Patent Description:
Spinal pathologies and disorders such as scoliosis, kyphosis, and other curvature abnormalities, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, tumor and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including deformity, pain, nerve damage, and partial or complete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes correction, fusion, fixation, discectomy, laminectomy and implantable prosthetics. As part of these surgical treatments, spinal constructs including vertebral rods are often used to provide stability to a treated region. Rods redirect stresses away from a damaged or defective region while healing takes place to restore proper alignment and generally support vertebral members. During surgical treatment, one or more rods and bone fasteners can be delivered to a surgical site. The rods may be attached via the fasteners to the exterior of two or more vertebral members. This disclosure describes an improvement over these prior technologies.

From e.g. <CIT>, <CIT>, <CIT>, <CIT>, <CIT> and <CIT> a spinal construct including a connector is known, the connector comprising: a body defining a transverse axis, the body including a wall disposed between a first passageway and a second passageway configured for loading of a spinal rod, the body further defining a first opening communicating with the first passageway and a second opening communicating with the second passageway.

Further, from e.g. <CIT> a spinal construct including a connector is known, the connector comprising: a body defining a transverse axis, the body including a passageway configured for loading of a spinal rod.

The present invention provides a spinal construct with the features according to claim <NUM>. Further preferred embodiments of the spinal construct are described in the dependent claims.

The exemplary embodiments of the surgical system and related methods of use disclosed are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of a surgical system and method for treatment of a spine disorder. In some embodiments, the systems and methods of the present disclosure are employed with a spinal joint fusion, for example, with a cervical, thoracic, lumbar and/or sacral region of a spine. The surgical methods or treatments described in the following do not form part of the invention but are helpful in understanding the invention.

In some embodiments, the present surgical system includes a spinal construct having a connector. In some embodiments, the connector includes a tulip hybrid crosslink connector. In some embodiments, the connector includes a top loading spinal rod passageway and a side loading spinal rod passageway. The connector is configured to connect a spinal rod with a spinal construct including, such as, for example, bone screws and a spinal rod. In some embodiments, the connector defines a transverse axis and includes a first implant cavity and a second implant cavity. In some embodiments, at least one of the implant cavities is configured for side loading a spinal rod. In some embodiments, the connector includes an opening communicating with the first implant cavity and an opening communicating with the second implant cavity.

In some embodiments, the connector includes a second opening angled towards the first opening to facilitate insertion of the connector through a small incision in a patient. In some embodiments, the connector is utilized with a cortical screw trajectory procedure. In some embodiments, the connector facilitates connecting spinal rods having a diameter of <NUM> by utilizing an angled second opening for connection of a set screw at the side loaded spinal rod. In some embodiments, the openings for the set screws are angled and not oriented perpendicular to a transverse axis of the connector, for example, disposed directly into the connector. In some embodiments, the openings for the set screws are disposed in substantially parallel relation. In some embodiments, the openings for the set screws are angled and not parallel. In some embodiments, a first set screw opening axis is disposed at an angle relative to the transverse axis of the connector and a second set screw opening axis oriented perpendicular to the transverse axis of the connector, for example, disposed directly into the connector. In some embodiments, the connector includes only one set screw opening, which is angled relative to the transverse axis of the connector. In some embodiments, the present surgical system includes a spinal construct having a connector with convergent angled set screw openings to facilitate a midline type cortical bone screw trajectory. In some embodiments, this configuration maintains surgical instruments in the same orientation throughout a surgical procedure while minimizing tissue exposure.

In some embodiments, one or all of the components of the surgical system may be disposable, peel-pack, pre-packed sterile devices. One or all of the components of the system may be reusable. The system may be configured as a kit with multiple sized and configured components.

In some embodiments, the surgical system of the present disclosure may be employed to treat spinal disorders such as, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor and fractures. In some embodiments, the 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, such as, 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. Similarly, when values are expressed as approximations, by use of the antecedent "about," it will be understood that the particular value forms another embodiment. It is also understood that all spatial references, such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure. For example, the references "upper" and "lower" are relative and used only in the context to the other, and are not necessarily "superior" and "inferior".

As used in the specification and including the appended claims, "treating" or "treatment" of a disease or condition refers to performing a procedure that may include administering one or more drugs to a patient (human, normal or otherwise or other mammal), employing implantable devices, and/or employing instruments that treat the disease, such as, for example, microdiscectomy instruments used to remove portions bulging or herniated discs and/or bone spurs, in an effort to alleviate signs or symptoms of the disease or condition. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, treating or treatment includes preventing or prevention of disease or undesirable condition (e.g., preventing the disease from occurring in a patient, who may be predisposed to the disease but has not yet been diagnosed as having it). In addition, treating or treatment does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes procedures that have only a marginal effect on the patient. Treatment can include inhibiting the disease, e.g., arresting its development, or relieving the disease, e.g., causing regression of the disease. For example, treatment can include reducing acute or chronic inflammation; alleviating pain and mitigating and inducing regrowth 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 spinal construct, 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 <FIG>, there are illustrated components of a surgical system, such as, for example, a spinal implant system <NUM>.

Spinal implant system <NUM> comprises a spinal construct including a connector <NUM>. In some embodiments, connector <NUM> is configured to connect a first spinal rod <NUM> with bone screws <NUM> and a second spinal rod <NUM>, as shown in <FIG>, <FIG>, and <FIG>.

Connector <NUM> includes a body <NUM> defining a transverse axis X1, as shown in <FIG>. Body <NUM> includes a wall <NUM> (<FIG>). Wall <NUM> includes a surface <NUM> that defines a portion of a cavity, such as for example, a receiver <NUM>, as shown in <FIG>. Receiver <NUM> includes a pair of spaced-apart arms <NUM>, <NUM> that define an implant cavity, such as, for example, a passageway <NUM> therebetween. Passageway <NUM> is configured for top loading of a spinal implant, such as, for example, spinal rod <NUM>, as shown in <FIG>.

Arms <NUM>, <NUM> each extend perpendicular to axis X1, as shown in <FIG>. In some embodiments, arm <NUM> and/or arm <NUM> may be disposed at alternative orientations relative to axis X1, such as, for example, transverse and/or other angular orientations such as acute or obtuse, coaxial and/or may be offset or staggered. Arms <NUM>, <NUM> each include an arcuate outer surface extending between a pair of side surfaces. In some embodiments, at least one of the outer surfaces and the side surfaces of arms <NUM>, <NUM> have at least one recess or cavity therein configured to receive an insertion tool, compression instrument and/or instruments for manipulating connector <NUM>.

Passageway <NUM> is substantially U-shaped. In some embodiments, all or only a portion of passageway <NUM> may have alternate cross-section configurations, such as, for example, closed, V-shaped, W-shaped, oval, oblong triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, and/or tapered. In some embodiments, surface <NUM> includes gripping elements or surfaces, such as, for example, one or more surfaces being rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured, to facilitate engagement with spinal rod <NUM>. Passageway <NUM> defines an axis A1 that extends transverse to axis X1. In some embodiments, axis A1 may be disposed at alternate orientations, relative to axis X1, such as, for example, parallel, perpendicular and/or angular orientations such as acute or obtuse, coaxial and/or may be offset or staggered.

Receiver <NUM> includes threaded surfaces <NUM> that define an opening <NUM>. Opening <NUM> extends along an axis X2, as shown in <FIG>. Axis X2 is disposed in a substantially perpendicular orientation relative to axis X1. In some examples, not claimed, axis X2 is disposed at alternate orientations, relative to axis X1, such as, for example, transverse and/or other angular orientations such as acute or obtuse, coaxial and/or may be offset or staggered. Opening <NUM> is disposed in communication with passageway <NUM> to facilitate fixation of spinal rod <NUM> with connector <NUM>.

Surfaces <NUM> are configured for engagement with a coupling member, such as, for example, a set screw <NUM>, to retain spinal rod <NUM> within passageway <NUM>. In some embodiments, surfaces <NUM> is disposed with set screw <NUM> in alternate fixation configurations, such as, for example, friction fit, pressure fit, locking protrusion/recess, locking keyway and/or adhesive. In some embodiments, all or only a portion of surfaces <NUM> may have alternate surface configurations to enhance engagement with a spinal rod and/or a set screw such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured.

Set screw <NUM> is configured for engagement with spinal rod <NUM> to facilitate fixation and/or locking of spinal rod <NUM> with receiver <NUM>. Set screw <NUM> is disposable with receiver <NUM> between a non-locking orientation, such that spinal rod <NUM> is translatable relative to connector <NUM> and a locked orientation, such that set screw <NUM> fixes spinal rod <NUM> with connector <NUM>.

Body <NUM> includes an extension <NUM>. Extension <NUM> includes an end <NUM> forming a receiver <NUM>. Receiver <NUM> includes a surface <NUM> that defines an implant cavity, such as, for example, a passageway <NUM>. Receiver <NUM> includes an arcuate configuration, such as, for example, a hooked shaped wall <NUM> that defines passageway <NUM> and is configured to capture spinal rod <NUM>. Receiver <NUM> is configured to facilitate side loading of spinal rod <NUM> with connector <NUM>.

Passageway <NUM> is configured for side loading of spinal rod <NUM>, as described herein. In some embodiments, passageway <NUM> is disposed separate and apart from passageway <NUM>. In some embodiments, passageway <NUM> is disposed in a side by side orientation relative to passageway <NUM>. In some embodiments, passageway <NUM> is disposed in a parallel orientation relative to passageway <NUM>. In some embodiments, passageway <NUM> is disposed transverse to passageway <NUM>. In some embodiments, passageway <NUM> is disposed in various orientations, such as, for example, perpendicular, transverse and/or at angular orientations, such as acute or obtuse relative to passageway <NUM>. In some embodiments, passageway <NUM> may be disposed offset or staggered from passageway <NUM>.

In some embodiments, passageway <NUM> may have various cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, surface <NUM> may includes gripping elements or surfaces, such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured to facilitate engagement with spinal rod <NUM>. Passageway <NUM> includes an axis A2 that extends transverse to axis X1. In some embodiments, axis A2 is disposed at alternate orientations, relative to axis X1, such as, for example, parallel, perpendicular and/or angular orientations such as acute or obtuse, coaxial and/or may be offset or staggered.

Extension <NUM> includes a threaded surface <NUM> that defines an opening <NUM>. Opening <NUM> extends between an end <NUM> and an end <NUM> and extends along an axis X3, as shown in <FIG>. Axis X3 is disposed in a substantially non-perpendicular orientation relative to axis X1. In some examples, not claimed, axis X3 may be disposed at alternate orientations, relative to axis X1, such as, for example, perpendicular, transverse and/or other angular orientations such as acute or obtuse, coaxial and/or may be offset or staggered. Opening <NUM> is disposed in communication with passageway <NUM> to facilitate fixation of spinal rod <NUM> with connector <NUM>.

Axis X3 is disposed in a non-parallel orientation relative to axis X2, as shown in <FIG>. Opening <NUM> is oriented such that end <NUM> is angled towards opening <NUM> to facilitate insertion of connector <NUM>. The configuration facilitates insertion of connector <NUM> into a patient through a smaller surgical incision made during a surgical procedure. In some embodiments, connector <NUM> may be utilized with a cortical screw trajectory procedure. In some embodiments, connector <NUM> facilitates connecting rods <NUM> each having a diameter of <NUM> by utilizing an angled opening <NUM> for connection of set screw <NUM> at side loaded spinal rod <NUM>. Convergent angled set screws <NUM>, <NUM> facilitate a midline type cortical bone screw trajectory, which maintains an orientation of the instruments throughout the procedure while minimizing tissue exposure.

Surface <NUM> is configured for engagement with a coupling member, such as, for example, a set screw <NUM>, to retain spinal rod <NUM> within passageway <NUM>. In some embodiments, surface <NUM> may be disposed with set screw <NUM> in alternate fixation configurations, such as, for example, friction fit, pressure fit, locking protrusion/recess, locking keyway and/or adhesive. In some embodiments, all or only a portion of surface <NUM> may have alternate surface configurations to enhance engagement with a spinal rod and/or a set screw such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured.

In some embodiments, spinal implant system <NUM> can include one or a plurality of connectors <NUM> such as those described herein and/or fixation elements, which may be employed with a single vertebral level or a plurality of vertebral levels. In some embodiments, connectors <NUM> is engaged with vertebrae in various orientations, such as, for example, series, parallel, offset, staggered and/or alternate vertebral levels. In some embodiments, connectors <NUM> is configured as multi-axial screws, sagittal angulation screws, pedicle screws, mono-axial screws, uni-planar screws, fixed screws, anchors, tissue penetrating screws, conventional screws, expanding screws. In some embodiments, connectors <NUM> is employed with wedges, anchors, buttons, clips, snaps, friction fittings, compressive fittings, expanding rivets, staples, nails, adhesives, posts, connectors, fixation plates and/or posts.

In assembly, operation and use, spinal implant system <NUM>, similar to the systems and methods described herein, is employed with a surgical procedure, such as, for example, a correction treatment of an applicable condition or injury of an affected section of a spinal column and adjacent areas within a body. Spinal implant system <NUM> may be completely or partially revised, removed or replaced.

In use, to treat a selected section of vertebrae V, including vertebrae V1, V2, as shown in <FIG>, a medical practitioner obtains access to a surgical site including vertebrae V in any appropriate manner, such as through incision and retraction of tissues. In some embodiments, spinal implant system <NUM> can be used in any existing surgical method or technique including open surgery, mini-open surgery, minimally invasive surgery and percutaneous surgical implantation, whereby vertebrae V is accessed through a mini-incision, or a sleeve that provides a protected passageway to the area. Once access to the surgical site is obtained, the particular surgical procedure can be performed for treating the spine disorder.

An incision is made in the body of a patient and a cutting instrument (not shown) creates a surgical pathway for implantation of components of spinal implant system <NUM>. A preparation instrument (not shown) can be employed to prepare tissue surfaces of vertebrae V, as well as for aspiration and irrigation of a surgical region.

Bone screws <NUM> are engaged with vertebrae V along a lateral side L of vertebrae V, as shown in <FIG>. Bone screws <NUM> are manipulated to drive, torque, insert or otherwise connect bone screws <NUM> with vertebrae V. Spinal rod <NUM> is delivered along the surgical pathway to a surgical site adjacent vertebrae V. Spinal rod <NUM> is disposed with bone screws <NUM> along vertebrae V. Connectors <NUM> are disposed adjacent spinal rod <NUM>. Each connector <NUM> is manipulated to dispose spinal rod <NUM> with passageway <NUM> from a top loading orientation.

Spinal rod <NUM> is fixed with receiver <NUM> by engaging set screw <NUM> with surface <NUM> of opening <NUM>. Set screw <NUM> is engaged with a surgical instrument, such as, for example, a driver (not shown), which advances set screw <NUM> along axis X2 into engagement with surface <NUM> in a locking orientation, as described herein. The driver engages set screw <NUM> to fix spinal rod <NUM> with receiver <NUM> and for attachment of spinal rod <NUM> with vertebrae V.

Spinal rod <NUM> is delivered along the surgical pathway to a surgical site adjacent vertebrae V. Spinal rod <NUM> is disposed with passageway <NUM> from a side loading orientation. Set screw <NUM> is disposed with opening <NUM> and engaged with surface <NUM> along axis X3. Set screw <NUM> is engaged with a surgical instrument, such as, for example, a driver (not shown), which advances set screw <NUM> into opening <NUM> in a non-locking orientation, as described herein. Spinal rod <NUM> is translatable relative to connector <NUM> to position spinal rod <NUM> relative to spinal rod <NUM> and connector <NUM>. The driver engages set screw <NUM> to fix spinal rod <NUM> with connector <NUM> and for attachment of spinal rod <NUM> with vertebrae V. In some embodiments, spinal rod <NUM> is configured to share the load applied to spinal rod <NUM>. In some embodiments, spinal rod <NUM> is configured to extend spinal rod <NUM> to an adjacent vertebral level. Spinal rod <NUM> is configured to add support and strength to spinal implant system <NUM> along vertebrae V.

In some embodiments, spinal implant system <NUM> includes a second set of connectors <NUM>, bone screws <NUM> and spinal rods <NUM>, <NUM> (not shown) delivered along the surgical pathway to the surgical site adjacent a contra-lateral side of vertebrae V. The second set of connectors <NUM>, bone screws <NUM> and spinal rods <NUM>, <NUM> are connected with the contra-lateral side of vertebrae V, similar to lateral side L described herein. In some embodiments, the spinal constructs of spinal implant system <NUM>, as described herein, are fixed with vertebrae V in a side by side orientation and/or a bi-lateral arrangement to stabilize vertebrae V and affect growth for a correction treatment to treat spine pathologies, as described herein. In some embodiments, one or all of the components of spinal implant system <NUM> can be delivered or implanted as a preassembled device or can be assembled in situ, in a selected order of assembly or the order of assembly of the particular components of spinal implant system <NUM> can be varied according to practitioner preference, patient anatomy or surgical procedure parameters.

Upon completion of the procedure, the surgical instruments, assemblies and non-implanted components of spinal implant system <NUM> are removed from the surgical site and the incision is closed. One or more of the components of spinal implant system <NUM> can be made of radiolucent materials such as polymers. Radiomarkers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. In some embodiments, the use of surgical navigation, microsurgical and image guided technologies is employed to access, view and repair spinal deterioration or damage, with the aid of spinal implant system <NUM>.

In some embodiments, spinal implant system <NUM> includes an agent, which may be disposed, packed, coated or layered within, on or about the components and/or surfaces of spinal implant system <NUM>. In some embodiments, the agent may include bone growth promoting material, such as, for example, bone graft to enhance fixation of the bone fasteners 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.

As shown in <FIG>, spinal implant system <NUM>, similar to the systems and methods described herein, includes a connector <NUM>, similar to connector <NUM> described herein.

Connector <NUM> includes a body <NUM> defining a transverse axis X4, as shown in <FIG>. Body <NUM> includes a wall <NUM>. Wall <NUM> includes a surface <NUM> that defines a portion of a cavity, such as for example, a receiver <NUM>, similar to receiver <NUM> as described herein. Receiver <NUM> includes a pair of spaced apart arms <NUM>, <NUM> that define an implant cavity, such as, for example, a passageway <NUM> therebetween. Passageway <NUM> is configured for top loading of spinal rod <NUM>, as described herein. Arms <NUM>, <NUM> each extend along an axis X5 in a non-perpendicular orientation relative to axis X4, as shown in <FIG>.

Receiver <NUM> includes threaded surfaces <NUM> that define an opening <NUM>. Opening <NUM> extends along axis X5 such that opening <NUM> extends X5 in a non-perpendicular orientation relative to axis X4. In some embodiments, axis X5 may be disposed at alternate orientations, relative to axis X4, such as, for example, perpendicular, transverse and/or other angular orientations such as acute or obtuse, coaxial and/or may be offset or staggered. Opening <NUM> is disposed in communication with passageway <NUM> to facilitate fixation of spinal rod <NUM> with connector <NUM>. Surfaces <NUM> are configured for engagement with set screw <NUM>, as described herein, to retain spinal rod <NUM> within passageway <NUM>.

Body <NUM> includes an extension <NUM>. Extension <NUM> includes an end <NUM> forming a receiver <NUM>. Receiver <NUM> includes a surface <NUM> that defines a passageway <NUM>. Receiver <NUM> includes a hooked shaped wall <NUM> that defines passageway <NUM> and configured to capture spinal rod <NUM>. Receiver <NUM> is configured to facilitate side loading of spinal rod <NUM>.

Passageway <NUM> is configured for side loading of spinal rod <NUM>, as described herein. In some embodiments, passageway <NUM> is disposed separate and apart from passageway <NUM>. In some embodiments, passageway <NUM> is disposed in a side by side orientation relative to passageway <NUM>. In some embodiments, passageway <NUM> is disposed in a parallel orientation relative to passageway <NUM>. In some embodiments, passageway <NUM> is disposed transverse to passageway <NUM>. In some embodiments, passageway <NUM> is disposed in various orientations, such as, for example, perpendicular, transverse and/or at angular orientations, such as acute or obtuse relative to passageway <NUM>. In some embodiments, passageway <NUM> is disposed offset or staggered from passageway <NUM>. In some embodiments, passageway <NUM> may have various cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, surface <NUM> may include gripping elements or surfaces, such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured to facilitate engagement with spinal rod <NUM>.

Extension <NUM> includes a threaded surface <NUM> that defines an opening <NUM>. Opening <NUM> extends between an end <NUM> and an end <NUM> and extends along an axis X6, as shown in <FIG>. Axis X6 is disposed in a substantially non-perpendicular orientation relative to axis X4. In some embodiments, axis X6 is disposed at alternate orientations, relative to axis X4, such as, for example, perpendicular, transverse and/or other angular orientations such as acute or obtuse, coaxial and/or may be offset or staggered. Opening <NUM> is disposed in communication with passageway <NUM> to facilitate fixation of spinal rod <NUM> with connector <NUM>. Axis X6 is disposed in a parallel orientation relative to axis X4 such that opening <NUM> is disposed parallel relative to opening <NUM>. Opening <NUM> is oriented such that end <NUM> is angled towards opening <NUM> to facilitate insertion of connector <NUM> through a smaller incision in a patient, as described herein.

Surface <NUM> is configured for engagement with a set screw <NUM>, as described herein, to retain spinal rod <NUM> within passageway <NUM>. Set screw <NUM> is configured for engagement with spinal rod <NUM> to facilitate fixation and/or locking of spinal rod <NUM> with receiver <NUM>. Set screw <NUM> is disposable with receiver <NUM> between a non-locking orientation, such that spinal rod <NUM> is translatable relative to connector <NUM> and a locked orientation, such that set screw <NUM> fixes spinal rod <NUM> with connector <NUM>.

Connector <NUM> includes a body <NUM> defining a transverse axis X7, as shown in <FIG>. Body <NUM> includes a wall <NUM>. Wall <NUM> includes a surface <NUM> that defines a portion of a cavity, such as for example, a closed receiver <NUM>. In some embodiments, receiver <NUM> includes a passageway <NUM> for disposal of an end of spinal rod <NUM>. In some embodiments, spinal rod <NUM> is monolithically formed with receiver <NUM>. In some embodiments, spinal rod <NUM> is integrally connected with receiver <NUM>. In some embodiments, spinal rod <NUM> is attached with receiver <NUM> with fastening elements and/or instruments.

Passageway <NUM> is configured for side loading of spinal rod <NUM>, as described herein. In some embodiments, passageway <NUM> positions spinal rod <NUM> separate and apart from spinal rod <NUM>. In some embodiments, passageway positions spinal rod <NUM> in a side by side orientation relative to spinal rod <NUM>. In some embodiments, passageway <NUM> positions spinal rod <NUM> in a parallel orientation relative to spinal rod <NUM>. In some embodiments, passageway <NUM> positions spinal rod <NUM> transverse to spinal rod <NUM>. In some embodiments, passageway <NUM> may position spinal rod <NUM> in various orientations, such as, for example, perpendicular, transverse and/or at angular orientations, such as acute or obtuse relative to spinal rod <NUM>. In some embodiments, passageway <NUM> may position spinal rod <NUM> offset or staggered from spinal rod <NUM>. In some embodiments, passageway <NUM> may have various cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. In some embodiments, surface <NUM> may include gripping elements or surfaces, such as, for example, rough, arcuate, undulating, mesh, porous, semi-porous, dimpled and/or textured to facilitate engagement with spinal rod <NUM>.

Extension <NUM> includes a threaded surface <NUM> that defines an opening <NUM>, as shown in <FIG>. Opening <NUM> extends between an end <NUM> and an end <NUM> and extends along an axis X8, as shown in <FIG>. Axis X8 is disposed in a substantially non-perpendicular orientation relative to axis X7. In some embodiments, axis X8 may be disposed at alternate orientations, relative to axis X7, such as, for example, perpendicular, transverse and/or other angular orientations such as acute or obtuse, coaxial and/or may be offset or staggered. Opening <NUM> is disposed in communication with passageway <NUM> to facilitate fixation of spinal rod <NUM> with connector <NUM>. Opening <NUM> is oriented such that end <NUM> is angled towards receiver <NUM> to facilitate insertion of connector <NUM> through a smaller incision in a patient, as described herein.

Claim 1:
A spinal construct including a connector (<NUM>), the connector (<NUM>) comprising:
a body (<NUM>) defining a transverse axis (X1), the body (<NUM>) including a wall (<NUM>) disposed between a first passageway (<NUM>) configured for top loading of a spinal rod (<NUM>) and a second passageway (<NUM>) configured for side loading of a spinal rod (<NUM>),
the body (<NUM>) further defining a first opening (<NUM>) communicating with the first passageway (<NUM>) and a second opening (<NUM>) communicating with the second passageway (<NUM>), the first opening (<NUM>) defining a first axis (X2) and the second opening (<NUM>) defining a second axis (X3),
wherein the first axis (X2) is disposed in a perpendicular orientation relative to the transverse axis (X1) and the second axis (X3) is disposed in a non-perpendicular orientation relative to the transverse axis (X1) and
wherein the second opening (<NUM>) is angled towards the first opening (<NUM>) so as to facilitate insertion of the connector (<NUM>) through a small incision.