  458  in implant  430  to maintain implant  430  at different angles relative to instrument  530 . 
     In one embodiment, instrument  530  includes a first member  532  extending longitudinally through second member  534  and out from an opening in a distal end of second member  534 . Second member  534  includes an inner hollow portion. First member  532  has a transverse dimension which is less than the inner hollow portion of second member  534 , such that first member  532  extends through the inner hollow portion of second member  534  and out from an opening in the distal end of second member  534 . Proximal end  432  includes at least one recess  454  sized and configured to receive at least a portion of first member  532 . As illustrated in  FIGS. 12 and 13 , recess  454  is a formed by cutting out a rectangular piece from the upper right corner of upper surface  440 , including at least a portion of proximal end  432  and at least a portion of side surface  446 . In particular, recess  454  is formed by making a first cut in the proximal end of side surface  446  which is perpendicular to longitudinal axis a 4  of implant  430 . Next, a second cut is made in proximal end  432  between side surfaces  444 ,  446 . The second cut is parallel to longitudinal axis a 4  of implant  430 . The first and second cuts define an area of recess  454 . Recess  454  may extend downward from upper surface  440  a distance between upper and lower surfaces  440 ,  442 . Recess  454  terminates prior to reaching lower surface  442  so as not to extend through upper and lower surfaces  440 ,  442 . It is envisioned that recess  454  may be triangular, square, pentagonal, hexagonal, or any other polygonal shape. Alternatively, recess  454  may have a round or oval shape. Recess  454  has a length extending along a longitudinal axis a 4  of implant  430  extending from proximal end  432  toward distal end  434  that terminates before distal end  434 . The length of recess  454  should be sufficient to permit instrument  530 , to engage implant  430  and pivot implant  430  axially. Accordingly, the length of recess  454  is slightly larger than an engaging portion of instrument  530 . To engage implant  430 , first member  532  of instrument  530  is extended through the opening in the distal end of second member and into recess  454 . Implant  430  may be rotated within interface  546  until first member  532  engages the first cut or the second cut that define an area of recess  454 . First member  532  engaging a linear edge of recess  454  prevents implant  430  from moving relative to instrument  530 . 
     In one embodiment, illustrated in  FIGS. 14 and 15 , the system of the present invention includes an instrument  730  having a similar configuration to instruments  130 , and  530 , but includes a capture surface  740  that may be translated between open and closed positions via rotation of a threaded surface  745  of a first member  732 . Instrument  730  includes a first member  732  and a second member  734  that is movable relative to first member  732 . Second member  734  is a sleeve configured to fit about first member  732  and has an opening in a distal end thereof through which first member  732  may extend. It is envisioned that first member  732  and/or second member  734  may be rectangular, cylindrical, or, in the alternative, may have other cross section shapes such as square, hexagonal or octagonal, for example. Second member  734  includes at least one recess  756  disposed within second member  734  in a perpendicular orientation relative to longitudinal axis a 5  of instrument  730  defined by a first wall  758  and a second wall  760 . 
     First member  732  includes a proximal end  736  and a distal end  738  having a capture surface  740  configured to engage a catch, such as catch  56  of implant  30 , for example. First member  732  is bifurcated longitudinally into a top portion  751  and a bottom portion  753  that is movable relative to top portion  751 . In one embodiment, top portion  751  is spring loaded such that top portion  751  moves relative to bottom portion  753  via a spring that will translate top portion  751  distally, relative to bottom portion  753 . A hook is fixed to the distal end of top portion  751  and a gate is fixed the distal end of bottom portion  753 . The hook defines a cavity configured to receive a catch such that implant may pivot about the catch when the catch is received within the cavity of the hook. Proximal end  736  includes a threaded surface  745  on the top and/or bottom portions of proximal end  736  and a wheel  766  having a bore extending through the center thereof having threads which correspond to threaded surface  745  such that threaded surface  745  may be threaded through the bore in wheel  766 . Wheel  766  has a size and shape configured to fit within recess  756  of second member  734 . As wheel  766  is turned in a first direction, such as clockwise, wheel  766  is moved distally along threaded surface  745  until wheel  766  engages first wall  758  of recess  756 . Turning wheel  766  clockwise while engaged with first wall  758  causes bottom portion  753  of first member  732  with the gate fixed to the distal end thereof to move distally, translating the gate over at least a portion of the cavity within the hook, as the hook remains stationary. As wheel  766  is turned in a second direction, such as counterclockwise, wheel  766  is moved proximally along threaded surface  745  until wheel  766  engages second wall  760  of recess  756 . Turning wheel  766  counterclockwise while engaged with second wall  760  causes bottom portion  753  of first member  732  with the gate fixed to the distal end thereof to move proximally, withdrawing the gate from at least a portion of the cavity within the hook, as the hook remains stationary. 
     Second member  734  includes a proximal end  742  and a distal end  744  having an interface  746  configured to engage an engagement surface, such as engagement surface  58  of implant  30 , to releasably lock implant  30  in at least one orientation relative to second member  734 . Interface  746  and engagement surface  58  each include at least one planar face such that interface  746  could be positioned perpendicarly against engagement surface  58 , when capture surface  740  engages catch  56 , to lock implant  30  at an angle relative to instrument  730  by preventing implant  30  from pivoting about catch  56 . As wheel  766  is turned clockwise, second member  736  is moved distally until interface  746  engages an engagement portion  58  of implant  30 . 
     In one embodiment, illustrated in  FIGS. 16-25 , the system of the present invention includes an implant  830 , which is similar in configuration to implant  30 , implant  230  and implant  430 . Implant  830  includes a first end, such as proximal end  832 , and a second end, such as distal end  834 , opposite proximal end  832 , upper and lower surfaces  840 ,  842 , and side surfaces  844 ,  846 . Implant  830  has a height defined by the distance between two adjacent vertebrae and a width defined by the distance between proximal end  832  and distal end  834 . The width of implant  830  is approximately the width of at least one of the vertebrae implant  830  is positioned between. Proximal end  832  includes a proximal face  836 , while distal end  834  includes a distal face  838 . Upper and lower surfaces  840 ,  842  are configured to interface with load bearing endplates of adjacent vertebrae, while side surfaces  844 ,  846 , proximal end  832  and distal end  834  extend between upper and lower surfaces  840 ,  842 . In one embodiment, proximal face  836  is planar while distal face  838  is convexly curved between upper and lower surfaces  840 ,  842  and is configured to allow at least a portion of distal face  838  to be inserted into a collapsed, undistracted disc space. However, it is envisioned that distal face  838  may also be pointed, planar or concavely curved between upper and lower surfaces  840 ,  842 . 
     Implant  830  includes at least one recess  854  disposed in proximal end  832  in a perpendicular orientation relative to transverse axis a 6  of implant  830 . Recess  854  is sized and configured to receive at least a portion of an insertion instrument, such as instrument  130 . In one embodiment recess  854  is rectangular, however it is envisioned that recess  854  may have a polygonal shape such as triangular, square, pentagonal, hexagonal, or may have a round or oval shape. Recess  854  extends through upper and lower surfaces  840 ,  842  and is disposed within proximal end  832  of implant  830  without extending through side surfaces  844 ,  846 , such that recess  854  is disposed between side surfaces  844 ,  846 . Recess  854  is disposed equidistant between side surfaces  844 ,  846 , however it is envisioned that recess  854  may be disposed in proximal face  836  such that one side of recess  854  is closer to side surface  844  than the opposite side of recess  854  is from side surface  846 , or vice versa. 
     Recess  854  includes a cylindrical pin, such as, for example, catch  856  disposed therein in a parallel orientation relative to transverse axis a 6  of implant  830  such that implant  830  can be pivoted about catch  856  in a coronal plane. Pivoting implant  830  about catch  856  in a coronal plane allows implant  830  to be inserted into the L4/L5 or L5/S1 disc space by angling down laterally from the top of the iliac crest. Catch  856  is configured to be captured by an instrument that facilitates positioning of spinal implant  830 , such as instrument  130 . In one embodiment, catch  856  extends through side surfaces  844 ,  846  in proximal end  832  of implant  830 . However, it is envisioned that catch  856  may disposed in proximal end  832  of implant  830  without extending through side surfaces  844 ,  846 . Catch  856  is disposed a distance from proximal end  832  extending along longitudinal axis a 7  of implant  830  toward distal end  834  which terminates before the inner portion of recess  854  such that an instrument, such as instrument  130 , may engage implant  830  and pivot implant  830  about catch  856  without the instrument contacting the bottom of recess  854 . In one embodiment, catch  856  is disposed equidistant between upper and lower surfaces  840 ,  842 , however, it is envisioned that catch  856  may also be positioned such that the catch  856  is closer to upper surface  840  than lower surface  842 , or vice versa. 
     Instrument  130  may engage implant  830  by capturing catch  856  within capture surface  140  such that implant  830  may pivot about catch  56 , relative to instrument  830 . In particular, capture surface  140  on the distal end of instrument  130  is inserted into recess  854  of implant  830  in an open position and is positioned to engage catch  856 . Capture surface  140  is then moved to a closed position, which captures catch  856  within capture surface  140  such that implant  830  may pivot about catch  856  until implant is in a desired orientation relative to instrument  130 . To lock implant  830  at the desired orientation, distal face  138  of instrument  130  is advanced toward implant  830  until distal face  138  engages proximal face  836  of implant  830  to releasably lock implant  830  in the desired orientation, thereby preventing implant  830  from rotating about catch  856 . Implant  830  may then be inserted into an intervertebral space in the desired orientation, leading with proximal end  832 . 
     As shown in  FIG. 22 , proximal face  836  includes a first lateral face  860  that converges with proximal face  836  to form a first angle relative to longitudinal axis a 7  of implant  830  and a second lateral face  862  that converges with proximal face  836  to form a second angle relative to longitudinal axis a 7  of implant  830 . Implant  830  is pivotable relative to second member  134  of instrument  130  via engagement of second member  134  with at least one of the first and second angles. In one embodiment, first lateral face  860  and second lateral face  862  are each disposed at the same angle relative to longitudinal axis a 7  of implant  830 . However, it is envisioned that first lateral face  860  and second lateral face  862  may be disposed at different angles relative to longitudinal axis a 7  of implant  830 . It is also envisioned that lateral faces  860 ,  862  may each be disposed at a variety of angles (from 0 to 90° and from 0 to −90°) relative to proximal face  836  such that implant  830  may be pivoted for insertion between adjacent vertebrae at a variety of angles using different approaches. 
     To insert implant  830  into an intervertebral space at the first angle, capture surface  140  of instrument  130  is inserted into recess  854  in proximal end  832  of implant  830  in an open position and is moved to engage catch  856 . Capture surface  140  is then moved to a closed position, which closes catch  856  within cavity  150  in a manner that permits implant  830  to pivot about catch  856 . Implant  830  is then positioned at the first angle, by pivoting implant  830  about catch  856  until first lateral face  860  and interface  146  of instrument  130  are substantially perpendicular to one another. Implant  830  may be locked to instrument  130  at the first angle by advancing distal face  138  of instrument  130  toward first lateral face  860  of implant  830  until interface  146  engages first lateral face  860  to releasably lock implant  830  at the first angle, thereby preventing implant  830  from rotating about catch  56 . Implant  830  may then be inserted into an intervertebral space at an angle equal to the first angle, relative to instrument  130 . Likewise, to insert implant  230  into an intervertebral space at the second angle, capture surface  140  of instrument  130  is inserted into recess  854  in proximal end  832  of implant  830  in an open position and is moved to engage catch  856 . Capture surface  140  is then moved to a closed position, which closes catch  856  within cavity  150  in a manner that permits implant  830  to pivot about catch  856 . Implant  830  is then positioned at the second angle by pivoting implant  830  about catch  856  until second lateral face  862  and interface  146  of instrument  130  are substantially perpendicular to one another. Implant  830  may be locked to instrument  130  at the second angle by advancing distal face  138  of instrument  130  toward second lateral face  862  of implant  830  until interface  146  engages second lateral face  862  to releasably lock implant  830  at the second angle, thereby preventing implant  830  from rotating about catch  856 . Implant  830  may then be inserted into an intervertebral space at an angle equal to the second angle, relative to instrument  130 . 
     In one embodiment shown in  FIG. 23 , proximal face  836  is convexly curved between upper and lower surfaces  840 ,  842  and interface  146  of instrument  130  has a curved geometry configured to mate with proximal face  836 . Capture surface  140  of instrument  130  may be inserted into recess  854  in proximal end  832  of implant  830  in an open position and moved to engage catch  856  such that implant  830  may pivot about catch  856 . Implant  830  is then positioned at the desired orientation relative to instrument  130 . Implant  830  may be locked to instrument  130  at the desired orientation by advancing distal face  138  of instrument  130  toward proximal face  836  of implant  830  until interface  146  engages proximal face  836  to releasably lock implant  830  at the desired, thereby preventing implant  830  from rotating about catch  856 . Implant  830  may then be inserted into an intervertebral space in the desired orientation. Protrusions and/or recesses on the distal face  138  can be used to lock the implant  830  at set angles once the distal face  138  is advanced towards the implant  830  and engages one of the protrusions/recesses that is associated with the orientation of implant  830 . 
     In one embodiment shown in  FIGS. 24-25 , implant  830  includes channels  855  extending along side surface  844  and side surface  846  a distance from proximal end  832  towards distal end  834  along the longitudinal axis a 7  of implant  830 . Channels  855  are each configured to receive a locking tab on an instrument, such as instrument  130 . Channels  855  are disposed equidistant between upper and lower surfaces  840 ,  842 , however, it is envisioned that channels  855  may be disposed in proximal face  836  such that the top of channels  855  are closer to upper surface  840  than the bottom of channels  855  are from lower surface  842 , or vice versa. Channels  855  have a depth extending longitudinally along longitudinal axis a 7  of implant  830  from proximal face  836  toward distal face  838  and terminates before distal face  838 . 
     Second portion  134  of instrument  130  may include locking tabs  155  extending from distal end  144  of second portion  134  along the side surfaces thereof which are configured to be received within channel  855  on either side of implant  830  to secure implant  830  to instrument  130 . In one embodiment, locking tabs  155  are disposed closer to the top surface of second portion  134  than the bottom surface. However it is also envisioned that locking tabs  155  may be disposed such that locking tabs  155  are closer to the bottom surface of second portion  134  than the top surface, or an equal distance form the top and bottom surfaces of second portion  134 . The distance between locking tabs  155  is approximately equal to the distance between side surfaces  844 ,  846  of implant  830 . More specifically, the distance between locking tabs  155  is approximately equal to the distance between channel  855  in side surface  844  and channel  855  in side surface  846 . The length of locking tabs  155  is approximately equal to the depth of channels  855 . Locking tabs  155  may be formed to at least partially elastically deform to engage implant  130  such that locking tabs  155  lock within channels  855 . In particular, locking tabs  155  may be configured to elastically deform such that locking tabs  155  may be expanded so that the distance between locking tabs  155  is greater than the distance between channel  855  in side surface  844  and channel  855  in side surface  846 . Locking tabs  155  are then positioned over channels  855 , and then return to their original, non-expanded configuration, such that locking tabs  155  snap into place within channels  855 . When locking tabs  155  are snapped into place within channels  855 , interface  146  of instrument  130  engages proximal face  836  of implant  830  such that implant  830  is prevented from pivoting about catch  856 . 
     In one embodiment, illustrated in  FIGS. 26 and 27 , the system of the present invention includes an implant  1030 , which is similar to implants  30 ,  230 ,  430  and  830  having a proximal end  1032 , a distal end  1034  opposite proximal end  1032 , an upper surface  1040 , a lower surface  1042  opposite upper surface  1040 , and side surfaces  1044 ,  1046 . Upper and lower surfaces  1040 ,  1042  are configured to interface with load bearing endplates of adjacent vertebrae, while side surfaces  1044 ,  1046 , proximal end  1032  and distal end  1034  extend between upper and lower surfaces  1040 ,  1042 . Upper and lower surfaces  1040 ,  1042  include bone engaging features  1052  configured to reduce slipping or movement relative to the vertebrae implant  1030  is placed between. 
     Implant  1030  has a height defined by the distance between two adjacent vertebrae and a width defined by the distance between proximal end  1032  and distal end  1034 . The width of implant  1030  is approximately the width of at least one of the vertebrae implant  1030  is positioned between. Proximal end  1032  includes a proximal face  1036 , while distal end  1034  includes a distal face  1038 . In one embodiment, proximal face  1036  is planar while distal face  1038  is convexly curved between upper and lower surfaces  1040 ,  1042  and is configured to allow at least a portion of distal face  1038  to be inserted into a collapsed, undistracted disc space. However, it is envisioned that distal face  1038  may also be pointed, planar or concavely curved between upper and lower surfaces  1040 ,  1042 . 
     Implant  1030  includes a bore extending longitudinally into proximal end  1032  that extends a distance from proximal end  1032  towards distal end  1034  along the longitudinal axis a 8  of implant  1030 . The bore is configured to receive a portion of an instrument, such as instrument  130 , to engage implant  1030  with the instrument. The bore is disposed equidistant between upper and lower surfaces  1040 ,  1042 , however, it is envisioned that the bore may also be disposed in proximal face  1036  such that the top of bore is closer to upper surface  1040  than the bottom of the bore is from lower surface  1042 , or vice versa. The bore has a depth extending longitudinally along longitudinal axis a 8  of implant  1030  from proximal face  1036  toward distal face  1038  and terminates before distal face  1038 . Implant  1030  further includes channels  1055  extending along side surface  1044  and side surface  1046  a distance from proximal end  1032  towards distal end  1034  along the longitudinal axis a 8  of implant  1030 . Channels  1055  are each configured to receive locking tabs on an instrument, such as instrument  130 . Channels  1055  are disposed equidistant between upper and lower surfaces  1040 ,  1042 , however, it is envisioned that channels  1055  may be disposed in proximal face  1036  such that the top of channels  1055  are closer to upper surface  1040  than the bottom of channels  1055  are from lower surface  1042 , or vice versa. A channel  1055  has a depth extending longitudinally along longitudinal axis a 8  of implant  1030  from proximal face  1036  toward distal face  1038  and terminates before distal face  1038 . 
     As illustrated in  FIGS. 26-30 , in addition to implant  1030 , the system of the present invention also includes an instrument  1130  configured to engage implant  1030 , pivot implant  1030  relative to instrument  1130 , lock implant  1030  at a particular angle relative to instrument  1130  and insert implant  1130  at the desired angle. Instrument  1130  includes a first member  1132  and a second member  1134  that is movable relative to first member  1132 . Second member  1134  is a sleeve configured to fit about first member  1132  and has an opening in the distal end thereof through which first member  1132  may extend. It is envisioned that first member  1132  and/or second member  1134  may be rectangular, cylindrical or, in the alternative, may have other cross section shapes such as square, hexagonal or octagonal, for example. The distal end of first member  1132  is configured to extend through the bore in proximal end  1032  of implant  1030  to engage instrument  1130  with implant  1030 . 
     Instrument  1130  further includes a pivoting joint  1136  positioned at the distal end of second member  1134  configured to pivot implant  1030  once implant  1030  is engaged with instrument  1130 . Pivoting joint  1136  includes a first portion  1138  and a second portion  1140  pivotably connected to first portion  1138  via a pivot point  1142 . Pivot point  1142  is defined by a protrusion  1144  on a side surface of first portion  1138  that is received within a corresponding recess  1146  in second portion  1140 . When protrusion  1144  is received within recess  1146 , first portion  1138  is pivotable relative to second portion  1140  such that first portion  1138  may pivot perpendicularly. First portion  1138  and second portion  1140  each have a rectangular cross section but may have other cross sectional shapes such cylindrical, square or hexagonal, for example. Second portion  1140  has a recess  1152  disposed in the distal end of second portion  1140  configured to receive at least a portion of first portion  1138 . As shown in  FIG. 26 , recess  1142  is rectangular and corresponds to the size and shape of the proximal end of first portion  1138  such that the proximal end of first portion  1138  is received within recess  1142 . 
     First portion  1138  of pivoting joint  1136  includes locking tabs  1155  extending from the distal end of first portion  1138  along side surface  1044  and side surface  1046  of implant  1030  configured to received within channel  1055  on either side of implant  1030 . In one embodiment, locking tabs  1155  are disposed closer to the top surface of first portion  1138  than the bottom surface thereof. However it is also envisioned that locking tabs  1155  may be disposed such that locking tabs  1155  are closer to the bottom surface of first portion  1138  than the top surface thereof, or an equal distance form the top and bottom surfaces of first portion  1138 . The distance between locking tabs  1155  is approximately equal to the distance between side surfaces  1044 ,  1046  of implant  1030 . More specifically, the distance between locking tabs  1155  is approximately equal to the distance between channel  1055  in side surface  1044  and channel  1055  in side surface  1046 . The length of locking tabs  1155  is approximately equal to the depth of channels  1055 . Locking tabs  1155  may be formed to at least partially elastically deform to engage implant  1030  such that locking tabs  1155  lock within channels  1055 . In particular, locking tabs  1155  may be configured to elastically deform such that locking tabs  1155  may be expanded so that the distance between locking tabs  1155  is greater than the distance between channel  1055  in side surface  1044  and channel  1055  in side surface  1046 . Locking tabs  1155  are then positioned over channels  1055 , and then return to their original, non-expanded configuration, such that locking tabs  1155  snap into place within channels  1055 . When locking tabs  1155  are snapped into place within channels  1055 , the distal end of first portion  1138  of pivoting joint  1136  engages proximal face  1036  of implant  1030 . 
     First portion  1138  of pivoting joint  1136  further includes a first lateral face  1148  that forms a first pivoting angle  1156  relative to the planar distal end of second portion  1140  and a second lateral face  1150  that forms a second pivoting angle  1158  relative to the planar distal end of second portion  1140 . In one embodiment, first lateral face  1148  and second lateral face  1150  are each disposed at the angle relative to the planar distal end of second portion  1140 . It is envisioned that first lateral face  1148  and second lateral face  1150  may each be disposed at a variety of angles (from 0 to 90° and from 0 to −90°) relative to the distal end of second portion  1140  such that first portion  1138  may be pivoted at a variety of angles relative to second portion  1140 . First portion  1138  is pivotable relative to second portion  1140  such that first portion  1138  pivots about pivot point  1142 . However, the planar distal end of second portion  1140  may engage a portion of first portion  1138  to prevent first portion  1138  from pivoting about pivot point  1142  in at least one direction. For example, first portion  1138  may be pivoted to the first pivoting angle  1156  such that the planar distal end of second portion  1040  engages first lateral face  1148 , which prevents first portion  1138  from pivoting upwardly about pivot point  1142 . However, first portion  1138  may be pivoted downwardly such that the planar distal end of second portion  1140  engages second lateral face  1150 , which prevents first portion  1138  from pivoting downwardly about pivot point  1142 . 
     Pivoting joint  1136  includes a bore extending longitudinally through first and second portions  1138 ,  1140  configured to create a passage for the distal end of first member  1132  such that the distal end of first member  1132  may extend through the bore in pivoting joint  1136  to engage an implant, such as implant  1030 . At least a portion of the distal end of first member  1132  is received within the recess in proximal end  1032 . First member  1132  is flexible so as to bend when pivoting joint  1136  is pivoted, while still engaging implant  1030 . The recess in proximal end  1032  of implant  1030  has a size and shape which corresponds to that of the distal end of first member  1132  such that the distal end of first member  1132  may be received within the recess in proximal end  1032  to engage implant  1030  and instrument  1130 . To engage implant  1030  and instrument  1130 , first member  1132  of instrument  1130  is extended through second member  1134  and the bore in pivoting joint  1136  and into the recess in proximal end  1032  of implant  1030 . 
     In operation, implant  1030  is connected to instrument  1130  by first inserting the distal end of first member  1132  into the recess in proximal end  1032 , and then positioning locking tabs  1154  into corresponding channels  1054  in implant  1030  until locking tabs  1154  snap into place within channels  1054 . First portion  1138  may be pivoted relative to second portion  1140  such that first lateral face  1148  of pivoting joint  1136  engages the distal end of second portion  1140  to maintain first portion  1038  at an angle relative to second portion  1040 . Alternatively, first portion  1038  may be pivoted relative to second portion  1140  such that second lateral face  1150  of pivoting joint  1136  engages the distal end of second portion  1140  to maintain first portion  1038  at an angle relative to second portion  1040 . Implant  1030  may be inserted between adjacent vertebrae. Implant  1030  may be disconnected from instrument  1130  before of after inserting implant  1030  into an intervertebral space by disengaging the distal end of first portion  1138  from the recess in proximal end  1032  of implant  1030  and removing locking tabs  1154  from channels  1054 . 
     Instrument  1130  may include a handle  1170  having a transverse dimension greater than that of second member  1134  to permit ease of gripping by a surgeon during use. Handle  1170  may be formed of stainless steel, for example, and may have a shape corresponding to that of second member  1134 . For example, it is envisioned that the handle  1170  could be cylindrical or, in the alternative, may have other cross section shapes such as square or rectangle, for example. The handle may also have flattened surfaces for receiving hammer blows used to manipulate instrument  1130  to pivot and/or position implant  1030  into the intervertebral disc space. 
     In one embodiment, the interbody implant system includes an implant having an agent, which includes a bone growth promoting material, which may be disposed, packed or layered within, on or about the components and/or surfaces thereof. The bone growth promoting material, such as, for example, bone graft can be a particulate material, which may include an osteoconductive material such as hydroxyapatite and/or an osteoinductive agent such as a bone morphogenic protein (BMP) to enhance bony fixation of spinal implant  30  with the adjacent vertebrae V. 
     It is contemplated that the bone graft may include therapeutic polynucleotides or polypeptides. It is further contemplated that the bone graft may include biocompatible materials, such as, for example, biocompatible metals and/or rigid polymers, such as, titanium elements, metal powders of titanium or titanium compositions, sterile bone materials, such as allograft or xenograft materials, synthetic bone materials such as coral and calcium compositions, such as hydroxyapatite, calcium phosphate and calcium sulfite, biologically active agents, for example, gradual release compositions such as by blending in a bioresorbable polymer that releases the biologically active agent or agents in an appropriate time dependent fashion as the polymer degrades within the patient. Suitable biologically active agents include, for example, BMP, Growth and Differentiation Factors proteins (GDF) and cytokines Spinal implant  30  can be made of radiolucent materials such as polymers. Radiomarkers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. 
     It is envisioned that 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. The agents may include pharmacological agents, such as, for example, antibiotics, anti-inflammatory drugs including but not limited to steroids, anti-viral and anti-retroviral compounds, therapeutic proteins or peptides, therapeutic nucleic acids (as naked plasmid or a component of an integrating or non-integrating gene therapy vector system), and combinations thereof. 
     The agent may also include analgesics or anesthetics such as acetic acid derivatives, COX-2 selective inhibitors, COX-2 inhibitors, enolic acid derivatives, propionic acid derivatives, salicylic acid derivatives, opioids, opioid/nonopioid combination products, adjuvant analgesics, and general and regional/local anesthetics. 
     The agent may also include antibiotics such as, for example, amoxicillin, beta-lactamases, aminoglycosides, beta-lactam (glycopeptide), clindamycin, chloramphenicol, cephalosporins, ciprofloxacin, erythromycin, fluoroquinolones, macrolides, metronidazole, penicillins, quinolones, rapamycin, rifampin, streptomycin, sulfonamide, tetracyclines, trimethoprim, trimethoprim-sulfamthoxazole, and vancomycin. 
     The agent may also include immunosuppressives agents, such as, for example, steroids, cyclosporine, cyclosporine analogs, cyclophosphamide, methylprednisone, prednisone, azathioprine, FK-506, 15-deoxyspergualin, prednisolone, methotrexate, thalidomide, methoxsalen, rapamycin, leflunomide, mizoribine (Bredinin™), brequinar, deoxyspergualin, and azaspirane (SKF 105685), Orthoclone OKT™ 3 (muromonab-CD3). Sandimmune™, Neoral™, Sangdya™ (cyclosporine), Prograf™ (FK506, tacrolimus), Cellcept™ (mycophenolate motefil, of which the active metabolite is mycophenolic acid), Imuran™ (azathioprine), glucocorticosteroids, adrenocortical steroids such as Deltasone™ (prednisone) and Hydeltrasol™ (prednisolone), Folex™ and Mexate™ (methotrxate), Oxsoralen-Ultra™ (methoxsalen) and Rapamuen™ (sirolimus). 
     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.