Patent Publication Number: US-2023139087-A1

Title: Revision connectors, systems and methods thereof

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     The present application is a continuation of U.S. patent application Ser. No. 16/460,451 filed on Jul. 2, 2019, which is a Divisional of U.S. patent application Ser. No. 15/228,019, filed on Aug. 4, 2016, which is Continuation-in-Part of U.S. patent application Ser. No. 15/083,467, filed on Mar. 29, 2016, both of which are incorporated herein by reference in their entireties. 
    
    
     BACKGROUND 
     Field of the Invention 
     The present invention relates to rod connectors, such as spinal hardware connectors. 
     Description of the Related Art 
     At times, spinal surgeons are forced to add additional fixation to spinal segments adjacent to previously instrumented levels. In these cases, the hardware from the initial surgery interferes with placement of new fixation for the adjacent level. Therefore, there is a need for connector implants that attach to the existing spinal fusion construct on one end and extend fixation to adjacent levels in need of fusion. Quicker recovery times and lessened discomfort makes minimally invasive surgical (MIS) techniques favorable in these situations. 
     SUMMARY 
     This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used to limit the scope of the claimed subject matter. 
     The present disclosure relates to components, systems, and methods for connecting one device to another device. For example, one elongate implant, such as a first rod, may be coupled to another elongate implant, such as a second rod. The elongate implants, such as rods, are well known to connect adjacent vertebrae in a spinal fusion procedure. Depending on the configuration of rods or implants, it may be desirable to have one rod connected to another rod or additional implant. In the case of two or more rods, these rods may be interconnected with one or more connectors, for example, in a single given surgery, such as a scoliosis operation, or at a later surgery, for example, in a revision surgery. In a revision surgery, connectors can be used to connect new fixation constructs to existing fixation constructs without the need to remove the original hardware. The different connection modes provided in the following exemplary embodiments offer a range of options to be chosen based on a specific clinical scenario and/or surgeon preference. Although certain configurations are shown herein, it is envisioned that any suitable number, type, and selection of connectors and implants may be chosen and configured by the skilled surgeon. 
     According to one embodiment, an articulating revision connector assembly may include a connector that is configured to connect a new construct to an existing construct in a patient. 
     In one embodiment, the articulating revision connector assembly comprises a rod and a connector attached to the rod. The connector includes an open clamp portion having a securing mechanism rotatably connected thereto and a closed clamp portion rotatably connected to the open clamp portion. The closed clamp portion has a passage extending therethrough. The passage is sized to allow passage of the rod therethrough. A locking mechanism is configured to releasably prevent rotation of the closed clamp portion relative to the open clamp portion when the rod is inserted into the passage. 
     In an alternative embodiment, the articulating revision connector assembly comprises a rod and a connector releasably connected to the rod. The connector includes a first connecting portion extending along a longitudinal axis. The first connecting portion has a first end having an open connection adapted to releasably retain the rod and a second end having a blind passage extending along the longitudinal axis. A second connecting portion is rotatably connected to the second end of the first connecting portion. The second connecting portion has an axial passage extending generally orthogonal to the longitudinal axis. 
     In still another alternative embodiment, a method of adding a new construct to an existing construct comprises the steps of: providing a connector having a first connecting portion with an open connection and a second connecting portion rotatably connected to the first connecting portion, the second connecting portion having an axial passage extending therethrough; inserting the open connection over a first rod in the existing construct; securing the first connecting portion to the first rod; inserting a second rod through the axial passage; rotating the second connecting portion relative to the first connecting portion to a desired location; and securing the second rod to the second connecting portion, thereby restricting rotation of the second connecting portion with respect to the first connecting portion. 
     In yet another exemplary embodiment, a spinal revision connector assembly comprises a body having a first end and a second end, a first connecting member at the first end, and a rod extending from the second end. 
     Another exemplary embodiment of a spinal revision connector assembly comprises an elongate rod having a first end and a second end, a tapered tip at the first end, and a securing structure at the second end. 
     In still another exemplary embodiment, the spinal revision connector assembly comprises a rod and a connector portion attached to an end of the rod. The connector portion has a space sized to allow the passage of a construct therethrough and a connector distal from the rod. 
     According to another exemplary embodiment, a connector comprises a first clamping portion having a first passage having a first longitudinal axis extending therethrough and being sized to allow a first rod to be inserted thereinto along the first longitudinal axis, a bottom portion having an opening in communication with the first passage, and a first securing mechanism rotatably connected thereto. The first securing mechanism is adapted to releasably secure the first rod in the first passage. A second clamping portion has a second passage having a second longitudinal axis extending therethrough such that the second longitudinal axis is parallel to the first longitudinal axis. The second passage is sized to allow a second rod to be inserted thereinto along the second longitudinal axis. 
     In another exemplary embodiment, a connector comprises a body having a bottom surface extending between a first end and a second end. The first end has a generally U-shaped first opening extending from the bottom surface such that the U-shaped opening is sized to receive a first rod extending therethrough along a first axis. A securing mechanism is extendable into the first opening to releasably secure the first rod to the body. The second end has a second opening extending therethrough along a second axis, parallel to the first axis. The second opening is sized to receive a second rod. 
     In still another exemplary embodiment, a method of adding a new construct to an existing construct comprises the steps of providing a connector having a first connecting portion with an open connection and a second connecting portion having an axial passage extending therethrough; inserting the open connection over a first rod in the existing construct; securing the first connecting portion to the first rod; inserting a second rod through the axial passage; and securing the second rod to the second connecting portion. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Other aspects, features, and advantages of the present invention will become more fully apparent from the following detailed description, the appended claims, and the accompanying drawings in which like reference numerals identify similar or identical elements. 
         FIG.  1    is a side elevational view of an articulating revision connector according to a first exemplary embodiment; 
         FIG.  2    is a perspective view of the articulating revision connector shown in  FIG.  1    connected to an existing rod construct; 
         FIG.  3    is a perspective view of the articulating revision connector and rod construct shown in  FIG.  2   , with the connector also being connected to a newly installed rod; 
         FIGS.  4 A-E  are end elevational views of the connector shown in  FIG.  1   , with the articulating portion rotated about multiple angles with respect to the fixed portion of the connector; 
         FIG.  5    is a sectional view of the articulating revision connector shown in  FIG.  1   ; 
         FIG.  6    is a side elevational view of an articulating revision connector according to a second exemplary embodiment; 
         FIG.  7    is a perspective view of an articulating revision connector according to a third exemplary embodiment; 
         FIG.  8    is a perspective view of the connector shown in  FIG.  7    connected to an existing rod construct and a newly installed rod; 
         FIG.  9    is a perspective view of an articulating revision connector according to a fourth exemplary embodiment; 
         FIG.  10    is a perspective view of the connector shown in  FIG.  9   , connected to an existing rod construct and a newly installed rod; 
         FIG.  11    is a perspective view of an articulating revision connector according to a fifth exemplary embodiment; 
         FIG.  12    is a perspective view of an integrated revision connector according to a sixth exemplary embodiment; 
         FIG.  13    is a perspective view of an integrated revision connector according to a seventh exemplary embodiment; 
         FIG.  14    is a perspective view of the integrated revision connector shown in  FIG.  13   , connected to an existing construct; 
         FIG.  15    is a side elevational view of the integrated revision connector connected to an existing construct shown in  FIG.  14     
         FIG.  16    is a perspective view of the integrated revision connector shown in  FIG.  13   , alternatively connected to an existing construct; 
         FIG.  17    is a perspective view of an integrated revision connector according to an eighth exemplary embodiment; 
         FIG.  18    is a perspective view of the integrated revision connector shown in  FIG.  17   , connected to an existing construct; 
         FIG.  19    is a perspective view of an integrated revision connector according to a ninth exemplary embodiment, connected to an existing construct; 
         FIG.  20    is a perspective view of an integrated revision connector according to a tenth exemplary embodiment; 
         FIG.  21    is a perspective view of the integrated revision connector shown in  FIG.  20   , connected to an existing construct; 
         FIG.  22    is a perspective view of the integrated revision connector shown in  FIG.  20   , alternatively connected to an existing construct; 
         FIG.  23    is a perspective view of an integrated revision connector according to an eleventh exemplary embodiment; 
         FIGS.  24 A-D  are side elevational views of advancing stages of a connecting mechanism of the integrated revision connector shown in  FIG.  23   ; 
         FIG.  25    is a sectional view of the connecting mechanism of the integrated revision connector shown in  FIG.  23   ; 
         FIG.  26    is a sectional view of the connecting mechanism of the integrated revision connector shown in  FIG.  23   , connected to an existing construct; 
         FIG.  27    is a perspective view of the integrated revision connector shown in  FIG.  23   , connected to the existing construct; 
         FIG.  28    is a perspective view of a link connector according to a twelfth exemplary embodiment; 
         FIG.  29    is a side elevational view of the link connector shown in  FIG.  28   , connected to adjacent screws; 
         FIG.  30    is a perspective view of a lateral connector according to a thirteenth exemplary embodiment; 
         FIG.  31    is a perspective view of a top loading connector according to a fourteenth exemplary embodiment; 
         FIG.  32    is a perspective view of the link connector shown in  FIG.  28    and the lateral connector shown in  FIG.  30   , connected to an existing construct and supporting a new construct; 
         FIG.  33    is a perspective view of a lateral offset link connector according to a fifteenth exemplary embodiment; 
         FIG.  34    is a perspective view of the lateral offset length connector shown in  FIG.  33    and the lateral connector shown in  FIG.  30   , connected to an existing construct and supporting a new construct; 
         FIG.  35    is a perspective view of a sagittal offset link connector according to a sixteenth exemplary embodiment; 
         FIG.  36    is a side elevational view of the sagittal offset connector shown in  FIG.  35   , and the lateral connector shown in  FIG.  30   , connected to an existing construct and supporting a new construct; 
         FIG.  37    is a perspective view of a revision connector according to a seventeenth exemplary embodiment; 
         FIG.  38    is a side elevational view of the revision connector shown in  FIG.  37   ; 
         FIG.  39    is a front elevational view of the revision connector shown in  FIG.  37   ; 
         FIG.  40    is a side elevational view of the revision connector shown in  FIG.  37   , mounted on an existing construct; 
         FIG.  41    is a sectional view of the revision connector and existing construct shown in  FIG.  40   ; 
         FIG.  42    is a sectional view of a revision connector according to an eighteenth exemplary embodiment, mounted on an existing construct; 
         FIG.  43    is a side elevational view of the revision connector shown in  FIG.  42   , connecting a new construct to the existing construct; 
         FIG.  44    is a perspective view of a revision connector according to a nineteenth exemplary embodiment; 
         FIG.  45    is a sectional view of the revision connector shown in  FIG.  44   , mounted on an existing construct; 
         FIG.  46    is a side elevational view of the revision connector shown in  FIG.  45   , connecting a new construct to the existing construct; 
         FIG.  47    is a perspective view of a revision connector according to a twentieth exemplary embodiment; 
         FIG.  48    is a sectional view of the revision connector shown in  FIG.  47   , with a set screw, mounted on existing construct; 
         FIG.  49    is a sectional view of the revision connector shown in  FIG.  47   , with a wedge, mounted on existing construct; 
         FIG.  50    is a side elevational view of the revision connector shown in  FIG.  47   , connecting a new construct to the existing construct; 
         FIG.  51    is a sectional view of the lateral connector shown in  FIG.  30   , mounted on an existing construct; 
         FIG.  52    is a perspective view of a new construct mounted on the lateral connector shown in  FIG.  30   ; 
         FIG.  53    is a perspective view of the lateral connector shown in  FIG.  30   , connecting the new construct to the existing construct; 
         FIG.  54    is a top plan view of the lateral connector shown in  FIG.  30   , connecting the new construct to the existing construct; 
         FIG.  55    is a perspective view of the top loading connector shown in  FIG.  31   , mounted on an existing construct; 
         FIG.  56    is a perspective view of the top loading connector shown in  FIG.  31   , connecting a new construct to the existing construct; 
         FIG.  57    is a side elevational view of the top loading connector shown in  FIG.  31   , connecting the new construct to the existing construct; 
         FIG.  58    is a perspective view of an offset revision rod according to a twenty-first exemplary embodiment; 
         FIG.  59    is a top plan view of the offset revision rod shown in  FIG.  58   ; 
         FIG.  60    is a side elevational view of a distraction/compression clamp according to a twenty-second exemplary embodiment; 
         FIG.  61    is a perspective view of the distraction/compression clamp shown in  FIG.  60   , connected to existing construct; 
         FIG.  62    is a side perspective view of a double head lateral connector according to a twenty-third exemplary embodiment; 
         FIG.  63    is a side elevational view of the double head lateral connector shown in  FIG.  62   ; 
         FIG.  64    is a top perspective view of the double head lateral connector shown in  FIG.  62   ; 
         FIG.  65    is a perspective view of a double head in-line connector according to a twenty-fourth exemplary embodiment; 
         FIG.  66    is a perspective view of a J-hook connector according to a twenty-fifth exemplary embodiment; 
         FIG.  67    is a perspective view of a modular head open lateral connector with connected rods according to a twenty-sixth exemplary embodiment; 
         FIG.  68    is a side elevational view modular open head lateral connector with connected rods shown in  FIG.  67   ; 
         FIG.  69    is a perspective view of a single head open lateral connector according to a twenty-seventh exemplary embodiment; 
         FIG.  70    is a perspective view of a double modular lateral connector according to a twenty-eighth exemplary embodiment; 
         FIG.  71    is a side elevational view of a Z-rod according to a twenty-ninth exemplary embodiment; 
         FIG.  72    is a perspective view of an in-line connector with integrated rod according to a thirtieth exemplary embodiment; 
         FIG.  73    is a perspective view of a top loading lateral connector with a closed connector portion according to a thirty-first exemplary embodiment; 
         FIG.  74    is a sectional view of the connector shown in  FIG.  73   ; 
         FIG.  75    is a perspective view of a top loading lateral connector with an open side connector portion according to a thirty-second exemplary embodiment; 
         FIG.  76    s a perspective view of a top loading lateral connector with a tulip portion according to a thirty-third exemplary embodiment; 
         FIG.  77    is a perspective view of a top loading lateral connector with a sliding member according to a thirty-fourth embodiment; 
         FIG.  78    is a cross-sectional view of the connector shown in  FIG.  77   ; 
         FIG.  79    is a perspective view of a top loading connector lateral with a pivoting member according to a thirty-fifth embodiment; 
         FIG.  80    is a cross-sectional view of the connector shown in  FIG.  79   ; 
         FIG.  81    is a perspective view of a top loading lateral connector with a cam lock according to a thirty-sixth embodiment; 
         FIG.  82    is a sectional view of the connector shown in  FIG.  81   , with the cam in an unlocking position; 
         FIG.  83    is a sectional view of the connector shown in  FIG.  81   , with the cam in an locking position; 
         FIG.  84    is a top plan view of the connector shown in  FIG.  81    connected to a rod, with the cam in the unlocking position; 
         FIG.  85    is a top plan view of the connector shown in  FIG.  81    connected to a rod, with the cam in the locking position; 
         FIG.  86    is an exploded side elevational view of a top loading connector according to a thirty-seventh embodiment; 
         FIG.  87    is a side elevational view of the top loading connector shown in  FIG.  86   ; 
         FIG.  88    is a sectional view of the top loading connector shown in  FIG.  86   ; 
         FIG.  89    is a sectional view of the top loading connector shown in  FIG.  86   , with the connector clamped onto a rod; 
         FIG.  90    is a side elevational view of the connector shown in  FIG.  86    clamped onto a rod assembly with a screw tulip connector mounted on top of the connector; 
         FIG.  91    is a side elevational view of the connector shown in  FIG.  86    clamped onto a rod assembly with a connector mounted on top of the connector; 
         FIG.  92    is an exploded side elevational view of a top loading connector according to a thirty-eighth embodiment; 
         FIG.  93    is a side elevational view of the top loading connector shown in  FIG.  92   ; 
         FIG.  94    is a sectional view of the top loading connector shown in  FIG.  92   ; 
         FIG.  95    is a sectional view of the top loading connector shown in  FIG.  92   , with the connector clamped onto a rod; 
         FIG.  96    is a side elevational view of the connector shown in  FIG.  92    clamped onto a rod assembly with a screw tulip connector mounted on top of the connector; and 
         FIG.  97    is a side elevational view of the connector shown in  FIG.  92    clamped onto a rod assembly with a connector mounted on top of the connector. 
     
    
    
     DETAILED DESCRIPTION 
     In the drawings, like numerals indicate like elements throughout. Certain terminology is used herein for convenience only and is not to be taken as a limitation on the present invention. The terminology includes the words specifically mentioned, derivatives thereof and words of similar import. The embodiments illustrated below are not intended to be exhaustive or to limit the invention to the precise form disclosed. These embodiments are chosen and described to best explain the principle of the invention and its application and practical use and to enable others skilled in the art to best utilize the invention. 
     Reference herein to “one embodiment” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the embodiment can be included in at least one embodiment of the invention. The appearances of the phrase “in one embodiment” in various places in the specification are not necessarily all referring to the same embodiment, nor are separate or alternative embodiments necessarily mutually exclusive of other embodiments. The same applies to the term “implementation.” 
     As used in this application, the word “exemplary” is used herein to mean serving as an example, instance, or illustration. Any aspect or design described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other aspects or designs. Rather, use of the word exemplary is intended to present concepts in a concrete fashion. 
     Additionally, the term “or” is intended to mean an inclusive “or” rather than an exclusive “or”. That is, unless specified otherwise, or clear from context, “X employs A or B” is intended to mean any of the natural inclusive permutations. That is, if X employs A; X employs B; or X employs both A and B, then “X employs A or B” is satisfied under any of the foregoing instances. In addition, the articles “a” and “an” as used in this application and the appended claims should generally be construed to mean “one or more” unless specified otherwise or clear from context to be directed to a singular form. 
     Unless explicitly stated otherwise, each numerical value and range should be interpreted as being approximate as if the word “about” or “approximately” preceded the value of the value or range. 
     The use of figure numbers and/or figure reference labels in the claims is intended to identify one or more possible embodiments of the claimed subject matter in order to facilitate the interpretation of the claims. Such use is not to be construed as necessarily limiting the scope of those claims to the embodiments shown in the corresponding figures. 
     It should be understood that the steps of the exemplary methods set forth herein are not necessarily required to be performed in the order described, and the order of the steps of such methods should be understood to be merely exemplary. Likewise, additional steps may be included in such methods, and certain steps may be omitted or combined, in methods consistent with various embodiments of the present invention. 
     Although the elements in the following method claims, if any, are recited in a particular sequence with corresponding labeling, unless the claim recitations otherwise imply a particular sequence for implementing some or all of those elements, those elements are not necessarily intended to be limited to being implemented in that particular sequence. 
     Also for purposes of this description, the terms “couple,” “coupling,” “coupled,” “connect,” “connecting,” or “connected” refer to any manner known in the art or later developed of joining or connecting two or more elements directly or indirectly to one another, and the interposition of one or more additional elements is contemplated, although not required. Conversely, the terms “directly coupled,” “directly connected,” etc., imply the absence of such additional elements. 
     The present disclosure relates to components, systems, and methods for connecting one elongate implant, such as a first rod, to another elongate implant, such as a second rod. The elongate implants, such as rods, are well known to connect adjacent vertebrae in a spinal fusion procedure. Depending on the configuration of rods or implants, it may be desirable to have one rod connected to another rod or additional implant. In the case of two or more rods, these rods may be interconnected with one or more connectors, for example, in a single given surgery, such as a scoliosis operation, or at a later surgery, for example, in a revision surgery. 
     For example, connectors can be used to connect new fixation constructs to existing fixation constructs without the need to remove index surgery hardware. A benefit to such direct attachment to existing constructs saves operating time, causes less disruption to the patient, and minimizes patient healing time. The ability of the inventive connectors to maintain connection with existing constructs can maximize utility in cases of varying patient anatomy and existing spinal constructs. The different connection modes provided in the following exemplary embodiments offer a range of options to be chosen based on a specific clinical scenario and/or surgeon preference. Thus, although certain configurations are shown herein, it is envisioned that any suitable number, type, and selection of connectors and implants, such as rods, may be chosen and configured by the skilled surgeon. 
     While the different connection modes disclosed herein can be used independently, those skilled in the art will recognize that the connection modes can be combined “à la carte” according to patient needs. Further, while the connection modes disclosed herein can be provided separately, kits that include various and multiple combinations of different connection modes can also be provided. 
     Referring to  FIGS.  1 - 5   , an articulating revision connector assembly  100  (“connector assembly  100 ”) according to a first exemplary embodiment is shown. Connector assembly  100  is used to attach to a first rod  50  that is already present in an existing construct. As shown in  FIG.  2   , first rod  50  can be supported by and secured to one or more screw heads  60  (e.g., a tulip assembly connected to a polyaxial pedicle screw). Although not shown, a cap or securing member, such as a threaded cap, may then be engaged with the threaded portion of the tulip to secure the rod  50  therein. While  FIG.  2    shows connector assembly  100  as being located between screw heads  60 , those skilled in the art will recognize that connector assembly  100  can be located in other places along first rod  50 . For example, the connector assembly  100  can positioned such that it is substantially in contact with a portion of the screw heads  60  (e.g. substantially in contact with an outer portion of the tulip assembly). 
     Referring back  FIG.  1   , connector assembly  100  is an open lateral connector that extends an existing construct an adjacent level. Connector assembly  100  includes an open clamp portion  110  rotatably connected to a closed clamp portion  130  that provides articulation about open clamp portion  110  to a desired angle. Once the desired rotational position is achieved, closed clamp portion  130  can be secured to open clamp portion  110 , locking the articulation. 
     Open clamp portion  110  includes a securing mechanism  112 , such as a set screw, that is rotatably connected thereto. Open clamp portion  110  includes a blind passage  114  with a clamp opening  116  that extends along a first axis “A 1 ”. Securing mechanism  112  is mounted in a through passage  118  (shown in  FIG.  5   ) extending generally orthogonally relative to first axis A 1 . 
     Closed clamp portion  130  is rotatably connected to open clamp portion  110 . Closed clamp portion  130  has a passage  132  extending therethrough that is sized to allow passage of a second rod  70  (shown in  FIG.  3   ) therethrough. The passage  132  is preferably sized and shaped to receive the rod  70 . In the embodiment shown, the passage  132  is elongated to have a length greater than its width to allow for some translation of the rod  70  in the passage  132  before the securing member  134  is tightened. It is envisioned, however, that the passage  132  may be substantially circular or cylindrical in shape. Rod  70  may be a Z-rod (shown in  FIG.  71   ) in order to extend rod  50  co-linearly, as shown in  FIG.  3   . Although not shown, any other suitable rod may be selected, for example, to allow for a parallel configuration or to select a rod that may be bent in situ. 
     Closed clamp portion  130  includes a securing member  134  that is adapted to bias second rod  70 . Securing member  134  is rotatably mounted in a through-passage  135  that extends generally obliquely relative to longitudinal axis A 1 . The rotation of closed clamp portion  130  relative to open clamp portion  110  is illustrated in  FIGS.  4 A- 4 E , which show closed clamp portion  130  rotated across five different positions relative to open clamp portion  110 . Those skilled in the art will recognize that closed clamp  130  has 360° of rotation relative to open clamp portion  110 . It is envisioned, however, that the clamp  130  may be permitted to rotate any suitable amount relative to open clamp portion  110 . 
     Referring to  FIG.  5   , a locking mechanism  150  is configured to releasably prevent rotation of closed clamp portion  130  relative to open clamp portion  110  when rod  70  (not shown in  FIG.  5   ) is inserted into passage  132 . Locking mechanism  150  includes a blind passage  152  formed in closed clamp portion  130  and extending along longitudinal axis A 1 . Passage  152  has a first set of teeth  154 . An insert  156  is longitudinally disposed in passage  152 . Insert  156  has a second set of teeth  158  that are releasably engageable with the first set of teeth  154 , such that, when insert  156  is longitudinally translated toward open clamp portion  110 , second set of teeth  158  engages first set of teeth  154 , restricting rotation of open clamp portion  110  relative to closed clamp portion  130 . 
     Passage  152  has an outwardly flared opening  160 , and insert  156  has a corresponding outwardly flared end  162  that is adapted to engage outwardly flared opening  160  when insert  156  is longitudinally translated toward open clamp portion  110 . Flared opening  160  of passage  152  also includes a lip  164  that extends radially away from first axis A 1 . 
     A cap  170  is threadably connected to closed clamp portion  130  to rotatably retain closed clamp portion  130  on open clamp portion  110 . Cap  170  includes a threaded connection  172  that threadably engaged with mating threads  174  on closed clamp portion  130 . An exterior of cap  170  also includes radially spaced recesses  176  allow for the application of a tool (not shown), such as, for example, a spanner wrench, to attach/remove cap  170  to/from closed clamp portion  130 . 
     A plurality of bushings and washers  180 - 184  are located on the exterior of open clamp portion  110  between cap  170  and lip  164  and serve to form a frictional connection between cap  170  and lip  164  when closed clamp portion  130  is locked to open clamp portion  110 . 
     To assemble connector assembly  100  and add rod  70  to an existing construct, clamp opening  116  of connector assembly  100  is secured to rod  50 , and rod  70  is then inserted into passage  132  as shown in the exemplary configuration shown in  FIG.  3   . When rod  70  is located at a desired angle with respect to rod  50 , securing mechanism  112  is advanced through passage  118 , such that securing mechanism  112  biases rod  70  against insert  156 , advancing insert  156  along longitudinal axis A 1  toward passage  114 . Teeth  158  on insert  156  engage with teeth  154  in passage  152  and seat flared end  162  of insert  156  on flared opening  160  of passage  152 , forcing lip  164  to bias toward cap  170 , thereby restricting rotation of open clamp portion  110  relative to closed clamp portion  130 . 
     In an alternative embodiment, shown in  FIG.  6   , a clamp assembly  200  incorporates closed clamp portion  130 , but, instead of open clamp portion  110 , includes an open clamp portion  210  rotatably attached thereto. Open clamp portion  210  comprises a clamp opening  216  extending obliquely relative to the first axis A 1 , with opening  216  in an offset plane relative to opening  132  in closed clamp portion  130 . 
     In another alternative embodiment of a connector assembly  300 , shown in  FIG.  7   , wherein an open clamp portion  310  comprises a clamp opening  316  extending generally orthogonally relative to first axis A 1  such that a blind end of opening  316  extends along first axis A 1 , allowing the insertion of rod  50  in opening  316  to be coplanar with rod  70  after rod  70  is inserted into passage  132 .  FIG.  8    shows the connection of connector assembly  300  with rod  70  extending in the same lateral plane as existing rod  50 . This configuration allows the open clamp portion  310  to be positioned beneath the existing rod  50 . A threaded cap (not shown) may then be engaged with the threaded portion on the top of the open clamp portion  310  to secure the rod  50  therein, thereby coupling rod  50  to rod  70 . 
     In still another embodiment of a connector assembly  400 , shown in  FIGS.  9  and  10   , an open clamp portion  410  comprises a clamp opening  416  extending generally orthogonally relative to first axis A 1  such that a blind end of opening  416  extends above first axis A 1 , allowing the insertion of rod  50  in opening  416  to be skewed with respect to rod  70  after rod  70  is inserted into passage  132 . The open clamp portion  410  may have a generally U-shaped configuration allowing for the open clamp portion  410  to be positioned beneath the existing rod  50 . A threaded cap (not shown) may then be engaged with the threaded portion on the top of the open clamp portion  410  to secure the rod  50  therein, thereby coupling existing rod  50  to new rod  70 . 
     In yet another embodiment of a connector assembly  500 , shown in  FIG.  11   , and articulating modular lateral head connector is provided. In this embodiment, the open clamp portion is replaced with a connection point, such as a post, configured to receive a rod having a modular connection point  1220 , for example, as depicted in  FIG.  28    and described in more detail below. The post or connection point may have a partially spherical outer surface with a generally flat top surface to enable engagement with a corresponding opening in the rod. 
     Referring now to  FIGS.  12 - 27   , a plurality of integrated revision connectors according to exemplary embodiments are shown. In an exemplary embodiment, shown in  FIG.  12   , a spinal revision connector assembly  600  includes a body  610  having a first end  612  and a second end  614 . Body  610  is generally a closed loop that provides a space sufficiently large for the insertion of a pre-existing construct, such as, for example, a spinal implant screw head (not shown) therethrough, thereby minimizing the amount of new construct that is to be connected to an existing construct. 
     A first connecting member  620  is located at first end  612 . In an exemplary embodiment, first connecting member  620  can be a threaded opening that allows for the insertion of a fastener, such as a set screw (not shown), that provides for connection to existing construct. 
     An upper surface  622  of first end  612  includes an arcuate recess  624  sized to accept a rod (not shown) from an existing construct. Similarly, a lower surface  626  includes an arcuate recess  628  sized to accept a rod (not shown) from an existing construct. Recesses  624 ,  626  can be the same or different sizes (as shown) in order to be able to accommodate rods of different diameters. 
     A rod  630  extends from second end  614  of body  610 . Rod  630  can have a tapered tip  632  at a distal end of rod  630  from body  610 . Rod  630  can extend an existing construct two adjacent level in order to provide required fixation. 
     In an alternative exemplary embodiment, shown in  FIGS.  13 - 16   , a spinal revision connector assembly  700  includes a body  710  having a first end  712  and a second end  714 . Body  710  is generally an open loop that provides a space sufficiently large for the insertion of body  710  over the top of a screw head  60  in an existing construct where rod  50  is of insufficient length protruding from the side of screw head  60 , as shown in  FIGS.  14  and  15   . Alternatively, body  710  can go around screw head  60  in the existing construct, as shown in  FIG.  16   . 
     A first connecting member  720  is located at first end  712 . In an exemplary embodiment, first connecting member  720  can be one or more threaded openings  722 ,  724 , that allow for the insertion of a fastener, such as a set screw (not shown), that provides for connection to existing construct. Additionally, a lower lip  726  is used to support an underside of rod  50  to provide secure clamping of first connecting member  720  to rod  50 , such that a passage  727  is formed between lower lip  726  and first end  712 . 
     A rod  730  extends from second end  714  of body  710 . Rod  730  can have a tapered tip  732  at a distal end of rod  730  from body  710 . Rod  730  extends along a common axis with passage  727  such that rod  730  extends the existing construct of rod  50  at an adjacent level. 
     In another alternative exemplary embodiment, shown in  FIGS.  17  and  18   , a spinal revision connector assembly  800  includes a body  800  and having a first end  812  and a second end  814 . Body  810  is generally an open loop with a space between first end  812  and second end  814  that allows for the insertion of body  810  over the top of screw head  60  in an existing construct where rod  50  is of insufficient length protruding from the side of screw head  60 , as shown in  FIG.  18   . It is noted that, in  FIG.  18   , the length of rod  50  extending beyond screw head  60  is longer than that shown in  FIG.  14   , allowing for the use of assembly  800 , as shown in  FIG.  18   . 
     A first connecting member  820  is located at first end  812  and a second connecting member  822  is located at second end  814 . First connecting member  820  and second connecting member  822  can be threaded openings that allow for the insertion of a fastener, such as a set screw (not shown), to secure assembly  800  to rod  50  where rod  50  is sufficiently long to allow rod  50  to extend beyond screw head  60 , such that rod  50  can be engaged and secured by second connecting member  822 , as shown in  FIG.  18   . Additionally, a first lower lip  824  at first connecting member  820  and a second lower lip  826  at second connecting member  822  are used to support an underside of rod  50  to provide secure clamping of connecting members  820 ,  822  to rod  50 , such that a passage  827  is formed between first lower lip  824  and first end  812  and between second lower lip  826  and second end  814 . 
     A rod  830  extends from second end  814  of body  810 . Rod  830  can have a tapered tip  832  at a distal end of rod  830  from body  810 . Rod  830  extends along a common axis with passage  827  such that rod  730  extends the existing construct of rod  50  at an adjacent level. 
     In still another alternative exemplary embodiment, shown in  FIG.  19   , a spinal revision connector assembly  900  includes a body  910  having a first end  912  and a second end  914 . Body  910  is generally a closed loop that provides a space between first end  912  and second end  914  sufficiently large for the insertion of a pre-existing construct, such as, for example, screw head  60 , therethrough, thereby minimizing the amount of new construct that is to be connected to an existing construct. 
     A first connecting member  920  is located at first end  912  and a second connecting member  922  is located at second end  914 . First connecting member  920  and second connecting member  922  can be threaded openings that allow for the insertion of a fastener, such as a set screw (not shown), to secure assembly  900  to rod  50  where rod  50  is sufficiently long to allow rod  50  to extend beyond screw head  60 , such that rod  50  can be engaged and secured by second connecting member  922 . 
     A rod  930  extends from second end  914  of body  910 . Rod  930  can have a tapered tip  932  at a distal end of rod  930  from body  910 . 
     In still another alternative exemplary embodiment, shown in  FIGS.  20 - 22   , a spinal revision connector assembly  1000  includes a body  1010  having a first end  1012  and a second end  1014 . Body  1010  is generally an open loop that provides a space between first end  1012  and second end  1014  that is sufficiently large for the insertion of a pre-existing construct, such as, for example, screw head  60 , therethrough, thereby minimizing the amount of new construct that is to be connected to an existing construct.  FIG.  21    shows body  1010  extending over top of screw head  60 , while  FIG.  22    shows body  1010  extending around screw head  60 . 
     A first connecting member  1020  is located at first end  1012 . First connecting member  1020  can be a threaded opening that allows for the insertion of a fastener, such as a set screw (not shown), to secure assembly  1000  to rod  50 . Connecting member  1020  also includes clamping surfaces  1022 ,  1024  that extend outwardly from first end  1012 . Clamping surfaces  1022 ,  1024  are spaced sufficiently from each other to allow rod  50  to slide therethrough such that, when the fastener or set screw is secured, first connecting member  1020  securely grips rod  50 . 
     A rod  1030  extends from second end  1014  of body  1010 . Rod  1030  can have a tapered tip  1032  at a distal end of rod  1030  from body  1010 . Rod  1030  extends at the adjacent level as for  50  (shown in  FIG.  21   ). 
     In another alternative exemplary embodiment, shown in  FIGS.  23 - 27   , a spinal revision connector assembly  1100  includes a body  1110  having a first end  1112  and a second end  1114 . First end  112  includes a clamp housing that contains an inner revolving mechanism  1116  that can be rotated to surround the underside of an existing rod  50 . 
     Mechanism  1116  includes a rotating clamp  1118  that is mounted on a pivot  1120 . A distal end of clamp  1118  includes a plurality of ratchet teeth  1122 . When clamp  1118  is rotated from the position shown in  FIG.  24 A  to the position shown in  FIG.  24 D , ratchet teeth  1122  engage a securing mechanism in the form of internal ratchet teeth  1124  within body  1110  to secure clamp  1118  around rod  50 , as shown in  FIG.  25   , preventing clamp  1118  from rotating backwards after final tightening. Clamp  1118  is rotated by rotating mechanism  1120 . As shown in  FIGS.  24 A- 24 D , rotating mechanism  1120  can be a hex head screw that can be rotated by engaging a hex head tool, such as, for example, an Allen wrench (not shown), with rotating mechanism  1120  and rotating. 
     Body  1110  includes arcuate cutouts  1126  on opposing sides thereof (only one cutout  1126  shown in  FIG.  25   ), that are sized to receive rod  50  so that body  1110  snugly fits on rod  50 . Body  1110  also includes a threaded top opening  1128  sized to receive a set screw  1129  inserted therein so that set screw  1129  can be screwed on top of rod  50 , as shown in  FIG.  26   . 
     A rod  1130  extends from second end  1114  of body  1110 . Second end  1114  comprises an offset portion  1132  and distal end  1134  extending away from offset portion  1132 , such that distal end  1134  is at an adjacent level with rod  50 , as shown in  FIG.  27   . A space is provided between first end  1112  and second end  1114  that is sufficiently large for the insertion of a pre-existing construct, such as, for example, a spinal implant screw head (not shown) therethrough, thereby minimizing the amount of new construct that is to be connected to an existing construct. 
     Referring now to  FIGS.  28 - 38   , a plurality of link connectors according to exemplary embodiments are shown. A first exemplary link connector  1200  is used with a mating modular connection point on a spinal screw, or a secondary connector implant. 
     Referring specifically to  FIGS.  28  and  29   , a connector  1200  includes a rod  1210  within modular connection point  1220  at a first end. Connection point  1220  is a generally hollow body. Also, connection point  1220  includes a threaded connector, such as, for example, a fastener or set screw  1222  rotatably connected thereto and extending into the hollow body of connection point  1220 . Additionally, connection point  1220  includes a diametrically opposed indents  1224  (only one indent  1224  shown in  FIG.  28   ) to accommodate a gripping tool, such as, for example, a spanner wrench (not shown) that can be used to secure rod  1210  at a desired position while set screw  1220  is being tightened. 
       FIG.  29    shows connector  1200  spanning screw heads  60 ,  62 . Connection point  1220  is secured directly to screw  62 , while rod  1210  is secured to screw head  60 , placed at an adjacent level. 
     Referring to  FIG.  30   , an exemplary embodiment of a lateral connector  1300  is shown. Lateral connector  1300  includes a base  1310  having a first end  1312  with a connection point  1314  extending upwardly therefrom. Connection point  1314  is sized to fit into connection point  1220  and receives set screw  1222  from link connector  1200 . 
     Base  1310  also has a second end  1320  that includes a rod clamp  1322 . Rod clamp  1322  includes an arcuate surface  1324  for engaging a rod and a top surface  1326 , extending above connection point  1314 , that supports a securing member, such as, for example, a set screw  1328  that can be rotated to secure rod  50  within rod clamp  1322 , as shown in  FIG.  32   . As shown in  FIG.  32   , rod  1210  can extend at an oblique angle relative to rod  50 , in order to accommodate for the lateral offset in lateral connector  1300 . 
     Referring to  FIG.  31   , a top loading connector  1400  is shown. Connector  1400  includes a body  1410  that includes a rod clamp  1412 . Rod clamp  1412  includes an arcuate surface  1414  for engaging a rod and a flat top surface  1416  disposed above arcuate surface  1414 . Top surface  1416  includes a first threaded connection  1418  that receives a set screw  1420 . Top surface  1416  also includes a second threaded connection  1422 , for receiving an additional connector (not shown). 
     Referring now to  FIGS.  33  and  34   , a lateral offset link connector  1500  is shown. Link connector  1500  is similar to link connector  1200 , with the exception that, instead of a straight elongate body  1210 , link connector  1500  includes a body  1510  having a first end  1512  connected to a modular connection point  1520 , similar to modular connection point  1220 , a second, free end,  1514 , and a lateral offset  1516 , connecting first end  1512  with second end  1514 . Lateral offset  1516  is sized to accommodate the same lateral offset as with lateral connector  1300 . 
     As shown in  FIG.  34   , modular connection point  1520  can be connected to lateral connector  1300 , which in turn is connected to a rod  50  in an existing construct such that second end  1514  extends generally co-linearly with rod  50 , thereby allowing second end  1514 , to effectively act as an extension of rod  50 . 
     Referring now to  FIGS.  35  and  36   , a sagittal offset link connector  1600  is shown. Link connector  1600  is similar to link connector  1500 , with the exception that, instead of lateral offset  1516 , link connector  1600  includes a body  1610  having a first end  1612  connected to modular connection point  1620 , similar to modular connection point  1520 , a second, free end,  1614 , and a sagittal offset  1616 , connecting first end  1612  with second end  1614 . Sagittal offset  1616  is sized to allow connector  1600  to extend upward and over a screw head  60  when connected to a lateral connector  1300  and rod  50 , as shown in  FIG.  36   . 
     As shown in  FIG.  36   , modular connection point  1620  can be connected to lateral connector  1300 , which in turn is connected to a rod  50  in an existing construct such that second end  1614  extends generally co-linearly with rod  50 , thereby allowing second end  1514 , to effectively act as an extension of rod  50 . 
     Referring now to  FIGS.  37 - 57   , a plurality of link connectors according to exemplary embodiments are shown.  FIGS.  37 - 41    show a connector  1700  according to an exemplary embodiment. Connector  1700  is connected to an existing rod by a twisting connection and subsequent to attachment, a second, new rod may be positioned above and in-line with the existing rod. For example, connector  1700  may be inserted between two existing screw head  60 , proximal to an adjacent level that needs additional fixation. 
     Connector  1700  includes a body  1710  having a connecting portion  1712  at a first end and a screw head portion  1720  at an opposing end. Connecting portion  1712  includes a pair of outwardly extending curved legs  1714 ,  1716  that extend downwardly from diametrically opposed sides of body  1710  in opposing directions, forming a passage  1718  sized to allow a rod  50  to extend therethrough. 
     Screw head portion  1720  includes a first arcuate portion  1722  and a second arcuate portion  1724  diametrically opposed from first arcuate portion  1722 , forming a rod through-passage  1725  extending therebetween. The interior faces of each of arcuate portion  1722 ,  1724  are threaded at threads  1726  to accommodate insertion of a set screw  1730 , shown in  FIG.  41   . 
     To install connector  1700  on a rod  50 , connector  1700  is inserted with rod through-hole  1725  facing in a medial/lateral direction and legs  1714 ,  1716  straddling rod  50 , as shown in  FIG.  40   . Connector  1700  is then rotated 90° in situ, so that rod  50  extends through passage  1718 , with legs  1714 ,  1716  extending underneath rod  50 , as shown in  FIG.  41   . Set screw  1730  is then screwed downward to engage rod  50 , securing connector  1700  to rod  50 . 
     In an alternative embodiment of a connector  1800 , shown in  FIG.  42   , instead of threads  1726  and set screw  1730 , lower interior surfaces of a first arcuate portion  1822  and a second arcuate portion  1824  are unthreaded and a wedge  1826  is advanced through a rod through-passage  1825  to engage rod  50  and secure rod  50  to connector  1800 . 
     As shown in  FIG.  43   , either connector  1700  or connector  1800  can be attached to an existing rod  50  through passage  1718  and a new construct with a rod  80  can be inserted through rod through-passage  1725 ,  1825 . A threaded cap (not shown) may then be engaged with the threaded portion on the top of the screw head portion  1720  to secure the rod  80  therein, thereby achieving fixation. If required, rod  80  can be bent to maintain new construct and an adjacent level with the existing rod  50 . 
       FIGS.  44 - 46    show a connector  1900  according to an exemplary embodiment. Connector  1900  includes a body  1910  having a connecting portion  1912  at a first end and a head portion  1930  at an opposing end. Connecting portion  1912  includes a first generally longitudinally extending leg  1914  having a connection mechanism  1916  extending therethrough. In an exemplary embodiment, connection mechanism  1916  can be a set screw. 
     Connecting portion  1912  also includes a second leg  1917 , having a first portion  1918  that extends generally longitudinally away from body  1910 , generally parallel to first leg  1914 . Second leg  1917  also includes a curved portion  1919  that curves an arcuate fashion toward first leg  1914 , forming a passage  1920  therebetween. Passage  1920  is sized to allow connector  1900  to be connected to an existing rod  50 , as shown in  FIG.  46   . Connection mechanism  1916  extends sufficiently through first leg  1914  to be able to extend into passage  1920 . 
     Head portion  1930  includes a first arcuate portion  1932  and a second arcuate portion  1934  diametrically opposed from first arcuate portion  1932 , forming a rod through-passage  1935  extending therebetween. Rod through-passage  1935  is sized to receive a rod  80  as part of a newly assembled construct, as shown in  FIG.  46   . If rod  80  is a “Z-Rod”, rod  80  can be configured to achieve fixation at an adjacent level with rod  50 . 
       FIGS.  47 - 50    show a connector  2000  according to an alternative exemplary embodiment. Connector  2000  is similar to connector  1900  as described above, with the exception that connector  2000  includes only a single leg  2017  extending downward from a body  2010 . Leg  2017  includes a first portion  2018  that extends longitudinally outwardly, away from body  2010  and a curved portion  2019  that curves in an open hook fashion toward an opposing side of body  2010 , forming an open passage  2020 . Curved portion  2019  includes an arcuate support face  2021  faces open passage  2020  and serves as a support for an existing rod  50 , as shown in  FIG.  50   . 
       FIG.  48    shows connector  2000  with an optional set screw  2030  can be threaded into a threaded passage  2032  to secure connector  2002  existing construct, such as, for example, rod  50 . 
     Alternatively,  FIG.  49    shows connector  2000  and optional wedge  2040  that can be used in place of set screw  2030 , to secure rod  50  in connector  2000 . 
     Similarly to connector  1900 , connector  2000  has a rod through-passage  2035  is sized to receive a rod  80  as part of a newly assembled construct, as shown in  FIG.  50   . If rod  80  is a “Z-Rod”, rod  80  can be configured to achieve fixation at an adjacent level with rod  50 . 
     Lateral connector  1300 , shown previously in  FIG.  30   , can be used as shown in  FIG.  51    to connect to a rod  50  in an existing construct. As shown in  FIGS.  52 - 54   , new construct  90  can be attached at connection point  1314  to achieve fixation. Instead of installing connector  1200  at an angle, as shown in  FIG.  32   ,  FIGS.  53  and  54    show that, when rod  80  is a Z-Rod, lateral connector  1300  can be used to support rod  80  such the rod  80  extends collinear with existing rod  50 . 
     Top loading connector  1400 , shown previously in  FIG.  31   , can be used. As shown in  FIGS.  55 - 57    to connect to an existing rod  50 . In an existing construct. As shown in  FIGS.  56  and  57   , new construct  90  can be attached at connection  1422  to achieve fixation. As will be appreciated by those skilled in the art, after the rod  80  is secured and attached to the existing rod  50  and the adjacent vertebra or vertebrae using a minimally invasive surgical (MIS) approach, the extensions may be detached from the tulips, thereby leaving the connector  1400  and rod  80  subcutaneously implanted in the patient. 
     Referring now to  FIGS.  58  and  59   , an offset revision rod  2100  according to an exemplary embodiment is shown. Revision rod  2100  has an elongate body  2110  having a first end  2112 , with an integrated single open clamp  2120  extending laterally therefrom. Claim  2120  includes a body  2122  with a clamp portion  2124  sized to accept and retain a rod (not shown) between proximal existing screw heads (also not shown). Body  2122  also includes a threaded opening  2126  sized to accept a fastener, such as a set screw (not shown), that can be screwed downwardly to secure the rod into clamp portion  2124 . 
     Body  2110  further has a second end  2130  an offset  2132 , between first end  2112  and second and  2130 , such that first and  2112  and second end  2130  extend parallel to each other. Rod  2100  allows a fixation to be extended to adjacent level with a single implant. Offset  2132  allows rod  2100  to navigate around a most proximal screw head (not shown) in an existing construct. 
     A distraction/compression clamp  2200  is shown in  FIGS.  60 - 61   . Clamp  2200  has a single open clamp  2210  with a through passage  2212  sized to accept a rod  50  inserted therethrough. Claim  2200  also includes a threaded opening  2220  that is sized to accept a set screw  2222  to secure clamp  2200  to rod  50 . Clamp  2200  can provide a fixed point for distraction and/or compression. 
     A double-headed lateral connector  2300  is shown in  FIGS.  62 - 64   . Connector  2300  includes a body  2310  having a first screw head  2320  (e.g., a first tulip) having a passage  2322  and a second screw head  2330  (e.g., a second tulip) having a passage  2332 . Screw heads  2320  and  2330  are separated from each other by a connecting member  2340 . Passage  2322  is sized to accept a first rod (not shown) from an existing construct and passage  2332  is sized to accept a second rod (not shown) from the new construct in order to extend the existing construct to an adjacent level. A threaded cap (not shown) may then be engaged with each of the threaded portions on the tops of the screw heads  2320  and  2330  to secure the respective rods therein, thereby coupling the rods substantially parallel to one another. While  FIG.  62    shows screw heads  2320 ,  2330  extending parallel to each other, those skilled in the art will recognize that screw heads  2320 ,  2330  can also be offset or angled relative to each other. 
     While  FIG.  62    shows connecting member  2340  connecting first screw head  2320  and second screw head  2330  only at the bottom portion of connector  2300 ,  FIGS.  63  and  64    show a connecting member  2350  that connects first screw head  2320  and second screw head  2330  along the length of the screw heads. 
       FIG.  65    shows a double-headed in-line connector  2400  according to an exemplary embodiment. While lateral connector  2300  discussed above laterally connects adjacent rods, in-line connector  2400  connects adjacent rods longitudinally. Connector  2400  includes a body  2410  having a first screw head  2420  having a passage  2422  and a second screw head  2430  having a passage  2432 . Screw heads  2420  and  2430  are separated from each other by a connecting member  2440 . Passage  2422  is sized to accept a rod (not shown) from an existing construct and passage  2432  is sized to accept a rod (not shown) from the new construct in order to extend existing construct to an adjacent level. A threaded cap (not shown) may then be engaged with each of the threaded portions on the tops of the screw heads  2420  and  2430  to secure the respective rods therein, thereby coupling the rods substantially in-line with one another. While  FIG.  65    shows screw heads  2420 ,  2430  extending parallel to each other, those skilled in the art will recognize that screw heads  2420 ,  2430  can also be offset or angled relative to each other. 
     A J-hook connector  2500  according to an exemplary embodiment is shown in  FIG.  66   . Connector  2500  includes an elongate body  2510  having a first end  2512  and a second end  2514 . First end  2512  includes an open clamp  2520  attached thereto. Clamp  2520  includes a passage  2522  sized to allow a rod (not shown) to be inserted therethrough. Clamp  2520  also includes a threaded opening  2524  sized to allow a set screw (not shown) to be inserted therethrough to secure the rod within opening  2524 . 
     Connector  2500  is used to connect a rod (not shown) on a first side of a patient&#39;s spine with first end  2512 , and to insert second end  2514  into a screw head (not shown) on an opposing side of the patient&#39;s spine. 
     A parallel connector  2600  according to an exemplary embodiment is shown in  FIGS.  67  and  68   . Connector  2600  includes a body  2610  having a generally oblong opening  2612  that is sized to allow the insertion of  2  rods  50 ,  50 ′ therethrough to extend the length of rod  50 , with rod  50 ′. As shown in  FIG.  68   , a single set screw  2620  extends through body  2610  between rods  50 ,  50 ′ to secure rods  50 ,  50 ′ to connector  2600 . While a single set screw  2600  is shown, those skilled in the art will recognize that to set screws, one located above each of rod  50 ,  50 ′, can be used to secure rods  50 ,  50 ′, respectively, to connector  2600 . 
       FIG.  69    shows a single open head lateral connector  2700  according to an exemplary embodiment. Connector  2700  includes an open clamp  2710  and an adjacent screw head  2720 , coupled to each other by a connector  2730 . 
     Open clamp  2710  includes an arcuate portion  2712 , forming a through-passage  2713  that is sized to accept a rod (not shown) from an existing construct inserted therein. Open clamp  2710  also includes a threaded opening  2714  sized to accept a set screw (not shown) that can be threaded into through-passage  2713  to secure the rod in through-passage  2713 . 
     Screw head  2720  includes a passage  2722  that is sized to allow the insertion of a rod (not shown) in new construct therein. Through-passage  2713  and passage  2722  extend in a common plane such that the rod in the new construct is at the same level as the rod in the existing construct. 
       FIG.  70    shows a double modular lateral connector  2800  according to an exemplary embodiment. Connector  2800  includes an elongate body  2810  having a first end  2812  and a second end  2814 , distal from first end  2812 . Each end  2812 ,  2814  includes a point of attachment  2820 ,  2822 , respectively for the attachment of modular screw heads side-by-side, as shown, allowing for options variety of screw heads. Each point of attachment  2820 ,  2822  may be in the form of a post having a partially-spherical outer surface with a substantially flatten top surface having one or more recesses therein. In one embodiment, a tulip can be placed on attachment point  2820  before or after connecting to an existing rod (not shown). The new rod (not shown) can then be introduced, for example, in a second tulip attached to attachment point  2822  in order to extend the fixation at an adjacent level. In the alternative, a rod  1200 , for example, shown in  FIG.  28   , with an integrated attachment point  1220  can connect to one or more of the posts on connector  2800 . While connection points  2820  and  2822  are shown as being parallel to each other, those skilled in the art will recognize that connection points  2820 ,  2822  can also be offset or angled relative to each other. 
       FIG.  71    shows a Z-rod  80  according to an exemplary embodiment. As shown previously throughout, rod  80  is used to link to an existing construct at an adjacent level. Rod  80  includes a generally elongate body  82  having a first end, a second end  86 , distal from first end  84 , and a bent portion  88 , located along body  82 , between first and  84  and second end  86 . The position and offset distance of bend portion  88  can be varied depending upon the location of existing construct and the particular patient anatomy. 
       FIG.  72    shows an in-line connector with an integrated rod  3000  according to an exemplary embodiment. Rod  3000  includes an elongate body  3010  having a first end  3012  and a second end  3014 , distal from first end  3012 . A closed connector  3020  is attached to first end  3012 . Connector  3020  includes an opening  3022 , in line with, and, distal from body  3010  into which an existing rod (not shown) is inserted to extend the length of an existing construct at an adjacent level. Then one or more fasteners or set screws (not shown) may be positioned in the one or more openings in the connector portion  3020  to secure the existing rod therein, thereby coupling the new rod extension to the existing rod construct. 
       FIGS.  73  and  74    show a top loading connector  3100  according to an exemplary embodiment. Connector  3100  is a top loading lateral connector that has a body  3102  having two clamping portions that are laterally offset from each other. A first clamping portion  3110  has a first axial passage  3112  having a first longitudinal axis  3114  extending therethrough. Referring to  FIG.  74   , axis  3114  extends perpendicularly outwardly from the plane of the paper of the Figure. 
     First passage  3112  is sized to allow a first rod, such as a rod  70  (shown in  FIG.  3   ) to be inserted thereinto. First passage  3112  is generally U-shaped and has a closed top portion  3113  that has a generally arcuate top wall  3115  and a bottom portion having an opening  3116  in communication with the rest of first passage  3112 . Opening  3116  is defined by generally parallel opposing sidewalls  3118 ,  3120  that extend at an angle oblique to the vertical relative to body  3102  as shown in  FIG.  74   . 
     Opening  3114  is sufficiently large to allow opening  3114  to extend over rod  70  such that first clamping portion  3110  can be placed over rod  70  and slid over rod  70  until rod  70  is located in top portion  3113 , as shown in  FIG.  74   . 
     A first securing mechanism  3122  is rotatably connected to first clamping portion  3110  and is adapted to extend into first passage  3112  to releasably secure first rod  70  in first passage  3112 . First securing mechanism  3122  includes a threaded through-hole  3124  extending through body  3102  to first passage  3112  and a set screw  3126  that is rotatably inserted into through-hole  3124 . A first end  3128  of set screw  3126  includes a threaded exterior  3127  that threadingly engages threaded through-hole  3124 . First end  3128  of set screw  3126  also includes a receiver  3129 , such as, for example, for an Allen wrench or a Torx® wrench, and an engagement end  3130  that extends into first passage  3112  to bias rod  70  against top wall  3115  in top portion  3113  to secure connector  3100  to rod  70 . 
     Set screw  3126  also includes a securing channel  3132  that extends around a periphery of set screw  3126  between first end  3128  and securing end  3130 . Securing channel  3132  includes a flared portion  3133  at a bottom end thereof. A retaining pin  3134  extends through body  3102  generally parallel to axis  3114  such that retaining pin  3134  extends through securing channel  3132  between set screw  3126  and through-hole  3124  and between threaded exterior  3127  and flared portion  3133  such that flared portion  3133  is stopped by retaining pin  3134  if set screw  3126  is attempted to be removed from body  3102 . 
     Set screw  3126  extends at an angle oblique to the horizontal. Set screw  3126  can be angled at such an angle to give the implanting physician a better angle to access set screw  3126  than if set screw  3126  extended in a horizontal plane. 
     A second clamping portion  3150  has a second passage  3151  that has a second longitudinal axis  3154  extending therethrough. Second passage  3151  comprises a generally circular axial passage, or through-opening,  3153 . Second longitudinal axis  3154  is parallel to first longitudinal axis  3114 , and is sized to allow a second rod, such as, for example, a rod  80  shown in  FIG.  71   , to be inserted thereinto along second longitudinal axis  3154 . 
     Similar to first clamping portion  3110 , second clamping portion  3150  incudes a second securing mechanism  3152  that is adapted to releasably secure second rod  80  in second passage  3153 . Second securing mechanism  3150  includes a threaded through-hole  3155  and a set screw  3156  that is rotatably inserted into through-hole  3124 . A first end  3158  of set screw  3156  includes a threaded exterior  3157  that threadingly engages threaded through-hole  3155 . First end  3158  of set screw  3156  also includes a receiver  3159 , such as, for example, for an Allen wrench or a Torx® wrench, and an engagement end  3160  that extends into second passage  3151  to bias a rod  80  (not shown) against the wall of through-opening  3153  to secure connector  3100  to rod  80 . 
     A shown in  FIG.  74   , first clamping portion  3120  has a height “A” and second clamping portion  3150  has a height “B” that is higher than height “A”. 
     Connector  3100  can be used to add a new construct to an existing construct. By way of example only, opening  3114  can be inserted over inserting first rod  70  in an existing construct. First connecting portion  3110  can be secured to first rod  70  by rotating securing mechanism  3122  and advancing securing mechanism  3122  into axial passage  3112  to secure first connecting portion  3110  to first rod  70 . Second rod  80  can be inserted through through-opening  3153  and secured by set screw  3156 . 
     An alternative embodiment of a connector  3200  is shown in  FIG.  75   . Connector  3200  is similar to connector  3100  with the exception of second connecting portion  3250 , which differs from second connecting portion  3150  in connector  3100  as described below. 
     Instead of generally circular passage  3151 , in connector  3200 , a second connector portion  3250  has second passage  3251  with an opening  3252  defined by a generally U-shaped wall  3253  that allows connector  3200  to be inserted over second rod  80  (not shown) instead of requiring second rod  80  to slide through passage  3251 . Also, connector  3200  can be reversed such that second connecting portion  3250  can be secured to existing rod  70  and first connecting portion  3110  can be secured to a new construct, such as rod  80 . 
     A securing mechanism  3252  uses a different set screw  3256  than set screw  3156 . Set screw  3256  has an engagement end  3260  having a tapered perimeter  3258  such that tapered perimeter  3258  engages second rod  80  and biases second rod  80  against wall  3153 . 
     Another alternative embodiment of a connector  3300  is shown in  FIG.  76   . Connector  3300  is similar to connector  3100  with the exception of second connecting portion  3350 , which differs from second connecting portion  3150  in connector  3100  as described below. In an exemplary embodiment, second connection portion  3350  can be a “tulip style” connection, as is recognized by those skilled in the art. 
     Second connecting portion  3350  has a second passage  3352  with a generally U-shaped opening  3354  that opens at the top of second connecting portion  3350  and has a closed bottom wall  3353  that is arcuate in shape. Opening  3354  is defined by bottom wall  3353  and opposing generally planar side walls  3356 ,  3358  that each include threads  3360 ,  3362 , respectively, that extend away from their respective walls  3356 ,  3338 . Threads  3360 ,  3362  are used to receive a securing member, such as set screw  3256  (shown in  FIG.  75   ). 
     Opening  3354  allows for the insertion of rod  80  (not shown), which has a circular cross-section, or some other construct with a non-circular cross-section, such as an oblong cross-section. 
     Another alternative embodiment of a sliding member top loading connector  3400  is shown in  FIGS.  77 - 78   . Connector  3400  is similar to connector  3100  with the exception of first connecting portion  3410 , which differs from first connecting portion  3110  in connector  3100  as described below. 
     First connecting portion  3410  includes an open first passage  3412  defined by an arcuate wall  3414  that allows connector  3400  to be placed over a member, such as rod  70  (shown in  FIG.  78   ), in an existing construct to add on to the existing construct. 
     First connecting portion  3410  includes a securing mechanism  3422  having a locking portion in the form of a member  3420  that is extendible into first passage  3412 . Member  3420  is translatably located in a horizontal passage  3411  that communicates with first passage  3412 . 
     Member  3420  is a generally cylindrical member that is longitudinally translatable between a first rod unlocking position and a first rod locking position to releasably secure rod  70  against generally arcuate wall  3414  that defines first passage  3412 . Member  3420  has a rod engaging surface  3424  that engages rod  70  and biases rod  70  against wall  3414 . Rod engaging surface  3424  is angled with respect to the horizontal such that, as member  3420  is translated from the rod unlocking position to the rod locking position (as shown in  FIG.  78   ), rod  70  slides up rod engaging surface  3424  to provide a secure connection between connector  3400  and rod  70 . 
     Member  3420  also includes a cam surface  3430  that is acted upon to move member  3420 . In an exemplary embodiment, cam surface  3430  is an arcuate surface, although those skilled in the art will recognize that cam surface  3430  can be another shape, such as for example, a sloped surface, so that, when cam surface  3430  is acted upon by another member from above, member  3420  translates into passage  3412 . 
     Member  3420  includes a longitudinal slot  3432  that extends within member  3420  between rod engaging surface  3424  and cam surface  3430 . A retaining pin  3436  extends through slot  3432  and retains member  3420  within horizontal passage  3411 . 
     Securing mechanism  3422  also includes a rotating portion in the form of a set screw  3440  that is adapted to engage cam surface  3430  of member  3420  such that member  3420  is longitudinally translatable into engagement with first rod  70 . Set screw  3440  is threadingly mounted in a threaded screw passage  3442  that is in communication with horizontal passage  3411 . Set screw  3440  includes a first end  3444  having a receiver  3446 , such as, for example, for an Allen wrench or a Torx® wrench, and an engagement end  3448  having a tapered tip  3450  such that, as set screw  3440  is screwed downwardly into screw passage  3442 , tapered tip  3450  engages cam surface  3430  and longitudinally translates member  3420  into passage  3412  and into engagement with rod  70 . 
     Still another alternative embodiment of a pivoting member top loading connector  3500  is shown in  FIGS.  79 - 80   . Connector  3500  is similar to connector  3100  with the exception of first connecting portion  3510 , which differs from first connecting portion  3110  in connector  3100  as described below. 
     First connecting portion  3510  includes an open first passage  3512  defined by an arcuate wall  3514  that allows connector  3500  to be placed over a member, such as rod  70  (shown in  FIG.  80   ), in an existing construct to add on to the existing construct. 
     First connecting portion  3510  includes a securing mechanism  3522  having a locking portion in the form of a member  3520  that is extendible into first passage  3512 . Member  3520  is pivotally located in a pivot member passage  3511  that communicates with first passage  3512 . 
     Member  3520  is a generally inverted “V-shaped” member that is pivotable about a pivot point  3521  in pivot member passage  3511  between a first rod unlocking position and a first rod locking position to releasably secure rod  70  in first passage  3512 . Member  3520  has a rod engaging surface  3524  (a first leg of the “V”) that engages rod  70  and biases rod  70  against wall  3514 . Rod engaging surface  3524  can have at least a slightly arcuate profile such that, as member  3520  is pivoted from the rod unlocking position to the rod locking position (as shown in  FIG.  80   ), rod engaging surface  3524  “cups” rod  70  to provide a secure connection between connector  3500  and rod  70 . Member  3520  also includes a cam surface  3530  as the remaining leg of the “V” that is acted upon to pivot member  3520 . 
     Securing mechanism  3522  also includes a rotating portion in the form of a set screw  3540  that is adapted to engage cam surface  3530  of member  3520  such that member  3520  is pivoted about pivot pin  3521 , pivoting rod engaging surface  3524  into engagement with first rod  70 . Set screw  3540  is threadingly mounted in a threaded screw passage  3542  that is in communication with pivot member passage  3511 . Set screw  3540  includes a first end  3544  having a receiver  3546 , such as, for example, for an Allen wrench or a Torx® wrench, and an engagement end  3548  having a tapered tip  3550  such that, as set screw  3540  is screwed downwardly into screw passage  3542 , tapered tip  3550  engages cam surface  3530  and pivots member  3520  into passage  3512  and into engagement with rod  70 . 
     Yet another alternative embodiment of a cam lock top loading connector  3600  is shown in  FIGS.  80 - 85   . Connector  3600  is similar to connector  3100  with the exception of first connecting portion  3610 , which differs from first connecting portion  3110  in connector  3100  as described below. 
     First connecting portion  3610  includes an open first passage  3612  defined by an arcuate wall  3614  that allows connector  3600  to be placed over a member, such as rod  70  (shown in  FIGS.  82 - 85   ), in an existing construct to add on to the existing construct. 
     First connecting portion  3610  includes a securing mechanism  3622  having a locking portion in the form of a member  3620  that is rotatably extendible into first passage  3612 . Member  3620  is rotatably located in a vertical passage  3611  that communicates with first passage  3612 . 
     Member  3620  includes a round portion  3624  having an axis  3626  that is off-center of the axis of rotation of member  3620  as shown in  FIGS.  84  and  85   . Rotation of member  3620  to the position shown in  FIGS.  82  and  84    causes round portion  3624  to rotate off center, allowing rod  70  to be untouched and unsecured within first passage  3612 . Rotation of member  3620  to the position shown in  FIGS.  83  and  85    causes round portion  3624  to rotate to the securing position, biasing rod  70  against wall  3614  of first passage  3612 . 
     An exemplary top loading modular connector  3700  is shown in  FIGS.  86 - 91   . Connector  3700  includes a threaded shaft  3710 , a clamp sleeve  3740  that slides over threaded shaft  3710 , a clamp body  3770  that is fit over clamp sleeve  3740 , and a locking nut  3790  that secures clamp sleeve  3740  and clamp body  3770  onto threaded shaft  3710 . 
     Threaded shaft  3710  has an elongate body  3712  having a top loading clamping portion  3714  and a connection end  3716  on top of clamping portion  3714 . Clamping portion  3714  includes a pair of legs  3718 ,  3720 , each having an arcuate cutout  3722 ,  3724 , respectively, that, when pressed together, form a generally semi-circular surface  3726 . Each leg  3718 ,  3720  includes an outwardly flared portion  3719 ,  3721 , respectively, that is engaged by clamp sleeve  3740  when clamp sleeve  3740  is compressed downwardly toward clamping portion  3714 , such that flared portions  3719 ,  3721  are biased toward each other so that legs  3718 ,  3720  grip rod  70 . 
     The diameter of surface  3726  is less than the diameter of rod  70 . A flexure cut  3728  with a relief cut  3730  at a top end thereof allows clamping portion  3714  to open and clamp around rod  70 . A central portion  3732  of threaded shaft  3710  has external threads  3734  that threadingly engage lock nut  3790 . 
     Clamp sleeve  3740  has a generally annular body  3742  with a generally circular diametric opening  3744  that is larger than the diameter of central portion  3732  of threaded shaft  3710  such that clamp sleeve  3740  can be slid over central portion  3732 . Clamp sleeve  3740  includes a pair of diametrically opposed clamp legs  3746 ,  3748  that extend downwardly from body  3742 . Each leg  3746 ,  3748  has a tapered interior cutout  3750 ,  5752 , respectively, that engages flared portions  3721 ,  3719 , respectively, to bias flared portions  3719 ,  3721  toward each other to engage rod  70 . 
     Body  3742  also includes an elongate detent  3754  on either side of body  3742  between legs  3746 ,  3748 . Detents  3754  each receive a corresponding tang (not shown) on clamp body  3770  to releasably secure clamp body  3770  to clamp sleeve  3740  when locking nut  3790  is threaded onto threaded shaft  3710 . 
     Clamp body  3770  has a generally annular body  3772  with a generally circular diametric opening  3774  that is larger than the diameter of central portion  3732  of threaded shaft  3710  such that clamp body  3770  can be slid over central portion  3732 . Clamp body  3770  includes a pair of diametrically opposed tang lips  3776  (only one tang lip  3776  shown in  FIG.  87   ) with a tang (not shown) that extends into a respective detent  3754  in clamp sleeve  3740  to secure clamp sleeve  3740  to clamp body  3770  and restrict rotation of clamp sleeve  3740  about threaded shaft  3710  when locking nut  3790  is threaded onto threaded shaft  3710 . 
     Locking nut  3790  has a body  3792  and a central opening  3794  defined by internal threads  3796  that threadingly engage threads  3734  on threaded shaft  3710 . 
     In a loading position, as shown in  FIG.  88   , clamp sleeve  3740  is free to move about clamping portion  3714  of threaded shaft  3710  to allow clamping portion  3714  to flex and accept rod  70 . When locking nut  3790  is threaded downwardly onto threads  3734  to the position shown in  FIG.  89   , locking nut  3790  forces clamp body  3770  downward over clamp sleeve  3740 , which in turn forces clamp sleeve  3740  downward along legs  3718 ,  3720  of threaded shaft  3710 , biasing legs  3718 ,  3720  toward each other, and gripping rod  70 . 
     As shown in  FIGS.  90  and  91   , clamping portion  3714  can be attached to an existing rod  70  from above while connection end  3716  serves as the attachment point for a screw tulip  72  (shown in  FIG.  90   ), a connector rod  1600  (shown in  FIG.  91   ), or other suitable construct in order to extend fixation to an adjacent level. 
     Another exemplary top loading modular connector  3800  is shown in  FIGS.  92 - 97   . Connector  3800  includes a clamp shaft  3810  and an outer sleeve  3750  that slides over clamp shaft  3810 . 
     Clamp shaft  3810  has an elongate body  3812  having a top loading clamping portion  3814  and a connection end  3816  on top of clamping portion  3814 . Clamping portion  3814  includes a pair of legs  3818 ,  3820 , each having an arcuate cutout  3822 ,  3824 , respectively, that, when pressed together, form a generally semi-circular surface  3826 . Each leg  3818 ,  3820  is flared outwardly from a central portion  3832  of clamp shaft  3810  with a generally convex surface. Central portion  3832  of clamp shaft  3810  has a first diameter, smaller than the diameter of clamping portion  3814 . 
     Each leg  3818 ,  3820  also includes an outwardly flared lower nub  3819 ,  3821 , respectively, that is engaged by outer sleeve  3850  when outer sleeve  3850  is compressed downwardly toward clamping portion  3814 , such that flared lower nubs  3819 ,  3821  grip outer sleeve  3850  and so that legs  3818 ,  3820  are biased toward each other, resulting in legs  3818 ,  3820  gripping rod  70 . Also, each leg  3818 ,  3820  also includes an outwardly flared upper nub  3823 ,  3825 , 
     The diameter of surface  3826  is less than the diameter of rod  70 . A flexure cut  3828  with a relief cut  3830  at a top end thereof allows clamping portion  3814  to open and clamp around rod  70 . 
     Clamp shaft  3850  has a generally annular body  3852  with a generally circular diametric lower opening  3854  that is slightly smaller than the diameter of clamping portion  3814  at the lower end of legs  3818 ,  3820  and a generally circular diametric upper opening  3855  that is larger than the diameter of connection end  3816  such that clamp shaft  3850  can be slid over connection end  3816 . 
     Clamp shaft  3850  includes a pair of diametrically opposed shaft legs  3856 ,  3858  that extend downwardly from body  3742 . Each leg  3856 ,  3858  has a tapered interior protrusion  3860 ,  5862 , respectively, that engages lower nubs  3819 ,  3821  respectively, to bias legs  3818 ,  3820  toward each other to engage rod  70 . Upper nubs  3823 ,  3825  keep outer sleeve  3850  from easily being pulled upwardly off clamp shaft  3810 . 
     In a loading position, as shown in  FIG.  94   , outer sleeve  3850  is free to move about clamp shaft  3810  to allow clamping portion  3814  to flex and accept rod  70 . When outer sleeve  3850  is advanced downwardly over lower nubs  3819 ,  3821  to the position shown in  FIG.  95   , shaft legs  3856 ,  3858  bias legs  3818 ,  3820  toward each other, and gripping rod  70 . 
     As shown in  FIGS.  96  and  97   , clamping portion  3814  is attached to an existing rod  70  from above while connection end  3816  serves as the attachment point for a screw tulip  72  (shown in  FIG.  96   ), a connector rod  1600  (shown in  FIG.  97   ), or other suitable construct, in order to extend fixation to an adjacent level. The connectors described herein offer versatility in connecting spinal rod implants together. In the case of an existing construct being accessed in a revision surgery, the new fixation constructs may be attached without the need to remove the original surgical hardware. Attaching directly to existing spinal rod constructs saves operating time, causes less disruption to the patient, and improves patient healing times. The connectors maximize utility in cases of varying patient anatomy and different configurations for existing constructs. The different connection modes offer a wide range of options for improved patient outcomes. 
     It will be further understood that various changes in the details, materials, and arrangements of the parts which have been described and illustrated in order to explain the nature of this invention may be made by those skilled in the art without departing from the scope of the invention as expressed in the following claims.