Patent Publication Number: US-2015073485-A1

Title: Surgical instrument and method

Description:
TECHNICAL FIELD 
     The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical system for implant delivery to a surgical site and a method for treating a spine. 
     BACKGROUND 
     Spinal pathologies and disorders such as scoliosis and other curvature abnormalities, kyphosis, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including deformity, pain, nerve damage, and partial or complete loss of mobility. 
     Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes correction, fusion, fixation, discectomy, laminectomy and implantable prosthetics. As part of these surgical treatments, spinal constructs such as vertebral rods are often used to provide stability to a treated region. Rods redirect stresses away from a damaged or defective region while healing takes place to restore proper alignment and generally support the vertebral members. During surgical treatment, one or more rods and bone fasteners can be delivered to a surgical site. This disclosure describes an improvement over these prior art technologies. 
     SUMMARY 
     In one embodiment, a surgical instrument is provided. The surgical instrument includes a first member including a capture element and an engagement surface engageable with an implant. A second member is disposed with the first member. An actuator is engageable with the second member such that the capture element releasably engages the implant. The actuator is configured to translate the first member between a first position such that the implant is movable relative to the first member and a second position such that the first member is fixed with the implant. In some embodiments, systems and methods of use are disclosed. 
    
    
     
       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 side view of components of one embodiment of a system in accordance with the principles of the present disclosure; 
         FIG. 2  is a side view of the components shown in  FIG. 1 ; 
         FIG. 3  is side view of the components shown in  FIG. 1 ; 
         FIG. 4  is a perspective view of the components shown in  FIG. 1 ; 
         FIG. 5  is a cross section view of the components shown in  FIG. 3 ; 
         FIG. 6  is a cross section view of the components shown in  FIG. 2 ; 
         FIG. 7  is a break away view of the components shown in  FIG. 1 ; 
         FIG. 8  is a break away view of the components shown in  FIG. 5 ; 
         FIG. 9  is a perspective view of a component of one embodiment of a system in accordance with the principles of the present disclosure; 
         FIG. 10  is a break away view of the components shown in  FIG. 2 ; 
         FIG. 11  is a break away view of components of one embodiment of a system in accordance with the principles of the present disclosure; 
         FIG. 12  is a perspective view of the components shown in  FIG. 11 ; 
         FIG. 13  is a cross section view of the components shown in  FIG. 12 ; 
         FIG. 14  is a break away view of the components shown in  FIG. 12 ; 
         FIG. 15  is a perspective view of components of one embodiment of a system in accordance with the principles of the present disclosure; 
         FIG. 16  is a break away view of the components shown in  FIG. 15 ; and 
         FIG. 17  is a cross section view of components of one embodiment of a system in accordance with the principles of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     The exemplary embodiments of the surgical system and related methods of use disclosed are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of a surgical system for implant delivery to a surgical site and a method for treating a spine. 
     In one embodiment, the surgical system and method includes an instrument for percutaneous insertion and rotation of spinal rods. In one embodiment, the surgical system and method include a pre-bent spinal rod inserted into a surgical site. In one embodiment, the spinal rod is rotated after insertion such that the bend in the spinal rod is disposed along a particular plane to achieve a correction to the spine. In one embodiment, the surgical system includes an instrument that can hold the spinal rod and rotate the spinal rod at the surgical site. In one embodiment, the surgical system includes an instrument that includes a spring configured to release and engage a clamp about a spinal rod. In one embodiment, the surgical system includes a wire is configured to fix the spinal rod with the instrument. 
     In one embodiment, the surgical system includes an actuator that is configured to rotate to open a clamp for insertion of a spinal rod. In one embodiment, the surgical system includes a spinal rod inserted into an instrument until the spinal rod snaps into a clamp. In one embodiment, the surgical system includes an actuator configured for rotation to lock a clamp around a spinal rod. In one embodiment, the surgical system includes a tab configured to lock and unlock a gear mechanism disposed with the instrument to facilitate or prevent rotation of a spinal rod. 
     In one embodiment, the surgical system includes an instrument configured for attachment to a rod for minimally invasive surgery. In one embodiment, the surgical system can rotate the rod to facilitate insertion for a derotation correction maneuver. In one embodiment, the surgical system includes an outer sleeve that actuates a clamp to hold the rod, and an inner shaft that locks and/or unlocks a ratchet mechanism to rotate a spinal rod. In one embodiment, the surgical system includes a wire to hold a spinal rod in place. In one embodiment, the surgical system can be used as an inserter and a rotator in, for example, a percutaneous lateral fusion. 
     In one embodiment, one or all of the components of the system are disposable, peel-pack, pre-packed sterile devices used with an implant. One or all of the components of the system may be reusable. The system may be configured as a kit with multiple sized and configured components. 
     In one embodiment, 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. In some embodiments, the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. In some embodiments, the disclosed system and methods may be alternatively employed in a surgical treatment with a patient in a prone or supine position, and/or employ various surgical approaches to the spine, including anterior, posterior, posterior mid-line, direct lateral, postero-lateral, and/or antero-lateral approaches, and in other body regions. The present disclosure may also be alternatively employed with procedures for treating the lumbar, cervical, thoracic, sacral and pelvic regions of a spinal column. The system and methods of the present disclosure may also be used on animals, bone models and other non-living substrates, such as, for example, in training, testing and demonstration. 
     The present disclosure may be understood more readily by reference to the following detailed description of the embodiments taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this application is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting. 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), employing implantable devices, and/or employing instruments that treat the disease, such as, for example, microdiscectomy instruments used to remove portions bulging or herniated discs and/or bone spurs, in an effort to alleviate signs or symptoms of the disease or condition. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, treating or treatment includes preventing or prevention of disease or undesirable condition (e.g., preventing the disease from occurring in a patient, who may be predisposed to the disease but has not yet been diagnosed as having it). In addition, treating or treatment does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes procedures that have only a marginal effect on the patient. Treatment can include inhibiting the disease, e.g., arresting its development, or relieving the disease, e.g., causing regression of the disease. For example, treatment can include reducing acute or chronic inflammation; alleviating pain and mitigating and inducing re-growth of new ligament, bone and other tissues; as an adjunct in surgery; and/or any repair procedure. Also, as used in the specification and including the appended claims, the term “tissue” includes soft tissue, ligaments, tendons, cartilage and/or bone unless specifically referred to otherwise. 
     The following discussion includes a description of a surgical system and related methods of employing the surgical system in accordance with the principles of the present disclosure. Alternate embodiments are also disclosed. Reference is made in detail to the exemplary embodiments of the present disclosure, which are illustrated in the accompanying figures. Turning to  FIGS. 1-14 , there are illustrated components of a surgical system, such as, for example, a surgical system  10  in accordance with the principles of the present disclosure. 
     The components of system  10  can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics and bone material and/or their composites, depending on the particular application and/or preference of a medical practitioner. For example, the components of system  10 , individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, superelastic metallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUM METAL® manufactured by Toyota Material Incorporated of Japan), ceramics and composites thereof such as calcium phosphate (e.g., SKELITE™ manufactured by Biologix Inc.), thermoplastics such as polyaryletherketone (PAEK) including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO 4  polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers, elastomeric composites, rigid polymers including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone material including autograft, allograft, xenograft or transgenic cortical and/or corticocancellous bone, and tissue growth or differentiation factors, partially resorbable materials, such as, 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 system  10  may have material composites, including the above materials, to achieve various desired characteristics such as strength, rigidity, elasticity, compliance, biomechanical performance, durability and radiolucency or imaging preference. The components of system  10 , individually or collectively, may also be fabricated from a heterogeneous material such as a combination of two or more of the above-described materials. The components of system  10  may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein. 
     System  10  is employed, for example, with a minimally invasive procedure, including percutaneous techniques, mini-open and open surgical techniques to deliver and introduce an implant, such as, for example, a spinal rod, at a surgical site within a body of a patient, for example, a section of a spine. In one embodiment, system  10  may deliver and introduce a spinal rod for a derotation correction treatment. In one embodiment, system  10  may insert and rotate a spinal rod in a percutaneous lateral fusion procedure. 
     System  10  includes a surgical instrument  12  that is configured for engagement with a spinal construct, such as, for example, a spinal rod  130 , as shown in  FIG. 8  and discussed herein. Instrument  12  includes a first member, such as, for example, an inner sleeve  14 . Sleeve  14  extends between an end  16  and an end  18  and defines a longitudinal axis L1. Sleeve  14  includes an outer surface  20  and an inner surface  22 . A portion of surface  20  is configured to form a cavity  58  configured for disposal of a capture element  28 , as discussed herein. Surface  22  defines a passageway  24  configured for translation of a shaft  26 , as discussed herein. End  18  of sleeve  14  includes capture element  28  and an engagement surface engageable with an implant, such as, for example, spinal rod  130 . In one embodiment, the engagement surface comprises a rotator  30 , as discussed herein, which engages spinal rod  130 . In one embodiment, the engagement surface comprises a distal end of shaft  26  that directly engages and/or contacts an outer surface of spinal rod  130  between a locked position and a non-locking position, similar to that described herein with regard to rotator  30 . End  16  is configured for engagement with an actuator  32 , as discussed herein. In one embodiment, end  16  includes a threaded portion  34  configured to engage actuator  32 . In some embodiments, the first member and/or engagement surface, as described herein, is engageable with the implant, as described herein, in one or a plurality of positions, such as, for example, a first, a second and a third position. 
     In some embodiments, all or only a portion of surfaces  20 ,  22  may have alternate surface configurations, such as, for example, rough, threaded for connection with surgical instruments, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. In some embodiments, sleeve  14  is circular in shape but may have alternate cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. 
     Shaft  26  is configured for disposal in passageway  24  such that shaft  26  axially translates to engage and disengage from rotator  30 , as discussed herein. Shaft  26  includes an outer surface  36  and extends between an end  38  and an end  40 . End  38  is configured for connection with actuator  32 . As shown in  FIG. 6 , in one embodiment, shaft  26  is resiliently biased, such as, for example, with a spring  42  into engagement with rotator  30 . Spring  42  is configured to bias shaft  26  into engagement with rotator  30  between a locked position, as shown in  FIG. 5  and a non-locking position, as shown in  FIG. 8 . In an expanded, non-compressed configuration, spring  42  biases shaft  26  into engagement with rotator  30 . Actuation of spring  42  causes shaft  26  to disengage from rotator  30 . In one embodiment, in the expanded, non-compressed configuration, spring  42  can be biased such that shaft  26  is disengaged from rotator  30 . End  40  includes at least one mating surface, such as, for example, a plurality of gear teeth  44  configured for engagement with at least one mating surface of rotator  30 , as discussed herein. 
     In some embodiments, all or only a portion of surface  36  may have alternate surface configurations, such as, for example, rough, threaded for connection with surgical instruments, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. In some embodiments, shaft  26  is circular in shape but may have alternate cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. 
     Instrument  12  includes a second member, such as, for example an outer sleeve  48 . Sleeve  48  includes an inner surface  50  and extends along axis L1 between an end  52  and an end  54 . Surface  50  defines a cavity, such as, for example, a passageway  56  configured for moveable disposal of sleeve  14 . A portion of surface  50  and a portion of surface  20  define cavity  58  configured for moveable disposal of capture element  28 . Cavity  58  includes concave end surfaces  59  extending from end  54 . Cavity  58  facilitates axial translation of capture element  28  such that proximal translation causes capture element  28  to move inwardly to lock spinal rod  130  and distal translation causes capture element  28  to move outwardly to unlock spinal rod  130 , as discussed herein. 
     As shown in  FIG. 7 , capture element  28  includes an elongate portion  60  extending between an end  62  and an end  64 . Capture element  28  extends along surface  20  within cavity  58 . End  62  includes a protrusion, such as, for example, a pin  66  configured to engage an opening  68  disposed in surface  20 . Pin  66  is configured to fix capture element  28  with sleeve  14 . In one embodiment, as shown in  FIG. 7 , portion  60  includes an extension  63  and an extension  65 . Extensions  63 ,  65  extend in parallel relation and form a cavity  67  therebetween. In some embodiments, extensions  63 ,  65  can extend in alternate configurations such as, for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse and/or co-axial. Cavity  67  facilitates inward and outward movement of extensions  63 ,  65 , as discussed herein. Each extension  63 ,  65  includes an arcuate end portion forming a capture portion, such as, for example, jaws  70 . Jaws  70  are moveable between a non-locking orientation, as shown in  FIG. 7 , and a locking orientation, as shown in  FIG. 12 . As shown in  FIG. 7 , jaws  70  are arcuate in shape such that concave portions  72  are configured to face each other forming a circular cavity  74 . Cavity  74  is configured for disposal of spinal rod  130 . Each of jaws  70  includes an inner surface  76 . Surfaces  76  define a capture mating surface  78  configured to engage a capture mating surface  141  of spinal rod  130 , as discussed herein. 
     Extensions  63 ,  65  are resiliently biased such that in the non-locking position, extensions  63 ,  65  and jaws  70  are positioned outwardly from each other to facilitate insertion of spinal rod  130 . In the locking position, extensions  63 ,  65  and jaws  70  are positioned inwardly towards each other to facilitate capture of spinal rod  130 . Translation of capture element  28  proximally into sleeve  48  causes convex surfaces  71  of jaws  70  to translate along concave end surfaces  59  such that jaws  70  are moved towards each other into the locking orientation to lock spinal rod  130  with capture element  28  and instrument  12 . As shown in  FIG. 10 , mating surface  78  includes a circumferential flange  80  configured to engage a circumferential recess  142  of spinal rod  130 . Capture of spinal rod  130  facilitates engagement with rotator  30  and movement of spinal rod  130  to a surgical site. 
     In some embodiments, jaws  70  may have alternate cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, all or only a portion of surface  76  may have alternate surface configurations, such as, for example, rough, threaded for connection with surgical instruments, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Rotator  30  includes an inner surface  84  and an outer surface  86 , as shown in  FIG. 8 . In one embodiment, rotator  30  includes a circular shape. Surface  84  defines a cavity  88  that is tapered along its depth to facilitate insertion and capture of spinal rod  130 . In some embodiments, cavity  88  can be non-tapered, such as, for example, having a uniform, constant dimension or diameter. Surface  84  includes substantially concave sidewalls  90  and substantially planar top and bottom walls  92  configured to engage a portion of spinal rod  130 . In one embodiment, as shown in  FIG. 9 , surface  84  includes at least one wire  150  to lock spinal rod  130  with rotator  30 . In some embodiments, wire  150  can be made from stainless steel alloys, commercially pure titanium, titanium alloys, Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, stainless steel alloys, superelastic metallic alloys such as Nitinol. 
     Surface  86  includes at least one mating surface, such as, for example, a plurality of gear teeth  98  configured for engagement with gear teeth  44 . Teeth  98  and teeth  44  engage to lock rotator  30  to resist and/or prevent rotator  30  and spinal rod  130  from relatively rotating. Disengagement of teeth  98  and teeth  44  allows rotator  30  to freely rotate relative to sleeve  14 . In one embodiment, teeth  44  and teeth  98  can include a ratchet mechanism for incremental rotation. In some embodiments, rotator  30 , cavity  88  and/or surface  84  may have alternate cross section configurations along the depth of rotator  30 , such as, for example, cylindrical, oval, oblong, triangular, rectangular, square, hexagonal including for example hexalobular, polygonal, irregular, uniform, non-uniform, non-tapered, constant dimension, and/or variable. In some embodiments, end  40 , surface  86  and/or the mating surfaces described herein may comprise alternate mating surface configurations, such as, for example, friction fit, pressure fit, pin-in-groove, keyed connection, slotted connection, fasteners, rough, threaded, arcuate, undulating, dimpled and/or textured. 
     Actuator  32  extends along axis L1 and includes a rotatable portion  102  and an elongated portion  104 . In some embodiments, actuator  32  may extend from sleeves  14 ,  48  in alternate configurations such as, for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or parallel. Portion  104  is configured to extend in a cavity  106  formed by sleeve  14  and sleeve  48  at ends  16 ,  52 . Portion  104  includes an inner surface  108  that defines a cavity  110  configured to receive end  16  of sleeve  14 . Surface  108  includes a threaded portion  112  configured to engage portion  34  of sleeve  14  to facilitate axial translation of sleeve  14 , which causes pivoting of capture element  28  via engagement with sleeve  48 . Portion  102  is rotatable about axis L1 such that rotation of portion  102  causes threaded portions  112 ,  34  to axially translate sleeve  14 . Portion  102  includes a surface  114  that defines a cavity  116  configured for disposal of spring  42 . In one embodiment, actuator  32  includes a lever  118  configured to engage spring  42  to bias shaft  26  between the locked position and the non-locking position with rotator  30 . Lever  118  is depressible between a first configuration, as shown in  FIG. 4 , and second configuration, as shown in  FIG. 2 , to actuate spring  42 . 
     Actuator  32  includes an outer surface  122  configured as a gripping surface. In some embodiments, all or only a portion of surface  122  may have alternate surface configurations, such as, for example, rough, threaded for connection with surgical instruments, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     System  10  includes a spinal construct, such as, for example, spinal rod  130  that extends between an end  132  and an end  134  along a longitudinal axis L2, as shown in  FIG. 11 . Ends  132 ,  134  each have a tapered portion configured for mating engagement with the tapered portion of rotator  30 . Each of ends  132 ,  134  includes convex side portions  136  and planar top and bottom portions  138  configured for engagement with rotator  30 . Each of ends  132 ,  134  includes a capture element mating portion  141 , such as, for example, a circumferential recess  142  configured for engagement with flange  80  of jaws  70  to facilitate capture of spinal rod  130 . In some embodiments, spinal rod  130  includes a single recess  142  disposed with end  132  or end  134 . Spinal rod  130  is configured for alignment and insertion with instrument  12 . In some embodiments, spinal rod  130  may be inserted into instrument  12  in alternate configurations such as, for example, perpendicular, transverse or other angular orientations such as acute or obtuse, co-axial and/or parallel. 
     In operation, to capture and deliver spinal rod  130  to a surgical site, spinal rod  130  is positioned substantially orthogonal to instrument  12  along axis L2, as shown by arrow A in  FIG. 11 . Jaws  70  are disposed in an open position such that jaws  70  are disengaged from concave end surfaces  59 , as shown in  FIG. 11 . An end  132  or  134  of spinal rod  130  is positioned such that convex side portions  136  engage concave sidewalls  90  and planar top and bottom portions  138  engage planar top and bottom walls  92  of rotator  30 , as shown in  FIG. 12 . Recess  142  mates with flange  80  such that spinal rod  130  mates in a fixed configuration with jaws  70 . 
     Portion  102  of actuator  32  is rotated, such as, for example, in a clockwise direction, as shown by arrow B in  FIG. 12 , to lock jaws  70  with spinal rod  130 . Rotation of actuator  32  causes sleeve  14  to translate, in the direction shown by arrow C in  FIG. 12 , causing portion  60  to translate within cavity  58 . Translation of portion  60  causes jaws  70  to move inwardly along concave end surfaces  59 , in the direction shown by arrow D in  FIG. 8 , to a locked position. Translation along concave end surfaces  59  causes jaws  70  to move inwardly to tighten and lock spinal rod  130  with instrument  12 . 
     Engagement of spinal rod  130  with rotator  30  prevents spinal rod  130  from rotating relative to rotator  30 . In an initial position, as shown in  FIG. 5 , rotator  30  is locked with shaft  26  for delivering and insertion of instrument  12  adjacent to a surgical site. Lever  118  is disposed in a first position such that spring  42  is in an expanded configuration such that spring  42  biases shaft  26  into a locked configuration with rotator  30 . Teeth  44  engage teeth  98  such that rotation of rotator  32  and spinal rod  130  attached therewith is resisted and/or prevented relative to shaft  26  and instrument  12 . As such, the orientation of spinal rod  130  can be adjusted and manipulated with instrument  12 . In some embodiments, rotator  30  is locked with shaft  26  such that rotation of instrument  12  facilitates rotation of spinal rod  130  into engagement with one or a plurality of fasteners, such as, bone screws disposed with vertebrae, for example, rotating instrument  12  rotates spinal rod  130  within implant cavities of the screws for delivery, insertion and/or positioning of spinal rod  130 . In some embodiments, instrument  12  rotates spinal rod  130  in a clockwise direction and/or a counter-clockwise direction. 
     To facilitate rotation of rotator  30  relative to shaft  26  and instrument  12 , lever  118  is depressed, in the direction shown by arrow E in  FIG. 12 , to actuate spring  42 . Lever  118  engages spring  42  to axially translate shaft  26 , in the direction shown by arrow F in  FIG. 13 , to disengage teeth  44  from teeth  98 . In this configuration, rotator  30  and spinal rod  130  attached therewith can rotate relative to sleeves  14 ,  48  and instrument  12  to facilitate movement of instrument  12  and spinal rod  130  at the surgical site. This configuration facilitates manipulation and adjustment of the orientation of sleeves  14 ,  48  and/or instrument  12  without altering the position and orientation of spinal rod  130 . In some embodiments, instrument  12  is rotated relative to rotator  30  and spinal rod  130  to facilitate selective orientation of instrument  12 . In some embodiments, instrument  12  rotates relative to spinal rod  130  in a clockwise direction and/or a counter-clockwise direction. 
     To disengage spinal rod  130 , portion  102  of actuator  32  is rotated, such as, for example, in a counter-clockwise direction, as shown by arrow G in  FIG. 12 , to dispose jaws  70  in a non-locking orientation and release spinal rod  130  from instrument  12 . Rotation of actuator  32  causes sleeve  14  to translate, in the direction shown by arrow H in  FIG. 12 , causing portion  60  to translate within cavity  58 . Translation of portion  60  cause jaws  70  to move outwardly along concave end surfaces  59 , in the direction shown by arrows I in  FIG. 8 , to a non-locking orientation. Translation along concave end surfaces  59  cause jaws  70  to move outwardly to release spinal rod  130 . 
     In assembly, operation and use, as shown in  FIGS. 11-12 , system  10 , similar to that described above, is employed with a surgical procedure for treatment of a spinal disorder affecting a section of a spine of a patient, as discussed herein. System  10  may also be employed with other surgical procedures. For example, system  10  can be used with a surgical procedure for treatment of a condition or injury of an affected section of the spine including vertebrae (not shown). 
     In use, to treat the affected section of vertebrae, a medical practitioner obtains access to a surgical site including vertebrae in any appropriate manner, such as through incision and retraction of tissues. In some embodiments, system  10  may be used in any existing surgical method or technique including open surgery, mini-open surgery, minimally invasive surgery, including percutaneous surgical implantation, whereby vertebrae are accessed through a micro-incision, or sleeve that provides a protected passageway to the area. Once access to the surgical site is obtained, the particular surgical procedure is performed for treating the spinal disorder. System  10  is employed to augment the surgical treatment. System  10  can be delivered or implanted as a pre-assembled device or can be assembled in situ. One or all of the components of system  10  may be completely or partially revised, removed or replaced during or after the surgical procedure. 
     Pilot holes or the like are made in vertebrae for receiving the shaft of a bone fastener (not shown). The components of system  10  are disposed adjacent vertebrae at a surgical site and the bone fasteners of system  10  are manipulable to fix or otherwise connect spinal rod  130  to vertebrae. In one embodiment, extenders (not shown) are employed to support the bone fasteners and provide a pathway for connecting spinal rods  130  with the bone fasteners. A driver (not shown) may be employed with the extenders to fix the bone fasteners with vertebrae. 
     Upon fixation of the bone fasteners with vertebrae, spinal rod  130  is positioned substantially orthogonal to instrument  12 . Jaws  70  are disposed in an open orientation, as described herein, such that jaws  70  are disengaged from concave end surfaces  59 . An end  132  or  134  of spinal rod  130  is positioned with instrument  12  such that convex side portions  136  engage concave sidewalls  90  and planar top and bottom portions  138  engage planar top and bottom walls  92  of rotator  30 . Recess  142  mates with flange  80  such that spinal rod  130  mates in a fixed configuration with jaws  70 . 
     Portion  102  of actuator  32  is rotated in a clockwise direction to lock jaws  70  with spinal rod  130 . Rotation of actuator  32  causes jaws  70  to move inwardly to tighten and lock spinal rod  130  with instrument  12 , as described herein. 
     Lever  118  is disposed in a first position and rotator  30  is locked with shaft  26 , as described herein, for delivering and insertion of instrument  12  adjacent to the surgical site. As such, the orientation of spinal rod  130  can be adjusted and manipulated with instrument  12 , as described herein. To facilitate rotation of shaft  26  and instrument  12  relative to rotator  30  and spinal rod  130 , lever  118  is depressed to actuate spring  42  and disengage teeth  44  from teeth  98 , as described herein. In this configuration, rotator  30  and spinal rod  130  attached therewith can rotate relative to sleeves  14 ,  48  and instrument  12  to facilitate movement of instrument  12  and spinal rod  130  at the surgical site. This configuration facilitates manipulation and adjustment of the orientation of sleeves  14 ,  48  and/or instrument  12  without altering the position and orientation of spinal rod  130 . 
     Actuator  32  is rotated in a counter-clockwise direction to dispose jaws  70  in a non-locking orientation and release spinal rod  130  from instrument  12 , as described herein. Upon completion of a procedure, described herein, the surgical instruments, assemblies and non-implanted components of spinal correction system  10  are removed and the incisions are closed. 
     One or more of the components of system  10  can be made of radiolucent materials such as polymers. Radiomarkers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. In some embodiments, the use of surgical navigation, microsurgical and image guided technologies may be employed to access, view and repair spinal deterioration or damage, with the aid of system  10 . In some embodiments, system  10  may comprise implants, which include one or a plurality of plates, connectors, longitudinal elements and/or bone fasteners for use with a single vertebral level or a plurality of vertebral levels. 
     In some embodiments, system  10  includes an agent, which may be disposed, packed, coated or layered within, on or about the components and/or surfaces of system  10 . In some embodiments, the agent may include bone growth promoting material, such as, for example, bone graft to enhance fixation of the components and/or surfaces of system  10  with vertebrae. In some embodiments, the agent may include one or a plurality of therapeutic agents and/or pharmacological agents for release, including sustained release, to treat, for example, pain, inflammation and degeneration. 
     In one embodiment, as shown in  FIGS. 15 and 16 , system  10  includes instrument  12 , described with regard to  FIGS. 1-14 , which comprises an actuator  232  extending transverse to axis L1 and includes a rotatable portion  302  and a handle portion  304 . Portion  302  includes an inner surface  308  that defines a cavity  310  configured to receive end  16  of sleeve  14 . Surface  308  includes a threaded portion  312  that engages portion  34  of sleeve  14  for disassembly and/or removal of components to facilitate, for example, cleaning. Sleeve  48  is manually translated, relative to sleeve  14 , to facilitate movement of capture element  28 . Sleeve  48  is biased by a spring  332  between a locked position and an unlocked position relative to capture element  28 . 
     Handle portion  304  includes an inner surface  306  that defines a cavity  309 . Cavity  309  is configured for disposal of a lever  314  that is configured to engage and disengage shaft  26  from rotator  30 . Lever  314  is configured for disposal between a first locked position and a second non-locking position. Lever  314  includes an engagement surface  315  configured to engage shaft  26 . Translation of lever  314  causes surface  315  to engage end  38  of shaft  26  to translate shaft  26  such that teeth  44  engage teeth  98 . Portion  304  includes a button  316  configured to actuate translation of lever  314 . 
     Actuator  232  includes an outer surface  322  configured as a gripping surface. In some embodiments, all or only a portion of surface  322  may have alternate surface configurations, such as, for example, rough, threaded for connection with surgical instruments, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     In operation, to capture and deliver spinal rod  130  to a surgical site, spinal rod  130  is positioned substantially orthogonal to instrument  12 . Sleeve  48  is manually translated, in the direction shown by arrow J in  FIG. 16 , such that jaws  70  are disposed in an open orientation such that jaws  70  are disengaged from concave end surfaces  59  and sleeve  48  is in the unlocked position. Sleeve  48  is released and spring  232  biases sleeve  48 , in the direction shown by arrow M in  FIG. 16 , to lock jaws  70  with spinal rod  130 . Recess  142  mates with flange  80  such that spinal rod  130  mates in a fixed configuration with jaws  70 . 
     Engagement of spinal rod  130  with rotator  30  resists and/or prevents spinal rod  130  from rotating relative to rotator  30 . In an initial position, rotator  30  is locked with shaft  26  for delivery and insertion of instrument  12  adjacent to a surgical site. In the locked orientation, teeth  44  are engaged with teeth  98  such that rotation of rotator  32  and spinal rod  130  attached therewith is prevented relative to shaft  26  and instrument  12 . 
     To facilitate rotation of rotator  30  relative to shaft  26  and instrument  12 , button  316  is depressed to actuate translation of lever  314 , in the direction shown by arrow J in  FIG. 16 , to translate shaft  26  to disengage teeth  44  from teeth  98 . In this configuration, rotator  30  and spinal rod  130  attached therewith can rotate relative to sleeves  14 ,  48  and instrument  12  to facilitate movement of instrument  12  and spinal rod  130  at the surgical site. To disengage spinal rod  130 , sleeve  48  is translated to release jaws  70  from spinal rod  130 . 
     In one embodiment, as shown in  FIG. 17 , system  10  includes instrument  12  described with regard to  FIGS. 1-14 , which comprises an actuator  432  extending transverse to axis L1 and includes a rotatable portion  502  and a handle portion  504 . Portion  502  includes an inner surface  508  that defines a cavity  510  configured to receive end  16  of sleeve  14 . Surface  508  includes a threaded portion  512  configured to engage portion  34  for disassembly and/or removal of components to facilitate, for example, cleaning. Sleeve  48  is manually translated, relative to sleeve  14 , to facilitate movement of capture element  28 . Sleeve  48  is biased by a spring  532  between a locked position and an unlocked position relative to capture element  28 . 
     Handle portion  504  includes an inner surface  506  that defines a cavity  509 . Cavity  509  is configured for disposal of a lever  514  that is configured to engage and disengage shaft  26  from rotator  30 . Lever  514  is configured for disposal between a first locked position and a second non-locking position. Lever  514  extends between an end  511  and an end  513 . End  511  includes an aperture  516  configured to receive a pin  518  disposed with shaft  26 . Translation of lever  514  within cavity  509  causes shaft  26  to move about pin  518  such that teeth  44  engage teeth  98 . End  513  includes a button  520  configured to actuate translation of lever  514 . 
     Actuator  432  includes an outer surface  522  configured as a gripping surface. In some embodiments, all or only a portion of surface  522  may have alternate surface configurations, such as, for example, rough, threaded for connection with surgical instruments, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     In operation, to capture and deliver spinal rod  130  to a surgical site, spinal rod  130  is positioned substantially orthogonal to instrument  12 . Sleeve  48  is translated, in the direction shown by arrow L in  FIG. 17 , against spring  532  such that jaws  70  are disposed in an open position such that jaws  70  engage concave end surfaces  59  and sleeve  48  is in the unlocked position. To lock jaws  70  with spinal rod  130 , sleeve  48  is biased by spring  532  in the opposite direction, in the direction shown by arrow N in  FIG. 17 , to lock sleeve  48  such that jaws  70  engage spinal rod  130 . Recess  142  mates with flange  80  such that spinal rod  130  mates into a fixed configuration with jaws  70 . 
     Engagement of spinal rod  130  with rotator  30  prevents rod from freely rotating within rotator  30 . In an initial position, rotator  30  is locked with shaft  26  for insertion of instrument  12  into the surgical site. In the locked position, button  520  is depressed such that lever  514  pivots about pin  518  and moves pin  518 , in the direction shown by arrow K in  FIG. 17 , such that shaft  26  translates, in the direction shown by arrow K, and teeth  44  are engaged with teeth  98  such that rotation of rotator  32  and spinal rod  130  attached therewith is resisted and/or prevented relative to shaft  26  and instrument  12 . 
     To facilitate rotation of rotator  30  relative to shaft  26  and instrument  12 , button  520  depressed to move lever  514  about pin  518  in the opposite direction, as shown by arrow L in  FIG. 17 , such that shaft  26  disengages teeth  44  from teeth  98 . In this configuration, rotator  30  and spinal rod  130  attached therewith can rotate relative to sleeves  14 ,  48  and instrument  12  to facilitate movement of instrument  12  and spinal rod  130 . To disengage spinal rod  130 , sleeve  48  is translated to release jaws  70  from spinal rod  130 . 
     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.