Patent Publication Number: US-10322012-B2

Title: Surgical instrument and method

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of application U.S. patent application Ser. No. 15/274,672, filed on Sep. 23, 2016, which is hereby incorporated by reference herein, in its entirety. 
    
    
     TECHNICAL FIELD 
     The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical system and a method for treating a spine. 
     BACKGROUND 
     Spinal pathologies and disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including deformity, pain, nerve damage, and partial or complete loss of mobility. 
     Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes fusion, fixation, corpectomy, discectomy, laminectomy and implantable prosthetics. For example, fusion and fixation treatments may be performed that employ implants to restore the mechanical support function of vertebrae. Surgical instruments are employed, for example, to prepare tissue surfaces for disposal of the implants. Surgical instruments are also employed to engage implants for disposal with the tissue surfaces at a surgical site. This disclosure describes an improvement over these prior technologies. 
     SUMMARY 
     In one embodiment, a surgical instrument is provided. The surgical instrument comprises a member connected with a spinal implant defining an axis. A first image guide is connected with the member and oriented relative to a sensor to communicate a signal representative of a position of the member. A second image guide is connected with the member and oriented to represent an angle measuring a second orientation of the axis relative to a first orientation. In some embodiments, surgical systems, implants and methods are provided. 
    
    
     
       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; 
         FIG. 2  is a perspective view of the components shown in  FIG. 1 ; 
         FIG. 3  is a perspective view of the components shown in  FIG. 1 ; 
         FIG. 4  is a cross-section view of the components shown in  FIG. 1 ; 
         FIG. 5  is an enlarged break away view of the components shown in  FIG. 4 ; 
         FIG. 6  is an enlarged break away view of the components shown in  FIG. 4 ; 
         FIG. 7  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 8  is a plan view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 9  is a plan view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 10  is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure; 
         FIG. 11  is a side view of the components shown in  FIG. 10 ; 
         FIG. 12  is a perspective view of the components shown in  FIG. 10 ; and 
         FIG. 13  is a side view of the components shown in  FIG. 10 . 
     
    
    
     DETAILED DESCRIPTION 
     The exemplary embodiments of a surgical system are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of a surgical system for preparing a surgical site, and a method for treating a spine. In some embodiments, the surgical system includes a surgical instrument having an image guide, such as, for example, a surgical navigation tracker. 
     In some embodiments, the surgical system includes a surgical instrument, such as, for example, an inserter employed with a selected spinal implant, such as, for example, an interbody implant, which is connected to the surgical instrument. In some embodiments, the surgical instrument includes an image guide, such as, for example, a rotational gauge. In some embodiments, the surgical instrument includes a clutch inserter with a rotational gauge. 
     In some embodiments, the spinal implant includes an intervertebral spacer. In some embodiments, the surgical system is employed with a method that includes manipulation, movement, translation and/or rotation of the implant with an intervertebral disc space. In some embodiments, the spinal implant includes markers for positioning and rotation. In some embodiments, the spinal implant includes a loop implant. 
     In some embodiments, the surgical instrument has an instrument tracker and a distal/working end. In some embodiments, the surgical tracker provides indicia and/or display of a location of the surgical instrument and its distal/working end. In some embodiments, the surgical system includes a surgical instrument having one or more image guides, which include one or more fiducial markers. In some embodiments, the fiducial marker includes a single ball-shaped marker. In some embodiments, the image guide is disposed adjacent a proximal end of the surgical instrument. In some embodiments, the image guide is attached to a longitudinal element of the surgical instrument that moves distally in a linear fashion relative to the surgical instrument and rotates the implant in the disc space. In some embodiments, the image guide provides indicia and/or display of a precise linear position of the image guide on the surgical instrument. In some embodiments, this configuration provides indicia and/or display of an amount of manipulation, movement, translation and/or rotation of the implant with tissue, such as, for example, an intervertebral space. 
     In some embodiments, the surgical system includes a surgical instrument having one or more image guides, which include a tracker that provides location of a surgical instrument in three dimensions, and a tracker that provides location of the surgical instrument and/or a spinal implant in two dimensions, such as, for example, a selected plane. In some embodiments, this configuration provides indicia and/or display of implant position corresponding to an amount of manipulation, movement, translation and/or rotation of the implant with tissue, such as, for example, an intervertebral space. In some embodiments, the surgical system includes a surgical instrument that comprises an inserter employed with a method for delivering an interbody spacer into an intervertebral disc space. In some embodiments, the method includes the step of manipulating, moving, translating and/or rotating the interbody spacer in a precise amount upon selected disposal of the interbody spacer in the intervertebral disc space. 
     In some embodiments, the surgical system includes a surgical instrument comprising a navigation compatible implant inserter. In some embodiments, the surgical system includes a surgical instrument having one or more image guides, which provide position and rotation indicia and/or display of an interbody implant via a camera sensor and a computer display screen. In some embodiments, the surgical system includes a surgical inserter that has two image guide arrays. In some embodiments, the image guide arrays interact with a navigation enabled camera sensor to provide imaging during insertion and rotation of an interbody implant. In some embodiments, the image guide arrays include a large top array used for insertion tracking of the surgical instrument, and may be used on either side of a patient. In some embodiments, the large top array is indexable for use on either side of the patient. 
     In some embodiments, the image guide arrays include a lower array, which provides location of the surgical instrument and/or a spinal implant. In some embodiments, the lower array includes a lower gauge shaft that translates in a linear fashion in direct contact with the implant and directly rotates a graduated gauge to provide rotational position of the implant. In some embodiments, the image guide arrays include the large top array and/or the lower array to increase the accuracy of implant placement. 
     In some embodiments, the surgical instrument includes a surgically navigated instrument, such as, for example, drills, drivers, and taps, which freely rotate about a centerline axis. In some embodiments, the surgical instrument includes a navigation tracker that is optically tracked and requires a line-of-sight view to a sensor, such as, for example, a camera. In some embodiments, the surgical system includes a navigation tracker attached to a surgical instrument and is disposed in a direct line of sight of a sensor, which includes one or more cameras. In some embodiments, the surgical system includes an O-arm medical imaging device that digitally captures images of an anatomy. In some embodiments, the tracker communicates with a surgical navigation system to determine and/or display surgical instrument positioning relative to the anatomy. 
     In some embodiments, one or all of the components of the surgical system may be disposable, peel pack and/or pre packed sterile devices. One or all of the components of the surgical system may be reusable. The surgical system may be configured as a kit with multiple sized and configured components. 
     In some embodiments, the surgical system of 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 surgical system of the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. In some embodiments, the surgical system may be alternatively employed in a surgical treatment with a patient in a prone or supine position, and/or employ various surgical approaches to the spine, including anterior, posterior, posterior mid-line, lateral, postero-lateral, and/or antero-lateral approaches, and in other body regions. The surgical system of 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 surgical system 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 surgical system of 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. 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 including a surgical instrument, related components and methods of employing the surgical system in accordance with the principles of the present disclosure. Alternate embodiments are disclosed. Reference is made in detail to the exemplary embodiments of the present disclosure, which are illustrated in the accompanying figures. Turning to  FIGS. 1-7 , 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, aluminum, 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, such as GUM METAL®), 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, polyimide, 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 fully open surgical procedure, a minimally invasive procedure including percutaneous techniques, and mini-open surgical techniques to deliver and introduce instrumentation and/or a spinal implant, such as, for example, an interbody implant, at a surgical site of a patient, which includes, for example, a spine having vertebrae V, as shown in  FIGS. 8 and 9 . In some embodiments, the spinal implant can include one or more components of one or more spinal constructs, such as, for example, cages, spacers, vertebral devices, bone fasteners, spinal rods, connectors and/or plates. 
     Surgical system  10  comprises a surgical instrument, such as, for example, an inserter  12 . Inserter  12  includes a member, such as, for example, a body  14  that defines a longitudinal axis A 1 . Body  14  extends between an end  16  and an end  18 . Body  14  includes an outer sleeve  20 . In some embodiments, one or more portions of outer sleeve  20  may be tubular, solid and/or define cavities for disposal of components of inserter  12 . 
     Outer sleeve  20  includes a handle  22  and a shaft  24 . Handle  22  extends between an end  26  and an end  28 . In some embodiments, handle  22  may have alternate cross section configurations, such as, for example, oval, oblong, triangular, square, hexagonal, polygonal, irregular, uniform, non-uniform and/or tapered. In some embodiments, handle  22  may be assembled with shaft  24 , as described herein. In some embodiments, handle  22  may be monolithically formed with shaft  24 . In some embodiments, handle  22  may be disposed at alternate orientations relative to shaft  24 , such as, for example, transverse, parallel, perpendicular and/or other angular orientations such as acute or obtuse, co-axial, offset, and/or staggered. 
     Handle  22  includes a surface  30  that defines a cavity  32 . Cavity  32  is configured for disposal of a longitudinal member, such as, for example, a shaft  34 . Shaft  34  is configured to connect a spinal implant  150  with inserter  12 , as described herein. Handle  22  is configured to facilitate manipulating, moving, translating and/or rotating spinal implant  150 , as described herein. Handle  22  includes an actuator that includes a pivoting grip  40  and a knob  60 , as described herein. 
     Grip  40  extends between an end  42  and an end  44 . In some embodiments, grip  40  is ergonomically designed to be held in a plurality of orientations. In some embodiments, grip  40  includes indents configured to facilitate manipulation of grip  40 . Grip  40  is connected with handle  22  at end  42  by a pin  46 . End  44  includes a flange  48  configured to facilitate locking and unlocking of grip  40  relative to handle  22 , as described herein. 
     Grip  40  is configured to rotate and/or pivot about pin  46  relative to axis A 1 . Grip  40  rotates about pin  46  between a locking orientation, as shown in  FIG. 2 , and a non-locking orientation, as shown in  FIG. 3 , of grip  40  with shaft  34 . Locking of grip  40  resists and/or prevents translation of shaft  34 , for example, such that spinal implant  150  is disposed in a selected and fixed position relative to end  18 , as described herein. Rotating grip  40  into a non-locking orientation allows for movement and/or translation of shaft  34  relative to body  14  to facilitate movement and/or rotation of spinal implant  150  relative to end  18 , as described herein. In some embodiments, grip  40  may be rotated through an angular range of 0-90 degrees relative to axis A 1 . In some embodiments, grip  40  may have various configurations, such as, for example, solid, tubular, arcuate, offset, staggered, uniform and non-uniform. 
     In some embodiments, grip  40  includes a biasing member, such as, for example, a torsion spring  49  disposed about pin  46 , as shown in  FIG. 4 . Spring  49  includes legs that are connected with grip  40  and body  14 . As such, spring  49  applies a biasing force to grip  40  to urge grip  40  into the non-locking orientation, as described herein. Grip  40  is manipulable to overcome the biasing force of spring  49  to pivot and/or rotate grip  40  for disposal in the locking orientation, as described herein. In some embodiments, grip  40  may be manually manipulable without a biasing member. 
     In some embodiments, the biasing member as described herein comprises a spring, a conical spring washer, a disc spring, a Belleville spring, a cupped spring washer, a coil spring, an elastomeric member, a clip, a leaf spring, gravity induced configuration, pneumatic configuration, hydraulic configuration and/or manual lever. In some embodiments, the biasing member may have a semi-rigid, rigid or elastic configuration, and/or have elastic properties, such as the elastic properties corresponding to the material examples described above, such that the biasing member provides a selective amount of movement between selected positions and orientations. In some embodiments, the biasing member may include a plurality of separately attachable or connectable portions or sections, such as bands or loops, or may be monolithically formed as a single continuous element. In some embodiments, the biasing member includes an axial element, such as, for example, a flexible shaft. In some embodiments, the biasing member has a solid disc or sphere shape. 
     Handle  22  includes a lock, such as, for example, a collar  50  configured to engage grip  40  for disposal in a locking orientation and a non-locking orientation relative to handle  22 . Collar  50  includes a cavity, such as, for example, a cutout  52 . Cutout  52  is configured to facilitate movement of grip  40  to a non-locking orientation, as described herein. Collar  50  is rotatable, in a clockwise direction and a counter-clockwise direction, between a locked orientation, as shown in  FIG. 1 , such that flange  48  is disposed within collar  50  and collar  50  resists and/or prevents pivoting of grip  40  relative to handle  22 , and a non-locked orientation, as shown in  FIG. 3 , such that flange  48  is aligned with cutout  52  for movement therethrough and relative to handle  22 . Alignment of cutout  52  with flange  48  allows grip  40  to disengage from collar  50  by passing through cutout  52 . Disengagement of grip  40  from collar  50  allows for pivoting of grip  40  relative to handle  22 . Grip  40  is configured to resist and/or prevent rotation of spinal implant  150  during a surgical procedure, as described herein. 
     Knob  60  is connected with handle  22  at end  26 . Knob  60  is rotatable, in a clockwise direction and a counter-clockwise direction, to facilitate movement and/or translation of shaft  34  for moving and/or rotating spinal implant  150  to a selected orientation, as described herein. Shaft  34  extends between an end  62  and an end  64 . 
     End  62  is engageable with knob  60  such that rotation of knob  60  causes shaft  34  to engage spinal implant  150  for movement and/or rotation relative to end  18 . In some embodiments, shaft  34  is connected with knob  60  by a pin. In some embodiments, shaft  34  is connected with knob  60  by a threaded engagement. Shaft  34  includes a surface  63  that defines a circumferential flange  65 . Flange  65  is configured for engagement with a flange  148  in the locking orientation of grip  40  to resist and/or prevent translation of shaft  34  relative to handle  22 . When engaged in a locking orientation of grip  40 , flange  148  applies a force to flange  65  in a mating engagement to apply a force and/or pressure to shaft  34 . This force fixes position of shaft  34  relative to handle  22  and/or forms a pressure fit between end  18  and spinal implant  150 . This configuration resists and/or prevents movement and/or rotation of spinal implant  150  relative to end  18 . Flange  148  disengages from flange  65  for disposal of shaft  34  in a non-locked orientation. Disengagement of flange  148  from flange  65  releases the mating engagement and/or pressure fit between end  18  and spinal implant  150  to allow movement and/or rotation of spinal implant  150  relative to end  18 . In some embodiments, grip  40  is selectively disposed in the locking and non-locking orientation to selectively fix and manipulate, move, translate, rotate and/or adjust position of spinal implant  150  relative to end  18  such that locking of grip  40  can be applied, released and/or re-applied for one or a plurality of iterations for positioning of spinal implant  150  with tissue. In some embodiments, grip  40  is selectively disposed in the locking and non-locking orientation to selectively fix and adjust position of spinal implant  150  in an angular range of 0 through 360 degrees relative to and about end  18 . In some embodiments, grip  40  is selectively disposed in the locking and non-locking orientation to selectively fix and manipulate, move, translate, rotate and/or adjust position of spinal implant  150  relative to end  18  in a range of movement of spinal implant  150  between an insertion or delivery orientation, for example, as shown and described herein with regard to  FIG. 1  and an implant orientation, as shown and described herein with regard to  FIG. 3 . 
     End  64  includes a surface  66  configured for mating engagement with a movable pin  156  disposed with spinal implant  150 , as described herein. In some embodiments, end  64  is configured for threaded engagement with pin  156  upon actuation of knob  60 . Actuation of knob  60  causes shaft  34  to draw spinal implant  150  into engagement with end  18  to fix spinal implant  150  with end  18  for delivery to a surgical site, as described herein. In some embodiments, surface  66  may have alternate surface configurations for mating engagement with a surface of spinal implant  150 , such as, for example, grooved, rough, dimpled, polished, textured and/or a drive or socket, which may include a square, triangular, hexagonal, polygonal, star, torx or hexalobe cross section. 
     In some embodiments, handle  22  includes a mating cavity  68  disposed at end  28 , as shown in  FIG. 5 . In some embodiments, mating cavity  68  may include a square, triangular, hexagonal, polygonal, star, torx or hexalobe cross section configured engage a correspondingly shaped portion of a surface that defines a mating surface  92  disposed with shaft  24 , as described herein. 
     Body  14  is configured for connection with an image guide, which includes a navigation component  70 , as described herein. Navigation component  70  is configured to generate a signal representative of a position of inserter  12 . In some embodiments, an image guide as described herein may include human readable visual indicia, human readable tactile indicia, human readable audible indicia, one or more components having markers for identification under x-ray, fluoroscopy, CT or other imaging techniques, at least one light emitting diode, a wireless component, a wired component, a near field communication component and/or one or more components that generate acoustic signals, magnetic signals, electromagnetic signals and/or radiologic signals. 
     Navigation component  70  includes a collar  72  configured for disposal with a portion of body  14 . In some embodiments, collar  72  is fixed with body  14 . In some embodiments, collar  72  is rotatable relative to body  14  about axis A 1 . In some embodiments, collar  72  is connected with body  14  via friction fit, pressure fit, interlocking engagement, mating engagement, dovetail connection, hook and loop closure, clips, barbs, tongue in groove, threaded, magnetic, key/keyslot, drill chuck and/or adhesive. 
     Collar  72  includes a post  80  extending therefrom. Post  80  defines an axis X 1 . Post  80  extends perpendicular to axis A 1  and is rotatable with collar  72  about axis A 1 . In some embodiments, axis X 1  may be disposed at alternate orientations relative to axis A 1 , such as, for example, parallel, transverse and/or other angular orientations, such as, acute or obtuse. 
     Navigation component  70  includes a tracking device having an emitter array  82  that is connected to collar  72  via post  80 . In some embodiments, post  80  includes a cavity  81 . In some embodiments, cavity  81  is configured to receive a threaded screw  83  configured to connect emitter array  82  with collar  72 . Emitter array  82  is rotatable with collar  72  about axis A 1 . In some embodiments, emitter array  82  may be disposed at alternate orientations relative to axis A 1 , such as, for example, parallel, perpendicular, transverse and/or other angular orientations, such as, acute or obtuse. 
     Emitter array  82  is configured for generating a signal to a sensor array  202 , as shown in  FIG. 7  and described herein, representing a three-dimensional spatial position and/or a trajectory of inserter  12  and/or spinal implant  150  relative to a portion of a patient&#39;s anatomy and/or a depth of inserter  12  and/or spinal implant  150  within the patient&#39;s anatomy for display on a monitor. Emitter array  82  includes four spaced apart arms having a substantially X-shape. Emitter array  82  includes markers, such as, for example, fiducials  84 . Fiducials  84  appear in the image produced by a surgical navigation system  200  of surgical system  10  for use as a point of reference or a measure. Emitter array  82  generates signals representing the position of various body reference points of the patient&#39;s anatomy. In some embodiments, fiducials  84  include at least one light emitting diode. In some embodiments, fiducials  84  may include other tracking devices capable of being tracked by sensor array  202 , such as, for example, a tracking device that actively generates acoustic signals, magnetic signals, electromagnetic signals and/or radiologic signals. In some embodiments, fiducials  84  may be removably attached to emitter array  82 . In some embodiments, one or more of fiducials  84  each include a single ball-shaped marker. 
     Shaft  24  extends distally from handle  22  and includes end  18 . Shaft  24  includes an end  90 . End  90  includes cavity  92  configured for a mating engagement with mating surface  68 . In some embodiments, cavity  92  may have various cross-section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable, tubular and/or tapered. 
     Shaft  24  includes a surface  94  that defines a cavity, such as, for example, an axial channel  96 . Channel  96  extends between an end  98  and an end  100 . Channel  96  is configured for disposal of a longitudinal element, such as, for example, a rod  102 . Rod  102  extends within channel  96  and includes an end  104  and an end  106  disposed adjacent end  18  and spinal implant  150  when attached with inserter  12 . 
     Rod  102  is configured for translation relative to shaft  24  as spinal implant  150  is moved and/or rotated for positioning with tissue to provide indicia and/or display of an amount of manipulation, movement, translation and/or rotation of spinal implant  150  with tissue, such as, for example, an intervertebral space, as described herein. In some embodiments, rod  102  may have alternate cross section configurations, such as, for example, oval, oblong, triangular, square, hexagonal, polygonal, irregular, uniform, non-uniform and/or tapered. 
     In some embodiments, rod  102  includes a biasing member, such as, for example, a coil spring  110  mounted within a cavity of rod  102  and engageable with body  14 . Spring  110  applies a biasing force to rod  102  to urge rod  102  into the insertion or delivery orientation, as described herein. With end  18  connected with spinal implant  150  in the insertion or delivery orientation, and handle  22  and shaft  34  disposed in the locking orientation, as described herein, spinal implant  150  is fixed with inserter  12 . End  18  is fixed with spinal implant  150  and end  106  engages a surface of spinal implant  150  to provide indicia and/or a display of end  18  and/or spinal implant  150 , as described herein. 
     End  104  includes an image guide  120 . Image guide  120  includes an angle gauge  122  and a navigation component  180 , as described herein. Gauge  122  measures a change in angle between an orientation, for example, a delivery orientation, as shown in  FIG. 8 , and an orientation, for example, an implant orientation, as shown in  FIG. 9 , as described herein. Image guide  120  represents and displays an angular measurement of the change in angle between selected relative orientations of spinal implant  150 . 
     Gauge  122  extends between an end  124  and an end  126 , as shown in  FIG. 5 . Gauge  122  rotates relative to shaft  24 , as described herein. End  124  includes a ring  128 , which is disposed about a pivot or pin  130  and configured to facilitate rotation of gauge  122  relative to shaft  24 . In some embodiments, pin  130  is fixed with rod  102 . In some embodiments, ring  128  is disposed with pin  130  in a substantially frictionless engagement to facilitate rotation of gauge  122  relative to shaft  24 . In some embodiments, pin  130  is fixed with gauge  122  and rotatable relative to shaft  24  such that gauge  122  rotates relative to shaft  24 . Gauge  122  pivots about pin  130  via ring  128  in response to translation of rod  102  such that gauge  122  rotates about pin  130 , as described herein. 
     Gauge  122  includes arcuate sections  132 ,  134 . Sections  132 ,  134  are disposed in a spaced apart relation. Section  132  includes a surface  136  that define a track  138 . Section  134  includes a surface  140  that defines a track  142 . Tracks  138 ,  142  are configured for moveable disposal of a member, such as, for example, a marker  144  disposed with rod  102 , as shown in  FIGS. 2 and 3 . 
     In some embodiments, marker  144  is displaced and/or translated axially with rod  102  from an initial orientation, for example the delivery orientation of spinal implant  150 , which indicates a resting, zero angle or calibration orientation of marker  144  and/or gauge  122 . From the initial orientation, rod  102  engages spinal implant  150  to manipulate, move, translate and/or rotate spinal implant  150  such that marker  144  is displaced and/or translated axially with rod  102 . In some embodiments, gauge  122  and/or marker  144  rotate about pin  130  relative to shaft  24  to measure a change in an angular orientation of gauge  122  and spinal implant  150  relative to inserter  12  and/or tissue, as described herein. In some embodiments, rod  102  translates in a proximal direction to overcome the biasing force of spring  110 . In some embodiments, rod  102  may translate in a proximal direction and a distal direction in the implant orientation for positioning spinal implant  150  with tissue. In some embodiments, such translation causes gauge  122  to rotate from rest and/or equilibrium and a restoring force due to gravity is subjected to gauge  122 . 
     Marker  144  causes gauge  112  to pivot or rotate about pin  130  such that marker  144  moves along tracks  138 ,  142  to indicate a measured angle of an implant orientation of spinal implant  150  relative to the initial orientation. In some embodiments, gauge  122  is rotated relative to marker  144  such that marker  144  is aligned with indicia  146  to represent and display an angular measurement of the angular difference of spinal implant  150  during insertion. In some embodiments, section  132  and/or section  134  include indicia  146  having information representing and displaying an angular measurement, as described herein. Pin  130  connects gauge  122  and marker  144  to shaft  24 . 
     In some embodiments, indicia  146  includes graduated markings disposed along a surface of section  132  and/or section  134 . In some embodiments, the markings display, represent and/or provide information relating to an angular range for measuring, selecting, adjusting and/or displaying an angle measured by gauge  122 , as described herein. In some embodiments, the markings may include bi-laterally disposed grooves equidistantly spaced apart and corresponding to measured angular increments of indicia  146 . 
     In some embodiments, indicia  146  includes markings that may be disposed in increments of 10 angular degrees. In some embodiments, indicia  146  may include an analog, such as, for example, a dial with a numerical indicator of angle and/or digital display, such as, for example, LED and/or LCD. In some embodiments, indicia  146  include human readable visual indicia, such as, for example, a label, color coding, alphanumeric characters or an icon. In some embodiments, indicia  146  include human readable tactile indicia, such as, for example, raised portions, lowered portions or Braille. In some embodiments, indicia  146  is a printed or written item in combination with a slot or groove, whereby the printed or written item is placed in the slot or groove to display information. In some embodiments, indicia  146  may be applied as an adhesive. 
     In some embodiments, gauge  122  and/or marker  144  and/or indicia  146  include radiolucent materials such as polymers. Radiomarkers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. In some embodiments, navigation component  180  is configured to generate a signal representative of an angular position of end  106 , end  18  and/or spinal implant  150 . In some embodiments, navigation component  180  is configured to generate the signal as spinal implant  150  rotates. Navigation component  180  includes a fiducial  182 . Fiducial  182  appears in an image produced by surgical navigation system  200  for use as a point of reference or a measure. Fiducial  182  generates signals representing positioning of gauge  122  and an angular position of spinal implant  150 . In some embodiments, fiducial  182  generates signals representing a position of spinal implant  150  being rotated to a selected orientation with tissue. In some embodiments, fiducial  182  generates signals representing a selected plane of a body, such as, for example, a transverse plane. In some embodiments, fiducial  182  includes at least one light emitting diode. In some embodiments, fiducial  182  may include other tracking devices capable of being tracked by sensor array  202 , such as, for example, a tracking device that actively generates acoustic signals, magnetic signals, electromagnetic signals, radiologic signals. In some embodiments, fiducial  182  may be removably attached to rod  102 . In some embodiments, fiducial  182  may include a single ball-shaped marker. In some embodiments, fiducial  182  may include one or a plurality of markers. 
     Navigation component  180  is disposed with gauge  122  and is rotatable to provide indicia and/or display the angular orientation and/or a trajectory of spinal implant  150  relative to inserter  12 , a portion of a patient&#39;s anatomy and/or a depth of end  18  and/or spinal implant  150  within the patient&#39;s anatomy. Rod  102  is oriented with shaft  24  and engageable with a surface of spinal implant  150  between a proximal position and a distal position relative to body  14  such that fiducial  182  provides the angular indicia and/or display of spinal implant  150 . 
     End  106  is configured for disposal adjacent a surface of spinal implant  150  such that rotation of spinal implant  150  causes rod  102  to translate within channel  96 , as shown in  FIGS. 8 and 9 . Translation of rod  102  causes fiducial  182  to rotate to indicate position, movement and/or rotation of spinal implant  150 . 
     In some embodiments, the proximal position of rod  102  corresponds to spinal implant  150  being connected with end  18  and disposed in an insertion or delivery orientation, as shown in  FIG. 8 . In some embodiments, in the insertion or delivery orientation, spinal implant  150  is disposed in axial alignment with shaft  24 . In some embodiments, the distal position of rod  102  corresponds to spinal implant  150  being connected with end  18  and disposed in an implant orientation, as shown in  FIG. 9 . In some embodiments, the two-dimensional spatial position and/or trajectory includes a plane of the patient&#39;s anatomy, such as, for example, a transverse plane. 
     Spinal implant  150  includes a vertebral engaging surface  152  and a vertebral engaging surface  154 . In some embodiments, the cross-sectional geometry of spinal implant  150  may have various configurations, such as, for example, round, oval, oblong, triangular, polygonal having planar or arcuate side portions, irregular, uniform, non-uniform, consistent, variable, horseshoe shape, U-shape or kidney bean shape. In some embodiments, surfaces  152 ,  154  may be smooth, even, rough, textured, porous, semi-porous, dimpled and/or polished. 
     In some embodiments, spinal implant  150  includes a cavity configured for disposal of a pin  156  to facilitate rotating and/or pivoting of spinal implant  150  relative to end  18 . Pin  156  includes a surface configured for engagement with end  64  of shaft  34 . In some embodiments, pin  156  includes a threaded inner surface that mates with threads  66  to facilitate connection of spinal implant  150  with inserter  12  for positioning of spinal implant  150  with tissue. 
     In some embodiments, spinal implant  150  is rotatable relative to pin  156  through a selected angular range. In some embodiments, spinal implant  150  is selectively rotatable relative to pin  156 . In some embodiments, spinal implant  150  is passively rotatable relative to pin  156  such that manipulation of inserter  12  connected with spinal implant  150  during insertion of spinal implant  150  with a vertebral space causes spinal implant  150  to rotate relative to pin  156  due to engagement with end  18  and resistance of tissue. 
     Inserter  12  is configured for disposal adjacent a surgical site such that navigation component  70  and/or navigation component  180  are oriented relative to sensor array  202  to facilitate communication between navigation component  70  and/or navigation component  180 , and sensor array  202  during a surgical procedure, as described herein. In some embodiments, sensor array  202  receives signals from navigation component  70  to provide a three-dimensional spatial position and/or a trajectory of inserter  12  and/or spinal implant  150  relative to a portion of a patient&#39;s anatomy and/or a depth of inserter  12  and/or spinal implant  150  within the patient&#39;s anatomy for display on a monitor. In some embodiments, sensor array  202  receives signals from navigation component  180  disposed with gauge  122  to provide an angular position of end  106 , end  18  and/or spinal implant  150 . See, for example, similar surgical navigation components and their use as described in U.S. Pat. Nos. 6,021,343, 6,725,080, 6,796,988, the entire contents of each of these references being incorporated by reference herein. 
     Surgical navigation system  200  is configured for acquiring and displaying medical imaging, such as, for example, x-ray images appropriate for a given surgical procedure, as shown in  FIG. 7 . In some embodiments, pre-acquired images of a patient are collected. In some embodiments, surgical navigation system  200  can include an O-arm® imaging device  204  sold by Medtronic Navigation, Inc. having a place of business in Louisville, Colo., USA. Imaging device  204  may have a generally annular gantry housing that encloses an image capturing portion  208 . 
     In some embodiments, image capturing portion  208  may include an x-ray source or emission portion and an x-ray receiving or image receiving portion located generally or as practically possible 180 degrees from each other and mounted on a rotor (not shown) relative to a track of image capturing portion  208 . Image capturing portion  208  can be operable to rotate 360 degrees during image acquisition. Image capturing portion  208  may rotate around a central point or axis, allowing image data of the patient to be acquired from multiple directions or in multiple planes. Surgical navigation system  200  can include those disclosed in U.S. Pat. Nos. 8,842,893, 7,188,998; 7,108,421; 7,106,825; 7,001,045; and 6,940,941; the entire contents of each of these references being incorporated by reference herein. 
     In some embodiments, surgical navigation system  200  can include C-arm fluoroscopic imaging systems, which can generate three-dimensional views of a patient. The position of image capturing portion  208  can be precisely known relative to any other portion of imaging device  204 . In some embodiments, a precise knowledge of the position of image capturing portion  208  can be used in conjunction with a tracking system  210  to determine the position of image capturing portion  208  and the image data relative to the patient. 
     Tracking system  210  can include various portions that are associated or included with surgical navigation system  200 . In some embodiments, tracking system  210  can also include a plurality of types of tracking systems, such as, for example, an optical tracking system that includes an optical localizer, such as, for example, sensor array  202  and/or an EM tracking system that can include an EM localizer. Various tracking devices can be tracked with tracking system  210  and the information can be used by surgical navigation system  200  to allow for a display of a position of an item, such as, for example, a patient tracking device  214 , an imaging device tracking device  216 , and an instrument tracking device, such as, for example, navigation components  70 ,  180 , to allow selected portions to be tracked relative to one another with the appropriate tracking system. 
     In some embodiments, the EM tracking system can include the STEALTHSTATION® AXIEM™ Navigation System, sold by Medtronic Navigation, Inc. having a place of business in Louisville, Colo. Exemplary tracking systems are also disclosed in U.S. Pat. Nos. 8,057,407, 5,913,820, 5,592,939, the entire contents of each of these references being incorporated by reference herein. 
     Fluoroscopic images taken are transmitted to computer  218  where they may be forwarded to surgical navigation computer  220 . Image transfer may be performed over a standard video connection or a digital link including wired and wireless. Computer  220  provides the ability to display, via monitor  222 , as well as save, digitally manipulate, or print a hard copy of the received images. In some embodiments, images may also be displayed to the surgeon through a heads-up display. 
     In some embodiments, surgical navigation system  200  provides for real-time tracking of inserter  12  and spinal implant  150 . Sensor array  202  is located in such a manner to provide a clear line of sight with navigation components  70 ,  180 , as described herein. In some embodiments, navigation components  70 ,  180  communicate with sensor array  202  via infrared technology. Sensor array  202  is coupled to computer  220 , which may be programmed with software modules that analyze signals transmitted by sensor array  202  to determine the position of each object in a detector space. A processor sends the information to monitor  222 , which provides a visual representation of the position of inserter  12  and spinal implant  150  relative to the patient&#39;s anatomy to allow the medical practitioner to move inserter  12  and spinal implant  150  to a desired location within the patient&#39;s anatomy. 
     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 spinal disorder affecting a section of a spine of a patient, as discussed herein. For example, the components of surgical system  10  can be used with a surgical procedure for treatment of a condition or injury of an affected section of the spine including vertebrae V, as shown in  FIGS. 8 and 9 . In some embodiments, one or all of the components of surgical system  10  can be delivered or implanted as a pre-assembled device or can be assembled in situ. Surgical system  10  may be completely or partially revised, removed or replaced. 
     The components of surgical system  10  can be employed with a surgical treatment of an applicable condition or injury of an affected section of a spinal column and adjacent areas within a body, such as, for example, vertebrae V. In some embodiments, the components of surgical system  10  may be employed with one or a plurality of vertebra, such as, for example, vertebra V 1  and vertebra V 2 . To treat a selected 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, the components of surgical system  10  can be used in any existing surgical method or technique including open surgery, mini-open surgery, minimally invasive surgery and percutaneous surgical implantation, whereby vertebrae V are accessed through a mini-incision, or sleeve that provides a protected passageway to the area. Once access to the surgical site is obtained, the particular surgical procedure can be performed for treating the spine disorder. 
     An incision is made in the body of a patient and a cutting instrument (not shown) creates a surgical pathway for delivery of components of surgical system  10  including inserter  12 , as described herein, adjacent an area within the patient&#39;s body, such as, for example, vertebra V 1  and vertebra V 2 . In some embodiments, a preparation instrument (not shown) is employed to remove disc tissue, fluids, adjacent tissues and/or bone, and scrape and/or remove tissue from endplate surfaces of vertebra V 1  and/or endplate surface of vertebra V 2 . In some embodiments, the size of spinal implant  150  is selected after trialing. In some embodiments, spinal implant  150  is visualized by fluoroscopy and oriented before introduction into the vertebral space. 
     Inserter  12  is connected with spinal implant  150 , as described herein, for disposal in an insertion or delivery orientation, as described herein. Grip  40  is initially disposed in the non-locking orientation and manipulated for rotation about pin  46  to the locking orientation, as shown in  FIG. 8  and described herein. Collar  50  is disposed in the locked orientation, as described herein. Knob  60  is rotated causing shaft  34  to engage pin  156  to connect spinal implant  150  with inserter  12 , as described herein, and draw ends  18 ,  106  into engagement with spinal implant  150 . 
     Spinal implant  150  is disposed in a selected and fixed position relative to end  18  such that spinal implant  150  is axially aligned with shaft  24 . Inserter  12  is manipulated to deliver spinal implant  150  to the vertebral space between vertebrae V 1 , V 2 . Sensor array  202  receives signals from navigation component  70  to provide a three-dimensional spatial position and/or a trajectory of inserter  12  and/or spinal implant  150  relative to the vertebral space between vertebrae V 1 , V 2  and/or a depth of inserter  12  and/or spinal implant  150  within the vertebral space for display on monitor  222 . 
     Inserter  12  selectively disposes spinal implant  150  with the vertebral space between vertebrae V 1 , V 2 , as shown in  FIG. 8 . With end  18  connected with spinal implant  150  in the insertion or delivery orientation, end  106  engages a surface of spinal implant  150  to provide the indicia and/or display of end  18  and/or spinal implant  150  in connection with fiducial  182 , as described herein. Collar  50  is rotated to the non-locked orientation, as described herein. Grip  40  is released for rotation about pin  46  to the non-locking orientation, as shown in  FIG. 9  and described herein. The pressure fit between ends  18 ,  106  is released and spinal implant  150  is movable and/or rotatable relative to end  18 ,  106 . 
     Manipulation of inserter  12  causes spinal implant  150  to move and/or rotate about pin  156 , as described herein, into position with the vertebral space between vertebrae V 1 , V 2 . As spinal implant  150  is manipulated, moved, translated and/or rotated in the implant orientation for positioning spinal implant  150  with the vertebral space between vertebrae V 1 , V 2 , spinal implant  150  is engaged with rod  102  such that rod  102  translates in a proximal direction. Such translation causes gauge  122  to rotate about pin  130  to align marker  144  with indicia  146  to indicate a measured angle of the implant orientation for positioning spinal implant  150  with the vertebral space between vertebrae V 1 , V 2  relative to the insertion or delivery orientation, as described herein. 
     In some embodiments, indicia  146  is visibly read by a practitioner viewing gauge  122 . In some embodiments, sensor array  202  receives signals from navigation component  180  to provide an angular position of end  106 , end  18  and/or spinal implant  150 , for example, within a transverse plane of vertebrae V. In some embodiments, locking and unlocking of grip  40  allows for selective movement and/or rotation of spinal implant  150  in the implant orientation. 
     Inserter  12  is disengaged from spinal implant  150 . In some embodiments, spinal implant  150  provides height restoration between vertebral bodies, decompression, restoration of sagittal and/or coronal balance and/or resistance of subsidence into vertebral endplates. In some embodiments, surgical system  10  includes a plurality of spinal implants  150 . In some embodiments, employing a plurality of spinal implants  150  can optimize the amount of vertebral space that can be spaced apart such that the joint spacing dimension can be preselected. The plurality of spinal implants  150  can be oriented in a side by side engagement, spaced apart and/or staggered. 
     In some embodiments, surgical system  10  may comprise various instruments including the configuration of the present disclosure, 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 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 with vertebrae V. 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 agent may include one or a plurality of therapeutic agents and/or pharmacological agents for release, including sustained release, to treat, for example, pain, inflammation and degeneration. Upon completion of the procedure, the surgical instruments, assemblies and non-implant components of surgical system  10  are removed from the surgical site and the incision is closed. 
     In one embodiment, as shown in  FIGS. 10-13 , surgical system  10 , similar to the systems and methods described above with regard to  FIGS. 1-9 , includes an inserter  312 . Inserter  312  includes a body  314  that defines a longitudinal axis A 2 , similar to body  14  described herein. Body  314  extends between an end  316  and an end  318 . Body  314  includes an outer sleeve  320 . Outer sleeve  320  includes a handle  322 , similar to handle  22  described herein. Outer surface  320  includes a shaft  324 , similar to shaft  24  described herein. In some embodiments, handle  322  may be assembled with shaft  324 , as described herein. 
     Handle  322  includes a cavity  332  configured for disposal of a shaft  334 , similar to shaft  34  described herein. Shaft  334  is configured to connect spinal implant  150 , described herein, with inserter  312 . Handle  322  is configured to facilitate manipulating, moving, translating and/or rotating spinal implant  150 , as described herein. Handle  322  includes an actuator that includes a pivoting grip  340 , similar to grip  40  described herein. The actuator includes a knob  360 , similar to knob  60  described herein. Grip  340  includes a flange  348  configured to facilitate locking and unlocking of grip  340  relative to handle  322 , similar to flange  48  described herein. 
     Grip  340  is configured to rotate and/or pivot relative to axis A 2  between a locking orientation, as shown in  FIG. 11 , and a non-locking orientation, as shown in  FIG. 13 , of grip  340  with shaft  334 . Locking of grip  340  resists and/or prevents translation of shaft  334 , for example, such that spinal implant  150  is disposed in a selected and fixed position relative to end  318 , similar to that described herein. Rotating grip  340  into a non-locking orientation allows for movement and/or translation of shaft  334  relative to body  314  to facilitate movement and/or rotation of spinal implant  150  relative to end  318 , as described herein. Handle  322  includes a collar  350 , similar to collar  50  described herein. Collar  350  includes a cutout  352 , similar to cutout  52  described herein. Cutout  352  is configured to facilitate movement of grip  340  to a non-locking orientation, as described herein. Collar  350  is configured to engage grip  340  for disposal in a locking orientation and a non-locking orientation relative to handle  322 . In some embodiments, grip  340 , similar to grip  40  described herein, is selectively disposed in the locking and non-locking orientation to selectively fix and manipulate, move, translate, rotate and/or adjust position of spinal implant  150  relative to end  318 . 
     Knob  360  is rotatable, in a clockwise direction and a counter-clockwise direction, to facilitate movement and/or translation of shaft  334  for moving and/or rotating spinal implant  150  to a selected orientation, as described herein. Actuation of knob  360  causes shaft  334  to draw spinal implant  150  into engagement with end  318  to fix spinal implant  150  with end  318  for delivery to a surgical site, as described herein. 
     Shaft  324  extends distally from handle  322  and includes end  318 . Shaft  324  includes an axial channel  396 . Channel  396  is configured for disposal of a rod  402 , similar to rod  102  described herein. Rod  402  extends within channel  396  and includes an end  404  and an end  406  disposed adjacent end  318  and spinal implant  150  when attached with inserter  312 . Rod  402  translates relative to shaft  324  and spinal implant  150  moves and/or rotates for positioning with tissue, such as, for example, an intervertebral space, as described herein. Rod  402  is oriented with shaft  324  and engageable with a surface of spinal implant  150  between a proximal position and a distal position relative to body  314 . 
     In some embodiments, rod  402  includes a biasing member, similar to coil spring  114 , as described herein, that applies a biasing force to rod  402  to urge rod  402  into the insertion or delivery orientation, as described herein. End  404  includes an image guide  420  having an angle gauge  422 , similar to gauge  122  described herein. Gauge  422  represents and displays an angular measurement of the change in angle between selected relative orientations of spinal implant  150 . Gauge  422  rotates relative to shaft  24 , as described herein. Gauge  422  includes tracks  438 ,  442  configured for moveable disposal of a marker  444 , as described herein. Gauge  422  measures a change in angular orientation of spinal implant  150  between an orientation, for example, a delivery orientation and an orientation, for example, an implant orientation, as described herein. 
     With end  318  connected with spinal implant  150  in the insertion or delivery orientation, and handle  322  and shaft  334  disposed in the locking orientation, as described herein, spinal implant  150  is fixed with inserter  312 . End  318  is fixed with spinal implant  150  and end  406  engages a surface of spinal implant  150 . As spinal implant  150  is manipulated, moved, translated and/or rotated in the implant orientation for positioning spinal implant  150  with tissue, spinal implant  150  is engaged with rod  402  such that rod  402  translates in a proximal direction to overcome the biasing force of the biasing member. In some embodiments, rod  402  may translate in a proximal direction and a distal direction in the implant orientation for positioning spinal implant  150  with tissue. In some embodiments, rod  402  may be manually manipulable without a biasing member. 
     In use, similar to the methods and surgical procedures employing surgical system  10  and inserter  12 , inserter  312  selectively disposes spinal implant  150  with the vertebral space between vertebrae V 1 , V 2 , as shown in  FIG. 12 . With end  318  connected with spinal implant  150  in the insertion or delivery orientation, end  406  engages a surface of spinal implant  150 . Collar  350  is rotated to the non-locked orientation, as described herein. Grip  340  is released for rotation to the non-locking orientation, as shown in  FIG. 13  and described herein. A pressure fit between ends  318 ,  406  is released and spinal implant  150  is movable and/or rotatable relative to end  318 ,  406 . 
     Manipulation of inserter  312  causes spinal implant  150  to move and/or rotate, as described herein, into position with the vertebral space between vertebrae V 1 , V 2 . As spinal implant  150  is manipulated, moved, translated and/or rotated in the implant orientation for positioning spinal implant  150  with the vertebral space between vertebrae V 1 , V 2 , spinal implant  150  is engaged with rod  402  such that rod  402  translates in a proximal direction. Gauge  422  provides visual indicia of a measured angle of the implant orientation for positioning spinal implant  150  with the vertebral space between vertebrae V 1 , V 2  relative to the insertion or delivery orientation, similar to that described herein. In some embodiments, locking and unlocking of grip  340  allows for selective movement and/or rotation of spinal implant  150  in the implant orientation. Inserter  312  is disengaged from spinal implant  150 . 
     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.