Patent Publication Number: US-2023136936-A1

Title: Surgical instrument and method

Description:
TECHNICAL FIELD 
     The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical system and a method for treating a spine that includes one or more instruments and implants disposed with vertebrae. 
     BACKGROUND 
     Spinal pathologies and disorders such as scoliosis and other curvature abnormalities, kyphosis, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including deformity, pain, nerve damage, and partial or complete loss of mobility. 
     Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes discectomy, corpectomy, laminectomy, fusion, fixation, correction and implantable prosthetics. As part of these surgical treatments, implants such as bone fasteners, interbody devices, plates, connectors and vertebral rods are often used to provide stability to a treated region. These implants can redirect stresses away from a damaged or defective region while healing takes place to restore proper alignment and generally support the vertebral members. Surgical instruments are employed, for example, to engage the implants for attachment to the exterior of one or more vertebral members. This disclosure describes an improvement over these prior technologies. 
     SUMMARY 
     In one embodiment, a surgical instrument is provided. The surgical instrument includes a first arm including a first support. A second arm includes a second support. A fulcrum defines an implant cavity with the supports and includes a plurality of mating elements engageable with alternately configured and/or dimensioned implants. In some embodiments, implants, spinal constructs and methods are disclosed. 
     In one embodiment, the surgical instrument includes a first arm including a first support. A second arm is provided that includes a second support. A fulcrum defines an implant cavity with the supports and includes a releasable lock configured to be positioned in a locked orientation and a non-locked orientation. 
     In one embodiment, a surgical system is provided. The surgical system includes an instrument comprising a first arm including a first support. A second arm includes a second support. A fulcrum defines an implant cavity with the supports and includes an adjustable mating element. The surgical system includes a spinal plate engageable with the adjustable mating element. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present disclosure will become more readily apparent from the specific description accompanied by the following drawings, in which: 
         FIG.  1    is a perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG.  2    is a perspective view with parts separated of the components shown in  FIG.  1   ; 
         FIG.  3    is a perspective view with parts separated of the components shown in  FIG.  1   ; 
         FIG.  4    is a perspective view with parts separated of the components shown in  FIG.  1   ; 
         FIG.  5    is a break away view of components of the system shown in  FIG.  1   ; 
         FIG.  6    is a break away view of components of the system shown in  FIG.  1   ; 
         FIG.  7    is a break away view in part cross-section of the components shown in  FIG.  1   ; 
         FIG.  8    is a break away view of the components shown in  FIG.  1   ; 
         FIG.  9    is a front view of the components shown in  FIG.  1   ; 
         FIG.  10    is a perspective view of the components shown in  FIG.  1   ; 
         FIG.  11    is a perspective view of the components shown in  FIG.  1   ; 
         FIG.  12    is a perspective view of one embodiment of a surgical system in accordance with the principles of the present disclosure; 
         FIG.  13    is a perspective view of one embodiment of a surgical system in accordance with the principles of the present disclosure; 
         FIG.  14    is a perspective view of one embodiment of a surgical system in accordance with the principles of the present disclosure; 
         FIG.  15    is a break away view of the components shown in  FIG.  1   ; 
         FIG.  16    is a break away view of the components shown in  FIG.  1   ; 
         FIG.  17    is a break away view in part cross-section of the components shown in  FIG.  16   ; 
         FIG.  18    is a perspective view of components of the system shown in  FIG.  1   ; 
         FIG.  19    is a break away view of the components shown in  FIG.  19   ; 
         FIG.  20    is a break away view in part cross-section of components of the system shown in  FIG.  1   ; 
         FIG.  21    is a break away view in part cross-section of the components shown in  FIG.  20   ; 
         FIG.  22    is a perspective view of components of the system shown in  FIG.  1   ; 
         FIG.  23    is a break away view of components shown in  FIG.  22   ; 
         FIG.  24    is a break away view of components shown in  FIG.  22   ; 
         FIG.  25    is a break away view of components shown in  FIG.  22   ; 
         FIG.  26    is a perspective view of components of the system shown in  FIG.  1   ; 
         FIG.  27    is a break away view of components shown in  FIG.  26   ; 
         FIG.  28    is a break away view of components shown in  FIG.  26   ; 
         FIG.  29    is a perspective view of one embodiment of components of a surgical system in accordance with the principles of the present disclosure; 
         FIG.  30    is a perspective view with parts separated of components shown in  FIG.  29   ; 
         FIG.  31    is a break away cross-section view of components shown in  FIG.  30   ; and 
         FIG.  32    is a break away view of components shown in  FIG.  29   . 
     
    
    
     DETAILED DESCRIPTION 
     The exemplary embodiments of the surgical system and related methods of use disclosed are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of a surgical system and a method for treating a spine that includes a surgical instrument and one or more implants disposed with vertebrae. In some embodiments, the surgical system includes a surgical instrument, that is configured for contouring surgical implants, for example, spinal plates. In some embodiments, the surgical instrument comprises a surgical implant contouring instrument that contours a cervical plate by gradually increasing the amount of lordotic curvature or decreasing the amount of lordotic curvature of the plate. In some embodiments, the surgical implant contouring instrument includes a dial mechanism configured for use with one or more alternately configured and/or dimensioned spinal plates. In some embodiments, the dial mechanism includes a selective locking configuration. In some embodiments, the one or more plates may comprise components of a spinal implant system and/or kit. In some embodiments, the systems and methods of the present disclosure comprise surgical navigation and medical devices including surgical instruments and implants that are employed with a surgical treatment, as described herein, for example, with a cervical, thoracic, lumbar and/or sacral region of a spine. 
     In some embodiments, the present surgical system includes a surgical instrument, for example, a surgical implant contouring instrument configured for contouring spinal implants, for example, anterior cervical plates. In some embodiments, the surgical implant contouring instrument comprises a spinal plate bender employed with anterior cervical plates contoured to a selected section of a patient&#39;s anatomy, for example, a section of a spine for fixation. In some embodiments, the spinal plate bender is configured to contour an anterior cervical plate to a surface geometry of a spine for centering and retaining the plate to the spine. 
     In some embodiments, the present surgical system includes a surgical instrument, for example, a cervical plate bender. In some embodiments, the cervical plate bender is configured for contouring one or more alternatively configured and/or dimensioned spinal plates, for example, anterior cervical plates. In some embodiments, the cervical plate bender is configured to contour single level anterior cervical plates implemented in anterior cervical discectomy and fusion (ACDF) procedures. In some embodiments, the cervical plate bender includes a locking mechanism configured for use with one or more alternatively configured and/or dimensioned spinal plates. In some embodiments, the locking mechanism includes a central locking dial mechanism. In some embodiments, the cervical plate bender is configured to contour single level cervical plates with a central plane aligning mechanism. In some embodiments, the cervical plate bender includes a rotating dial mechanism configured to adjust the cervical plate bender for implementation with one or more alternatively configured and/or dimensioned spinal plates. In some embodiments, the one or more alternatively configured and/or dimensioned spinal plates include varying lengths. In some embodiments, the spinal plate includes a cervical plate for use in a single vertebral level. In some embodiments, the cervical plate includes a dimension of 19 mm in length. In some embodiments, the cervical plate includes a dimension of 21 mm in length. In some embodiments, the cervical plate includes a dimension of 23 mm in length. 
     In some embodiments, the present surgical implant contouring instrument is configured to contour a plate to increase or decrease lordosis of the plate. In some embodiments, a surface of the surgical implant contouring instrument is configured to increase lordosis of a plate, and a surface of the surgical implant contouring instrument is configured to decrease lordosis of the plate. In some embodiments, the surface of the surgical implant contouring instrument that increases lordosis of the plate is disposed on a side of the surgical implant contouring instrument, and the surface of the surgical implant contouring instrument that decreases lordosis of the plate is disposed on an opposing side of the surgical implant contouring instrument. In some embodiments, the surgical implant contouring instrument includes a pair of arms. In some embodiments, the surgical implant contouring instrument includes a pair of orientation control discs, a central disc locking pin and nut, a pair of dials, a central block to increase lordosis, a central block to decrease lordosis, a pair of 3 mm diameter balls, a set of four compression springs, a central block locking pin, a pair of plate locking pins, a pair of pull buttons, a pair of pins, a pair of bottom rollers to increase lordosis, a pair of bottom rollers to decrease lordosis, and/or a pair of flat springs. 
     In some embodiments, the present surgical implant contouring instrument is configured for contouring an anterior cervical plate. In some embodiments, the anterior cervical plate does not include a lordotic curve pre-manufactured into the anterior cervical plate. In some embodiments, the surgical implant contouring instrument is configured to contour the anterior cervical plate to gradually increase a selected amount of lordotic curvature or decrease a selected amount of lordotic curvature. In some embodiments, the surgical implant contouring instrument is configured to lock a plate with the locking mechanism at a central position on the surgical implant contouring instrument to align with a central plane of the plate to contour the plate for lordotic curvature. In some embodiments, locking the plate with the surgical implant contouring instrument enables a plate with selected dimensions and/or a single vertebral level cervical plate to be locked in place, avoiding the need for a user, for example, a surgeon to manually check central alignment of the plate. In some embodiments, the plate is locked with the surgical implant contouring instrument to avoid manually holding the plate in position with the surgical implant contouring instrument and to avoid slippage of the plate during contouring. 
     In some embodiments, the present surgical implant contouring instrument is configured for single vertebral level plate contouring. In some embodiments, the surgical implant contouring instrument includes a block configured for increasing lordosis of a plate and a block configured for decreasing lordosis of a plate. In some embodiments, each block is centrally disposed on the surgical implant contouring instrument. In some embodiments, each block is V-shaped. In some embodiments, the surgical implant contouring instrument is configured to contour plates at a minimum bend curvature required for plates that include a cap assembly. In some embodiments, the surgical implant contouring instrument includes a grooved central block and rollers configured for disposal with a plate. In some embodiments, locking caps are configured for disposal with the blocks and rollers. In some embodiments, the surgical implant contouring instrument includes a locking mechanism configured to secure a plate at a central orientation on the surgical implant contouring instrument during contouring. In some embodiments, the surgical implant contouring instrument engages with a lateral milled cutout face of the plate. In some embodiments, the face of the plate is flush with the dial of the surgical implant contouring instrument. In some embodiments, the dial mechanism engages with a ball and spring. In some embodiments, a plate contouring setting is selected for use with a selected plate size and the dial mechanism is rotated to the selected plate contouring setting. In some embodiments, the user can select from multiple plate contouring settings each configured for contouring a selected plate size. In some embodiments, the multiple plate contouring settings of the dial mechanism includes three plate size options. In some embodiments, the surgical implant contouring instrument is configured to contour a plate efficiently and is configured to reduce human error. In some embodiments, the surgical implant contouring instrument is configured to maintain plate alignment during plate contouring and avoids the need for a user to maintain visual and manual plate alignment. In some embodiments, the surgical implant contouring instrument is configured for use with a single vertebral level or multi vertebral level cervical plate system. In some embodiments, the surgical implant contouring instrument is configured for use with various spinal plate configurations, for example, lumbar, cervical, thoracic, sacral and/or pelvic. 
     In some embodiments, the present surgical system includes a surgical instrument, including a surgical implant contouring instrument that is employed with a method for contouring a plate to increase or decrease lordosis of the plate, the method includes the step of positioning the surgical implant contouring instrument in an open orientation. In some embodiments, in the open orientation, a pair of handle arms are spaced apart relative to each other. In some embodiments, the method includes the step of selecting a plate size for contouring. In some embodiments, the plate size includes 19 mm, 21 mm or 23 mm. In some embodiments, a dial mechanism of the surgical implant contouring instrument is rotated in a direction, for example clockwise or anti-clockwise until a selected plate size indicia, for example, a marking is aligned into a contour position. In some embodiments, the dial mechanism auto locks into one of the three size orientations via a ball and spring mechanism. In some embodiments, the ball and spring mechanism engages with the dial mechanism to prevent unintentional movement of the dial mechanism during use. In some embodiments, the method includes the step of contouring the plate to increase or decrease lordotic angle of the plate. In some embodiments, the plate is inserted into a selected side of the surgical implant contouring instrument that is specific to either increasing or decreasing the lordotic angle of the plate. In some embodiments, each side of the surgical implant contouring instrument, for example, on an arm of the surgical implant contouring instrument, is laser marked with indicia that indicates a side for increasing lordosis or decreasing lordosis of the plate. In some embodiments, the indicia includes text. In some embodiments, the plate is a cervical plate. In some embodiments, the method includes the step of inserting the plate into a selected side of the surgical implant contouring instrument. In some embodiments, a lock button is translated in a direction to insert the plate onto a central block of the surgical implant contouring instrument. In some embodiments, the method includes the step of releasing the lock button. In some embodiments, the user visually confirms that the lock button is fully released into its original orientation. In some embodiments, the plate is adjusted for engagement at a back side of the block. In some embodiments, the method includes the step of positioning the surgical implant contouring instrument in a closed orientation to contour the plate to a selected curvature/angle to increase lordosis. In some embodiments, the arms are manually translated towards each other for contouring. In some embodiments, the arms are manually translated towards each other and translation is prevented when the desired curvature of the plate is reached. In some embodiments, the surgical implant contouring instrument includes a stop element that prevents the surgical implant contouring instrument from contouring the plate more than 20 degrees. In some embodiments, the surgical implant contouring instrument contours the plate from 1 degree to 30 degrees. In some embodiments, to decrease lordosis, the method steps described above are repeated on the side of the surgical implant contouring instrument specific to decreasing the lordotic angle of the plate. 
     In one embodiment, one or all of the components of the surgical system are disposable, peel-pack, pre-packed sterile devices used with an implant. One or all of the components of the surgical system may be reusable. The surgical system may be configured as a kit with multiple sized and configured components. 
     In some embodiments, the present disclosure may be employed to treat spinal disorders, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor and fractures. In some embodiments, the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. In some embodiments, the disclosed surgical system and methods may be alternatively employed in a surgical treatment with a patient in a prone or supine position, and/or employ various surgical approaches to the spine, including anterior, posterior, posterior mid-line, lateral, postero-lateral, and/or antero-lateral approaches, and in other body regions. The present disclosure may also be alternatively employed with procedures for treating the lumbar, cervical, thoracic, sacral and pelvic regions of a spinal column. The system and methods of the present disclosure may also be used on animals, bone models and other non-living substrates, for example, in training, testing and demonstration. 
     The present disclosure may be understood more readily by reference to the following detailed description of the embodiments taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this application is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting. Also, as used in the specification and including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” or “approximately” one particular value and/or to “about” or “approximately” another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. It is also understood that all spatial references, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure. For example, the references “upper” and “lower” are relative and used only in the context to the other, and are not necessarily “superior” and “inferior”. 
     Further, as used in the specification and including the appended claims, “treating” or “treatment” of a disease or condition refers to performing a procedure that may include administering one or more drugs to a patient (human, normal or otherwise or other mammal), employing implantable devices, and/or employing instruments that treat the disease, for example, microdiscectomy instruments used to remove portions bulging or herniated discs and/or bone spurs, in an effort to alleviate signs or symptoms of the disease or condition. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, treating or treatment includes preventing or prevention of disease or undesirable condition (e.g., preventing the disease from occurring in a patient, who may be predisposed to the disease but has not yet been diagnosed as having it). In addition, treating or treatment does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes procedures that have only a marginal effect on the patient. Treatment can include inhibiting the disease, e.g., arresting its development, or relieving the disease, e.g., causing regression of the disease. For example, treatment can include reducing acute or chronic inflammation; alleviating pain and mitigating and inducing re-growth of new ligament, bone and other tissues; as an adjunct in surgery; and/or any repair procedure. Also, as used in the specification and including the appended claims, the term “tissue” includes soft tissue, ligaments, tendons, cartilage and/or bone unless specifically referred to otherwise. 
     The following discussion includes a description of a surgical system and related methods of employing the surgical system in accordance with the principles of the present disclosure. Alternate embodiments are also disclosed. Reference will now be made in detail to the exemplary embodiments of the present disclosure, which are illustrated in the accompanying figures. Turning now to  FIGS.  1 - 28   , there is illustrated components of a surgical system  10  in accordance with the principles of the present disclosure. 
     The components of surgical system  10  can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics and bone material and/or their composites, depending on the particular application and/or preference of a medical practitioner. For example, the components of surgical system  10 , individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, stainless steel alloys, superelastic metallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUM METAL® manufactured by Toyota Material Incorporated of Japan), ceramics and composites thereof such as calcium phosphate (e.g., SKELITE™ manufactured by Biologix Inc.), thermoplastics such as polyaryletherketone (PAEK) including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO 4  polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers, elastomeric composites, rigid polymers including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone material including autograft, allograft, xenograft or transgenic cortical and/or corticocancellous bone, and tissue growth or differentiation factors, partially resorbable materials, such as, composites of metals and calcium-based ceramics, composites of PEEK and calcium based ceramics, composites of PEEK with resorbable polymers, totally resorbable materials, such as, for example, calcium based ceramics such as calcium phosphate, tri-calcium phosphate (TCP), hydroxyapatite (HA)-TCP, calcium sulfate, or other resorbable polymers such as polyaetide, polyglycolide, polytyrosine carbonate, polycaroplaetohe and their combinations. Various components of surgical system  10  may have material composites, including the above materials, to achieve various desired characteristics such as strength, rigidity, elasticity, compliance, biomechanical performance, durability and radiolucency or imaging preference. The components of surgical system  10 , individually or collectively, may also be fabricated from a heterogeneous material such as a combination of two or more of the above-described materials. The components of surgical system  10  may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein. 
     Surgical system  10  is employed, for example, with a minimally invasive procedure, including percutaneous techniques, mini-open and open surgical techniques to deliver and introduce an implant, for example, spinal plate  14 ,  14 A and/or  14 B at a surgical site within a body of a patient, for example, a section of a spine. Surgical system  10  includes a surgical instrument, for example, an implant contouring instrument  12  that is employed, for example, to contour an implant, for example, plate  14 ,  14 A and/or  14 B during a surgical treatment to the configuration and/or dimension of the spine. In some embodiments, the contour can include adjustment and/or correction of the components of surgical system  10  including, for example, increasing or decreasing lordosis, as described herein. In some embodiments, lordosis is increased from 1 to 20 degrees and kyphosis is decreased from 1 to 20 degrees, as described herein. In some embodiments, contour/contouring can include deforming, shaping, bending and/or conforming plate  14 ,  14 A and/or  14 B to increase or decrease lordosis. 
     Implant contouring instrument  12  defines a longitudinal axis X, as shown in  FIG.  1    and includes an arm  16  and an arm  18 , as shown in  FIG.  2   . Arms  16 ,  18  are configured to be pivotable between an open orientation and a closed orientation relative to each other to move a fulcrum  36  of implant contouring instrument  12  to facilitate contouring of plate  14 ,  14 A or  14 B as described herein. Arm  16  extends between an end  20  and an end  22 . End  20  includes a surface that defines an opening  24  configured for disposal of a portion of a support, for example, a portion of a transverse roller  26 , as shown in  FIG.  3    and described herein. In some embodiments, arm  16  may comprise overall and/or cross-section configurations, for example, cylindrical, round, oval, rectangular, polygonal, irregular, tapered, offset, staggered, uniform and non-uniform. In some embodiments, one or more of the surfaces of arm  16  may have alternate surface configurations, for example, rough, threaded for connection with surgical instruments, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. In some embodiments, all or only a portion of arm  16  may be disposed at various orientations, relative to axis X, for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered. 
     Arm  18  extends between an end  28  and an end  30 . End  28  includes a surface that defines an opening  32  configured for disposal of a portion of a support, for example, a portion of a transverse roller  34 , as shown in  FIG.  3    and described herein. In some embodiments, arm  18  may comprise overall and/or cross-section configurations, for example, cylindrical, round, oval, rectangular, polygonal, irregular, tapered, offset, staggered, uniform and non-uniform. In some embodiments, one or more of the surfaces of arm  18  may have alternate surface configurations, for example, rough, threaded for connection with surgical instruments, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. In some embodiments, all or only a portion of arm  18  may be disposed at various orientations, relative to axis X, for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered. 
     Fulcrum  36  defines a longitudinal axis Y, as shown in  FIG.  1    and is configured to translate relative to transverse rollers  26 ,  34  to engage plate  14 ,  14 A or  14 B and to contour plate  14 ,  14 A or  14 B to a selected lordosis and/or kyphosis. Fulcrum  36  includes a link  38  defined from a surface of arm  16 , as shown in  FIG.  2   . Link  38  is configured for disposal within a slot  40  of arm  18 , as described herein for pivotable engagement between arms  16 ,  18 . Link  38  includes a surface that defines an opening  42 . Opening  42  is configured for disposal with a pin  44  of fulcrum  36 , as shown in  FIG.  4   . Fulcrum  36  includes a link  46  and a link  48  defined from surfaces of arm  18 , as shown in  FIG.  2   . Link  46  is parallel relative to link  48 . Slot  40  is defined from an interior of links  46 ,  48 . Link  46  includes a surface that defines an opening  50  and link  48  includes a surface that defines an opening  52 . Openings  50 ,  52  are configured for disposal with pin  44 , as shown in  FIGS.  4  and  5   . Links  38 ,  46  and  48  are disposed at an angle α 1  to facilitate contouring plate  14 ,  14 A or  14 B at an angle from 1 degree to 20 degrees, as shown in  FIG.  2   . In some embodiments, links  46 ,  48  may comprise overall and/or cross-section configurations, for example, cylindrical, round, oval, rectangular, polygonal, irregular, tapered, offset, staggered, uniform and non-uniform. 
     Fulcrum  36  includes a disc  54 , as shown in  FIG.  3   . Disc  54  is configured for engagement with a surface of link  46 , as shown in  FIGS.  3  and  4   . Disc  54  includes a surface that defines an opening  56 . Opening  56  is configured engagement with pin  44  and a nut  58 . Fulcrum  36  includes a disc  60 , as shown in  FIG.  4   . Disc  60  is configured for engagement with a surface of link  48 , as shown in  FIG.  4   . Disc  60  includes a surface that defines an opening  62 . Opening  62  is configured for disposal with pin  44 . Pin  44  is disposable and translatable within openings  42 ,  50 ,  52 ,  56  and  62 , and disposable with nut  58  to form a pivot P 1 , as shown in  FIG.  5   . Arms  16 ,  18  are movable between the open orientation and the closed orientation to translate fulcrum  36  via pivot P 1  relative to transverse rollers  26 ,  34  to engage and contour plate  14 ,  14 A or  14 B to a selected lordosis and/or kyphosis. In some embodiments, lordosis is increased from 1 to 20 degrees and kyphosis is decreased from 1 to 20 degrees. A stop element  57  is defined from surfaces  59 ,  61  of links  46 ,  48  and a surface  63  of link  32 , as shown in  FIGS.  2  and  25   . Stop element  57  is configured to limit implant contouring instrument  12  from contouring plate  14 ,  14 A or  14 B beyond 20 degrees. 
     Fulcrum  36  defines an implant cavity  64  with transverse rollers  26 ,  34  on a lordosis surface (LS) of implant contouring instrument  12 , as shown in  FIG.  5   , and an implant cavity  66  on a kyphosis surface (KS) of implant contouring instrument  12 , as shown in  FIG.  6   . Arm  16  and/or arm  18  includes indicia, for example, laser markings including text that indicates the KS or the LS of implant contouring instrument  12 , as shown in  FIGS.  10  and  11   . In some embodiments, the LS is a side of implant contouring instrument  12  and the KS is an opposing side of implant contouring instrument  12 . 
     Arms  16 ,  18  are biased to the open orientation via a pair of springs, for example, flat springs  68 ,  70 , as shown in  FIG.  4   . An end  72  of spring  68  is configured for fixed engagement with a portion of arm  16 . An inner surface of arm  16  defines an opening  74  that is configured for engagement with an opening  76  of end  72  and disposal of a pin  78 , as shown in  FIG.  4   . An end  80  of spring  70  is configured for fixed engagement with a portion of arm  18 . An inner surface of arm  18  defines an opening  82  that is configured for engagement with an opening  84  of end  80  and disposal of a pin  86 , as shown in  FIG.  9   . Springs  68 ,  70  matingly engage at ends  88 ,  90 , as shown in  FIG.  5   . 
     Transverse roller  26  includes a surface  94  and a surface  96 , as shown in  FIGS.  3 - 6   . An intermediate portion  98  is disposed between surface  94  and surface  96  and is configured for disposal with opening  24  of arm  16 , as shown in  FIGS.  2 - 4   . Surface  94  is monolithic with intermediate portion  98 , and intermediate portion  98  is configured for disposal with an opening  100  of surface  96 , as shown in  FIG.  4   . In some embodiments, intermediate portion  98  is monolithic with surface  94  and surface  96 . Surface  94  includes arcuate portions  102 ,  104  and a planar portion  106  configured for engagement with plate  14 ,  14 A or  14 B to facilitate contouring of plate  14 ,  14 A or  14 B as shown in  FIG.  3    and described herein. In some embodiments, surface  94  may comprise overall and/or cross-section configurations, for example, cylindrical, round, oval, rectangular, polygonal, irregular, tapered, offset, staggered, uniform and non-uniform. In some embodiments, surface  94  includes a lordosis surface. 
     Surface  96  includes arcuate portions  108 ,  110  and a planar portion  112  configured for engagement with plate  14 ,  14 A or  14 B to facilitate contouring of plate  14 ,  14 A or  14 B as shown in  FIG.  4    and described herein. In some embodiments, surface  96  may comprise overall and/or cross-section configurations, for example, cylindrical, round, oval, rectangular, polygonal, irregular, tapered, offset, staggered, uniform and non-uniform. In some embodiments, surface  96  includes a kyphosis surface. In some embodiments, transverse roller  26  may include various surface configurations, for example, rough, friction, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application. 
     Transverse roller  34  includes a surface  114  and a surface  116 , as shown in  FIGS.  3 - 6   . An intermediate portion  118  is disposed between surface  114  and surface  116  and is configured for disposal with opening  32  of arm  18 , as shown in  FIGS.  2 - 4   . Surface  114  is monolithic with intermediate portion  118 , and intermediate portion  118  is configured for disposal with an opening  120  of surface  116 , as shown in  FIG.  4   . In some embodiments, intermediate portion  118  is monolithic with surface  114  and surface  116 . Surface  114  includes arcuate portions  122 ,  124  and a planar portion  126  configured for engagement with plate  14 ,  14 A or  14 B to facilitate contouring of plate  14 ,  14 A or  14 B as shown in  FIG.  3    and described herein. In some embodiments, surface  114  may comprise overall and/or cross-section configurations, for example, cylindrical, round, oval, rectangular, polygonal, irregular, tapered, offset, staggered, uniform and non-uniform. In some embodiments, surface  114  includes a lordosis surface. 
     Surface  116  includes arcuate portions  128 ,  130  and a planar portion  132  configured for engagement with plate  14 ,  14 A or  14 B to facilitate contouring of plate  14 ,  14 A or  14 B, as shown in  FIG.  4    and described herein. In some embodiments, surface  116  may comprise overall and/or cross-section configurations, for example, cylindrical, round, oval, rectangular, polygonal, irregular, tapered, offset, staggered, uniform and non-uniform. In some embodiments, surface  116  includes a kyphosis surface. In some embodiments, transverse roller  34  may include various surface configurations, for example, rough, friction, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application. 
     Implant contouring instrument  12  includes a member, for example, a rotatable dial  134  disposed on the LS of implant contouring instrument  12  and a rotatable dial  136  disposed on the KS of implant contouring instrument  12 , as shown in  FIGS.  3 - 6   . Rotatable dials  134 ,  136  are configured to be selectively engageable with alternatively configured and/or dimensioned implants, for example, implants  14 ,  14 A and  14 B disposable within implant cavities  64 ,  66 , as shown in  FIGS.  5  and  6   . Dial  134  includes mating elements, for example, projections  138 ,  140  and  142 , as shown in  FIG.  3   . Projection  138  is configured to mate with a selected plate  14 , projection  140  is configured to mate with a selected plate  14 A and projection  142  is configured to mate with a selected plate  14 B, as shown in  FIGS.  8  and  12 - 14   . Plate  14  includes a 19 mm dimension, plate  14 A includes a 21 mm dimension and plate  14 B includes a 23 mm dimension. Indicia, including laser marked wording is disposed on dial  134  below each projection  138 ,  140 ,  142  to indicate the dimensions of the selected plate  14 ,  14 A or  14 B that is compatible with the selected projection  138 ,  140  or  142 , as shown in  FIG.  8   . In some embodiments, plate  14 ,  14 A and/or  14 B include dimensions of 16 to 26 mm. 
     Projection  138  engages with a side  144  or a side  146  of plate  14 , as shown in  FIG.  12   . Projection  140  engages with a side  148  or a side  150  of plate  14 A, as shown in  FIG.  13   . Projection  142  engages with a side  152  or a side  154  of plate  14 B, as shown in  FIG.  14   . In some embodiments, sides  144 ,  146 ,  148 ,  150 ,  152 , and/or  154  may comprise overall and/or cross-section configurations, for example, cylindrical, round, oval, rectangular, polygonal, irregular, tapered, offset, staggered, uniform and non-uniform. In some embodiments, sides  144 ,  146 ,  148 ,  150 ,  152 , and/or  154  may include various surface configurations, for example, rough, friction, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application. In some embodiments, dial  134  includes one projection. In some embodiments, dial  134  includes 1 to 5 projections. 
     Dial  134  includes a gripping surface  156 , as shown in  FIG.  3   . Gripping surface  156  is configured for engagement with a user for rotating dial  134  to a selected projection  138 ,  140  or  142  for use with a selected plate  14 ,  14 A or  14 B. 
     Dial  134  is configured for engagement with disc  54  and portions of releasable locks  158 ,  164  as shown in  FIGS.  3 ,  5  and  7    and described herein. Dial  134  includes a lock spring  160  and a ball bearing  162  configured to lock dial  134  to a locking orientation, to prevent unintentional movement of dial  134  when rotated to a selected projection  138 ,  140  or  142 . A surface of dial  134  defines a centrally disposed opening  157  that includes indents  159 , as shown in  FIGS.  3 ,  7  and  8   . Indents  159  are configured for locked engagement with ball bearing  162 , as described herein to position dial  134  in the locking orientation. 
     Dial  136  includes mating elements, for example, projections  166 ,  168  and  170 , as shown in  FIG.  9   . Projection  166  is configured to mate with a selected plate  14 , projection  168  is configured to mate with a selected plate  14 A and projection  170  is configured to mate with a selected plate  14 B, as shown in  FIGS.  12 - 14   . Projection  166  engages with side  144  or side  146  of plate  14 , as shown in  FIG.  12   . Projection  168  engages with side  148  or side  150  of plate  14 A, as shown in  FIG.  13   . Projection  170  engages with side  152  or side  154  of plate  14 B, as shown in  FIG.  14   . Indicia, including laser marked text is disposed on dial  136  below each projection  166 ,  168 ,  170  to indicate the dimensions of the selected plate  14 ,  14 A or  14 B that is compatible with the selected projection  166 ,  168  or  170 , similar to what is shown in  FIG.  8    for dial  134 . In some embodiments, dial  136  includes one projection. In some embodiments, dial  136  includes 1 to 5 projections. 
     Dial  136  includes a gripping surface  172 , as shown in  FIG.  4   . Gripping surface  172  is configured for engagement with a user for rotating dial  136  to a selected projection  166 ,  168  or  170  for use with a selected plate  14 ,  14 A or  14 B. 
     Dial  136  is configured for engagement with disc  60  and a portion of releasable lock  164  as shown in  FIGS.  4  and  6    and described herein. Dial  136  includes a lock spring  174  and a ball bearing  176  configured to lock dial  136  in a locking orientation, to prevent unintentional movement of dial  136  when rotated to a selected projection  166 ,  168  or  170 . A surface of dial  136  defines a centrally disposed opening  177  that includes indents  179 , as shown in  FIG.  4   . Indents  179  are configured for locked engagement with ball bearing  176 , as described herein to position dial  136  in the locking orientation. 
     As described above, dial  134  is fixed to implant contouring instrument  12  on the LS and dial  136  is fixed to implant contouring instrument  12  on the KS, as shown in  FIGS.  5  and  6   . An elongate portion  178  of lock  164  is configured for disposal through opening  177  of dial  136 , an opening  182  of disc  60 , an opening  184  of link  48 , an opening  186  of link  38 , an opening  188  of link  46 , an opening  190  of disc  54 , opening  157  of dial  134  and an opening  194  of an end portion  196  of lock  158 , as shown in  FIGS.  2 - 4   . 
     Spring  160  and ball bearing  162  are configured for translation within a recess  198  of end portion  196  and spring  160  is configured for disposal and translation within a recess  200  of elongate portion  178 , as shown in  FIGS.  7  and  8   . Spring  160  and ball bearing  162  are configured to lock dial  134  to the locking orientation when dial  134  is rotated to a selected projection  138 ,  140  or  142 . Dial  134  is rotated to a selected projection  138 ,  140  or  142  and spring  160  translates ball bearing  162  into an indent  159  to lock dial  134  at a selected projection  138 ,  140  or  142 . 
     Spring  174  and ball bearing  176  are configured for disposal and translation within a recess  202  of elongate portion  178 , as shown in  FIG.  4   . Spring  174  and ball bearing  176  are configured to lock dial  136  to the locking orientation when dial  136  is rotated to a selected projection  166 ,  168  or  170 . Dial  134  is rotated to a selected projection  166 ,  168  or  170  and spring  174  translates ball bearing  176  into an indent  179  to lock dial  136  at a selected projection  166 ,  168  or  170 . 
     Releasable lock  158  is disposed on the LS of implant contouring instrument  12  and is configured to be positioned in a locked orientation to engage with plate  14 ,  14 A or  14 B, as shown in  FIGS.  18 - 19    and an unlocked orientation to disengage with plate  14 ,  14 A or  14 B, as shown in  FIGS.  16 - 17   . Releasable lock  158  is configured for maintaining central or symmetrical alignment of plate  14 ,  14 A or  14 B relative to implant contouring instrument  12  during contouring of plate  14 ,  14 A or  14 B. Releasable lock  158  includes a housing  204 , as shown in  FIG.  3   . Housing  204  includes an end  205  that includes end portion  196  and a surface that defines a transverse opening  206  that is configured for disposal of a pin  208 , as shown in  FIGS.  3  and  4   . A surface of elongate portion  178  defines a transverse opening  210 . Pin  208  is configured for disposal with openings  206 ,  210  to fix releasable lock  158  with elongate portion  178 . 
     Housing  204  includes an end  212 , as shown in  FIG.  3   . An interior surface of end  212  includes a recess  214  configured for disposal of a spring  216  and a portion of a tab  218 , as shown in  FIG.  17   . An outer surface of end  212  defines a slot  220 , as shown in  FIGS.  3  and  17   . A button, for example, a pull button  222  is engageable with tab  218  via a pin  224 . Pin  224  is configured for disposal with an opening  226  of button  222  and an opening  228  of tab  218 , as shown in  FIGS.  3  and  17   . Releasable lock  158  is spring biased in the locked orientation via spring  216 . An end  230  of tab  218  is configured for engagement with plate  14 ,  14 A and/or  14 B, as shown in  FIG.  19   . 
     Releasable lock  164  is disposed on the KS of implant contouring instrument  12  and is configured to be positioned in a locked orientation to engage with plate  14 ,  14 A or  14 B, similar to what is shown in  FIGS.  18 - 19    with regard to lock  158  and a non-locked orientation to disengage with plate  14 ,  14 A or  14 B, similar to what is shown in  FIGS.  16 - 17    with regard to lock  158 . Releasable lock  164  is configured for maintaining central or symmetrical alignment of plate  14 ,  14 A or  14 B relative to implant contouring instrument  12  during contouring of plate  14 ,  14 A or  14 B. Releasable lock  164  includes a housing  232 , as shown in  FIG.  4   . Housing  232  includes an end  234  that includes elongate portion  178 . 
     Housing  232  includes an end  236 , as shown in  FIG.  4   . An interior surface of end  236  includes a recess (not shown) configured for disposal of a spring  238  and a portion of a tab  240 , as shown in  FIG.  4   . An outer surface of end  236  defines a slot (not shown). A button, for example, a pull button  242  is engageable with tab  240  via a pin  244 , as shown in  FIG.  6   . Pin  244  is configured for disposal with an opening  246  of button  242  and an opening  248  of tab  240 , as shown in  FIGS.  4  and  6   . Releasable lock  164  is spring biased to the locked orientation via spring  238 . An end  250  of tab  240  is configured for engagement with plate  14 ,  14 A and/or  14 B, similar to what is shown in  FIG.  19    with regard to end  230  of tab  218 . 
     In some embodiments, surgical system  10  includes implants, for example, a plurality of bone fasteners (not shown) for attaching plate  14 ,  14 A and/or  14 B to vertebrae. In some embodiments, surgical system  10  can include one or a plurality of bone fasteners such as those described herein and/or fixation elements, which may be employed with a single vertebral level. In some embodiments, the bone fasteners and/or fixation elements may be engaged with vertebrae in various orientations, for example, series, parallel, offset, staggered and/or alternate vertebral levels. In some embodiments, the bone fasteners and/or fixation elements may include one or a plurality of anchors, tissue penetrating screws, conventional screws, expanding screws, wedges, anchors, buttons, clips, snaps, friction fittings, compressive fittings, expanding rivets, staples, nails, adhesives, posts, fixation plates and/or posts. 
     In assembly, operation and use, surgical system  10 , similar to that described herein, is employed with a surgical procedure for treatment of a spinal disorder affecting a section of a spine of a patient, as discussed herein. Surgical system  10  may also be employed with other surgical procedures. For example, surgical system  10  can be used with a surgical procedure for treatment of a condition or injury, for example, a correction treatment to treat adolescent idiopathic scoliosis and/or Scheuermann&#39;s kyphosis of a spine. 
     In use, to treat the affected section of vertebrae, a medical practitioner obtains access to a surgical site including vertebrae in any appropriate manner, such as through incision and retraction of tissues. In some embodiments, surgical system  10  may be used in any existing surgical method or technique including open surgery, mini-open surgery, minimally invasive surgery, and percutaneous surgical implantation, whereby vertebrae is accessed through a micro-incision, or sleeve that provides a protected passageway to the area. Once access to the surgical site is obtained, the particular surgical procedure is performed for treating the spinal disorder. Surgical system  10  is then employed to augment the surgical treatment. Pilot holes are made in selected vertebra of vertebrae for receiving bone fasteners. Bone fasteners are fastened with plate  14 ,  14 A and/or  14 B and the vertebra or vertebrae. 
     During the surgical procedure, the contour of vertebrae and/or other portions of an anatomy of a patient selected for disposal and/or attachment of an implant, for example, plate  14 ,  14 A and/or  14 B, can be measured and/or determined in situ. In one embodiment, the contour measurement, which may include implant geometry, relative angular orientation of the implant to vertebrae and/or respective portions of the implant, can be measured and/or determined using medical imaging, x-ray, surgical navigation, gauges, provisional, working and/or trial implants and treated using implant contouring instrument  12 . 
     In one embodiment, implant contouring instrument  12 , similar to that described, is used to contour plates  14 ,  14 A and/or  14 B in a deformity correction procedure, which includes in situ coronal bending for residual coronal or sagittal deformity. For example, to contour plate  14 ,  14 A or  14 B, implant contouring instrument  12  is positioned in an open orientation, as shown in  FIG.  10   . In the open orientation, arms  16 ,  18  are spaced apart and ends  20 ,  28  of arms  16 ,  18  are in flush engagement relative to each other. A plate size is selected from plates  14 ,  14 A and  14 B. To increase lordosis of a selected plate  14 ,  14 A or  14 B, dial  134  is rotated in a direction, for example a clockwise direction as shown by arrow A or an anti-clockwise direction as shown by arrow B in  FIG.  10    until a selected plate size indicia is aligned and selected. Dial  134  locks into position as described herein. Plate  14 ,  14 A or  14 B is selected and button  222  is translated in a direction, for example, an upward direction as shown by arrow C in  FIGS.  15  and  16    to lift tab  218  in the upward direction shown by arrow C. Plate  14 ,  14 A or  14 B is inserted into cavity  64 , as shown in  FIG.  16   . Button  222  is released and tab  218  is translated in a direction, for example, a downward direction shown by arrow D as shown in  FIGS.  18  and  19   . In some embodiments, the medical practitioner visually confirms that button  222  is fully released into its original orientation. In some embodiments, the selected plate  14 ,  14 A or  14 B is manually adjusted by the medical practitioner to ensure proper engagement of plate  14 ,  14 A or  14 B within cavity  64  where plate  14 ,  14 A or  14 B is flush with a selected projection  138 ,  140 ,  142  and tab  218 , as shown in  FIGS.  20  and  21   . 
     Implant contouring instrument  12  is positioned in the closed orientation to contour plate  14 ,  14 A or  14 B to a selected curvature/angle to increase lordosis of plate  14 ,  14 A or  14 B, as shown in  FIGS.  24  and  25   . In the closed orientation, arms  16 ,  18  are translated in a direction, for example, an inward direction as shown by arrows E in  FIG.  22    and ends  20 ,  28  of arms  16 ,  18  are translated in a direction, for example, an outward direction shown by arrows F in  FIG.  25   . Fulcrum  36  coupled with surface  94  of transverse roller  26  and surface  114  of transverse roller  34  contour plate  14 ,  14 A or  14 B as ends  20 ,  28  are translated in the outward direction. When the desired lordosis is reached, continued translation of arms  16 ,  18  is prevented via stop element  57 , as shown in  FIG.  25   . Button  222  is translated in the upward direction of arrow C in  FIGS.  15  and  16    to translate tab  218  such that plate  14 ,  14 A or  14 B can be removed from implant contouring instrument  12 . To decrease lordosis of plate  14 ,  14 A or  14 B, the steps described above are repeated on the KS of implant contouring instrument  12  specific to decreasing the lordotic angle of plate  14 ,  14 A or  14 B. 
     In some embodiments, surgical system  10  includes an agent, which may be disposed, packed or layered within, on or about the components and/or surfaces of surgical system  10 . In some embodiments, the agent may include bone growth promoting material, for example, bone graft to enhance fixation of bone fasteners with vertebrae. In some embodiments, the agent may include one or a plurality of therapeutic agents and/or pharmacological agents for release, including sustained release, to treat, for example, pain, inflammation and degeneration. 
     The components of surgical system  10  can be made of radiolucent materials such as polymers. Radiomarkers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. In some embodiments, the use of microsurgical and image guided technologies may be employed to access, view and repair spinal deterioration or damage, with the aid of surgical system  10 . Upon completion of the procedure, the surgical instruments, assemblies and non-implant components of surgical system  10  are removed from the surgical site and the incision is closed. 
     In one embodiment, as shown in  FIGS.  29 - 32   , surgical system  10 , similar to the systems and methods described above with regard to  FIGS.  1 - 28   , includes an implant contouring instrument  312 , similar to implant contouring instrument  12  described herein. Implant contouring instrument  312  is employed, for example, to contour an implant, for example, plate  14 ,  14 A and/or  14 B during a surgical treatment to the configuration and/or dimension of the spine to increase or decrease lordosis, as described herein. In some embodiments, lordosis is increased from 1 to 30 degrees and kyphosis is decreased from 1 to 30 degrees, as described herein. 
     Implant contouring instrument  312  defines a longitudinal axis XX, as shown in  FIG.  29    and includes an arm  316  and an arm  318 , as shown in  FIG.  29    and similar to arms  16 ,  18  described above with regard to implant contouring instrument  12 . Arms  316 ,  318  are configured to be pivotable between an open and a closed orientation relative to each other to move a fulcrum  336  of implant contouring instrument  312  to facilitate contouring of plate  14 ,  14 A or  14 B as described herein. Arm  316  extends between an end  320  and an end  322 . End  320  includes a surface that defines an opening  324  configured for disposal of a portion of a support, for example, a portion of a transverse roller  326 , as shown in  FIG.  29    and described herein. Arm  318  extends between an end  328  and an end  330 . End  328  includes a surface that defines an opening  332  configured for disposal of a portion of a support, for example, a portion of a transverse roller  334 , as shown in  FIG.  29    and described herein. 
     Fulcrum  336  defines a longitudinal axis YY, as shown in  FIG.  29    and is configured to translate relative to transverse rollers  326 ,  334  to engage plate  14 ,  14 A or  14 B and to contour plate  14 ,  14 A or  14 B to a selected lordosis and/or kyphosis. Transverse rollers  326 ,  334  are similar to transverse rollers  26 ,  34  described above with regard to implant contouring instrument  12 . Fulcrum  336  includes a link  338  defined from a surface of arm  316 , as shown in  FIGS.  30  and  31   . Link  338  is configured for disposal within a slot  340  of arm  318 , as described herein for pivotable engagement between arms  316 ,  318 . Link  338  includes a surface that defines an opening  342 . Opening  42  is configured for disposal with a pin  344  of fulcrum  336 , as shown in  FIG.  29   . Fulcrum  336  includes a link  346  and a link  348  defined from surfaces of arm  318 , as shown in  FIG.  30   . Link  346  is parallel relative to link  348 . Slot  340  is defined from an interior of links  346 ,  348 . Link  346  includes a surface that defines an opening  350  and link  348  includes a surface that defines an opening  352 . Openings  350 ,  352  are configured for disposal with pin  344 , as shown in  FIG.  29   . Links  338 ,  346  and  348  are disposed at an angle α 2  to facilitate contouring of plate  14 ,  14 A or  14 B at an angle from 1 degree to 30 degrees, as shown in  FIGS.  30  and  31   . 
     Fulcrum  336  includes a disc  354  and a disc  360  similar to discs  54  and  60  described above with regard to implant contouring instrument  12 . A stop element  357 , as shown in  FIG.  32    is similar to stop element  57  described above with regard to implant contouring instrument  12 . Stop element  357  is configured to limit implant contouring instrument  312  from contouring plate  14 ,  14 A or  14 B beyond 30 degrees. 
     Fulcrum  336  defines an implant cavity  364  with transverse rollers  326 ,  334  on a lordosis surface (LS) of implant contouring instrument  312 , as shown in  FIG.  32   , and an implant cavity  366  on a kyphosis surface (KS) of implant contouring instrument  312 , as shown in  FIG.  29   . Arm  316  and/or arm  318  includes indicia, for example, laser markings including text that indicates the KS or the LS of implant contouring instrument  312 , similar to the laser markings described above with regard to implant contouring instrument  12 . In some embodiments, the LS is a side of implant contouring instrument  312  and the KS is an opposing side of implant contouring instrument  312 . Implant contouring instrument  312  includes flat springs  368  and  370 , rotatable dials  434 ,  436  and releasable locks  458 ,  464 , similar to flat springs  68 ,  70 , rotatable dials  134 ,  136  and releasable locks  158 ,  164  described above with regard to implant contouring instrument  12 . 
     It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplification of the various embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.