Patent Publication Number: US-2022218395-A1

Title: Surgical system and method

Description:
TECHNICAL FIELD 
     The present disclosure generally relates to medical devices for the treatment of spinal disorders, and more particularly to a surgical system and a method for correction of a spinal disorder. 
     BACKGROUND 
     Spinal disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis, kyphosis and other curvature abnormalities, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including pain, nerve damage, and partial or complete loss of mobility. 
     Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes correction, ligamentotaxy, corpectomy, discectomy, laminectomy, fusion, fixation and implantable prosthetics. Correction treatments used for positioning and alignment of vertebrae may employ spinal implants including spinal constructs and interbody devices for stabilization of a treated section of a spine. In some cases, the spinal implants may be manipulated with surgical instruments for compression and distraction of vertebrae. This disclosure describes an improvement over these prior technologies. 
     SUMMARY 
     In one embodiment, a surgical system is provided. The surgical system includes an implant support engageable with a receiver of a fastener having a shaft fixed with vertebral tissue. A sleeve having a first mating surface releasably engageable with the implant support and a second mating surface releasably engageable with the receiver. An adaptor connected with the implant support to releasably engage a surgical instrument to distract and/or compress the vertebral tissue. In some embodiments, surgical instruments, constructs, implants and methods are disclosed. 
     In one embodiment, the surgical system includes at least one implant support having a first implant support extending between a proximal end and a distal end. The distal end is configured to capture a first wall of a receiver of a fastener having a shaft fixed with vertebral tissue. The receiver includes the first wall and a second wall that define an implant cavity. A sleeve includes a proximal flange defining mating grooves being releasably engageable with the proximal end and at least one distal projection being releasably engageable with the second wall. An adaptor extends longitudinally along the first implant support for connection with the distal end to releasably engage a surgical instrument to distract and/or compress the vertebral tissue. 
     In one embodiment, the surgical system includes a first implant support having an adaptor and being releasably engageable with a first wall of a receiver of a first fastener having a shaft fixed with vertebral tissue. The receiver includes the first wall and a second wall that define an implant cavity. A first sleeve includes a flange being releasably engageable with the first implant support and a distal end being releasably engageable with the second wall. A second implant support includes an adaptor and is releasably engageable with a first wall of a receiver of a second fastener having a shaft fixed with vertebral tissue. The receiver of the second fastener includes the first wall and a second wall that define an implant cavity. A second sleeve includes a flange being releasably engageable with the second implant support and a distal end being releasably engageable with the second wall of the second fastener. A surgical instrument includes a first member and a second member. The adaptor of the first implant support is releasably engageable with the first member and the adaptor of the second implant support is releasably engageable with the second member. The members are relatively movable to distract and/or compress the vertebral tissue. 
    
    
     
       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 components of one embodiment of a surgical system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 2  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 3  is a break away perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 4  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 5  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 6  is a perspective view of the components shown in  FIG. 5 ; 
         FIG. 7  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure with a patient body; 
         FIG. 8  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure with a patient body; 
         FIG. 9  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure disposed with a patient body; 
         FIG. 10  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure being handled by a user with vertebrae; 
         FIG. 11  is a top view of components of one embodiment of a surgical system, in accordance with the principles of the present disclosure with vertebrae; 
         FIG. 12  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure disposed with a patient body; 
         FIG. 13  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure being handled by a user disposed with a patient body; 
         FIG. 14  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure being handled by a user disposed with a patient body; 
         FIG. 15  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure being handled by a user with a patient body; 
         FIG. 16  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure being handled by a user with a patient body; 
         FIG. 17  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure being handled by a user with a patient body; 
         FIG. 18  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure being handled by a user with a patient body; and 
         FIG. 19  is a side view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure disposed with vertebrae, 
     
    
    
     DETAILED DESCRIPTION 
     The exemplary embodiments of the system and related methods of use disclosed are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of a surgical system and method for correction of a spine disorder. In some embodiments, the present surgical system includes surgical instruments that allow vertebral manipulation to treat spinal disorders, as described herein, for managing lordosis and/or kyphosis restoration. In some embodiments, the surgical instruments allow for parallel distraction and/or compression of vertebral tissue. 
     In some embodiments, the present surgical system includes a trauma instrument. In some embodiments, the present surgical system is utilized with a method to correct complex spinal deformities. In some embodiments, the present surgical system is utilized with a method to treat degenerative spinal disorders and/or employed with transforaminal lumbar interbody fusion procedures, In some embodiments, the present surgical system is configured for utilization with a sagittal adjusting screw (SAS), a fixed axis screw (FAS) and/or a multi-axial screw (MAS). In some embodiments, the present surgical system comprises a single distractor to treat degenerative spinal disorders, for example, for disposal along a side of vertebrae oriented for decompression and/or interbody cage insertion. 
     In some embodiments, the present surgical system includes a surgical instrument employed with a surgical method including degenerative lumbar spine fusion. In some embodiments, the present surgical system includes a surgical instrument employed with a surgical method including the step of segmental posterior stabilization with MAS screws. In some embodiments, the present surgical system includes a surgical method including an interbody fusion, posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) utilizing a minimally invasive surgical approach or a percutaneous approach. In some embodiments, the present surgical system includes bone screw extenders, tissue retractors and a distractor/compressor system. In some embodiments, the present surgical system includes segmental distraction to facilitate decompression, including final construct compression. In some embodiments, the present surgical system includes radio transparent tissue retractor blades. 
     In some embodiments, the present surgical system includes a surgical instrument employed with a surgical method including the step of: connecting extenders, such as, for example, implant supports with MAS screws; connecting a sleeve with the implant support and the bone screw; and employing a universal screw driver for percutaneous implantation of the bone screw utilizing a PAK needle, guidewire or fluoroscopy. In some embodiments, the present surgical system includes screw based segmental distraction. In some embodiments, the segmental distraction is accomplished by utilizing a distractor, angulation modules and lock elements to distract the bone screw heads. 
     In some embodiments, the present surgical system includes a dilator configured to evaluate tissue depth from graduations disposed thereon. In some embodiments, the present surgical system includes a retractor having a selection of blade lengths. In some embodiments, the present surgical system includes the step if inserting the retractor blades along the dilator and manipulating and/or adjusting angulation of the blades and the distance between the blades. In some embodiments, the present surgical system includes a light source configured for connection with the retractor. 
     In some embodiments, the adaptor is employed with a surgical method including the step of inserting the adaptor with a surgical site and the step of sliding a sleeve along the implant support. In some embodiments, the method includes the step of securing the sleeve to the implant support. In some embodiments, the method includes the step of connecting a compressor/distractor with the adaptor. In some embodiments, the method includes the step of connecting an angulation module with the adaptor, the compressor/distractor and the extender, In some embodiments, the method includes the step of securing the angulation module, the compressor/distractor and the adaptor with a locking element. In some embodiments, the method includes the step of distracting and/or compressing a posterior ligament. In some embodiments, the method includes the step of actuating a rack and pinion mechanism disposed with the compressor/distractor to facilitate distraction or compression. 
     In some embodiments, one or all of the components of the surgical system are disposable, peel-pack, pre-packed sterile devices used with a spinal construct. One or all of the components of the surgical system may be reusable. The surgical system may be configured as a kit with multiple sized and configured components. 
     In some embodiments, the present disclosure may be employed to treat spinal disorders such as, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor and fractures. In some embodiments, the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. In some embodiments, the disclosed surgical system and methods may be alternatively employed in a surgical treatment with a patient in a prone or supine position, and/or employ various surgical approaches to the spine, including posterior and/or posterior mid-line and in other body regions. The present disclosure may also be alternatively employed with procedures for treating the lumbar, cervical, thoracic, sacral and pelvic regions of a spinal column. The system and methods of the present disclosure may also be used on animals, bone models and other non-living substrates, such as, for example, in training, testing and demonstration. 
     The present disclosure may be understood more readily by reference to the following detailed description of the embodiments taken in connection with the accompanying drawing figures, which form a part of this disclosure, It is to be understood that this application is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting. In some embodiments, as used in the specification and including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise, Ranges may be expressed herein as from “about” or “approximately” one particular value and/or to “about” or “approximately” another particular value, When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. It is also understood that all spatial references, such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure. For example, the references “upper” and “lower” are relative and used only in the context to the other, and are not necessarily “superior” and “inferior.” 
     As used in the specification and including the appended claims, “treating” or “treatment” of a disease or condition refers to performing a procedure that may include administering one or more drugs to a patient (human, normal or otherwise or other mammal), employing implantable devices, and/or employing instruments that treat the disease, such as, for example, microdiscectomy instruments used to remove portions bulging or herniated discs and/or bone spurs, in an effort to alleviate signs or symptoms of the disease or condition. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, treating or treatment includes preventing or prevention of disease or undesirable condition (e.g., preventing the disease from occurring in a patient, who may be predisposed to the disease but has not yet been diagnosed as having it). In addition, treating or treatment does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes procedures that have only a marginal effect on the patient. Treatment can include inhibiting the disease, e.g., arresting its development, or relieving the disease, e,g., causing regression of the disease. For example, treatment can include reducing acute or chronic inflammation; alleviating pain and mitigating and inducing re-growth of new ligament, bone and other tissues; as an adjunct in surgery; and/or any repair procedure. Also, as used in the specification and including the appended claims, the term “tissue” includes soft tissue, ligaments, tendons, cartilage and/or bone unless specifically referred to otherwise. 
     The following discussion includes a description of a surgical system and related methods of employing the surgical system in accordance with the principles of the present disclosure, Alternate embodiments are disclosed. Reference is made to the exemplary embodiments of the present disclosure, which are illustrated in the accompanying figures. Turning to  FIGS. 1-6 , there are illustrated components of a surgical system  10 . 
     The components of surgical system  10  can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics and bone material and/or their composites. For example, the components of surgical system  10 , individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, superelastic metallic alloys (e.g., Nitinol, super elasto-plastic metals), ceramics and composites thereof such as calcium phosphate (e.g., SKELITE™), 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 surgical system  10  may have material composites, including the above materials, to achieve various desired characteristics such as strength, rigidity, elasticity, compliance, biomechanical performance, durability and radiolucency or imaging preference. The components of surgical system  10 , individually or collectively, may also be fabricated from a heterogeneous material such as a combination of two or more of the above-described materials. The components of surgical system  10  may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein. 
     Surgical system  10  is employed, for example, with a minimally invasive procedure, including percutaneous techniques, mini-open and open surgical techniques to deliver and introduce instrumentation and/or components of spinal constructs at a surgical site within a patient body of a patient, for example, a section of a spine. In some embodiments, one or more of the components of surgical system  10  are configured for engagement with spinal constructs attached with vertebrae to manipulate tissue and/or correct a spinal disorder, such as, for example, a sagittal deformity, as described herein. In some embodiments, surgical system  10  may be employed with surgical procedures, such as, for example, corpectomy, discectomy and/or fracture/trauma treatment and may include fusion and/or fixation that employ implants to restore the mechanical support function of vertebrae. 
     Surgical system  10  includes an extender, such as, for example, an implant support and a sleeve  80 , both engageable with a bone screw  600 . Implant support  14  includes an adaptor  50  connectable to a surgical instrument, such as, for example, a compressor/distractor  250  to facilitate manipulation of tissue, as described herein. 
     Implant support  14  extends along an axis X 1 , as shown in  FIG. 2 . Implant support  14  includes an extension  20  and an extension  22 , as shown in  FIG. 3 . Extensions  20 ,  22  are relatively moveable to each other via relative translation of a translation element, such as, for example, a slide  26  disposed with implant support  14 , as shown in  FIG. 3 . Slide  26  is manipulated for translation within channel  28  to move extensions  20 ,  22  between an open orientation and a closed, capture orientation. Slide  26  is translated, in a direction shown by arrow A in  FIG. 3 , to cause extensions  20 ,  22  to rotate and expand, in a direction shown by arrows B, to the open orientation. In the open orientation, pins  30  are seated in a bottom of slots  32  of slide  26 . Slide  26  is translated, in a direction shown by arrow C in  FIG. 4 , to cause extensions  20 ,  22  to rotate and contract, in a direction shown by arrows D, to the closed orientation to capture a wall  604  of a receiver  602  of bone screw  600 , as shown in  FIG. 3 . In the closed orientation, pins  30  are seated in at the top of slots  32 . In some embodiments, extensions  20 ,  22  are flexible to facilitate contraction. 
     Positioning of implant support  14  with wall  604  provides for direct access to receiver  602  to facilitate insertion of a spinal rod. In some embodiments, one or more implant supports  14  are manipulable, as described herein, to provide a counter-torque for small deformity maneuvers and manipulation of vertebrae during a surgical treatment, for example, to displace, pull, twist or align vertebrae. Implant support  14  includes a surface  40  that defines a channel  42 . Channel  42  is configured for disposal of slide  26 , as described herein. 
     Adaptor  50  is pivotable and/or rotatable relative to implant support  142  and/or bone screw  600 , as shown in  FIGS. 2 and 6 . Rotation of adaptor  50  facilitates engagement of implant support  14  via adaptor  50  with compressor/distractor  250 , as described herein. Adaptor  50  extends between an end  54  and an end  56 . End  54  is connected to sleeve  52  by a pin hinge  58 . Pin  58  facilitates rotation of adaptor  50  relative to implant support  14  and/or bone screw  600 . In some embodiments, adaptor  50  may be variously oriented relative to implant support  14 , such as, for example, transverse, perpendicular, angular and/or offset. End  56  includes an arm  60  extending therefrom. Rotation of arm  60  facilitates connection of adaptor  50  and implant support  14  with compressor/distractor  250 , as described herein. In some embodiments, arm  60  is may be variously oriented relative to axis X 1 , such as, for example, parallel, perpendicular, angular and/or offset. 
     Arm  60  includes a surface  62  that defines a threaded lock surface  64 . Surface  64  is engageable with a lock nut  274  to fix compressor/distractor  250  with implant supports  14  and adaptors  50 , as described herein. In some embodiments, surface  64  may have alternative locking and/or tool engaging surfaces, such as, for example, rectangular, polygonal, hexalobe, oval, irregular, cruciform, phillips, square, polygonal or star cross sectional configuration. 
     Sleeve  80  is connectable with implant support  14  and wall  606 . Sleeve  80  includes a body  82  extending between an end  84  and an end  86 , as shown in  FIG. 7 . Body  82  extends along implant support  14 . End  84  includes a flange  88  and a flange  90  that define a mating surface, such as, for example, mating grooves  92 . Mating grooves  92  are configured for disposal of a proximal portion of implant support  14 , as shown in  FIGS. 4-6 . Flanges  88 ,  90  are flexible such that flanges  88 ,  90  snap fit into engagement with implant support  14 . Upon disposal of implant support  14  with mating grooves  92 , sleeve  80  is disposed in a configuration to capture a wall  606  of receiver  602 , as shown in  FIGS. 5 and 6 . 
     End  86  includes a surface  100  that defines a mating surface  102 . Surface  102  is configured for capture of wall  606 . Surface  102  includes a distal projection  104  configured for engagement with a cavity  608  disposed with wall  606  of receiver  602  to facilitate engagement. 
     Bone screw  600  includes, such as, for example, a multi-axial receiver  602  and a shaft  610 . Receiver  602  is moveable relative to shaft in a multi axial configuration. Receiver  602  includes spaced apart walls  604 ,  606 , as shown in  FIG. 5 . Receiver  602  is configured for engagement with implant support  14  and sleeve  80 , as described herein, Walls  604 ,  606  each include a surface that defines cavities  608 . Cavities  608  facilitate connection with implant support  14  and/or sleeve  80 , as described herein. Walls  604 ,  606  include an inner surface that defines a U-shaped passageway  612  for disposal of a spinal rod, as described herein. The inner surface of receiver  602  includes a thread form configured for engagement with a set screw. 
     In assembly, operation and use, surgical system  10 , similar to the systems and methods described herein, is employed with a surgical procedure, for treatment of a spine of a patient including vertebrae V, as shown in  FIGS. 7-19 . Surgical system  10  may also be employed with surgical procedures, such as, for example, discectomy, laminectomy, fusion, laminotomy, laminectomy, nerve root retraction, foramenotomy, facetectomy, decompression, spinal nucleus or disc replacement and bone graft and implantable prosthetics including plates, rods, and bone engaging fasteners. 
     Surgical system  10  is employed with a procedure for treatment of an applicable condition or injury of an affected section of a spinal column and adjacent areas within a body. For example, vertebrae V includes a vertebral level V 1 , a vertebral level V 2  and a vertebral level V 3 , as shown in  FIG. 19 . Diseased and/or damaged vertebrae and intervertebral discs are disposed at vertebra V 2  between vertebrae V 1  and V 3 . In some embodiments, components of surgical system  10  are configured for insertion with a vertebral space to space apart articular joint surfaces, provide support and maximize stabilization of vertebrae V. 
     In use, to treat the affected section of vertebrae V, a medical practitioner obtains access to a surgical site including vertebrae V in any appropriate manner, such as through incision and retraction of tissues. In some embodiments, surgical system  10  may be used in any existing surgical method or technique including open surgery, mini-open surgery, minimally invasive surgery and percutaneous surgical implantation, whereby vertebrae V is accessed through a mini-incision, or sleeve that provides a protected passageway to the area. 
     An incision is made in the body of a patient and a cutting instrument (not shown) creates a surgical pathway for implantation of components of surgical system  10 . A preparation instrument (not shown) can be employed to prepare tissue surfaces of vertebrae V, as well as for aspiration and irrigation of a surgical region. 
     Pilot holes or the like are made in selected vertebrae V 1  and V 3  for receiving bone screws  600 . Implant support  14 , including adaptor  50 , is engaged with wall  604  of receiver  602 , as described herein. Sleeve  80  is engaged with wall  606  of receiver  602 , as described herein. Mating grooves  88 ,  90  are engaged with implant support  14 , as described herein. A driver  650  is disposed adjacent vertebrae V at a surgical site and is manipulated to drive, torque, insert or otherwise connect bone screw  600  with vertebrae. 
     Compressor/distractor  250  is connected with implant supports  14  via adaptors  50 , as shown in  FIG. 7 , to allow for distraction and/or compression of vertebrae V connected with bone screw  600 . Compressor/distractor  250  includes a longitudinal element, such as, for example, a rack  252 , as shown in  FIG. 1 . Rack  252  extends between an end  254  and an end  256  defining a longitudinal axis A 1  Rack  252  is configured to connect adjacent implant support  14 . Rack  252  includes an outer surface  258  having a plurality of teeth, such as, for example, splines  260  engageable with an arm  282 , as described herein. Rack  252  includes an arm  262  extending from end  254 . In some embodiments, arm  262  is attached with rack  252  with, for example, with clips, hooks, adhesives and/or flanges. 
     Arm  262  includes a surface that defines an opening  263  configured for disposal of surface  62  for mounting compressor/distractor  250  with implant support  14 , adaptor  50  and sleeve  80 , as shown in  FIG. 7 . Rack  252  includes arm  282  that is axially translatable along axis Al relative to arm  262 . Arm  282  includes a surface that defines an opening  283  configured for disposal of surface  62  for mounting compressor/distractor  250  with implant support  14 , adaptor  50  and sleeve  80 . 
     Compressor/distractor  250  includes a ratchet, which includes splines  260  and arm  282  engageable in a bi-directional and/or two-way ratchet configuration. Arm  282  includes a latch  300  that includes a pinion or pawl (not shown) engageable with splines  260 . Latch  300  is pivotable relative to arm  282  for disposal in a distraction position, as described herein. In the distraction position, latch  300  engages rack  252  to allow axial and/or incremental translation of arm  282  relative to arm  262 /rack  252  and prevents axial translation of arm  282  relative to arm  262 /rack  252 , in an opposing direction. As such, distraction of vertebral tissue connected with implant supports  14  can be performed. 
     Latch  300  is pivotable relative to arm  282 , as shown in  FIG. 7 . For example, latch  300  is pivotable for disposal in a neutral position. In the neutral position, latch  300  disengages from rack  252  to allow free axial translation of arm  262 /rack  252  relative to arm  282 . Latch  300  is pivotable relative to arm  282  for disposal in a compression position (not shown). In the compression position, latch  300  engages rack  252  to allow axial and/or incremental translation of arm  282  relative to arm  262 /rack  252  to compress vertebral tissue and prevents axial translation of arm  282  relative to arm  262 /rack  252 , in an opposing direction. As such, compression of vertebral tissue connected with implant supports  14  can be performed. In some embodiments, a rotatable key  302  includes a gear surface engageable with splines  260  to axially and/or incrementally translate rack  252  to facilitate distraction and/or compression, as described herein. 
     Angulation module  266  is connectable with compressor/distractor  250 , implant supports  14  and adaptor  50 , as shown in  FIGS. 8 and 9 . Module  266  is mounted with surfaces  62  for connection with compressor/distractor  250 , implant supports  14  and adaptor  50  via lock nut  274 . Module  266  includes spaced apart arms  290  that define a cavity  292 . Arms  290  are configured for capture of implant supports  14  to facilitate parallel distraction. Module  266  is fixed with implant supports  14  to allow for angulation and/or correction of vertebral tissue connected with implant supports  14 , individually, in combination or simultaneously. In some embodiments, engagement of implant supports  14  with module  266  facilitates parallel manipulation of vertebrae attached with implant supports  14 . In some embodiments, modules  266  are connected with compressor/distractor  250  and/or implant supports  14  to maintain a corrected vertebral angle of vertebrae during distraction and/or compression, as described herein. 
     For example, latch  300  is pivotable to the distraction position, as described herein, to allow translation of arm  282 , in the direction shown by arrow E, and prevent translation of arm  282 , in the direction shown by arrow F, relative to arm  262 /rack  252 , as shown in  FIG. 10 . As such, distraction of vertebrae V 1 , V 3  connected with implant supports  14  can be performed. 
     In some embodiments, a dilator  700  is inserted between implant supports  14  into contact with bony anatomy and determine tissue depth. In some embodiments, a retractor blades  800  are translated along dilator  700  into engagement with the bony anatomy, as shown in  FIG. 10 . Blades  800  are disposed with tissue to form a surgical passageway, as shown in  FIG. 11 , to facilitate insertion of a spinal implant, such as, for example, an interbody spinal implant. In some embodiments, blades  800  are selected according to a desired length and/or width. A blade holder  802  is attached to blades  800  and utilized to manipulate and/or adjust blades  800 , as shown in  FIG. 10 . 
     In some embodiments, a light source is disposed with retractor  800  to provide illumination to the working channel. In some embodiments, compressor/distractor  250  is employed segmental distraction to facilitate insertion of an interbody implant and decompressing tissue. 
     In some embodiments, a rod inserter  440  is engaged with a spinal rod  450  to direct and/or guide spinal rod  450  through implant supports  14  into receiver  602 . In some embodiments, a driver (not shown) is utilized to engage a set screw (not shown) with bone screws  600  to fix one end of spinal rod  450 . Retractor  800  is removed, and blades are translated out of the surgical site, as shown in  FIG. 13 . One of sleeves  80  is disengaged from implant supports  14 , as shown in  FIG. 13 , and implant supports  14  are crossed. In some embodiments, a crossing block  900  captures the crossed implant supports  14 , as shown in  FIG. 14 . Compressor/distractor  250  is disposed in a compression position, as described herein, and key  302  is rotated to selectively compress vertebrae V. The driver  550  is utilized to engage a second set screw (not shown) with bone screw  600  to fix a second end of spinal rod  450 , as shown in  FIG. 16 . 
     Compressor/distractor  250  and implant supports  14  are removed, as shown in  FIGS. 17-18 . For example, lock nuts  274  are disengaged from surface  64 . Latch  300  is set to the neutral position. Angulation modules  266  and compressor/distractor  250  are disengaged from adaptors  50  and implant supports  14 . Implant supports  14  are removed. 
     Upon completion of a procedure, as described herein, the surgical instruments, assemblies and non-implanted components of surgical system  10  are removed and the incision(s) are closed. One or more of the components of surgical system  10  can be made of radiolucent materials such as polymers. Radiomarkers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. In some embodiments, the use of surgical navigation, microsurgical and image guided technologies may be employed to access, view and repair spinal deterioration or damage, with the aid of surgical system  10 . In some embodiments, surgical system  10  may include one or a plurality of plates, connectors and/or bone fasteners for use with a single vertebral level or a plurality of vertebral levels. 
     In some embodiments, surgical system  10  includes one or a plurality of alternate surgical instruments, each configured for mating engagement in a quick release configuration with spinal constructs, as described herein. This configuration facilitates the interchangeability of the spinal constructs with the alternate surgical instruments. In some embodiments, surgical system  10  includes one or a plurality of alternate surgical instruments, such as, for example, inserters, extenders, reducers, spreaders, distracters, blades, retractors, clamps, forceps, elevators and drills, which may be alternately sized and dimensioned, and arranged as a kit. 
     In some embodiments, surgical system  10  includes an agent, which may be disposed, packed, coated or layered within, on or about the components and/or surfaces of surgical system  10 . In some embodiments, the agent may include bone growth promoting material, such as, for example, bone graft to enhance fixation of the components and/or surfaces of surgical system  10  with vertebrae. In some embodiments, the agent may include one or a plurality of therapeutic agents and/or pharmacological agents for release, including sustained release, to treat, for example, pain, inflammation and degeneration. 
     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.