Patent Publication Number: US-2022218394-A1

Title: Bone tie methods

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 17/174,032 filed on Feb. 11, 2021, which claims priority benefit to U.S. Provisional Patent Application No. 62/976,596, filed Feb. 14, 2020, the entirety of each are hereby incorporated by reference herein in their entirety. 
    
    
     FIELD 
     Some embodiments described herein relate generally to systems and methods for performing spinal fusion and, in particular, to bone ties and bone tie inserters. 
     DESCRIPTION OF THE RELATED ART 
     Traumatic, inflammatory, and degenerative disorders of the spine can lead to severe pain and loss of mobility. According to some studies, back and spinal musculoskeletal impairments are the leading causes of lost work productivity in the United States. Pain as a result of some type of spinal impairment may have its source in a variety of pathologies or clinical conditions. 
     One source for back and spine pain is related to degeneration of the facets of the spine or facet arthritis. Bony contact or grinding of degenerated facet joint surfaces may play a role in some pain syndromes. While many technological advances have focused on the spinal disc and artificial replacement or repair of the disc, little advancement in facet repair has been made. Facet joint and disc degeneration frequently occur together. Thus, there is a need to address the clinical concerns raised by degenerative facet joints. 
     The current standard of care to address the degenerative problems with the facet joints is to fuse the two adjacent vertebrae together. By performing this surgical procedure, the relative motion between the two adjacent vertebrae is stopped, thus stopping motion of the facets and any potential pain generated as a result thereof. This surgical procedure has a high rate of morbidity and can potentially lead to further clinical complications such as adjacent segment disorders. This procedure is also not reversible. 
     Therefore, if the patient has an unsatisfactory result, they may be subject to additional surgical fusion procedures. 
     Another source for back and spine pain is related to imbalances, malalignments, deficiencies, or deformities of the spine. The current standard of care to address these types of problems is to use hardware such as rods and screws to achieve correction or improvement of the condition. 
     SUMMARY 
     Devices and methods are disclosed for treating the vertebral column. In some embodiments, a bone tie for securing or fusing facets is provided. In some embodiments, a bone tie inserter is provided. In some embodiments, a method of use to treat the spine is provided. 
     In some embodiments, a bone tie for treating the spine is provided. The bone tie can include a proximal end and a distal end. The bone tie can include a head section comprising a rounded head. The bone tie can include a neck section extending proximally from the head section. 
     In some embodiments, the bone tie can include a body section extending proximally from the neck section, wherein the body section comprises one or more gears. In some embodiments, the bone tie can include a fastener section, wherein the fastener section comprises a ratchet. In some embodiments, the bone tie can include a body section extending proximally from the neck section, wherein the body section comprises a groove. In some embodiments, the head section comprises a flange. In some embodiments, the head section comprises a radiopaque marker. 
     In some embodiments, a bone tie inserter for placing a bone tie for treating the spine is provided. The bone tie inserter can include a bone tie advancer. The bone tie advancer can include a shaft. The bone tie advancer can include an advancer portion comprising a curved surface configured to guide a rounded head of a bone tie. The bone tie inserter can include a bone tie retriever. The bone tie retriever can include a shaft. The bone tie retriever can include a retriever portion configured to receive the rounded head. In some embodiments, the rounded head of the bone tie is configured to pivot and/or rotate within the retriever portion. 
     In some embodiments, the bone tie inserter can include the bone tie. In some embodiments, the advancer portion comprises a curve. In some embodiments, the retriever portion comprises a ledge. In some embodiments, the retriever portion comprises a channel. In some embodiments, the retriever portion is configured to receive the rounded head of a bone tie. In some embodiments, the advancer portion comprises a channel configured to receive a neck section extending proximally from the rounded head. 
     In some embodiments, a method of treating bone portions is provided. The method can include forming a lumen in a first bone portion. The method can include forming a lumen in a second bone portion. The method can include advancing a rounded head of a bone tie with a bone tie advancer through the lumen of the first bone portion and into the lumen of the second bone portion. In some embodiments, the bone tie advancer is removably coupled to the rounded head or a neck section extending from the rounded head. The method can include advancing the rounded head of the bone tie into a retriever portion of a bone tie retriever. In some embodiments, the retriever portion comprises a channel to receive the rounded head. The method can include withdrawing the bone tie retriever from the second bone portion, wherein the bone tie is configured to pivot and/or rotate as the bone tie retriever is withdrawn. 
     In some embodiments, the bone tie advancer comprises a channel to receive the neck section of the bone tie. In some embodiments, the bone tie advancer comprises a curve. In some embodiments, the bone tie advancer comprises a rounded section to abut the rounded head of the bone tie. In some embodiments, the bone tie retriever comprises an opening, wherein the neck section pivots, or pivots and rotates, from extending from the channel to extending through the opening. In some embodiments, the bone tie retriever comprises one or more retention features configured to retain the bone tie. In some embodiments, the bone tie retriever comprises a ledge. In some embodiments, the ledge facilitates pivoting and/or rotating of the rounded head of the bone tie. 
     In some embodiments, a method of treating vertebrae is provided. The method can include positioning a bone tie around a transverse process of a first vertebra. The method can include positioning the bone tie around a transverse process of a second vertebra. The method can include tightening the bone tie, wherein the bone tie is configured to correct or improve the condition of a coronal plane deformity. 
     In some embodiments, the bone tie comprises a fastener section comprising a ratchet, wherein the bone tie comprises one or more gears configured to engage the ratchet. In some embodiments, the bone tie comprises a rounded head configured to be guided around the transverse processes. In some embodiments, tightening the bone tie comprises applying a torque to the vertebrae. In some embodiments, the coronal plane deformity is lateral scoliosis. 
     In some embodiments, a method of treating vertebrae is provided. The method can include positioning a bone tie around a spinous process of a first vertebra. The method can include positioning the bone tie around a transverse process of a second vertebra. The method can include tightening the bone tie, wherein the bone tie is configured to achieve rotational correction or rotational improvement. 
     In some embodiments, the transverse process is to the right of the spinous process. In some embodiments, the transverse process is to the left of the spinous process. In some embodiments, the first vertebra is a superior vertebra and the second vertebra is an inferior vertebra. In some embodiments, the first vertebra is an inferior vertebra and the second vertebra is a superior vertebra. In some embodiments, the method can include positioning a second bone tie around the spinous process of the first vertebra, positioning the second bone tie around a second transverse process of the second vertebra, and tightening the second bone tie, wherein the bone tie is configured to achieve rotational correction or rotational improvement. In some embodiments, the transverse process is to the right of the spinous process and the second transverse process is to the left of the spinous process. 
     In some embodiments, a method of treating vertebrae is provided. The method can include positioning a bone tie around a lamina of a first vertebra. The method can include positioning a bone tie around a lamina of a second vertebra. The method can include tightening the bone tie, wherein the bone tie is configured to correct or improve the condition of a sagittal plane deformity. 
     In some embodiments, the sagittal plane deformity is deficient lordosis. In some embodiments, the bone tie is tensioned to set the sagittal correction or improvement. 
     In some embodiments, a method of treating vertebrae is provided. The method can include forming a straight or linear lumen through a first vertebra and a second vertebra. In some embodiments, the lumen is through the lamina or articular process of the second vertebra. The method can include advancing a bone tie into the lumen. The method can include tightening the bone tie. 
     In some embodiments, the lumen is through the vertebral body of the first vertebra. In some embodiments, the lumen is through the pedicle of the first vertebra. In some embodiments, the bone tie is configured to facilitate fusion. In some embodiments, the method can include inserting an implant between a portion of the first vertebra and the second vertebra. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The structure and method of use will be better understood with the following detailed description of embodiments, along with the accompanying illustrations, in which: 
         FIG. 1  is a perspective front view of an embodiment of a bone tie. 
         FIG. 2  is a perspective back view of the bone tie of  FIG. 1 . 
         FIG. 3  is a perspective view of a proximal portion of the bone tie of  FIG. 1 . 
         FIG. 4  is a perspective view of a distal portion of the bone tie of  FIG. 1 . 
         FIG. 5  is an enlarged perspective view of a distal portion of the bone tie of  FIG. 1 . 
         FIG. 6  is a perspective front view of an embodiment of a bone tie advancer. 
         FIG. 7  is a perspective front view of a distal portion of the bone tie advancer of  FIG. 6 . 
         FIG. 8  is a perspective back view of a distal portion of the bone tie advancer of  FIG. 6 . 
         FIG. 9  is a perspective front view of an embodiment of a bone tie retriever. 
         FIG. 10  is a perspective front view of a distal portion of the bone tie retriever of  FIG. 9 . 
         FIG. 11  is a front view of a distal portion of the bone tie retriever of  FIG. 9 . 
         FIG. 12  is a cross-sectional view of the distal portion of the bone tie retriever of  FIG. 9 . 
         FIG. 13  is a cross-sectional view of the distal portion of the bone tie retriever of  FIG. 9 . 
         FIG. 14  is a view of the bone tie of  FIG. 1 , the bone tie advancer of  FIG. 6 , and the bone tie retriever of  FIG. 9  within the vertebrae. 
         FIG. 15  is an enlarged view of  FIG. 14 . 
         FIG. 16  is a cross-sectional view of the bone tie of  FIG. 1  and the bone tie retriever of  FIG. 9  within the vertebrae. 
         FIG. 17  is a side view of the bone tie of  FIG. 1 , the bone tie advancer of  FIG. 6 , and the bone tie retriever of  FIG. 9 . 
         FIG. 18  is a perspective view of the bone tie of  FIG. 1 , the bone tie advancer of  FIG. 6 , and the bone tie retriever of  FIG. 9 . 
         FIG. 19  is a perspective view of the bone tie of  FIG. 1  and the bone tie retriever of  FIG. 9 . 
         FIG. 20  is a perspective view of the bone tie of  FIG. 1  and the bone tie retriever of  FIG. 9 . 
         FIG. 21  is a distal view of the bone tie of  FIG. 1  and the bone tie retriever of  FIG. 9 . 
         FIG. 22  is a flow chart for a method of using the bone tie. 
         FIG. 23  is a view of the bone tie around the transverse processes of adjacent vertebrae. 
         FIG. 24  is a view of the spine with a coronal plane deformity. 
         FIG. 25  is a view of the bone tie positioned to correct a coronal plane deformity. 
         FIG. 26  is a flow chart for a method of using the bone tie. 
         FIG. 27  is a view of the bone tie around the spinous process of a first vertebra and around the transverse process of a second adjacent vertebra. 
         FIG. 28  is a view of the spine with a rotational deformity. 
         FIG. 29  is a view of the bone tie positioned to correct a rotational deformity. 
         FIG. 30  is a flow chart for a method of using the bone tie. 
         FIG. 31  is a view of the bone tie around the lamina of adjacent vertebrae. 
         FIG. 32  is a view of the spine with a sagittal plane deformity. 
         FIG. 33  is a view of the bone tie positioned to correct a sagittal plane deformity. 
         FIG. 34  is a flow chart for a method of using the bone tie. 
         FIG. 35  is a view of the bone tie through the pedicle of a first vertebra and the lamina of a second vertebra. 
         FIG. 36  is a view of the spine with a lumen being formed through the pedicle of a first vertebra and the lamina of a second vertebra. 
         FIG. 37  is a view of the bone tie positioned through the lumen. 
         FIG. 38  is another view of the bone tie positioned through the lumen. 
     
    
    
     DETAILED DESCRIPTION 
     Although certain preferred embodiments and examples are disclosed below, it will be understood by those in the art that the disclosure extends beyond the specifically disclosed embodiments and/or uses of the invention and obvious modifications and equivalents thereof. Thus, it is intended that the scope should not be limited by the particular disclosed embodiments described below. 
     The systems and methods described herein relate to embodiments of bone ties, embodiments of bone tie inserters, and methods of use. The bone tie inserter can facilitate insertion of a bone tie, as described herein. The bone tie can be inserted within a bone lumen, such as a bone lumen between adjacent vertebrae. The bone tie can be advanced by a bone tie advancer. The bone tie can be received by a bone tie retriever. In some embodiments, the bone tie pivots and/or rotates as the bone tie is withdrawn from the bone lumen between adjacent vertebrae. 
     The methods can include wrapping the bone tie around transverse processes of adjacent vertebrae to correct coronal plane deformity. The methods can include wrapping the bone tie around the spinous process of one vertebra and around the transverse process of a second adjacent vertebra to achieve rotational correction. The methods can include wrapping the bone tie around the lamina of adjacent vertebrae to achieve sagittal correction. The methods can include applying tension to the bone tie to set the sagittal correction. The methods can include passing the bone tie through a lumen in a vertebral body or a pedicle of the inferior vertebra and the lamina or articular process of the superior vertebra. 
     1. Anatomy of the Spine 
     The vertebral column comprises a series of alternating vertebrae and fibrous discs that provide axial support and movement to the upper portions of the body. The vertebral column typically comprises thirty-three vertebrae, with seven cervical (C1-C7), twelve thoracic (T1-T12), five lumbar (L1-L5), five fused sacral (S1-S5) and four fused coccygeal vertebrae. Each typical thoracic vertebra includes an anterior body with a posterior arch. The posterior arch comprises two pedicles and two laminae that join posteriorly to form a spinous process. Projecting from each side of the posterior arch is a transverse, superior and inferior articular process. The facets of the superior and inferior articular processes form facet joints with the articular processes of the adjacent vertebrae. The facet joints are true synovial joints with cartilaginous surfaces and a joint capsule. 
     The orientation of the facet joints vary, depending on the level of the vertebral column. In the C1 and C2 vertebrae, the facet joints are parallel to the transverse plane. In the C3 to C7 vertebrae, the facets are oriented at a 45 degree angle to the transverse plane and parallel to the frontal plane, respectively. This orientation allows the facet joints of the cervical vertebrae to flex, extend, lateral flex and rotate. At a 45 degree angle in the transverse plane, the facet joints of the cervical spine can guide, but do not limit, the movement of the cervical vertebrae. For the thoracic vertebrae, the facets are oriented at a 60 degree angle to the transverse plane and a 20 degree angle to the frontal plane, respectively. This orientation is capable of providing lateral flexion and rotation, but only limited flexion and extension. For the lumbar region, the facet joints are oriented at 90 degree angles to the transverse plane and a 45 degree angle to the frontal plane, respectively. The lumbar vertebrae are capable of flexion, extension and lateral flexion, but little, if any, rotation because of the 90 degree orientation of the facet joints in the transverse plane. The actual range of motion along the vertebral column can vary considerably with each individual vertebra. Vertebrae V1 and V2, as used herein, can refer to any vertebrae within the vertebral column of a patient. In some embodiments, V1 is superior to V2. In some embodiments, V2 is superior to V1. In some embodiments, V1 is adjacent to V2. In some embodiments, V1 and V2 are separated by one or more additional vertebrae. 
     In addition to guiding movement of the vertebrae, the facet joints also contribute to the load-bearing ability of the vertebral column. One study by King et al. Mechanism of Spinal Injury Due to Caudocephalad Acceleration, Orthop. Clin. North Am., 6:19 1975, found facet joint load-bearing as high as 30% in some positions of the vertebral column. The facet joints may also play a role in resisting shear stresses between the vertebrae. Over time, these forces acting on the facet joints can cause degeneration and arthritis. 
     2. Bone Tie 
       FIGS. 1-5  depict views of an embodiment of a bone tie  100 .  FIG. 1  illustrates a perspective front view.  FIG. 2  illustrates a perspective back view.  FIG. 3  illustrates a perspective view of a proximal portion of the bone tie  100 .  FIG. 4  illustrates a perspective view of a distal portion of the bone tie  100 .  FIG. 5  illustrates an enlarged perspective view of a distal portion of the bone tie  100 . 
     The bone tie  100  can be a generally elongate member. The bone tie  100  can comprise a proximal end  102  and a distal end  104 . The bone tie  100  can include a length between the proximal end  102  and the distal end  104 . The proximal end  102  can be configured to be near the hands of the user when the user is manipulating the bone tie inserter as described herein. The distal end  104  can be configured to be inserted into a bone lumen as described herein. The distal end  104  can be configured to be the first portion of the bone tie  100  that is inserted in the lumen. The distal end  104  can be the leading end of the bone tie  100 . In some methods of use, the proximal end  102  extends away from the vertebrae during insertion of the bone tie  100 . In some methods of use, the proximal end  102  is held by the user. In some methods of use, the proximal end  102  is unconstrained during insertion of the bone tie  100 . In some methods of use, only a portion of the bone tie  100  near the distal end  104  is grasped and manipulated by the bone tie inserter as described herein. In some methods of use, a portion of the bone tie  100  near the proximal end  102  is retained along the bone tie inserter. 
     The bone tie  100  can include one or more sections along the length of the bone tie  100 . The sections can have a different shape, configuration, or function than an adjacent section of the bone tie  100 . In some embodiments, one or more non-adjacent sections can have the same shape, configuration, or function as another section of the bone tie  100 . In some embodiments, one or more additional sections are provided. In some embodiments, one or more of the sections provided herein are omitted. 
     The bone tie  100  can include a fastener section  106 . The fastener section  106  can be located at or near the proximal end  102 . The fastener section  106  can include any mechanism configured to secure the fastener section  106  to another section of the bone tie  100 . The fastener section  106  can include a mechanism that allows the bone tie  100  to be secured in a single direction of travel such as a ratchet. The fastener section  106  can include a mechanism that allows the bone tie  100  to be secured in two directions of travel such as a pair of gears. 
     The bone tie  100  can include a first section  108 . The first section  108  can be closer to the proximal end  102  than the distal end  104 . The first section  108  can have a first cross-sectional shape. The first section  108  can extend distally from the fastener section  106 . The bone tie  100  can include a second section  110 . The second section  110  can be closer to the proximal end  102  than the distal end  104 . The second section  110  can have a second cross-sectional shape. The second section  110  can extend distally from the first section  108 . The bone tie  100  can include a third section  112 . The third section  112  can be closer to the distal end  104  than the proximal end  102 . The third section  112  can have a third cross-sectional shape. The third section  112  can extend distally from the second section  110 . 
     The bone tie  100  can include a neck section  114 . The neck section  114  can be closer to the distal end  104  than the proximal end  102 . The neck section  114  can taper from the third section  112  toward the distal end  104 . The neck section  114  can extend distally from the third section  112 . The neck section  114  can facilitate manipulation of the distal portion of the bone tie  100  by the bone tie inserter, as described herein. The neck section  114  can be shaped to interface with the bone tie inserter. The neck section  114  can be shaped to form a mechanical interfit or coupling as described herein. 
     The bone tie  100  can include a head section  116 . The head section  116  can be located at or near the distal end  104 . The neck section  114  can taper toward the head section  116 . The head section  116  can extend distally from the neck section  114 . The head section  116  can facilitate manipulation of the distal portion of the bone tie  100  by the bone tie inserter, as described herein. The head section  116  can be shaped to be grasped or cupped by the bone tie inserter. The head section  116  can be shaped to pivot and/or rotate relative to the bone tie inserter. 
       FIG. 2  is a perspective back view of the bone tie  100 . The bone tie  100  can have a smooth surface along the first section  108 , the second section  110 , and the third section  112 . The bone tie  100  can have a continuous surface along the first section  108 , the second section  110 , and the third section  112 . 
       FIG. 3  illustrates a perspective view of a proximal portion of the bone tie  100 . The bone tie can include the proximal end  102 , the fastener section  106 , first section  108 , and the second section  110 . 
     The fastener section  106  can include a lumen  118 . The lumen  118  can be oriented perpendicular to a longitudinal axis  150  of the bone tie  100 . The bone tie  100  can include a ratchet  122  disposed within the lumen  118 . The ratchet  122  is configured to deflect to allow one or gears to travel through the lumen  118  in one direction, but limit or prevent travel in another direction. The fastener section  106  can form an enlarged end of the bone tie  100 . The fastener section  106  can be generally rectangular or cuboid. The fastener section  106  can have a width larger than the first section  108 . The fastener section  106  can have a thickness larger than the first section  108 . The fastener section  106  can include rounded edges or corners. The fastener section  106  can have any shape to accommodate the ratchet  122  disposed therewithin. The fastener section  106  can have any shape to accommodate any fastener mechanism described herein. 
     The first section  108  can have the first cross-sectional shape. The first cross-sectional shape can be generally rectangular or cuboid. The first cross-sectional shape can have rounded edges or corners. The first section  108  can include a width and a thickness. The first section  108  can include a groove  124 . The groove  124  can reduce the thickness of the first section  108 . The groove  124  can taper from the fastener section  106 . The groove  124  can taper to the second section  110 . 
     The second section  110  can have the second cross-sectional shape. The second cross-sectional shape can be generally rectangular or cuboid. The second cross-sectional shape can have rounded edges or corners. The second section  110  can include a groove  126 . The groove  124  of the first section  108  can extend to the groove  126  of the second section  110 . The second section  110  can include one or more gears  128 . The gears  128  can be ramped surfaces. The gears  128  can form a rack. The gears  128  can be wedge surfaces. The gears  128  can be inclined upward toward the proximal end  102 . The gears  128  can be inclined downward toward the distal end  104 . The gears  128  can be disposed within the groove  126  of the second section  110 . The first section  108  and the second section  110  can include a constant width. The first section  108  and the second section  110  can include a constant thickness. The first section  108  and the second section  110  can include a constant thickness measured along the edges of the first section  108  and the second section  110 . 
       FIG. 4  illustrates a perspective view of a distal portion of the bone tie  100 . The bone tie can include the second section  110 , the third section  112 , the neck section  114 , the head section  116 , and the distal end  104 . 
     The third section  112  can have a third cross-sectional shape. The third cross-sectional shape can be generally rectangular or cuboid. The third cross-sectional shape can have rounded edges or corners. In some embodiments, the first cross-sectional shape and the third cross-sectional shape are the same or similar. The third section  112  can include a width and a thickness. The third section  112  can include a groove  130 . The groove  130  can reduce the thickness of the third section  112 . The groove  130  can taper from the second section  110 . The groove  130  can taper to the neck section  114 . 
     Two or more of the first section  108 , the second section  110 , and the third section  112  can include a constant width. Two or more of the first section  108 , the second section  110 , and the third section  112  can include a constant thickness. Two or more of the first section  108 , the second section  110 , and the third section  112  can include a constant thickness measured along the edges of the respective sections. The bone tie  100  can have a constant width along a substantial portion of the length. The bone tie  100  can have a constant thickness along a substantial portion of the length. 
       FIG. 5  illustrates an enlarged view of the distal portion of the bone tie  100 . The bone tie  100  can include the neck section  114 . The neck section  114  tapers along the width. The neck section  114  tapers from a larger width near the third section  112  to a smaller width near the head section  116 . The neck section  114  can include a groove  132 . The groove  132  can reduce the thickness of the neck section  114 . The groove  132  of the neck section  114  can extend from the groove  130  of the third section  112 . 
     The neck section  114  can lie in a plane along the longitudinal axis  150  of the bone tie  100  or the neck section  114  can include a curve  134 . The curve  134  can have a constant radius of curvature. Two or more of the first section  108 , the second section  110 , and the third section  112  can be planar. The bone tie  100  can lie in a plane along a substantial portion of the length. The curve  134  can extend from the plane of the bone tie. The curve  134  can extend upward from the grooves  124 ,  126 ,  130 ,  132  of the bone tie  100 . The curve  134  can extend upward from the gears  128  of the second section  110 . The curve  134  can extend away from the longitudinal axis  150  of the bone tie  100 . 
     The bone tie  100  can include the head section  116 . The head section  116  can include a head  136 . The head  136  can be rounded. The head  136  can be spherical. The head  136  can extend to the distal end  104  of the bone tie  100 . The head section  116  can include a flange  138 . The flange  138  can be positioned on the head  136 . The flange  138  can be a rounded bill that extends from the head  136 . The flange  138  can include a first tapered surface  140  and a second tapered surface  142 . The first tapered surface  140  and the second tapered surface  142  can have different slopes. The second tapered surface  142  can form a ledge by which the head section  116  or head  136  can be grasped. The first tapered surface  140  and the second tapered surface  142  extend to the neck section  114 . 
     The bone tie  100  can include a marker  144 . The marker  144  can facilitate visualization of the bone tie  100 , or a portion thereof. In the illustrated embodiment, the head  136  can include the marker  144 . The head  136  can include a bore  146 . The bore  146  can extend from an edge of the head  136  inward toward or past the center of the head  136 . The marker  144  can be disposed within the bore  146 . The marker  144  can be a radiopaque marker. The marker  144  can be formed of a metal or other radiopaque material. The marker  144  can identify the distal end  104  of the bone tie  100 . In some embodiments, the bone tie  100  comprises a non-radiopaque material. In some embodiments, one or more radiopaque markers may be embedded in or on the bone tie  100  to assist in placement or monitoring of the bone tie  100  under radiographic visualization. 
     The bone tie  100  can be a flexible fastening band. The bone tie  100  can include the proximal end portion  102  and the distal end portion  104 . In some embodiments, the head section  116  can be removed. The neck section  114  can be advanced through the lumen  118 . When the neck section  114  is advanced, the ratchet  122  can extend into the groove  132 . The third section  112  can be advanced through the lumen  118 . When the third section  112  is advanced, the ratchet  122  can extend into the groove  130 . The second section  110  can be advanced through the lumen  118 . When the second section  110  is advanced, the ratchet  122  can extend into the groove  126 . The ratchet  122  can engage the gears  128 . The ratchet  122  can allow the second section  110  to travel through the lumen  118  in one direction, but limit travel through the lumen  118  in the opposite direction. 
     The bone tie  100  can be configured for altering the motion at the facet joints of the vertebral column. In some embodiments, the bone tie  100  can prevent motion of the facet joint. In some embodiments, the bone tie  100  can limit or reduce motion of the facet joint. In some embodiments, the bone tie  100  can limit motion to a range depending on the tightening of the loop of the bone tie  100 . In some methods of use, the bone tie promotes fusion of the facet joints. 
     The bone tie  100  can be configured for altering the spacing at the facet joints of the vertebral column. In some embodiments, the bone tie  100  can reduce the spacing. In some embodiments, the bone tie  100  can maintain the anatomical spacing. The bone tie  100  can be a retaining member for anchoring a prosthesis or implant within the facet joint. In some embodiments, the bone tie  100  can pass through a central opening of the prosthesis or implant when the prosthesis or implant is inserted within the facet joint space. The bone tie  100  can be adapted for securing the location of the prosthesis or implant with respect to at least one of the articular surfaces. 
     The prosthesis or implant can have any shape or configuration. The prosthesis or implant can be substantially disc shaped. The first side of the prosthesis or implant can be concave, convex, or flat. The second side of the prosthesis or implant can be concave, convex, or flat. The shape can be determined based on a shape of a bone portion that the first side and the second side are configured to contact. In some embodiments, the prosthesis or implant fits entirely within the joint disc space. The prosthesis or implant can include any biocompatible material, e.g., stainless steel, titanium, PEEK, nylon, etc. 
     The bone tie  100  can have a width of 0.5 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, 4 mm, or any range of the foregoing values. The width of the bone tie  100  can vary along the length of the bone tie  100 . The bone tie  100  can have a thickness of 0.5 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, 4 mm, or any range of the foregoing values. The thickness of the bone tie  100  can vary along the length of the bone tie  100 . The bone tie  100  can have a length of 10 mm, 20 mm, 30 mm, 40 mm, 50 mm, 60 mm, 70 mm, 80 mm, 90 mm, 100 mm, 110 mm, 120 mm, 130 mm, 140 mm, 150 mm, 160 mm, 170 mm, 180 mm, 190 mm, 200 mm, or any range of the foregoing values. For example, the bone tie  100  can have a length of 175 mm. In some embodiments, the second section  110  or the gears  128  can have a length of 5 mm, 10 mm, 15 mm, 20 mm, 25 mm, 30 mm, 35 mm, 40 mm, 45 mm, 50 mm, 60 mm, 65 mm, 70 mm, 75 mm, 80 mm, or any range of the foregoing values. 
     The bone tie  100  can be manufactured from any of a variety of materials known in the art, including but not limited to a polymer such as polyetheretherketone (PEEK), polyetherketoneketone (PEKK), polyethylene, fluoropolymer, hydrogel, or elastomer; a ceramic such as zirconia, alumina, or silicon nitride; a metal such as titanium, titanium alloy, cobalt chromium or stainless steel; or any combination of the materials described herein. The bone tie  100  can include any biocompatible material, e.g., stainless steel, titanium, PEEK, nylon, etc. In some embodiments, the bone tie  100  comprises at least two materials. The bone tie  100  can include a reinforcement piece disposed within the bone tie  100 . By selecting a particular configuration and the one or more materials for the bone tie  100 , the bone tie  100  can be designed to have the desired flexibility and resiliency. 
     In some embodiments, the bone tie  100  can form a unitary structure. The bone tie  100  can be integrally formed from the proximal end  102  to the distal end  104 . In some embodiments, the bone tie  100  can include one or more unitarily formed sections along the length of the bone tie  100 . One or more of the fastener section  106 , the first section  108 , the second section  110 , the third section  112 , the neck section  114 , and the head section  116  can be unitarily formed. In some embodiments, the bone tie  100  can include one or more separately formed sections along the length of the bone tie  100 . One or more of the fastener section  106 , the first section  108 , the second section  110 , the third section  112 , the neck section  114 , and the head section  116  can be separately formed. In some embodiments, the marker  144  is separately formed. In some embodiments, the bone tie  100  can form a monolithic structure. The bone tie  100  can be monolithically formed or separately formed. The bone tie  100  can be formed of the same or similar material. The sections of the bone tie  100  can be formed of the same or similar construction. In some embodiments, the bone tie  100  is formed from an injection molding process. 
     In some embodiments, the shape of the first section  108 , the second section  110 , and/or the third section  112  can be determined based on the shape of an artificial lumen formed through an articular process of a vertebra. In some embodiments, the shape of the artificial lumen is cylindrical, the shape of the head  136  can be rounded or spherical to allow the head  136  to slideably advance through the artificial lumen. In some embodiments, the shape of the artificial lumen has a cross-sectional dimension or diameter greater than the cross-sectional dimension or diameter of the head  136  to allow the head  136  to slideably advance through the artificial lumen. The head  136  can have a larger cross-sectional dimension or diameter than the first section  108 , the second section  110 , the third section  112 , and the neck section  114  to allow the first section  108 , the second section  110 , the third section  112 , and the neck section  114  to easily slide within the artificial lumen. 
     In some embodiments, the characteristic of the bone tie  100  can vary along the length of the bone tie  100 . The characteristics can vary between one or more of the fastener section  106 , the first section  108 , the second section  110 , the third section  112 , the neck section  114 , and the head section  116 . In some embodiments, each section has different characteristics. In some embodiments, the flexibility of the bone tie  100  varies along the length of the bone tie  100 . In some embodiments, the torsional strength of the bone tie  100  varies along the length of the bone tie  100 . In some embodiments, the resistance to deformation or elongation of the bone tie  100  varies along the length of the bone tie  100 . In some embodiments, the characteristic of the bone tie  100  vary based, at least in part, on the shape of the various sections. 
     In some embodiments, the characteristic of the bone tie  100  vary based on the material of the various sections. In some embodiments, the characteristic of the bone tie  100  vary along the length based, at least in part, on a reinforcement piece. The reinforcement piece can be separately formed from or integrally formed with the bone tie  100 . The reinforcement piece can comprise a different material or material property. In some embodiments, the reinforcement piece is disposed within a section of the bone tie  100 . The reinforcement piece can be disposed within the fastener section  106 , the first section  108 , the second section  110 , the third section  112 , the neck section  114 , the head section  116 , any combination of the foregoing, or disposed only within one or more sections of the foregoing. The reinforcement piece can increase the strength of a section of the bone tie  100 . In some embodiments, the reinforcement piece has a substantially uniform shape. The shape, material, or other characteristics of the reinforcement piece can be selected depending on the desired bending and/or torsion characteristics of the material chosen. The reinforcement piece can increase or decrease bending strength. The reinforcement piece can increase or decrease torsion strength. Any shape, material, or other property of the reinforcement piece can be selected to achieve the desired bending and/or torsion strength of the bone tie  100 . In some embodiments, the reinforcement piece is radiopaque. In some embodiments, the reinforcement piece is radiolucent. 
     3. Bone Tie Advancer 
       FIGS. 6-8  depict views of an embodiment of a bone tie advancer  200 .  FIG. 6  illustrates a perspective front view.  FIG. 7  illustrates a perspective front view of a distal portion.  FIG. 8  illustrates a perspective back view of a distal portion. The bone tie advancer  200  can include a proximal end  202  and a distal end  204 . 
     The bone tie advancer  200  can include a proximal handle  206 . The proximal handle  206  can be any shape configured to be gripped by the user. The proximal handle  206  can include one or more grooves designed to accommodate the fingers of the user. The proximal handle  206  can be shaped for right-handed use, left-handed use, or ambidextrous use. The proximal handle  206  can include an impact cap  208 . The impact cap  208  can have a flat proximal end to allow a force to be applied. 
     The bone tie advancer  200  can include a shaft  210 . The shaft  210  can extend distally from the proximal handle  206 . The shaft  210  can include an upper portion  212 . The upper portion  212  can be cylindrical. The upper portion  212  can have one or more cylindrical sections of varying diameters. The upper portion  212  can include a stepped surface. The upper portion  212  can have any cross-sectional shape including round, square, rectangular, polygonal, oval, or any other shape. The upper portion  212  can be an elongate member. The upper portion  212  can lie along a longitudinal axis  250 . 
     The shaft  210  can include a tapered portion  214 . The tapered portion  214  can be distal to the upper portion  212  of the shaft  210 . The tapered portion  214  can have a narrower cross-section toward the distal end  204 . The tapered portion  214  can be frusto-conical. The tapered portion  214  can have a reduced cross-section relative to the upper portion  212  of the shaft  210  to enable the shaft  210  to be positioned relative to the patient&#39;s anatomy. The tapered portion  214  can lie along the longitudinal axis  250 . The tapered portion  214  can taper inward relative to the longitudinal axis  250 . The upper portion  212  and the tapered portion  214  can be coaxial. 
     The shaft  210  can include a curved portion  216 . The curved portion  216  can be distal to the tapered portion  214  of the shaft  210 . The curved portion  216  can have a substantially constant width. The curved portion  216  can have a reduced cross-section relative to the upper portion  212  of the shaft  210  to enable the shaft  210  to be positioned relative to the patient&#39;s anatomy. The curved portion  216  can be shaped to be inserted within the artificial lumen of the bone portions. The curved portion  216  can be shaped according to the lumen-forming tool that creates the lumen in the bone portions. The curved portion  216  can have a constant radius of curvature. The curved portion  216  can curve away from the longitudinal axis  250  of the upper portion  212 . The curved portion  216  can extend laterally from the longitudinal axis  250  of the upper portion  212 . 
       FIGS. 7 and 8  are enlarged views of the distal portion of the bone tie advancer  200 . The curved portion  216  can include a rounded surface  218 . The rounded surface  218  can extend distally from the tapered portion  214 . The rounded surface  218  can be proximal-facing. The shaft  210  can include a planar surface  220 . The planar surface  220  can be distal-facing. The planar surface  220  can form the outside curve of the curved portion  216 . The rounded surface  218  can form the inside curve of the curved portion  216 . The planar surface  220  can extend along at least a portion of the curved portion  216 . The planar surface  220  can extend along at least a portion of the tapered portion  214 . 
     The shaft  210  can include an advancer portion  222 . The advancer portion  222  can be configured to interface with the bone tie  100 . The advancer portion  222  can be located at or near the distal end  204  of the bone tie advancer  200 . The advancer portion  222  can include a curved surface  224 . The curved surface  224  can correspond to the curvature of the head  136 . The curved surface  224  can cup the head  136 . The curved surface  224  can curve around the distal-facing portion of the head  136 . The curved surface  224  can allow the force of the bone tie advancer  200  to be transferred to the head  136 . The curved surface  224  can allow movement of the bone tie advancer  200  to be transferred to the head  136 . The curved surface  224  can form the distal end  204  of the bone tie advancer  200 . The advancer portion  222  can include a tapered surface  226 . The tapered surface  226  can be proximal-facing. The tapered surface  226  can allow visualization and clearance relative to the patient&#39;s anatomy. The advancer portion  222  can include retaining arms  230 . The retaining arms  230  can extend proximally from the curved surface  224  and can be separately formed from or integrally formed with the curved surface  224 . The retaining arms  230  can engage the flange  138 . The retaining arms  230  can engage the second tapered surface  142  of the flange  138 . The retaining arms  230  can engage the neck section  114 . The interior portion of the retaining arms  230  can be rounded, tapered, or any other shape corresponding to the flange  138 , second tapered surface  142  and/or neck section  114 . The retaining arms  230  can facilitate secure engagement of the bone tie  100  for insertion of the bone tie  100  within the artificial lumen of the bone portions. 
     The advancer portion  222  can include a channel  228 . The channel  228  can correspond to the shape of the neck section  114  of the bone tie  100 . The neck section  114  of the bone tie  100  can be disposed within the channel  228  when the curved surface  224  abuts the head  136 . The channel  228  can be formed by three sides. The three sides can include rounded edges. The three sides can have any shape to accept the bone tie  100 . The channel  228  can include an open side. The open side can be distal-facing. The channel  228  can surround a portion of the neck section  114  of the bone tie  100 . When the neck section  114  of the bone tie  100  is disposed within the channel  228 , the curved surface  224  can align and abut the head  136 . The channel  228  can increase the contact between the advancer portion  222  and the bone tie  100 . 
     4. Bone Tie Retriever 
       FIGS. 9-13  depict views of an embodiment of a bone tie retriever  300 .  FIG. 9  illustrates a perspective front view.  FIG. 10  illustrates a perspective front view of a distal portion.  FIG. 11  illustrates a front view of a distal portion.  FIG. 12  illustrates a cross-sectional view of the distal portion.  FIG. 13  illustrates a cross-sectional view of the distal portion. The bone tie retriever  300  can include a proximal end  302  and a distal end  304 . 
     The bone tie retriever  300  can include a proximal handle  306 . The proximal handle  306  can be any shape configured to be gripped by the user. The proximal handle  306  can include one or more grooves designed to accommodate the fingers of the user. The proximal handle  306  can be shaped for right-handed use, left-handed use, or ambidextrous use. The proximal handle  306  can include an impact cap  308 . The impact cap  308  can have a flat proximal end to allow a force to be applied. The proximal handles  206 ,  306  can be the same or similar. The proximal handles  206 ,  306  can be mirror images. In some embodiments, the proximal handle  206  can be designed for use with the right hand of the user and the proximal handle  306  can be designed for use with the left hand of the user. The proximal handles  206 ,  306  can be different. The proximal handles  206 ,  306  can include a different visual indicator to indicate the different functions of the bone tie advancer  200  and the bone tie retriever  300 . In some embodiments, the proximal handles  206 ,  306  can be different colors or include a visual marking. 
     The bone tie retriever  300  can include a shaft  310 . The shaft  310  can extend distally from the proximal handle  306 . The shaft  310  can include an upper portion  312 . The upper portion  312  can be cylindrical. The upper portion  312  can have one or more cylindrical sections of varying diameters. The upper portion  312  can include a stepped surface. The upper portion  312  can have any cross-sectional shape including round, square, rectangular, polygonal, oval, or any other shape. The upper portion  312  can be an elongate member. The upper portion  312  can lie along a longitudinal axis  350 . The upper portions  212 ,  312  can be the same or substantially similar. The shaft  310  can include a retriever portion  314 . The retriever portion  314  can be distal to the upper portion  312  of the shaft  310 . 
       FIG. 10  illustrates an enlarged view of a distal portion of the bone tie retriever  300 . The retriever portion  314  can be shaped to receive the head  136  of the bone tie  100 . The retriever portion  314  can include a channel  316 . The channel  316  can include a rounded portion  320 . The rounded portion  320  can include a curvature corresponding to the head  136  of the bone tie  100 . The channel  316  can be concave along the longitudinal axis  350 . 
     The channel  316  can include a ledge  318 . The ledge  318  can be flat, curved, or tapered. The ledge  318  can include a curvature that corresponds to the curvature of the head  136 . The ledge  318  can be dimensioned to allow for pivotal and/or rotational movement of the head  136  within the channel  316 . In some embodiments, the ledge  318  can have a curved or poly-axial surface configured to accept the head  136 . In some embodiments, the ledge  318  can be concave. In some embodiments, the ledge  318  can have a concavity that corresponds to a convexity of the head  136 . The concavity of the ledge  318  can allow the head  136  to pivot and/or rotate while still retaining the head  136  within the channel  316 . The ledge  318  can allow the head  136 , and thus the bone tie  100 , to pivot 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, 90°, 100°, 110°, 120°, 130°, 140°, 150°, 160°, 170°, 180°, or any range of the foregoing values. In particular embodiments, the ledge  318  can allow the head  136 , and thus the bone tie  100 , to pivot 60°, 70°, 80°, 90°, or any range of the foregoing values. The ledge  318  can allow the head  136  to abut and rotate against the ledge  318 . 
     The retriever portion  314  can include an opening  322 . The opening  322  can be located at or near the distal end  304 . The ledge  318  surrounds the opening  322 . The ledge  318  can be shaped to allow the neck section  114  to pass through the opening  322 . The ledge  318  can be shaped to prevent the head  136  from passing through the opening  322 . The ledge  318  can be sized according to the corresponding bone tie  100 . 
     The retriever portion  314  can include one or more retention features  324 . In the illustrated embodiment, the retriever portion  314  includes two retention features  324 . The one or more retention features  324  narrow the channel  316  near the distal end  304 . The channel  316  extends through the one or more retention features  324 . The one or more retention features  324  can be disposed near the ledge  318 . The one or more retention features  324  can function to retain the head  136  when the head  136  is seated against the ledge  318 . 
     In some embodiments, the channel  316  may be dimensioned to allow entry of the head  136 , or the head  136  and neck section  114 , in generally one particular orientation. In some embodiments, the channel  316  may be dimensioned to allow entry of the head  136 , or the head  136  and neck section  114 , in a range of orientations. In some embodiments, the channel  316  may be dimensioned to allow entry of the head  136  wherein the neck section  114  is generally perpendicular to the longitudinal axis  350  of the shaft  310 . In some embodiments, the channel  316  may be dimensioned to allow retention of the head  136  wherein the neck section  114  is generally parallel to or coaxial with the longitudinal axis  350 . In some embodiments, the channel  316  is configured to allow the neck section  114  to pass between the one or more retention features  324 . In some embodiments, the retriever portion  314  is configured to allow the neck section  114  to pivot, or pivot and rotate, from extending between the one or more retention features  324  to extending into the opening  322 . In some embodiments, the retriever portion  314  is configured to allow the neck section  114  to pivot, or pivot and rotate, from the opening  322  to the channel  316 . In some embodiments, the channel  316  is configured to prevent or limit the head  136  from passing between the one or more retention features  324 . 
     5. Methods of Use 
       FIGS. 14 and 15  illustrate the bone tie  100 , the bone tie advancer  200 , and the bone tie retriever  300  in relation to vertebrae during methods of use.  FIGS. 14 and 15  illustrate the bone tie  100 , the bone tie advancer  200 , and the bone tie retriever  300 . The proximal ends are visible and the distal ends are disposed within lumens in the vertebrae.  FIG. 15  is a close-up view of  FIG. 14 .  FIG. 16  is a cross-sectional view illustrating a placement of the bone tie  100  and the bone tie retriever  300  in relation to the vertebrae. 
     The bone tie  100  can be configured to stabilize or fuse adjacent vertebrae. The bone tie  100  can be used to fuse a vertebra V1 and vertebra V2 via the inferior articular process IAP 1 A of vertebra V1 and the superior articular process SAP 2 A of vertebra V2. In some methods of use, a second bone tie  100  can be used to fuse a vertebra V1 and vertebra V2 via the inferior articular process IAP 1 B of vertebra V1 and the superior articular process SAP 2 B of vertebra V2. In some embodiments, vertebra V1 and vertebra V2 are fused using only one of bone tie  100 . In some embodiments, one bone tie  100  can be used to stabilize vertebra V1 and vertebra V2 via one of the inferior articular process IAP 1 A of vertebra V1 and the superior articular process SAP 2 A of vertebra V2, or, via the inferior articular process IAP 1 B of vertebra V1 and the superior articular process SAP 2 B of vertebra V2. In some embodiments, two bone ties  100  can be used to stabilize vertebra V1 and vertebra V2 via both of the inferior articular process TAP 1 A of vertebra V1 and the superior articular process SAP 2 A of vertebra V2, and, the inferior articular process IAP 1 B of vertebra V1 and the superior articular process SAP 2 B of vertebra V2. The methods described herein can be repeated for any pair of an inferior articular process and a superior articular process. 
     In some methods of use, a lumen is formed through the articular processes. The lumen can be formed with a lumen-forming tool, such as a drill, tissue punch, or reamer. The lumen is formed through one or more articular processes of the vertebrae to facilitate implantation of the bone tie  100 . In some embodiments, at least a portion of the lumen has a curved or non-linear configuration. In some embodiments, at least a portion of the lumen has a straight or linear configuration. In some methods of use, two or more lumens are formed. A drill or other device can be used to form a lumen in superior articular process SAP of vertebra V2 and inferior articular process IAP of vertebra V1. Specifically, the drill can be used to form the lumen in a facet of superior articular process SAP of vertebra V2 and to form the lumen in a facet of inferior articular process IAP of vertebra V1. In some embodiments, one lumen-forming tool forms one or more lumens. In some embodiments, two lumen-forming tools are utilized to form two lumens. 
     In some methods of use, a portion of the surface of the facet of SAP and IAP can be prepared for fusion. In some methods of use, a portion of the surface of the facet can be ground, scored, roughened, or sanded, such that the surface of the facet can better adhere to any substances to aid in fusion and/or otherwise fuse more readily to an implant or prosthesis. In some methods of use, the surgical procedure can include preparing the area near and/or around the vertebra by, for example, removing all or a portion of ligaments, cartilage, and/or other tissue. In some methods of use, the area near and/or around a facet joint can be prepared by removing all or a portion of the facet joint capsule. The implant or prosthesis, if provided, can be inserted between the superior articular process SAP of vertebra V2 and inferior articular process IAP of vertebra V1. 
       FIG. 16  illustrates a cross-sectional view of the vertebrae. The bone tie  100 , the bone tie advancer  200  (not shown in  FIG. 16 ), and the bone tie retriever  300  can be located within lumens as described herein. The first lumen  400  can be curved. The first lumen  400  can extend from a first vertebra toward a second vertebra. The first lumen  400  can extend through the facet joint space. The second lumen  402  can be straight. The second lumen  402  can extend downward from a surface of the second vertebra. The second lumen  402  can extend only through the second vertebra. The second lumen  402  can intersect the first lumen  400 . 
     The bone tie  100  can be positioned within and adjacent to the bone tie advancer  200 . As the bone tie advancer  200  is moved by the user, the head section  116  and the neck section  114  is correspondingly moved. The bone tie  100  can be advanced through the first lumen  400  by the bone tie advancer  200 . The bone tie  100  can be advanced through the facet joint space by the bone tie advancer  200 . The bone tie  100  can be advanced through at least a portion of the second lumen  402  by the bone tie advancer  200 . In some embodiments, the bone tie  100  and the bone tie advancer  200  can have a bend or curve to facilitate directing the head  136  of the bone tie  100  into the lumen  400 . In some embodiments, the bone tie  100  and the bone tie advancer  200  can have a bend or curve corresponding to the curvature of the first lumen  400 . The bone tie  100  and the bone tie advancer  200  can have any shape that allows the passage through the first lumen  400  and into the second lumen  402 . 
     The bone tie  100  is advanced until the head  136  of bone tie  100  is positioned near the bone tie retriever  300 . The bone tie  100  is advanced until the head  136  of bone tie  100  is inserted into the channel  316 . The bone tie  100  and the bone tie advancer  200  can have any shape that allows the passage of the head  136  into the channel  316 . The bone tie  100  can be advanced until the head  136  abuts the inside wall of the retriever portion  314 . The bone tie  100  can be advanced until any further advancement is prevented by the retriever portion  314 . 
     During advancement, the head  136  of the bone tie  100  can be monitored under radiographic visualization. The head  136  can include one or more markers  144 . In the illustrated embodiment, the head  136  can include a bore  146  configured to receive the marker  144 . The marker  144  can facilitate visualization of the head  136  because the marker  144  can be radiopaque. The marker  144  can facilitate placement of the head  136  relative to the lumens  400 ,  402 . The marker  144  can facilitate placement of the head  136  relative to the retriever portion  314 . 
       FIGS. 17-18  illustrate the bone tie  100 , the bone tie advancer  200 , and the bone tie retriever  300  during methods of use.  FIG. 17  is a side view of the bone tie  100 , the bone tie advancer  200 , and the bone tie retriever  300 .  FIG. 18  is a perspective view of the bone tie  100 , the bone tie advancer  200 , and the bone tie retriever  300 . 
     The bone tie  100  can be coupled to the bone tie advancer  200 .  FIG. 17  illustrates the bone tie  100  coupled to the bone tie advancer  200 .  FIG. 18  is an enlarged view of the distal portion. The bone tie  100  can include the neck section  114  and the head section  116 . The bone tie advancer  200  can include the advancer portion  222 . The advancer portion  222  can couple to the head section  116  of the bone tie  100 . The advancer portion  222  can couple to the head  136  of the bone tie  100 . The advancer portion  222  can include a curved surface  224  that can grasp the head  136 . The advancer portion  222  can couple to the neck section  114  of the bone tie  100 . The advancer portion  222  can include a channel  228  that can grasp a portion of the neck section  114 . The advancer portion  222  can couple to the bone tie  100  prior to insertion of the bone tie  100 , or after bone tie  100  has been inserted, into a lumen in a bone portion. The movement of the bone tie advancer  200  can cause movement of the bone tie  100 . 
     The bone tie advancer  200  can move the head  136  of the bone tie  100  toward the bone tie retriever  300 . The retriever portion  314  can include the channel  316 . The channel  316  can be concave along the longitudinal axis  350  of the shaft  310 . The channel  316  can be shaped to receive the head  136  of the bone tie  100 . The head  136  can be inserted proximal to the one or more retention features  324 . The head  136  can be inserted along the length of the channel  316 . The head  136  can be inserted proximal to the ledge  318 . The head  136  can be inserted proximal to the opening  322 . 
     The head  136  enters the channel  316  when advanced by the bone tie advancer  200 . The neck section  114  enters the channel  316  when advanced by the bone tie advancer  200 . In some methods of use, the bone tie advancer  200  enters the channel  316 . In some methods of use, the bone tie advancer  200  does not enter the channel  316 . 
     The bone tie advancer  200  can be used to advance the bone tie  100  through the first lumen  400 . The first lumen  400  can be curved. The bone tie advancer  200  can include the curved portion  216 . The curved portion  216  can have the same or similar curvatures as the curved lumen  400 . The curved lumen  400  can be formed in the bone to allow passage of the bone tie advancer  200 . The user manipulates the proximal handle  206  to align the advancer portion  222  with the opening of the first lumen  400 . The user can pivot and/or rotate and translate the bone tie advancer  200  to move the bone tie advancer  200  and the bone tie  100  through the first vertebra V1. The user can pivot and/or rotate and translate the bone tie advancer  200  to move the bone tie advancer  200  and the bone tie  100  through the facet joint space. The user can pivot and/or rotate and translate the bone tie advancer  200  to move the bone tie advancer  200  and the bone tie  100  into the second vertebra V2. 
     The bone tie retriever  300  can be inserted into the second lumen  402 . The second lumen  402  can be generally straight. The second lumen  402  can extend distally beyond the first lumen  400 . The second lumen  402  can extend to a depth to allow the channel  316  of the bone tie retriever  300  to align with the first lumen  400  when the bone tie retriever  300  is within the second lumen  402 . The second lumen  402  can be any size or depth in order to accommodate the retriever portion  314  therewithin. The retriever portion  314  can be positioned within the second lumen  402  such that when the head section  116  is advanced from the first lumen  400 , the head section  116  is inserted along the length of the channel  316 . In some embodiments, the retriever portion  314  can be positioned within the second lumen  402  such that when the head section  116  is advanced from the first lumen  400 , the head section  116 , or the head section  116  and at least a portion of the neck section  114 , is inserted along the length of the channel  316 . The retriever portion  314  can be positioned such that the head  136  is inserted proximal to the one or more retention features  324 . In some embodiments, the distal end  304  of the bone tie retriever  300  can be recessed below the first lumen  400  when the bone tie retriever  300  is received within the second lumen  402 . 
       FIGS. 19-21  illustrate the bone tie  100  and the bone tie retriever  300  during methods of use.  FIG. 19  is a perspective view of the bone tie  100  and the bone tie retriever  300  in a first orientation.  FIG. 20  is a perspective view of the bone tie  100  and the bone tie retriever  300  in a second orientation.  FIG. 21  is a distal view of the bone tie  100  and the bone tie retriever  300  in the second orientation. 
       FIG. 19  is a perspective view of the bone tie  100  and the bone tie retriever  300  in a first orientation. In some methods of use, the head  136  of the bone tie  100  is inserted into the bone tie retriever  300  in generally one particular orientation. In some methods of use, the neck section  114  of the bone tie  100  is perpendicular to the longitudinal axis  350  of the bone tie retriever  300  when the bone tie  100  is inserted into the bone tie retriever  300 . In some methods of use, the head  136  of the bone tie  100  is inserted into the bone tie retriever  300  in a range of orientations. In some methods of use, the neck section  114  of the bone tie  100  is generally skewed to the longitudinal axis  350  of the bone tie retriever  300  when the bone tie  100  is inserted into the bone tie retriever  300 . In some methods of use, the neck section  114  of the bone tie  100  can be any angle to the longitudinal axis  350  of the bone tie retriever  300  including 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, 90°, 100°, 110°, 120°, 130°, 140°, 150°, 160°, 170°, 180°, or any range of the foregoing values. In particular methods of use, the neck section  114  of the bone tie  100  can be any angle to the longitudinal axis  350  of the bone tie retriever  300  including 60°, 70°, 80°, 90°, 100°, 110°, 120°, or any range of the foregoing values. 
       FIG. 20  is a perspective view of the bone tie  100  and the bone tie retriever  300  in a second orientation.  FIG. 21  is a distal view of the bone tie  100  and the bone tie retriever  300  in the second orientation. In some methods of use, the neck section  114  of the bone tie  100  is generally aligned with the longitudinal axis  350  of the bone tie retriever  300  when the bone tie  100  is pivoted. In some methods of use, the neck section  114  of the bone tie  100  can be any angle to the longitudinal axis  350  of the bone tie retriever  300  including 0°, 5°, 10°, 15°, 20°, 25°,30°, 35°,40°, 45°, 50°, 55°, 60°, or any range of the foregoing values. 
     In some methods of use, the head  136  of the bone tie  100  is configured to slide within the channel  316 . In some methods of use, the head  136  slides distally within the channel  316 . The channel  316  can include the ledge  318 . The ledge  318  can include a curvature that corresponds to the curvature of the head  136 . The ledge  318  can be dimensioned to allow for pivotal and/or rotational movement of the head  136  within the channel  316 . In some embodiments, the ledge  318  can have a curved or poly-axial surface configured to accept the head  136 . In some embodiments, the ledge  318  can be concave. In some embodiments, the ledge  318  can have a concavity that corresponds to a convexity of the head  136 . The ledge  318  can allow the head  136  to abut and rotate against the ledge  318 . The one or more retention features  324  can allow the head  136  to be seated and rotate within the distal portion of the bone tie retriever  300 . As the head  136  slides distally, the neck section  114  slides between the one or more retention features  324 . 
     The concavity of the ledge  318  can allow the head  136  to pivot and/or rotate while still retaining the head  136  within the channel  316 . The ledge  318  can allow the head  136 , and thus the bone tie  100 , to pivot and/or rotate. In some methods of use, the bone tie  100  can pivot approximately 90°. In some methods of use, the bone tie  100  pivots 30°, 40°, 50°, 60°, 70°, 80°, 90°, 100°, 110°, 120°, 130°, 140°, 150°, or any range of the foregoing values. 
     In some embodiments, the channel  316  may be dimensioned to allow retention of the head  136  when the neck section  114  is generally parallel or coaxial to the longitudinal axis  350  of the shaft  310 . In some embodiments, the channel  316  is configured to allow the neck section  114  to pass between the one or more retention features  324 . In some embodiments, the retriever portion  314  is configured to allow the neck section  114  to pivot, or pivot and rotate, from extending between the one or more retention features  324  into the opening  322 . The opening  322  can be located at or near the distal end  304 . The ledge  318  surrounds the opening  322 . The ledge  318  can be shaped to support the head  136  when the bone tie  100  is pivoted and/or rotated. The ledge  318  and/or the one or more retention features  324  can be shaped to constrain the head  136  when the bone tie  100  is pivoted and/or rotated. 
     The bone tie  100  can be retracted by the bone tie retriever  300 . The bone tie retriever  300  can be pulled distally from the second lumen  402 . The neck section  114  can pivot and/or rotate to extend distally from the bone tie retriever  300  as the bone tie  100  is pulled proximally. The one or more retention features  324  can limit or prevent lateral movement of the head  136  when the bone tie is in the second orientation relative to the bone tie retriever  300 . The one or more retention features  324  can facilitate retention of the head  136  within the channel  316 . The bone tie retriever  300  can pull the bone tie  100  through the second lumen  402 . The bone tie retriever  300  can pull the bone tie  100  until the distal end  104  of the bone tie  100  is outside of the lumen  402 . 
     In some methods of use, the proximal end  102  and the distal end  104  can be outside of the vertebrae after use of the bone tie advancer  200  and bone tie retriever  300 . The bone tie  100  can form a curved shape. In some methods of use, a portion of the second section  110  can be disposed within the lumens  400 ,  402 . In some methods of use, a portion of the third section  112  can be disposed within the lumens  400 ,  402 . In some methods of use, a portion of the second section  110  and a portion of the third section  112  can be disposed within the lumens  400 ,  402  when the proximal end  102  and the distal end  104  are outside of the vertebrae. 
     In some methods of use, the head section  116  can be removed. The bone tie  100  can be cut or severed near the neck section  114 . The bone tie  100  can be cut or severed to remove the head section  116 . The bone tie  100  can be cut or severed to remove the head section  116  and a portion of the neck section  114 . The head section  116  can be discarded. The head section  116  and a portion of the neck section  114  can be discarded. The neck section  114  can be advanced through the lumen  118  of the fastener section  106 . While the neck  114  is being advanced, the ratchet  122  can extend into the groove  132 . The third section  112  can be advanced through the lumen  118 . While the third section  112  is being advanced, the ratchet  122  can extend into the groove  130 . The second section  110  can be advanced through the lumen  118 . While the second section  110  is being advanced, the ratchet  122  can extend into the groove  126 . The ratchet  122  can engage the one or more gears  128 . The ratchet  122  can allow the second section  110  to travel through the lumen  118  in one direction, but limit or prevent travel in the opposite direction. 
     The bone tie  100  can form a loop. The fastener section  106  can be secured to the second section  110 . Securing the fastener section  106  can be based on the type of fastener member used. By way of example, securing the fastener section  106  can include inserting the opposite end of the bone tie  100  into the lumen  118  of the fastener section  106 , and advancing the opposite end through the fastener section  106 . The fastener section  106  can engage the one or more gears  128  of the second section  110 . The one or more gears  128  can be shaped to allow each gear  128  to displace the ratchet  122  of fastener section  106  in only one direction. 
     After the bone tie  100  is secured, superior articular process SAP of vertebra V2 can fuse to inferior articular process IAP of vertebra V1. Fusing can include one or more of bone material from superior articular process SAP of vertebra V2, bone material from inferior articular process IAP of vertebra V1, and/or the implant or prosthesis that fuses superior articular process SAP of vertebra V2 to inferior articular process IAP of vertebra V1. In some embodiments, after superior articular process SAP of vertebra V2 is fused to inferior articular process IAP of vertebra V1, the bone tie  100  is not removed. In some embodiments, after superior articular process SAP of vertebra V2 is fused to inferior articular process IAP of vertebra V1, all or a portion of the bone tie  100  can be removed. In some embodiments, the bone tie  100  can be removed after fusion of superior articular process SAP of vertebra V2 to inferior articular process IAP of vertebra V1 has started, but has not finished. In some embodiments, the bone tie  100  may comprise a bioabsorbable or bioresorbable material. 
     In use, the bone tie  100  can be configured to stabilize a first vertebra and/or a second vertebra by securing an articular process of the first vertebra to an articular process of a second vertebra. More specifically, the bone tie  100  can be configured to stabilize the first vertebra and/or a second vertebra by securing an articular process of the first vertebra to an articular process of a second vertebra. The bone tie  100  can be placed into a suitable position relative to the first vertebra and/or the second vertebra, and a distal portion of the bone tie  100  can be inserted into the lumen of the fastener section  106 . The bone tie  100  can be configured to substantially encircle at least a portion of the first vertebra and the second vertebra. In some methods of use, the bone tie  100  forms a loop about the articular process of the first vertebra and the articular process of the second vertebra. In some methods of use, the neck section  114  and the third section  112  can be advanced through the fastener section  106  such that the area disposed within the loop formed by the bone tie  100  is reduced. 
     As the bone tie  100  is tightened, the bone tie  100  exerts a compressive force on the articular process of the first vertebra and the articular process of the second vertebra. In some methods of use, the implant or prosthesis can be disposed between the articular process of the first vertebra and the articular process of the second process such that a desired distance between the articular process of the first vertebra and the articular process of the second process is maintained. The implant or prosthesis can be retained within a loop or other defined segment of the bone tie  100 . In some methods of use, the excess portion of the second section  110  and/or the third section  112  can be removed once the bone tie  100  is tightened. In some embodiments, the excess portion of the bone tie  100  can be removed from the space around the vertebrae. The excess portion of the bone tie  100  can be removed by cutting or breaking the excess portion of the bone tie  100 . The excess portion can be removed without loosening or removing the loop formed by the bone tie  100  around the first vertebra and the second vertebra. 
       FIG. 22  is a flow chart for a method of using the bone tie  100 .  FIG. 23  illustrates a view of the vertebrae.  FIG. 24  is a view of the spine with a coronal plane deformity.  FIG. 25  is a view of the bone tie  100  positioned to correct a coronal plane deformity. The bone tie  100  can be positioned around the transverse processes of adjacent vertebrae. The bone tie  100  can be positioned via the bone tie advancer  200 . The bone tie  100  can be captured by the bone tie retriever  300 . In some embodiments, the surgeon can position the bone tie  100  without the bone tie advancer  200 . In some embodiments, the surgeon can capture the bone tie  100  without the bone tie retriever  300 . In some embodiments, the surgeon can position the bone tie manually, depending on the anatomical location of fixation and the patient&#39;s anatomy. Manual positioning can be by hand and/or by use of one or more of various tools. 
     The bone tie  100  can be configured to correct a deformity of adjacent vertebrae. The bone tie  100  can be configured to provide a torque or rotational force. The bone tie  100  can be configured to stabilize the vertebrae in a corrected position. The bone tie  100  can be configured to fuse the vertebrae in a corrected position. The bone tie  100  can be anchored to one or more specific anatomical locations to provide the appropriate torque. The bone tie  100  can include one or more fastener portions to anchor the bone tie  100  to the spinous process and/or the transverse process with one or more fasteners. The bone tie  100  can include one or more fastener portions to anchor the bone tie  100  to any anatomical portion of vertebra V1 and/or any anatomical portion of vertebra V2 with one or more fasteners. 
     The bone tie  100  can be used to fuse the vertebra V1 and vertebra V2 via the transverse process TP 1 A of vertebra V1 and the transverse process TP 2 A of vertebra V2. In some methods of use, a second bone tie  100  can be used to fuse the vertebra V1 and vertebra V2 via the transverse process TP 1 B of vertebra V1 and the transverse process TP 2 B of vertebra V2. In some embodiments, the rotational alignment of vertebra V1 and vertebra V2 is corrected using only one bone tie  100 . In some embodiments, one bone tie  100  can be used to correct vertebra V1 and vertebra V2 via the right transverse process TP 1 A of vertebra V1 and the right transverse process TP 2 A of vertebra V2, or, via the left transverse process TP 1 B of vertebra V1 and the left transverse process TP 2 B of vertebra V2. For an example reference herein, the transverse processes TP 1 A, TP 2 A are on the right when viewed from the front of the patient and the transverse processes TP 1 B, TP 2 B are on the left when viewed from the front of the patient. In some embodiments, two bone ties  100  can be used to stabilize vertebra V1 and vertebra V2. In some embodiments that utilize two bone ties  100 , one bone tie  100  is positioned around the transverse process TP 1 A of vertebra V1 and the transverse process TP 2 A of vertebra V2 (shown in  FIG. 23 ) and another bone tie is positioned around the transverse process TP 1 B of vertebra V1 and the transverse process TP 2 B of vertebra V2 (not shown). In some embodiments that utilize two bone ties  100 , two bone ties  100  are positioned around the transverse process TP 1 A of vertebra V1 and the transverse process TP 2 A of vertebra V2. Other configurations are contemplated. In some embodiments, the two bone ties  100  exert the same rotational force. In some embodiments, the two bone ties  100  exert a different rotational force. The methods described herein can be repeated for any pair of transverse processes. 
     In some methods of use, a pathway is formed around the transverse processes. The pathway can be formed with any tool, such as a dilator or retractor. The pathway can be formed via a posterior approach to the spine. The pathway can be formed via a lateral approach to the spine. The pathway can be formed via minimally invasive surgical techniques. The pathway can be formed via any of a variety of approaches to the spine. The pathway is formed around two or more transverse processes of vertebrae to facilitate implantation of the bone tie  100 . In some embodiments, at least a portion of the pathway has a curved or non-linear configuration. In some embodiments, at least a portion of the pathway has a straight or linear configuration. In some methods of use, two or more pathways are formed. In some embodiments, one tool forms one or more pathways. In some embodiments, two tools are utilized to form two pathways. 
     In some methods of use, a portion of the surface of the transverse process can be prepared for receiving bone tie  100 . In some methods of use, a portion of the surface of the transverse process can be ground, scored, roughened, or sanded, such that the surface of the transverse process can better receive the bone tie  100 . In some methods of use, the surgical procedure can include preparing the area near and/or around the transverse processes by, for example, removing all or a portion of ligaments, cartilage, and/or other tissue. 
     In some methods, the facet joint is prepared prior to securing the bone tie  100  around the transverse processes. In some methods of use, the area near and/or around a facet joint can be prepared by removing all or a portion of the facet joint capsule. The implant or prosthesis, if provided, can be inserted between the superior articular process SAP of vertebra V2 and inferior articular process IAP of vertebra V1. 
     In some methods of use, a portion of the vertebra can be prepared for fusion. In some methods of use, an intervertebral implant is inserted between the superior and inferior vertebrae. The intervertebral implant can be a cage configured to be packed with material to promote fusion. The intervertebral implant can comprise a metal or polymer material. The intervertebral implant can comprise bony material from the patient, a donor, or a synthetic source. In some methods of use, the area near and/or around the intervertebral disc space can be prepared by removing all or a portion of the intervertebral disc. 
     The bone tie  100  can be advanced around a first transverse process of a first vertebra. The bone tie  100  can be advanced around a second transverse process of a second vertebra. The bone tie  100  can be advanced by the bone tie advancer  200 . In some embodiments, the bone tie  100  and the bone tie advancer  200  can have a bend or curve to facilitate directing the head  136  of the bone tie  100  around the transverse processes. In some embodiments, the bone tie  100  and the bone tie advancer  200  can have a bend or curve corresponding to the curvature of the transverse process. In some embodiments, the bone tie advancer  200  is selected from a plurality of bone tie advancers  200  having different curvatures. The bone tie  100  and the bone tie advancer  200  can have any shape that allows the passage around the transverse processes. The bone tie  100  and the bone tie advancer  200  can have any shape that allows the passage of the head  136  around the transverse processes. 
     During advancement, the head  136  of the bone tie  100  can be monitored under radiographic visualization. The head  136  can include one or more markers  144 . In the illustrated embodiment, the head  136  can include the bore  146  configured to receive the marker  144 . The marker  144  can be radiopaque. The marker  144  can facilitate placement of the head  136  relative to the transverse process. The marker  144  can facilitate placement of the head  136  relative to the retriever portion  314  if the bone tie retriever  300  is utilized. The bone tie  100  can be retracted by the bone tie retriever  300  from a position below the transverse process to a position above the transverse process. The bone tie retriever  300  can be pulled to facilitate forming the loop around the transverse processes. 
     The bone tie  100  is configured to form a loop around the transverse processes. In some embodiments, the bone tie  100  is configured to form a loop around the transverse processes on one side of the spine such as the right side. The bone tie  100  is configured to bring the transverse processes together. In some embodiments, the bone tie  100  is configured to form a u-shaped configuration until the bone tie  100  is secured. The u-shaped configuration can extend underneath the transverse processes. A portion of the bone tie  100  is underneath the transverse processes while the head  136  and the fastener section  106  can be above the transverse processes. 
     In some methods of use, the head section  116  can be removed after the bone tie  100  is positioned underneath the transverse processes. The bone tie  100  can be cut or severed near the neck section  114 . The bone tie  100  can be cut or severed to remove the head section  116  and a portion of the neck section  114 . The head section  116  can be discarded. 
     The bone tie  100  can be fastened to form a loop. The neck section  114  can be advanced through the lumen  118  of the fastener section  106 . While the neck  114  is being advanced, the ratchet  122  can extend into the groove  132 . The third section  112  can be advanced through the lumen  118  of the fastener section  106 . While the third section  112  is being advanced, the ratchet  122  can extend into the groove  130 . The second section  110  can be advanced through the lumen  118  of the fastener section  106 . While the second section  110  is being advanced, the ratchet  122  can extend into the groove  126 . The ratchet  122  can engage the one or more gears  128 . The ratchet  122  can allow the second section  110  to travel through the lumen  118  of the fastener section  106  in one direction, but limit or prevent travel in the opposite direction. 
     The bone tie  100  can be tightened in one direction. The bone tie  100  can be tightened by advancing a portion of the bone tie  100  through the fastener section  106 . The fastener section  106  can be tightened along the length of the bone tie  100 . In some methods of use, the neck section  114 , the third section  112 , and at least a portion of the second section  100  can be advanced through the fastener section  106  such that the area disposed within the loop formed by the bone tie  100  is reduced. The fastener section  106  can engage the one or more gears  128  of the second section  110 . The one or more gears  128  can be shaped to allow each gear  128  to displace the ratchet  122  of fastener section  106  in only one direction. The bone tie  100  can be tightened until flush with the transverse processes. The bone tie  100  can be tightened until the transverse processes are moved into the desired positon. The bone tie  100  can be tightened until no further tightening is allowed. 
     The bone tie  100  can be tightened to exert a force on the vertebrae. The bone tie  100  can be tightened to exert a torque on the vertebrae. The bone tie  100  can be tightened to correct a condition of the vertebrae. The bone tie  100  can apply a force to the transverse processes to correct a deformity. The bone tie  100  can correct a coronal plane deformity. The bone tie  100  can apply a force to the transverse processes to correct a scoliosis. The bone tie  100  can apply a force to the transverse processes to correct lateral scoliosis. 
     In some methods, the bone tie  100  remains in place to correct the deformity. In some methods, the bone tie  100  is removed after the deformity is corrected. In some methods, the bone tie  100  is removed and replaced. In some methods, the bone tie  100  is replaced with another bone tie that further corrects the coronal plane deformity. In some methods, the bone tie  100  is replaced with another bone tie that exerts a stronger force or torque. In some embodiments, the bone tie  100  may comprise a bioabsorbable or bioresorbable material. 
     In use, the bone tie  100  can be configured to stabilize the first vertebra and the second vertebra by securing the transverse process of the first vertebra to the transverse process of the second vertebra. The bone tie  100  can be placed into a suitable position relative to the first vertebra and the second vertebra. The bone tie  100  can be placed into a suitable position that allows a distal portion of the bone tie  100  to be inserted into the lumen  118  of the fastener section  106 . In some embodiments, the fastener section  106  is positioned near one of the transverse processes once the bone tie  100  is tightened. In some embodiments, the fastener section  106  is positioned between the transverse processes once the bone tie  100  is secured. In some embodiments, the fastener section  106  is positioned over the top or exposed surface of the transverse processes once the bone tie  100  is tightened. The bone tie  100  can be configured to substantially encircle at least a portion of the first vertebra and the second vertebra. In some methods of use, the bone tie  100  forms a loop about the transverse process of the first vertebra and the transverse process of the second vertebra. 
     As the bone tie  100  is tightened, the bone tie  100  exerts a compressive force on the transverse process of the first vertebra and the transverse process of the second vertebra. In some methods of use, this compressive force is spaced a distance away from the intervertebral disc. The compressive force can therefore apply a torque to the spinal column to correct a deformity or scoliosis of the patient. 
       FIG. 26  is a flow chart for a method of using the bone tie  100 .  FIG. 27  illustrates a view of the vertebrae.  FIG. 28  is a view of the spine with a rotational deformity.  FIG. 29  is a view of the bone tie  100  positioned to correct or improve the condition of a rotational deformity. The bone tie  100  can be positioned around the spinous process of the first vertebra and around the transverse process of the second vertebra. The bone tie  100  can be positioned via the bone tie advancer  200 , for instance to wrap around the transverse process. The bone tie  100  can be captured by the bone tie retriever  300 , for instance to wrap around the transverse process. In some embodiments, the surgeon can position the bone tie  100  without the bone tie advancer  200 . In some embodiments, the surgeon can capture the bone tie  100  without the bone tie retriever  300 . In some embodiments, the surgeon can position the bone tie  100  manually around the spinous process. In some embodiments, the surgeon can position the bone tie  100  manually around the transverse process. Manual positioning can be by hand and/or by use of one or more of various tools. 
     The bone tie  100  can be configured to provide a rotational correction. The bone tie  100  can be configured to provide a torque on adjacent vertebrae. The bone tie  100  can be anchored to one or more specific anatomical locations to provide the appropriate torque. The bone tie  100  can include one or more fastener portions to anchor the bone tie  100  to the spinous process and/or the transverse process with one or more fasteners. The bone tie  100  can include one or more fastener portions to anchor the bone tie  100  to any anatomical portion of vertebra V1 and/or any anatomical portion of vertebra V2 with one or more fasteners. Examples of bone ties can be found in U.S. application Ser. Nos. 13/033,791, 13/403,698, and 16/751,883 which are hereby incorporated in their entirety. Additional examples of bone ties including those with anchoring portions can be found in U.S. application Ser. Nos. 13/804,407 and 13/804,521 which are hereby incorporated in their entirety. The bone tie  100  can pull the spinous process toward the transverse process. The bone tie  100  can pull the transverse process toward the spinous process. The bone tie  100  can pull the transverse process and the spinous process together. The bone tie  100  can be configured to stabilize the vertebrae in a rotationally corrected position. The bone tie  100  can be configured to facilitate the fusion of the vertebrae in a rotationally corrected position. 
     The bone tie  100  can be used to couple the vertebra V1 and vertebra V2 via the spinous process SP 1  of vertebra V1 and the transverse process TP 2 A of vertebra V2. The transverse process TP 2 A of vertebra V2 is located on the right of the patient when viewed from the front. The bone tie  100  can be used to pull the spinous process SP 1  of vertebra V1 toward the right if coupled with the transverse process TP 2 A of vertebra V2, when viewed from the front of the patient. The bone tie  100  can be used to pull the spinous process SP 1  of vertebra V1 toward the left if coupled with the transverse process TP 2 B of vertebra V2, when viewed from the front of the patient. The bone tie  100  can be used to pull the spinous process SP 2  of vertebra V2 toward the right if coupled with the transverse process TP 1 A of vertebra V1. The bone tie  100  can be used to pull the spinous process SP 2  of vertebra V2 toward the left if coupled with the transverse process TP 1 B of vertebra V1. 
     In some methods, two bone ties  100  can be used to couple the vertebra V1 and vertebra V2 via the spinous process SP 1  of vertebra V1 and the transverse processes TP 2 A, TP 2 B of vertebra V2. In some methods, two bone ties  100  can be used to couple the vertebra V1 and vertebra V2 via the spinous process SP 2  of vertebra V2 and the transverse processes TP 1 A, TP 1 B of vertebra V1. The bone ties  100  can apply equal forces. The bone ties  100  can apply unequal forces. The bone ties  100  can be used to align the spinous process SP 1  of vertebra V1 with the spinous process SP 2  of vertebra V2 by applying equal forces. The bone ties  100  can be used to correct the rotation of the spinous process SP 1  of vertebra V1 by applying unequal forces. 
     In some methods, two bone ties  100  can be used to couple the vertebra V1, vertebra V2, and vertebra V 3  via the spinous process SP 1  of vertebra V1 and the transverse processes, TP 2 A of vertebra V2 and TP 3 A of vertebra V 3  (not shown). The bone tie  100  can be used to pull the spinous process SP 1  of vertebra V1 toward the right if coupled with the transverse process TP 2 A of vertebra V2 and the transverse process TP 3 A of vertebra V 3 , when viewed from the front of the patient. In some methods, two bone ties  100  can be used to couple the vertebra V1, vertebra V2, and vertebra V 3  via the spinous process SP 1  of vertebra V1 and the transverse processes, TP 2 B of vertebra V2 and TP 3 B of vertebra V 3 . The bone tie  100  can be used to pull the spinous process SP 1  of vertebra V1 toward the left if coupled with the transverse process TP 2 B of vertebra V2 and the transverse process TP 3 B of vertebra V 3  when viewed from the front of the patient. 
     In some embodiments, the rotational correction of vertebra V1 and vertebra V2 is corrected using only one bone tie  100 . In some embodiments, one bone tie  100  can be used to correct vertebra V1 and vertebra V2 via coupling the spinous process to either the right transverse process or the left transverse process. In some embodiments, two bone ties  100  can be used to correct vertebra V1 and vertebra V2 via both of the right and left transverse processes. In some embodiments, two bone ties  100  can be used to correct vertebra V1 and vertebra V2 via two right transverse processes or two left transverse processes. The methods described herein can be repeated for any pair of spinous process and transverse process. 
     In some methods of use, a pathway is formed around the transverse process. In some methods of use, a pathway is formed around the spinous process. The pathway can be formed with any tool, such as a dilator or retractor. The pathway can be formed via a posterior approach to the spine. The pathway can be formed via a lateral approach to the spine. The pathway can be formed via minimally invasive surgical techniques. The pathway can be formed via any of a variety of approaches to the spine. The pathway is formed around the transverse process and the spinous process to facilitate implantation of the bone tie  100 . In some embodiments, at least a portion of the pathway has a curved or non-linear configuration. In some embodiments, at least a portion of the pathway has a straight or linear configuration. 
     In some methods of use, a portion of the surface of the transverse process can be prepared for coupling with the bone tie  100 . In some methods of use, a portion of the surface of the spinous process can be prepared for coupling with the bone tie  100 . In some methods of use, a portion of the surface of the transverse process and/or spinous process can be ground, scored, roughened, or sanded, such that the surface of the transverse process and/or spinous process can better receive the bone tie  100 . In some methods of use, the surgical procedure can include preparing the area near and/or around the transverse process and/or spinous process by, for example, removing all or a portion of ligaments, cartilage, and/or other tissue. 
     In some methods, the facet joint is prepared prior to securing the one or more bone ties  100  around the transverse process and spinous process. In some methods of use, the area near and/or around a facet joint can be prepared by removing all or a portion of the facet joint capsule. The implant or prosthesis, if provided, can be inserted between the superior articular process SAP of vertebra V2 and inferior articular process IAP of vertebra V1. 
     In some methods of use, a portion of the vertebra can be prepared for fusion. In some methods of use, an intervertebral implant is inserted between the superior and inferior vertebrae. The intervertebral implant can be a cage configured to be packed with material to promote fusion. The intervertebral implant can comprise a metal or polymer material. The intervertebral implant can comprise bony material from the patient, a donor, or a synthetic source. In some methods of use, the area near and/or around the intervertebral disc space can be prepared by removing all or a portion of the intervertebral disc. 
     The bone tie  100  can be advanced around the transverse process of the first vertebra. The bone tie  100  can be advanced around the spinous process of the second vertebra. The bone tie  100  can be advanced by the bone tie advancer  200 . In some embodiments, the bone tie  100  and the bone tie advancer  200  can have a bend or curve to facilitate directing the head  136  of the bone tie  100  around the transverse process. In some embodiments, the bone tie  100  and the bone tie advancer  200  can have a bend or curve to facilitate directing the head  136  of the bone tie  100  around the spinous process. The bone tie  100  and the bone tie advancer  200  can have any shape that allows the passage around the transverse process and/or the spinous process. 
     During advancement, the head  136  of the bone tie  100  can be monitored under radiographic visualization. During advancement, the surgeon can directly monitor the head  136  of the bone tie  100 . The spinous process can be exposed such that the surgeon can visualize the pathway around the spinous process. The transverse process can be exposed such that the surgeon can visualize the pathway around the transverse process. The surgeon can manually pass the bone tie  100  around the spinous process. The surgeon can manually pass the bone tie  100  around the transverse process. The bone tie  100  can be pulled by the distal end  104  to facilitate forming the loop around the transverse process and the spinous process. The bone tie  100  can be pushed by the proximal end  102  to facilitate forming the loop around the transverse process and the spinous process. 
     The bone tie  100  is configured to form a loop around the transverse process and the spinous process. In some embodiments, the bone tie  100  is configured to form a loop around the transverse process on one side of the spine such as the right side. In some embodiments, the bone tie  100  is configured to form a u-shaped configuration around the transverse process until the bone tie  100  is tightened. The u-shaped configuration can extend underneath the transverse process. In some embodiments, the bone tie  100  is configured to form a u-shaped configuration around the spinous process until the bone tie  100  is tightened. The u-shaped configuration can extend around the spinous process. 
     In some methods of use, the head section  116  can be removed after the bone tie  100  is positioned underneath the transverse process. In some methods of use, the head section  116  can be removed after the bone tie  100  is positioned around the spinous process. The head section  116  can facilitate movement by the bone tie advancer  200  underneath the transverse process. The head section  116  can facilitate capture by the bone tie receiver  300  underneath the transverse process. In some methods, the bone tie advancer  200  and the bone tie receiver  300  can be utilized when passage of the bone tie  100  is visually obstructed. In some methods of use, the head section  116  can be removed after the bone tie  100  is positioned around the transverse process and/or the spinous process. The bone tie  100  can be cut or severed. The head section  116  can be discarded after positioning around the transverse process and around the spinous process. 
     The bone tie  100  can form a loop by inserting the distal end into the lumen  118  of the fastener section  106 . The loop can be subsequently reduced in diameter. The second section  110  of the bone tie  100  can be advanced through the lumen  118  of the fastener section  106  to engage the ratchet  122  with the gears  128 . The ratchet  122  can allow the second section  110  to travel through the lumen  118  in one direction through the fastener section  106 , but limit or prevent travel of the second section  110  through the fastener section  106  in the opposite direction. 
     The loop of the bone tie  100  can be tightened. The bone tie  100  can be tightened by further advancing a portion of the bone tie  100  through the fastener section  106 . In some methods of use, the neck section  114 , the third section  112 , and at least a portion of the second section  100  can be advanced through the fastener section  106  such that the area disposed within the loop formed by the bone tie  100  is reduced by tightening. The fastener section  106  can be secured when the ratchet  122  engages a gear  128 . 
     The bone tie  100  can be tightened to achieve rotational correction. The bone tie  100  can be tightened to exert a torque on the vertebrae. The bone tie  100  can be tightened to correct a rotational condition of the vertebrae. The bone tie  100  can apply a torque to the spinous process to correct a deformity. The bone tie  100  can correct a spinous process deformity. 
     In some methods, the bone tie  100  remains in place to correct the rotational deformity. In some methods, the bone tie  100  is removed after the rotational deformity is corrected. In some methods, the bone tie  100  is removed and replaced. In some methods, the bone tie  100  is replaced with another bone tie that further corrects the rotational deformity. In some methods, the bone tie  100  is replaced with another bone tie that exerts a stronger torque. 
     In use, the bone tie  100  can be configured to stabilize the first vertebra and the second vertebra by securing the transverse process of the first vertebra to the spinous process of the second vertebra or vice versa. The bone tie  100  can be placed into a suitable position relative to the first vertebra and the second vertebra. The bone tie  100  can be placed into a suitable position that allows a distal portion of the bone tie  100  to be inserted into the lumen  118  of the fastener section  106 . In some embodiments, the fastener section  106  is positioned near the transverse process once the bone tie  100  is tightened. In some embodiments, the fastener section  106  is positioned between the transverse process and the spinous process once the bone tie  100  is tightened. In some embodiments, the fastener section  106  is positioned over the top or exposed surface of the transverse process or spinous process once the bone tie  100  is tightened. The bone tie  100  can be configured to substantially encircle at least a portion of the first vertebra and the second vertebra. In some methods of use, the bone tie  100  forms a loop at least partially around the transverse process of the first vertebra and the spinous process of the second vertebra. In some methods of use, the bone tie  100  forms a loop at least partially around the spinous process of the first vertebra and the transverse process of the second vertebra. 
     As the bone tie  100  is tightened and subsequently secured, the bone tie  100  exerts a rotational force on the spinous process. The spinous process can move as a result of the force. As the bone tie  100  is tightened and subsequently secured, the bone tie  100  exerts a rotational force on the transverse process. The transverse process can move as a result of the force. In some embodiments the spinous process and the transverse process are brought together. In some methods of use, the force by the bone tie  100  is spaced a distance away from the intervertebral disc producing a torque. The torque can achieve rotational correction of the spinal column. The torque can correct a rotational deformity of the patient. 
       FIG. 30  is a flow chart for a method of using the bone tie  100 .  FIG. 31  illustrates a view of the vertebrae.  FIG. 32  is a view of the spine with a sagittal plane deformity.  FIG. 33  is a view of the bone tie positioned to correct or improve the condition of a sagittal plane deformity. The bone tie  100  can be positioned around the lamina of adjacent vertebrae. The bone tie  100  can be positioned via the bone tie advancer  200 . The bone tie advancer  200  can facilitate passing the bone tie  100  under the lamina. The bone tie  100  can be captured by the bone tie retriever  300 . The bone tie retriever  300  can facilitate retrieval of the bone tie  100  once the bone tie  100  is passed under the lamina. The bone tie advancer  200  and the bone tie retriever  300  can be utilized when the pathway around the anatomy is obstructed or difficult. In some embodiments, the surgeon can position the bone tie  100  without the bone tie advancer  200 . In some embodiments, the surgeon can position the bone tie  100  without the bone tie retriever  300 . In some embodiments, the surgeon can position the bone tie  100  manually around one or more of the lamina of adjacent vertebrae. Manual positioning can be by hand and/or by use of one or more of various tools. 
     The bone tie  100  can be configured to achieve a sagittal correction. The bone tie  100  can be configured to correct lordosis. The bone tie  100  can be configured to provide a torque or rotational force. The bone tie  100  can be configured to correct the curvature of the spine. The bone tie  100  can be configured to reduce bowing of the spine. The bone tie  100  can be anchored to one or more specific anatomical locations to provide the appropriate torque. The bone tie  100  can include one or more fastener portions to anchor the bone tie  100  to the spinous process and/or the transverse process with one or more fasteners. The bone tie  100  can include one or more fastener portions to anchor the bone tie  100  to any anatomical portion of vertebra V1 and/or any anatomical portion of vertebra V2 with one or more fasteners. 
     The bone tie  100  can be used to align vertebra V1 and vertebra V2 via the lamina of vertebra V1 and the lamina of vertebra V2. The bone tie  100  can be used to align vertebra V1 and vertebra V2 via the lamina to the right of the spinous process SP 1  of vertebra V1 and the lamina to the right of the spinous process SP 2  of vertebra V2. The bone tie  100  can be used to align vertebra V1 and vertebra V2 via the lamina to the left of the spinous process SP 1  of vertebra V1 and the lamina to the left of the spinous process SP 2  of vertebra V2. 
     In some methods of use, a second bone tie  100  can be used to align vertebra V1 and vertebra V2 via the lamina of vertebra V1 and the lamina of vertebra V2. The first bone tie  100  can be used to align vertebra V1 and vertebra V2 via the lamina to the right of the spinous process SP 1  of vertebra V1 and the lamina to the right of the spinous process SP 2  of vertebra V2. The second bone tie  100  can be used to align vertebra V1 and vertebra V2 via the lamina to the left of the spinous process SP 1  of vertebra V1 and the lamina to the left of the spinous process SP 2  of vertebra V2. In some embodiments, the two bone ties  100  exert the same force. In some embodiments, the two bone ties  100  exert a different force. 
     The bone tie  100  can be used to align vertebra V1 and vertebra V2 via the lamina in a crossing pattern. The bone tie  100  can be used to align the vertebra V1 and vertebra V2 via the lamina to the right of the spinous process SP 1  of vertebra V1 and the lamina to the left of the spinous process SP 2  of vertebra V2. The bone tie  100  can be used to align the vertebra V1 and vertebra V2 via the lamina to the left of the spinous process SP 1  of vertebra V1 and the lamina to the right of the spinous process SP 2  of vertebra V2. 
     In some embodiments, the sagittal correction of vertebra V1 and vertebra V2 is achieved using only one bone tie  100 . In some embodiments, the sagittal correction of vertebra V1 and vertebra V2 is achieved using two or more of bone ties  100  (e.g., two bone ties  100 , three bone ties  100 , four bone ties  100 , etc.). One or more bone tie  100  can be positioned to the right of the spinous processes, SP 1 , SP 2 . One or more bone ties  100  can be positioned to the left of the spinous processes, SP 1 , SP 2 . Two or more bone ties  100  can be positioned to the right of the spinous processes, SP 1 , SP 2 , in spaced apart locations. Two or more bone ties  100  can be positioned on the left of the spinous processes, SP 1 , SP 2 , in spaced apart locations. The methods described herein can be repeated for any two or more lamina and at any number of locations along the spine. 
     In some methods of use, a pathway is formed around the lamina. The pathway can be formed with any tool, such as a dilator or retractor. The pathway can be formed via a posterior approach to the spine. The pathway can be formed via a lateral approach to the spine. The pathway can be formed via minimally invasive surgical techniques. The pathway can be formed via any of a variety of approaches to the spine. The pathway is formed around the lamina of the vertebrae to facilitate implantation of the bone tie  100 . In some embodiments, at least a portion of the pathway has a curved or non-linear configuration. In some embodiments, at least a portion of the pathway has a straight or linear configuration. In some methods of use, two or more pathways are formed. 
     In some methods of use, a portion of the surface of the lamina can be prepared to receive the bone tie  100 . In some methods of use, a groove can be formed in a portion of the surface of the lamina to receive the bone tie  100 . In some methods of use, a portion of the surface of the lamina can be ground, scored, roughened, or sanded, such that the surface of the lamina can better receive the bone tie  100 . In some methods of use, the surgical procedure can include preparing the area near and/or around the lamina by, for example, removing all or a portion of ligaments, cartilage, and/or other tissue. 
     In some methods, the facet joint is prepared prior to securing the one or more bone ties  100  around the lamina of adjacent vertebrae. In some methods of use, the area near and/or around a facet joint can be prepared by removing all or a portion of the facet joint capsule. The implant or prosthesis, if provided, can be inserted between the superior articular process SAP of vertebra V2 and inferior articular process IAP of vertebra V1. 
     In some methods of use, a portion of the vertebra can be prepared for fusion. In some methods of use, an intervertebral implant is inserted between the superior and inferior vertebrae. The intervertebral implant can be a cage configured to be packed with material to promote fusion. The intervertebral implant can comprise a metal or polymer material. The intervertebral implant can comprise bony material from the patient, a donor, or a synthetic source. In some methods of use, the area near and/or around the intervertebral disc space can be prepared by removing all or a portion of the intervertebral disc. 
     The bone tie  100  can be advanced around the first lamina of the first vertebra. The bone tie  100  can be advanced around the second lamina of the second vertebra. The bone tie  100  can be moved by the bone tie advancer  200 . In some embodiments, the bone tie  100  and the bone tie advancer  200  can have a bend or curve to facilitate directing the head  136  of the bone tie  100  around the lamina. In some embodiments, the bone tie advancer  200  is selected from a plurality of bone tie advancers  200  having different curvatures. The different curvatures can correspond to different anatomy. The curvature for the bone tie advancer  200  configured to move around the lamina can be different from the curvature for the bone tie advancer configured to move around the transverse process. The bone tie  100  and the bone tie advancer  200  can have any shape that allows the passage around the lamina. The bone tie  100  and the bone tie advancer  200  can have any shape that allows the passage of the head  136  to form a loop around the lamina. 
     During advancement, the head  136  of the bone tie  100  can be monitored under radiographic visualization. During advancement, the head  136  of the bone tie  100  can be visually inspected by the surgeon. The bone tie  100  can be pulled to facilitate forming the loop around the lamina. The bone tie  100  can be pushed to facilitate forming the loop around the lamina. 
     The bone tie  100  is configured to form a loop around the lamina. In some embodiments, the bone tie  100  is configured to form a loop around the lamina on one side of the spine such as the right side. In some embodiments, the bone tie  100  is configured to form a u-shaped configuration. The u-shaped configuration can extend underneath the lamina. In some methods of use, the head section  116  can be removed after the bone tie  100  is positioned underneath the lamina. The bone tie  100  can be cut or severed once the bone tie  100  is in the u-shaped configuration. The head section  116  can be discarded. 
     The bone tie  100  can form a loop by advancing a portion of the bone tie  100  through the fastener section  106 . The neck section  114  can be advanced through the lumen  118  of the fastener section  106 . The third section  112  can be advanced through the lumen  118  of the fastener section  106 . The second section  110 , or a portion thereof, can be advanced through the lumen  118  of the fastener section  106 . The ratchet  122  can engage the one or more gears  128 . The ratchet  122  can allow the second section  110  to travel through the lumen  118  in one direction to tighten the loop. 
     The bone tie  100  can be tightened around the lamina of adjacent vertebrae. The bone  100  can be tightened to exert a force on the vertebrae. The force can bring the vertebrae together. The force can achieve sagittal correction. The force can restore lordosis. The force can correct the curvature of the spine. The bone tie  100  can be tightened to exert a torque on the vertebrae. The torque can cause a rotational correction of the vertebrae. The torque can correct the sagittal alignment. 
     In some methods, the bone tie  100  remains in place for sagittal correction. In some methods, the bone tie  100  is removed after a period of time. In some methods, the bone tie  100  is removed after fusion of vertebrae. In some methods, the bone tie  100  is removed and replaced with another bone tie that exerts a stronger force or torque. 
     In use, the bone tie  100  can be configured to stabilize the first vertebra and/or a second vertebra by securing the lamina of the first vertebra to the lamina of the second vertebra. The bone tie  100  can be placed into a suitable position relative to the first vertebra and/or the second vertebra. The bone tie  100  can be placed into a suitable position that allows a distal portion of the bone tie  100  to be inserted into the lumen  118  of the fastener section  106  by the surgeon. In some embodiments, the fastener section  106  is positioned near one of the lamina. In some embodiments, the fastener section  106  is positioned between the lamina of adjacent vertebrae. In some embodiments, the fastener section  106  is positioned over the top or exposed surface of the lamina. The bone tie  100  can be configured to substantially encircle at least a portion of the first vertebra and the second vertebra. 
     As the bone tie  100  is tightened, the bone tie  100  exerts a compressive force on the lamina of the first vertebra and the lamina of the second vertebra. In some methods of use, this compressive force can allow for sagittal correction. The compressive force can restore lordosis. In some embodiments, the method can include applying tension to the bone tie  100  to set sagittal correction. The bone tie  100  can be tightened to achieve the desired correction. The bone tie  100  can be tightened to achieve the desired lordosis. 
       FIG. 34  is a flow chart for a method of using the bone tie  100 .  FIG. 35  illustrates a view of the vertebrae.  FIG. 36  is a view of the spine with a lumen being formed through the pedicle of a first vertebra and the lamina of a second vertebra.  FIG. 37  is a view of the bone tie  100  positioned through the lumen.  FIG. 38  is another view of the bone tie  100  positioned through the lumen. The bone tie  100  can be positioned through one or more vertebrae. The bone tie  100  can be positioned through a vertebral body. The bone tie  100  can be positioned through a pedicle. The bone tie  100  can be positioned through a lamina. The bone tie  100  can be positioned through an articular process. The bone tie  100  can be positioned through a vertebral body or a pedicle of an inferior vertebra. The bone tie  100  can be positioned through a lamina or articular process of a superior vertebrae. Other configurations are contemplated. Manual positioning can be by hand and/or by use of one or more of various tools. 
     The bone tie  100  can be configured to stabilize or fuse adjacent vertebrae. The bone tie  100  can be used to fuse vertebra V1 and vertebra V2 via lumens formed in vertebra V1 and vertebra V2. In some embodiments, a lumen is formed through the vertebral body or the pedicle of the inferior vertebra. In some embodiments, a lumen is formed through the lamina or articular process of the superior vertebrae. In some embodiments, a lumen is formed through any portions of the vertebra V1 and vertebra V2. In some embodiments, a lumen is formed through any aligned or coaxial portions of the vertebra V1 and vertebra V2. In some embodiments, a lumen is formed through any portions of the vertebra V1 and vertebra V2 connected via a straight or linear pathway. In some embodiments, a lumen is formed through any portions of the vertebra V1 and vertebra V2 connected via a curved or non-linear pathway. The pathway can be formed via a posterior approach to the spine. The pathway can be formed via a lateral approach to the spine. The pathway can be formed via minimally invasive surgical techniques. The pathway can be formed via any of a variety of approaches to the spine. 
     In some methods of use, a second bone tie  100  can be used to fuse vertebra V1 and vertebra V2 via a second lumen formed in vertebra V1 and vertebra V2. The second lumen can join similar portions of the vertebra V1 and vertebra V2. In some embodiments, a second lumen is formed through the vertebral body or the pedicle of the inferior vertebra. In some embodiments, a second lumen is formed through the lamina or articular process of the superior vertebrae. 
     In some embodiments, vertebra V1 and vertebra V2 are fused using only one bone tie  100 . In some embodiments, one bone tie  100  can be used to stabilize vertebra V1 and vertebra V2 by inserting the bone tie  100  through a formed lumen. In some embodiments, one bone tie  100  can be used to stabilize vertebra V1 and vertebra V2 on the right side of the spinous processes. In some embodiments, one bone tie  100  can be used to stabilize vertebra V1 and vertebra V2 on the left side of the spinous processes. In some embodiments, two bone tie  100  can be used to stabilize vertebra V1 and vertebra V2 by inserting each bone tie  100  through a formed lumen. In some embodiments, two bone ties  100  can be used to stabilize vertebra V1 and vertebra V2 on both the right and left sides of the spinous processes. The methods described herein can be repeated for any pair of vertebrae and at any number of locations along the spine. 
     In some methods of use, a lumen is formed through the vertebral body. In some methods of use, a lumen is formed through the pedicle. In some methods of use, a lumen is formed through the lamina. In some methods of use, a lumen is formed through the articular process. In some methods of use, a lumen is formed through any portion of the inferior vertebra. In some methods of use, a lumen is formed through any portion of the superior vertebra. The lumen can be formed with a lumen-forming tool, such as a drill, tissue punch, or reamer. The lumen-forming tool can form a linear lumen. The lumen-forming tool can form a non-linear lumen. The lumen is formed through the vertebrae to facilitate implantation of the bone tie  100 . In some embodiments, at least a portion of the lumen has a curved or non-linear configuration. In some embodiments, at least a portion of the lumen has a straight or linear configuration. In some methods of use, two or more lumens are formed. In some embodiments, one lumen-forming tool forms one or more lumens. In some embodiments, two lumen-forming tools are utilized to form two lumens. 
     In some methods of use, a portion of the vertebra can be prepared for fusion. In some methods of use, a portion of the vertebra can be ground, scored, roughened, or sanded, such that the portion of the vertebra can better adhere to any substances to aid in fusion and/or otherwise fuse more readily to an implant or prosthesis. In some methods of use, an intervertebral implant is inserted between the superior and inferior vertebrae. The intervertebral implant can be a cage configured to be packed with material to promote fusion. The intervertebral implant can comprise a metal or polymer material. The intervertebral implant can comprise bony material from the patient, a donor, or a synthetic source. In some methods of use, a facet implant is inserted between the superior articular process and the inferior articular process. The facet implant can be a disk configured to be packed with material to promote fusion. The facet implant can comprise a metal or polymer material. The facet implant can comprise bony material from the patient, a donor, or a synthetic source. In some methods of use, the surgical procedure can include preparing the area near and/or around the vertebra by, for example, removing all or a portion of ligaments, cartilage, and/or other tissue. In some methods of use, the area near and/or around the intervertebral disc space can be prepared by removing all or a portion of the intervertebral disc. In some methods of use, the area near and/or around the facet joint can be prepared by removing all or a portion of the facet joint capsule. The implant or prosthesis, if provided, can be inserted between portions of the vertebrae. 
     The bone tie  100 , the bone tie advancer  200 , and the bone tie retriever  300  can be located within lumens as described herein. In some embodiments, a straight lumen is formed between the inferior vertebra and the superior vertebra. The bone tie advancer  200  can be shaped to move the bone tie  100  through this lumen. The bone tie  100  can be positioned within and adjacent to the bone tie advancer  200 . As the bone tie advancer  200  is moved by the user, the head section  136  and the neck section  114  is correspondingly moved. The bone tie  100  can be advanced through the straight lumen by the bone tie advancer  200 . The bone tie  100  can be advanced through the vertebral body by the bone tie advancer  200 . The bone tie  100  can be advanced through the pedicle by the bone tie advancer  200 . The bone tie  100  can be advanced through the lamina by the bone tie advancer  200 . In some embodiments, the bone tie  100  and the bone tie advancer  200  can have a bend or curve to facilitate directing the head  136  of the bone tie  100  into the lumen. In some embodiments, the bone tie  100  and the bone tie advancer  200  can have straight or liner portion to facilitate directing the head  136  of the bone tie  100  into the lumen. The bone tie  100  and the bone tie advancer  200  can have any shape that allows the passage through the lumen formed in the vertebrae. In some embodiments, the bone tie  100  is advanced manually by the surgeon. In some embodiments, the bone tie  100  is advanced without the bone tie advancer  200 . 
     The bone tie retriever  300  can be positioned to receive the head  136  of the bone tie  100 . The bone tie  100  is advanced by the bone tie advancer  200  until the head  136  of bone tie  100  is positioned near the bone tie retriever  300 . The bone tie  100  is further advanced until the head  136  of bone tie  100  is inserted into the channel  316  of the bone tie retriever  300 . The bone tie  100  and the bone tie advancer  200  can have any shape that allows the passage of the head  136  into the channel  316 . The bone tie  100  can be advanced until the head  136  abuts the inside wall of the retriever portion  314 . The bone tie  100  can be advanced until any further advancement is prevented by the retriever portion  314 . The bone tie  100  can be retracted by the bone tie retriever  300 . The bone tie retriever  300  can be pulled to pull the head  136  of the bone tie  100  distally. The bone tie retriever  300  can be moved in any orientation to move the head  136  of the bone tie  100 . The neck section  114  can pivot and/or rotate to extend distally from the bone tie retriever  300  as the bone tie  100  is pulled proximally. In some embodiments, the bone tie  100  is retrieved manually by the surgeon. In some embodiments, the bone tie  100  is retrieved without the bone tie retriever  300 . 
     During advancement, the head  136  of the bone tie  100  can be monitored under radiographic visualization. The head  136  of the bone tie  100  can be monitored under radiographic visualization during passage through the lumen. The head  136  of the bone tie  100  can be monitored under radiographic visualization when the view of the bone tie  100  is obstructed. The head  136  of the bone tie  100  can be monitored under radiographic visualization when the head  136  cannot be visualized by the surgeon. The marker  144  on the head  136  can facilitate placement of the head  136  relative to the lumen. The marker  144  can facilitate placement of the head  136  relative to the retriever portion  314 . 
     The bone tie  100  can form a straight shape through the lumen extending between the vertebrae. The bone tie  100  can extend through the vertebral body or pedicle of the inferior vertebrae. The bone tie  100  can extend through the lamina or articular process of the superior vertebrae. In some methods of use, a portion of the second section  110  can be disposed within the lumen. In some methods of use, a portion of the third section  112  can be disposed within the lumen. In some methods of use, a portion of the second section  110  and a portion of the third section  112  can be disposed within the lumen when the proximal end  102  and the distal end  104  are outside of the vertebrae. 
     In some methods of use, the head section  116  can be removed to allow for tightening of the bone tie  100 . The head section  116  can be removed after the bone tie  100  is passed through the lumen. The head section  116  can be removed after the bone tie  100  wraps around a portion of the patient&#39;s anatomy. The head section  116  can be discarded in preparation for tightening the bone tie  100 . 
     In some methods, the neck section  114  can be advanced through the lumen  118  of the fastener section  106  after the head section  116  is severed. While the neck  114  is being advanced, the ratchet  122  can extend into the groove  132 . In some embodiments, the neck  114  does not include gears. The neck  114  can slide in both directions relative to the fastener section  106 . The bone tie  100  can form a loop once a portion of the bone tie  100  enters the lumen  118  of the fastener section  106 . 
     The third section  112  can be advanced through the lumen  118  of the fastener section  106 . While the third section  112  is being advanced, the ratchet  122  can extend into the groove  130 . In some embodiments, the third section  112  does not include gears. The third section  112  can slide in both directions relative to the fastener section  106 . 
     The second section  110  can be advanced through the lumen  118  of the fastener section  106 . While the second section  110  is being advanced, the ratchet  122  can extend into the groove  126 . The ratchet  122  can engage the one or more gears  128  located in the second section  110 . The ratchet  122  can allow the second section  110  to travel through the lumen  118  of the fastener section  106  in one direction to further tighten the bone tie  100 . The ratchet  122  can allow the second section  110  to travel through the lumen  118  of the fastener section  106  in one direction to reduce the diameter of the loop of the bone tie  100 . The ratchet  122  can allow the second section  110  to travel through the lumen  118  of the fastener section  106  in one direction to apply a tension or force or torque on the underlying anatomy. The ratchet  122  can allow the second section  110  to travel through the lumen  118  of the fastener section  106  in one direction to correct a rotational alignment. The ratchet  122  can allow the second section  110  to travel through the lumen  118  of the fastener section  106  in one direction to bring the vertebrae together. 
     The ratchet  122  can limit or prevent travel in the opposite direction. The ratchet  122  can limit or prevent travel that can loosen the bone tie  100 . The ratchet  122  can limit or prevent travel that can increase the diameter of the loop of the bone tie  100 . The ratchet  122  can limit or prevent travel that can lessen the tension or force or torque on the underlying anatomy. The ratchet  122  can limit or prevent movement of the vertebrae. The ratchet  122  can limit or prevent rotation of the vertebrae. The bone tie  100  can be tightened to achieve the desired clinical outcome. 
     The bone tie  100  is secured by the ratchet  122  engaging a gear  128 . Once the desired tension in the bone tie  100  is achieved, the bone tie  100  will maintain this tension by engagement of the ratchet  122  with the gear  128 . The bone tie  100  will only be able to be further tensioned. The bone tie  100  is not configured to loosen under normal anatomical loads. 
     After the bone tie  100  is secured, the superior vertebra can fuse to inferior vertebra. Fusion can include one or more bone material from the superior vertebra and/or bone material from the inferior vertebra. Fusion can include an implant or prosthesis positioned between adjacent vertebrae. In some embodiments, after vertebrae are fused, the bone tie  100  is removed. In some embodiments, after vertebrae are fused, the bone tie  100  is not removed. In some embodiments, the bone tie  100  may comprise a bioabsorbable or bioresorbable material. 
     In use, the bone tie  100  can be configured to stabilize the first vertebra and the second vertebra by securing a portion of the first vertebra to a portion of a second vertebra. More specifically, the bone tie  100  can be configured to stabilize the first vertebra and the second vertebra by securing the vertebral body or pedicle of the first vertebra to the lamina or articular process of a second vertebra. The bone tie  100  can be placed into a suitable position relative to the first vertebra and the second vertebra. The bone tie  100  can be configured to extend through the lumen to substantially encircle at least a portion of the first vertebra and the second vertebra. In some methods of use, the bone tie  100  extends through a straight lumen between the vertebrae. In some methods of use, the bone tie  100  forms a loop after extending through the straight lumen. In some methods of use, the bone tie  100  forms a loop through the vertebral body of the inferior vertebra. In some methods of use, the bone tie  100  forms a loop through the pedicle of the inferior vertebra. In some methods of use, the bone tie  100  forms a loop though the lamina of the superior vertebra. In some methods of use, the bone tie  100  forms a loop though the articular process of the superior vertebra. In some methods of use, the bone tie  100  forms a loop around a portion of the spine after extending through the lumen. 
     As the bone tie  100  is tightened, the bone tie  100  exerts a compressive force on the first vertebra and the second vertebra. In some methods of use, this compressive force is spaced a distance away from the intervertebral disc. The compressive force can therefore apply a torque to the spinal column to correct a deformity or scoliosis of the patient or improve the condition of a deformity or scoliosis of the patient. In some methods, the bone tie  100  can be configured to provide a torque or rotational force. In some methods, the compressive force does not apply a torque. The bone tie  100  can be configured to stabilize the vertebrae in a corrected position. The bone tie  100  can be configured to fuse the vertebrae in a corrected position. The bone tie  100  can be anchored to one or more specific anatomical locations to provide the appropriate torque. The bone tie  100  can include one or more fastener portions to anchor the bone tie  100  to the spinous process and/or the transverse process with one or more fasteners. The bone tie  100  can include one or more fastener portions to anchor the bone tie  100  to any anatomical portion of vertebra V1 and/or any anatomical portion of vertebra V2 with one or more fasteners. 
     In some methods of use, the implant or prosthesis can be disposed between the first vertebra and the second vertebrae such that a desired distance between the first vertebra and the second vertebrae is maintained. In some methods of use, the excess portion of the second section  110  and/or the third section  112  can be removed once the bone tie  100  is tightened. The excess portion of the bone tie  100  can be removed by cutting or breaking the excess portion of the bone tie  100 . The excess portion can be removed without loosening or removing the loop formed by the bone tie  100  around the first vertebra and the second vertebra. 
     The method can include tightening the bone tie  100 . The method can include advancing the bone tie  100  along the ratchet  122 . Each of gears  128  can be wedge shaped to allow each of gears  128  to displace the ratchet  122  of the fastener section  106  in only one direction. In some embodiments, gears  128  can be other shapes including rectangular in cross-section. The gears  128  can extend along a portion of the length of the bone tie  100 . As each gear  128  passes through the ratchet  122 , the shape of the gear  128  prevents loosening of the bone tie  100 . Travel of the bone tie  100  can be limited to the distance or length of the gear  128 . 
     The bone tie  100  can have any shape. The bone tie  100  can have a shape to conform to a portion of the bone. In some methods, the fastener section  106  can be configured to remain within the body of the patient. The fastener section  106  can be near the proximal end  102 . The fastener section  106  can have a shape configured to conform to the shape of the bone. The fastener section  106  can have a flat surface configured to engage bone. The ratchet  122  can be disposed within a lumen. The lumen can prevent encroachment of tissue relative to the ratchet  122 . The fastener section  106  can have an enlarged head configured to distribute forces to the bone. The fastener section  106  can have an enlarged head configured to prevent subsidence into bone. 
     In some methods, the first section  108  can be configured to remain within the body of the patient. The first section  108  can be closer to the proximal end  102  than the distal end  104 . The first section  108  can have a first cross-sectional shape configured to conform to the shape of the bone. The first section  108  can be rounded. The rounded surface or edges may facilitate engagement with a rounded lumen or pathway. The first section  108  can have a flat surface configured to contact bone. The flat surface can be configured to distribute forces to the bone. The flat surface can prevent subsidence into bone. The flat surface can be on a back side of the bone tie  100 . 
     In some methods, the second section  110  can be configured to remain within the body of the patient. In some methods, a portion of the second section  110  can be configured to remain within the body of the patient. In some methods, a portion of the second section  110  is cut after tightening to remove excess length of the bone tie  100 . The second section  110  can be closer to the proximal end  102  than the distal end  104 . The second section  110  can have a first cross-sectional shape configured to conform to the shape of the bone. The second section  110  can be rounded. The rounded surface or edges may facilitate engagement with a rounded lumen or pathway. The second section  110  can have a flat surface configured to contact bone. The flat surface can be configured to distribute forces to the bone. The flat surface can prevent subsidence into bone. The flat surface can be on a back side of the bone tie  100 . The flat surface can be opposite the gears  128 . The gears  128  can be disposed within a groove  126 . The groove  126  can prevent encroachment of tissue relative to the gears  128 . The second section  110  can have raised edges relative to the gears  128 . The raised edges can slide along corresponding groves in the lumen  118  of the fastener section  106 . The raise edges can facilitate alignment of the gears  128  with the ratchet  122 . 
     In some methods, the third section  112 , or a portion thereof, can be configured to remain within the body of the patient. In some methods, the third section  112  is cut after tightening to remove excess length of the bone tie  100 . The third section  112  can have raised edges relative to the groove  130 . The raised edges can slide along corresponding groves in the lumen  118  of the fastener section  106 . The raised edges of the second section  110  and the third section  112  can be continuous. 
     The first section  108 , the second section  110 , and the third section  112  can be any portion of the length of the bone tie  100 . In some embodiments, the second section  110  is at least 30% of the length of the bone tie  100 . In some embodiments, the third section  112  is at least 30% of the length of the bone tie  100 . Other configurations are contemplated. The first section  108  can be 5% of the total length, 10% of the total length, 15% of the total length, 20% of the total length, 25% of the total length, 30% of the total length, 35% of the total length, 40% of the total length, 45% of the total length, 50% of the total length, or any range of the foregoing values. The second section  110  can be 5% of the total length, 10% of the total length, 15% of the total length, 20% of the total length, 25% of the total length, 30% of the total length, 35% of the total length, 40% of the total length, 45% of the total length, 50% of the total length, 55% of the total length, 60% of the total length, 65% of the total length, 70% of the total length, 75% of the total length, 80% of the total length, 85% of the total length, 90% of the total length, 95% of the total length, or any range of the foregoing values. The third section  112  can be 5% of the total length, 10% of the total length, 15% of the total length, 20% of the total length, 25% of the total length, 30% of the total length, 35% of the total length, 40% of the total length, 45% of the total length, 50% of the total length, or any range of the foregoing values. In some embodiments, the length of second section  110  can be about equal to the length of the third section  112 . In some embodiments, the length of second section  110  can be greater than the length of the third section  112 . In some embodiments, the length of second section  110  can be less than the length of the third section  112 . 
     The bone tie  100  can be configured to loop around at least a portion of the anatomy. In some embodiments, the bone tie  100  completely encircles the anatomy. In some embodiments, the bone tie  100  completely encircles the transverse process. In some embodiments, the bone tie  100  completely encircles the spinous process. In some embodiments, the bone tie  100  completely encircles the lamina. In some embodiments, the bone tie  100  partially encircles the anatomy of the patient. The bone tie  100  can contact or wrap around 5% of the anatomy of the patient, 10% of the anatomy of the patient, 15% of the anatomy of the patient, 20% of the anatomy of the patient, 25% of the anatomy of the patient, 30% of the anatomy of the patient, 35% of the anatomy of the patient, 40% of the anatomy of the patient, 45% of the anatomy of the patient, 50% of the anatomy of the patient, 55% of the anatomy of the patient, 60% of the anatomy of the patient, 65% of the anatomy of the patient, 70% of the anatomy of the patient, 75% of the anatomy of the patient, 80% of the anatomy of the patient, 85% of the anatomy of the patient, 90% of the anatomy of the patient, 95% of the anatomy of the patient, 100% of the anatomy of the patient, or any range of the foregoing values. 
     The first section  108  can have a uniform shape. The first section  108  can have a substantially cuboidal shape or a substantially cylindrical shape. The second section  110  can have a uniform shape. The second section  110  can have a substantially cuboidal shape or a substantially cylindrical shape. The third section  112  can have a uniform shape. The third section  112  can have a substantially cuboidal shape or a substantially cylindrical shape. The first section  108  and the third section  112  can have the same or similar shape. 
     The bone tie  100  can be disposed around a portion of the vertebra. The bone tie  100  can be disposed around a portion of the inferior vertebra. The bone tie  100  can be disposed around a portion of the superior vertebra. The bone tie  100  can be disposed around a portion of the inferior vertebra and around a portion of the superior vertebra. The bone tie  100  can be disposed through a portion of the vertebra. The bone tie  100  can be disposed through a portion of the inferior vertebra. The bone tie  100  can be disposed through a portion of the superior vertebra. The bone tie  100  can be disposed through a portion of the inferior vertebra and through a portion of the superior vertebra. 
     The bone tie  100  can be utilized alone. The bone tie  100  can be utilized in connection with another bone tie  100 . The bone tie  100  can be utilized in connection with an implant. The bone tie  100  can be utilized in connection with an interbody implant. The bone tie  100  can be utilized in connection with a facet implant. The bone tie  100  can be utilized in connection with fusion material. The bone tie  100  can be utilized in connection with bone grafts. The bone tie  100  can be utilized in connection with any substance. The bone tie  100  can be utilized in connection with any biologic and/or chemical substance, including, but not limited to, medicine, adhesives, etc., and/or a bone graft, including, but not limited to, autograft, allograft, xenograft, alloplastic graft, a synthetic graft, and/or combinations of grafts, medicines, and/or adhesives. While exemplary references are made with respect to vertebra, in some embodiments another bone can be involved. While specific reference may be made to a specific vertebra and/or subset and/or grouping of vertebrae, it is understood that any vertebra and/or subset and/or grouping, or combination of vertebrae can be used. The bone tie  100  can deliver a substance. The bone tie  100  can be packed with a substance after tightening. The lumen that the bone tie  100  extends through can be packed with a substance. The bone tie  100  can be configured to retain, carry and/or otherwise deliver a substance to aid in fusion, such as, for example, medicines, adhesives, bone graft, and/or combinations of substances. 
     The bone tie  100  can have several advantages. The bone tie  100  can allow for simplified subsequent removal techniques versus traditional hardware. The bone tie  100  can be easily cut to be removed. The bone tie  100  can be removed after fusion. The bone tie  100  can be adjusted during a procedure to adjust the tension on the underlying anatomy. The bone tie  100  can be adjusted during a procedure to increase or decrease the tension on the underlying anatomy. The bone tie  100  can be removed during a procedure to adjust the tension on the underlying anatomy. The bone tie  100  can be removed during a procedure to decrease the tension on the underlying anatomy. The bone tie  100  can removed and replaced with another bone tie  100 . The bone tie  100  can absorb over time within the body of the patient. The bone tie  100  can be advantageously tightened in one direction. The bone tie  100  can maintain the tension under normal anatomical loads. 
     The bone tie  100  can be utilized to correct or improve the condition of a variety of ailments. The bone tie  100  can be utilized to correct or improve the condition of a coronal plane deformity. The bone tie  100  can be utilized to correct or improve the condition of a lateral scoliosis. The bone tie  100  can be utilized to achieve rotational correction. The bone tie  100  can be utilized to achieve sagittal correction. The bone tie  100  can be utilized to restore lordosis. The bone tie  100  can be tensioned to set sagittal correction. The bone tie  100  can be tensioned to set lordosis. 
     The bone tie  100  can be utilized in combination with navigation systems to achieve desired trajectories. The bone tie  100  can be utilized in combination with guidance systems to achieve desired trajectories. The bone tie  100  can be utilized in combination with probes to achieve desired trajectories. The probe can facilitate forming an operative channel through the tissue of a patient to access a portion of the patient&#39;s spine. In operation, the probe can be inserted into a patient. In some embodiments, the probe is inserted into an anchorable location, such as a collagenous tissue, bone, or vertebral disc. In some embodiments, the probe comprises at least one electrode. In some embodiments, the at least one electrode is capable of stimulating a nerve to provoke an electromyographic response in the nerve. 
     In some embodiments described herein, the bone tie  100  can be used to stabilize and/or fixate a first vertebra to a second vertebra. The bone tie  100  can be configured to reduce pain associated with a bone portion. The bone tie  100  can be configured to reduce further degradation of a spine. The bone tie  100  can be configured to reduce further degradation of a specific vertebra of a spine. The bone tie  100  can be configured to reduce movement until the first vertebra and the second vertebra have fused. The bone tie  100  can be configured to stabilize the first vertebra and second vertebra by securing an articular process of the first vertebra to an articular process of a second vertebra. 
     Although this invention has been disclosed in the context of certain preferred embodiments and examples, it will be understood by those skilled in the art that the present invention extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention and obvious modifications and equivalents thereof. In addition, while several variations of the invention have been shown and described in detail, other modifications, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combinations or sub-combinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the invention. It should be understood that various features and aspects of the disclosed embodiments can be combined with, or substituted for, one another in order to form varying modes of the disclosed invention. For all the embodiments described above, the steps of the methods need not be performed sequentially. Thus, it is intended that the scope of the present invention herein disclosed should not be limited by the particular disclosed embodiments described above, but should be determined only by a fair reading of the claims that follow.