Patent Publication Number: US-2023149055-A1

Title: Surgical instrument and method

Description:
TECHNICAL FIELD 
     The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical system and 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 implants such as vertebral rods and/or fasteners 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 vertebral members. During surgical treatment, spinal implants can be delivered to a surgical site, for example, so that the rods may be attached via the fasteners to the exterior of two or more vertebral members. Surgical treatment may employ surgical instruments and implants that are manipulated for engagement with vertebrae to position and align one or more vertebrae. This disclosure describes an improvement over these prior technologies. 
     SUMMARY 
     In one embodiment, a surgical instrument is provided. The surgical instrument includes a first member. A second member is disposable with the first member and includes an inner surface. An actuator defines a cavity and is releasably connectable with the first member. A third member is engageable with the inner surface. The first member and the second member are translatable relative to the actuator. In some embodiments, systems, spinal constructs, implants and methods are disclosed. 
     In some embodiments, the surgical instrument includes an outer sleeve. An inner sleeve is disposable with the outer sleeve and includes an inner surface. An actuator includes a rotatable knob and a collar. The collar is releasably connectable with the outer sleeve. An inner shaft is engageable with the inner surface of the inner sleeve. The outer sleeve is translatable relative to the knob. The inner sleeve is translatable relative to the collar. 
     In some embodiments, the surgical instrument includes a first member including an end having a rim. A second member is disposable with the first member and includes an inner surface. An actuator includes a knob and a collar. The collar is engageable with the rim and the knob is releasably connectable with the first member. A third member is engageable with the inner surface and includes a drive. The first member is translatable relative to the knob. The second member is translatable relative to the collar. The drive of the third member being engageable with a socket of a bone fastener head. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present disclosure will become more readily apparent from the specific description accompanied by the following drawings, in which: 
         FIG.  1    is a perspective view of components of one embodiment of a surgical system in accordance with the principles of the present disclosure disposed with vertebrae; 
         FIG.  2    is a perspective view with parts separated of the components of the surgical system shown in  FIG.  1   ; 
         FIG.  3    is a side view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  4    is a side view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  5    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  6    is a cross section view of the components shown in  FIG.  5   ; 
         FIG.  7    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  8    is a cross section view of the components shown in  FIG.  7   ; 
         FIG.  9    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  10    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  11    is an end view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  12    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  13    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  14    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  15    is a cross section view of components of the surgical system shown in  FIG.  14   ; 
         FIG.  16    is a component of the surgical system shown in  FIG.  1   ; 
         FIG.  17    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  18    is a break away view of components of the surgical system shown in  FIG.  1   ; 
         FIG.  19    is a cross section view of components of the surgical system shown in  FIG.  18   ; 
         FIG.  20    is a cross section view of components of the surgical system shown in  FIG.  18   ; 
         FIG.  21    is a cross section view of components of the surgical system shown in  FIG.  18   ; 
         FIG.  22    is a cross section view of components of the surgical system shown in  FIG.  18   ; 
         FIG.  23    is a break away view of the components shown in  FIG.  1   ; 
         FIG.  24    is a break away view of components of the surgical system shown in  FIG.  1   ; and 
         FIG.  25    is a break away view of components of the surgical system shown in  FIG.  1   . 
     
    
    
     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 spinal implant system and a method for treating a spine. In some embodiments, the systems and methods of the present disclosure comprise medical devices including surgical instruments and implants that are employed with a surgical treatment, as described herein, for example, with a cervical, thoracic, lumbar and/or sacral region of a spine. 
     In some embodiments, the present surgical system includes a surgical instrument including a surgical driver configured for connection with selected ranges of bone fasteners, for example, screws for use with surgical robotic systems. In some embodiments, the surgical driver defines a selected length. In some embodiments, the length, for example, a bucket length, includes a distance between a selected portion of a shaft of the surgical driver and a distal end of an outer sleeve of the surgical driver. In some embodiments, the surgical driver includes an actuator, for example, a knob. In some embodiments, the bucket length is configured to be shortened via translation of the outer sleeve within the knob. In some embodiments, the bucket length is shortened such that the surgical driver includes a bucket length range of about 150 millimeters (mm) to 300 mm. In some embodiments, the bucket length range is about 201 mm to 260 mm. In some embodiments, the bucket length is configured to be shortened via translation of the outer sleeve within the knob such that the surgical driver is compatible for connection with bone screw lengths in a range of about 25 mm to 150 mm. In some embodiments, the surgical driver is configured for use in procedures, for example, adult deformity procedures. 
     In some embodiments, the present surgical system includes a surgical driver configured for use in surgical navigation. In some embodiments, the surgical navigation includes robotic and/or navigation guidance. In some embodiments, the surgical driver includes an actuator, for example, a knob and a collar. In some embodiments, the collar is slidably engageable with an inner surface of the knob. In some embodiments, the collar is configured for engagement with an outer sleeve to translate the outer sleeve relative to the knob. In some embodiments, an inner sleeve is configured for disposal with the outer sleeve. In some embodiments, the outer sleeve and the inner sleeve are detachable from the surgical driver via the collar. In some embodiments, the outer sleeve is disposed in a releasable connection with the knob via the collar. In some embodiments, the knob is translationally fixed to a shaft of the surgical driver. In some embodiments, the outer sleeve translates within the knob via the collar and the knob does not translate within an inner surface of the sleeve. In some embodiments, translation of the outer sleeve within the knob enables a decrease in bucket length. In some embodiments, the knob includes recesses configured to accommodate an assembly and/or dis-assembly of the device. In some embodiments, the knob includes recesses, for example, four thumb recesses. In some embodiments, the knob is acorn shaped. 
     In some embodiments, the present surgical system includes a surgical driver. In some embodiments, the surgical driver includes a shaft, an actuator including a knob and collar, an outer sleeve, an inner sleeve and a navigation locking component including a bushing lock. In some embodiments, the surgical driver is configured for connection with a shank of a screw. In some embodiments, the knob does not translate relative to the bushing to release the shank of the screw. In some embodiments, the bushing is fixed to the shaft. In some embodiments, the bushing extends to an end that includes a flange. In some embodiments, the flange is configured to engage an end of the knob to prevent unintentional loosening of the knob during use. In some embodiments, the flange includes a thread. 
     In some embodiments, the present surgical system includes a surgical driver that includes an actuator, for example, a knob and a collar. In some embodiments, the collar is configured for disposal within the knob and is configured for engagement with an outer sleeve of the driver. In some embodiments, the collar includes an engagement indicator configured to indicate translation of the outer sleeve within the knob. In some embodiments, the collar includes a pair of pins fixed to the collar. In some embodiments, the pins include a selected color. In some embodiments, a head of each of the pins is laser marked black and/or is anodized/physical vapor deposition (PVD) coated. In some embodiments, the knob includes a pair of indicator windows. In some embodiments, each pin of the collar is viewable via each of the windows to indicate translation of the outer sleeve within the knob. In some embodiments, the pins are viewable in the windows when the outer sleeve translates in a distal direction relative to the knob and an end of the outer sleeve is disposed over a collet of an inner sleeve. In some embodiments, the pins are not viewable and the collet is fully exposed in the windows when the outer sleeve translates in a proximal direction relative to the knob. In some embodiments, the windows are tapered to increase visibility of the pins. 
     In some embodiments, the present surgical system includes a surgical driver including the outer sleeve and the inner sleeve that are detachable from the knob via the collar. In some embodiments, the knob includes the pair of windows each configured for viewing each of the pins. In some embodiments, the knob includes a pair of slots each configured for slidable engagement with each of the pins such that the pins are translatable. In some embodiments, the knob includes two openings. In some embodiments, a pair of spring-loaded buttons of the collar, for example, plungers, are configured for disposal with the openings. In some embodiments the spring loaded plungers are configured to prevent axial translation, releasable connection and facilitate disengagement of the outer sleeve with the knob. In some embodiments, each spring includes a force of about 0.5 to 1.5 pound force (lbf) at solid. In some embodiments, full depression of each of the springs includes a force of about 1 to 4 pounds (lbs) per plunger. In some embodiments, pins are configured to retain the plungers to the collar. In some embodiments, the plungers and/or the pins are laser welded. In some embodiments, the fixed pins are laser welded on an outer surface of the collar. In some embodiments, a shank is configured for disposal through an 8 to 12 mm diameter robotic arm guide of the surgical driver. 
     In some embodiments, the present surgical system includes a method of assembling components of a surgical driver to connect the outer sleeve including the step of aligning a keyway of each of the plungers with corresponding slots. In some embodiments, the method includes the step of aligning the pair of fixed pins with the slots in the knob and depressing the pair of plungers until the plungers engage in a snap fit with the openings. 
     In some embodiments, the present surgical system includes a method of disassembling components of a surgical driver to disconnect the outer sleeve from the surgical driver including the step of depressing the pair of plungers simultaneously to slide the collar out of an interior of the knob such that the outer sleeve is disconnected from the surgical driver. In some embodiments, an instrument or pusher is provided to depress the plungers due to the size of the pair of openings of the collar. In some embodiments, components of the surgical driver can be disassembled to clean the surgical driver. 
     In some embodiments, the present surgical system includes a surgical instrument that can be employed with an end effector of a robotic arm to facilitate implantation with the robotic arm. In some embodiments, the surgical instrument is guided through the end effector for a guide-wireless screw insertion. In some embodiments, the surgical instrument comprises a robotic guided surgical screw driver employed with robotic and/or navigation guidance, which may include an image guide. 
     In some embodiments, the surgical system of the present disclosure may be employed to treat spinal disorders, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor and fractures. In some embodiments, the surgical system of the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. In some embodiments, the disclosed surgical system 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 surgical system of 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 surgical system of the present disclosure may also be used on animals, bone models and other non-living substrates, for example, in training, testing and demonstration. 
     The surgical system of 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. In some embodiments, as used in the specification and including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” or “approximately” one particular value and/or to “about” or “approximately” another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. It is also understood that all spatial references, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure. For example, the references “upper” and “lower” are relative and used only in the context to the other, and are not necessarily “superior” and “inferior”. 
     As used in the specification and including the appended claims, “treating” or “treatment” of a disease or condition refers to performing a procedure that may include administering one or more drugs to a patient (human, normal or otherwise or other mammal), employing implantable devices, and/or employing instruments that treat the disease, for example, microdiscectomy instruments used to remove portions bulging or herniated discs and/or bone spurs, in an effort to alleviate signs or symptoms of the disease or condition. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, treating or treatment includes preventing or prevention of disease or undesirable condition (e.g., preventing the disease from occurring in a patient, who may be predisposed to the disease but has not yet been diagnosed as having it). In addition, treating or treatment does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes procedures that have only a marginal effect on the patient. Treatment can include inhibiting the disease, e.g., arresting its development, or relieving the disease, e.g., causing regression of the disease. For example, treatment can include reducing acute or chronic inflammation; alleviating pain and mitigating and inducing re-growth of new ligament, bone and other tissues; as an adjunct in surgery; and/or any repair procedure. In some embodiments, as used in the specification and including the appended claims, the term “tissue” includes soft tissue, ligaments, tendons, cartilage and/or bone unless specifically referred to otherwise. 
     The following discussion includes a description of a surgical system including a surgical instrument, related components and 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 - 25   , there are illustrated components of a spinal implant system  10 , in accordance with the principles of the present disclosure. 
     The components of spinal implant 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. For example, the components of spinal implant system  10 , individually or collectively, can be fabricated from materials such as stainless steel alloys, aluminum, 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®), ceramics and composites thereof such as calcium phosphate (e.g., SKELITE™), 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, 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, 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 spinal implant 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 spinal implant 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 spinal implant system  10  may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein. 
     Spinal implant system  10  is employed, for example, with a fully open surgical procedure, a minimally invasive procedure including percutaneous techniques, and mini-open surgical techniques to deliver and introduce instrumentation and/or a spinal implant, for example, a bone fastener, at a surgical site of a patient, which includes, for example, a spine. In some embodiments, the spinal implant can include one or more components of one or more spinal constructs, for example, interbody devices, interbody cages, bone fasteners, spinal rods, tethers, connectors, plates and/or bone graft, and can be employed with various surgical procedures including surgical treatment of a cervical, thoracic, lumbar and/or sacral region of a spine. 
     Spinal implant system  10  includes a surgical instrument, for example, a surgical driver  12 . Surgical driver  12  is configured for connection with an implant, for example, a bone fastener  300 , as shown in  FIG.  1   . Surgical driver  12  includes a member, for example, an inner shaft  14 . Shaft  14  is configured for engagement with a member, for example, an inner sleeve  30 , as described herein. Shaft  14  extends between an end  18  and an end  20  and defines a longitudinal axis X disposed therebetween, as shown  FIG.  2   . End  18  is configured for engagement with a member, for example, a navigation component  200 , as described herein. End  20  includes a drive  21  connectable with a head  302  including a drive socket  304  of bone fastener  300 , as shown in  FIGS.  2 ,  4  and  10   . Drive  21  includes a star shaped configuration (see, for example, a similar star shaped configuration of Torx® (Acument Global Technologies, Inc., Sterling Heights, Mich., USA)). In some embodiments, drive  21  may have different cross-section configurations, including square, hexagonal, polygonal, triangular or hexalobe. In some embodiments, end  20  may have various surface configurations, including, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Shaft  14  includes a bushing  22 , as shown in  FIG.  2   . Bushing  22  is configured for connection with navigation component  200 . Bushing  22  is press fit welded to a surface of shaft  14 . Bushing  22  includes a flange  24  configured for engagement with a component of an actuator  25 , for example, a knob  26 , as shown in  FIGS.  2  and  24   , and described herein. Flange  24  is configured to contact a surface of knob  26 . In some embodiments, flange  24  is configured to prevent loosening of knob  26  during use. 
     Surgical driver  12  includes a member, for example, an outer sleeve  28 , as shown in  FIG.  2   . Outer sleeve  28  is configured for releasable connection to and translation, for example, axial translation within knob  26 . In some embodiments, outer sleeve  28  is configured for releasable connection with variously configured drivers and is not limited to connection with surgical driver  12 . Outer sleeve  28  extends between an end  32  and an end  34 . In some embodiments, outer sleeve  28  may have alternate cross section configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. In some embodiments, outer sleeve  28  may have various surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Outer sleeve  28  includes an inner surface that defines a passageway  36  that is coaxial with longitudinal axis X and is configured for disposal of inner sleeve  30 , as described herein. In some embodiments, passageway  36  may have various surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     End  32  includes a surface that defines a rim  38 , as shown in  FIGS.  2  and  6   . Rim  38  is configured for engagement with an interior groove  40  of a component of actuator  25 , for example, an adjustment collar  42  and a retaining ring  43 . Engagement between adjustment collar  42  and outer sleeve  28  facilitates translation of outer sleeve  28  within knob  26 , as described herein. Rim  38  is rotatably fixed with adjustment collar  42 , as described herein. In some embodiments, rim  38  may have various surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Inner sleeve  30  extends between an end  44  and an end  46 , as shown in  FIG.  2   . Inner sleeve  30  is configured for disposal with outer sleeve  28  and engagement with shaft  14 . In some embodiments, inner sleeve  30  may have alternate cross section configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. In some embodiments, inner sleeve  30  may have alternate surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Inner sleeve  30  includes an inner surface that defines a passageway  48 , as shown in  FIG.  8   . Passageway  48  is coaxial with longitudinal axis X and is configured for engagement with shaft  14 , as described herein. In some embodiments, passageway  48  may have various surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     End  44  includes a threaded surface  50 , as shown in  FIG.  2   . Threaded surface  50  is configured for engagement with a threaded inner surface  52  of adjustment collar  42  such that inner sleeve  30  translates relative to adjustment collar  42 , as shown in  FIGS.  2  and  8   . In some embodiments, threaded inner surface  52  may have alternative surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. End  44  includes a surface that includes a slot, for example, a keyway  54 , as shown in  FIG.  2   . Keyway  54  is configured for engagement with a projection or tab, for example, a key  56  of shaft  14  such that shaft  14  matingly engages with inner sleeve  30 . Keyway  54  includes an end  55  configured to limit translation of key  56  of shaft  14  during engagement of key  56  with end  55 . In some embodiments, keyway  54  may have alternately shaped configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. In some embodiments, key  56  may have alternately shaped configurations that match the shaped configuration of keyway  54 , for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. 
     End  46  includes a collet  58 , as shown in  FIGS.  2 ,  4  and  10   . Collet  58  is configured for connection with bone fastener  300 , for example, with a correspondingly shaped outer surface of head  302 , as shown in  FIGS.  4  and  10   . Collet  58  includes a plurality of circumferential slots  60  such that collet  58  is flexible or can flexibly engage head  302 . Collet  58  is flexible such that collet  58  expands about head  302  and contracts about head  302  to connect head  302  with sleeve  30 . Collet  58  is configured for engagement with end  34  of outer sleeve  28 , as shown in  FIGS.  3  and  4   . Collet  58  expands about head  302  when collet  58  is not engaged with end  34  of outer sleeve  28 , as shown in  FIG.  4   , and collet  58  contracts about head  302  when engaged with end  34  of outer sleeve  28 , as shown in  FIG.  3   . Engagement between end  34  of outer sleeve  28  with collet  58  tensions collet  58  such that collet  58  contracts about head  302 . In some embodiments, collet  58  includes various cross section configurations, for example, round for mating engagement with the correspondingly shaped outer surface of head  302 . In some embodiments, collet  58  may have alternative surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Inner sleeve  30  includes a surface that defines a pair of slots  62 , as shown in  FIG.  2   . Slots  62  are disposed adjacent collet  58  and are configured for slidable engagement with a pair of pins  64  disposed within a pair of openings  66  defined from a surface of outer sleeve  28 . Outer sleeve  28  is translatable relative to inner sleeve  30 , and inner sleeve  30  is rotatably fixed relative to outer sleeve  28  via engagement of slots  62 , pins  64  and openings  66 . In some embodiments, slots  62  may have alternate cross section configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. 
     Knob  26  extends between an end  68  and an end  70 , as shown in  FIG.  2   . See, for example, the embodiments and disclosure of systems and methods of components of an actuator, shown and described in commonly owned and assigned U.S. patent application Ser. No. ______ filed ______, 2021 (docket no. A0007204US01), and published as U.S. patent application Publication Ser. No. ______, on ______, the entire contents of which being incorporated herein by reference. 
     A retaining ring  72  is configured for disposal at end  68 . Retaining ring  72  is configured for engagement with a portion of shaft  14  and an inner surface of bushing  22 , as shown in  FIG.  6   , such that knob  26  is translationally fixed with retaining ring  72  and flange  24  but is configured to rotate relative to shaft  14 . Knob  26  is releasably connectable with outer sleeve  28  via adjustment collar  42 , and outer sleeve  28  is translatable relative to knob  26  via adjustment collar  42 , as described herein. Knob  26  defines a cavity  74 . An interior wall  76  of knob  26  is configured for slidable engagement with an outer surface of adjustment collar  42 , as shown in  FIG.  6   . In some embodiments, cavity  74  may have alternate cross section configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. 
     Knob  26  defines an exterior gripping surface  76  that includes at least one indent  78 , as shown in  FIG.  5   . In some embodiments, gripping surface  76  may have alternative surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Knob  26  includes a wall  80  that defines a pair of opposing windows  82 , as shown in  FIGS.  5 ,  6 ,  9  and  10   . Windows  82  are configured to display indicia, for example, pins  90 ,  92  of adjustment collar  42  to indicate translation/positioning of outer sleeve  28  relative to knob  26 , as described herein. Wall  82  includes inner surfaces  84 , as shown in  FIG.  10   . Inner surfaces  84  are tapered. In some embodiments, inner surfaces  84  are tapered to increase visibility of pins  90 ,  92 . In some embodiments, windows  82  may have alternate cross section configurations, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. 
     Adjustment collar  42  is configured to releasably connect and translate outer sleeve  28  with knob  26 , as described herein. Translation of outer sleeve  28  within knob  26  via adjustment collar  42  enables the bucket length of surgical driver  12 , described herein, to be shortened. In some embodiments, surgical driver  12  includes a bucket length range of 201 mm to 260 mm and is compatible for connection with bone fastener  300  lengths of 25 to 150 mm. Adjustment collar  42  includes a surface that defines a recess  86  and a recess  88 , as shown in  FIGS.  14  and  15   . Recess  86  is disposed opposite of recess  88 . Pin  90  is configured for fixed engagement with recess  86  and pin  92  is configured for fixed engagement with recess  88 . Pin  90  is configured for slidable engagement with an interior slot  94  of wall  76  of knob  26  and pin  92  is configured for slidable engagement with an interior slot  96  of wall  76  of knob  26  for translation of adjustment collar  42  within knob  26 , as shown in  FIG.  16   . Pins  90 ,  92  are translated within slots  94 ,  96  respectively and during selected translation of outer sleeve  28 , pins  90 ,  92  are viewable via windows  82  of knob  26 , as shown in  FIG.  19   . In some embodiments, pins  90 ,  92  are laser welded to recesses  86 ,  88 . In some embodiments, all or a portion of pins  90 ,  92  are laser marked a selected color, for example, black. In some embodiments, pins  90 ,  92  are manufactured in one or more selected colors, for example, pink, red, orange, yellow, green, blue, purple, brown, white and/or black. In some embodiments, pins  90 ,  92  are anodized and/or PVD coated. 
     Adjustment collar  42  includes a surface that defines a recess  98  and a recess  100 , as shown in  FIG.  15   . Recess  98  is disposed opposite of recess  100 . A button  102  is configured for disposal with recess  98  and a button  104  is configured for disposal with recess  100 , as shown in  FIGS.  14  and  15   . Buttons  102 ,  104  are configured to prevent axial translation of outer sleeve  28  relative to knob  26  and to facilitate disengagement of outer sleeve  28  with knob  26 . Button  102  is biased, for example, via a pair of springs  106  and button  104  is biased, for example, via a pair of springs  108 , as shown in  FIG.  15   . In some embodiments, springs  106  and  108  include a force of 1 to 4 lbs when contracted. Button  102  is configured for slidable engagement with an interior slot  110  of wall  76  of knob  26  and button  104  is configured for slidable engagement with an interior slot  112  of wall  76  of knob  26 , as shown in  FIG.  16   . Buttons  102 ,  104  are translated within slots  110 ,  112  respectively to dispose buttons  102 ,  104  with transverse openings  114 ,  116  respectively of knob  26 , as shown in  FIGS.  16  and  19   . Buttons  102 ,  104  are configured for snap engagement with openings  114 ,  116 , as shown in  FIG.  18   . Pins  117  are configured to retain buttons  102 ,  104  with adjustment collar  42 , as shown in  FIG.  14   . In some embodiments, buttons  102 ,  104  include plungers. 
     Adjustment collar  42  includes a cavity  118 , as shown in  FIG.  14   . Inner sleeve  30  is configured for disposal within cavity  118 . An interior wall  115  of adjustment collar  42 , as shown in  FIG.  14    includes interior groove  40  that engages rim  38  of outer sleeve  28  and threaded inner surface  52  that engages with threaded surface  50  of inner sleeve  30 , as described herein. In some embodiments, wall  115  may have alternative surface configurations, for example, smooth, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Bone fastener  300  includes head  302  including drive socket  304  configured for engagement with shaft  14  and an elongated shaft  306  configured for penetrating tissue, as shown in  FIGS.  9  and  10   . In some embodiments, selected portions or all of bone fastener  300  may have various cross-section configurations, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable, tubular and/or tapered. In some embodiments, selected portions or all of bone fastener  300  may have various surface configurations, for example, smooth and/or surface configurations to enhance engagement with tissue, for example, rough, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured. 
     Shaft  306  has a cylindrical cross section configuration and includes an outer surface having an external thread form. In some embodiments, the thread form may include a single thread turn or a plurality of discrete threads. In some embodiments, other engaging structures may be disposed on shaft  306 , for example, a nail configuration, barbs, expanding elements, raised elements and/or spikes to facilitate engagement of shaft  306  with tissue, for example, vertebrae. 
     In some embodiments, the outer surface of shaft  306  may include one or a plurality of openings. In some embodiments, all or only a portion of shaft  306  may be disposed at alternate orientations, relative to a longitudinal axis of bone fastener  300 , for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered. In some embodiments, all or only a portion of shaft  306  may be cannulated. 
     In assembly, operation and use, spinal implant system  10 , similar to the systems and methods described herein, is employed with a surgical procedure, for example, a treatment of an applicable condition or injury of an affected section of a spinal column and adjacent areas within a body. In some embodiments, one or all of the components of spinal implant system  10  can be delivered or utilized as a pre-assembled device or can be assembled in situ. Spinal implant system  10  may be completely or partially revised, removed or replaced. 
     In some embodiments, spinal implant system  10  is employed with an end effector  202 , as shown in  FIG.  1    of a robotic arm (not shown) to facilitate implantation with the robotic arm. In some embodiments, spinal implant system  10  is employed with robotic and/or navigation guidance (including navigation component  200 ), which may include an image guide. 
     Surgical driver  12  is assembled prior to the surgical procedure. To releasably connect outer sleeve  28  with knob  26 , adjustment collar  42  attached to outer sleeve  28  and inner sleeve  30  is translated, in a direction shown by arrow A in  FIG.  5   . Adjustment collar  42  engages wall  76  of knob  26 , as shown in  FIG.  6   . Pins  90 ,  92  slidably engage slots  94 ,  96  and buttons  102 ,  104  are depressed and engage with slots  110 ,  112 . Buttons  102 ,  104  are disposed with openings  114 ,  116  as springs  106 ,  108  expand to translate buttons  102 ,  104  in an upward direction, as shown by arrows B in  FIG.  19   , in a snap fit engagement of buttons  102 ,  104  with openings  114 ,  116  thereby releasably connecting outer sleeve  28  with knob  26 . 
     To connect surgical driver  12  with bone fastener  300 , drive  21  engages with socket  304  of bone fastener  300 . Shaft  14  is held rigid by a user and inner sleeve  30  is translated in a direction, for example, a distal direction, as shown by arrow C in  FIG.  4    to engage collet  58  with head  302 . Knob  26  is rotated in a direction, as shown by arrow D in  FIG.  8    to translate outer sleeve  28  in a direction, for example, a distal direction, as shown by arrow E in  FIGS.  8  and  9    to translate end  34  of outer sleeve  28  over collet  58 . Translation of end  34  of outer sleeve  28  over collet  58  facilitates contraction of collet  58  about head  302  to connect surgical driver  12  with bone fastener  300 . Shaft  14  engages socket  304  to drive and fix bone fastener  300  with tissue, for example, a vertebra V1 of vertebrae V, shown in  FIG.  1   . 
     To disconnect bone fastener  300  from surgical driver  12 , knob  26  is rotated in a direction, shown by arrow F in  FIG.  6   . Outer sleeve  28  is translated in a direction, for example, a proximal direction, as shown by arrow G in  FIGS.  6  and  10    via rotation of knob  26  until collet  58  is fully exposed. Shaft  14  and collet  58  are pulled in a direction, for example, a proximal direction, as shown by arrow H in  FIG.  4    to disengage socket  304  and head  302  of bone fastener  300  respectively. 
     In some embodiments, spinal implant system  10  includes an agent, which may be disposed, packed, coated or layered within, on or about the components and/or surfaces of spinal implant system  10 . In some embodiments, the agent may include bone growth promoting material, for example, bone graft to enhance fixation of the components and/or surfaces of spinal implant 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. 
     Upon completion of the procedure, the surgical instruments, assemblies and non-implanted components of spinal implant system  10  are removed from the surgical site and the incision is closed. 
     To disassemble/disconnect outer sleeve  28  from knob  26 , buttons  102 ,  104  are simultaneously translated in a downward direction, as shown by arrows I in  FIG.  19   . Buttons  102 ,  104  are translated into slots  110 ,  112  as outer sleeve  28  is disconnected from knob  26  and translated in a direction, as shown by arrow J in  FIG.  5   . 
     One or more of the components of spinal implant 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, surgical driver  12  is guided to the surgical site via a guidewire, for example, a K-wire (not shown) and/or without the use of an image guide, as described herein. 
     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.