Patent Publication Number: US-2023149056-A1

Title: Surgical instrument and method

Description:
TECHNICAL FIELD 
     The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical system and method for treating a spine. 
     BACKGROUND 
     Spinal pathologies and disorders such as scoliosis and other curvature abnormalities, kyphosis, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, tumor and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including deformity, pain, nerve damage, and partial or complete loss of mobility. 
     Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes correction, fusion, fixation, discectomy, laminectomy and implantable prosthetics. As part of these surgical treatments, spinal implants such as vertebral rods and/or fasteners are often used to provide stability to a treated region. Rods redirect stresses away from a damaged or defective region while healing takes place to restore proper alignment and generally support vertebral members. During surgical treatment, spinal implants can be delivered to a surgical site, for example, so that the rods may be attached via the fasteners to the exterior of two or more vertebral members. Surgical treatment may employ surgical instruments and implants that are manipulated for engagement with vertebrae to position and align one or more vertebrae. This disclosure describes an improvement over these prior technologies. 
     SUMMARY 
     In one embodiment, a surgical instrument is provided. The surgical instrument includes a first member and an actuator disposed with the first member. An assembly includes a second member engageable with a bone fastener receiver and a third member that is rotatable relative to the second member and threadably engageable with the bone fastener receiver to capture the bone fastener receiver. In some embodiments, systems, spinal constructs, implants and methods are disclosed. 
     In some embodiments, the surgical instrument includes a driver and an actuator disposed with the driver. An assembly includes an outer sleeve engageable with a bone fastener receiver and an inner sleeve being rotatable with the actuator. The inner sleeve is rotatable relative to the outer sleeve and threadably engageable with the bone fastener receiver to capture the bone fastener receiver. 
     In some embodiments, the surgical instrument includes a driver including a shaft and a flange. The driver includes an actuator disposed adjacent to the flange and is rotatable relative to the shaft. An assembly includes an outer sleeve engageable with a bone fastener receiver and an inner sleeve having a collar being releasably connectable with the actuator such that the inner sleeve is rotatably fixed with the actuator. The inner sleeve is rotatable relative to the outer sleeve and threadably engageable with the bone fastener receiver to capture the bone fastener receiver. 
    
    
     
       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 the surgical system shown in  FIG.  1   ; 
         FIG.  3    is a perspective view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  4    is a perspective view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  5    is a perspective view of components of the surgical system shown in  FIG.  1    with parts separated; 
         FIG.  6    is a break away cross section view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  7    is a break away cross section view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  8    is a break away cross section view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  9    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  10    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  11    is a break away view of components of the surgical system shown in  FIG.  1   ; and 
         FIG.  12    is a cross section view of components of the surgical system shown in  FIG.  1   . 
     
    
    
     DETAILED DESCRIPTION 
     The exemplary embodiments of the surgical 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 spinal implant system and a method for treating a spine. In some embodiments, the systems and methods of the present disclosure comprise medical devices including surgical instruments and implants that are employed with a surgical treatment, as described herein, for example, with a cervical, thoracic, lumbar and/or sacral region of a spine. 
     In some embodiments, the present surgical system includes a surgical instrument, for example, a driver configured for use with surgical navigation. In some embodiments, the driver includes an assembly including an inner sleeve and an outer sleeve that is configured for releasable connection with an actuator for engagement and capture of a receiver of a bone fastener. In some embodiments, the receiver is connected with a shank of the bone fastener. In some embodiments, the assembly is configured to releasably connect and disconnect from the driver such that the driver can capture alternatively configured bone fasteners via alternatively configured assemblies and/or sleeves. In some embodiments, the driver includes a shank sleeve. In some embodiments, the driver is configured to releasably connect and disconnect with the shank sleeve such that the shank sleeve can be replaced with the assembly. In some embodiments, the assembly can be assembled during manufacture, prior to surgery and/or during surgery. 
     In some embodiments, the bone fastener includes a bone screw. In some embodiments, the bone screw includes a receiver attached to a shank of the bone screw. In some embodiments, the receiver is pre-assembled with the shank prior to a surgical procedure. In some embodiments, the receiver can be assembled with the shank before, during or after the surgical procedure. In some embodiments, the bone screw is delivered through an arm guide of a robot. In some embodiments, the arm guide includes a diameter of 13.48 or 15.6 mm. 
     In some embodiments, the present surgical system includes a driver configured for engagement with an assembly including an inner sleeve and an outer sleeve. In some embodiments, the outer sleeve is configured for attachment to a receiver of a bone screw. In some embodiments, the outer sleeve is configured for disposal with a portion of the driver and engagement with a knob. In some embodiments, the inner sleeve is configured for threaded engagement with the receiver. In some embodiments, the inner sleeve is configured for engagement with the knob. 
     In some embodiments, the present surgical system includes an assembly including an inner sleeve and an outer sleeve. In some embodiments, the outer sleeve is configured for connection and engagement with the inner sleeve. In some embodiments, the outer sleeve is configured to translate relative to the inner sleeve. In some embodiments, the inner sleeve is configured to rotate about a key on a driver shaft. 
     In some embodiments, the present surgical system includes a driver that is configured for fixation with a head of a bone screw. In some embodiments, the driver includes an actuator including a knob that is translationally fixed to a shaft of the driver and is configured to rotate about a portion of the fixed shaft. In some embodiments, the actuator includes a collar that is engageable with an assembly. In some embodiments, the collar is configured to rotate and translate relative to the knob. In some embodiments, the assembly includes an inner sleeve and an outer sleeve. In some embodiments, the outer sleeve is configured for axial translation relative to the driver and the inner sleeve is configured for rotational engagement relative to the driver. 
     In some embodiments, the present surgical system described above includes a method of loading a bone screw with a surgical driver, the method including the steps of engaging a receiver of the bone screw with a distal end of the driver. In some embodiments, the method includes the step of positioning and engaging a head of the bone screw with an end of the driver. In some embodiments, the end of the driver includes a tip configuration. In some embodiments, the end of the driver includes a star shaped tip configuration (see, for example, a similar star shaped tip configuration of Torx® (Acument Global Technologies, Inc., Sterling Heights, Mich., USA)). In some embodiments, the method includes the step of translating an outer sleeve of the driver in a direction, for example, a distal direction, and surfaces, for example, flats of the outer sleeve engage surfaces, for example, flats of the receiver. In some embodiments, the method includes the step of manually retaining/holding the outer sleeve and the receiver while a knob of the driver is rotated such that an inner sleeve disposed with the outer sleeve is rotated to threadingly engage with inner threaded surface of the receiver. In some embodiments, the method includes the step of finally tightening the bone screw with the driver. In some embodiments, tightening of the bone screw with the driver includes retaining/holding the outer sleeve while rotating the knob. 
     In some embodiments, the present surgical system includes a surgical instrument that can be employed with an end effector of a robotic arm to facilitate implantation with the robotic arm. In some embodiments, the surgical instrument is guided through the end effector for a guide-wireless screw insertion. In some embodiments, the surgical instrument comprises a robotic guided screw driver employed with robotic and/or navigation guidance, which may include an image guide. 
     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 disclosed 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, direct 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. In some embodiments, 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 also 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 - 12   , there are illustrated components of a spinal implant system  10 , in accordance with the principles of the present disclosure. 
     The components of spinal implant system  10  can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics and bone material and/or their composites. For example, the components of spinal implant system  10 , individually or collectively, can be fabricated from materials such as stainless steel alloys, 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, 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 spinal implant system  10  may have material composites, including the above materials, to achieve various desired characteristics such as strength, rigidity, elasticity, compliance, biomechanical performance, durability and radiolucency or imaging preference. The components of spinal implant system  10 , individually or collectively, may also be fabricated from a heterogeneous material such as a combination of two or more of the above-described materials. The components of spinal implant system  10  may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein. 
     Spinal implant system  10  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, a bone fastener, at a surgical site of a patient, which includes, for example, a spine. In some embodiments, the spinal implant can include one or more components of one or more spinal constructs, such as, for example, interbody devices, interbody cages, bone fasteners, spinal rods, tethers, connectors, plates and/or bone graft, and can be employed with various surgical procedures including surgical treatment of a cervical, thoracic, lumbar and/or sacral region of a spine. 
     Spinal implant system  10  includes a surgical instrument  12 . Surgical instrument  12  is configured for connection with an implant, for example, a bone fastener  200 , as shown in  FIG.  1   . Surgical instrument  12  includes a member, for example, a driver  14 . Driver  14  is configured for engagement with a member, for example, an inner sleeve  20  of an assembly  16 , as described herein. Driver  14  extends between an end  22  and an end  24  and defines a longitudinal axis X disposed therebetween, as shown  FIG.  5   . End  22  is configured for engagement with a component, for example, a navigation component (not shown), as described herein. End  24  includes a drive  26 , as shown in  FIG.  5   , which is connectable with a head  202  including a drive socket  204  of bone fastener  200 , as shown in  FIGS.  9  and  12   . Drive  26  includes a shaped tip configuration. In some embodiments, drive  26  may have different cross-section configurations, including square, hexagonal, polygonal, triangular, star or hexalobe. In some embodiments, end  24  may have alternate surface configurations, including, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Driver  14  includes a bushing  28 , as shown in  FIG.  6   . Bushing  28  is configured for connection with the navigation component. In some embodiments, bushing  28  can be alternatively connected with the navigation component, for example, monolithic, integral connection, frictional engagement, threaded engagement, mutual grooves, screws, adhesive, nails, barbs and/or raised element. 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. 
     Bushing  28  is connected to a surface of driver  14 . In some embodiments, bushing  28  is press fit welded to a surface of driver  14 . Bushing  28  includes a flange  30  configured for engagement with a component of an actuator  32 , for example, a knob  34 , as shown in  FIG.  6   , and described herein. Flange  30  is configured to contact a surface of knob  34  and is configured to engage knob  34  to translationally fix knob  34  with driver  14 . In some embodiments, flange  30  is configured to prevent loosening of knob  34  during use. 
     Assembly  16  includes inner sleeve  20  and a member, for example, an outer sleeve  18 , as shown in  FIGS.  2 - 4   . Assembly  16  is configured for connection with actuator  32  for engagement and capture of bone fastener  200 . In some embodiments, assembly  16  is configured for releasable connection with alternately configured drivers. Outer sleeve  18  is configured for axial translation within knob  34  and engagement with a receiver  206  of bone fastener  200 . Outer sleeve  18  is tubular, extending between an end  36  and an end  38 . In some embodiments, outer sleeve  18  may have alternate cross section configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. In some embodiments, outer sleeve  18  may have alternate surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Outer sleeve  18  includes an inner surface that defines a passageway  40  that is coaxial with longitudinal axis X and is configured for disposal of inner sleeve  20 , as described herein. In some embodiments, passageway  40  may have alternate surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     End  36  includes an inner surface that defines a ledge  42 , as shown in  FIGS.  6  and  8   . Ledge  42  is configured for engagement with a circumferential groove  52  of inner sleeve  20 , as described herein. Ledge  42  translationally fixes inner sleeve  20  relative to outer sleeve  18 , as described herein. In some embodiments, ledge  42  may have alternate surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     End  38  includes mating surfaces, for example, flats  44  that are configured for engagement with mating surfaces, for example, flats  208  of receiver  206 , as shown in  FIGS.  4 ,  10  and  11   . In some embodiments, flats  44 ,  208  may have alternately shaped configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. 
     Outer sleeve  18  includes an outer surface that defines windows  45 , as shown in  FIG.  4   . Windows  45  are configured to facilitate cleaning of surgical instrument  12 . In some embodiments, windows  45  may have alternate cross section configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. 
     Inner sleeve  20  is tubular, extending between an end  46  and an end  48 , as shown in  FIG.  3   . Inner sleeve  20  is configured for disposal with outer sleeve  18  and is threadably engageable with receiver  206  to capture receiver  206 , as described herein. Inner sleeve  20  is rotatable relative to outer sleeve  18 . In some embodiments, inner sleeve  20  may have alternate cross section configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. In some embodiments, inner sleeve  20  may have alternate surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Inner sleeve  20  includes an inner surface that defines a passageway  50 , as shown in  FIGS.  3  and  6   . Passageway  50  is coaxial with longitudinal axis X and is configured for disposal of driver  14 , as described herein. Inner sleeve  20  is configured for rotation about driver  14 . Inner sleeve  20  rotates about driver  14  and a counterbore  53  of inner sleeve  20  prevents engagement of inner sleeve  20  with a key  51  of driver  14  such that key  51  is rotationally and axially cleared, as shown in  FIGS.  6  and  7   . In some embodiments, passageway  50  may have alternate surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     End  46  includes circumferential groove  52  and buttons  54  configured for rotational engagement with ledge  42 , as shown in  FIGS.  7  and  8   . Buttons  54  are configured for engagement with openings  56  at end  36  of outer sleeve  18 . In some embodiments, circumferential groove  52  may have alternative surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. End  46  is configured for connection with a component of actuator  32 , for example, an adjustment collar  58 , as described herein. End  46  is monolithic and rotationally fixed with adjustment collar  58 . In some embodiments, end  46  is not monolithic with adjustment collar  58 . 
     End  48  includes a threaded portion  60 , as shown in  FIGS.  3 ,  9  and  10   . Threaded portion  60  is configured for engagement with a threaded inner surface  210  of receiver  206  to capture bone fastener  200 , as shown in  FIGS.  9  and  10   . Inner sleeve  20  is rotated relative to outer sleeve  18  to capture bone fastener  200 , as described herein. In some embodiments, threaded portion  60  may have alternative surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. In some embodiments, selected portions or all of threaded portion  60  may have alternate cross-section configurations, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable, tubular and/or tapered. 
     Actuator  32  includes knob  34  and adjustment collar  58 . See, for example, the embodiments and disclosure of systems and methods of components of an actuator, shown and described in commonly owned and assigned U.S. patent application Ser. No. ______/______,______ filed ______, 2021 (docket no. A0006559US01), and published as U.S. Patent Application Publication No. ______, on ______ ______, ______, the entire contents of which being incorporated herein by reference. 
     Knob  34  extends between an end  62  and an end  64 , as shown in  FIG.  6   . A retaining ring  66  is configured for disposal at end  62 . Retaining ring  66  is configured for engagement with a portion of driver  14  and an inner surface of bushing  28 , as shown in  FIG.  6   , such that knob  34  is translationally fixed with retaining ring  66  and flange  30  but is configured to rotate relative to driver  14 . Knob  34  is releasably connectable with assembly  16  via adjustment collar  58 , and outer sleeve  18  is translatable relative to knob  34  via adjustment collar  58 , as described herein. Knob  34  defines a cavity  68 . An interior wall  70  of knob  34  is configured for slidable engagement with an outer surface of adjustment collar  58 , as shown in  FIG.  6   . In some embodiments, cavity  68  may have alternate cross section configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. 
     Knob  34  defines an exterior gripping surface  72  that includes at least one indent  74 , as shown in  FIG.  5   . In some embodiments, gripping surface  72  may have alternative surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Knob  34  includes a wall  76  that defines a pair of opposing windows  78 , as shown in  FIG.  5   . Windows  78  are configured to display indicia, for example, pins  86 ,  88  of adjustment collar  58  to indicate translation/positioning of outer sleeve  18  relative to knob  34 , as described herein. Wall  76  includes inner surfaces  80 , as shown in  FIG.  5   . Inner surfaces  80  are tapered. In some embodiments, inner surfaces  80  are tapered to increase visibility of pins  86 ,  88 . In some embodiments, windows  78  may have alternate cross section configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. 
     Adjustment collar  58  is configured to releasably connect assembly  16  with knob  34 , translate outer sleeve  18  with knob  34  and rotate inner sleeve  20  relative to outer sleeve  18 , as described herein. Adjustment collar  58  includes a surface that defines a recess  82  and a recess  84 , as shown in  FIGS.  2  and  3   . Recess  82  is disposed opposite of recess  84 . Pin  86  is configured for fixed engagement with recess  82  and pin  88  is configured for fixed engagement with recess  84 . Pin  86  is configured for slidable engagement with an interior slot  90  of wall  70  of knob  34  and pin  88  is configured for slidable engagement with an interior slot  92  of wall  70  of knob  34  for translation of adjustment collar  58  within knob  34 , as shown in  FIG.  5   . Pins  86 ,  88  are translated within slots  90 ,  92  respectively and during selected translation of outer sleeve  18 , pins  86 ,  88  are viewable via windows  78  of knob  34 , as shown in  FIG.  5   . In some embodiments, pins  86 ,  88  are laser welded to recesses  82 ,  84 . In some embodiments, all or a portion of pins  86 ,  88  are laser marked a selected color, for example, black. In some embodiments, pins  86 ,  88  are manufactured in one or more selected colors, for example, pink, red, orange, yellow, green, blue, purple, brown, white and/or black. In some embodiments, pins  86 ,  88  are anodized and/or PVD coated. 
     Adjustment collar  58  includes a surface that defines a recess  94  and a recess  96 , as shown in  FIGS.  2  and  6   . Recess  94  is disposed opposite of recess  96 . A button  98  is configured for disposal with recess  94  and a button  100  is configured for disposal with recess  96 , as shown in  FIG.  6   . Buttons  98 ,  100  are configured to facilitate disengagement of assembly  16  with knob  34 . Button  98  is biased, for example, via a pair of springs  102  and button  100  is biased, for example, via a pair of springs  104 , as shown in  FIG.  6   . In some embodiments, springs  102  and  104  include a force of 1 to 4 lbs when contracted. Button  98  is configured for slidable engagement with an interior slot  106  of wall  70  of knob  34  and button  100  is configured for slidable engagement with an interior slot  108  of wall  70  of knob  34 , as shown in  FIG.  5   . Buttons  98 ,  100  are translated within slots  106 ,  108  respectively to dispose buttons  98 ,  100  with transverse openings  110 ,  112  respectively of knob  34 , as shown in  FIG.  5   . Buttons  98 ,  100  are configured for snap engagement with openings  110 ,  112 . Pins  114  are configured to retain buttons  98 ,  100  with adjustment collar  58 , as shown in  FIG.  6   . In some embodiments, buttons  98 ,  100  include plungers. 
     Bone fastener  200  includes head  202  including drive socket  204  configured for engagement with driver  14 , and receiver  206  configured for engagement with end  38  of outer sleeve  18  and end  48  of inner sleeve  20 . Bone fastener  200  includes an elongated shaft  212  configured for penetrating tissue, as shown in  FIGS.  10 - 12   . Bone fastener  200  includes a crown  214  and includes expandable elements  216 ,  218  configured for disposal within an interior of receiver  206 , as shown in  FIG.  12   . In some embodiments, selected portions or all of bone fastener  200  may have alternate cross-section configurations, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable, tubular and/or tapered. In some embodiments, selected portions or all of bone fastener  200  may have alternate surface configurations, for example, smooth and/or surface configurations to enhance engagement with tissue, for example, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Shaft  212  has a cylindrical cross section configuration and includes an outer surface having an external thread form. In some embodiments, the thread form may include a single thread turn or a plurality of discrete threads. In some embodiments, other engaging structures may be disposed on shaft  212 , for example, a nail configuration, barbs, expanding elements, raised elements and/or spikes to facilitate engagement of shaft  212  with tissue, for example, vertebrae. 
     In some embodiments, the outer surface of shaft  212  may include one or a plurality of openings. In some embodiments, all or only a portion of shaft  212  may be disposed at alternate orientations, relative to a longitudinal axis of bone fastener  200 , for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered. In some embodiments, all or only a portion of shaft  212  may be cannulated. 
     In assembly, operation and use, spinal implant system  10 , similar to the systems and methods described herein, is employed with a surgical procedure, for example, a treatment of an applicable condition or injury of an affected section of a spinal column and adjacent areas within a body. In some embodiments, one or all of the components of spinal implant system  10  can be delivered or utilized as a pre-assembled device or can be assembled in situ. Spinal implant system  10  may be completely or partially revised, removed or replaced. 
     In some embodiments, spinal implant system  10  is employed with an end effector (not shown) of a robotic arm (not shown) to facilitate implantation with the robotic arm. In some embodiments, spinal implant system  10  is employed with robotic and/or navigation guidance (including a navigation component (not shown)), which may include an image guide. 
     Surgical instrument  12  is assembled prior to the surgical procedure. In some embodiments, assembly  16  is configured to releasably connect and disconnect from driver  14  such that driver  14  can capture alternatively configured bone fasteners via alternatively configured assemblies and/or sleeves. In some embodiments, driver  14  includes a shank sleeve (not shown) that is configured for connection to a bone fastener (not shown) including a shank. See, for example, the embodiments and disclosure of systems and methods of components of a shank sleeve, shown and described in commonly owned and assigned U.S. patent application Ser. No. ______/______,______ filed ______, 2021 (docket no. A0006559US01), and published as U.S. Patent Application Publication No. ______, on ______ ______, ______, the entire contents of which being incorporated herein by reference. In some embodiments, driver  14  is configured to releasably connect and disconnect with the shank sleeve such that the shank sleeve can be replaced with assembly  16  to capture receiver  206  of bone fastener  200 . In some embodiments, assembly  16  can be assembled during manufacture, prior to surgery and/or during surgery. 
     To releasably connect assembly  16  with knob  34 , adjustment collar  58  attached to inner sleeve  20  and in engagement with outer sleeve  18 , is translated in a direction shown by arrow A in  FIG.  12   . Adjustment collar  58  engages wall  70  of knob  34 , as shown in  FIG.  12   . Pins  86 ,  88  slidably engage slots  90 ,  92  and buttons  98 ,  100  are depressed and engage with slots  106 ,  108 . Buttons  98 ,  100  are disposed with openings  110 ,  112  as springs  102 ,  104  expand to translate buttons  98 ,  100  in an upward direction, as shown by arrows B in  FIG.  6   , in a snap fit engagement of buttons  98 ,  100  with openings  110 ,  112  thereby releasably connecting assembly  16  with knob  34 . 
     To connect surgical instrument  12  with bone fastener  200 , driver  14  via drive  26  engages with drive socket  204  of bone fastener  200 . Driver  14  is held rigid by a user and outer sleeve  18  is manually translated in a direction, for example, a distal direction, as shown by arrow C in  FIG.  12    until threaded portion  60  of inner sleeve  20  contacts threaded inner surface  210  of receiver  206 . Knob  34  is rotated in a direction, as shown by arrow D in  FIG.  12    to rotate inner sleeve  20  via adjustment collar  58  to engage threaded portion  60  with threaded inner surface  210  as flats  44  of outer sleeve  18  matingly engage flats  208  of receiver  206  to capture bone fastener  200 , as shown in  FIGS.  11  and  12   . Driver  14  via drive  26  engages socket  204  to drive and fix bone fastener  200  with tissue, for example, a vertebra V 1  of vertebrae V, shown in  FIG.  1   . 
     To disconnect bone fastener  200  from surgical instrument  12 , knob  34  is rotated in a direction, shown by arrow E in  FIG.  12   . Inner sleeve  20  rotates as outer sleeve  18  is translated in a direction, for example, a proximal direction, as shown by arrow A. As outer sleeve  18  is translated, driver  14  disengages from socket  204  of bone fastener  200  respectively. 
     In some embodiments, spinal implant system  10  includes an agent, which may be disposed, packed, coated or layered within, on or about the components and/or surfaces of spinal implant system  10 . In some embodiments, the agent may include bone growth promoting material, for example, bone graft to enhance fixation of the components and/or surfaces of spinal implant 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. 
     Upon completion of the procedure, the surgical instruments, assemblies and non-implanted components of spinal implant system  10  are removed from the surgical site and the incision is closed. 
     To disassemble/disconnect assembly  16  from knob  34 , buttons  98 ,  100  are simultaneously translated in a downward direction, as shown by arrows F in  FIG.  6   . Buttons  98 ,  100  are translated into slots  106 ,  108  as assembly  16  outer is disconnected from knob  34  and translated in a direction, as shown by arrow C in  FIG.  12   . In some embodiments, an instrument or pusher (not shown) is provided to translate buttons  98 ,  100  in the downward direction to facilitate disconnection of assembly  16  from knob  34 . 
     One or more of the components of spinal implant system  10  can be made of radiolucent materials such as polymers. Radiomarkers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. In some embodiments, surgical instrument  12  is guided to the surgical site via a guidewire, for example, a K-wire (not shown) and/or without the use of an image guide, as described herein. 
     It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplification of the various embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.