Patent Publication Number: US-2021161566-A1

Title: Mis cross-connector

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 16/415,443, filed on May 17, 2019, which is a continuation of U.S. patent application Ser. No. 14/936,071, filed on Nov. 9, 2015, the entirety of which is incorporated herein by reference in its entirety for all purposes. 
    
    
     FIELD OF THE DISCLOSURE 
     The present disclosure relates to bone fixation constructs that may include a stabilization element, and, more particularly, to bone fixation constructs that may include a connector system that may be coupled to, for example, one or more elongate members. 
     BACKGROUND OF THE DISCLOSURE 
     Intervertebral discs are susceptible to a variety of weaknesses and abnormalities that can affect their ability to provide support and structure. Many of the abnormalities may be the result of, for example, trauma, degenerative disc disease, or tumors, which can cause severe pain or damage to the nervous system. Also, movement of the spinal column may be significantly limited by such abnormalities. Known treatments of such abnormalities typically involve affixing screws or hooks to one or more vertebrae and connecting the screws or hooks to a rod that is aligned with the longitudinal axis of the spinal column to immobilize the spinal segments with respect to each other. Pedicle screw systems are frequently used to provide spinal fixation. 
     A number of pedicle screw systems are known, which share common techniques and principles of screw placement and rod attachment. Generally, bone screws are screwed into pedicles of vertebrae and coupled to at least one elongated rod. The pedicles, which consist of a strong shell of cortical bone and a core of cancellous bone, are generally used for the bone screw sites because they provide a strong point of attachment to a spine and, thereby, the greatest resistance against bone-metal junction failure. Known pedicle screw systems typically include pedicle screws and rods to stabilize adjacent spinal segments. Such systems may also include variable angled coupling caps (or heads) on the pedicle screws to allow for angular adjustment of the coupling mechanism between the rod and screws. Since pedicle size and angulation varies throughout the spinal column, several different sizes and shapes of pedicle screws are used in these systems. These systems are generally designed to provide stable and rigid structures to promote bone growth and fusion. The systems may include a pair of rods, plates, or other elongate members affixed to the pedicle screws along the longitudinal axis of the spine. 
     The strength and stability of a multi-rod, plate, or other elongate member assembly can be increased by intercoupling the elongate members with a cross connector that extends substantially horizontal to the longitudinal axes of the elongate members, across the spine. Due to a wide variety of factors, the elongate members are seldom geometrically aligned in clinical applications. Furthermore, typical cross connectors are inserted through either a fully open or mini-open procedure, resulting in resection of the spinal ligaments and bone. A minimally invasive connector system with at least some adjustability is needed that can accommodate for variations in geometrical alignment while minimizing damage to the supporting anatomical structures. 
     SUMMARY OF THE DISCLOSURE 
     The present disclosure is generally directed towards a bone fixation system or construct for implanting in bone, wherein the bone fixation system comprises a connector assembly to add additional stability to the system. The bone fixation system comprises: a plurality of bone fastener assemblies that attach to bone; a pair of elongate members that attach to the plurality of bone fastener assemblies; a connector member that contacts the pair of elongate members; and a plurality of locking caps that secure the connector member and the elongate members to the plurality of bone fastener assemblies, wherein at least one of the plurality of locking caps comprises a cap portion and a hook portion, where the cap portion is adapted to rotate while the hook portion is stationary. 
     At least one of the plurality of bone fastener assemblies may comprise: a bone fastener that attaches to bone; a coupler that connects to the bone fastener; and an extender that connects to the coupler. The extender may comprise: a coupling portion that attaches to the coupler; and a blade portion that attaches to the coupling portion. The coupling portion may comprise a threading. The blade portion may comprise a pair of extender blades. The cap portion of the at least one of the plurality of locking caps may comprise a threading that engages the threading in the coupling portion. The hook portion of the at least one of the plurality of locking caps may comprise a receptacle that receives a contact portion of the connector member. The receptacle may include an interface section that contacts the contact portion of the connector member, and a tapered section that contacts the contact portion of the connector member and allows adjustability of the connector member in the receptacle. 
     The bone fixation system may further comprise a sleeve that guides the connector member and said at least one of the plurality of locking caps during installation of the bone fixation system. 
     Additional features, advantages, and embodiments of the disclosure may be set forth or apparent from consideration of the detailed description and drawings. Moreover, it is to be understood that both the foregoing summary of the disclosure and the following detailed description are exemplary and intended to provide further explanation without limiting the scope of the disclosure as claimed. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are included to provide a further understanding of the disclosure, are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and together with the detailed description serve to help explain the principles of the disclosure. No attempt is made to show structural details of the disclosure in more detail than may be necessary for a fundamental understanding of the disclosure and the various ways in which it may be practiced. In the drawings: 
         FIG. 1  shows an exemplary embodiment of a bone fixation construct, according to the principles of the disclosure; 
         FIG. 2  shows a detailed view of a portion A of the bone fixation construct in  FIG. 1 ; 
         FIGS. 3A-3C  show a perspective view, a side view and a bottom view, respectively, of an exemplary embodiment of a locking cap, according to the principles of the disclosure; 
         FIGS. 3D-3E  show a bottom view of the locking cap in  FIGS. 3A-3C  with a connector member; 
         FIG. 4  shows the bone fixation construct of  FIG. 1  during a process of installing the connector member; 
         FIG. 5  shows a detailed perspective view of a portion of the bone fixation construct in  FIG. 4  after insertion of the connector member; 
         FIG. 6  shows a detailed side view of the portion of the bone fixation construct in  FIG. 4  after insertion of the connector member; 
         FIG. 7  shows a detailed front (or back) view of the portion of the fixation construct in  FIG. 4  after insertion of the connector member; 
         FIG. 8  shows another exemplary embodiment of a bone fixation construct, according to the principles of the disclosure; 
         FIG. 9  shows an exemplary embodiment of a connector assembly, according to the principles of the disclosure; 
         FIG. 10  shows an exemplary embodiment of a hook member that may be included in the connector assembly of  FIG. 9 ; 
         FIG. 11  shows yet another exemplary embodiment of a bone fixation construct, according to the principles of the disclosure; 
         FIG. 12  shows another exemplary embodiment of a connector assembly, according to the principles of the disclosure; 
         FIG. 13  shows an exemplary embodiment of a hook member that may be included in the connector assembly of  FIG. 12 ; 
         FIGS. 14A-14D  show yet another exemplary embodiment of a hook member, according to the principles of the disclosure; 
         FIGS. 15A-15D  show an example of an implant head inserter that may be used with the hook member of  FIGS. 14A-14D ; and 
         FIGS. 16-28  show yet another exemplary embodiment of a bone fixation construct during a process of installing the construct in bone. 
     
    
    
     The present disclosure is further described in the detailed description that follows. 
     DETAILED DESCRIPTION OF THE DISCLOSURE 
     The disclosure and the various features and advantageous details thereof are explained more fully with reference to the non-limiting embodiments and examples that are described and/or illustrated in the accompanying drawings and detailed in the following description. It should be noted that the features illustrated in the drawings are not necessarily drawn to scale, and features of one embodiment may be employed with other embodiments as the skilled artisan would recognize, even if not explicitly stated herein. Descriptions of well-known components and processing techniques may be omitted so as to not unnecessarily obscure the embodiments of the disclosure. The examples used herein are intended merely to facilitate an understanding of ways in which the disclosure may be practiced and to further enable those of skill in the art to practice the embodiments of the disclosure. Accordingly, the examples and embodiments herein should not be construed as limiting the scope of the disclosure. Moreover, it is noted that like reference numerals represent similar parts throughout the views of the drawings. 
       FIG. 1  shows an example of a bone fixation construct  10  that is constructed according to the principles of the disclosure. The bone fixation construct  10  includes a plurality of bone fasteners  20  (for example, four), one or more elongate members  30  (for example, two), a plurality of couplers  40  (for example, four), a plurality of extenders  60  (for example, four), and a connector assembly  70 . The various components of the bone fixation construct  10  (or  10 A, or  10 B, or  10 C, discussed below) may be made of a material such as, for example, stainless steel, titanium, titanium-alloy, or the like. 
       FIG. 2  shows a detailed view of a portion A of the bone fixation construct  10  in  FIG. 1 , which includes the connector assembly  70 . As seen in the illustration, the connector assembly  70  includes a pair of locking caps  210  and a connector member  35 . 
     Referring to  FIGS. 1 and 2 , and referring to one of the bone fasteners  20  with the understanding that the description may apply equally to the other bone fasteners  20 , the bone fastener  20  may include a bone screw, such as, for example, any of the various pedicle screws common in the art, including, for example, a polyaxial pedicle screw. The bone fastener  20  may include a shaft portion that may be configured at the distal end to penetrate and facilitate insertion of the bone fastener  20  into bone. At the proximal end, the bone fastener  20  may include a head portion (not shown) that may be coupled to a corresponding coupler  40  and configured to be, for example, polyaxially adjustable with respect to the corresponding coupler  40 . For instance, the coupler  40  may pivot and/or rotate with respect to the corresponding bone fastener  20 . 
     The head portion of the bone fastener  20  may include a tool receptacle (not shown) at its proximal end that is configured to receive a driver tool (not shown) to drive the bone fastener  20  into bone. The tool receptacle may have a hexagon shape, a torque-screw shape, or any other shape that may facilitate the bone fastener  20  being driven into a bone by the driver tool. 
     The shaft portion of the bone fastener  20  may have a thread (not shown) that is adapted to be screwed into a bone, such as, for example, a vertebra. Alternative formations may be formed in/on the shaft portion which provide the intended purposes of securing the bone fastener  20  within a bone, as described herein. The shaft may have a tapered shape, which may be provided with a high pitch thread. It is noted that the length, diameter, thread pitch, and thread diameter ratio of the shaft may be selected based on the particular application of the bone fastener  20 , as understood by those skilled in the art. 
     The bone fasteners  20  may be substantially the same or substantially different from each other with respect to, for example, shaft length, shaft diameter, thread pitch, thread diameter ration, and the like. 
     The elongate member  30  may include, for example, an elongate rod, a pin (not shown), a brace (not shown), a spring (not shown), a cord (not shown), a resilient extension (not shown), or any other stabilization device that may be secured by the locking cap(s)  210  in the coupler(s)  40  to provide stabilization to the construct  10 . The locking cap(s)  210  may be used to secure the elongate member  30  in the coupler(s)  40 , as illustrated in  FIG. 1 . 
     Referring to one of the couplers  40 , with the understanding that the description may apply equally to the other couplers  40 , the coupler  40  may include a coupler body  41  that may have, for example, a “tulip” shape (shown in  FIG. 7 ). The coupler body  41  may be configured to rotate and/or pivot with respect to the bone fastener  20 . At its proximal end, the coupler body  41  may include a pair of upwardly extending arms  42 ,  43  and a slot  44  formed between the extending arms  42 ,  43  (for example, shown in  FIG. 7 ). The slot  44  may be configured to receive the elongate member  30 , as illustrated in  FIG. 7 . The coupler body  41  may be configured to receive and hold the locking cap  210 , as seen in  FIG. 1 . 
     The coupler body  41  may hold the locking cap  210  in a predetermined location along the longitudinal axis of the coupler body  41  after insertion in the coupler body  41 , so that a contact surface  216  (shown in  FIG. 3B ) of the locking cap  210  contacts and presses upon a surface of the elongate member  30  to hold and secure the elongate member  30  in a fixed position, preventing the elongate member  30  from moving rotationally, angularly or longitudinally. 
     The coupler body  41  may include a threading that may be provided on the interior surfaces of the upwardly extending arms  42 ,  43 , as seen in  FIG. 1 . The threading may be configured to receive and engage a corresponding threading  212  on the locking cap  210  (shown in  FIG. 3B ). Alternatively, the coupler body  41  may include a tongue and grove mechanism (not shown), or any other retaining mechanism that can secure the locking cap  30  in a predetermined location in the coupler body  41 . 
     Referring to  FIG. 7 , the upwardly extending arms  42 ,  43  of the coupler body  41  may extend longitudinally in a superior direction and include an interior, an exterior, and upper surfaces. One or both of the extending arms  42 ,  43  may include one or more extender engaging portions (not shown), which may be configured to receive and engage corresponding portions of the extender  60 . The coupler body  41  may be configured to receive and engage a driver tool (not shown) and be driven by the tool to rotate and/or angularly adjust the coupler body  41 . The coupler body  41  may be adjusted (for example, rotated and/or pivoted) simultaneously with the corresponding extender  60 . The extender  60  may be configured to be attachable to and/or removable from the coupler body  41 . The extender  60  may be integrally formed with the coupler body  41  and configured to be removable from the coupler body  41 . 
     Referring to one of the extenders  60 , with the understanding that the description may apply equally to the other extenders  60 , the extender  60  may include, for example, a coupling portion  64  and a blade portion  66 . The blade portion may include a pair of extender blades  67 ,  68 . The length and/or diameter of the extender  60  may vary to meet varying patient anatomy. The blade portion  66  may be coupled to, or integrally formed with the coupling portion  64 . The coupling portion  64  may include a threading  62  (shown in  FIG. 2 ) that may be configured to receive and engage the threading  212  on the locking cap  210  (shown in  FIG. 3B ). The coupling portion  64  may be removably connected to a corresponding coupler  40 . The interface between the coupling portion  64  and the corresponding coupler  40  may be configured to be substantially seamless, allowing the locking cap  210  to be seamlessly screwed longitudinally along the inner surfaces of the coupling portion  64  and the threading in the coupler body  41 . 
     The extender  60  may be configured to retract tissue and provide an unobstructed channel for insertion of tools (not shown), such as, for example, a screw driver (not shown), rod introduction instrument  500  (shown in  FIGS. 26-27 ), and the like. For instance, the blade portion  66 , including the extender blades  67 ,  68 , may be configured to provide a longitudinal channel that extends from the proximal ends of the extender blades  67 ,  68 , to the head portion (not shown) of the bone fastener  20 , allowing for tools, such as, for example, the screw driver (not shown) to be inserted into, engage the head portion (not shown) and drive the bone fastener  20  into bone (not shown). The extender channel may be configured to receive and guide, for example, the elongate member  30 , which may be introduced at the proximal end of the extender blades  67 ,  68  and travel through the extender channel (for example, percutaneously) to the distal end of the blade portion  66 . At the distal end of the blade portion  66 , the elongate member  30  may be manipulated and maneuvered using, for example, the rod introduction instrument  500  (shown in  FIGS. 26-27 ) into a desired position in the bone fixation construct  10  (shown in  FIG. 1 ). 
       FIGS. 3A-3C  show a perspective view, a side view and a bottom view, respectively, of an exemplary embodiment of the locking cap  210 ; and  FIGS. 3D-3E  show a bottom view of the locking cap  210  with a connector member  35  adjustably positioned at different angles with respect to the locking cap  210 . As seen in  FIGS. 1-2 and 3A-3E , the connector assembly  70  may include the pair of locking caps  210  and the connector member  35 . 
     Referring to  FIGS. 1-2 and 3A-3C , each of the locking caps  210  may be positioned in a corresponding coupler  40  and adjusted to secure a contact portion  355  of the connector member  35  in the bone fixation construct  10 . Each locking cap  210  may include a cap portion  211  and a hook portion  213 . The cap portion  211  may be attached to the hook portion  213  such that the cap portion  211  may be capable of spinning freely with respect to the hook portion  213 . The cap portion  211  may include the threading  212  and a tool receptacle  215 . The tool receptacle  215  may have a hexagon shape, a torque-screw shape, or any other shape that may facilitate the cap portion  211  being driven to, for example, rotate in and fasten to the coupler body  41  by the driver tool (not shown). 
     As seen in  FIGS. 3A-3C , the hook portion  213  may include a receptacle  214  that may be configured to receive a portion (for example, the contact portion  355 ) of the connector member  35 . The receptacle  214  may include an interface section  217  and one or more tapered sections  218 ,  219 . The interface section  217  has an inner diameter this is greater than the outer diameter of the portion of the connector member  35  to be secured by the locking cap  210 . The tapered sections  218 ,  219  may have a conical shape. The tapered sections  218 ,  219  have varying inner diameters that range from a diameter that is substantially equal to the inner diameter of the interface section  217  nearest the interface and increasing to an inner diameter that is greater than the inner diameter of the interface section  217 , so as to allow angular movement of the contact portion  355  of the connector member  35  in the receptacle  214 , and, thereby, adjustability of the connector member  35  with respect to the locking cap  210 . The receptacle  214  may have a height H (shown in  FIG. 3B ) that is less than the height (or thickness) of, for example, the contact portion  355 , such that a part of the contact portion  355 , when the connector member  35  is installed in the receptacle  214 , extends below the lower surface of the hook portion  213 , so that it may be forced by the hook portion  213  to contact and engage the surface of the elongate member  30 , thereby securing the connector member  35 , elongate member  30  and locking cap  210  to the coupler  40 . 
     Referring to  FIGS. 3D-3E , the connector member  35  may be substantially the same as, or different from the elongate member  30 . The connector member  35  may be substantially round in its cross-section and substantially elongated in its length. The connector member  35  may include, for example, an elongate rod (shown in  FIG. 2 ), a pin (not shown), a brace (not shown), a spring (not shown), a cord (not shown), a resilient extension (not shown), or any other stabilization device that may be secured by the locking caps  210  to the construct  10 . The connector member  35  may include attributes that may be selected based on, for example, variations in anatomy. For instance, the connector member  35  attributes that may be selected include a length, width, configuration, shape, or the like, depending on the particular application. 
     The connector member  35  may include the contact portion  355  at one or both ends. The contact portion  355  may be formed between ends  354 ,  356 , as seen in  FIG. 3D . The contact portion  355  may be substantially flat, or it may be shaped to match to and receive the outer surface of the elongate member  30 . For instance, the contact portion  355  may include an interface portion similar to interface section  217  (shown in  FIG. 3C ) and/or at least one tapered portion similar to tapered section(s)  218  (and/or  219 ). The contact portion  355  may be configured to provide greater surface contact between the surface(s) of the contact portion  355  and the surface of the elongate member  30 , thereby preventing the elongate member  30  from moving (for example, sliding, rotating, or pivoting). The contact portion  355  may have any structure that may facilitate engaging and securing the connector member  35  on top of the elongate member(s)  30 , without departing from the scope or spirit of the disclosure. The contact portion  355  may be configured to rest atop of the elongate member  30 , as seen in  FIG. 2 . 
     The connector member  35  includes an end  352  that may include a tool engagement portion  353 . The tool engagement portion  353  may be configured to be securely held by the rod introduction instrument  500  (shown in  FIGS. 26-27 ), such that the connector member  35  may be rotated about its longitudinal axis, and linearly and/or angularly adjusted in the real-world coordinate system, including the x-axis, y-axis, and z-axis (shown in  FIG. 5 ). 
       FIG. 4  shows the bone fixation construct  10  in a near-complete form during a process of installing the connector member  35 ; and,  FIGS. 5-8  show detailed views of a portion B of the bone fixation construct  10  after installation of the connector member  35  in the bone fixation construct  10 . 
     Referring to  FIG. 4 , after a surgical area is cleaned on a patient, a minimally invasive incision made, muscle tissue moved to the side(s), and other common surgical procedures carried out, tracks for the bone fasteners  20  may be prepared. In this regard, hard bone surface may be removed and a guide track may be inserted under x-ray guidance into, for example, the pedicle of the vertebrae. The depth and position of the guide track may be checked. Where the bone fastener  20  includes a bone screw, a thread may be tapped into the bone to form a tap (not shown) to receive and securely hold the bone fastener  20 . The process would be repeated for each bone fastener  20  of the bone fixation construct  10 . 
     Using a driver tool (not shown), as is known by those skilled in the art, the driver tool may be inserted in and moved through the extender channel of the extender  60  toward the bone fastener  20 . The tool may contact the head portion (not shown) of the bone fastener  20  and the driver tool may be manipulated until the driver tool head (not shown) is sufficiently seated in and engaged with the tool receptacle (not shown) in the bone fastener  20  to ensure a secure connection. The driver tool, including the bone fastener assembly that comprises the bone fastener  20 , the coupler  40 , and the extender  60 , can then be aligned with the tap (not shown) in the bone and screwed into the threaded tap. 
     Alternatively, the bone fastener assembly, including the bone fastener  20 , the coupler  40 , and the extender  60 , may be partially installed in the tap before being contacted by the driver tool. Once the bone fastener assembly is implanted in the desired position, the driver tool may be removed and the process repeated for each bone fastener assembly, including the bone fastener  20 , coupler  40 , and extender  60  of the bone fixation construct  10 . 
     After the bone fasteners  20  are securely and properly placed in corresponding taps, a first elongate member  30  may be inserted into and moved through the extender channel of the extender  60  toward the distal end of the coupling portion  64  of the extender  60 . The elongate member  30  may be positioned in the slots  44  (shown in  FIG. 7 ) of the pair of adjacent couplers  40 . The pair of couplers  40  may be adjusted and positioned such that the slots  44  of the couplers substantially line up with each other, providing a virtual channel for the elongate member  30 . Once the elongate member  30  is seated in a desired position with respect to the pair of couplers  40 , a cap (not shown) may be installed in the coupler  40  proximate the distal end  301  of the elongate member  30  (shown in  FIG. 4 ) and positioned to secure a portion of the elongate member  30  in the coupler  40 . In the case where cap (not shown) includes a threading, the cap may be screwed into the coupler  40  using a screw driver (not shown). 
     Alternatively, the cap (not shown) may be partially installed in the coupler  40  prior to installation of the bone fastener assembly, which includes the bone fastener  20 , coupler  40 , and extender  60 . The distal end  301  of the elongate member  30  may be inserted through the opening in the coupler  40  formed by the slot  44  and bottom side of the cap (not shown). After the elongate member  30  is seated in a desired position, the cap (not shown) may be positioned to secure the distal end  301  of the elongate member  30  in the coupler  40 , such as, for example, by screwing the cap (not shown) in the coupler  40 . 
     The process may be repeated for the second elongate member  30 , which may be positioned in the slots  44  (shown in  FIG. 7 ) of a second pair of adjacent couplers  40 . The second pair of couplers  40  may be adjusted and positioned such that the slots  44  of the second pair of couplers substantially line up with each other, providing a virtual channel for the second elongate member  30 . Another cap (not shown) may be installed in the coupler  40  that is located proximate the distal end  301  of the elongate member  30  (shown in  FIG. 4 ), and positioned to secure end  301  in the coupler  40 . 
     The cap(s) (not shown) may include the locking cap  210  (shown in  FIGS. 3A-3E ), a cap  50  (shown in  FIG. 8 ), a cap  92  (shown in  FIG. 12 ), or any other cap that is known in the art and that may be installed in the coupler  40  to secure the elongate member  30  in the coupler, including, for example, a set screw, or the like, or any of the various caps that include a bottom portion (not shown) that may be shaped to match the shape of the elongate member  30  so as to provide increased surface contact between the cap (not shown) and elongate member  30 . 
     As seen in  FIG. 4 , after the pair of elongate members  30  are positioned in the bone fixation construct  10 , a sleeve  300  may be positioned over a proximate end of the extender  60  and slid over the extender body toward its distal end. The sleeve  300  may be slid over part of the length of the extender  60 , leaving sufficient space at its distal end to introduce and install the connector member  35  (shown in  FIG. 5 ). Once the connector member  35  is in position, the locking cap(s)  210  may be inserted into the corresponding coupler(s)  40 . 
     Alternatively, one of the locking caps  210  may be installed prior to installation of the connector member  35 . In this instance, an end of the connector member  35  may be inserted through an opening  47  that is formed by the receptacle  214  (shown in  FIG. 3A ) and the elongate member  30 , as seen in  FIG. 4 . 
     Referring to  FIGS. 4-6 , the sleeve  300  includes a sleeve body  310  that may have a longitudinal extender channel  320  formed therein and extending from (and through) the proximal end of the sleeve body  310  to (and through) the distal end of the sleeve body  310 . The extender channel  320  may have an internal geometry (not shown) that prevents it from spinning around the extender  60 . The extender channel  320  is configured to receive and slide on the extender  60 , having an inner diameter that is greater than the outer diameter of the extender  60 . 
     The sleeve body  310  may also include an instrumentation channel  330  formed therein. The instrumentation channel  330  extends from (and through) the proximal end of the sleeve body  310  to (and through) the distal end of the sleeve body  310 . The instrumentation channel  330  may have an internal geometry (not shown) that guides the connector member  35  to and through a sleeve opening  340  formed in the distal end of the sleeve  300 . The sleeve opening  340  may be formed on one side of the sleeve body  310 , allowing for exit of the connector member  35  on that side of the sleeve body  310 ; or, the sleeve opening  340  may be formed as, for example, a cut-out in the distal end of the sleeve body  310 , allowing for exit of the connector member  35  on either side of the sleeve body  310 . 
     The sleeve  310  may include a sleeve cutout  350  at its distal end that may be contoured to match the shape of the elongate member  30 . The sleeve cutout  350  may facilitate proper alignment of the sleeve  310  with the elongate member  30 , as well as help to keep the sleeve  310  stationary with respect to the elongate member  30 . 
     The extender channel  320  and the instrumentation channel  330  may be configured such that the locking cap  210  may be inserted in the proximal end of the sleeve body  310  and moved through the channels  320 ,  330  to and through the distal end of the sleeve body  310 , and to the corresponding coupler  40 . The inner diameter (or width) of the instrumentation channel  330  may be less than the inner diameter (or width) of the extender channel. The instrumentation channel  330  may include an inner geometry that may help to align and position the hook portion  213  of the locking cap  210  (shown in  FIG. 3A ) such that the longitudinal axis of the locking cap  210  is substantially parallel to the elongate member  30  in the corresponding coupler  40 . 
     Referring to  FIGS. 5-6 , the bone fixation construct  10  may be secured by threading the locking caps  210  into locked positions. In this regard, as each of the locking caps  210  is threaded (or screwed) in the corresponding coupler  40 , the locking cap  210  travels toward the elongate member  30 , locking the elongate member  30  in place and simultaneously locking the connector member  35  on top of the elongate member  30 . 
     Referring to  FIG. 7 , the connector member  35  may be positioned such that the contact portion  355  is positioned on top of the elongate member  30 . The ends  354 ,  356  may assist in positioning the contact portion  355  on top of the elongate member  30 , as well as properly positioning the connector member  35  in the connector assembly  70 . The ends  354 ,  356  may function as stops to prevent the connector member  35  from moving beyond either end  354 ,  356  with respect to the elongate member  30 . The connector member  35  may include a contact portion  355  (not shown) at its other end (not shown), which may be similarly seated on top of and secured to the second elongate member  30 . 
     At completion of placement of the bone fixation construct  10 , the construct may be installed in adjacent vertebrae, with the bone fasteners  20  implanted in the pedicles of the vertebrae.  FIG. 28  shows an example of a bone fixation construct  10 C installed in adjacent vertebrae, which is discussed in greater detail below. The connector member  35  (secured with locking caps  210 ) connects and secures the adjacent elongate members  30  to each other, thereby providing rigidity and stabilization between the elongate members  30 . 
       FIG. 8  shows another exemplary embodiment of a bone fixation construct  10 A, according to the principles of the disclosure. The bone fixation construct  10 A includes a plurality of the bone fasteners  20 , a plurality of couplers  40 A, a plurality of caps  50 , and a connector assembly  70 A. Each of the caps  50  may include a driver receptacle  55  that receives and is engaged by a driver (not shown) to rotate and, thereby, travel toward the elongate member  30  seated in the coupler  40 A, contacting and securing the elongate member  30  in the coupler  40 A. The contact surface (not shown) of the caps  50  may be shaped to substantially match the outer shape of the elongate member  30 , thereby increasing the surface contact and coefficient of static friction between the elongate member  30  and bottom surface of the caps  50 . 
     The bone fixation construct  10 A may be installed according to a process similar to that described above with respect to the bone fixation construct  10 , or any other process commonly used to implant constructs, as understood by those skilled in the art. Once the bone fixation construct  10  is installed, the connector assembly  70 A may be installed, as described herein, thereby providing increased stability of the construct. 
       FIG. 9  shows an exemplary embodiment of the connector assembly  70 A, which provides a low profile configuration that can be inserted through a minimally invasive surgery (MIS) opening, and which may easily attach to pre-existing elongate members. The connector assembly  70 A includes a connector member  80  and a pair of hook members  90 . The connector member  80  may be similar to the connector member  35  (shown in  FIG. 1 ) or the elongate member  30 . The connector member  80  may include, for example, an elongate rod (shown in  FIG. 9 ), a pin (not shown), a brace (not shown), a spring (not shown), a cord (not shown), a resilient extension (not shown), or any other stabilization device that may be secured in the hook members  90  to provide stabilization. The connector member  80  may include attributes that may be selected based on, for example, variations in anatomy. For instance, the connector member  80  attributes may be selected from various lengths, widths, shapes, or the like, depending on the particular application. 
     The connector member  80  may be secured at each end  82 ,  84  to the hook members  90  by means of fasteners  92 . Each fastener  92  may include a recess  94  that receives and is engaged by a driver tool (not shown) to drive the fastener  92  in and toward the connector member  80 , thereby contacting and securing the connector member  80  to the hook member  90 . The fastener  92  may include a threading  99  (shown in  FIG. 12 ). The fastener  92  may include, for example, a set screw, a bolt, a screw, a cap, a pin, or the like. 
       FIG. 10  shows an exemplary embodiment of the hook member  90 . As seen, the hook member  90  includes a hook member body  91  that may include an opening  93 , a receptacle  95 , a hook portion  96 , and an opening  97 . The opening  93  may be configured to receive and engage the fastener  92 . The opening  93  may include a threading that may engage the corresponding threading  99  on the fastener  92  and cause the fastener  92  to be screwed downward (or upward) when the fastener  92  is rotated with respect to the hook member body  91 . 
     The receptacle  95  may be shaped to receive and securely hold the elongate member  30  (shown in  FIG. 8 ) in the hook member body  91 . The receptacle  95  may be configured to catch and hold the entirety of the width (or diameter) of the elongate member  30  in the hook member body  91 . 
     The hook portion  96  forms a lower part of the receptacle  95 . The hook portion  96  may be shaped to catch and aid in attaching and securing the hook member  90  to the elongate member  30 . For instance, the hook portion  96  may include an upwardly inclined configuration to catch the elongate member  30 , such that the hook member body  91  will move upward with respect to the elongate member  30  as the elongate member  30  is moved deeper into the receptacle  95 . 
     The opening  97  may be shaped to substantially match the shape of the end  82  (or  84 ) of the connector member  80 . In the example seen in  FIGS. 8-10 , the opening  97  has a round shape, which receives and holds a cylindrically-shaped end  82  (or  84 ) of the connector member  80 . The inner diameter of the opening  97  is greater than the outer diameter of the connector member end  82  (or  84 ). The inner diameter of the opening  97  extends into the receptacle  95  (shown in  FIG. 10 ), such that when the elongate member  30  is properly seated in the receptacle  95  and the end  82  (or  84 ) of the connector member  80  is inserted into the opening  97 , the connector member  80  may contact and force the elongate member  30  toward the hook portion  96  and inward toward the connector member body  91 . The connector member  80  may be forced against the elongate member  30  by operation of the fastener  92 , which contacts the connector member  80  and forces the connector member  80  against the elongate member  30  as the fastener  92  is screwed into the connector member body  91 . 
     The opening  97  may include internal geometry such that it guides the connector member  80  toward the hook portion  96  as the connector member end  82  (or  84 ) is inserted further into the opening  97 . For instance, the interior surface of the opening  97  may be angled so that the surfaces of inner walls of the opening  97  force the connector member  80  downward as the end  82  (or  84 ) travels deeper into the opening  97 . 
     Referring to  FIGS. 9-10 , after the bone fixation construct  10 A is implanted, the connector assembly  70 A may be installed in the construct. According to a non-limiting example of an installation process, one of the hook members  90  may be delivered to the site of the construct through a minimally invasive surgical opening, positioned proximate a predetermined portion of one of the elongate members  30 , and hooked onto the elongate member  30  using a tool (not shown) that may be similar to, for example, the implant head inserter  400  (shown in  FIGS. 15A-15D ), such that the elongate member  30  is positioned completely within the receptacle  95 . Using the same tool (not shown) or another tool (not shown) the connector member  80  may be delivered to the installation site of the hook member  90  and the end  82  (or  84 ) may be inserted into the opening  97  in the hook member  90 . The fastener  92  may be rotated using, for example, a screw driver (not shown) to drive the fastener  92  toward the hook portion  96 , thereby contacting and forcing the connector member  80  against the elongate member  30  and forcing the elongate member downward and inward in the hook member body  91 , against the inner and lower surfaces of the receptacle  95 . As illustrated, the hook portion  96  may be shaped so as to prevent removal of the elongate body  30  from the hook member body  91  without first releasing the fastener  92  and/or removing the connector member  80 . 
     The second hook member  90  may be delivered to the site of the connector assembly  70 A and attached to the end  84  (or  82 ) of the connector member  80  (via opening  97  in the hook member  90 ) substantially simultaneously with attachment to the second elongate member  30  (via receptacle  95 ). Alternatively, the second hook member  90  may be attached to the second elongate member  30  and rotated about the elongate member to receive and insert the connector member  80  into the opening  97  of the second hook member  90 . Once installed in the desired position, the second fastener  92  may be tightened to securely lock the connector member  80  and elongate member  30  in the hook member  90 . 
       FIG. 11  shows yet another exemplary embodiment of a bone fixation construct  10 B. The bone fixation construct  10 B may include substantially the same elements as the bone fixation construct  10 A (shown in  FIG. 9 ), except that the construct  10 B includes a connector assembly  70 B in lieu of the connector assembly  70 A. 
       FIG. 12  shows a perspective view of the connector assembly  70 B that may be introduced to the bone fixation construct  10 B through an MIS opening to add stability to the construct, while minimizing damage to supporting anatomical structures. As seen in  FIG. 12 , the connector assembly  70 B is a low profile structure that may easily attach to pre-existing elongate members. 
       FIG. 13  shows an example of a clip member  190  that may be included in the connector assembly  70 B. 
     Referring to  FIGS. 11-13 , the connector assembly  70 B may include a pair of clip members  190 , a pair of fasteners  92  and the connector member  80 . The clip member(s)  190  may include a clip member body  191  and a clamp  196 . The clamp  196  may include, for example, a spring clamp housed within an external collet, such that when the clamp  196  is pushed onto an elongate member  30 , the external collet pushes on the spring forks, keeping the clip member  190  locked to the elongate member  30 . The clip member body  191  may include a pair of upwardly extending arms  192  and a pair of downwardly extending arms  197 ,  198 . The upwardly extending arms  192  of the clip member body  191  may extend longitudinally in a superior direction and include an interior, an exterior, and upper surfaces. The interior of the upwardly extending arms  192  may include a threading (not shown) and form an opening  193  to receive and engage a corresponding threading on the cap  92 . The arms  192  form a slot  199  therebetween that is configured to receive and hold the connector member  80 , as illustrated in  FIGS. 11 and 12 . 
     The downwardly extending arms  197 ,  198  may extend longitudinally in an inferior direction and include an interior, an exterior, and lower surfaces. The interior of the downwardly extending arms  197 ,  198  may include a receptacle (not shown) formed by inner walls of the clip member body  191  and extending arms  197 ,  198 . The receptacle (not shown) may include an opening in the superior direction, such that when the clamp  196  is installed therein, the connector member  80  may contact and press upon the upper surface (not shown) of the clamp  196 , thereby forcing the clamp  196  to compress and reduce the diameter of the opening between the extending arms  197 ,  198 . In this regard, the interior of the clip member body  191  may be hollowed along its longitudinal axis, providing an unobstructed pass-through from the opening  193  and downward through the slot  195 . 
     The interior of the extending arms  197 ,  198  may include channels (not shown) or cut-outs (not shown) that are configured to receive and hold portions of the clamp  196 . The arms  197 ,  198  form a slot  195  therebetween that is configured to receive and hold the elongate member  30 , as illustrated in  FIG. 11 . The channels (not shown) or cut-outs (not shown) may be formed to have a gradient angle such that when the clamp  196  is pressed (for example, by the connector member  80  under force of the cap  92 ), the side walls of the clamp  196  are forced inward by the interior walls of the extending arms  197 ,  198 , toward the center point of the slot  199 . The channel formed by the slot  199  may be substantially orthogonal to the channel formed by the slot  195 . 
     Referring to  FIGS. 11-12 , after the bone fixation construct  10 B is implanted, the connector assembly  70 B may be installed in the construct. According to a non-limiting example of an installation process, one of the clip members  190  (with the clamp  196 ) may be delivered through a MIS opening to the site of the construct, positioned proximate a predetermined portion of one of the elongate members  30 , and clipped onto the elongate member  30  using a tool (not shown), which may be similar to the implant head inserter  400  (shown in  FIGS. 15A-15D ), such that the slot  195  is positioned on and envelopes the diameter of the elongate member  30 . The process may be repeated for the second clip member  190 . 
     The fasteners  92  may be pre-installed in the clip members  190 , and positioned so as to form sufficient space in the slots  199  to allow the connector member  80  to pass there-through and be installed in the clip members  190 . 
     Once the clip members  190  are in place, using the same tool (not shown), or another tool (not shown), the connector member  80  may be delivered to the installation site of the clip members  190  and the connector member  80  may be passed through the slot  199  of one of the clip members  190  and positioned with the end  82  (or  84 ) in the slot  199  of the other clip member  190 , as seen in  FIG. 12 . The fasteners  92  may be rotated using, for example, a screw driver (not shown) to drive the fastener  92  against the connector member  80 , thereby forcing the connector member  80  against the upper surface (not shown) of the clamp  196 , forcing the clamp  196  to compress around and secure to the elongate member in the slot  195 . 
     Alternatively, the connector assembly  70 B may be preassembled with the fasteners  92  partially tightened so as to keep the connector assembly  70 B intact during insertion, delivery, positioning and mounting of the connector assembly  70 B to the elongate members  30 , but sufficiently loose to allow for manipulation of the connector member  80  and/or installation of the clip members  190  onto the corresponding elongate members  30 . Once the connector assembly  10 B is mounted and positioned in the desired locations on the elongate members  30 , the fasteners  92  may be tightened and, thereby, the connector assembly  70 B may be locked and secured in the bone fixation construct  10 B. 
       FIGS. 14A-14D  show yet another exemplary embodiment of a hook member  290  that may be included in a connector assembly  70 C (shown in  FIG. 18 ) of a bone fixation construct  10 C.  FIG. 14A  shows a front (or back) view of the hook member  290 ;  FIG. 14B  shows a back (or front) view of the hook member  290 ;  FIG. 14C  shows a side view of the hook member  290 ; and,  FIG. 14D  shows a perspective view of the hook member  290 . 
     Referring to  FIGS. 14A-14D , the hook member  290  comprises a hook member body that may include an opening  293 , a receptacle  295 , a hook portion  296 , and an opening  297 . The hook member body may include a guide(s)  298  that may facilitate alignment of the hook member during installation by, for example, the implant head inserter  400  (shown in  FIGS. 15A-15D ). The hook member  290  may include a tool engagement portion  291  that may be contacted and engaged with, for example, the implant head inserter  400  (shown in  FIGS. 15A-15D ) to assist the implant head inserter  400  to grasp and hold the hook member  290  during installation. 
     The opening  293  may be configured to receive and engage the fastener  92 . The opening  293  may include, for example, a stab incision. The opening  293  may include a threading that may engage a corresponding threading on the fastener  92  and cause the fastener  92  to be screwed downward (or upward) when the fastener  92  is rotated with respect to the hook member body. The opening  293  may be formed by a pair of upwardly extending arms  292 . 
     The receptacle  295  may be shaped to receive and securely hold the elongate member  30  (shown in  FIG. 18 ) in the hook member body. The receptacle  295  may be configured to catch and hold the entirety of the width (or diameter) of the elongate member  30  in the hook member body. The receptacle  295  may include one or more capture members  299  that help to pre-lock and hold the elongate member  30  in the receptacle  295 , preventing the hook member  290  from falling off once in place. The one or more capture members  299  may provide a user with tactile feel once the elongate member  30  is secured in the receptacle  295 . 
     The hook portion  296  forms a lower part of the receptacle  295 , and may be shaped to catch and aid in attaching and securing the hook member  290  to the elongate member  30 . For instance, the hook portion  296  may include an upwardly inclined configuration to catch the elongate member  30 , such that the hook member body will move upward with respect to the elongate member  30  as the elongate member  30  is moved deeper into the receptacle  295 . 
     The opening  297  may be shaped to substantially match the shape of the connector member  180  (shown in  FIG. 18 ). As seen in  FIGS. 14A and 14B , the opening  297  may have a round shape that receives and holds a cylindrically-shaped connector member  180 . The inner diameter of the opening  297  is greater than the outer diameter of the connector member  180 . The inner diameter of the opening  297  extends into the receptacle  295 , such that when the elongate member  30  is properly seated in the receptacle  295  and the connector member  180  is inserted into the opening  297 , the connector member  180  may contact and force the elongate member  30  toward the hook portion  296  (or bottom surface of the receptacle  295 ) and inward toward the connector member body under force of the fastener  92 . For instance, the connector member  180  may be forced against the elongate member  30  by operation of the fastener  92 , which contacts the connector member  180  and forces the connector member  180  against the elongate member  30  as the fastener  92  is screwed into the connector member body. 
     The connector member  280  may be similar to the connector member  35  (shown in  FIG. 1 ), the elongate member  30  (shown in  FIG. 1 ), the connector member  80  (shown in  FIG. 9 ), or the like. The connector member  180  may include, for example, an elongate rod (shown in  FIG. 18 ), a pin (not shown), a brace (not shown), a spring (not shown), a cord (not shown), a resilient extension (not shown), or any other stabilization device that may be secured in the hook members  290  to provide stabilization. The connector member  180  may include attributes that may be selected based on, for example, variations in anatomy. For instance, the connector member  180  attributes may be selected from various lengths, widths, shapes, or the like, depending on the particular application. 
     The opening  297  may include a geometry such that it guides the connector member  180  toward the hook portion  296  as the end of the connector member  180  is inserted further into the opening  297 . For example, the interior surface of the opening  297  may include tapered sections  294 , which may be angled so that the surface of the tapered sections  294  forces the connector member  180  toward the center and/or downward as the end of the connector member  180  travels deeper into the opening  297 . 
       FIGS. 15A-15D  show an example of an implant head inserter  400  that may be used with the hook member  290  to install the hook member  290  in a bone fixation construct  10 C (shown in  FIG. 18 ).  FIG. 15A  shows the implant head inserter  400  in an unlocked position;  FIG. 15B  shows the implant head inserter  400  in the unlocked position with a hook member  290  attached at the distal end;  FIG. 15C  shows the implant head inserter  400  in a locked position with the hook member  290  attached at the distal end; and,  FIG. 15D  shows another view of the implant head inserter  400  in the locked position with the hook member  290  attached at the distal end. 
     Referring to  FIG. 15A , the implant head inserter  400  may include a handle  410 , a sleeve  420 , and an inner member  430 . The inner member  430  may include a spring clamp that may be compressed by the sleeve  420  as the inner member  430  travels in the direction of the handle  410 . Conversely, the sleeve  420  may release the inner member  430  as the inner member  430  travels in the direction away from the handle  410 . The sleeve  420  may include a functional gap (or cutout)  424  formed between a pair of extending members, as seen in  FIG. 15A , which may be configured to flex outward or inward as the inner member  430  travels toward and away from the handle  410 . 
     The sleeve  420  may include a handle engagement portion (not shown) that attaches to the handle  410 , allowing the handle  410  to rotate about the longitudinal axis of the sleeve  420 . The handle  410  may be coupled to the inner member  430  and configured to drive the inner member  430  as the handle  410  is rotated. The sleeve may include one or more openings  422 , which may show portions of the inner member  430 . 
     The inner member  430  may include a substantially cylindrical body with a pair of extending members  434 ,  436  at its distal end  433 . The extending members  434 ,  436  may be made of a memory-shape material (for example, a metal, a plastic, or the like, that is made to hold a predetermined shape, but compress under force) whereby the extending members  434 ,  436  expand away from each other as the distal end  433  moves out and away from the distal end of the sleeve  420 . Conversely, the extending members  434 ,  436  compress toward each other as the distal end  433  moves into the sleeve  4320 . The extending members  434 ,  436  may include a guide-contact portion (not shown) that contacts and engages the guide(s)  298  on the hook member  290  to properly align the hook member  290  during installation. 
     Referring to  FIGS. 15B and 15C , the implant head inserter  400  may be configured into the unlocked position by, for example, turning the handle  401  in a predetermined direction, and a hook member  290  may be attached to the distal end  433  (shown in  FIG. 15B ). The implant head inserter  400  may then be operated to the locked position by, for example, turning the handle  410  in the opposite direction, thereby locking the hook member  290  at its distal end (shown in FIG.  15 C).  FIG. 15D  shows another view of the implant head inserter  400  in the locked position with the hook member  290  attached at the distal end. 
       FIGS. 16-28  show yet another exemplary embodiment of a bone fixation construct  10 C during a process of installing the construct in bone. The bone fixation construct  10 C may include substantially the same elements as the bone fixation construct  10 A (shown in  FIG. 8 ) or  10 B (shown in  FIG. 11 ), except that the construct  10 C includes a connector assembly  70 C in lieu of the connector assembly  70 A or  70 B, respectively. The bone fixation construct  10 C may be installed according to a process similar to that described above with respect to the bone fixation construct  10  (or  10 A, or  10 B), or any other process commonly used to implant constructs, as understood by those skilled in the art. Once the bone fixation construct  10 C is installed, the connector assembly  70 C may be installed, as described herein, thereby providing increased stability of the construct. 
     Referring to  FIGS. 16-18 , after the bone fixation construct  10 C is implanted, the connector assembly  70 C may be installed in the construct. According to a non-limiting example of an installation process, one of the hook members  290  may be delivered to the site of the construct through a minimally invasive surgical opening, positioned proximate a predetermined portion of one of the elongate members  30 , and hooked onto the elongate member  30  using the implant head inserter  400  (shown in  FIG. 16 ), such that the elongate member  30  is positioned completely within the receptacle  95 . Once the hook member  290  is properly hooked on to the elongate member  30 , such as, for example, when the elongate member  30  is within the receptacle  295  (shown in  FIG. 14C ) and caught by the capture member(s)  299 , the handle  410  may be operated to extend the inner member  430 , thereby releasing the hook member  290  (shown in  FIG. 17 ). 
       FIG. 18  shows an example of inserting the fastener  92  into an inner channel of the sleeve  420  and inner member  430 , so as to deliver the fastener  92  to the hook member  290  and install the fastener  92  into the hook member  290 , thereby securing the connector member  180  in the hook member  290 , and securing the connector member  180  and hook member  290  to the elongate member  30 . 
       FIGS. 19-28  show the various stages of installation of the connector assembly  70 C in the bone fixation construct  10 C. Initially, using the implant head inserter  400 , a first hook member  290  may be attached to one of the elongate members  30  (shown in  FIG. 19 ). The process may then be repeated for the second hook member  290 , attaching it to the second elongate member  30  (shown in  FIG. 20 ). With both hook members  290  attached to respective elongate members  30 , the connector member  180  may be installed in the hook members  290  using, for example, the rod introduction instrument  500  to insert and position the connector member  180  in the hook members  290  (shown in  FIGS. 21 and 26-27 ). The connector member  180  may include a frustoconical end which may facilitate introduction of the connector member  180  through various tissue including ligaments and bone. For example,  FIGS. 27 and 28  show connector element  180  being passed through a spinous process of a vertebra during installation. It is contemplated that this is achieved by making the end of the connector member  180  sharp enough to penetrate tissue or to use a separate instrument to create an initial through bore for the connector member  180  to travel through during installation. Once the connector member  180  is properly positioned in the hook members  290 , fasteners  92  may be installed in the hook members  290 , thereby securing the connector member  180  and hook members to the elongate members  30 , and bone fixation construct  10 C (shown in  FIGS. 24-25 and 28 ). 
       FIG. 28  shows an example of the bone fixation construct  10 C, including connector assembly  70 C implanted in a pair of adjacent vertebrae  510  of a spine  500 , according to the principles of the disclosure. As seen, the bone fixation construct  10 C provides a low profile structure with increased stability. 
     The terms “including,” “comprising,” and variations thereof, as used in this disclosure, mean “including, but not limited to,” unless expressly specified otherwise. 
     The terms “a,” “an,” and “the,” as used in this disclosure, means “one or more,” unless expressly specified otherwise. 
     Devices that are in communication with each other need not be in continuous communication with each other, unless expressly specified otherwise. In addition, devices that are in communication with each other may communicate directly or indirectly through one or more intermediaries. 
     Although process steps, method steps, or the like, may be described in a sequential order, such processes and methods be configured to work in alternate orders. In other words, any sequence or order of steps that may be described does not necessarily indicate a requirement that the steps be performed in that order. The steps of the processes or methods described herein may be performed in any order practical. Further, some steps may be performed simultaneously. 
     When a single device or article is described herein, it will be readily apparent that more than one device or article may be used in place of a single device or article. Similarly, where more than one device or article is described herein, it will be readily apparent that a single device or article may be used in place of the more than one device or article. The functionality or the features of a device may be alternatively embodied by one or more other devices which are not explicitly described as having such functionality or features. 
     While the disclosure has been described in terms of exemplary embodiments, those skilled in the art will recognize that the disclosure can be practiced with modifications in the spirit and scope of the appended claims. These examples are merely illustrative and are not meant to be an exhaustive list of all possible designs, embodiments, applications or modifications of the disclosure.