Patent Publication Number: US-2013245690-A1

Title: Implant system and method

Description:
TECHNICAL FIELD 
     The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a spinal implant system and method that employs a connector and provides stabilization of vertebrae, which may include the sacroiliac region. 
     BACKGROUND 
     Spinal disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including pain, nerve damage, and partial or complete loss of mobility. For example, after a disc collapse, severe pain and discomfort can occur due to the pressure exerted on nerves and the spinal column. In another example, disorders of the sacroiliac joint can cause low back and radiating buttock and leg pain in patients. 
     Non-surgical treatments, such as medication, injection, mobilization, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes fusion, fixation, discectomy, laminectomy and implantable prosthetics. During surgical treatment, one or more rods may be attached via fasteners to the exterior of two or more vertebral members. Fasteners may also be attached to iliac bone. The present disclosure describes an improvement over these prior art technologies. 
     SUMMARY 
     Accordingly, a surgical system and method is provided. In one particular embodiment, in accordance with the principles of the present disclosure, an implant system comprises a fastener including a proximal portion and a distal portion configured for penetrating tissue. The proximal portion defines a first cavity that defines a first longitudinal axis. A connector extends between a first end and a second end configured for disposal in the first cavity and movement within a first plane. The connector is moveable along the first longitudinal axis relative to the distal portion. A receiver is attached to the connector and includes an implant cavity defining a second longitudinal axis and configured for disposal of an implant. The implant cavity is rotatable about the first longitudinal axis such that the implant is rotatable in a second plane relative to the distal portion of the fastener. 
     In one embodiment, the implant system comprises a fastener including a proximal portion and a distal portion configured for penetrating tissue. The proximal portion includes an inner surface that defines a first cavity having a substantially triangular configuration. The inner surface includes a first planar portion, a second planar portion and a third arcuate portion. The first cavity defines a first longitudinal axis. A connector has a tapered configuration between a first end and a second end. The first end includes a spline surface radially disposed thereabout and the second end is configured for movable disposal in the first cavity. A receiver includes a spline surface configured to mate with the spline surface of the first end and an implant cavity defining a second longitudinal axis having a transverse orientation relative to first longitudinal axis. The implant cavity is selectively translatable within a coronal plane of a body and rotatable about the second longitudinal axis through an angle of 0 to 360 degrees in a sagittal plane of the body such that the connector is selectively fixable in a position upon fixed engagement of the spline surfaces. 
     In one embodiment, a method for treating a disorder is provided. The method comprises the steps of providing an implant system comprising: a fastener including a proximal portion and a distal portion configured for penetrating tissue, the proximal portion defining a first cavity that defines a first longitudinal axis, a connector extending between a first end and a second end configured for disposal in the first cavity and movement within a first plane, the connector being moveable along the first longitudinal axis relative to the distal portion, and a receiver attached to the connector and including an implant cavity defining a second longitudinal axis and being configured for disposal of an implant, the implant cavity being rotatable about the first longitudinal axis such that the implant is rotatable in a second plane relative to the distal portion of the fastener; selectively moving the connector in the first plane to a position along the first longitudinal axis; and selectively rotating the implant cavity in the second plane to a position within the second plane. 
    
    
     
       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 particular embodiment of an implant system in accordance with the principles of the present disclosure; 
         FIG. 2  is a side view of a fastener of the implant system shown in  FIG. 1 ; 
         FIG. 3  is a perspective view of components of the implant system shown in  FIG. 1 ; 
         FIG. 4  is a top view of the implant system shown in  FIG. 1 ; 
         FIG. 5  is a perspective view of the components shown in  FIG. 1  with parts separated; and 
         FIG. 6  is a plan view of one embodiment of an implant system in accordance with the principles of the present disclosure attached with vertebrae and an iliac bone of a patient. 
     
    
    
     Like reference numerals indicate similar parts throughout the figures. 
     DETAILED DESCRIPTION 
     The exemplary embodiments of the implant system and methods disclosed are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of an implant system and method for treating a disorder. It is envisioned that the implant system and methods disclosed may provide stability to a portion of the anatomy of a patient, such as, for example, vertebrae, a sacroiliac (SI) joint, iliac bone and maintains structural integrity while reducing stress on the SI joint and/or portions of the anatomy adjacent the SI joint. 
     In one embodiment, the implant system includes a low profile Iliac wing screw connector and a low profile bone screw. In one embodiment, a screw and rod bolt connector are provided that allow for ilio-sacral implantation. It is contemplated that the screw and connector are low profile such that the screw is a closed head style with a connector that allows for coronal and sagittal adjustment. This configuration enables the screw and connector to be disposed close to a body surface and retain adjustability while maintaining strength of fixation and/or attachment with the body surface. 
     In one embodiment, a low profile iliac connector and screw are provided that include additional degrees of rotation for an increased level of space with an anatomy and/or body surface. 
     It is envisioned that the present disclosure may be employed to treat spinal disorders such as, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor and fractures. It is contemplated that the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. It is further contemplated that 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 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, such as, for example, in training, testing and demonstration. 
     The present disclosure may be understood more readily by reference to the following detailed description of the disclosure taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this disclosure 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 of the claimed disclosure. 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, such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure. For example, the references “upper” and “lower” are relative and used only in the context to the other, and are not necessarily “superior” and “inferior”. 
     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), 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 including an implant system, related components and exemplary methods of employing the implant 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. 1-5 , there is illustrated components of a surgical system including an implant system in accordance with the principles of the present disclosure. 
     The components of the surgical system 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 the implant system, 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-BaSO4 polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers, elastomeric composites, rigid polymers including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone material including autograft, allograft, xenograft or transgenic cortical and/or corticocancellous bone, and tissue growth or differentiation factors, partially resorbable materials, such as, for example, composites of metals and calcium-based ceramics, composites of PEEK and calcium based ceramics, composites of PEEK with resorbable polymers, totally resorbable materials, such as, for example, calcium based ceramics such as calcium phosphate, tri-calcium phosphate (TCP), hydroxyapatite (HA)-TCP, calcium sulfate, or other resorbable polymers such as polyaetide, polyglycolide, polytyrosine carbonate, polycaroplaetohe and their combinations. Various components of the surgical system 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 the surgical system, 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 the surgical system may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein. 
     The implant system is configured for attachment to vertebrae and/or iliac bone (as shown, for example, in  FIG. 6 ) during surgical treatment of a spinal disorder, examples of which being discussed herein. The implant system includes a bone fastener  30 , a connector  32  and a receiver  34 . It is envisioned that the implant system may include one or a plurality of fasteners, connectors and/or receivers. 
     Bone fastener  30  includes a proximal portion, such as, for example, a head  36  having an inner surface  37  that defines a first cavity, such as, for example, a passageway  38 . Passageway  38  defines a first longitudinal axis a. Passageway  38  extends through lateral surfaces of head  36 . Passageway  38  is configured to receive and movably support at least a portion of connector  32  such that connector  32  can translate axially within passageway  38  along axis a through a first plane, such as, for example, a coronal plane of a body. It is contemplated that connector  32  may be disposed with bone fastener  30  for relative movement thereto in orientations relative to axis a, such as, for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered. It is further contemplated that connector  32  may move relative to bone fastener  30  in alternate planes relative to a body, such as, for example, transverse and/or sagittal planes of a body. 
     Inner surface  37  includes an arcuate portion  39 , a first planar portion  41 , a second planar portion  43  and an angled portion  45 . The portions of inner surface  37  define a substantially triangular configuration of passageway  38 . Portion  39  is concavely curved toward a body surface to facilitate capture of connector  32  with the body. It is envisioned that all or only a portion of the passageway  38  may be variously configured and dimensioned, such as, for example, round, oval, oblong, square, rectangular, polygonal, irregular, uniform, non-uniform, offset, staggered, tapered, consistent or variable, depending on the requirements of a particular application. In one embodiment, the first cavity may extend through only a portion of head  36  and not completely through. 
     Head  36  includes a second threaded cavity  47  configured to receive a coupling member, such as, for example, a setscrew (not shown) to releasably fix connector  32  with bone fastener  30  in a selected position along axis a through the coronal plane of the body. The setscrew is threaded with cavity  47  into fixed engagement with an outer surface of connector. It is envisioned that connector  32  may be coupled with bone fastener  30  in alternate fixation configurations, such as, for example, friction fit, pressure fit, locking protrusion/recess, locking keyway and/or adhesive. It is contemplated that all or only a portion of connector  32  may have alternate surface configurations to enhance fixation with bone fastener  30 , such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application. 
     Head  36  has a reduced thickness having a diameter d and an increased thickness having a diameter d 1  to enhance the low profile configuration of bone fastener  30  with a body. As such, head  36  has tapered surfaces such that at least a portion of head  36  may seat more closely with the anatomy of a patient, thereby reducing the profile of bone fastener  30 . In one embodiment, at least a portion of the outer surface of head  36  is threaded for penetration with a body surface such that bone fastener  30  has a low profile when fixed with a body of a patient. 
     Bone fastener  30  includes a distal portion, such as, for example, a shaft  40 . Shaft  40  is threaded along the length thereof and configured for penetrating tissue. Shaft  40  has a cylindrical cross section configuration and includes an outer surface having an external thread form. It is contemplated that the thread form may include a single thread turn or a plurality of discrete threads. It is further contemplated that other engaging structures may be located on shaft  40 , such as, for example, a nail configuration, barbs, expanding elements, raised elements and/or spikes to facilitate engagement of shaft  40  with tissue, such as, for example, vertebrae and/or iliac bone. 
     It is envisioned that all or only a portion of shaft  40  may have alternate cross section configurations, such as, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. It is contemplated that the outer surface of shaft  40  may include one or a plurality of openings. It is further contemplated that all or only a portion of the outer surface of shaft  40  may have alternate surface configurations to enhance fixation with tissue such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application. It is envisioned that all or only a portion of shaft  40  may be disposed at various orientations, relative to axis a, such as, for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse and/or may be offset or staggered. It is further envisioned that all or only a portion of shaft  40  may be cannulated. 
     Connector  32  extends between a first end  50  and a second end  52 . Connector  32  includes an arcuate surface  49 , a first planar surface  51 , a second planar surface  53  and an angled surface  55 , corresponding to the configuration of inner surface  37  of bone fastener  30  for mating engagement therewith. Connector  32  defines a substantially triangular configuration for slidable movement within passageway  38  in a close fitting engagement. It is envisioned that all or only a portion of the cross section configuration of connector  32  may be variously configured and dimensioned, such as, for example, round, oval, oblong, square, rectangular, polygonal, irregular, uniform, non-uniform, offset, staggered, tapered, consistent or variable, depending on the requirements of a particular application. 
     First end  50  is configured for movement within passageway  38  along axis a in the coronal plane of the body for selective fixation in a position along axis a. Connector  32  is moveable along axis a relative to shaft  40  of fastener  30 . It is envisioned that first end  50  may be inserted into passageway  38 . Second end  52  is moved within passageway  38  in the coronal plane along axis a, in a first axial direction or a second axial direction oriented in an opposing direction to the first axial direction, by sliding connector  32  relative to head  36 . Upon determination of selected positioning of connector  32  relative to shaft  40 , which is disposed in tissue, for example, vertebrae and/or iliac bone, the setscrew is threaded with head  36  to fixably engage the outer surface of connector  32 . 
     Connector  32  has a uniform cross section configuration, which defines a diameter d 2 , extending to second end  52 . Second end  52  has a tapered configuration such that second end  52  uniformly tapers to an endmost surface  142  of second end  52  having an increased diameter d 3 . Diameter d 3  provides a limit on axial translation of connector  32  upon engagement with bone fastener  30 . 
     Second end  52  includes a first disk  46 , which includes endmost surface  142 . Surface  142  is substantially planar and includes an opening  70 . Surface  142  includes a splined surface, such as, for example, a plurality of radial splines  144  disposed circumferentially about surface  142 . Splines  144  are configured to releasably fix receiver  34  with connector  32  in a selected rotatable position about axis a in a second plane, such as, for example, a sagittal plane of the body relative to shaft  40  of bone fastener  30 . It is envisioned that receiver  34  may be coupled with connector  32  in alternate fixation configurations, such as, for example, friction fit, pressure fit, locking protrusion/recess, locking keyway and/or adhesive. It is further envisioned that receiver  34  may be disposed with connector  32  for relative movement thereto in orientations relative to axis a, such as, for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered. It is contemplated that receiver  34  may move relative to connector  32  in alternate planes relative to a body, such as, for example, transverse and/or coronal planes of a body. It is further contemplated that all or only a portion of surface  142  may have alternate surface configurations to enhance fixation with receiver  34 , such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application. 
     Receiver  34  is selectively rotatable in the sagittal plane of the body and selectively fixable in a position within the sagittal plane. First end  50  defines an opening  70  configured to receive at least a portion of receiver  34  to rotatably connect receiver  34  and connector  32 . In one embodiment, receiver  34  may be rotated through an angle of 0 to 360 degrees relative to connector  32 . 
     Receiver  34  includes a body portion  54  having an extension  56  having a reduced thickness configuration for disposal in opening  70 . Extension  56  includes a first locking part, such as, for example, prongs  58 , which extend transversely from body portion  54  along axis a. Prongs  58  each have a flange  60  that extend laterally. In one embodiment, body portion  54  has an elastic configuration such that prongs  58  are resiliently biased outwardly. It is envisioned that extension  56  may be spring-loaded, or include a biased member, or a shape-memory member. 
     Extension  56  of receiver  34  is fixed with connector  32  and relative rotation thereto with a second locking part, such as, for example, a wishbone clip  66 . Clip  66  has base  64  and extending lobes  69 , such that clip  66  has a wishbone configuration. Prongs  58  are inserted within opening  70  such that clip  66  is disposed between prongs  58 . Flanges  60  engage an inner surface that defines opening  70  such that prongs  58  retain receiver  34  with connector  32 . Clip  66  occupies some or all of the space between prongs  58  to prevent prongs  58  from inward movement to prevent release of flanges  60 . This configuration prevents undesired removal of extension  56  from connector  32 . In one embodiment, clip  66  may have a width that is approximately equal to or slightly larger than the gap between prongs  58  when prongs  58  and receiver  34  are in an unstressed state. In one embodiment, clip  66  may include a block, such as, for example, a ball, cylinder, planar solid or other relatively solid structure. 
     Connector  32  is mounted with receiver  34  by inserting extension  56  with opening  70 . It is envisioned that prongs  58  can be squeezed together either by external pressure, snap-fit, friction fit and/or threaded engagement. 
     Receiver  34  includes a second disk  48 , which includes endmost surface  148  and an inner surface  150  that defines an opening  72  extending through second disk  48 . Surface  148  is substantially planar and includes opening  72 , which is configured for disposal of extension  56 . Surface  148  includes a splined surface, such as, for example, a plurality of radial splines  152  disposed circumferentially about surface  148 . It is contemplated that all or only a portion of surface  142  may have alternate surface configurations to enhance fixation with connector  32 , such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application. 
     Splines  152  are configured to engage splines  142  to releasably fix receiver  34  with connector  32  in a selected rotatable position about axis a in the sagittal plane of the body relative to shaft  40  of bone fastener  30 . Splines  142 ,  152  are configured to mesh such that implant cavity  62  and second disk  48  can rotate and lock at different angles in the sagittal plane. Second disk  48  is locked in position relative to first disk  46  by forcing disks  46 ,  48  into engagement. In one embodiment, disks  46 ,  48  are resiliently biased towards for fixed engagement. 
     Receiver  34  includes an inner surface that defines an implant cavity  62  extending through body portion  54 . Implant cavity  62  is configured for disposal of an implant, such as, for example, a vertebral rod of a vertebral rod system a surgical arthrodesis procedure  162 , described with regard to  FIG. 6 , and defines a second longitudinal axis a 1 . Implant cavity  62  has a transverse orientation relative to passageway  38 . Axis a is transversely orientated relative to axis a 1 . Implant cavity  62  is rotatable relative to axis a 1 , through an angle α, such that implant cavity  62  is rotatable in the sagittal plane of the body relative to shaft  40  of bone fastener  30 . It is contemplated that angle α may be in a range of 0 to 360 degrees relative to axis a 1 . 
     It is envisioned that implant cavity  62  may be variously configured and dimensioned, such as, for example, round, oval, oblong, square, rectangular, polygonal, irregular, uniform, non-uniform, offset, staggered, tapered, consistent or variable, depending on the requirements of a particular application. It is further envisioned that implant cavity  62  may be movable relative to axis a 1  in orientations, such as, for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered. It is contemplated that implant cavity  62  may move relative to connector  32  in alternate planes relative to a body, such as, for example, transverse and/or coronal planes of a body. In one embodiment, implant cavity  62  may be disposed at an angle of about 30 to about 150 degrees relative to passageway  38  and axis a may be disposed at an angle of about 30 to about 150 degrees relative to axis a 1 . 
     Body portion  54  includes a threaded cavity  64  configured to receive a coupling member, such as, for example, a setscrew (not shown) to releasably fix an implant, such as, for example, a vertebral rod of a vertebral rod system  162  ( FIG. 6 ) with receiver  34  in a selected rotation position at an angle α relative to axis a 1  in the sagittal plane of the body relative to shaft  40  of bone fastener  30 . The setscrew is threaded with cavity  64  into fixed engagement with an outer surface of the rod implant. It is envisioned that rod  162  may be coupled with receiver  34  in alternate fixation configurations, such as, for example, friction fit, pressure fit, locking protrusion/recess, locking keyway and/or adhesive. It is contemplated that all or only a portion of receiver  34  may have alternate surface configurations to enhance fixation with the rod implant, such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application. 
     In assembly, operation and use, the implant system including bone fastener  30 , connector  32  and receiver  34  is employed with a surgical procedure for treatment of a spinal disorder affecting a section of a spine and/or ilium bones of a pelvis of a patient, as discussed herein. The implant system may also be employed with other surgical procedures. The implant system is employed with a surgical procedure for treatment of a condition or injury of an affected section of the spine including vertebrae V, which may include sacrum S, and/or ilium I, as shown in  FIG. 6 . It is contemplated that the implant system including bone fastener  30 , connector  32  and receiver  34  is attached to vertebrae V and/or ilium I for a surgical arthrodesis procedure, such as fusion, and/or dynamic stabilization application of the affected section of the spine to facilitate healing and therapeutic treatment, while providing flexion, extension and/or torsion capability. In fusion applications, it is contemplated that the implant system provides flexibility to a bone construct for improved compliance and less rigidity. In dynamic applications, it is contemplated that the implant system provides flexibility to a bone construct. 
     In use, to treat the affected section of the spine and/or ilium bones of a pelvis, a medical practitioner obtains access to a surgical site including vertebra V and/or ilium I in any appropriate manner, such as through incision and retraction of tissues. It is envisioned that the implant system including bone fastener  30 , connector  32  and receiver  34  may be used in any existing surgical method or technique including open surgery, mini-open surgery, minimally invasive surgery and percutaneous surgical implantation, whereby the vertebrae V and/or ilium I 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 bone disorder. The implant system including bone fastener  30 , connector  32  and receiver  34  is then employed to augment the surgical treatment. The implant system including bone fastener  30 , connector  32  and receiver  34  can be delivered or implanted as a pre-assembled device or can be assembled in situ. The implant system may be completely or partially revised, removed or replaced, for example, replacing a rod implant of vertebral rod system  162  and/or one or all of the components of the implant system. 
     In one embodiment, vertebral rod system  162  includes one or a plurality of vertebral rods and fasteners for attaching the rods to vertebrae V, as shown in  FIG. 6 . System  162  extends from a first portion  164  to a second portion  166  disposed adjacent a sacroiliac (SI) region SIR of the patient. Second portion includes two axially aligned and spaced apart rods  168 . Rods  168  each have a rigid, arcuate portion  170  extending across a sacrum S and ilium I of region SIR. 
     A first bone fastener  30  is configured for fixation with an ilium surface I 1  and a second bone fastener  30  is configured for fixation with an ilium surface  12 . Pilot holes are made in ilium surfaces I 1 , I 2  for receiving first and second bone fasteners  30 . Each threaded shaft  40  of first and second bone fasteners  30  are inserted or otherwise connected to ilium surfaces I 1 , I 2 , according to the particular requirements of the surgical treatment. Connector  32  is attached with bone fastener  30 , and receiver  34  is attached with connector  32 , as described above. 
     According to the orientation and position of each portion  170 , each second end  52  is selectively moved within passageway  38  in a coronal plane of the patient along axis a by sliding connector  32  relative to head  36 . Upon determination of selected positioning of connector  32  relative to shaft  40 , the setscrew is threaded with head  36  to fixably engage the outer surface of connector  32  to lock connector  32  in the selected axial position relative to bone fastener  30 . 
     Implant cavity  62  is selectively rotated to an angle α relative to axis a 1  in the sagittal plane of the patient corresponding to the orientation and position of each portion  170 . This configuration allows orientation of implant cavity  62  to receive each portion  170  for disposal of each portion  170  therein. The setscrew is threaded with cavity  64  into fixed engagement with an outer surface of each portion  170  to fix receiver  34  in the selected rotation orientation, for example, at angle α relative to axis a 1  in the sagittal plane, relative to bone fastener  30 . The splined surfaces of disks  46 ,  48  are brought into fixed engagement, as discussed above, to lock receiver  34  in the selected rotation orientation. 
     It is contemplated that the implant system configuration of bone fastener  30 , connector  32  and receiver  34  are low profile ilium surfaces I 1 , I 2  that allows for coronal and sagittal adjustment. This configuration enables the implant system to be disposed close to a body surface and retain adjustability while maintaining strength of fixation and/or attachment with the body surface. 
     In one embodiment, the implant system includes an agent, which may be disposed, packed or layered within, on or about the components and/or surfaces of the implant system. It is envisioned that the agent may include bone growth promoting material, such as, for example, bone graft to enhance fixation of the fixation elements with vertebrae V. 
     It is contemplated that the agent may include therapeutic polynucleotides or polypeptides. It is further contemplated that the agent may include biocompatible materials, such as, for example, biocompatible metals and/or rigid polymers, such as, titanium elements, metal powders of titanium or titanium compositions, sterile bone materials, such as allograft or xenograft materials, synthetic bone materials such as coral and calcium compositions, such as HA, calcium phosphate and calcium sulfite, biologically active agents, for example, gradual release compositions such as by blending in a bioresorbable polymer that releases the biologically active agent or agents in an appropriate time dependent fashion as the polymer degrades within the patient. Suitable biologically active agents include, for example, BMP, Growth and Differentiation Factors proteins (GDF) and cytokines. The components of the implant system can be made of radiolucent materials such as polymers. Radiomarkers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. It is envisioned that 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. 
     It is envisioned that the use of microsurgical and image guided technologies may be employed to access, view and repair spinal deterioration or damage, with the aid of the implant system. Upon completion of the procedure, the surgical instruments and assemblies are removed and the incision is closed. 
     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.