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

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, ligamentotaxy, corpectomy, discectomy, laminectomy, fusion, fixation and implantable prosthetics. Correction treatments used for positioning and alignment of vertebrae may employ spinal implants including spinal constructs and interbody devices for stabilization of a treated section of a spine. In some cases, the spinal implants may be manipulated with surgical instruments for compression and distraction of vertebrae. This disclosure describes an improvement over these prior technologies.

A surgical system with the features as defined in the preamble of claim <NUM> is known from <CIT>.

According to the present invention a surgical system comprisesan implant support engageable with a receiver of a fastener having a shaft configured to be fixed to vertebral tissue;a sleeve having a first mating surface releasably engageable with the implant support and a second mating surface releasably engageable with the receiver; andan adaptor connected with the implant support to releasably engage a surgical instrument to distract and/or compress the vertebral tissue,wherein the receiver includes spaced-apart walls that define an implant cavity, and wherein the implant support is engageable with a first wall of the spaced-apart walls of the receiver, whereinthe second mating surface is engageable with a second wall of the spaced-apart walls of the receiver, wherein the sleeve includes an end which includes a surface that defines the second mating surface, wherein the second mating surface is configured for capture of the second wall, wherein the second mating surface includes a distal projection configured for engagement with a cavity disposed within the second wall of the spaced-apart walls of the receiver to facilitate engagement.

In one embodiment, the sleeve includes a proximal flange defining mating grooves being releasably engageable with the proximal end and at least one distal projection being releasably engageable with the second wall. An adaptor extends longitudinally along the first implant support for connection with the distal end to releasably engage a surgical instrument to distract and/or compress the vertebral tissue.

In one embodiment, the surgical system includes a first implant support having an adaptor and being releasably engageable with a first wall of a receiver of a first fastener having a shaft fixed with vertebral tissue. The receiver includes the first wall and a second wall that define an implant cavity. A first sleeve includes a flange being releasably engageable with the first implant support and a distal end being releasably engageable with the second wall. A second implant support includes an adaptor and is releasably engageable with a first wall of a receiver of a second fastener having a shaft fixed with vertebral tissue. The receiver of the second fastener includes the first wall and a second wall that define an implant cavity. A second sleeve includes a flange being releasably engageable with the second implant support and a distal end being releasably engageable with the second wall of the second fastener. A surgical instrument includes a first member and a second member. The adaptor of the first implant support is releasably engageable with the first member and the adaptor of the second implant support is releasably engageable with the second member. The members are relatively movable to distract and/or compress the vertebral tissue.

The embodiments of the system and related methods of use (the methods not claimed) 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 correction of a spine disorder. In some embodiments, the present surgical system includes surgical instruments that allow vertebral manipulation to treat spinal disorders, as described herein, for managing lordosis and/or kyphosis restoration. In some embodiments, the surgical instruments allow for parallel distraction and/or compression of vertebral tissue.

In some embodiments, the present surgical system includes a trauma instrument. In some examples, the present surgical system is utilized with a method to correct complex spinal deformities. In some examples, embodiments, the present surgical system is utilized with a method to treat degenerative spinal disorders and/or employed with transforaminal lumbar interbody fusion procedures. In some embodiments, the present surgical system is configured for utilization with a sagittal adjusting screw (SAS), a fixed axis screw (FAS) and/or a multi-axial screw (MAS). In some embodiments, the present surgical system comprises a single distractor to treat degenerative spinal disorders, for example, for disposal along a side of vertebrae oriented for decompression and/or interbody cage insertion.

In some examples, embodiments, the present surgical system includes a surgical instrument employed with a surgical method including degenerative lumbar spine fusion. In some examples, embodiments, the present surgical system includes a surgical instrument employed with a surgical method including the step of segmental posterior stabilization with MAS screws. In some examples, the present surgical system includes a surgical method including an interbody fusion, posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) utilizing a minimally invasive surgical approach or a percutaneous approach. In some examples, the present surgical system includes bone screw extenders, tissue retractors and a distractor/compressor system. In some examples, embodiments, the present surgical system includes segmental distraction to facilitate decompression, including final construct compression. In some examples, the present surgical system includes radio transparent tissue retractor blades.

In some examples, the present surgical system includes a surgical instrument employed with a surgical method including the step of: connecting extenders, such as, for example, implant supports with MAS screws; connecting a sleeve with the implant support and the bone screw; and employing a universal screw driver for percutaneous implantation of the bone screw utilizing a PAK needle, guidewire or fluoroscopy. In some examples, the present surgical system includes screw based segmental distraction. In some examples, the segmental distraction is accomplished by utilizing a distractor, angulation modules and lock elements to distract the bone screw heads.

In some examples, the present surgical system includes a dilator configured to evaluate tissue depth from graduations disposed thereon. In some examples, the present surgical system includes a retractor having a selection of blade lengths. In some examples, the present surgical system includes the step of inserting the retractor blades along the dilator and manipulating and/or adjusting angulation of the blades and the distance between the blades. In some examples, the present surgical system includes a light source configured for connection with the retractor.

In some examples, the adaptor is employed with a surgical method including the step of inserting the adaptor with a surgical site and the step of sliding a sleeve along the implant support. In some examples, the method includes the step of securing the sleeve to the implant support. In some examples, the method includes the step of connecting a compressor/distractor with the adaptor. In some examples, the method includes the step of connecting an angulation module with the adaptor, the compressor/distractor and the extender. In some examples, the method includes the step of securing the angulation module, the compressor/distractor and the adaptor with a locking element. In some examples, the method includes the step of distracting and/or compressing a posterior ligament. In some examples, the method includes the step of actuating a rack and pinion mechanism disposed with the compressor/distractor to facilitate distraction or compression.

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

In some examples, embodiments, 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 examples, the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. In some examples, the disclosed surgical system and methods may be alternatively employed in a surgical treatment with a patient in a prone or supine position, and/or employ various surgical approaches to the spine, including posterior and/or posterior mid-line and in other body regions. The present disclosure may also be alternatively employed with procedures for treating the lumbar, cervical, thoracic, sacral and pelvic regions of a spinal column. The system and methods of the present disclosure may also be used on animals, bone models and other non-living substrates, such as, for example, in training, testing and demonstration.

The present disclosure may be understood more readily by reference to the following detailed description of the embodiments and examples taken in connection with the accompanying drawing figures, which form a part of this disclosure.

For background information, "treating" or "treatment" of a disease or condition refers to performing a procedure that may include administering one or more drugs to a patient (human, normal or otherwise or other mammal), employing implantable devices, and/or employing instruments that treat the disease, such as, for example, microdiscectomy instruments used to remove portions bulging or herniated discs and/or bone spurs, in an effort to alleviate signs or symptoms of the disease or condition. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, treating or treatment includes preventing or prevention of disease or undesirable condition (e.g., preventing the disease from occurring in a patient, who may be predisposed to the disease but has not yet been diagnosed as having it). In addition, treating or treatment does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes procedures that have only a marginal effect on the patient. Treatment can include inhibiting the disease, e.g., arresting its development, or relieving the disease, e.g., causing regression of the disease. For example, treatment can include reducing acute or chronic inflammation; alleviating pain and mitigating and inducing re-growth of new ligament, bone and other tissues; as an adjunct in surgery; and/or any repair procedure. Also, as used in the specification and including the appended claims, the term "tissue" includes soft tissue, ligaments, tendons, cartilage and/or bone unless specifically referred to otherwise.

The following discussion includes a description of a surgical system in accordance with the principles of the present invention. Alternate embodiments are disclosed. Reference is made to the embodiments of the present invention, which are illustrated in the accompanying figures. Turning to <FIG>, there are illustrated components of a surgical system <NUM>.

The components of surgical system <NUM> 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 surgical system <NUM>, individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade <NUM> titanium, super-elastic titanium alloys, cobalt-chrome alloys, superelastic metallic alloys (e.g., Nitinol, super elasto-plastic metals), 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<NUM> polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers, elastomeric composites, rigid polymers including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone material including autograft, allograft, xenograft or transgenic cortical and/or corticocancellous bone, and tissue growth or differentiation factors, partially resorbable materials, such as, for example, composites of metals and calcium-based ceramics, composites of PEEK and calcium based ceramics, composites of PEEK with resorbable polymers, totally resorbable materials, such as, for example, calcium based ceramics such as calcium phosphate, tri-calcium phosphate (TCP), hydroxyapatite (HA)-TCP, calcium sulfate, or other resorbable polymers such as polyaetide, polyglycolide, polytyrosine carbonate, polycaroplaetohe and their combinations.

Surgical system <NUM> is employed, for example, with a minimally invasive procedure, including percutaneous techniques, mini-open and open surgical techniques to deliver and introduce instrumentation and/or components of spinal constructs at a surgical site within a patient body of a patient, for example, a section of a spine. In some embodiments, one or more of the components of surgical system <NUM> are configured for engagement with spinal constructs attached with vertebrae to manipulate tissue and/or correct a spinal disorder, such as, for example, a sagittal deformity, as described herein. In some examples, embodiments, surgical system <NUM> may be employed with surgical procedures, such as, for example, corpectomy, discectomy and/or fracture/trauma treatment and may include fusion and/or fixation that employ implants to restore the mechanical support function of vertebrae.

Surgical system <NUM> includes an extender, such as, for example, an implant support <NUM> and a sleeve <NUM>, both engageable with a bone screw <NUM>. Implant support <NUM> includes an adaptor <NUM> connectable to a surgical instrument, such as, for example, a compressor/distractor <NUM> to facilitate manipulation of tissue, as described herein.

Implant support <NUM> extends along an axis X1, as shown in <FIG>. Implant support <NUM> includes an extension <NUM> and an extension <NUM>, as shown in <FIG>. Extensions <NUM>, <NUM> are relatively moveable to each other via relative translation of a translation element, such as, for example, a slide <NUM> disposed with implant support <NUM>, as shown in <FIG>. Slide <NUM> is manipulated for translation within channel <NUM> to move extensions <NUM>, <NUM> between an open orientation and a closed, capture orientation. Slide <NUM> is translated, in a direction shown by arrow A in <FIG>, to cause extensions <NUM>, <NUM> to rotate and expand, in a direction shown by arrows B, to the open orientation. In the open orientation, pins <NUM> are seated in a bottom of slots <NUM> of slide <NUM>. Slide <NUM> is translated, in a direction shown by arrow C in <FIG>, to cause extensions <NUM>, <NUM> to rotate and contract, in a direction shown by arrows D, to the closed orientation to capture a wall <NUM> of a receiver <NUM> of bone screw <NUM>, as shown in <FIG>. In the closed orientation, pins <NUM> are seated in at the top of slots <NUM>. In some embodiments, extensions <NUM>, <NUM> are flexible to facilitate contraction.

Positioning of implant support <NUM> with wall <NUM> provides for direct access to receiver <NUM> to facilitate insertion of a spinal rod. In some examples, embodiments, one or more implant supports <NUM> are manipulable, as described herein, to provide a counter-torque for small deformity maneuvers and manipulation of vertebrae during a surgical treatment, for example, to displace, pull, twist or align vertebrae. Implant support <NUM> includes a surface <NUM> that defines a channel <NUM>. Channel <NUM> is configured for disposal of slide <NUM>, as described herein.

Adaptor <NUM> is pivotable and/or rotatable relative to implant support <NUM> and/or bone screw <NUM>, as shown in <FIG> and <FIG>. Rotation of adaptor <NUM> facilitates engagement of implant support <NUM> via adaptor <NUM> with compressor/distractor <NUM>, as described herein. Adaptor <NUM> extends between an end <NUM> and an end <NUM>. End <NUM> is connected to sleeve <NUM> by a pin hinge <NUM>. Pin <NUM> facilitates rotation of adaptor <NUM> relative to implant support <NUM> and/or bone screw <NUM>. In some embodiments, adaptor <NUM> may be variously oriented relative to implant support <NUM>, such as, for example, transverse, perpendicular, angular and/or offset. End <NUM> includes an arm <NUM> extending therefrom. Rotation of arm <NUM> facilitates connection of adaptor <NUM> and implant support <NUM> with compressor/distractor <NUM>, as described herein. In some embodiments, arm <NUM> is may be variously oriented relative to axis X1, such as, for example, parallel, perpendicular, angular and/or offset.

Arm <NUM> includes a surface <NUM> that defines a threaded lock surface <NUM>. Surface <NUM> is engageable with a lock nut <NUM> to fix compressor/distractor <NUM> with implant supports <NUM> and adaptors <NUM>, as described herein. In some embodiments, surface <NUM> may have alternative locking and/or tool engaging surfaces, such as, for example, rectangular, polygonal, hexalobe, oval, irregular, cruciform, phillips, square, polygonal or star cross sectional configuration.

Sleeve <NUM> is connectable with implant support <NUM> and wall <NUM>. Sleeve <NUM> includes a body <NUM> extending between an end <NUM> and an end <NUM>, as shown in <FIG>. Body <NUM> extends along implant support <NUM>. End <NUM> includes a flange <NUM> and a flange <NUM> that define a mating surface, such as, for example, mating grooves <NUM>. Mating grooves <NUM> are configured for disposal of a proximal portion of implant support <NUM>, as shown in <FIG>. Flanges <NUM>, <NUM> are flexible such that flanges <NUM>, <NUM> snap fit into engagement with implant support <NUM>. Upon disposal of implant support <NUM> with mating grooves <NUM>, sleeve <NUM> is disposed in a configuration to capture a wall <NUM> of receiver <NUM>, as shown in <FIG>.

End <NUM> includes a surface <NUM> that defines a mating surface <NUM>. Surface <NUM> is configured for capture of wall <NUM>. Surface <NUM> includes a distal projection <NUM> configured for engagement with a cavity <NUM> disposed with wall <NUM> of receiver <NUM> to facilitate engagement.

Bone screw <NUM> includes, such as, for example, a multi-axial receiver <NUM> and a shaft <NUM>. Receiver <NUM> is moveable relative to shaft in a multi axial configuration. Receiver <NUM> includes spaced apart walls <NUM>, <NUM>, as shown in <FIG>. Receiver <NUM> is configured for engagement with implant support <NUM> and sleeve <NUM>, as described herein. Walls <NUM>, <NUM> each include a surface that defines cavities <NUM>. Cavities <NUM> facilitate connection with implant support <NUM> and/or sleeve <NUM>, as described herein. Walls <NUM>, <NUM> include an inner surface that defines a U-shaped passageway <NUM> for disposal of a spinal rod, as described herein. The inner surface of receiver <NUM> includes a thread form configured for engagement with a set screw.

In assembly, operation and use, surgical system <NUM>, similar to the systems and methods described herein, is employed with a surgical procedure, for treatment of a spine of a patient including vertebrae V, as shown in <FIG>. Surgical system <NUM> may also be employed with surgical procedures, such as, for example, discectomy, laminectomy, fusion, laminotomy, laminectomy, nerve root retraction, foramenotomy, facetectomy, decompression, spinal nucleus or disc replacement and bone graft and implantable prosthetics including plates, rods, and bone engaging fasteners.

Surgical system <NUM> is employed with a procedure for treatment of an applicable condition or injury of an affected section of a spinal column and adjacent areas within a body. For example, vertebrae V includes a vertebral level V1, a vertebral level V2 and a vertebral level V3, as shown in <FIG>. Diseased and/or damaged vertebrae and intervertebral discs are disposed at vertebra V2 between vertebrae V1 and V3. In some embodiments, components of surgical system <NUM> are configured for insertion with a vertebral space to space apart articular joint surfaces, provide support and maximize stabilization of vertebrae V.

In use, to treat the affected section of vertebrae V, 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 examples, surgical system <NUM> may 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 sleeve that provides a protected passageway to the area.

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 surgical 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.

Pilot holes or the like are made in selected vertebrae V1 and V3 for receiving bone screws <NUM>. Implant support <NUM>, including adaptor <NUM>, is engaged with wall <NUM> of receiver <NUM>, as described herein. Sleeve <NUM> is engaged with wall <NUM> of receiver <NUM>, as described herein. Mating grooves <NUM>, <NUM> are engaged with implant support <NUM>, as described herein. A driver <NUM> is disposed adjacent vertebrae V at a surgical site and is manipulated to drive, torque, insert or otherwise connect bone screw <NUM> with vertebrae.

Compressor/distractor <NUM> is connected with implant supports <NUM> via adaptors <NUM>, as shown in <FIG>, to allow for distraction and/or compression of vertebrae V connected with bone screw <NUM>. Compressor/distractor <NUM> includes a longitudinal element, such as, for example, a rack <NUM>, as shown in <FIG>. Rack <NUM> extends between an end <NUM> and an end <NUM> defining a longitudinal axis A1. Rack <NUM> is configured to connect adjacent implant support <NUM>. Rack <NUM> includes an outer surface <NUM> having a plurality of teeth, such as, for example, splines <NUM> engageable with an arm <NUM>, as described herein. Rack <NUM> includes an arm <NUM> extending from end <NUM>. In some embodiments, arm <NUM> is attached with rack <NUM> with, for example, with clips, hooks, adhesives and/or flanges.

Arm <NUM> includes a surface that defines an opening <NUM> configured for disposal of surface <NUM> for mounting compressor/distractor <NUM> with implant support <NUM>, adaptor <NUM> and sleeve <NUM>, as shown in <FIG>. Rack <NUM> includes arm <NUM> that is axially translatable along axis A1 relative to arm <NUM>. Arm <NUM> includes a surface that defines an opening <NUM> configured for disposal of surface <NUM> for mounting compressor/distractor <NUM> with implant support <NUM>, adaptor <NUM> and sleeve <NUM>.

Compressor/distractor <NUM> includes a ratchet, which includes splines <NUM> and arm <NUM> engageable in a bi-directional and/or two-way ratchet configuration. Arm <NUM> includes a latch <NUM> that includes a pinion or pawl (not shown) engageable with splines <NUM>. Latch <NUM> is pivotable relative to arm <NUM> for disposal in a distraction position, as described herein. In the distraction position, latch <NUM> engages rack <NUM> to allow axial and/or incremental translation of arm <NUM> relative to arm <NUM>/rack <NUM> and prevents axial translation of arm <NUM> relative to arm <NUM>/rack <NUM>, in an opposing direction. As such, distraction of vertebral tissue connected with implant supports <NUM> can be performed.

Latch <NUM> is pivotable relative to arm <NUM>, as shown in <FIG>. For example, latch <NUM> is pivotable for disposal in a neutral position. In the neutral position, latch <NUM> disengages from rack <NUM> to allow free axial translation of arm <NUM>/rack <NUM> relative to arm <NUM>. Latch <NUM> is pivotable relative to arm <NUM> for disposal in a compression position (not shown). In the compression position, latch <NUM> engages rack <NUM> to allow axial and/or incremental translation of arm <NUM> relative to arm <NUM>/rack <NUM> to compress vertebral tissue and prevents axial translation of arm <NUM> relative to arm <NUM>/rack <NUM>, in an opposing direction. As such, compression of vertebral tissue connected with implant supports <NUM> can be performed. In some embodiments, a rotatable key <NUM> includes a gear surface engageable with splines <NUM> to axially and/or incrementally translate rack <NUM> to facilitate distraction and/or compression, as described herein.

Angulation module <NUM> is connectable with compressor/distractor <NUM>, implant supports <NUM> and adaptor <NUM>, as shown in <FIG> and <FIG>. Module <NUM> is mounted with surfaces <NUM> for connection with compressor/distractor <NUM>, implant supports <NUM> and adaptor <NUM> via lock nut <NUM>. Module <NUM> includes spaced apart arms <NUM> that define a cavity <NUM>. Arms <NUM> are configured for capture of implant supports <NUM> to facilitate parallel distraction. Module <NUM> is fixed with implant supports <NUM> to allow for angulation and/or correction of vertebral tissue connected with implant supports <NUM>, individually, in combination or simultaneously. In some embodiments, engagement of implant supports <NUM> with module <NUM> facilitates parallel manipulation of vertebrae attached with implant supports <NUM>. In some embodiments, modules <NUM> are connected with compressor/distractor <NUM> and/or implant supports <NUM> to maintain a corrected vertebral angle of vertebrae during distraction and/or compression, as described herein.

For example, latch <NUM> is pivotable to the distraction position, as described herein, to allow translation of arm <NUM>, in the direction shown by arrow E, and prevent translation of arm <NUM>, in the direction shown by arrow F, relative to arm <NUM>/rack <NUM>, as shown in <FIG>. As such, distraction of vertebrae V1, V3 connected with implant supports <NUM> can be performed.

In some embodiments, a dilator <NUM> is inserted between implant supports <NUM> into contact with bony anatomy and determine tissue depth. In some embodiments, a retractor blades <NUM> are translated along dilator <NUM> into engagement with the bony anatomy, as shown in <FIG>. Blades <NUM> are disposed with tissue to form a surgical passageway, as shown in <FIG>, to facilitate insertion of a spinal implant, such as, for example, an interbody spinal implant. In some embodiments, blades <NUM> are selected according to a desired length and/or width. A blade holder <NUM> is attached to blades <NUM> and utilized to manipulate and/or adjust blades <NUM>, as shown in <FIG>.

In some embodiments, a light source is disposed with retractor <NUM> to provide illumination to the working channel. In some embodiments, compressor/distractor <NUM> is employed segmental distraction to facilitate insertion of an interbody implant and decompressing tissue.

In some embodiments, a rod inserter <NUM> is engaged with a spinal rod <NUM> to direct and/or guide spinal rod <NUM> through implant supports <NUM> into receiver <NUM>. In some embodiments, a driver (not shown) is utilized to engage a set screw (not shown) with bone screws <NUM> to fix one end of spinal rod <NUM>. Retractor <NUM> is removed, and blades are translated out of the surgical site, as shown in <FIG>. One of sleeves <NUM> is disengaged from implant supports <NUM>, as shown in <FIG>, and implant supports <NUM> are crossed. In some embodiments, a crossing block <NUM> captures the crossed implant supports <NUM>, as shown in <FIG>. Compressor/distractor <NUM> is disposed in a compression position, as described herein, and key <NUM> is rotated to selectively compress vertebrae V. The driver <NUM> is utilized to engage a second set screw (not shown) with bone screw <NUM> to fix a second end of spinal rod <NUM>, as shown in <FIG>.

Compressor/distractor <NUM> and implant supports <NUM> are removed, as shown in <FIG>. For example, lock nuts <NUM> are disengaged from surface <NUM>. Latch <NUM> is set to the neutral position. Angulation modules <NUM> and compressor/distractor <NUM> are disengaged from adaptors <NUM> and implant supports <NUM>. Implant supports <NUM> are removed.

Upon completion of a procedure, as described herein, the surgical instruments, assemblies and non-implanted components of surgical system <NUM> are removed and the incision(s) are closed. One or more of the components of surgical 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 may be employed to access, view and repair spinal deterioration or damage, with the aid of surgical system <NUM>. In some embodiments, surgical system <NUM> may include one or a plurality of plates, connectors and/or bone fasteners for use with a single vertebral level or a plurality of vertebral levels.

In some embodiments, surgical system <NUM> includes one or a plurality of alternate surgical instruments, each configured for mating engagement in a quick release configuration with spinal constructs, as described herein. This configuration facilitates the interchangeability of the spinal constructs with the alternate surgical instruments. In some embodiments, surgical system <NUM> includes one or a plurality of alternate surgical instruments, such as, for example, inserters, extenders, reducers, spreaders, distractors, blades, retractors, clamps, forceps, elevators and drills, which may be alternately sized and dimensioned, and arranged as a kit.

Claim 1:
A surgical system (<NUM>) comprising:
an implant support (<NUM>) engageable with a receiver (<NUM>) of a fastener (<NUM>) having a shaft (<NUM>) configured to be fixed to vertebral tissue (V1, V2, V3);
a sleeve (<NUM>) having a first mating surface releasably engageable with the implant support (<NUM>) and a second mating surface (<NUM>) releasably engageable with the receiver (<NUM>); and
an adaptor (<NUM>) connected with the implant support (<NUM>) to releasably engage a surgical instrument (<NUM>) to distract and/or compress the vertebral tissue (V1, V2, V3),
wherein the receiver (<NUM>) includes spaced-apart walls (<NUM>, <NUM>) that define an implant cavity (<NUM>), and wherein the implant support (<NUM>) is engageable with a first wall (<NUM>) of the spaced-apart walls (<NUM>, <NUM>) of the receiver (<NUM>),
characterized in that
the second mating surface (<NUM>) is engageable with a second wall (<NUM>) of the spaced-apart walls (<NUM>, <NUM>) of the receiver (<NUM>), wherein the sleeve (<NUM>) includes an end (<NUM>) which includes a surface (<NUM>) that defines the second mating surface (<NUM>), wherein the second mating surface (<NUM>) is configured for capture of the second wall (<NUM>), wherein the second mating surface (<NUM>) includes a distal projection (<NUM>) configured for engagement with a cavity (<NUM>) disposed within the second wall (<NUM>) of the spaced-apart walls (<NUM>, <NUM>) of the receiver (<NUM>) to facilitate engagement.