Patent Publication Number: US-9408641-B2

Title: Spinal rod link reducer

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority to U.S. Provisional Application Ser. No. 61/025,761, filed Feb. 2, 2008, and to U.S. Provisional Application Ser. No. 61/080,162 filed Jul. 11, 2008, the contents of both of which is incorporated by reference herein in its entirety. 
    
    
     TECHNICAL FIELD OF THE INVENTION 
     The present invention relates in general to the field of bone fixation, and more particularly, to a novel rod link reducer for use during the correction of mild to severe spinal deformities. 
     STATEMENT OF FEDERALLY FUNDED RESEARCH 
     None. 
     BACKGROUND OF THE INVENTION 
     Without limiting the scope of the invention, its background is described in connection with pedicle screws. 
     In rigid severe spine deformity with coronal or sagittal decompensation, translation of the spinal column is necessary for restoration of trunk balance as well as deformity correction. However, the conventional correction methods, such as posterior correction only or anterior release and posterior instrumentation, are usually unsatisfactory. Therefore, a more aggressive approach, such as reconstructive techniques, is necessary. In 1922, Maclennan 1  first illustrated vertebrectomy and demonstrated an apical resection from a posterior-only approach with postoperative casting for the treatment of severe scoliosis. Several authors 2-8  have subsequently reported their experience with vetebrectomy, mostly for congenital scoliosis. In 1987, Bradford 9  performed both anterior and posterior vertebral column resection (VCR) with spinal shortening and posterior instrumentation and fusion demonstrating excellent restoration of coronal with relatively few complications. Leatherman 6  introduced a two-stage anterior and posterior correction procedure for congenital spinal deformity. Bradford and Bochie-Adjei 10  also reported a single stage anterior and posterior resection of hemivertebra and spinal arthordesis. However, the anterior-posterior vertebral column resection (VCR) has disadvantages such as long operative time, potential significant blood loss, and risk of intraoperative neurologic impairment due to the spinal column segment instability during the resection and the correction procedure. 
     In 2002, Suk 11-13  introduced a technique of a single posterior approach to perform VCR (PVCR) that offered significant advantages over the combined anterior-posterior VCR. The surgery consisted of temporary stabilization of the vertebral column with segmental pedicle screw fixation, resection of the vertebral column at the apex of the deformity via the posterior route followed by gradual deformity correction and global fusion. In the surgical technique, multiple pedicle screws were utilized proximal and distal to the vertebral resection to securely fix the spine prior to any bony resection. Provisional single rod placement is performed during the bony resection to prevent sudden spinal column translations which may result in spinal cord injury. The vertebral column resection and deformity correction were carried out either by exchanging the temporary precontoured rods one by one or by in situ rod bending. However, these technique have a number of disadvantages: 1) the risk of intraoperative mishaps due to the instability resulting from exchanging the temporary rods may produce spinal cord injury; 2) limitation in deformity correction secondary to a “one-time” correction maneuver utilized using the Suk technique; 3) short segment fixation using the provisional rods since multiple exchanges prevent long rod utilization; and 4) additional surgical time necessary with multiple removal and insertion of the temporary provisional rods. 
     One such fixation system is taught in U.S. Pat. No. 7,220,262, issued to Hynes. Briefly, the spinal fixation system and related methods include pedicle screws secured in two columns, one along each side of the spine. Cross support rods have ends connected to pedicle screw heads. A longitudinally extending rod is supported on the cross supports and recessed in the cavity created by removal of portions of spinous processes, providing a reduced profile of the installed construct. Several types of cross supports are shown such as: arms from the screws inward to rings or yokes connecting the longitudinal rod; cross rods with ends connected to the screws and having centrally-located yokes for the longitudinal rod; cross rods with articulating longitudinal rod portions fixed or swiveled to them. These cross rods may have end portions angled posterior toward anterior to accommodate lateral positioned pedicle screws, but shorter cross rods without angled end portions enable medialized pedicle screw orientation. 
     United States Patent Application No. 20070270810, filed by Sanders is directed to a pedicle screw spinal rod connector arrangement. Briefly, a pedicle screw spinal rod connector arrangement is provided that includes in a body having an opening for mounting a head of an inserted pedicle screw. A bracket connected with the body forms a lateral restraint. A bridge is connected with and extends over the body. A spinal rod-receiving slot is provided between the bridge and the bracket. The connector arrangement also has a wedge axially offset from the pedicle screw moveable downward by a setscrew mounted with the bridge. The wedge imparts a locking force on the pedicle screw head and a generally lateral locking force on the spinal rod. 
     Yet another example is shown in United States Patent Application No. 20070233062, filed by Berry for a pedicle screw system with offset stabilizer rod. In this example, an improved pedicle screw system is provided with an offset stabilizer rod for the internal fixation of the spine. The pedicle screw system includes at least two multi-angle pedicle screw units adapted for anchored securement to patient bone, and an elongated stabilizer rod extending therebetween. Each pedicle screw unit includes a bone screw associated with an anchor bracket defining a laterally offset and upwardly open channel or trough for receiving and supporting the stabilizer rod. A securement member such as a set screw is fastened to the anchor bracket for compressively retaining the stabilizer rod within the bracket channel or trough. The securement member may also bear against the associated bone screw for compressively retaining the screw in position relative to the anchor bracket. 
     SUMMARY OF THE INVENTION 
     The present invention solves various problems of current spinal fixation systems and the control of the positioning of temporary rod during spinal surgery. The present invention allows the surgeon to stabilize the spine, effectively derotate the spine, safely translate the spine and when required easily derotate and translate the spine to treat spinal deformities. 
     The present inventors recognized there and other disadvantages of the current implant strategies used during Posterior Vertebral Column Resection (PVCR) by designing a new pedicle screw posterior instrumentation system. The present invention includes screws, methods, kits and systems that provide a safer, easier and better correction, as well as shorter operation time method for the PVCR of the severe spinal deformity. The present invention takes advantage of the top-loading and side-loading current designs as well as a universal connecting link to provide three-dimensional correction. These components provide: 1) continued stabilization of the spine during bony resection as well as correction; 2) allow for controlled correction of the spine using both rods; and 3) provide the ability to place the permanent rods while the long provisional rod is in places so instability is not created. 
     The present invention includes: 1) a pedicle screw with a screw head that can receive two rods. The bone screw head includes two rod-receivers. One receiver member is basic “U” shape (top-loading component) that extends from the top of the screw head to receive a temporary rod. Another receiver member has a basic “C” shape (side-loading component) that is inferior to the first receiver. The second receiver receives a final rod. There is also a breakaway mechanism between the first and second apertures so that the first aperture can be removed while the final rod is fixed; 2) rod-link reducer has a basic “H” shape that rigidly links and locks the temporary rods, which allows attachment to the rod at any orientation in the coronal, sagittal, and transverse planes so as to make compression, distraction, derotation and cantilever method; 3) reduction handle connects with the rod-link reducer; and 4) 5.5 mm diameter rod. For the PVCR of severe spinal deformity, this instrumentation system would provide: 1) better maintenance of spinal stability throughout the surgical procedure to reduce risk of the spinal cord injuries; 2) more reliable reconstruction of the vertebral column; 3) better and easier correction of the deformity; and 4) shorter operative time. 
     More particularly, the present invention includes a rod link reducer for a spinal fixation system, the rod link reducer includes a first and a second spinal rod manipulator; a first spinal rod manipulator joint connected to the first spinal rod manipulator and a second spinal rod manipulator joint connected to the second spinal rod manipulator; a first and a second translatable transverse shaft connected to the first and second joints, respectively; and a universal reducer connected to both the first and second translatable transverse shafts, wherein the reducer, the shafts and the linkers provide movement and temporary fixation of a spine that has been manipulated into a final position during spinal surgery. In one aspect, the spinal rod manipulator is further defined as comprising a handle and a rod attachment fixation point, wherein the rod attachment fixation point at least partially surrounds a rod with a semi-permanent fastener. In another aspect, the first, the second or both the first and second translatable transverse shafts connects to the universal reducer and are capable of sliding to increase or decrease the distance between the first and second joints. The universal reducer can be, for example, a ball joint, a universal joint, a pivot, a slot, a collar, a bearing, a dove-tail, a ball-joint, a gimbal, a level, or a sleeve that permits movement of the translatable transverse shafts in two or more dimensions. In another aspect, the universal reducer may also includes a fastener that semi-permanently fixes the position of the reducer in relation to the first, the second or both translatable transverse shafts. The first and second joints may each also includes an independent fastener that semi-permanently fixes the relative position of the first spinal rod manipulator to the first translatable transverse shaft, the second spinal rod manipulator to the second translatable transverse shaft or both the first and second spinal rod manipulator to the first and second translatable transverse shafts, respectively. Any component of the rod link reducer comprises titanium, stainless steel, spring steel, aluminum, Niobium and alloys thereof, carbon fiber, ceramics, polymers, composites or combinations thereof. 
     In another embodiment, the present invention includes a method of correcting a spinal deformity by fastening two or more pedicle screw into two or more vertebra; interconnecting the pedicle screws with two or more temporary rods; connecting a of link reducer between the temporary rods, the rod link reducer having a first and a second spinal rod manipulator; a first spinal rod manipulator joint connected to the first spinal rod manipulator and a second spinal rod manipulator joint connected to the second spinal rod manipulator; a first and a second translatable transverse shaft connected to the first and second joints, respectively; and a universal reducer connected to both the first and second translatable transverse shafts, wherein the reducer, the shafts and the linkers provide movement and temporary fixation of a spine that has been manipulated into a final position during spinal surgery. Next, the user correct the position of the spine by manipulating the temporary rods attached to the pedicle screws; interconnects the pedicle screws with a permanent fixation rod; and finally removes the temporary rod. One example of a pedicle screw for use with the present invention may include a bone fastener and a rod coupling head, the rod coupling head comprising a lower and an upper rod coupling: the lower rod coupling including a lateral rod opening adapted to receive a permanent rod; an angled bore extends into the lateral rod opening; and a permanent rod fastener in the angled bore to engage a permanent rod in the lateral rod opening; and a upper rod coupling having: an upper rod opening adapted to receive a temporary rod, wherein the upper rod opening is formed to receive a temporary rod fastener, wherein the upper rod coupling is detachable from the lower rod coupling at a transition, wherein a temporary rod is temporarily affixed into the upper rod opening during a bone realignment and a permanent rod is positioned in the lateral rod opening and engaged by the permanent rod fastener upon final bone alignment. In one aspect, the spinal rod manipulator is further defined as comprising a handle and a rod attachment fixation point, wherein the rod attachment fixation point at least partially surrounds a rod with a semi-permanent fastener. In another aspect, the first, the second or both the first and second translatable transverse shafts connects to the universal reducer and are capable of sliding to increase or decrease the distance between the first and second joints. The universal reducer may include a ball joint, a universal joint, a pivot, a slot, a collar, a bearing, a dove-tail, a ball-joint, a gimbal, a level, or a sleeve that permits movement of the translatable transverse shafts in two or more dimensions. In another aspect, the universal reducer further may also include a fastener that semi-permanently fixes the position of the reducer in relation to the first, the second or both translatable transverse shafts. The first and second joints may each include an independent fastener that semi-permanently fixes the relative position of the first spinal rod manipulator to the first translatable transverse shaft, the second spinal rod manipulator to the second translatable transverse shaft or both the first and second spinal rod manipulator to the first and second translatable transverse shafts, respectively. 
     The present invention also includes a kit that includes a rod link reducer of a spinal fixation system, the rod link reducer having a first and a second spinal rod manipulator; a first spinal rod manipulator joint connected to the first spinal rod manipulator and a second spinal rod manipulator joint connected to the second spinal rod manipulator; a first and a second translatable transverse shaft connected to the first and second joints, respectively; and a universal reducer connected to both the first and second translatable transverse shafts, wherein the reducer, the shafts and the linkers provide movement and temporary fixation of a spine that has been manipulated into a final position during spinal surgery. The kit may also include two or more pedicle screw into two or more vertebra, the pedicle screw including a bone fastener and a rod coupling head, the rod coupling head comprising separate lower and upper lower rod couplings: the lower rod coupling including: a lateral rod opening adapted to receive a permanent rod; an angled bore extends into the lateral rod opening; and a permanent rod fastener in the angled bore to engage a permanent rod in the lateral rod opening; and a upper rod coupling including: an upper rod opening adapted to receive a temporary rod, wherein the upper rod opening is formed to receive a temporary rod fastener; and two or more temporary rod fasteners. The kit may also include at least one of two or more permanent rods, two or more temporary rods, one or more rod link reducers, a plurality of pedicle screws and one or more leverage handles. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       For a more complete understanding of the features and advantages of the present invention, reference is now made to the detailed description of the invention along with the accompanying figures and in which: 
         FIG. 1  shows one embodiment of the pedicle screw of the present invention. 
         FIGS. 2A to 2C  show a cross-sectional view of the pedicle screw in operation. 
         FIGS. 3A and 3B  show an isometric view and a cross-sectional view, respectively, of the pedicle screw  10 . 
         FIGS. 4A and 4B  show an isometric view and a cross-sectional view, respectively, of the pedicle screw  10 . 
         FIGS. 5A and 5B  show an isometric view and a cross-sectional view, respectively, of the pedicle screw  10 . 
         FIGS. 6A and 6B  show an isometric view and a cross-sectional view, respectively, of the pedicle screw  10 . 
         FIGS. 7A and 7B  show an isometric view and a cross-sectional view, respectively, of the pedicle screw  10 . 
         FIG. 8  shows a rod link reducer  10  for use with the present invention. 
         FIG. 9  is a cross-sectional side view of one embodiment of the rod link reducer  10  present invention. 
         FIG. 10  is a side view of one embodiment of a rod manipulator. 
         FIGS. 11 to 13  show the first step in a spinal fixation process. 
         FIG. 14  shows the use of the rod link reducer and pedicle screw of the present invention. 
         FIG. 15  shows an overlay of the planning and tools for a surgical procedure to correct a severe spinal deformity. 
         FIGS. 16A to 16E  shows the invention in use a procedure that includes distraction, translation and apical derotation for correction of a single severe spinal curve. 
         FIGS. 17A to 17E  shows the invention in use a procedure for correction of a double major severe spinal curve (Thoracic and Lumbar curve). 
         FIG. 18  is a detailed view of one embodiment of an apical derotation without linking the two pedicle screws. 
         FIG. 19  is an isometric view of a design of the rod-link reducer of the present invention. 
         FIG. 20  is an isometric view rod-link reducer of the present invention. 
         FIG. 21  is an isometric view of another design of the rod-link reducer of the present invention. 
         FIG. 22  shows a six-segment plastic spine model was instrumented to test three constructs: (1) temporary rod/apical rod-link reducer (left panel); (2) provisional rod (center panel); and (3) final rod (right panel). 
         FIG. 23  is a picture that illustrates a perspective view of a rod-link reduce which links and locks the provisional rods on the concavity 
         FIG. 24  is a picture that illustrates a perspective view of a rod-link reduce which links and locks the provisional rods on the convexity 
         FIGS. 25-26  are pictures illustrating perspective view of the parts of the rod-link reducer. 
         FIG. 27  is a picture that illustrates a cross sectional view of the rod-link reducer on the coronal plane. 
         FIG. 28  is a picture that illustrates a cross sectional view of the rod-link reducer on the sagittal plane. 
         FIG. 29  is an image that shows the pedicle screws, provisional rods, and two rod-link-reducers are fixed in a coronal curve deformity model. 
         FIG. 30  is an image that shows the rod-link-reducers correct the coronal curve. 
         FIG. 31  is an image that shows the provisional rods and the rod-link-reducers and the final rods are with the spine which is corrected. 
         FIG. 32  is an image that shows the final rods with the spine which is corrected. 
         FIG. 33  is an image that shows the rod-link-reducers correct the sagittal curve to the normal kyphosis. 
         FIG. 34  is an image that shows the rod-link-reducers correct the sagittal curve to the normal lordosis. 
         FIG. 35  is an image that shows the pedicle screws, provisional rods, and two rod-link-reducers are fixed in a sagittal curve deformity model. 
         FIG. 36  is an image that shows the final rod insertion after the sagittal curve correction. 
         FIG. 37  is an image that shows the final rods are with the spine which is corrected. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     While the making and using of various embodiments of the present invention are discussed in detail below, it should be appreciated that the present invention provides many applicable inventive concepts that can be embodied in a wide variety of specific contexts. The specific embodiments discussed herein are merely illustrative of specific ways to make and use the invention and do not delimit the scope of the invention. 
     To facilitate the understanding of this invention, a number of terms are defined below. Terms defined herein have meanings as commonly understood by a person of ordinary skill in the areas relevant to the present invention. Terms such as “a”, “an” and “the” are not intended to refer to only a singular entity, but include the general class of which a specific example may be used for illustration. The terminology herein is used to describe specific embodiments of the invention, but their usage does not delimit the invention, except as outlined in the claims. 
     Posterior vertebral column resection (PVCR) can be used for correction of the most severe spinal deformities. Current implant strategies used for more common and moderate spinal deformity are not ideal for those complex cases. Sure they do not provide continuous stability of the spine as one transition between resection and correction, are cumbersome, and the application of correction forces are not ideal. The new system disclosed herein was designed specifically to surgically treat severe spinal deformity. 
     The treatment of severe rigid spinal deformity is a demanding and difficult surgical challenge. The PVCR has been considered to be an effective alternative to the conventional anteriorposterior VCR in severe rigid spinal deformity. However, the current implant strategies used during PVCR afford the limited correction, potential risk of spinal cord injuries, and long operative time. This new instrumentation system may offer: 1) better maintenance of spinal stability throughout the surgical procedure to reduce risk of the spinal cord injuries; 2) more reliable reconstruction of the vertebral column; 3) better and easier correction of the deformity; and 4) shorter operative time. 
     The novel pedicle screw/rod-link reducer posterior instrumentation system was developed to provide a safer, easier and improved deformity correction, as well as shorter surgical time for the PVCR of the severe spinal deformity. Biomechanical evaluation of this system demonstrated spinal stability throughout the surgical procedure to reduce the risk of spinal cord injuries. 
     The temporary rod/rod-link reducer construct provided similar stiffness and stability compared to the provisional and final rod constructs. This new system may offer a safer, easier and improved deformity correction, as well as shorter surgical time for the PVCR of the severe spinal deformity. 
     Significance: Current implant strategies used for more common and moderate spinal deformity are not ideal for the most severe spinal deformities. A novel pedicle screw/rod-link reducer has been designed to offer better maintenance of spinal stability throughout the surgical procedure to reduce risk of the spinal cord injuries. This system may therefore provide a safer, easier and improved deformity correction, as well as shorter surgical time for the PVCR of the severe spinal deformity. 
     Implant Components: The instrumentation system may include one or more of the following components: a pedicle screw, a rod-link reducer, reduction handle, temporary long rod, and final rod. The pedicle screw includes a threaded shank for insertion into the bone and a screw head having a first aperture and a second aperture. The first aperture has a basic “U” (tulip) shape (top-loading component) that extends from the top of the screw head and is open on both sides of the screw head to receive a first longitudinal member (a temporary rod) and a set of female threads formed in the inner walls of the first aperture. A first compression member engages the set of female threads of the first aperture and the face of the first compression member contacts the first longitudinal member. The second aperture has a basic “C” shape (side-loading component) that lines up superior to the threaded shank and inferior to the first aperture. The second aperture is open on both sides of the head to receive a second longitudinal member (a final rod). The second aperture also includes a second set of female threads that accommodate a second compression member that screwably engages the second set of female threads and the face of the second compression member contacts the second longitudinal member. There is a breakaway mechanism between the first and second apertures. 
     The rod-link reducer has a basic “H” shape that rigidly links and locks the first longitudinal members (temporary rods). The rod-link reducer includes: 1) two top-tightening locking mechanisms (break-off set screws) those provide access ensure the adequate grip on the temporary rods by the set screws; 2) an adjustable central mechanism by functioning in a multi-axial manner, allows attachment to the rod at any orientation in the coronal, sagittal, and transverse planes. The mechanism allows to make compression, distraction, derotation and cantilever method; 3) two adjustable lateral mechanisms (break-off set screws) allow the locking mechanisms adequately to attach the temporary rods; 4) two squared ends those connect with two reduction handles. 
     The reduction handle is a column shape and has two portion ends. The first end has a squared access that connects with the squared end of the rod-link reducer. The second end is a solid column. The temporary rod and the final rod are the diameter of 5.5 mm rods those are made of stainless steel or titanium. 
     In operation, the present invention may be used as follows: With the spine exposed posteriorly, the pedicle screws will be inserted segmentally, except for the resected levels (apex). The spine is then divided into cephalad and caudal portions by the resected levels. At the cephalad portion, two temporary rods will be fixed on the convex and concave side via the first aperture of the pedicle screw respectively. Another two temporary rods will be similarly fixed at the caudal portion. The two temporary rods on the concave side will be connected with a rod-link reducer and locked to the shape of the deformity without any attempt at correction. Resection of the vertebral column will be performed at the convex side of the apex. Following resection on the convex side, another rod-link reducer will be connected and locked on the two convex temporary rods. The resection of the remaining vertebra will be performed on the concave side. 
     Deformity correction is performed by loosening the adjustable central mechanism of the rod-link reducer on the convex side with the reduction handles, which will be gradually compressed to shorten the resected gap. During the compression the resected gap on the convexity, the central part of rod-link reducer on the concavity will be gradually loosen to match the compression/shortening on the convexity. 
     After deformity correction, two final rods will be fixed on the convex and concave side via the second aperture of the pedicle screw respectively. The two rod-link reducers will be unlocked and all temporary rods will be removal. A custom wrench will be used to remove the first aperture parts of the pedicle screw. 
     The pedicle screw and any of its components including the bone fastener, threads, neck and screwhead, may be made of a non-organic material that is durable and that can be implanted in a human body, such as titanium, stainless steel, spring steel, aluminum, Niobium, carbon fiber, ceramics, polymers, composites or any relatively hard material (e.g. Titanium-Aluminium-Niobium-alloy). Generally, the material selected will be biocompatible, that is, compatible with the surrounding bone and tissue. 
     The present invention provides a substantial improvement in addressing clinical problems indicated for surgical treatment of chronic or acute spinal injuries, including traumatic spinal injuries, scoliosis (abnormal lateral curvature of the spine), kyphosis (abnormal forward curvature of the spine, often in the thoracic spine), excess lordosis (abnormal backward curvature of the spine, often in the lumbar spine), spondylolisthesis (forward displacement of one vertebra over another, often in a lumbar or cervical spine) and other disorders caused by abnormalities, disease or trauma, such as ruptured or slipped discs, degenerative disc disease, fractured vertebra, and the like. 
       FIG. 1  shows one embodiment of the pedicle screw  10  of the present invention. The pedicle screw  10  includes a bone fastener  12  and a rod coupling head  14 . The rod coupling head  14  includes a lower rod coupling  16  having a lower rod opening  18 , depicted in a lateral configuration. The lower rod opening  18  may have any angle so long as the material of the pedicle screw  10  that surrounds the lower rod opening  18  is sufficiently strong to retain and affix a permanent rod. The lower rod coupling  16  also includes a bore  20 , through which a permanent rod fastener  22  can be inserted to fasten a permanent rod. As in the case of the lower rod opening  18 , the material of the pedicle screw  10  surrounding the bore  20  will also be sufficiently strong to retain and affix a permanent rod. The upper rod coupling  24  has an upper rod opening  26 . The upper rod coupling  24  is formed to permit the user to insert a temporary rod using a temporary rod fastener  28 . The lower and upper rod couplings  16  and  24 , respectively, will often be made of unitary construction. For illustration purposes, and not necessarily as an element or limitation, a transition  32  is denoted. In unitary embodiments, the transition  32  may be modified (e.g., notched, cut, scratched or weakened) to provide for the breakage of the upper rod coupling  24 . In another embodiment, the transition  32  may provide a semi-permanent attachment between the lower rod coupling  16  and the upper rod coupling  24 , such that the transition is a universal joint, a pivot, a slot, a collar, a bearing, a dove-tail, a ball-joint, a gimbal, a level, or a sleeve. Likewise, the lower rod coupling  16  and the bone fastener  12  may be connected with a universal joint, a pivot, a slot, a collar, a bearing, a dove-tail, a ball-joint, a gimbal, a level, or a sleeve. When made in a unitary construction, the pedicle screw  10  may be machined, sintered, cast, welded or glued as long as the pedicle screw  10  is of sufficient strength for the bone fixation application. 
       FIGS. 2A to 2C  show a cross-sectional view of the pedicle screw  10  in operation. In  FIG. 2A , the pedicle screw has been affixed to a bone (not depicted) and a temporary rod  34  has been inserted into the upper rod opening  26  and semi-permanently affixed using the temporary rod fastener  28 . In the embodiment depicted, the upper rod opening  26  is shows internally threaded and the temporary rod fastener  28  is shows externally threaded. The skilled artisan will recognize that the present invention also includes fastener embodiments in which the threading is reversed, the threading is external to the upper rod coupling and the fastener is internally threaded, the fastener is a cap, the fastener and the coupling snap together, are wedged together, twist and lock. Likewise, the permanent rod fastener is also able to engage the permanent rod in a variety of manners, including pins, latches, threading, snapping, wedging and locking. The permanent rod may even be glued or welded. 
       FIG. 2B  shows the addition of the permanent rod  36  in addition to the temporary rod  34 . Next, the temporary rod fastener  28  and the temporary rod are removed (not depicted). Finally,  FIG. 2C  shows the final assembly in which the upper rod coupling is removed completely by breaking the upper rod coupling into tabs  40  at breakpoints  38 . 
       FIGS. 3A and 3B  shows an isometric view and a cross-sectional view, respectively, of the pedicle screw  10  in which the lower rod coupling  16  and the upper rod coupling  24  are connected by in which a screw portion  50  is fastened into opening  52  and which permits the potential for some rotations about the axis of the screw portion  50 . After the permanent rod has been affixed into the pedicle screw  10 , the upper rod fastener  24  is removed. 
       FIGS. 3A and 3B  show an isometric view and a cross-sectional view, respectively, of the pedicle screw  10  in which the lower rod coupling  16  and the upper rod coupling  24  are connected by in which a screw portion  50  is fastened into opening  52  and which permits the potential for some rotations about the axis of the screw portion  50 . After the permanent rod has been affixed into the pedicle screw  10 , the upper rod fastener  24  is removed. 
       FIGS. 4A and 4B  show an isometric view and a cross-sectional view, respectively, of the pedicle screw  10  in which the lower rod coupling  16  and the upper rod coupling  24  are connected by in which a screw  54  is fastened through opening  56  into opening  52  and which permits the potential for some rotations about the axis of the screw  54 . After the permanent rod has been affixed into the pedicle screw  10 , the upper rod fastener  24  is removed by unscrewing screw  54 . The screw  54  also permits control over the mechanical force required to rotate the upper rod coupling  24 . For configurations in which the lower rod coupling  16  and the upper rod coupling  24  are separate, the interface between the two make be smooth, rough or patterned (e.g., random or non-random) or coated. 
       FIGS. 5A and 5B  show an isometric view and a cross-sectional view, respectively, of the pedicle screw  10  in which the lower rod coupling  16  and the upper rod coupling  24  are connected by in which a screw  54  is fastened through opening  56  into opening  52  and which permits the potential for some rotations about the axis of the screw  54 . After the permanent rod has been affixed into the pedicle screw  10 , the upper rod fastener  24  is removed by unscrewing screw  54 . In this configuration the lower rod coupling  16  and the upper rod coupling  24  are separate and the interface between the upper and lower rod couplings ( 24 ,  16 ) is enhanced by the addition of a slit  60  that dove-tails with a notch  62 . The notch  62  can even be placed at an angle or can also be made square such that the upper rod coupling  24  can be placed parallel or perpendicular to the direction of the permanent or temporary rods. 
       FIGS. 6A and 6B  show an isometric view and a cross-sectional view, respectively, of the pedicle screw  10  in which the lower rod coupling  16  and the upper rod coupling  24  are connected by in which a screw  54  is fastened through opening  56  into opening  52  and which permits the potential for some rotations about the axis of the screw  54 . After the permanent rod has been affixed into the pedicle screw  10 , the upper rod fastener  24  is removed by unscrewing screw  54 . In this configuration the lower rod coupling  16  and the upper rod coupling  24  are separate and the interface between the upper and lower rod couplings ( 24 ,  16 ) is enhanced by the addition of a slit  60  that dove-tails with an external notch  62 . The notch  62  can even be placed at an angle or can also be made square such that the upper rod coupling  24  can be placed parallel or perpendicular to the direction of the permanent or temporary rods. 
       FIGS. 7A and 7B  show an isometric view and a cross-sectional view, respectively, of the pedicle screw  10  in which the lower rod coupling  16  and the upper rod coupling  24  are connected by in which a screw  54  is fastened through opening  56  into opening  52  and which permits the potential for some rotations about the axis of the screw  54 . After the permanent rod has been affixed into the pedicle screw  10 , the upper rod fastener  24  is removed by unscrewing screw  54 . In this configuration the lower rod coupling  16  and the upper rod coupling  24  are separate and the interface between the upper and lower rod couplings ( 24 ,  16 ) is enhanced by the addition of dove-tail joints (shown in two different configurations). The notch  62  can even be placed at an angle or can also be made square such that the upper rod coupling  24  can be placed parallel or perpendicular to the direction of the permanent or temporary rods. 
       FIG. 8  is an isometric view of a rod link reducer  100  for use with the present invention. The rod link reducer  100  includes first and second spinal rod manipulators  102 ,  104 , which are connected to a first spinal rod manipulator joint  106  connected to the first spinal rod manipulator  102  and a second spinal rod manipulator joint  108  connected to the second spinal rod manipulator  104 . First and second translatable transverse shafts  110 ,  112  connected to the first and second joints  106 ,  108 , respectively, which connected to a reducer  114  connected to both the first and second translatable transverse shafts  110 ,  112 , wherein the reducer  114 , the shafts  110 ,  112  and the linkers  106 ,  108  provide movement and temporary fixation of a spine that has been manipulated into a final position during spinal surgery. 
       FIG. 9  is a cross-sectional side view of one embodiment of the rod link reducer  10  present invention, shown in this embodiment with screws  116 . The skilled artisan will recognize that the screws  116  provide reversible mechanical fixation between the different parts of the system that can be tightened and loosened during spinal adjustments. Any given joint may include some friction or resistance during use up to and including total fixation. The screws  116  can be replaced or include pins, set screws, cotter pins, internal or external compression, compression fittings, collared fittings, screw-drives or even electrical, pneumatic or hydraulic movement or pressure. In the embodiment depicted, first and second translatable transverse shafts  110 ,  112  as shown as adjustment sleeves slidably fitted within a housing  118  is an axial bore  120  and within the axial bore a strut  122  in which the screw  116  serves as a fastener positioned to secure the strut  122  within the housing  118 , wherein the struts  112  allow for coarse longitudinal movement of the strut  122  with respect to the strut housing  118 . The skilled artisan will recognize that the strut-bore configuration can be reversed (bore-strut) or replaced with side-by-side struts, internal-external slidable pins within a groove, screw-drives, magnetic drives, electrical, pneumatic or hydraulic drives so long as the translatable transverse shafts  110 ,  112  permit the user to expand and/or contract one or both the translatable transverse shafts  110 ,  112 . 
       FIG. 10  is a side view of one embodiment of rod manipulators  102 ,  104 . In this side view screws  116  are shown as well as either first or second joint  106 ,  108 . The rod manipulators  102 ,  104  include a head  130  that has an opening  132  that first a rod (temporary or permanent) for spinal fixation. The screw  116  is used to engage and retain the rod. The rod manipulators  102 ,  104  will be made from a material with sufficient tensile strength to allow the manipulator to fasten to the rod but also to permit the user to translate movement from the handle  134  into the rod in any direction. The handle  134  may itself also include a coating (not depicted) to improve the grip of a user during use or may be shaped to permit a second handle to attach to the handle  134  to increase the leverage of a user when manipulating a spine during spinal fixation surgery. Again, while this embodiment is shown with screws, any fastening method (pins, set-screws, compression, collets, etc.) may be used to fasten the various components of the rod link reducer of the present invention. 
     The rod link reducer  100  may be used in conjunction with existing spinal screw and rod fixation systems or may be used in conjunction with the pedicle screw  10 . The size and thickness of rods may be varied depending on the type of surgery, tensile strength required and preference of the user. 
       FIG. 11  shows the first step in a spinal fixation process. In this embodiment, a temporary rod  34  has been attached to pedicle screws  10  (while not depicted, the pedicle screws may be attached individual vertebra. Examples of conditions that may be treated using the present invention include kyphosis, lordosis, scoliosis or combinations thereof. A rod link reducer  100  is shown connected to the temporary rod  34  and the spine (not shown) has been aligned. In  FIG. 12 , the permanent rod  36  is introduced into the pedicle screw  10  while the rod link reducer  110  holds the entire assembly in place while the permanent rod is permanently affixed to the pedicle screws  10 . Finally,  FIG. 13  shows the final spinal rod assembly after removing the temporary rod and the breakable tabs from the pedicle screws  10 . 
       FIG. 14  shows the advantage provided by the rod link reducer  100  of the present invention. In this top view of the operation of the present invention, two rod link reducers  100   a ,  100   b  are connected to two pairs of temporary rods  34   a - d  and pedicle screws  10   a - h . By compressing, distracting or rotating the rod link reducers  100   a ,  100   b , the user can manipulate the spine in all directions necessary for spinal alignment and fixation. Furthermore, the user is able to compress, distract, and translate any of the spinal segments until arriving at a final position. The rod link reducer  100  is tightened upon final positioning and the permanent rod can be inserted into the pedicle screws. Furthermore, the rod link reducers  100   a ,  100   b  can be tightened in a single plane at a time while still manipulating the rest of the spine in the other planes. 
     The present invention can be used to correct mild to severe spinal deformities, including sever deformities. The present invention includes the following advantages: a reduced risk of intraoperative mishaps due to the instability caused by exchanging the temporary rods with the permanent rod, it increases the directions in which the deformities can be corrected and reduces the number of tools, and surgical time caused by temporary rod failure or slipping that occurs between the final positioning of the temporary rods and the fixation of the permanent rod. It has been found that the present invention allows the surgeon to shorten the duration of the operation and also increases the extent of correction in a single procedure. 
       FIG. 15  shows an overlay of the planning and tools for a surgical procedure to correct a severe spinal deformity. An x-ray is shown of a malformed spine and the tools are overlaid to plan the positioning of the pedicle screws, rods and rod link reducer. Next, the user determines the various different steps in the correction, including the compression, distraction, apical derotation and translation of one or both pairs of temporary rods. Also shown are optional tools or handles to increase the leverage of the surgeon, taking into account the accessibility of tools due to the translation and rotation of the underlying spine prior to treatment. In certain cases, the steps may be alternated to maximize the leverage of the rod link reducers in different direction, thereby maximizing efficiency of the movement, increasing the effectiveness of the procedure and minimizing the time of the procedure. 
       FIGS. 16A to 16E  shows the invention in use a procedure that includes distraction, translation and apical derotation.  FIG. 16A  shows a single right thoracic rigid curve  200 .  FIG. 16B  shows the first step in the procedure in which temporary rods  34   a  and  34   b , which are fixed at a proximal portion of the spine and another one fixed at distal portion of the curve about a concavity. The temporary rods  34   a ,  34   b  are attached to the single right thoracic rigid curve  200  using pedicle screws (not depicted) on either end of the site for distraction, translation and apical derotation. One example of the pedicle screws that may be used in the procedure is pedicle screw  10 .  FIG. 16C  shows the rod link reducer  100  connected to temporary rods  34   a  and  34   b  on the concavity. Next, derotation instruments  202   a - c  are attached to the apical vertebrae.  FIG. 16D  shows the combined distraction, translation and apical derotation of the spine in which the rod link reducer  100  is used for the distraction and translation (arrows) and the derotation instruments  202   a - c , seen as a cross-sectional view of the spine at a vertebrae  304 , is are used alone or in combination (in this instance) for apical derotation via linker  308  attached to pedicle screws  310 . The skilled artisan will recognize that these tools may be used for a distraction, translation and/or apical rotation, however, most procedures will involve a combinations of these manipulations.  FIG. 16E  shows a variation of the combined distraction, translation and apical derotation outlined in  FIGS. 16A-16D  in which pairs of temporary rods  34   a ,  34   b  are shown in parallel along the proximal and distal segments of the spine. A second rod link reducer  101  is shown as two provisional rods  34  are on the concavity. Convex provisional compression is to help the curve correction. 
       FIGS. 17A to 17E  shows the use of the rod link reducer  100  on a spinal convexity.  FIG. 17A  shows a right thoracic rigid curve  300  onto which two temporary rods  34   a ,  34   b  are on the concavity of the thoracic curve and two temporary rods  34   c ,  34   d  are on the concavity of the lumbar curve as shown in  FIG. 17B .  FIG. 17C  shows the attachment of two rod-link reducers  100   a ,  100   b  fixed on the concavity for both curves, respectively. Next, the combined distraction, translation and apical derotation for both curves is depicted in which derotation instruments  202   a - c  and  202   d - e  are attached to the vertebrae  204 ,  305  through pedicle screws  306  via linkers  308 . The linkers  308  serve as attachment points for the derotation instruments  202   a - e  and can be used to increase the leverage for the distraction, translation and apical derotation.  FIG. 17E  shows the positioning of a pair of convex temporary rods at each site are used for compression maneuvers to help in the correction of the two curves using two rod link reducers  100 ,  101  about each of the treatment sites. 
       FIG. 18  is a detailed view of one embodiment of an apical derotation without linking the two pedicle screws  310   a,b . In this embodiment, the linkers  308   a,b  are used directly to aid in the apical rotation of a single vertebrae  304  without a linked derotation instrument. 
       FIGS. 19, 20 and 21  shows various designs of the rod-link reducer  100 .  FIG. 19  shows a rod link reducer  100  that includes a universal connector on the central portion. The rod link reducer  100  includes first and second spinal rod manipulators  102 ,  104 , which are connected to a first spinal rod manipulator joint  106  connected to the first spinal rod manipulator  102  and a second spinal rod manipulator joint  108  connected to the second spinal rod manipulator  104 . First and second translatable transverse shafts  110 ,  112  slides through joints  106 ,  108 , respectively. The joints  106 ,  108  can tighten to fix the transverse shafts  110 ,  112  individually. In  FIG. 19 , the two translatable transverse shafts  110 ,  112  have movement around a reducer  114 , which is depicted as a single reducer with universal movement. In one example, the reducer  114  may be fixed to act as a straight rod to limit the movement of the first and second spinal rod manipulators  102 ,  104  in two planes.  FIGS. 20 and 21  show the rotation between the rod-connector. This design would be stronger and easily to install and give surgeons more free for surgery. 
     As the skilled artisan will appreciate the first and second translatable transverse shafts  110 ,  112  may be in-line, as depicted in  FIGS. 19-21 , or may be parallel on two separate planes allowing the first and second translatable transverse shafts to extend past the ends of the opposite shaft. By allowing the first and second translatable transverse shafts to move in parallel, the distance between first and second spinal rod manipulators  102 ,  104  can be reduced to a minimum in certain manipulations. As can also be seen from these figures, the first and second rod manipulator joints  106 ,  108  can slide toward or away from the temporary rods  34   a,b . The configuration presented herein allows six degrees of freedom in any direction, while also providing the necessary strength and leverage to perform complex spinal deformity surgery in a reduced space. 
       FIG. 22A to 22D  shows the new pedicle screw and apical rod-link reducer posterior instrumentation system that includes: (1) pedicle screw with a screw head that can receive two 5.5-mm rods (provisional and final rods) with a breakaway mechanism between the two rod-receivers; (2) a rod-link reducer rigidly linking the provisional rods at the apex, allowing attachment to the rod at any orientation so as to easily make compression, distraction, derotation and cantilever maneuver. While the deformity is corrected using the provisional rod/rod-link reducer, the final rod is fixed and then the provisional ones are removed. A six-segment plastic spine model was instrumented to model three constructs: (1) provisional rod/apical rod-link reducer; (2) provisional rod; and (3) final rod. The spines were tested using pure bending moments. Segmental range of motion (ROM) was recorded using a three-dimensional motion analysis system. 
       FIG. 23  is a drawing illustrating a perspective view of the rod-link reducer  100  which links and locks the first and second translatable transverse shafts  110 / 112 . The reducer  114  provides a mechanism to rotate the device on the concavity. For example, the reducer  114  can have a ball bearing like mechanism controlled by the screw  116  as seen in  FIG. 23 .  FIG. 24  is a drawing illustrating a perspective view of the rod-link reducer  100  which links and locks the first and second translatable transverse shafts  110 / 112 . The reducer  114  provides a mechanism to rotate the device on the convexity. 
       FIGS. 25 and 26  are diagrams illustrating perspective views of the parts of the rod-link reducer  100 . Specifically,  FIG. 25  shows the first and second translatable transverse shafts  110 / 112 , and the reducer  114  and the screw  116 .  FIG. 26  shows the parts of the either first or second joint  106 / 108 . 
       FIG. 27  is a diagram showing the combination of parts from  FIGS. 25 and 26  with the first and second translatable transverse shafts  110 / 112 , reducer  114 , the screw  116 , and either first or second joint  106 / 108 . 
       FIG. 28  is a diagram similar to  FIG. 10  with a side view of one embodiment of rod manipulators  102 / 104 . In this side view screws  116  are shown as well as either first or second joint  106 / 108 . The rod manipulators  102 / 104  include a head  130  that has an opening  132  that first a rod (temporary or permanent) for spinal fixation. The screw  116  is used to engage and retain the rod. In particular, the cross sections of the either first or second joint  106 / 108  are shown. 
       FIG. 29  is an image of 2 rod-link reducers  100   a/b  which links and locks the first and second translatable transverse shafts  110   a/b  and  112   a/b . The reducer  114   a/b  provides a mechanism to rotate the device on the concavity. For example, the reducer  114  can have a ball bearing like mechanism controlled by the screw  116   a/b . The rod link reducer  100   a/b  includes first and second spinal rod manipulators  102   a/b  and  104   a/b , which are connected to a first spinal rod manipulator joint  106   a/b  connected to the first spinal rod manipulator  102   a/b  and a second spinal rod manipulator joint  108   a/b  connected to the second spinal rod manipulator  104   a/b . First and second translatable transverse shafts  110   a/b ,  112   a/b  slides through joints  106   a/b ,  108   a/b , respectively. The joints  106   a/b  and  108   a/b  can tighten to fix the transverse shafts  110   a/b  and  112   a/b  individually. The two translatable transverse shafts  110   a/b ,  112   a/b  have movement around the reducer  114   a/b , which is depicted as a single reducer with universal movement. The first and second spinal rod manipulators  102   a/b  and  104   a/b  are connected to the temporary rods  34   a/b/c/d  affixed to the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  in the spine for alignment. 
       FIG. 30  is an image of 2 rod-link reducer  100   a/b  which links and locks the first and second translatable transverse shafts  110   a/b  and  112   a/b  showing the reducers correcting the coronal curve. The reducer  114   a/b  provides a mechanism to rotate the device on the concavity. For example, the reducer  114  can have a ball bearing like mechanism controlled by the screw  116   a/b . The rod link reducer  100   a/b  includes first and second spinal rod manipulators  102   a/b  and  104   a/b , which are connected to a first spinal rod manipulator joint  106   a/b  connected to the first spinal rod manipulator  102   a/b  and a second spinal rod manipulator joint  108   a/b  connected to the second spinal rod manipulator  104   a/b . First and second translatable transverse shafts  110   a/b ,  112   a/b  slides through joints  106   a/b ,  108   a/b , respectively. The joints  106   a/b  and  108   a/b  can tighten to fix the transverse shafts  110   a/b  and  112   a/b  individually. The two translatable transverse shafts  110   a/b ,  112   a/b  have movement around the reducer  114   a/b , which is depicted as a single reducer with universal movement. The first and second spinal rod manipulators  102   a/b  and  104   a/b  are connected to the temporary rods  34   a/b/c/d  affixed to the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  in the spine for alignment. 
       FIG. 31  is an image that shows the rod-link-reducers and the provisional rods and the final rods with the spine which is corrected. The reducer  114   a/b  provides a mechanism to rotate the device on the concavity. For example, the reducer  114  can have a ball bearing like mechanism controlled by the screw  116   a/b . The rod link reducer  100   a/b  includes first and second spinal rod manipulators  102   a/b  and  104   a/b , which are connected to a first spinal rod manipulator joint  106   a/b  connected to the first spinal rod manipulator  102   a/b  and a second spinal rod manipulator joint  108   a/b  connected to the second spinal rod manipulator  104   a/b . First and second translatable transverse shafts  110   a/b ,  112   a/b  slides through joints  106   a/b ,  108   a/b , respectively. The joints  106   a/b  and  108   a/b  can tighten to fix the transverse shafts  110   a/b  and  112   a/b  individually. The two translatable transverse shafts  110   a/b ,  112   a/b  have movement around the reducer  114   a/b , which is depicted as a single reducer with universal movement. The first and second spinal rod manipulators  102   a/b  and  104   a/b  are connected to the temporary rods  34   a/b/c/d  affixed to the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  in the spine for alignment. In addition to the temporary rods  34   a/b/c/d , permanent rods  36   a/b  are introduced into the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  while the rod link reducers  100   a/b  holds the entire assembly in place.  FIG. 31  shows the permanent rods  36   a/b  with the temporary rods  34   a/b/c / and the rod link reducers  100   a/b  in position. 
       FIG. 32  is an image that shows the final rods with the spine which is corrected.  FIG. 32 , the permanent rods  36   a/b  are introduced into the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  while the rod link reducer (not shown) holds the entire assembly in place while the permanent rods  36   a/b  are permanently affixed to the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l .  FIG. 32  shows the final spinal rod assembly after removing the temporary rods (not shown) and the breakable tabs from the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l.    
       FIG. 33  is an image that shows the rod-link-reducers correct the sagittal curve to the normal kyphosis. The reducer  114   a/b  provides a mechanism to rotate the device. For example, the reducer  114  can have a ball bearing like mechanism controlled by the screw  116   a/b . The rod link reducer  100   a/b  includes first and second spinal rod manipulators  102   a/b  and  104   a/b , which are connected to a first spinal rod manipulator joint  106   a/b  connected to the first spinal rod manipulator  102   a/b  and a second spinal rod manipulator joint  108   a/b  connected to the second spinal rod manipulator  104   a/b . First and second translatable transverse shafts  110   a/b ,  112   a/b  slides through joints  106   a/b ,  108   a/b , respectively. The joints  106   a/b  and  108   a/b  can tighten to fix the transverse shafts  110   a/b  and  112   a/b  individually. The two translatable transverse shafts  110   a/b ,  112   a/b  have movement around the reducer  114   a/b , which is depicted as a single reducer with universal movement. The first and second spinal rod manipulators  102   a/b  and  104   a/b  are connected to the temporary rods  34   a/b/c/d  affixed to the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  in the spine for alignment. 
       FIG. 34  is an image that shows the rod-link-reducers correct the sagittal curve to the normal lordosis. The reducer  114   a/b  provides a mechanism to rotate the device. For example, the reducer  114  can have a ball bearing like mechanism controlled by the screw  116   a/b . The rod link reducer  100   a/b  includes first and second spinal rod manipulators  102   a/b  and  104   a/b , which are connected to a first spinal rod manipulator joint  106   a/b  connected to the first spinal rod manipulator  102   a/b  and a second spinal rod manipulator joint  108   a/b  connected to the second spinal rod manipulator  104   a/b . First and second translatable transverse shafts  110   a/b ,  112   a/b  slides through joints  106   a/b ,  108   a/b , respectively. The joints  106   a/b  and  108   a/b  can tighten to fix the transverse shafts  110   a/b  and  112   a/b  individually. The two translatable transverse shafts  110   a/b ,  112   a/b  have movement around the reducer  114   a/b , which is depicted as a single reducer with universal movement. The first and second spinal rod manipulators  102   a/b  and  104   a/b  are connected to the temporary rods  34   a/b/c/d  affixed to the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  in the spine for alignment. The skilled artisan will recognize that the instant invention may be used to correct all forms of alignments including kyphosis and lordosis. 
       FIG. 35  is an image that shows the pedicle screws, provisional rods, and two rod-link-reducers are fixed in a sagittal curve deformity model. The reducer  114   a/b  provides a mechanism to rotate the device. For example, the reducer  114  can have a ball bearing like mechanism controlled by the screw  116   a/b . The rod link reducer  100   a/b  includes first and second spinal rod manipulators  102   a/b  and  104   a/b , which are connected to a first spinal rod manipulator joint  106   a/b  connected to the first spinal rod manipulator  102   a/b  and a second spinal rod manipulator joint  108   a/b  connected to the second spinal rod manipulator  104   a/b . First and second translatable transverse shafts  110   a/b ,  112   a/b  slides through joints  106   a/b ,  108   a/b , respectively. The joints  106   a/b  and  108   a/b  can tighten to fix the transverse shafts  110   a/b  and  112   a/b  individually. The two translatable transverse shafts  110   a/b ,  112   a/b  have movement around the reducer  114   a/b , which is depicted as a single reducer with universal movement. The first and second spinal rod manipulators  102   a/b  and  104   a/b  are connected to the temporary rods  34   a/b/c/d  affixed to the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  in the spine for alignment. 
       FIG. 36  is an image that shows the final rod insertion after the sagittal curve correction.  FIG. 36  is an image that shows the rod-link-reducers and the provisional rods and the final rods with the spine which is corrected. The reducer  114   a/b  provides a mechanism to rotate the device on the concavity. For example, the reducer  114  can have a ball bearing like mechanism controlled by the screw  116   a/b . The rod link reducer  100   a/b  includes first and second spinal rod manipulators  102   a/b  and  104   a/b , which are connected to a first spinal rod manipulator joint  106   a/b  connected to the first spinal rod manipulator  102   a/b  and a second spinal rod manipulator joint  108   a/b  connected to the second spinal rod manipulator  104   a/b . First and second translatable transverse shafts  110   a/b ,  112   a/b  slides through joints  106   a/b ,  108   a/b , respectively. The joints  106   a/b  and  108   a/b  can tighten to fix the transverse shafts  110   a/b  and  112   a/b  individually. The two translatable transverse shafts  110   a/b ,  112   a/b  have movement around the reducer  114   a/b , which is depicted as a single reducer with universal movement. The first and second spinal rod manipulators  102   a/b  and  104   a/b  are connected to the temporary rods  34   a/b/c/d  affixed to the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  in the spine for alignment. In addition to the temporary rods  34   a/b/c/d , permanent rod  36  are introduced into the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  while the rod link reducers  100   a/b  holds the entire assembly in place.  FIG. 36  shows the permanent rod  36  with the temporary rods  34   a/b/c/d  and the rod link reducers  100   a/b  in position. 
       FIG. 37  is an image that shows the final rods are with the spine which is corrected.  FIG. 37 , the permanent rod  36  are introduced into the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l  while the rod link reducer (not shown) holds the entire assembly in place while the permanent rod  36  are permanently affixed to the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l .  FIG. 37  shows the final spinal rod assembly after removing the temporary rods (not shown) and the breakable tabs from the pedicle screws  10   a/b/c/d/e/f/g/h/i/j/k/l.    
     It was found that using the present invention no significant differences in the ROM between the three constructs except right lateral bending in which the provisional rod/rod-link and the provisional rod constructs ROM were greater than the final rod construct (P=0.005) (Table 1). 
     
       
         
           
               
             
               
                 TABLE 1 
               
             
            
               
                   
               
               
                 Range of Motion (Degree) in the Three Constructs 
               
            
           
           
               
               
               
               
            
               
                   
                 Provisional Rod + 
                 Provisional 
                 Final 
               
               
                   
                 Rod Link 
                 Rod 
                 Rod 
               
               
                   
                   
               
            
           
           
               
               
               
               
            
               
                 Flexion 
                 4.3 ± 1.7 
                 3.1 ± 0.2 
                 3.2 ± 0.5 
               
               
                 Extension 
                 1.3 ± 0.1 
                 1.2 ± 0.3 
                 1.8 ± 0.6 
               
               
                 Left Lateral Bending 
                 1.8 ± 0.8 
                 1.9 ± 1   
                 2.1 ± 0.6 
               
               
                 Right Lateral Bending* 
                 2.2 ± 0.3 
                 2.3 ± 0.5 
                 1.6 ± 0.1 
               
               
                   
               
               
                 *ANOVA P-Value = 0.005, Provisional Rod + Rod Link and Provisional Rod Construct ROM &gt; Final Rod Construct. 
               
            
           
         
       
     
     The provisional rod/rod-link reducer construct provided similar stiffness and stability compared to the provisional and final rod constructs. This new system may offer a safer, easier and improved deformity correction, as well as shorter surgical time for the PVCR of the severe spinal deformity. 
     The novel pedicle screw/rod-link reducer offers better maintenance of spinal stability throughout the surgical procedure to reduce risk of the spinal cord injuries. This system may therefore provide a safer, easier and improved deformity correction, as well as shorter surgical time for the PVCR of the severe spinal deformity. 
     The present invention overcomes the following disadvantages of existing systems, namely, the limitation for the apical vertebral derotation and translation. Another disadvantage or existing systems is the difficulty for concave rod derotation and/or translation which result in pedicle screw loosening with damage to the spinal cord. The present invention overcomes both of these advantages by providing a stable, sturdy platform for use of temporary and permanent rods using a single pedicle screw. The pedicle screw of the present invention maximizes the structural-mechanical properties of each fixation point (the lower versus the upper rod coupling) for each specific type of rod (permanent or temporary) while at the same time maximizing the efficiency of the surgical procedure with less tools and equipment. Furthermore, surgeons are already familiar with similar tools and fasteners and do not have to learn new procedures, techniques or the use of new tools. 
     It is contemplated that any embodiment discussed in this specification can be implemented with respect to any method, kit, reagent, or composition of the invention, and vice versa. Furthermore, compositions of the invention can be used to achieve methods of the invention. 
     It will be understood that particular embodiments described herein are shown by way of illustration and not as limitations of the invention. The principal features of this invention can be employed in various embodiments without departing from the scope of the invention. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, numerous equivalents to the specific procedures described herein. Such equivalents are considered to be within the scope of this invention and are covered by the claims. 
     All publications and patent applications mentioned in the specification are indicative of the level of skill of those skilled in the art to which this invention pertains. All publications and patent applications are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference. 
     The use of the word “a” or “an” when used in conjunction with the term “comprising” in the claims and/or the specification may mean “one,” but it is also consistent with the meaning of “one or more,” “at least one,” and “one or more than one.” The use of the term “or” in the claims is used to mean “and/or” unless explicitly indicated to refer to alternatives only or the alternatives are mutually exclusive, although the disclosure supports a definition that refers to only alternatives and “and/or.” Throughout this application, the term “about” is used to indicate that a value includes the inherent variation of error for the device, the method being employed to determine the value, or the variation that exists among the study subjects. 
     As used in this specification and claim(s), the words “comprising” (and any form of comprising, such as “comprise” and “comprises”), “having” (and any form of having, such as “have” and “has”), “including” (and any form of including, such as “includes” and “include”) or “containing” (and any form of containing, such as “contains” and “contain”) are inclusive or open-ended and do not exclude additional, unrecited elements or method steps. 
     The term “or combinations thereof” as used herein refers to all permutations and combinations of the listed items preceding the term. For example, “A, B, C, or combinations thereof” is intended to include at least one of: A, B, C, AB, AC, BC, or ABC, and if order is important in a particular context, also BA, CA, CB, CBA, BCA, ACB, BAC, or CAB. Continuing with this example, expressly included are combinations that contain repeats of one or more item or term, such as BB, AAA, MB, BBC, AAABCCCC, CBBAAA, CABABB, and so forth. The skilled artisan will understand that typically there is no limit on the number of items or terms in any combination, unless otherwise apparent from the context. 
     All of the compositions and/or methods disclosed and claimed herein can be made and executed without undue experimentation in light of the present disclosure. While the compositions and methods of this invention have been described in terms of preferred embodiments, it will be apparent to those of skill in the art that variations may be applied to the compositions and/or methods and in the steps or in the sequence of steps of the method described herein without departing from the concept, spirit and scope of the invention. All such similar substitutes and modifications apparent to those skilled in the art are deemed to be within the spirit, scope and concept of the invention as defined by the appended claims. 
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