Patent Publication Number: US-9883952-B2

Title: Spinal construct and method

Description:
TECHNICAL FIELD 
     The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a spinal construct configured for disposal with spaced vertebrae and a method for treating a spine. 
     BACKGROUND 
     Spinal disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including pain, nerve damage, and partial or complete loss of mobility. 
     Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes fusion, fixation, corpectomy, discectomy, laminectomy and implantable prosthetics. In procedures, such as, for example, corpectomy and discectomy, fusion and fixation treatments may be performed that employ implants to restore the mechanical support function of vertebrae. This disclosure describes an improvement over these prior technologies. 
     SUMMARY 
     In one embodiment, a spinal construct is provided. The spinal construct includes a first endplate that is configured to engage a first vertebral surface. An expandable member is connected with the first endplate and includes a mating element. A second endplate is configured to engage a second vertebral surface and includes an in-situ guide surface engageable with the mating element to connect the member with the second endplate. In some embodiments, systems and implants are disclosed. 
     In one embodiment, a method for treating a spine disorder is provided. The method comprises the steps of; delivering a first endplate with a first holder extending laterally therefrom about vertebral tissue along a substantially posterior approach and adjacent a first vertebral surface; connecting a first stabilizer with the first holder and the first vertebral surface; delivering a second endplate with a second holder extending laterally therefrom about vertebral tissue along a substantially posterior approach and adjacent a second vertebral surface; connecting a second stabilizer with the second holder and the second vertebral surface; delivering a member along a substantially posterior approach for disposal between the endplates; and removing the holders and the stabilizers from adjacent the vertebral surfaces. 
    
    
     
       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 spinal implant system in accordance with the principles of the present disclosure with parts separated; 
         FIG. 2  is a perspective view of components of the system shown in  FIG. 1 ; 
         FIG. 3  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure with parts separated; 
         FIG. 4  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure; 
         FIG. 5  is a break away view of the components shown in  FIG. 4 ; 
         FIG. 6  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure; 
         FIG. 7  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure; 
         FIG. 8  is a break away view of the components shown in  FIG. 7 ; 
         FIG. 9  is a plan view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 10  is a plan view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 11  is a plan view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 12  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 13  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 14  is a plan view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 15  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 16  is a plan view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 17  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 18  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 19  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 20  is a plan view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 21  is a plan view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 22  is a plan view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 23  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG. 24  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure; 
         FIG. 25  is a perspective view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae; and 
         FIG. 26  is a plan view of components of one embodiment of a spinal implant system in accordance with the principles of the present disclosure disposed with vertebrae. 
     
    
    
     DETAILED DESCRIPTION 
     The exemplary embodiments of a 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 that includes a spinal construct configured for disposal with spaced vertebrae and a method for treating a spine. 
     In some embodiments, the spinal implant system is employed with a method for a vertebral body replacement (VBR) and supplemental posterior spinal fixation in only one posterior approach. In some embodiments the spinal implant system includes specialized VBR endplates. In some embodiments, the endplates are pre-placed and/or fixed in position by connection to posterior screws and then combined in-situ with an expansion portion of a VBR device to create an assembled expandable VBR construct from a posterior approach. 
     In some embodiments, the spinal implant system includes an open endplate including channels for receiving ball connectors on ends of the expandable VBR construct. In some embodiments, the spinal implant system includes connections for pre-placement and endplate stabilization. In some embodiments, the spinal implant system includes a posterior fixator connector. In some embodiments, the posterior fixator connector is added to an existing/pre-placed VBR construct after expansion by virtue of a clamp attachment. 
     In some embodiments, the spinal implant system is employed with a method for vertebral body replacement (VBR) via a posterior approach. In some embodiments, the method is employed with a single posterior approach. In some embodiments, the method includes a step of posterior decompression and an anterior reconstruction along the same surgical posterior approach. In some embodiments, the spinal implant system and method provide a decrease in surgery time, a decrease in morbidity for the patient, and a surgical technique where endplates are inserted initially to provide a larger vertebral endplate coverage. 
     In some embodiments, the spinal implant system includes a posterior endplate. In some embodiments, the endplate includes a gripping zone. In some embodiments, the endplate includes a footprint. In some embodiments, the surgical system includes a ramp to guide VBR device insertion. In some embodiments, the spinal implant system includes an implant holder. In some embodiments, the implant holder is moved in a lateral direction +/− in alignment with a pedicle. In some embodiments, the spinal implant system includes an endplate holder. In some embodiments, the endplate holder is configured to grab the endplate above a superior nerve root. 
     In some embodiments, the spinal implant system is employed with a method for segment stabilization and bone resection. In some embodiments, the method provides segment stabilization with a rod. In some embodiments, the rod is one size. In some embodiments, the method facilitates resection of a vertebra. 
     In some embodiments, the spinal implant system is employed with a method for endplate placement. In some embodiments, the method includes the step of introducing a first endplate and inserting the first endplate with an endplate holder. In some embodiments, the first endplate is inserted laterally through the dural sac. In some embodiments, the first endplate is then rotated in between a first vertebra and a second vertebra. In some embodiments, the endplates are narrow in depth and large in width and are configured to facilitate insertion while keeping contact with a large surface area of bone. 
     In some embodiments, the spinal implant system includes an endplate stabilizer. In some embodiments, the method includes locking the first endplate into a position with the endplate stabilizer. In some embodiments, the method includes inserting a superior endplate with a Kerrison endplate holder below the superior nerve root. In some embodiments, a standard endplate holder is then screwed to the endplate, passing above the superior nerve root. In some embodiments, a second endplate is then placed in the same manner as the first endplate. In some embodiments, both endplates are locked in place. In some embodiments, endplate placement is checked by fluoroscopic control. 
     In some embodiments, the spinal implant system includes an expandable VBR device. In some embodiments, the spinal implant system is employed with a method that includes aligning the expandable VBR device with endplate ramps. In some embodiments, the expandable VBR device is then inserted in between the endplates and expanded. In some embodiments, the spinal implant system includes a VBR break off locking screw. In some embodiments, the method includes locking the expandable VBR device with the break off locking screw. In some embodiments, the method includes tightening the break off locking screw and when tightening is finalized and proper torque is achieved, breaking the locking screw. 
     In some embodiments, the spinal implant system includes an endplate break off locking screw and spacers. In some embodiments, the spacers are disposable. In some embodiments, the spacers are blue. In some embodiments, the method includes removing the spacers. In some embodiments, the method includes locking the endplates via tightening the endplate break off locking screw until it breaks at the proper torque. In some embodiments, the method provides secured placement of the endplates. In some embodiments, the method includes removing and disposing of the broken parts of the endplate locking screws. In some embodiments, the method includes removing endplate stabilizers and endplate holders. In some embodiments, the method provides posterior support. In some embodiments, a second rod is inserted into the pedicle screws and final tightening of the break off nut is performed after appropriate posterior compression. In some embodiments, the spinal implant system includes a VBR posterior fixator. In some embodiments, the VBR posterior fixator aids in stabilizing the spinal implant system. In some embodiments, the method includes attaching a VBR posterior fixator, which includes a rod via clipping onto the expandable VBR device and linking to a posterior construct. In some embodiments, the method includes tightening the VBR fixator rod such that the connection with the expandable VBR device is locked. In some embodiments, the method includes locking the rod via a TSRH-3D small connector. 
     In some embodiments, the spinal implant system includes a VBR posterior link. In some embodiments, the spinal implant system includes a first and a second endplate break off setscrew. In some embodiments, the surgical system includes a first posterior endplate. In some embodiments, the surgical system includes a first endplate ball joint. In some embodiments, the surgical system includes an expandable centerpiece. In some embodiments, the surgical system includes a second endplate ball joint. In some embodiments, the surgical system includes a second posterior endplate. 
     In some embodiments, the spinal implant system includes an endplate inserter. In some embodiments, the spinal implant system includes a spacer. In some embodiments, the spinal implant system includes a short screwdriver. In some embodiments, the spinal implant system includes a spur gear key. In some embodiments, the spinal implant system includes a VBR expander. In some embodiments, the spinal implant system includes a long screwdriver. In some embodiments, the spinal implant system includes an implant holder. 
     In some embodiments, the spinal implant system includes compact VBR implants and instruments. In some embodiments, the spinal implant system includes lengthened endcap holders. In some embodiments, the spinal implant system includes a perpendicular extension with a push button for release. In some embodiments, an endcap setscrew is disposed at an end of the perpendicular extension. In some embodiments, the spinal implant system includes ball joints that are configured for disposal at opposing ends of an expandable centerpiece. In some embodiments, three lengths of the centerpiece are available. In some embodiments, endcap height and a bottom portion of the ramp are lowered. In some embodiments, the spinal implant system includes a slide in and a fall in design. In some embodiments, the spinal implant system includes a VBR expander that includes a spur gear. In some embodiments, the spur gear is directly driven with a handle. In some embodiments, the spinal implant system includes a locking screw. In some embodiments, the locking screw includes a thread that is preceded by a taper. In some embodiments, the taper is configured to prevent any abutment with the expandable centerpiece. 
     In some embodiments, the spinal implant system includes compact VBR implants and instruments that are configured for vertebral body replacement by a posterior surgical approach. In some embodiments, the spinal implant system includes a calibrator. In some embodiments, the calibrator includes a mechanical function configured to lock a position during distraction. In some embodiments, the spinal implant system includes an endcap holder. In some embodiments, endcap gripping and setscrew tightening are separate functions. In some embodiments, the locking screw is configured to be inserted, tightened and sheared. 
     In some embodiments, the spinal implant system includes a centerpiece. In some embodiments, the spinal implant system includes a plurality of centerpieces. In some embodiments, the centerpieces are configured for engagement at opposing ends with a first ball joint and a second ball joint, and are specific for a TLIF approach. In some embodiments, the centerpiece includes two designs and is available in three sizes. In some embodiments, the centerpieces are configured in various sizes and dimensions. In some embodiments, a slide in centerpiece having a collapsed height with two endcaps is 29 mm, 33 mm or 39 mm. In some embodiments, a slide in centerpiece having an expanded height with two endcaps is 34 mm, 42 mm or 54 mm. In some embodiments, a slide in centerpiece having a minimal height between endcaps allowing centerpiece insertion is 29 mm, 33 mm or 39 mm. In some embodiments, a fall in centerpiece having a collapsed height with two endcaps is 29 mm, 33 mm or 39 mm. In some embodiments, a fall in centerpiece having an expanded height with two endcaps is 34 mm, 42 mm or 54 mm. In some embodiments, a fall in centerpiece having a minimal height between endcaps allowing centerpiece insertion is 32 mm, 36 mm or 42 mm. 
     In some embodiments, the endcaps include footprints that are decreased. In some embodiments, the endcap holder includes a perpendicular extension with a release button disposed on a shaft. In some embodiments, the spinal implant system includes stabilizing clamps. In some embodiments, the stabilizing clamps are configured for an open clamping design for endcap holder connection to the pedicle screw. In some embodiments, the calibrator includes ball ends configured similar and/or identical to a portion of the centerpiece for engagement. In some embodiments, the ball ends engage into an endcap socket joint. In some embodiments, the calibrator includes visual indicia. In some embodiments, the visual indicia includes a laser marked ruler that indicates an appropriate centerpiece size to select. 
     In some embodiments, the calibrator is configured to facilitate assembling of endcaps with an expandable centerpiece at a selected lordosis/kyphosis angle prior to implantation, for anterior, antero-lateral and lateral surgical approaches. In some embodiments, a method of employing the spinal implant system includes setting a lordosis/kyphosis angle(s) by selecting an endcap socket(s); inserting selected endcaps into an appropriate socket housing; assembling two sockets onto a frame and placing a centerpiece between a provisional shaft; aligning the provisional shaft with the angle corresponding to the surgical approach; and tightening each endcap screw with a screw driver. 
     In some embodiments, a method of employing the spinal implant system includes setting a lordosis/kyphosis angle(s) by selecting an endcap socket at 0, 5, 10, 15 or 20 angular degrees; inserting a selected first endcap into a socket slot; placing a centerpiece on the socket with a provisional shaft; positioning the provisional shaft to the angle corresponding to the surgical approach; tightening an endcap screw with a screw driver; returning the construct up-side-down; and repeating previous operations for a second endcap. In some embodiments, the method facilitates visualization of the lordosis/kyphosis angles with regard to the orientation given to the VBR inserter and the surgical approach. 
     In some embodiments, the method provides for a VBR via a posterior lumbar approach. In some embodiments, the method provides access to posterior structures. In some embodiments, pedicle screws are placed on one side of a surgical site. In some embodiments, a first endcap is inserted between two nerve roots using a Kerrison type implant holder. In some embodiments, the implant holder is reconnected to an endcap holder below the inferior root. In some embodiments, a second endcap is directly inserted with the endcap holder. In some embodiments, a calibrator is inserted into the resection of a vertebral body along with ball ends of an instrument into the endcap socket joint. In some embodiments, after the end cap position is adjusted with the calibrator, distraction is then applied to the endcaps so that teeth disposed on the endcaps impact into the vertebral endplates. In some embodiments, distraction is applied to determine the size of the centerpiece to implant. In some embodiments, an x-ray is used to determine the distance between the endcaps and the vertebral endplates. In some embodiments, stable positioning of the endcaps is ensured via connection to the pedicle screws via the stabilizing clamps. 
     In some embodiments, the calibrator maintains constant pressure on the endcaps during the connection of the stabilizing clamps to the pedicle screws. In some embodiments, the calibrator includes a locking feature configured to prevent distraction force during connection. In some embodiments, the calibrator includes arms. In some embodiments, the calibrator arms are stiff and/or non-flexible. 
     In some embodiments, the method includes the step of connecting the expandable centerpiece to the VBR expander, and then inserting the VBR expander into a vertebral defect. In some embodiments, the VBR expander is then disposed in between endcaps. In some embodiments, the spinal implant system includes ball and socket joints that are assembled together. In some embodiments the centerpiece is expanded. In some embodiments, a locking screw is inserted. In some embodiments the method includes x-ray control to verify proper tightening of the locking screw. In some embodiments, the locking screw includes a rounded tip. In some embodiments, the rounded tip translates beyond a posterior wall of the centerpiece. In some embodiments, endcap holders are released by pressing a push button to tighten the endcap setscrews. In some embodiments, pressure is added to the endcap holders to maintain contact with the endcaps while the setscrews are tightened. In some embodiments, the endcap holder includes a handle. In some embodiments, the handle is removable. In some embodiments, the functions of the endcap holder and setscrew holder are separated. In some embodiments, a posterior link is clamped to the centerpiece and is fixed to a posterior rod. In some embodiments, the posterior link is configured to provide an efficient supplemental fixation to ensure good stability of the final construct through the same surgical approach. In some embodiments, the spinal implant system provides ease and speed for connecting the posterior link to the posterior rod. 
     In some embodiments, the spinal implant system includes a 29-34 mm expandable centerpiece combined with endcaps. In some embodiments, the spinal implant system includes a 33-42 mm expandable centerpiece combined with endcaps. In some embodiments, the spinal implant system includes a 39-54 mm expandable centerpiece combined with endcaps. In some embodiments, the spinal implant system includes a locking screw, a first endplate inserter, a second endplate inserter, a small connector and/or a posterior link. 
     In some embodiments, the spinal implant system includes a plurality of instruments. In some embodiments, the spinal implant system includes a first endplate inserter, a second endplate inserter, a modified Kerrison surgical instrument, a stabilizing clamp, a handle, a nut driver, a calibrator, VBR inserter, a spur gear key and/or a long nut driver. 
     In one embodiment, one or all of the components of the spinal implant system are disposable, peel-pack, pre-packed sterile devices used with an implant. One or all of the components of the spinal implant system may be reusable. The spinal implant system may be configured as a kit with multiple sized and configured components. 
     In some embodiments, the present disclosure may be employed to treat spinal disorders such as, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor, infection, such as, for example, tuberculosis, and fractures. In some embodiments, the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. In some embodiments, the disclosed spinal implant system and methods may be alternatively employed in a surgical treatment with a patient in a prone or supine position, and/or employ various surgical approaches to the spine, including anterior, posterior, posterior mid-line, direct lateral, postero-lateral, and/or antero-lateral approaches, and in other body regions. The present disclosure may also be alternatively employed with procedures for treating the lumbar, cervical, thoracic, sacral and pelvic regions of a spinal column. The spinal implant system and methods of the present disclosure may also be used on animals, bone models and other non-living substrates, such as, for example, in training, testing and demonstration. 
     The present disclosure may be understood more readily by reference to the following detailed description of the embodiments taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this application is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting. In some embodiments, as used in the specification and including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” or “approximately” one particular value and/or to “about” or “approximately” another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. It is also understood that all spatial references, such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure. For example, the references “upper” and “lower” are relative and used only in the context to the other, and are not necessarily “superior” and “inferior”. 
     As used in the specification and including the appended claims, “treating” or “treatment” of a disease or condition refers to performing a procedure that may include administering one or more drugs to a patient (human, normal or otherwise or other mammal), employing implantable devices, and/or employing instruments that treat the disease, such as, for example, microdiscectomy instruments used to remove portions bulging or herniated discs and/or bone spurs, in an effort to alleviate signs or symptoms of the disease or condition. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, treating or treatment includes preventing or prevention of disease or undesirable condition (e.g., preventing the disease from occurring in a patient, who may be predisposed to the disease but has not yet been diagnosed as having it). In addition, treating or treatment does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes procedures that have only a marginal effect on the patient. Treatment can include inhibiting the disease, e.g., arresting its development, or relieving the disease, e.g., causing regression of the disease. For example, treatment can include reducing acute or chronic inflammation; alleviating pain and mitigating and inducing re-growth of new ligament, bone and other tissues; as an adjunct in surgery; and/or any repair procedure. Also, as used in the specification and including the appended claims, the term “tissue” includes soft tissue, ligaments, tendons, cartilage and/or bone unless specifically referred to otherwise. 
     The following discussion includes a description of a surgical system and related methods of employing the surgical system in accordance with the principles of the present disclosure. Alternate embodiments are 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. 1-2 , there is illustrated components of a surgical system, such as, for example, a spinal implant system  10 . 
     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, 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 minimally invasive procedure, including percutaneous techniques, mini-open and open surgical techniques to deliver and introduce instrumentation and/or an implant, such as, for example, a corpectomy implant, at a surgical site within a body of a patient, for example, a section of a spine. In some embodiments, spinal implant system  10  may be employed with surgical procedures, such as, for example, corpectomy and discectomy, which include fusion and/or fixation treatments that employ implants, to restore the mechanical support function of vertebrae. 
     Spinal implant system  10  includes a spinal construct  12 . In some embodiments, spinal construct  12  comprises a VBR device. In some embodiments, spinal construct  12  comprises a plurality of members assembled for implantation with a body of a patient during a surgical procedure, as described herein. In some embodiments, spinal construct  12  comprises endplates that are pre-positioned and fixed with vertebral tissue via posterior screws. In some embodiments, the endplates of spinal construct  12  are assembled in-situ, as described herein, with an expansion portion and/or centerpiece, such as, for example, a spinal implant  100  described herein, which comprises an assembled expandable spinal construct  12 . 
     Spinal construct  12  includes a member, such as, for example, an endplate  14 . Endplate  14  includes a surface  16  configured to engage vertebrae, as described herein. Surface  16  is substantially planar. In some embodiments, all or only a portion of surface  16  may be arcuate, concave, convex, undulating and/or angled. In some embodiments, surface  16  can have cross-hatch texturing, spikes, barbs, raised elements, a porous titanium coating, and/or be rough, textured, porous, semi-porous, dimpled and/or polished such that it facilitates engagement with tissue. In some embodiments, the vertebral tissue may include intervertebral tissue, endplate surfaces and/or cortical bone. 
     Endplate  14  includes a surface  18 . Surface  18  includes a wall  20  that defines a cavity  22 . Cavity  22  is configured for engagement with a mating element of a member, such as, for example, an expandable spinal implant  100 , as described herein. In some embodiments, cavity  22  may have various cross section configurations, such as, for example, circular, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. 
     Wall  20  defines an in-situ guide surface, such as, for example, a ramp  24 . Ramp  24  includes a tapered configuration including surfaces of wall  20  that taper outwardly from surface  16 . In some embodiments, ramp  24  has a U-shaped configuration. In some embodiments, all or only a portion of ramp  24  may be arcuate, concave, convex, undulating, funnel shaped and/or angled. 
     Ramp  24  is configured to facilitate alignment and translation of implant  100  into cavity  22  by guiding implant  100  along the surfaces of ramp  24  into cavity  22 , as described herein. In some embodiments, in-situ guidance of one or more of the components of spinal construct  12  includes assembly of the components of spinal construct  12  in place, in position, within, on or about the body of a patient and/or at a surgical site, and/or adjacent to selected tissue for implantation of spinal construct  12  with the selected tissue. In some embodiments, in-situ guidance of one or more of the components of spinal construct  12  includes assembly of the components of spinal construct  12  in-vivo with a body of a patient. In some embodiments, endplate  14  is configured for engagement with vertebrae and is fixed in position and then assembled in-vivo with implant  100  during a surgical procedure, as described herein. 
     Wall  20  includes a surface  28  that defines an opening  30  disposed adjacent ramp  24 . Opening  30  is configured for engagement with a surgical instrument, such as, for example, an inserter support  162 , as shown in  FIGS. 3-6 , that comprises a portion of a provisional frame  160  to stabilize components of spinal implant system  10  during implantation of spinal construct  12  with the selected tissue, as described herein. In some embodiments, opening  30  is threaded for a threaded engagement with inserter support  162 , as described herein. 
     Wall  20  includes a surface  32  that defines an opening  34  disposed adjacent ramp  24 . Opening  34  is configured for engagement with an inserter support  162 , as described herein. In some embodiments, opening  34  is threaded for a threaded engagement with inserter support  162 , as described herein. Opening  34  is disposed on an opposite side of ramp  24  from opening  30 , as shown in  FIG. 2 . Openings  30 ,  34  can be disposed in various and/or relative positions with endplate  14  to facilitate manipulation, introduction, delivery and/or implantation during a surgical procedure, and/or along surgical pathways, such as, for example, posterior, oblique, lateral and/or anterior. In some embodiments, opening  34  may be disposed at alternate orientations, relative to opening  30 , such as, for example, parallel, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered. 
     Surface  18  includes a wall  40 . Wall  40  includes a surface  42  that defines a groove  44 . Groove  44  is configured for engagement with a surgical instrument, such as, for example, an inserter  190  ( FIGS. 7 and 8 ), as described herein. Surface  18  includes a wall  46 . Wall  46  includes a surface  48  that defines a groove  50 . Groove  50  is configured for engagement with inserter  190 . Wall  46  is disposed on an opposite side of ramp  24  from wall  40 , as shown in  FIG. 2 . 
     Spinal construct  12  includes a member, such as, for example, an endplate  60 . Endplate  60  includes a surface  62  configured to engage vertebrae, as described herein. Surface  62  is substantially planar. In some embodiments, all or only a portion of surface  62  may be arcuate, concave, convex, undulating and/or angled. In some embodiments, surface  62  can have cross-hatch texturing, spikes, barbs, raised elements, a porous titanium coating, and/or be rough, textured, porous, semi-porous, dimpled and/or polished such that it facilitates engagement with tissue. In some embodiments, endplate  60  may be similarly or alternately configured relative to endplate  14 . 
     Endplate  60  includes a surface  64 . Surface  64  includes a wall  66  that defines a cavity  68 . Cavity  68  is configured for engagement with a mating element of implant  100 , as described herein. In some embodiments, cavity  68  may have various cross section configurations, such as, for example, circular, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. 
     Wall  66  defines an in-situ guide surface, such as, for example, a ramp  70 . Ramp  70  includes a tapered configuration including surfaces of wall  66  that taper outwardly from surface  62 . In some embodiments, ramp  70  has a U-shaped configuration. In some embodiments, all or only a portion of ramp  70  may be arcuate, concave, convex, undulating, funnel shaped and/or angled. 
     Ramp  70  is configured to facilitate alignment and translation of implant  100  into cavity  68  by guiding implant  100  along the surfaces of ramp  70  into cavity  68 , as described herein. In some embodiments, endplate  60  is configured for engagement with vertebrae and is fixed in position and then assembled in-vivo with implant  100  during a surgical procedure, as described herein. 
     Wall  66  includes a surface  72  that defines an opening  74  disposed adjacent ramp  70 . Opening  74  is configured for engagement with an inserter support  162 , as described herein. In some embodiments, opening  74  is threaded for a threaded engagement with an inserter support  162 , as described herein. 
     Wall  66  includes a surface  76  that defines an opening  78  disposed adjacent ramp  70 . Opening  78  is configured for engagement with an inserter support  162 , as described herein. In some embodiments, opening  78  is threaded for a threaded engagement with inserter support  162 , as described herein, Opening  78  is disposed on an opposite side of ramp  70  from opening  74 . Openings  74 ,  78  can be disposed in various and/or relative positions with endplate  60  to facilitate manipulation, introduction, delivery and/or implantation during a surgical procedure, and/or along surgical pathways, such as, for example, posterior, oblique, lateral and/or anterior. In some embodiments, opening  78  may be disposed at alternate orientations, relative to opening  74 , such as, for example, parallel, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered. 
     Surface  64  includes a wall  77 . Wall  77  includes a surface  79  that defines a groove  80 . Groove  80  is configured for engagement with an inserter  190  ( FIGS. 7 and 8 ), as described herein. Surface  62  includes a wall  82 . Wall  82  includes a surface  84  that defines a groove  86 . Groove  86  is configured for engagement with an inserter  190 . Wall  82  is disposed on an opposite side of ramp  70  from wall  77 . 
     Implant  100  includes an outer body  102  having a tubular configuration. Body  102  extends in a linear configuration and defines a longitudinal axis X 1 . In some embodiments, body  102  may extend in alternate configurations, such as, for example, arcuate, offset, staggered and/or angled portions, which may include acute, perpendicular and obtuse. 
     Body  102  extends between an end  104  and an end  106 . End  106  defines an end face  108  that is configured to engage endplate  60 , as described herein. In some embodiments, end face  108  can include a surface that may be rough, textured, porous, semi-porous, dimpled and/or polished. 
     Body  102  includes a wall, such as, for example, a tubular wall  110 . Wall  110  includes an inner surface  112  that defines an axial cavity  114  extending between ends  104 ,  106 . In some embodiments, wall  110  includes a cylindrical cross-section. In some embodiments, the cross-section geometry of wall  110  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. 
     Wall  110  includes an inwardly oriented surface  116  that defines a lateral cavity, such as, for example, a side window  118 . Window  118  includes an aperture, such as, for example, an opening  120 . Opening  120  is configured for disposal of an instrument utilized to facilitate expansion of body  102  and a member, such as, for example, an inner body  130  of implant  100 , as described herein. Opening  120  is oriented for disposal of a surgical instrument, such as, for example, an inserter (not shown) configured for engagement with gear teeth of body  130 . Opening  120  is oriented substantially transverse, such as, for example, perpendicular to axis X 1 . In some embodiments, opening  120  may be variously oriented relative to axis X 1 , such as, for example, parallel or angled, which may include acute and obtuse orientations. In some embodiments, wall  120  may include one or a plurality of openings. In some embodiments, opening  120  may be variously configured, such as, for example, circular, 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, wall  110  defines openings  122  configured to receive an agent, which may include bone graft (not shown) and/or other materials, as described herein, for employment in a fixation or fusion treatment used for example, in connection with a corpectomy. 
     End face  108  is connected with a mating element  124 . Mating element  124  includes a head  126  configured for disposal with cavity  68 . Mating element  124  includes a cylindrical shaft extending from head  126  that includes a thread form, which is engaged with end face  108  in threaded fixation. Mating element  124  is configured to facilitate alignment with endplate  60  such that head  126  is aligned with the opening of cavity  68 . Implant  100  translates into cavity  68  by guiding head  126  along the surfaces of ramp  70  into cavity  68 , as described herein. Disposal of mating element  124  with cavity  68  and engagement of head  126  with the surfaces of wall  66  that define cavity  68  form a spheroidal joint  128 , as shown in  FIG. 15 . In some embodiments, head  126  comprises a ball and cavity  68  comprises a socket such that spheroidal joint  128  includes a ban and socket configuration. In some embodiments, the mating elements can include biasing members, clips, key/keyway/keyslot, dovetail, tongue/groove, male/female, pin/groove, threaded, barbs, hooks and/or adhesive. In some embodiments, the mating elements are machined with end face  108  to limit a length of spinal construct  12 . 
     In some embodiments, spheroidal joint  128  facilitates movement of implant  100  relative to endplate  60  in a plurality of degrees of freedom to one or a plurality of orientations. In some embodiments, spheroidal joint  128  facilitates movement of implant  100  relative to endplate  60  between a first angular orientation and a second angular orientation. In some embodiments, spheroidal joint  128  provides rotation of implant  100  about axis X 1  relative to endplate  60  and disposal of implant  100  at a plurality of orientations relative endplate  60 . 
     Body  130  has a tubular configuration and is oriented for disposal within axial cavity  114 . Body  130  extends in a linear configuration relative to axis X 1 . In some embodiments, body  130  may extend in alternate configurations, such as, for example, arcuate, offset, staggered and/or angled portions, which may include acute, perpendicular and obtuse. 
     Body  130  extends between an end  132  and an end  134 . End  132  defines an end face  136  configured to engage endplate  14 , as described herein. In some embodiments, end face  136  can include a surface that may be rough, textured, porous, semi-porous, dimpled and/or polished. 
     Body  130  includes a wall, such as, for example, a tubular wall  138 . In some embodiments, wall  138  includes a cylindrical cross-section. In some embodiments, the cross-sectional geometry of wall  138  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. 
     Wall  138  includes a surface  140 . Surface  140  includes a gear rack  142  having a plurality of teeth  144  that are disposed therealong. Teeth  144  extend into opening  120  for engagement of a surgical instrument with rack  142  to facilitate axial translation of body  130  relative to body  102  between a contracted configuration and an expanded configuration for disposal in a selected orientation, as described herein. In some embodiments, teeth  144  are disposed in a linear, serial configuration along surface  140  in an offset configuration relative to axis X 1 . In some embodiments, the offset configuration of teeth  144  cause teeth  144  to extend into opening  120  to facilitate axial translation of body  130  relative to body  102  between a contracted configuration and an expanded configuration for disposal in a selected orientation. 
     Wall  138  includes a surface  146  that defines an opening, such as, for example, an axial slot  148 . Slot  148  is disposed along axis X 1 . Slot  148  is configured for engagement with a lock  150 , as described herein. In some embodiments, the cross-sectional geometry of slot  148  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, surface  146  is smooth, even, rough, textured, porous, semi-porous, dimpled and/or polished. In some embodiments, slot  148  may extend in alternate configurations, such as, for example, arcuate, offset, staggered and/or angled portions, which may include acute, perpendicular and obtuse relative to axis X 1 . 
     End face  136  is connected with a mating element  152 . Mating element  152  includes a head  154  configured for disposal with cavity  22 . Mating element  152  includes a cylindrical shaft extending from head  154  that includes a thread form, which is engaged with end face  136  in threaded fixation. Mating element  152  is configured to facilitate alignment with endplate  14  such that head  154  is aligned with the opening of cavity  22 . Implant  100  translates into cavity  22  by guiding head  154  along the surfaces of ramp  24  into cavity  22 , as described herein. Disposal of mating element  152  with cavity  22  and engagement of head  154  with the surfaces of wall  20  that define cavity  22  form a spheroidal joint  156 , as shown in  FIG. 15 . In some embodiments, head  154  comprises a ball and cavity  22  comprises a socket such that spheroidal joint  156  includes a ball and socket configuration. In some embodiments, the mating elements are machined with end face  136  to limit a length of spinal construct  12 . 
     In some embodiments, spheroidal joint  156  facilitates movement of implant  100  relative to endplate  14  in a plurality of degrees of freedom to one or a plurality of orientations. In some embodiments, spheroidal joint  156  facilitates movement of implant  100  relative to endplate  14  between a first angular orientation and a second angular orientation. In some embodiments, spheroidal joint  156  provides rotation of implant  100  about axis X 1  relative to endplate  14  and disposal of implant  100  at a plurality of orientations relative endplate  14 . 
     Lock  150  includes a reduced diameter portion that is frangibly connected to a portion of lock  150 . In some embodiments, lock  150  is fabricated from a fracturing and/or frangible material such that manipulation of a portion of lock  150  can fracture and separate a portion of lock  150  at a predetermined force and/or torque limit, as described herein. In some embodiments, as force and/or torque is applied and resistance increases, for example, the predetermined torque and force limit is approached. In some embodiments, lock  150  is configured for a threaded engagement with slot  148 . 
     In some embodiments, a portion of lock  150  can fracture and separate at a predetermined force or torque limit, which may be in a range of approximately 2 Newton meter (N-m) to 8 N-m. In some embodiments, lock  150  may have the same or alternate cross section configurations, may be fabricated from a homogenous material or heterogeneously fabricated from different materials, and/or alternately formed of a material having a greater degree, characteristic or attribute of plastic deformability, frangible property and/or break away quality to facilitate fracture and separation of lock  150 . 
     In some embodiments, as shown in  FIGS. 10-20 , spinal implant system  10 , as described herein, includes a provisional frame  160  that is configured for connection with one or more vertebral surfaces and/or one or more implants and spinal constructs, for example, to provisionally fix and/or stabilize endplates and/or a centerpiece implant with one or more vertebral surfaces. In some embodiments, provisional frame  160  can be employed as provisional and/or working construct and/or scaffold to temporarily support endplates and/or a centerpiece implant with one or more vertebral surfaces during a surgical treatment and/or provide a template configuration for spinal implants, as described herein. In some embodiments, spinal implant system  10  may include one or a plurality of provisional frames  160 . In some embodiments, a plurality of provisional frames  160  may be disposed in various alternate orientations, such as, for example, side by side, parallel, transverse, co-axial and/or may be offset or staggered. In some embodiments, one or more components of provisional frame  60  may provide a template configuration for spinal implants, such as, implantable, final, permanent, removable, non-removable, bio-absorbable, resorbable and/or bio-degradable. 
     In some embodiments, provisional frame  160  includes inserter support  162 , as shown in  FIGS. 4 and 5 . Inserter support  162  extends between an end  164  and an end  166 . End  164  includes a threaded surface  168 . Surface  168  is configured for engagement with opening  30  and/or opening  34  to facilitate insertion of end plate  14  and provisional fixation of endplate  14  with a selected vertebral surface. Inserter support  162  includes a surface  170  that defines a channel  172  extending between end  164  and end  166 . Channel  172  is configured for disposal of a lock, such as, for example, a breakoff set screw  176 , as shown in  FIGS. 3 and 6 . 
     Setscrew  176  includes a portion  178  and a portion  180 . Portions  178 ,  180  are connected at a reduced diameter portion  182  that is tangibly connected to portion  180 . In some embodiments, portion  180  is configured for engagement with opening  30  and/or opening  34 . In some embodiments, portions  178 ,  180  are fabricated from a fracturing and/or frangible material such that manipulation of portion  178  relative to portion  180  can fracture and separate portion  178  from portion  180  at a predetermined force and/or torque limit, as described herein. In some embodiments, as force and/or torque is applied to portion  178  and resistance increases, for example, due to fixation of portion  180  with spinal construct  12 , as described herein, the predetermined torque and force limit is approached. 
     In some embodiments, as shown in  FIGS. 11-20 , provisional frame  160  includes one or a plurality of stabilizers, such as, for example, rods  200 . Rod  200  includes a collar that defines a cavity  202  configured for disposal of inserter support  162 , as described herein. In some embodiments, provisional frame  160  may include a plurality of supports and/or stabilizers, which may be relatively disposed in a side by side, irregular, uniform, non-uniform, offset and/or staggered orientation or arrangement. In some embodiments, the supports and/or stabilizers can have a uniform thickness/diameter. In some embodiments, the supports and/or stabilizers may have various surface configurations, such as, for example, rough, threaded for connection with surgical instruments, arcuate, undulating, dimpled, polished and/or textured. In some embodiments, the thickness defined by the supports and/or stabilizers may be uniformly increasing or decreasing, or have alternate diameter dimensions along its length. In some embodiments, the supports and/or stabilizers may have various cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, the supports and/or stabilizers may have various lengths. 
     In some embodiments, the supports and/or stabilizers may have a flexible configuration and fabricated from materials, such as, for example, polyester, polyethylene, fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers and elastomeric composites. In one embodiment, the flexibility of the supports and/or stabilizers includes movement in a lateral or side to side direction and prevents expanding and/or extension in an axial direction. In some embodiments, all or only a portion of the supports and/or stabilizers 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. In some embodiments, the supports and/or stabilizers may be compressible in an axial direction. 
     In some embodiments, as shown in  FIGS. 7 and 8 , spinal implant system  10 , as described herein, includes an inserter  190 , which is engageable with endplate  60  and/or endplate  14  for disposal with one or more vertebral surfaces. In some embodiments, inserter  190  is configured as a Kerrison type surgical instrument. Inserter  190  extends between an end  192  and an end  194 . End  192  includes a flange, such as, for example, a hook  196  that is configured for engagement with groove  44  and/or groove  86  to facilitate insertion of endplate  60  below a superior nerve root. 
     Referring to  FIGS. 9-23 , in assembly, operation and use, spinal implant system  10 , similar to the systems and methods described herein, and including spinal construct  12  is employed with a surgical procedure, such as, for example, a lumbar corpectomy for treatment of a spine of a patient including vertebrae V. Spinal implant system  10  may also be employed with other surgical procedures, such as, for example, discectomy, laminectomy, fusion, laminotomy, laminectomy, nerve root retraction, foramenotomy, facetectomy, decompression, spinal nucleus or disc replacement and bone graft and implantable prosthetics including vertebral replacement devices, interbody devices, plates, rods, and bone engaging fasteners for securement of the components of spinal construct  12 . 
     Spinal implant system  10  is employed with a lumbar corpectomy including surgical arthrodesis, such as, for example, fusion to immobilize a joint for treatment of an applicable condition or injury of an affected section of a spinal column and adjacent areas within a body. For example, vertebrae V includes vertebra V 1  and vertebra V 2 . A diseased and/or damaged vertebra and intervertebral discs are disposed between the vertebrae V 1  and V 2 . In some embodiments, spinal construct  12  is configured for insertion within a vertebral space S to space apart articular joint surfaces, provide support and maximize stabilization of vertebrae V. 
     In use, to treat the affected section of vertebrae V, a medical practitioner obtains access to a surgical site including vertebrae V in any appropriate manner, such as through incision and retraction of tissues. In some embodiments, spinal implant system  10  may be used in any existing surgical method or technique including open surgery, mini-open surgery, minimally invasive surgery and percutaneous surgical implantation, whereby vertebrae V is accessed through a mini-incision, or sleeve that provides a protected passageway to the area. Once access to the surgical site is obtained, corpectomy is performed for treating the spine disorder. The diseased and/or damaged portion of vertebrae V, and diseased and/or damaged intervertebral discs are removed to create a vertebral space S. 
     A preparation instrument (not shown) is employed to remove disc tissue, fluids, adjacent tissues and/or bone, and scrape and/or remove tissue from vertebral surface E 1  of vertebra V 1  and/or vertebral surface E 2  of vertebra V 2 . Spinal construct  12  is provided with at least one agent, similar to those described herein, to promote new bone growth and fusion to treat the affected section of vertebrae V. The components of spinal implant system  10  may be completely or partially revised, removed or replaced. In some embodiments, spinal construct  12  is employed to stabilize vertebrae V as a pre-assembled device or can be assembled in situ. 
     Pilot holes are made in selected vertebrae V 1 , V 2  for receiving fasteners, such as, for example, bone screws  210   a ,  210   b ,  210   c ,  210   d . Bone screws  210   a ,  210   b ,  210   c ,  210   d  are delivered to the surgical site and implanted with vertebrae V such that each bone screw is inserted, attached or otherwise engaged with a particular vertebra, as shown in  FIG. 9 . Bone screws  210   a ,  210   b ,  210   c ,  210   d  each include a receiver defining an implant cavity configured for disposal of vertebral rods  212 . Vertebral rod  212  is delivered to the surgical site and connected with bone screws  210   a  and  210   b  for implant with a lateral portion of vertebrae V in connection treating the spine disorder. 
     Endplate  14 , as described herein, is connected with inserter support  162 , which comprises a portion of provisional frame  160 , via opening  30  such that inserter support  162  extends laterally from endplate  14 , as shown in  FIG. 10 . Breakoff set screw  176  is disposed with channel  172 . In some embodiments, a spacer  214  is engaged with break off set screw  176  and inserter support  162  to resist and/or prevent undesired engagement of portion  180  with endplate  14 . 
     Endplate  14  is inserted into vertebral space S via a posterior approach for engagement with vertebral surface E 1 . In some embodiments, inserter support  162  is engaged with endplate  14  and inserted laterally to a dural sac of the spine and then rotated between vertebrae V 1 , V 2  for positioning. In some embodiments, endplate  14  may be delivered to the surgical site with inserter  190 , as described herein. Rod  200 , as described herein, which comprises a portion of provisional frame  160 , is connected with bone screw  210   d  with a coupling member, such as, for example, a setscrew  216   d , as shown in  FIG. 11 . Inserter support  162  is disposed with cavity  202 . Attachment of inserter support  162  with rod  200  provisionally fixes and/or stabilizes inserter support  162  and endplate  14  with vertebra V 1 . 
     Endplate  60  is connected with inserter  190 , as shown in  FIGS. 12 and 13 , via groove  80  or groove  86 , as described herein, and inserted into vertebral space S via a posterior approach for engagement with vertebral surface E 2 . In some embodiments, endplate  60  is inserted below a superior nerve root of the spine. An inserter support  162   a , similar to support  162 , is connected with endplate  60  via opening  74 . A breakoff set screw  176   a  is disposed with inserter support  162   a . In some embodiments, a spacer  214   a  is engaged with break off set screw  176   a  and inserter support  162   a  to prevent and/or resist undesired engagement of breakoff set screw  176   a  with spinal construct  12 , A rod  200   a , similar to rod  200 , which comprises a portion of provisional frame  160 , is connected with bone screw  210   c  with a lock, such as, for example, a setscrew  216   c , as shown in  FIG. 14 . Inserter support  162   a  is disposed with cavity  202   a . Attachment of inserter support  162   a  with rod  200   a  provisionally fixes and/or stabilizes inserter support  162   a  and endplate  14  with vertebra V 2 . 
     Implant  100 , as described herein, is delivered to the surgical site via a posterior approach and inserted into vertebral space  5 , as shown in  FIGS. 15 and 16 . Implant  100  is delivered adjacent the components of spinal construct  12  and inserted with endplates  14 ,  60 . Mating element  124  is aligned with endplate  60  such that head  126  is aligned with the opening of cavity  68 . Implant  100  translates into cavity  68  by guiding head  126  along the surfaces of ramp  70  into cavity  68  for in-situ assembly of the components of spinal construct  12 . Disposal of mating element  124  with cavity  68  and engagement of head  126  with the surfaces of wall  66  form spheroidal joint  128 . Mating element  152  is aligned with endplate  14  such that head  154  is aligned with the opening of cavity  22 . Implant  100  translates into cavity  22  by guiding head  154  along the surfaces of ramp  24  into cavity  22  for in-situ assembly of the components of spinal construct  12 . Disposal of mating element  152  with cavity  22  and engagement of head  154  with the surfaces of wall  20  form spheroidal joint  156 . 
     An instrument (not shown) is configured to selectively expand and/or contract body  130  relative to body  102  of implant  100 . Lock  150  is engaged with implant  100  to fix body  130  relative to body  102  at a selected expansion, as shown in  FIG. 17 . As a force and/or torque is applied to lock  150  and resistance increases, for example, the predetermined torque and force limit is approached, a portion of lock  150  fractures and separates at a predetermined force or torque limit, as shown in  FIG. 18 . 
     Spacers  214 ,  214   a  are removed from inserters  162 ,  162   a , as shown in  FIG. 19 . Breakoff set screws  176 ,  176   a  translate into engagement with endplates  14 ,  60 . Breakoff set screws  176 ,  176   a  are manipulated such that portion  180  and a portion  180   a  fracture and separate from portion  178  and a portion  178   a  at a predetermined force and/or torque limit, as described herein. Portions  178 ,  178   a  are removed from inserters  162 ,  162   a , as shown in  FIG. 20 . Inserters  162 ,  162   a  and rods  200 ,  200   a  are removed from vertebrae V, as shown in  FIG. 21 . 
     A vertebral rod  212   a  is delivered to the surgical site and connected with bone screws  210   c  and  210   d  for implant with a contralateral portion of vertebrae V in connection treating the spine disorder. In some embodiments, spinal construct  12  includes vertebral rod  212  and/or vertebral rod  212   a . In some embodiments, an agent(s), as described herein, may be applied to areas of the surgical site to promote bone growth. In some embodiments, one or all of the components of spinal implant system  10  can be delivered to the surgical site via mechanical manipulation and/or a free hand technique. 
     In some embodiments, spinal construct  12  may include fastening elements, which may include locking structure, configured for fixation with vertebrae to secure joint surfaces and provide complementary stabilization and immobilization to a vertebral region. In some embodiments, locking structure may include fastening elements such as, for example, rods, plates, cups, hooks, adhesives and/or flanges. In some embodiments, spinal implant system  10  can be used with screws to enhance fixation. In some embodiments, spinal implant system  10  and any screws and attachments may be coated with an agent, similar to those described herein, for enhanced bony fixation to a treated area. 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, the use of microsurgical and image guided technologies may be employed to access, view and repair spinal deterioration or damage, with the aid of spinal implant system  10 . Upon completion of the procedure, the non-implanted components, surgical instruments and assemblies of spinal implant system  10  are removed and the incision is closed. 
     In one embodiment, as shown in  FIGS. 24-26 , spinal implant system  10 , similar to the systems and methods described herein, includes spinal construct  12 , similar to that described herein. Spinal construct  12  is employed with provisional frame  160 , similar to that described herein, which includes a posterior fixator  300  that is connected with an existing VBR device such as spinal construct  12 , as described with regard to  FIGS. 1-23 , for positional locking of implant  100  with one or more components of spinal construct  12 . 
     Fixator  300  includes a shaft  302  that extends between an end  304  and an end  306 . End  304  includes a gripping portion, such as, for example, a clip  308 . Clip  308  includes a surface  310  that defines a cavity  312 . In some embodiments, clip  308  is configured for releasable engagement with implant  100 . In some embodiments, clip  308  is configured for permanent engagement with implant  100 . In some embodiments, clip  308  is configured for engagement with implant  100  and movable relative thereto via slidable engagement therewith, for example, in relative circumferential rotation. In some embodiments, clip  308  includes a resilient configuration configured to snap fit with implant  100 . 
     Fixator  300  is configured for attachment to one or more components of spinal construct  12 , such as, for example, a vertebral rod  212   a  and implant  100 . Vertebral rod  212   a  is attached with vertebrae V 1 , V 2 , as described herein. Fixator  300  is connected or attached with vertebral rod  212   a  via a connector  316   a  to positionally fix and/or stabilize implant  100  with the components of spinal construct  12 . 
     In some embodiments, connector  316   a  is selectively adjustable and/or rotatable to movably adjust fixator  300  relative to vertebral rod  212   a  and/or implant  100  for connecting fixator  300  with the components of spinal construct  12 . In some embodiments, connector  316   a  includes radial splines that can be spaced apart for rotation of shaft  302  relative to vertebral rod  212   a  and engagement of the splines for selective fixation of shaft  302  in a particular orientation relative to vertebral rod  212   a . In a fixed orientation of shaft  302  relative to vertebral rod  212   a , fixator  300  stabilizes implant  100 , which is connected with endplates  14 ,  60  and disposed with vertebrae V. In some embodiments, fixator  300  is locked with rod  212   a  to fix implant  100  with endplates  14 ,  60  and vertebrae V. 
     In some embodiments, fixator  300  is connected with a surgical instrument, such as, for example, an inserter  314 , similar to those described herein, and as shown in  FIG. 24 , for manipulation thereof during surgical treatment, as described herein. Inserter  314  delivers fixator  300  to a surgical site with vertebrae V 1 , V 2  adjacent the components of spinal construct  12 . 
     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.