Patent Description:
Fixation systems can be used in orthopedic surgery to maintain a desired spatial relationship between multiple bones or bone fragments. For example, various conditions of the spine, such as fractures, deformities, and degenerative disorders, can be treated by attaching a spinal fixation system to one or more vertebrae. Such systems typically include a spinal fixation element, such as a rigid or flexible rod or plate that is coupled to the vertebrae by attaching the element to various anchoring devices, such as screws, hooks, or wires. Once installed, the fixation system holds the vertebrae in a desired position until healing or spinal fusion can occur, or for some other period of time.

There are many instances in which it may be desirable to connect multiple implants to each other. For example, some revision surgeries involve extending a previously-installed construct to additional vertebral levels by coupling a newly-installed spinal rod to a previously-installed rod. By way of further example, aspects of the patient's anatomy, the surgical technique used, or the desired correction may require that multiple spinal rods be connected to one another. As yet another example, coupling multiple rods to one another can improve the overall strength and stability of an implanted construct.

There can be various difficulties associated with connecting multiple implants to each other. The available space for the implanted construct can often be very limited, particularly in the cervical area of the spine. Also, manipulating and handling these relatively small implants in the surgical wound may be challenging or cumbersome for the surgeon. There is a continual need for improved implant connectors and related methods.

<CIT> discloses an implantable spinal cross connector for connecting one or more spinal fixation devices, and more preferably for connecting two spinal fixation rods that are implanted within a patient's spinal system. In general, an exemplary cross connector includes an elongate body with at least one rod-receiving recess formed therein, and a locking mechanism that is adapted to couple to the elongate body and that is effective to lock a spinal fixation rod within the rod-receiving recess(es). In one embodiment, the locking mechanism applies a force to the first and second movable shoes to cause the shoes to move linearly and lock first and second spinal fixation rods within the first and second rod-receiving recesses.

Implant connectors and related methods are disclosed herein. The invention provides a connector according to claim <NUM>. The described methods are not explicitly claimed but are useful for understanding the invention.

Implant connectors and related methods are disclosed herein. In some embodiments, a connector can include a low-profile portion to facilitate use of the connector in surgical applications where space is limited. A connector includes a biased rod-pusher to allow the connector to "snap" onto a rod and/or to "drag" against the rod, e.g., for provisional positioning of the connector prior to locking.

Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the invention is defined by the appended claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments provided the resulting embodiments fall within the scope of the appended claims.

<FIG> illustrates an exemplary embodiment of a connector <NUM>. As shown, the connector <NUM> can include a body <NUM> that defines first and second rod-receiving recesses <NUM>, <NUM>, a rod pusher <NUM>, a nut <NUM>, a bias element or spring clip <NUM>, a first locking element or set screw <NUM>, and a second locking element or set screw <NUM>. The nut <NUM> can be configured to translate laterally within the body <NUM>, and can be biased by the spring clip <NUM> in a direction that urges the rod pusher <NUM> into a first rod R1 disposed in the first rod-receiving recess <NUM>. The first set screw <NUM> can be tightened to lock the connector <NUM> to the first rod R1. The second set screw <NUM> can be tightened to lock a second rod R2 in the second rod-receiving recess <NUM> of the connector <NUM>. The illustrated connector <NUM> can thus allow for independent locking of first and second rods R1, R2 to the connector. The connector <NUM> can include one or more low-profile portions to facilitate use in tight spaces. For example, the first rod-receiving recess <NUM> can be formed in a portion of the connector body <NUM> having a reduced-profile, e.g., to fit between bone anchors implanted in adjacent levels of the cervical spine.

The body <NUM> can include proximal and distal ends 102p, 102d that define a proximal-distal axis A1. The proximal end 102p of the body <NUM> can include a pair of spaced apart arms <NUM>, <NUM> that define the second rod-receiving recess <NUM> there between. A rod R2 disposed in the second rod-receiving recess <NUM> can have a central longitudinal rod axis A2. The second rod-receiving recess <NUM> can be open in a proximal direction, such that a rod R2 can be inserted into the recess by moving the rod distally with respect to the connector <NUM>. Each of the arms <NUM>, <NUM> can extend from the distal portion 102d of the body <NUM> to a free end. The outer surfaces of each of the arms <NUM>, <NUM> can include a feature (not shown), such as a recess, dimple, notch, projection, or the like, to facilitate coupling of the connector <NUM> to various instruments. For example, the outer surface of each arm <NUM>, <NUM> can include an arcuate groove at the respective free end of the arms for attaching the connector <NUM> to an extension tower or retractor. The arms <NUM>, <NUM> can include or can be coupled to extension or reduction tabs (not shown) that extend proximally from the body <NUM> to functionally extend the length of the arms <NUM>, <NUM>. The extension tabs can facilitate insertion and reduction of a rod or other implant, as well as insertion and locking of the set screw <NUM>. The extension tabs can be configured to break away or otherwise be separated from the arms <NUM>, <NUM>. The inner surfaces of each of the arms <NUM>, <NUM> can be configured to mate with the second set screw <NUM>. For example, the inner surfaces of the arms <NUM>, <NUM> can include threads that correspond to external threads formed on the second set screw <NUM>. Accordingly, rotation of the second set screw <NUM> with respect to the body <NUM> about the axis A1 can be effective to translate the set screw with respect to the body axially along the axis A1.

The distal end 102d of the body <NUM> can define an interior cavity <NUM> in which the nut <NUM> can be disposed. At least one dimension of the cavity <NUM> can be greater than a corresponding dimension of the nut <NUM> to allow the nut to translate within the cavity along a rod pusher axis A3. The axis A3 can be perpendicular or substantially perpendicular to the axis A1. The axis A3 can also be perpendicular or substantially perpendicular to the axis A2. The axis A3 can extend from the axis A1 at an angle in the range of about <NUM> degrees to about <NUM> degrees. In the illustrated embodiment, the cavity <NUM> has an oval-shaped cross section. An undercut groove <NUM> can be formed in the cavity <NUM> to receive at least a portion of the spring clip <NUM>. As shown in <FIG>, the cross section of the groove <NUM> can be substantially elliptical with different sized curvatures at each end of the major axis of the ellipse. A first end 124A of the groove <NUM> can have a relatively smaller radius of curvature and a second, opposite end 124B of the groove <NUM> can have a relatively larger radius of curvature. Curved transition portions of the groove <NUM> can extend between the first and second ends 124A, 124B, such that the groove is generally egg-shaped in cross section. The diameter of the first end 124A of the groove can be less than the resting diameter of the spring clip <NUM>, such that the spring clip's tendency to expand towards its resting diameter urges the spring clip and, by extension, the nut <NUM> and the rod pusher <NUM>, along the axis A3 towards the first rod-receiving recess <NUM>. The diameter of the second end 124B of the groove <NUM> can be greater than, equal to, or slightly less than the resting diameter of the spring clip <NUM>.

A recess <NUM> sized to receive at least a portion of the first set screw <NUM> can be formed in the body <NUM>, as shown for example in <FIG>. The recess <NUM> can be formed distal to the cavity <NUM>. The recess <NUM> can be frustoconical as shown to provide a ramped bearing surface for engagement with the distal end of the first set screw <NUM>. In other embodiments, the recess <NUM> can be cylindrical or can have other shapes.

A tunnel <NUM> can be formed in the body <NUM> and can extend along the axis A3 between the cavity <NUM> and the first rod-receiving recess <NUM>. The tunnel <NUM> can have a shape that is substantially a negative of the exterior shape of the rod pusher <NUM>. The rod pusher <NUM> can be slidably disposed within the tunnel <NUM> such that the rod pusher can translate along the axis A3 with respect to the body <NUM>.

The body <NUM> can include a cantilevered wing portion <NUM> that defines the first rod-receiving recess <NUM>. A rod R1 disposed in the first rod-receiving recess <NUM> can have a central longitudinal rod axis A4. The axis A4 can be parallel to the axis A2 as shown, or can be perpendicular or obliquely angled with respect to the axis A2. The wing portion <NUM> can extend radially-outward from the second arm <NUM> of the body <NUM>. The wing portion <NUM> can have a width 130W and a height <NUM>. A ratio of the width 130W to the diameter of the first rod-receiving recess <NUM> (or of a rod R1 disposed therein) can be less than about <NUM>:<NUM>, less than about <NUM>:<NUM>, and/or less than about <NUM>:<NUM>. A ratio of the height <NUM> to the diameter of the first rod-receiving recess <NUM> (or of a rod R1 disposed therein) can be less than about <NUM>:<NUM>, less than about <NUM>:<NUM>, and/or less than about <NUM>:<NUM>. In some embodiments, the height <NUM> can be less than about <NUM>, less than about <NUM>, and/or less than about <NUM>. The first rod-receiving recess <NUM> can be open in a distal direction such that a rod R1 can be inserted into the recess by moving the connector <NUM> distally with respect to the rod. In other embodiments, the first rod-receiving recess <NUM> can be open in a proximal direction, e.g., by flipping the wing portion <NUM> and forming it such that it extends from a distal portion of the body <NUM>, or open in a lateral direction.

The nut <NUM> can be positioned within the cavity <NUM> formed in the body <NUM>. The nut <NUM> can be sized such that it is laterally translatable within the cavity <NUM>, along the axis A3. The nut <NUM> can be generally cylindrical with first and second arms <NUM>, <NUM> extending in a proximal direction to respective free ends of the arms. The first and second arms <NUM>, <NUM> can be aligned with the first and second arms <NUM>, <NUM> of the body <NUM> such that a recess defined there between is aligned with the second rod-receiving recess <NUM>. Accordingly, the second rod R2 can be simultaneously cradled between the arms <NUM>, <NUM> of the nut <NUM> and the arms <NUM>, <NUM> of the body <NUM> when the rod is disposed in the second rod-receiving recess <NUM>.

The nut <NUM> can include a mating feature configured to couple the nut to the rod pusher <NUM>. For example, the nut can include a dovetail groove <NUM> formed in an exterior surface thereof sized to receive a corresponding dovetail projection <NUM> formed on the rod pusher <NUM>. The mating feature can be configured to prevent movement of the rod pusher <NUM> with respect to the nut <NUM> along the axis A3, while still allowing movement of the rod pusher with respect to the nut along the axis A1. Accordingly, the nut <NUM> can be assembled to the rod pusher <NUM> and the body <NUM> by inserting the rod pusher through the tunnel <NUM> along the axis A3 such that the dovetail projection <NUM> extends into the cavity <NUM> of the body <NUM>, and then lowering the nut distally into the cavity along the axis A1, with the projection <NUM> of the rod pusher <NUM> sliding into the groove <NUM> of the nut as the nut is advanced into the cavity. It will be appreciated that the groove can alternatively be formed in the rod pusher <NUM> and the projection formed on the nut <NUM>. It will further be appreciated that the nut <NUM> can be formed integrally with the rod pusher <NUM>, or mated to the rod pusher in other ways.

The nut <NUM> can include an annular groove <NUM> formed in an exterior surface thereof sized to receive at least a portion of the spring clip <NUM>. When the connector <NUM> is assembled, the spring clip <NUM> can extend partially into the groove <NUM> formed in the cavity <NUM> and partially into the groove <NUM> formed in the nut <NUM> to retain the nut within the cavity.

The nut <NUM> can define a central opening <NUM> that extends completely through the nut along the axis A1. The inner surface of the opening <NUM> can be configured to mate with the first set screw <NUM>. For example, the inner surface <NUM> can include threads that correspond to external threads formed on the first set screw <NUM>. Accordingly, rotation of the first set screw <NUM> with respect to the nut <NUM> about the axis A1 can be effective to translate the set screw with respect to the nut axially along the axis A1.

As noted above, the rod pusher <NUM> can be slidably disposed within the tunnel <NUM> of the body <NUM> and can be configured to translate with respect to the body along the axis A3. The rod pusher <NUM> can include a bearing surface <NUM> configured to contact and bear against a rod R1 disposed in the first rod-receiving recess <NUM>. The bearing surface <NUM> can extend at an oblique angle with respect to a longitudinal axis of the rod pusher <NUM> such that the bearing surface is ramped. The bearing surface <NUM> can be planar as shown, or can be convex, concave, pointed, sharpened, etc. For example, the bearing surface <NUM> can be concave and can define a section of a cylinder, such that the bearing surface matches or approximates the contour of a cylindrical rod R1 disposed in the first rod-receiving recess <NUM>. The rod pusher <NUM> can include a projection <NUM> or other mating feature, as described above, for mating the rod pusher to the nut <NUM>.

The bias element can be configured to bias the nut <NUM> and the rod pusher <NUM> towards the first rod-receiving recess <NUM>. In the illustrated embodiment, the bias element is a C-shaped spring clip <NUM>. The spring clip <NUM> can be formed from a resilient material such that, when radially-compressed, the spring clip tends to expand radially-outward towards its resting diameter. Accordingly, when compressed into the groove <NUM> formed in the cavity <NUM>, the spring clip <NUM> can exert a radial-outward force against the walls of the groove and can tend to urge the nut <NUM> and the rod pusher <NUM> towards the first rod-receiving recess <NUM>. While a C-shaped spring clip <NUM> is shown, various other bias elements can be used instead or in addition, such as leaf springs, wire springs, wave springs, coil springs, and the like.

The first set screw <NUM> can include a proximal portion 114p and a distal portion 114d. The proximal portion 114p of the first set screw <NUM> can include an exterior thread configured to mate with the interior threads of the nut <NUM> to allow the first set screw to be advanced or retracted along the axis A1 with respect to the nut by rotating the first set screw about the axis A1. The proximal portion 114p of the first set screw <NUM> can include a driving interface <NUM> configured to receive a driver for applying a rotational force to the first set screw about the axis A1. The distal portion 114d of the first set screw <NUM> can define a bearing surface configured to contact and bear against the recess <NUM> formed in the body <NUM>. In the illustrated embodiment, the distal portion 114d of the first set screw <NUM> defines a frustoconical ramped bearing surface that corresponds to the ramped bearing surface of the recess <NUM>. While a first set screw <NUM> is shown, it will be appreciated that other locking elements can be used instead or addition, such as a closure cap that advances and locks by quarter-turn rotation, a closure cap that slides in laterally without rotating, and so forth.

The second set screw <NUM> can include an exterior thread configured to mate with the interior threads formed on the arms <NUM>, <NUM> of the body <NUM> to allow the second set screw to be advanced or retracted along the axis A1 with respect to the body by rotating the second set screw about the axis A1. The second set screw <NUM> can include a driving interface <NUM> configured to receive a driver for applying a rotational force to the second set screw about the axis A1. The distal surface of the second set screw <NUM> can be configured to contact and bear against a rod R2 disposed in the second rod-receiving <NUM> recess to lock the rod to the connector <NUM>. When tightened against the rod R2, the second set screw <NUM> can prevent the rod from translating relative to the connector <NUM> along the axis A2 and/or from rotating with respect to the connector about the axis A2. While a second set screw <NUM> is shown, it will be appreciated that other locking elements can be used instead or addition, such as a closure cap that advances and locks by quarter-turn rotation, a closure cap that slides in laterally without rotating, a nut that threads onto an exterior of the connector <NUM>, and so forth.

Operation of the connector <NUM> is illustrated schematically in <FIG>.

As shown in <FIG>, the connector <NUM> can have a resting configuration in which no rod is disposed in the first or second rod-receiving recesses <NUM>, <NUM>. In this configuration, the biasing force of the spring clip <NUM> can cause the spring clip to slide into the larger diameter portion 124B of the groove <NUM>, thereby sliding the nut <NUM> and the rod pusher <NUM> towards the first rod-receiving recess <NUM>. The first set screw <NUM> can be mounted in the nut <NUM> at this time, but not advanced far enough for the distal end 114d of the set screw to contact the recess <NUM> of the body <NUM>.

In the resting configuration, the wing portion <NUM> of the body <NUM> and the free end of the rod pusher <NUM> can define an aperture <NUM> that is smaller than the diameter of a first rod R1 to which the connector <NUM> is to be coupled. Accordingly, as shown in <FIG>, as the rod R1 is inserted into the first rod-receiving recess <NUM>, the rod bears against the rod pusher <NUM> to move the connector <NUM> out of the resting configuration. Insertion of the rod R1 can move the rod pusher <NUM> and the nut <NUM> along the axis A3, thereby compressing the spring clip <NUM> towards the smaller diameter portion 124A of the groove <NUM>. As the largest cross-sectional portion of the rod R1 is positioned in the aperture <NUM>, the nut <NUM> can be displaced to its furthest distance from the first rod-receiving recess <NUM>.

As shown in <FIG>, once the largest cross-sectional portion of the rod R1 clears the aperture <NUM> as the rod is seated in the first rod-receiving recess <NUM>, the biasing force of the spring clip <NUM> can cause the nut <NUM> and the rod pusher <NUM> to move back along the axis A3 towards the first rod-receiving recess. This movement can at least partially close the aperture <NUM> around the rod R1 to capture the rod in the first rod-receiving recess <NUM>. The biasing force of the spring clip <NUM> can resist retrograde movement of the rod pusher <NUM> and thus resist disconnection of the connector <NUM> from the first rod R1. The spring clip <NUM> can be at least partially compressed when the rod R1 is fully seated in the recess <NUM>, such that the rod pusher <NUM> exerts a continuous drag force on the rod R1. When the connector <NUM> is positioned as desired with respect to the first rod R1, the first set screw <NUM> can be tightened within the nut <NUM> to lock the rod in the first rod-receiving recess <NUM>. As the first set screw <NUM> is tightened, the ramped surface of the first set screw can bear against the ramped surface of the recess <NUM> to urge the nut <NUM> towards the first rod-receiving recess <NUM> and urge the rod pusher <NUM> firmly into contact with the rod R1. When the first set screw <NUM> is tightened, the connector <NUM> can be locked to the first rod R1 to resist or prevent translation of the rod R1 with respect to the connector along the axis A4 and to resist or prevent rotation of the rod R1 with respect to the connector about the axis A4. A second rod R2 can be positioned in the second rod-receiving recess <NUM> and the second set screw <NUM> can be tightened to lock the rod R2 to the body <NUM>.

The connector <NUM> can thus be used to connect a first spinal rod R1 to a second spinal rod R2. While use of the connector <NUM> with first and second spinal rods is generally described herein, it will be appreciated that the connector can instead be configured for use with other types of orthopedic hardware, whether implanted or external. For example, one or both halves of the connector <NUM> can be modified to couple other various components to each other (e.g., to couple a rod to a plate, to couple a plate to a plate, to couple a rod to cable, to couple a cable to a cable, and so forth).

The connector <NUM> can provide various benefits for the user and/or patient. For example, the biased rod pusher <NUM> can provide tactile feedback when the connector <NUM> is "snapped" onto the first rod R1, giving the user confidence that the rod has been attached successfully before tightening the connector <NUM>. The biased rod pusher <NUM> can also apply friction or "drag" to the rod R1 prior to locking the set screws <NUM>, <NUM>, helping to keep the connector <NUM> in place and prevent "flopping" while still allowing free movement when intended by the user. By way of further example, the low-profile geometry of the wing portion <NUM> of the connector <NUM> can allow the connector to be used in surgical areas where space is limited (e.g., in the cervical area of the spine). In an exemplary method, the wing portion <NUM> of the connector <NUM> can be hooked onto a first rod R1 at a location between two bone anchors to which the rod is coupled, the two bone anchors being implanted in adjacent vertebral levels of the cervical spine. As yet another example, the connector <NUM> can facilitate independent locking of the first and second rods R1, R2. This can allow the connector <NUM> to be locked to the first rod R1 to limit or prevent movement of the connector before the second rod R2 is attached and/or locked.

<FIG> illustrate an exemplary embodiment of a connector <NUM>. As shown, the connector <NUM> includes a body <NUM> that defines first and second rod-receiving recesses <NUM>, <NUM>, a rod pusher <NUM>, a bias element or spring wire <NUM>, and a locking element or set screw <NUM>. The rod pusher <NUM> can be configured to translate laterally within the body <NUM>, and is biased by the spring wire <NUM> in a direction that urges the rod pusher into a first rod R1 disposed in the first rod-receiving recess <NUM> (in appended claim <NUM>, the rod pusher is biased by a bias element, which may be a spring wire). The set screw <NUM> is tightened to lock the connector <NUM> to both the first rod R1 and to a second rod R2 disposed in the second rod-receiving recess <NUM>. The illustrated connector <NUM> can thus allow for one-step locking of first and second rods R1, R2 to the connector. The connector <NUM> can include one or more low-profile portions to facilitate use in tight spaces. For example, the first rod-receiving recess <NUM> can be formed in a portion of the connector body <NUM> having a reduced-profile, e.g., to fit between bone anchors implanted in adjacent levels of the cervical spine.

The body <NUM> includes proximal and distal ends 202p, 202d that define a proximal-distal axis A1. The proximal end 202p of the body <NUM> can include a pair of spaced apart arms <NUM>, <NUM> that define the second rod-receiving recess <NUM> there between. A rod R2 disposed in the second rod-receiving recess <NUM> can have a central longitudinal rod axis A2. The second rod-receiving recess <NUM> can be open in a proximal direction, such that a rod R2 can be inserted into the recess by moving the rod distally with respect to the connector <NUM>. Each of the arms <NUM>, <NUM> can extend from the distal portion 202d of the body <NUM> to a free end. The outer surfaces of each of the arms <NUM>, <NUM> can include a feature (not shown), such as a recess, dimple, notch, projection, or the like, to facilitate coupling of the connector <NUM> to various instruments. For example, the outer surface of each arm <NUM>, <NUM> can include an arcuate groove at the respective free end of the arms for attaching the connector <NUM> to an extension tower or retractor. The arms <NUM>, <NUM> can include or can be coupled to extension or reduction tabs (not shown) that extend proximally from the body <NUM> to functionally extend the length of the arms <NUM>, <NUM>. The extension tabs can facilitate insertion and reduction of a rod or other implant, as well as insertion and locking of the set screw <NUM>. The extension tabs can be configured to break away or otherwise be separated from the arms <NUM>, <NUM>. The inner surfaces of each of the arms <NUM>, <NUM> can be configured to mate with the set screw <NUM>. For example, the inner surfaces of the arms <NUM>, <NUM> can include threads that correspond to external threads formed on the set screw <NUM>. Accordingly, rotation of the set screw <NUM> with respect to the body <NUM> about the axis A1 can be effective to translate the set screw with respect to the body axially along the axis A1.

The distal end 202d of the body <NUM> defines a tunnel <NUM> in which the rod pusher <NUM> is disposed. The tunnel <NUM> extends along a rod pusher axis A3 between the second rod-receiving recess <NUM> and the first rod-receiving recess <NUM>. The rod pusher <NUM> can be configured to translate within the tunnel <NUM> along the axis A3. The axis A3 can be perpendicular or substantially perpendicular to the axis A1. The axis A3 can also be perpendicular or substantially perpendicular to the axis A2. The axis A3 can extend from the axis A1 at an angle in the range of about <NUM> degrees to about <NUM> degrees. The tunnel <NUM> can have a shape that is substantially a negative of the exterior shape of the rod pusher <NUM>. A through-bore <NUM> can be formed in the body <NUM> such that the through-bore intersects with the tunnel <NUM>. The through-bore <NUM> can extend perpendicular or substantially perpendicular to the axis A3. The through-bore <NUM> can be sized to receive the spring wire <NUM> therein, as described further below. The through-bore <NUM> can be open at both ends or one or both ends can be closed.

The body <NUM> can include a cantilevered wing portion <NUM> that defines the first rod-receiving recess <NUM>. A rod R1 disposed in the first rod-receiving recess <NUM> can have a central longitudinal rod axis A4. The axis A4 can be parallel to the axis A2 as shown, or can be perpendicular or obliquely angled with respect to the axis A2. The wing portion <NUM> can extend radially-outward from the second arm <NUM> of the body <NUM>. The wing portion <NUM> can have a width 230W and a height <NUM>. A ratio of the width 230W to the diameter of the first rod-receiving recess <NUM> (or of a rod R1 disposed therein) can be less than about <NUM>:<NUM>, less than about <NUM>:<NUM>, and/or less than about <NUM>:<NUM>. A ratio of the height <NUM> to the diameter of the first rod-receiving recess <NUM> (or of a rod R1 disposed therein) can be less than about <NUM>:<NUM>, less than about <NUM>:<NUM>, and/or less than about <NUM>:<NUM>. In some embodiments, the height <NUM> can be less than about <NUM>, less than about <NUM>, and/or less than about <NUM>. The first rod-receiving recess <NUM> can be open in a distal direction such that a rod R1 can be inserted into the recess by moving the connector <NUM> distally with respect to the rod. In other embodiments, the first rod-receiving recess <NUM> can be open in a proximal direction, e.g., by flipping the wing portion <NUM> and forming it such that it extends from a distal portion of the body <NUM>, or in a lateral direction.

As noted above, the rod pusher <NUM> can be slidably disposed within the tunnel <NUM> of the body <NUM> and can be configured to translate with respect to the body along the axis A3. The rod pusher <NUM> includes a first bearing surface 244A configured to contact and bear against a first rod R1 disposed in the first rod-receiving recess <NUM>. The bearing surface 244A can extend at an oblique angle with respect to a longitudinal axis of the rod pusher <NUM> such that the bearing surface is ramped. The bearing surface 244A can be planar as shown, or can be convex, concave, pointed, sharpened, etc. For example, the bearing surface 244A can be concave and can define a section of a cylinder, such that the bearing surface matches or approximates the contour of a cylindrical rod R1 disposed in the first rod-receiving recess <NUM>. The rod pusher <NUM> includes a second bearing surface 244B configured to contact and bear against a second rod R2 disposed in the second rod-receiving recess <NUM>. The bearing surface 244B can extend at an oblique angle with respect to a longitudinal axis of the rod pusher <NUM> such that the bearing surface is ramped. The bearing surface 244B can be planar as shown, or can be convex, concave, pointed, sharpened, etc. For example, the bearing surface 244B can be concave and can define a section of a cylinder, such that the bearing surface matches or approximates the contour of a cylindrical rod R2 disposed in the second rod-receiving recess <NUM>.

The rod pusher <NUM> can include a through bore <NUM>. The through-bore <NUM> can extend perpendicular or substantially perpendicular to the axis A3. The through-bore <NUM> can be sized to receive the spring wire <NUM> therein. In at least some positions of the rod pusher <NUM> with respect to the body <NUM>, the through-bore <NUM> of the rod pusher can be aligned with the through-bore <NUM> of the body, such that the spring wire <NUM> extends through both through-bores <NUM>, <NUM>. As best shown in <FIG>, the through-bore <NUM> can include a middle portion and opposed end portions. The middle portion of the through-bore <NUM> can approximate the dimensions of the spring wire <NUM>. For example, the middle portion can be cylindrical and can have a diameter that is substantially equal to the diameter of the spring wire <NUM>. The end portions of the through-bore <NUM> can be elongated or can otherwise have a dimension greater than the diameter of the spring wire <NUM> to allow the rod pusher <NUM> to translate along the axis A3 and to accommodate the bend radius of the spring wire <NUM> during such translation. In some embodiments, the middle portion of the through-bore <NUM> can be defined by a pin inserted through the rod pusher <NUM>, as described further below with respect to <FIG>.

The bias element is configured to bias the rod pusher <NUM> towards the first rod-receiving recess <NUM>. In the illustrated embodiment, the bias element is a cylindrical spring wire <NUM>. The spring wire <NUM> can be formed from a resilient material such that, when deformed from a straight line, the spring wire tends to flex back towards its straight resting configuration. Accordingly, when deformed by movement of the rod pusher <NUM>, the spring wire <NUM> can exert a force against the interior of the through-bore <NUM> to urge the rod pusher <NUM> towards the first rod-receiving recess <NUM>. While a straight, cylindrical spring wire <NUM> is shown, various other bias elements can be used instead or in addition, such as non-straight or non-cylindrical wires, leaf springs, spring clips, wave springs, coil springs, and the like. In some embodiments, the bias element can be omitted. For example, the rod pusher <NUM> can be free to float within the tunnel <NUM>, or can be retained by a pin or other retention feature without being biased towards the first rod-receiving recess <NUM>.

The set screw <NUM> can include an exterior thread configured to mate with the interior threads formed on the arms <NUM>, <NUM> of the body <NUM> to allow the set screw to be advanced or retracted along the axis A1 with respect to the body by rotating the set screw about the axis A1. The set screw <NUM> can include a driving interface <NUM> configured to receive a driver for applying a rotational force to the set screw about the axis A1. The distal surface of the set screw <NUM> can be configured to contact and bear against a rod R2 disposed in the second rod-receiving <NUM> recess to lock the rod to the connector <NUM>. When tightened against the rod R2, the set screw <NUM> can prevent the rod from translating relative to the connector <NUM> along the axis A2 and/or from rotating with respect to the connector about the axis A2. While a set screw <NUM> is shown, it will be appreciated that other locking elements can be used instead or addition, such as a closure cap that advances and locks by quarter-turn rotation, a closure cap that slides in laterally without rotating, a nut that threads onto an exterior of the connector <NUM>, and so forth.

As shown in <FIG>, the connector <NUM> can have a resting configuration in which no rod is disposed in the first or second rod-receiving recesses <NUM>, <NUM>. In this configuration, the biasing force of the spring wire <NUM> can cause the rod pusher <NUM> to slide towards the first rod-receiving recess <NUM>.

In the resting configuration, the wing portion <NUM> of the body <NUM> and the free end of the rod pusher <NUM> can define an aperture <NUM> that is smaller than the diameter of a first rod R1 to which the connector <NUM> is to be coupled. Accordingly, as shown in <FIG>, as the rod R1 is inserted into the first rod-receiving recess <NUM>, the rod bears against the rod pusher <NUM> to move the connector <NUM> out of the resting configuration. Insertion of the rod R1 can move the rod pusher <NUM> along the axis A3, thereby deforming the spring wire <NUM> from its resting state. As the largest cross-sectional portion of the rod R1 is positioned in the aperture <NUM>, the rod pusher <NUM> can be displaced to its furthest distance from the first rod-receiving recess <NUM>.

As shown in <FIG>, once the largest cross-sectional portion of the rod R1 clears the aperture <NUM> as the rod is seated in the first rod-receiving recess <NUM>, the biasing force of the spring wire <NUM> can cause the rod pusher <NUM> to move back along the axis A3 towards the first rod-receiving recess. This movement can at least partially close the aperture <NUM> around the rod R1 to capture the rod in the first rod-receiving recess <NUM>. The biasing force of the spring wire <NUM> can resist retrograde movement of the rod pusher <NUM> and thus resist disconnection of the connector <NUM> from the first rod R1. The geometry of the connector <NUM> can be selected such that, when the rod R1 is fully seated in the first rod-receiving recess <NUM>, the spring wire <NUM> is deformed from its resting state. The spring wire <NUM> can thus press the rod pusher <NUM> against the rod R1 to provide a friction or drag effect, before the set screw <NUM> is tightened and/or before a second rod R2 is positioned in the connector <NUM>.

A second rod R2 can be positioned in the second rod-receiving recess <NUM>, and the set screw <NUM> can be tightened to lock the connector <NUM> to the first and second rods R1, R2. As the set screw <NUM> is tightened, the second rod R2 can press against the second bearing surface 244B of the rod pusher <NUM>, urging the rod pusher towards the first rod-receiving recess <NUM> and firmly into contact with the rod R1. When the set screw <NUM> is tightened, the connector <NUM> can be locked to the first and second rods R1, R2 to resist or prevent translation of the rods R1, R2 with respect to the connector along the axes A2, A4 and to resist or prevent rotation of the rods R1, R2 with respect to the connector about the axes A2, A4.

As shown in <FIG>, the second rod-receiving recess <NUM> can be shaped to encourage contact between the second rod R2 and the second bearing surface 244B of the rod pusher <NUM>. In other words, the recess <NUM> can be shaped to reduce or eliminate the risk that the second rod R2 will only bear against the floor of the recess <NUM> when the set screw <NUM> is tightened, without applying sufficient force to the bearing surface 244B. As shown, the recess <NUM> can include a relief disposed in alignment with the end of the tunnel <NUM> such that the rod pusher <NUM> protrudes into the recess. The recess <NUM> can thus be asymmetrical about the axis A1, and can deviate from a symmetrical U-shape. When the rod R2 is bottomed out in the recess <NUM>, the central longitudinal axis A2 of the rod can be offset from the axis A1. The central longitudinal axis of the rod R2 when the rod is fully seated is shown in <FIG> as axis A5. The recess <NUM> can be configured such that, as the rod R2 is seated within the recess <NUM>, it translates distally along the axis A1 and laterally along the axis A3.

As shown in <FIG>, the connector <NUM> can include a saddle <NUM>. The saddle <NUM> can be included in addition to the asymmetrical recess <NUM> or as an alternative thereto. The saddle <NUM> can be positioned within a cavity <NUM> formed in the body <NUM>. The saddle <NUM> can be generally cylindrical with first and second arms <NUM>, <NUM> extending in a proximal direction to respective free ends of the arms. The first and second arms <NUM>, <NUM> can be aligned with the first and second arms <NUM>, <NUM> of the body <NUM> such that a recess defined there between is aligned with the second rod-receiving recess <NUM>. Accordingly, the second rod R2 can be simultaneously cradled between the arms <NUM>, <NUM> of the saddle <NUM> and the arms <NUM>, <NUM> of the body <NUM> when the rod is disposed in the second rod-receiving recess <NUM>. The saddle <NUM> can include a ramped bearing surface <NUM> configured to contact and bear against the second bearing surface 244B of the rod pusher <NUM>. The bearing surface <NUM> can extend at an oblique angle with respect to the axis A1. The bearing surface <NUM> can be planar as shown, or can be convex, concave, pointed, sharpened, etc. In operation, a force applied to the saddle <NUM> along the direction A1, e.g., by tightening the set screw <NUM> down onto the saddle or down onto a rod R2 disposed in the saddle, can cause the saddle <NUM> to translate distally with respect to the body <NUM> and cause the bearing surface <NUM> to ramp along the bearing surface 244B of the rod pusher <NUM>, urging the rod pusher towards the first rod-receiving recess <NUM> along the axis A3. Accordingly, tightening the set screw <NUM> can be effective to simultaneously lock both rods R1, R2 to the connector <NUM>. The saddle <NUM> can allow for locking of rods having different diameters in the second rod-receiving recess <NUM>, while still ensuring that, regardless of the diameter of the second rod R2, sufficient force is applied to the rod pusher <NUM> to lock the first rod R1.

As shown in <FIG>, the rod pusher <NUM> can be configured to pivot with respect to the body <NUM>, instead of translating relative to the body or in addition to translating relative to the body. The tunnel <NUM> can be oversized or can include one or more reliefs <NUM> formed therein to allow the rod pusher <NUM> to rotate within the tunnel about a pivot axis A8. The rod pusher <NUM> can be pivotally mounted within the tunnel <NUM> by a pivot pin <NUM>. The connector <NUM> can include a bias element to bias the rod pusher <NUM>. For example, a spring wire of the type described above can be used to bias translation of the rod pusher <NUM> relative to the body <NUM>. By way of further example, the pivot pin <NUM> can be a torsion bar that biases rotation of the rod pusher <NUM> relative to the body <NUM>. Other ways of biasing rotation of the rod pusher <NUM> can be used instead or in addition, such as coil springs, leaf springs, and the like. In operation, a force applied to a first end of the rod pusher <NUM> along the direction A1, e.g., by tightening the set screw <NUM> down onto a rod R2 disposed in the second recess <NUM>, can cause the rod pusher to pivot or rotate about the pivot axis A8, urging a second opposite end of the rod pusher against a rod R1 disposed in the first recess <NUM>. Accordingly, tightening the set screw <NUM> can be effective to simultaneously lock both rods R1, R2 to the connector <NUM>. The connector of <FIG> can provide a mechanical advantage in locking the first rod R1 due to the lever action of the pivoting rod pusher <NUM>.

In some embodiments, the arms <NUM>, <NUM> can extend proximally past the maximum dimension of the rod R2 and the set screw <NUM> can include an outer screw configured to bear against a proximal-facing surface of the arms. An inner set screw can be threadably mounted within the outer set screw. Accordingly, the outer set screw can be tightened first to press down on the saddle <NUM> and lock the first rod R1 in the first rod-receiving recess <NUM>. Then, the inner set screw can be tightened to press down on the second rod R2 and lock the second rod in the second rod-receiving recess <NUM>. The dual set screw can thus facilitate independent locking of the first and second rods R1, R2 to the connector <NUM>. While not shown in <FIG>, embodiments of the connector <NUM> that include a saddle <NUM> can also include a bias element as described above for biasing the rod pusher <NUM> towards the first rod-receiving recess <NUM>.

The connector <NUM> can provide various benefits for the user and/or patient. For example, the biased rod pusher <NUM> can provide tactile feedback when the connector <NUM> is "snapped" onto the first rod R1, giving the user confidence that the rod has been attached successfully before tightening the connector. The biased rod pusher <NUM> can also apply friction or "drag" to the rod R1 prior to locking the set screw <NUM>, helping to keep the connector in place and prevent "flopping" while still allowing free movement when intended by the user. By way of further example, the low-profile geometry of the wing portion <NUM> of the connector <NUM> can allow the connector to be used in surgical areas where space is limited (e.g., in the cervical area of the spine). In an exemplary method, the wing portion <NUM> of the connector <NUM> can be hooked onto a first rod R1 at a location between two bone anchors to which the rod is coupled, the two bone anchors being implanted in adjacent vertebral levels of the cervical spine. As yet another example, the connector <NUM> can facilitate simultaneous and/or single-step locking of the first and second rods R1, R2. This can allow the connector <NUM> to be locked to both rods R1, R2 with minimal steps. In other embodiments, the connector <NUM> can facilitate independent locking of the rods R1, R2, e.g., with use of a saddle <NUM> and dual set screw.

<FIG> illustrate an exemplary embodiment of a connector <NUM>. As shown, the connector <NUM> can include a body <NUM> that defines first and second rod-receiving recesses <NUM>, <NUM>, a rod pusher <NUM>, a bias element or leaf spring <NUM>, a first locking element or set screw <NUM>, and a second locking element or set screw <NUM>. The rod pusher <NUM> can be biased by the leaf spring <NUM> in a direction that urges the rod pusher into a first rod R1 disposed in the first rod-receiving recess <NUM>. The first set screw <NUM> can be tightened to lock the connector <NUM> to the first rod R1. The second set screw <NUM> can be tightened to lock a second rod R2 in the second rod-receiving recess <NUM> of the connector <NUM>. The illustrated connector <NUM> can thus allow for independent locking of first and second rods R1, R2 to the connector. The connector <NUM> can include one or more low-profile portions to facilitate use in tight spaces. For example, the first rod-receiving recess <NUM> can be formed in a portion of the connector body <NUM> having a reduced-profile, e.g., to fit between bone anchors implanted in adjacent levels of the cervical spine.

The body <NUM> can include proximal and distal ends 302p, 302d that define a proximal-distal axis A1. The proximal end 302p of the body <NUM> can include a pair of spaced apart arms <NUM>, <NUM> that define the second rod-receiving recess <NUM> there between. A rod R2 disposed in the second rod-receiving recess <NUM> can have a central longitudinal rod axis A2. The second rod-receiving recess <NUM> can be open in a proximal direction, such that a rod R2 can be inserted into the recess by moving the rod distally with respect to the connector <NUM>. Each of the arms <NUM>, <NUM> can extend from the distal portion 302d of the body <NUM> to a free end. The outer surfaces of each of the arms <NUM>, <NUM> can include a feature (not shown), such as a recess, dimple, notch, projection, or the like, to facilitate coupling of the connector <NUM> to various instruments. For example, the outer surface of each arm <NUM>, <NUM> can include an arcuate groove at the respective free end of the arms for attaching the connector <NUM> to an extension tower or retractor. The arms <NUM>, <NUM> can include or can be coupled to extension or reduction tabs (not shown) that extend proximally from the body <NUM> to functionally extend the length of the arms <NUM>, <NUM>. The extension tabs can facilitate insertion and reduction of a rod or other implant, as well as insertion and locking of the set screw <NUM>. The extension tabs can be configured to break away or otherwise be separated from the arms <NUM>, <NUM>. The inner surfaces of each of the arms <NUM>, <NUM> can be configured to mate with the second set screw <NUM>. For example, the inner surfaces of the arms <NUM>, <NUM> can include threads that correspond to external threads formed on the second set screw <NUM>. Accordingly, rotation of the second set screw <NUM> with respect to the body <NUM> about the axis A1 can be effective to translate the set screw with respect to the body axially along the axis A1.

The body <NUM> can include a cantilevered wing portion <NUM> that defines the first rod-receiving recess <NUM>. A rod R1 disposed in the first rod-receiving recess <NUM> can have a central longitudinal rod axis A4. The axis A4 can be parallel to the axis A2 as shown, or can be perpendicular or obliquely angled with respect to the axis A2. The wing portion <NUM> can extend radially-outward from the second arm <NUM> of the body <NUM>. The wing portion <NUM> can have a width 330W and a height <NUM>. A ratio of the width 330W to the diameter of the first rod-receiving recess <NUM> (or of a rod R1 disposed therein) can be less than about <NUM>:<NUM>, less than about <NUM>:<NUM>, and/or less than about <NUM>:<NUM>. A ratio of the height <NUM> to the diameter of the first rod-receiving recess <NUM> (or of a rod R1 disposed therein) can be less than about <NUM>:<NUM>, less than about <NUM>:<NUM>, and/or less than about <NUM>:<NUM>. In some embodiments, the height <NUM> can be less than about <NUM>, less than about <NUM>, and/or less than about <NUM>. The first rod-receiving recess <NUM> can be open in a lateral direction such that a rod R1 can be inserted into the recess by moving the connector <NUM> laterally with respect to the rod. In other embodiments, the first rod-receiving recess <NUM> can be open in a proximal or distal direction, e.g., by flipping the orientation of the wing portion <NUM>, the first set screw <NUM>, and the rod pusher <NUM>.

A tunnel <NUM> can be formed in the body <NUM> and can extend along a tunnel axis A6 between a proximal-facing surface of the body <NUM> and the first rod-receiving recess <NUM>. The tunnel <NUM> can be formed in the wing portion <NUM> of the body <NUM>. The tunnel <NUM> can have a shape that is substantially a negative of the exterior shape of the rod pusher <NUM>. The rod pusher <NUM> can be slidably disposed within the tunnel <NUM> such that the rod pusher can translate along the axis A6 with respect to the body <NUM>. A through-bore <NUM> can be formed in the body <NUM> such that the through-bore intersects with the tunnel <NUM>. The through-bore <NUM> can extend perpendicular or substantially perpendicular to the axis A6. The through-bore <NUM> can be sized to receive the leaf spring <NUM> therein, as described further below. The through-bore <NUM> can be rectangular or substantially rectangular as shown, or can have other shapes. The through-bore <NUM> can have a maximum height in the proximal-distal direction that is less than a corresponding height of the leaf spring <NUM> in its resting position. Accordingly, when disposed within the through-bore <NUM>, the leaf spring <NUM> can be maintained in a deformed position such that it exerts a constant biasing force on the rod pusher <NUM>. The through-bore <NUM> can be open at both ends or one or both ends can be closed.

A proximal end of the tunnel <NUM> can define a recess <NUM> sized to receive at least a portion of the first set screw <NUM>. The inner surface of the recess <NUM> can be configured to mate with the first set screw <NUM>. For example, the inner surface <NUM> can include threads that correspond to external threads formed on the first set screw <NUM>. Accordingly, rotation of the first set screw <NUM> with respect to the body <NUM> about the axis A6 can be effective to translate the set screw with respect to the body axially along the axis A6. The recess <NUM> can be cylindrical as shown or can be conical or have other shapes.

As noted above, the rod pusher <NUM> can be slidably disposed within the tunnel <NUM> of the body <NUM> and can be configured to translate with respect to the body along the axis A6. The rod pusher <NUM> can include a bearing surface <NUM> configured to contact and bear against a rod R1 disposed in the first rod-receiving recess <NUM>. The bearing surface <NUM> can include a distal-facing surface of the rod pusher <NUM>. At least a portion of the bearing surface <NUM> can extend at an oblique angle with respect to a longitudinal axis of the rod pusher <NUM> such that the bearing surface is ramped. The bearing surface <NUM> can be planar as shown, or can be concave, convex, pointed, sharpened, etc. For example, the bearing surface <NUM> can be concave and can define a section of a cylinder, such that the bearing surface matches or approximates the contour of a cylindrical rod R1 disposed in the first rod-receiving recess <NUM>. The rod pusher <NUM> can include a projection <NUM> or other mating feature for mating the rod pusher to the leaf spring <NUM>. The projection <NUM> can include an undercut or reduced distal portion and an enlarged proximal portion.

The bias element can be configured to bias the rod pusher <NUM> towards the first rod-receiving recess <NUM>. In the illustrated embodiment, the bias element is a rectangular leaf spring <NUM>. The leaf spring <NUM> can be formed from a resilient material such that, when deformed from a resting position, the leaf spring <NUM> tends to flex back towards the resting configuration. Accordingly, when deformed by movement of the rod pusher <NUM>, the leaf spring <NUM> can exert a force against the interior of the through-bore <NUM> to urge the rod pusher <NUM> towards the first rod-receiving recess <NUM>. While a flat rectangular leaf spring <NUM> is shown, various other bias elements can be used instead or in addition, such as spring wires, spring clips, wave springs, coil springs, and the like. In some embodiments, the bias element can be omitted. For example, the rod pusher <NUM> can be free to float within the tunnel <NUM>, or can be retained by a pin or other retention feature without being biased towards the first rod-receiving recess <NUM>. The leaf spring <NUM> can include an opening <NUM> or other mating feature for mating the leaf spring to the rod pusher <NUM>. In the illustrated embodiment, the leaf spring <NUM> includes a keyed opening <NUM> configured to mate with the projection <NUM> of the rod pusher <NUM>. The opening <NUM> can have a first portion 336A with a diameter that is large enough for the enlarged proximal portion of the projection <NUM> to pass through the opening. The opening <NUM> can have a second portion 336B with a diameter that is large enough for the reduced distal portion of the projection <NUM> to pass through the opening but not large enough for the enlarged proximal portion of the projection <NUM> to pass through the opening. The leaf spring <NUM> can thus be configured to retain the rod pusher <NUM> within the body <NUM> and vice versa.

Assembly of the leaf spring <NUM> to the rod pusher <NUM> is illustrated schematically in <FIG>. As shown in <FIG>, the rod pusher <NUM> can be inserted into the tunnel <NUM> and positioned distal to the through-bore <NUM>. The leaf spring <NUM> can be inserted into the through-bore <NUM> to position the first portion 336A of the opening <NUM> in line with the projection <NUM> of the rod pusher <NUM>, as shown in <FIG>. The rod pusher <NUM> can be moved proximally to pass the projection <NUM> through the first portion 336A of the opening <NUM>, and then the leaf spring <NUM> can be inserted further into the through-bore <NUM> to position the projection <NUM> in the second portion 336B of the opening <NUM>, as shown in <FIG>. In this position, the enlarged proximal portion of the projection <NUM> sits proximal to the leaf spring <NUM> and cannot pass through the opening <NUM>, thereby retaining the rod pusher <NUM> within the body <NUM>. The spring force of the leaf spring <NUM> acting against the interior of the through-bore <NUM> can be effective to retain the leaf spring within the through-bore.

The first set screw <NUM> can include an exterior thread configured to mate with the interior threads of the recess <NUM> to allow the first set screw to be advanced or retracted along the axis A6 with respect to the body <NUM> by rotating the first set screw about the axis A6. The first set screw <NUM> can include a driving interface <NUM> configured to receive a driver for applying a rotational force to the first set screw about the axis A6. The distal surface of the first set screw <NUM> can be configured to contact and bear against a portion of the rod pusher <NUM>, e.g., the projection <NUM>, to urge the rod pusher <NUM> against a rod R1 disposed in the first rod-receiving <NUM> recess and lock the rod to the connector <NUM>. When tightened against the rod pusher <NUM> and, by extension, the rod R1, the first set screw <NUM> can prevent the rod from translating relative to the connector <NUM> along the axis A4 and/or from rotating with respect to the connector about the axis A4. While a first set screw <NUM> is shown, it will be appreciated that other locking elements can be used instead or addition, such as a closure cap that advances and locks by quarter-turn rotation, a closure cap that slides in laterally without rotating, a nut that threads onto an exterior of the connector <NUM>, and so forth.

As shown in <FIG>, the connector <NUM> can have a resting configuration in which no rod is disposed in the first or second rod-receiving recesses <NUM>, <NUM>. In this configuration, the biasing force of the leaf spring <NUM> can cause the rod pusher <NUM> to slide distally towards the first rod-receiving recess <NUM>.

In the resting configuration, the wing portion <NUM> of the body <NUM> and the distal end of the rod pusher <NUM> can define an aperture <NUM> that is smaller than the diameter of a first rod R1 to which the connector <NUM> is to be coupled. Accordingly, as shown in <FIG>, as the rod R1 is inserted into the first rod-receiving recess <NUM>, the rod bears against the rod pusher <NUM> to move the connector <NUM> out of the resting configuration. Insertion of the rod R1 can move the rod pusher <NUM> proximally along the axis A6, thereby compressing the leaf spring <NUM> within the through-bore <NUM>. As the largest cross-sectional portion of the rod R1 is positioned in the aperture <NUM>, the rod pusher <NUM> can be displaced to its furthest distance from the first rod-receiving recess <NUM>.

As shown in <FIG>, once the largest cross-sectional portion of the rod R1 clears the aperture <NUM> as the rod is seated in the first rod-receiving recess <NUM>, the biasing force of the leaf spring <NUM> can cause the rod pusher <NUM> to move distally, back along the axis A6 towards the first rod-receiving recess. This movement can at least partially close the aperture <NUM> around the rod R1 to capture the rod in the first rod-receiving recess <NUM>. The biasing force of the leaf spring <NUM> can resist retrograde movement of the rod pusher <NUM> and thus resist disconnection of the connector <NUM> from the first rod R1. The leaf spring <NUM> can be at least partially compressed when the rod R1 is fully seated in the recess <NUM>, such that the rod pusher <NUM> exerts a continuous drag force on the rod R1. When the connector <NUM> is positioned as desired with respect to the first rod R1, the first set screw <NUM> can be tightened to lock the rod in the first rod-receiving recess <NUM>. As the first set screw <NUM> is tightened, the rod pusher <NUM> can be pressed distally, firmly into contact with the rod R1. When the first set screw <NUM> is tightened, the connector <NUM> can be locked to the first rod R1 to resist or prevent translation of the rod R1 with respect to the connector along the axis A4 and to resist or prevent rotation of the rod R1 with respect to the connector about the axis A4. A second rod R2 can be positioned in the second rod-receiving recess <NUM> and the second set screw <NUM> can be tightened to lock the rod R2 to the body <NUM>.

The connector <NUM> can thus be used to connect a first spinal rod R1 to a second spinal rod R2. While use of the connector <NUM> with first and second spinal rods is generally described herein, it will be appreciated that the connector can instead be configured for use with other types of orthopedic hardware, whether implanted or external. For example, one or both halves of the connector <NUM> can be modified to couple other various components to each other (e.g., to couple a rod to a plate, to couple a plate to a plate, to couple a rod to cable, to couple a cable to a cable, and so forth). By way of further example, half of the connector <NUM>, e.g., the portion of the body in which the second rod-receiving recess <NUM> is formed, can be replaced with an integral rod, a transverse bar, a cable connector, a plate with an opening formed therein for receiving a bone anchor, and so forth. In some embodiments, the structure of the connector <NUM> for attaching the second rod R2 can be a mirror image of the opposite half of the connector <NUM>. In other words, the connector <NUM> can include two leaf springs <NUM>, two rod pushers <NUM>, etc..

The connector <NUM> can provide various benefits for the user and/or patient. For example, the biased rod pusher <NUM> can provide tactile feedback when the connector <NUM> is "snapped" onto the first rod R1, giving the user confidence that the rod has been attached successfully before tightening the connector. The biased rod pusher <NUM> can also apply friction or "drag" to the rod R1 prior to locking the set screw <NUM>, helping to keep the connector <NUM> in place and prevent "flopping" while still allowing free movement when intended by the user. The snap and drag features of the connector <NUM> can be completely independent of the set screw <NUM>, such that the connector can snap and drag onto a rod R1 regardless of whether the set screw <NUM> is tightened or even present in the connector. By way of further example, the low-profile geometry of the wing portion <NUM> of the connector <NUM> can allow the connector to be used in surgical areas where space is limited (e.g., in the cervical area of the spine). In an exemplary method, the wing portion <NUM> of the connector <NUM> can be hooked onto a first rod R1 at a location between two bone anchors to which the rod is coupled, the two bone anchors being implanted in adjacent vertebral levels of the cervical spine. As yet another example, the connector <NUM> can facilitate independent locking of the first and second rods R1, R2. This can allow the connector <NUM> to be locked to the first rod R1 to limit or prevent movement of the connector before the second rod R2 is attached and/or locked.

<FIG> illustrate an exemplary embodiment of a connector <NUM>. Except as indicated below and as will be readily appreciated by one having ordinary skill in the art, the structure and operation of the connector <NUM> is substantially similar to that of the connector <NUM>, and therefore a detailed description is omitted here for the sake of brevity.

As shown, the connector <NUM> can include a body <NUM> that defines first and second rod-receiving recesses <NUM>, <NUM>, a rod pusher <NUM>, a bias element or spring wire <NUM>, a first locking element or set screw <NUM>, and a second locking element or set screw <NUM>. The rod pusher <NUM> can be biased by the spring wire <NUM> in a direction that urges the rod pusher into a first rod R1 disposed in the first rod-receiving recess <NUM>. The first set screw <NUM> can be tightened to lock the connector <NUM> to the first rod R1. The second set screw <NUM> can be tightened to lock a second rod R2 in the second rod-receiving recess <NUM> of the connector <NUM>. The illustrated connector <NUM> can thus allow for independent locking of first and second rods R1, R2 to the connector. The connector <NUM> can include one or more low-profile portions to facilitate use in tight spaces. For example, the first rod-receiving recess <NUM> can be formed in a portion <NUM> of the connector body <NUM> having a reduced-profile, e.g., to fit between bone anchors implanted in adjacent levels of the cervical spine.

The body <NUM> can include proximal and distal ends 402p, 402d that define a proximal-distal axis A1. The proximal end 402p of the body <NUM> can include a pair of spaced apart arms <NUM>, <NUM> that define the second rod-receiving recess <NUM> there between. A rod R2 disposed in the second rod-receiving recess <NUM> can have a central longitudinal rod axis A2.

As shown for example in <FIG>, a spring wire <NUM> can be used to bias the rod pusher <NUM> towards the first rod-receiving recess <NUM>, instead of or in addition to the leaf spring <NUM> of the connector <NUM>. The rod pusher <NUM> can include a through bore <NUM> sized to receive the spring wire <NUM> therein. In at least some positions of the rod pusher <NUM> with respect to the body <NUM>, the through-bore <NUM> of the rod pusher can be aligned with the through-bore <NUM> of the body, such that the spring wire <NUM> extends through both through-bores <NUM>, <NUM>. The through-bore <NUM> can include a middle portion and opposed end portions. The middle portion of the through-bore <NUM> can approximate the dimensions of the spring wire <NUM>. For example, the middle portion can be cylindrical and can have a diameter that is substantially equal to the diameter of the spring wire <NUM>. The end portions of the through-bore <NUM> can be elongated or can otherwise have a dimension greater than the diameter of the spring wire <NUM> to allow the rod pusher <NUM> to translate along the tunnel axis A6 and to accommodate the bend radius of the spring wire <NUM> during such translation. The longitudinal axes of the through-bores <NUM>, <NUM> and the spring wire <NUM> can extend perpendicular or substantially perpendicular to the axis A6 and parallel or substantially parallel to the axis A4, as shown in <FIG>. Alternatively, as shown in <FIG>, the longitudinal axes of the through-bores <NUM>, <NUM> and the spring wire <NUM> can extend perpendicular or substantially perpendicular to the axis A6 and perpendicular or substantially perpendicular to the axis A4.

As shown in <FIG>, the rod pusher <NUM> can be configured to translate along the axis A6 within a tunnel <NUM> formed in the body <NUM>. The rod pusher <NUM> can translate within the tunnel <NUM> under the bias of the spring wire <NUM> to provide a snap and drag feature with respect to the first rod R1.

In other embodiments, the rod pusher <NUM> can pivot with respect to the body <NUM> about a rotation axis instead of or in addition to translating. For example, as shown in <FIG>, the rod pusher <NUM> can be pivotally mounted within the tunnel <NUM> on a pivot pin or axle <NUM>. The rod pusher <NUM> can therefore rotate along the arc A7 as a rod R1 is inserted into the first rod-receiving recess <NUM>. Apart from this pivoting movement, operation of the connector <NUM> shown in <FIG> is the same as described above.

<FIG> illustrate an exemplary embodiment of a connector <NUM>. As shown, the connector <NUM> includes a body <NUM> that defines first and second rod-receiving recesses <NUM>, <NUM>, a rod pusher <NUM>, a bias element or leaf spring <NUM>, and a locking element or set screw <NUM>. The rod pusher <NUM> can be configured to translate laterally within the body <NUM>, and is biased by the leaf spring <NUM> in a direction that urges the rod pusher into a first rod R1 disposed in the first rod-receiving recess <NUM> (in appended claim <NUM>, the rod pusher is biased by a bias element, which may be a leaf spring). The set screw <NUM> is tightened to lock the connector <NUM> to both the first rod R1 and to a second rod R2 disposed in the second rod-receiving recess <NUM>. The illustrated connector <NUM> can thus allow for one-step locking of first and second rods R1, R2 to the connector. The connector <NUM> can include one or more low-profile portions to facilitate use in tight spaces. For example, the first rod-receiving recess <NUM> can be formed in a portion of the connector body <NUM> having a reduced-profile, e.g., to fit between bone anchors implanted in adjacent levels of the cervical spine.

The body <NUM> includes proximal and distal ends 502p, 502d that define a proximal-distal axis A1. The proximal end 502p of the body <NUM> can include a pair of spaced apart arms <NUM>, <NUM> that define the second rod-receiving recess <NUM> there between. A rod R2 disposed in the second rod-receiving recess <NUM> can have a central longitudinal rod axis A2. The second rod-receiving recess <NUM> can be open in a proximal direction, such that a rod R2 can be inserted into the recess by moving the rod distally with respect to the connector <NUM>. Each of the arms <NUM>, <NUM> can extend from the distal portion 502d of the body <NUM> to a free end. The outer surfaces of each of the arms <NUM>, <NUM> can include a feature (not shown), such as a recess, dimple, notch, projection, or the like, to facilitate coupling of the connector <NUM> to various instruments. For example, the outer surface of each arm <NUM>, <NUM> can include an arcuate groove at the respective free end of the arms for attaching the connector <NUM> to an extension tower or retractor. The arms <NUM>, <NUM> can include or can be coupled to extension or reduction tabs (not shown) that extend proximally from the body <NUM> to functionally extend the length of the arms <NUM>, <NUM>. The extension tabs can facilitate insertion and reduction of a rod or other implant, as well as insertion and locking of the set screw <NUM>. The extension tabs can be configured to break away or otherwise be separated from the arms <NUM>, <NUM>. The inner surfaces of each of the arms <NUM>, <NUM> can be configured to mate with the set screw <NUM>. For example, the inner surfaces of the arms <NUM>, <NUM> can include threads that correspond to external threads formed on the set screw <NUM>. Accordingly, rotation of the set screw <NUM> with respect to the body <NUM> about the axis A1 can be effective to translate the set screw with respect to the body axially along the axis A1.

The distal end 502d of the body <NUM> defines a tunnel <NUM> in which the rod pusher <NUM> can be disposed. The tunnel <NUM> extends along a rod pusher axis A3 between the second rod-receiving recess <NUM> and the first rod-receiving recess <NUM>. The rod pusher <NUM> is configured to translate within the tunnel <NUM> along the axis A3. The axis A3 can be perpendicular or substantially perpendicular to the axis A1. The axis A3 can also be perpendicular or substantially perpendicular to the axis A2. The axis A3 can extend from the axis A1 at an angle in the range of about <NUM> degrees to about <NUM> degrees. The tunnel <NUM> can have a shape that is substantially a negative of the exterior shape of the rod pusher <NUM>. The tunnel <NUM> can include opposed recesses <NUM> formed therein sized to receive respective ends of the leaf spring <NUM>. As shown in <FIG>, the recesses <NUM> can be formed by drilling bore holes <NUM> into the distal-facing surface of the body <NUM>, such that the bore holes <NUM> intersect with the tunnel <NUM>. Alternatively, the recesses <NUM> can be formed by a lateral through-bore similar to the through-bore <NUM> of the connector <NUM> described above, but instead being vertically-elongated or otherwise dimensioned to receive the leaf spring <NUM>.

The body <NUM> can include a cantilevered wing portion <NUM> that defines the first rod-receiving recess <NUM>. A rod R1 disposed in the first rod-receiving recess <NUM> can have a central longitudinal rod axis A4. The axis A4 can be parallel to the axis A2 as shown, or can be perpendicular or obliquely angled with respect to the axis A2. The wing portion <NUM> can extend radially-outward from the second arm <NUM> of the body <NUM>. The wing portion <NUM> can have a width 530W and a height <NUM>. A ratio of the width 530W to the diameter of the first rod-receiving recess <NUM> (or of a rod R1 disposed therein) can be less than about <NUM>:<NUM>, less than about <NUM>:<NUM>, and/or less than about <NUM>:<NUM>. A ratio of the height <NUM> to the diameter of the first rod-receiving recess <NUM> (or of a rod R1 disposed therein) can be less than about <NUM>:<NUM>, less than about <NUM>:<NUM>, and/or less than about <NUM>:<NUM>. In some embodiments, the height <NUM> can be less than about <NUM>, less than about <NUM>, and/or less than about <NUM>. The first rod-receiving recess <NUM> can be open in a distal direction such that a rod R1 can be inserted into the recess by moving the connector <NUM> distally with respect to the rod. In other embodiments, the first rod-receiving recess <NUM> can be open in a proximal direction, e.g., by flipping the wing portion <NUM> and forming it such that it extends from a distal portion of the body <NUM>, or in a lateral direction.

As noted above, the rod pusher <NUM> is slidably disposed within the tunnel <NUM> of the body <NUM> and is configured to translate with respect to the body along the axis A3. The rod pusher <NUM> includes a first bearing surface 544A configured to contact and bear against a first rod R1 disposed in the first rod-receiving recess <NUM>. The bearing surface 544A can extend at an oblique angle with respect to a longitudinal axis of the rod pusher <NUM> such that the bearing surface is ramped. The bearing surface 544A can be planar as shown, or can be convex, concave, pointed, sharpened, etc. For example, the bearing surface 544A can be concave and can define a section of a cylinder, such that the bearing surface matches or approximates the contour of a cylindrical rod R1 disposed in the first rod-receiving recess <NUM>. The rod pusher <NUM> includes a second bearing surface 544B configured to contact and bear against a second rod R2 disposed in the second rod-receiving recess <NUM>. The bearing surface 544B can extend at an oblique angle with respect to a longitudinal axis of the rod pusher <NUM> such that the bearing surface is ramped. The bearing surface 544B can be planar as shown, or can be convex, concave, pointed, sharpened, etc. For example, the bearing surface 544B can be concave and can define a section of a cylinder, such that the bearing surface matches or approximates the contour of a cylindrical rod R2 disposed in the second rod-receiving recess <NUM>.

The rod pusher <NUM> can include a through-bore <NUM>. The through-bore <NUM> can extend perpendicular or substantially perpendicular to the axis A3. The through-bore <NUM> can be sized to receive the leaf spring <NUM> therein. In at least some positions of the rod pusher <NUM> with respect to the body <NUM>, the through-bore <NUM> of the rod pusher can be aligned with the recesses <NUM> of the body, such that the leaf spring <NUM> extends through the through-bore <NUM> and into the opposed recesses <NUM>. As shown in <FIG>, the through-bore <NUM> can include a middle portion and opposed end portions. The middle portion of the through-bore <NUM> can approximate the dimensions of the leaf spring <NUM>. For example, the middle portion can have a width that is substantially equal to the thickness of the leaf spring <NUM>. The end portions of the through-bore <NUM> can be elongated or can otherwise have a dimension greater than the thickness of the leaf spring <NUM> to allow the rod pusher <NUM> to translate along the axis A3 and to accommodate the bend radius of the leaf spring <NUM> during such translation.

As shown, the internal geometry of the through-bore <NUM> can be defined at least in part by a pin <NUM>. In particular, the pin <NUM> can define the reduced-width middle portion of the through-bore <NUM>. The pin <NUM> can be inserted through a pin hole <NUM> formed in the rod pusher <NUM> that intersects with the through-bore <NUM>. The pin hole <NUM> can extend perpendicular or substantially perpendicular to the axis A3 and parallel or substantially parallel to the axis A1. Forming the internal geometry of the through-bore <NUM> in this manner can advantageously reduce the complexity of the manufacturing process as compared, for example, with forming the internal geometry as shown in <FIG> above.

The connector <NUM> can be assembled by inserting the leaf spring <NUM> through the through-bore <NUM> formed in the rod pusher <NUM> and then inserting the rod pusher <NUM> into the tunnel <NUM> of the body <NUM>. As the rod pusher <NUM> is inserted into the body <NUM>, the ends of the leaf spring <NUM> can be temporarily deformed against sidewalls of the tunnel until the ends are aligned with and snap into the recesses <NUM> formed in the tunnel.

The bias element can be configured to bias the rod pusher <NUM> towards the first rod-receiving recess <NUM>. In the illustrated embodiment, the bias element is a rectangular leaf spring <NUM>. The leaf spring <NUM> can be formed from a resilient material such that, when deformed from a straight line, the leaf spring tends to flex back towards its straight resting configuration. Accordingly, when deformed by movement of the rod pusher <NUM>, the leaf spring <NUM> can exert a force against the interior of the through-bore <NUM> to urge the rod pusher <NUM> towards the first rod-receiving recess <NUM>. While a straight, rectangular leaf spring <NUM> is shown, various other bias elements can be used instead or in addition, such as non-straight or non-rectangular leaf springs, spring wires, spring clips, wave springs, coil springs, and the like. In some embodiments, the bias element can be omitted. For example, the rod pusher <NUM> can be free to float within the tunnel <NUM>, or can be retained by a pin or other retention feature without being biased towards the first rod-receiving recess <NUM>. Use of a relatively flat leaf spring <NUM> as shown can, in some embodiments, provide certain advantages. For example, a cylindrical spring wire may need to be made very thin to provide the desired spring force, which can make manufacturing and assembly of the connector <NUM> challenging. By using a relatively flat leaf spring <NUM>, the bias element can be made thin enough to provide the desired spring force without making manufacturing or assembly more difficult. Also, a relatively flat leaf spring <NUM> can be less prone to rotation, making it easier to constrain movement of the bias element and/or limiting rotation of the rod pusher <NUM> within the tunnel <NUM>.

The set screw <NUM> can include an exterior thread configured to mate with the interior threads formed on the arms <NUM>, <NUM> of the body <NUM> to allow the set screw to be advanced or retracted along the axis A1 with respect to the body by rotating the set screw about the axis A1. The set screw <NUM> can include a driving interface <NUM> configured to receive a driver for applying a rotational force to the set screw about the axis A1. The distal surface of the set screw <NUM> is configured to contact and bear against a rod R2 disposed in the second rod-receiving <NUM> recess to lock the rod to the connector <NUM>. When tightened against the rod R2, the set screw <NUM> can prevent the rod from translating relative to the connector <NUM> along the axis A2 and/or from rotating with respect to the connector about the axis A2. While a set screw <NUM> is shown, it will be appreciated that other locking elements can be used instead or addition, such as a closure cap that advances and locks by quarter-turn rotation, a closure cap that slides in laterally without rotating, a nut that threads onto an exterior of the connector <NUM>, and so forth.

As will be appreciated by one having ordinary skill in the art having reviewed the present disclosure, operation of the connector <NUM> is substantially the same as that of the connector <NUM> described above. Accordingly, a detailed description is omitted here for the sake of brevity. Any of the features described above with respect to the connector <NUM>, including those shown in <FIG>, can be applied to the connector <NUM>.

The connector <NUM> can provide various benefits for the user and/or patient. For example, the biased rod pusher <NUM> can provide tactile feedback when the connector <NUM> is "snapped" onto the first rod R1, giving the user confidence that the rod has been attached successfully before tightening the connector. The biased rod pusher <NUM> can also apply friction or "drag" to the rod R1 prior to locking the set screw <NUM>, helping to keep the connector in place and prevent "flopping" while still allowing free movement when intended by the user. By way of further example, the low-profile geometry of the wing portion <NUM> of the connector <NUM> can allow the connector to be used in surgical areas where space is limited (e.g., in the cervical area of the spine). In an exemplary method, the wing portion <NUM> of the connector <NUM> can be hooked onto a first rod R1 at a location between two bone anchors to which the rod is coupled, the two bone anchors being implanted in adjacent vertebral levels of the cervical spine. As yet another example, the connector <NUM> can facilitate simultaneous and/or single-step locking of the first and second rods R1, R2. This can allow the connector <NUM> to be locked to both rods R1, R2 with minimal steps. In other embodiments, the connector <NUM> can facilitate independent locking of the rods R1, R2, e.g., with use of a saddle and dual set screw.

<FIG> illustrate an exemplary embodiment of a connector <NUM>. As shown, the connector <NUM> can include a body <NUM> that defines first and second rod-receiving recesses <NUM>, <NUM>, a rod pusher <NUM>, a bias element or leaf spring <NUM>, a first locking element or set screw <NUM>, and a second locking element or set screw <NUM>. The rod pusher <NUM> can be configured to translate laterally within the body <NUM>, and can be biased by the leaf spring <NUM> in a direction that urges the rod pusher into a first rod R1 disposed in the first rod-receiving recess <NUM>. The first set screw <NUM> can be tightened to lock the connector <NUM> to the first rod R1. The second set screw <NUM> can be tightened to lock a second rod R2 in the second rod-receiving recess <NUM> of the connector <NUM>. The illustrated connector <NUM> can thus allow for independent locking of first and second rods R1, R2 to the connector. The connector <NUM> can include one or more low-profile portions to facilitate use in tight spaces. For example, the first rod-receiving recess <NUM> can be formed in a portion of the connector body <NUM> having a reduced-profile, e.g., to fit between bone anchors implanted in adjacent levels of the cervical spine.

The body <NUM> can include proximal and distal ends 602p, 602d that define a proximal-distal axis A1. The proximal end 602p of the body <NUM> can include a pair of spaced apart arms <NUM>, <NUM> that define the second rod-receiving recess <NUM> there between. A rod R2 disposed in the second rod-receiving recess <NUM> can have a central longitudinal rod axis A2. The second rod-receiving recess <NUM> can be open in a proximal direction, such that a rod R2 can be inserted into the recess by moving the rod distally with respect to the connector <NUM>. Each of the arms <NUM>, <NUM> can extend from the distal portion 602d of the body <NUM> to a free end. The outer surfaces of each of the arms <NUM>, <NUM> can include a feature (not shown), such as a recess, dimple, notch, projection, or the like, to facilitate coupling of the connector <NUM> to various instruments. For example, the outer surface of each arm <NUM>, <NUM> can include an arcuate groove at the respective free end of the arms for attaching the connector <NUM> to an extension tower or retractor. The arms <NUM>, <NUM> can include or can be coupled to extension or reduction tabs (not shown) that extend proximally from the body <NUM> to functionally extend the length of the arms <NUM>, <NUM>. The extension tabs can facilitate insertion and reduction of a rod or other implant, as well as insertion and locking of the second set screw <NUM>. The extension tabs can be configured to break away or otherwise be separated from the arms <NUM>, <NUM>. The inner surfaces of each of the arms <NUM>, <NUM> can be configured to mate with the second set screw <NUM>. For example, the inner surfaces of the arms <NUM>, <NUM> can include threads that correspond to external threads formed on the second set screw <NUM>. Accordingly, rotation of the second set screw <NUM> with respect to the body <NUM> about the axis A1 can be effective to translate the set screw with respect to the body axially along the axis A1.

The distal end 602d of the body <NUM> can define a tunnel <NUM> in which the rod pusher <NUM> can be disposed. The tunnel <NUM> can extend along a rod pusher axis A3 between the second rod-receiving recess <NUM> and the first rod-receiving recess <NUM>. The rod pusher <NUM> can be configured to translate within the tunnel <NUM> along the axis A3. The axis A3 can be perpendicular or substantially perpendicular to the axis A1. The axis A3 can also be perpendicular or substantially perpendicular to the axis A2. The axis A3 can extend from the axis A1 at an angle in the range of about <NUM> degrees to about <NUM> degrees. The tunnel <NUM> can have a shape that is substantially a negative of the exterior shape of the rod pusher <NUM>. The tunnel <NUM> can include opposed recesses <NUM> formed therein sized to receive respective ends of the leaf spring <NUM>. The recesses <NUM> can be formed by drilling bore holes into the distal-facing surface of the body <NUM>, such that the bore holes intersect with the tunnel <NUM>, as described above with respect to <FIG>. Alternatively, the recesses <NUM> can be formed by a lateral through-bore similar to the through-bore <NUM> of the connector <NUM> described above, but instead being vertically-elongated or otherwise dimensioned to receive the leaf spring <NUM>.

The distal end 602d of the body <NUM> can define a recess <NUM> sized to receive at least a portion of the first set screw <NUM>, as shown for example in <FIG>. The recess <NUM> can be formed distal to the tunnel <NUM>. The inner surface of the recess <NUM> can be configured to mate with the first set screw <NUM>. For example, the inner surface can include threads that correspond to external threads formed on the first set screw <NUM>. Accordingly, rotation of the first set screw <NUM> with respect to the body <NUM> about the axis A1 can be effective to translate the set screw with respect to the body axially along the axis A1.

The body <NUM> can include a cantilevered wing portion <NUM> that defines the first rod-receiving recess <NUM>. A rod R1 disposed in the first rod-receiving recess <NUM> can have a central longitudinal rod axis A4. The axis A4 can be parallel to the axis A2 as shown, or can be perpendicular or obliquely angled with respect to the axis A2. The wing portion <NUM> can extend radially-outward from the second arm <NUM> of the body <NUM>. The wing portion <NUM> can have a width 630W and a height <NUM>. A ratio of the width 630W to the diameter of the first rod-receiving recess <NUM> (or of a rod R1 disposed therein) can be less than about <NUM>:<NUM>, less than about <NUM>:<NUM>, and/or less than about <NUM>:<NUM>. A ratio of the height <NUM> to the diameter of the first rod-receiving recess <NUM> (or of a rod R1 disposed therein) can be less than about <NUM>:<NUM>, less than about <NUM>:<NUM>, and/or less than about <NUM>:<NUM>. In some embodiments, the height <NUM> can be less than about <NUM>, less than about <NUM>, and/or less than about <NUM>. The first rod-receiving recess <NUM> can be open in a distal direction such that a rod R1 can be inserted into the recess by moving the connector <NUM> distally with respect to the rod. In other embodiments, the first rod-receiving recess <NUM> can be open in a proximal direction, e.g., by flipping the wing portion <NUM> and forming it such that it extends from a distal portion of the body <NUM>, or in a lateral direction.

As noted above, the rod pusher <NUM> can be slidably disposed within the tunnel <NUM> of the body <NUM> and can be configured to translate with respect to the body along the axis A3. The rod pusher <NUM> can include a first bearing surface 644A configured to contact and bear against a first rod R1 disposed in the first rod-receiving recess <NUM>. The bearing surface 644A can extend at an oblique angle with respect to a longitudinal axis of the rod pusher <NUM> such that the bearing surface is ramped. The bearing surface 644A can be planar as shown, or can be convex, concave, pointed, sharpened, etc. For example, the bearing surface 644A can be concave and can define a section of a cylinder, such that the bearing surface matches or approximates the contour of a cylindrical rod R1 disposed in the first rod-receiving recess <NUM>.

The rod pusher <NUM> can include a second bearing surface 644B configured to contact and bear against a corresponding bearing surface of the first set screw <NUM>, as described further below. The bearing surface 644B can extend at an oblique angle with respect to a longitudinal axis of the rod pusher <NUM> such that the bearing surface is ramped. The bearing surface 644B can be conical as shown, or can be planar, convex, concave, pointed, sharpened, etc..

The rod pusher <NUM> can include a third bearing surface 644C configured to contact and bear against a second rod R2 disposed in the second rod-receiving recess <NUM>. The bearing surface 644C can extend at an oblique angle with respect to a longitudinal axis of the rod pusher <NUM> such that the bearing surface is ramped. The bearing surface 644C can be planar as shown, or can be convex, concave, pointed, sharpened, etc. For example, the bearing surface 644C can be concave and can define a section of a cylinder, such that the bearing surface matches or approximates the contour of a cylindrical rod R2 disposed in the second rod-receiving recess <NUM>. It will be appreciated that the third bearing surface 644C can be omitted and/or need not necessarily contact the second rod R2.

The rod pusher <NUM> can include a through-bore <NUM>. The through-bore <NUM> can extend perpendicular or substantially perpendicular to the axis A3. The through-bore <NUM> can be sized to receive the leaf spring <NUM> therein. In at least some positions of the rod pusher <NUM> with respect to the body <NUM>, the through-bore <NUM> of the rod pusher can be aligned with the recesses <NUM> of the body, such that the leaf spring <NUM> extends through the through-bore <NUM> and into the opposed recesses <NUM>. The through-bore <NUM> can include a middle portion and opposed end portions, e.g., in a manner similar to the through-bore <NUM> described above with respect to <FIG>. The middle portion of the through-bore <NUM> can approximate the dimensions of the leaf spring <NUM>. For example, the middle portion can have a width that is substantially equal to the thickness of the leaf spring <NUM>. The end portions of the through-bore <NUM> can be elongated or can otherwise have a dimension greater than the thickness of the leaf spring <NUM> to allow the rod pusher <NUM> to translate along the axis A3 and to accommodate the bend radius of the leaf spring <NUM> during such translation.

In some embodiments, for example as shown in <FIG>, the bias element can be a spring wire <NUM> similar to the spring wire <NUM> of the connector <NUM> described above.

In some embodiments, the internal geometry of the through-bore <NUM> formed in the rod pusher <NUM> can be formed in a manner similar to that of the rod pusher <NUM> in the connector <NUM> described above.

The first set screw <NUM> can include a proximal portion 614p and a distal portion 614d. The proximal portion 614p of the first set screw <NUM> can define a bearing surface configured to contact and bear against the second bearing surface 644B of the rod pusher <NUM>. In the illustrated embodiment, the proximal portion 614p of the first set screw <NUM> defines a frustoconical ramped bearing surface that corresponds to the ramped bearing surface 644B of the rod pusher <NUM>. The proximal portion 614p of the first set screw <NUM> can include a driving interface <NUM> configured to receive a driver for applying a rotational force to the first set screw about the axis A1. The distal portion 614d of the first set screw <NUM> can include an exterior thread configured to mate with the interior threads of the recess <NUM> to allow the first set screw to be advanced or retracted along the axis A1 with respect to the body <NUM> by rotating the first set screw about the axis A1. While a first set screw <NUM> is shown, it will be appreciated that other locking elements can be used instead or addition, such as a closure cap that advances and locks by quarter-turn rotation, a closure cap that slides in laterally without rotating, and so forth. In some embodiments, the first set screw is short enough in the vertical dimension so that it does not interfere with a rod R2 seated in the second rod recess <NUM>. In other embodiments, the rod R2 can bear against the proximal end of the first set screw <NUM> when locked to the connector <NUM>.

The second set screw <NUM> can include an exterior thread configured to mate with the interior threads formed on the arms <NUM>, <NUM> of the body <NUM> to allow the second set screw to be advanced or retracted along the axis A1 with respect to the body by rotating the second set screw about the axis A1. The second set screw <NUM> can include a driving interface <NUM> configured to receive a driver for applying a rotational force to the set screw about the axis A1. The distal surface of the second set screw <NUM> can be configured to contact and bear against a rod R2 disposed in the second rod-receiving <NUM> recess to lock the rod to the connector <NUM>. When tightened against the rod R2, the second set screw <NUM> can prevent the rod from translating relative to the connector <NUM> along the axis A2 and/or from rotating with respect to the connector about the axis A2. While a second set screw <NUM> is shown, it will be appreciated that other locking elements can be used instead or addition, such as a closure cap that advances and locks by quarter-turn rotation, a closure cap that slides in laterally without rotating, a nut that threads onto an exterior of the connector <NUM>, and so forth.

In operation, the connector <NUM> can have a resting configuration in which no rod is disposed in the first or second rod-receiving recesses <NUM>, <NUM>. In this configuration, the biasing force of the leaf spring <NUM> can cause the rod pusher <NUM> to slide towards the first rod-receiving recess <NUM>.

In the resting configuration, the wing portion <NUM> of the body <NUM> and the free end of the rod pusher <NUM> can define an aperture <NUM> that is smaller than the diameter of a first rod R1 to which the connector <NUM> is to be coupled. Accordingly, as the rod R1 is inserted into the first rod-receiving recess <NUM>, the rod bears against the rod pusher <NUM> to move the connector <NUM> out of the resting configuration. Insertion of the rod R1 can move the rod pusher <NUM> along the axis A3, thereby deforming the leaf spring <NUM> from its resting state. As the largest cross-sectional portion of the rod R1 is positioned in the aperture <NUM>, the rod pusher <NUM> can be displaced to its furthest distance from the first rod-receiving recess <NUM>.

Once the largest cross-sectional portion of the rod R1 clears the aperture <NUM> as the rod is seated in the first rod-receiving recess <NUM>, the biasing force of the leaf spring <NUM> can cause the rod pusher <NUM> to move back along the axis A3 towards the first rod-receiving recess. This movement can at least partially close the aperture <NUM> around the rod R1 to capture the rod in the first rod-receiving recess <NUM>. The biasing force of the leaf spring <NUM> can resist retrograde movement of the rod pusher <NUM> and thus resist disconnection of the connector <NUM> from the first rod R1.

The geometry of the connector <NUM> can be selected such that, when the rod R1 is fully seated in the first rod-receiving recess <NUM>, the leaf spring <NUM> is deformed from its resting state. The leaf spring <NUM> can thus press the rod pusher <NUM> against the rod R1 to provide a friction or drag effect, before the set screws <NUM>, <NUM> are tightened and/or before a second rod R2 is positioned in the connector <NUM>.

When the connector <NUM> is positioned as desired with respect to the first rod R1, the first set screw <NUM> can be advanced proximally relative to the body <NUM> to lock the rod in the first rod-receiving recess <NUM>. As the first set screw <NUM> is advanced proximally, e.g., by rotating the first set screw <NUM> about the axis A1, the ramped surface of the first set screw can bear against the ramped surface 644B of the rod pusher <NUM> to urge the rod pusher towards the first rod-receiving recess <NUM> and firmly into contact with the rod R1. When the first set screw <NUM> is tightened, the connector <NUM> can be locked to the first rod R1 to resist or prevent translation of the rod R1 with respect to the connector along the axis A4 and to resist or prevent rotation of the rod R1 with respect to the connector about the axis A4. From a human factors standpoint, a user may generally associate clockwise rotation with tightening. Accordingly, the first set screw <NUM> can have reverse threads such that clockwise rotation of the first set screw (from the perspective of a user positioned proximal to the connector <NUM>) moves the first set screw proximally relative to the body <NUM> to tighten the connector <NUM> onto the first rod R1. Alternatively, the first set screw <NUM> can include normal threads and counterclockwise rotation can move the first set screw proximally.

A second rod R2 can be positioned in the second rod-receiving recess <NUM> and the second set screw <NUM> can be tightened to lock the rod R2 to the body <NUM>. In some embodiments, the second rod R2 can bear against the third bearing surface 644C of the rod pusher <NUM> such that tightening the second rod R2 to the connector <NUM> exerts additional locking force on the first rod R1.

The connector <NUM> can provide various benefits for the user and/or patient. For example, the biased rod pusher <NUM> can provide tactile feedback when the connector <NUM> is "snapped" onto the first rod R1, giving the user confidence that the rod has been attached successfully before tightening the connector. The biased rod pusher <NUM> can also apply friction or "drag" to the rod R1 prior to locking the set screws <NUM>, <NUM>, helping to keep the connector in place and prevent "flopping" while still allowing free movement when intended by the user. By way of further example, the low-profile geometry of the wing portion <NUM> of the connector <NUM> can allow the connector to be used in surgical areas where space is limited (e.g., in the cervical area of the spine). In an exemplary method, the wing portion <NUM> of the connector <NUM> can be hooked onto a first rod R1 at a location between two bone anchors to which the rod is coupled, the two bone anchors being implanted in adjacent vertebral levels of the cervical spine. As yet another example, the connector <NUM> can facilitate independent locking of the first and second rods R1, R2. This can allow the connector <NUM> to be locked to the first rod R1 to limit or prevent movement of the connector before the second rod R2 is attached and/or locked.

An exemplary method of using the connectors disclosed herein is described below.

The procedure can begin by forming an open or percutaneous incision in the patient to access a target site. The target site can be one or more vertebrae, a long bone or multiple portions of a long bone, or any other bone or non-bone structure of the patient. As shown in <FIG>, the target site can be multiple vertebrae in the patient's cervical and thoracic spine.

Bone anchors can be driven into one or more of the vertebrae and spinal rods can be attached thereto using known techniques. In the illustrated example, bilateral spinal rods R1, R2 are coupled to four adjacent vertebrae V1-V4 using eight bone anchors S1-S8. In addition, bilateral rods R3, R4 are coupled to the next two adjacent vertebrae V5-V6 using four bone anchors S9-S12. The rods R1, R2 can be connected to the rods R3, R4, respectively, using four connectors C1-C4 of the type described herein (e.g., any of the connectors <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> or combinations or variations thereof).

As shown, the low-profile nature of the connectors C1-C4 can allow them to be installed at adjacent vertebral levels on the same rod (e.g., between V2/V3 and between V3/V4). As also shown, the connectors C1-C4 can connect to the rods R1, R2 between bone anchors installed in adjacent vertebral levels.

The connectors C1-C4 can "snap" onto the rods R1, R2, thereby providing tactile feedback to the user that the connectors are secured.

The connectors C1-C4 can "drag" against the rods R1, R2, thereby allowing for provisional positioning and retention of the connectors prior to locking the connectors to the rods R1, R2 and/or to the rods R3, R4.

The snap and/or drag features of the connectors C1-C4 can provide confidence that the connector will stay in position, can make construct assembly easier, and can reduce the risk of having to retrieve dropped connectors from vital vascular or neural structures.

The connectors C1-C4 can include independent locking features such that they can be locked to the rods R1, R2 prior to being locked to the rods R3, R4 or vice versa.

The connectors C1-C4 can include single-step locking features such that they can be simultaneously locked to their respective rods. For example, connector C1 can be simultaneously locked to rods R1 and R3.

All of the rods R1-R4, the connectors C1-C4, and the bone anchors S1-S12 can be installed in a single procedure.

Alternatively, the rods R1, R2 and the bone anchors S1-S8 may have been installed in a previous procedure, and the current procedure can be a revision procedure in which the rods R3, R4, the connectors C1-C4, and the bone anchors S9-S12 are installed to extend the previously-installed construct to additional levels.

The connectors C1-C4 can be attached to position the rods R1-R4 such that they are substantially parallel to one another and substantially lie in a common coronal plane as shown. The connectors C1-C4 can also be rotated <NUM> degrees from the orientation shown to position the rod pairs R1, R3 and R2, R4 such that they substantially lie in respective common sagittal planes.

The above steps can be repeated to install additional rods and/or connectors at the same or at different vertebral levels. Final tightening or other adjustment of the construct can be performed and the procedure can be completed using known techniques and the incision closed.

It should be noted that any ordering of method steps expressed or implied in the description above or in the accompanying drawings is not to be construed as limiting the disclosed methods to performing the steps in that order. Rather, the various steps of each of the methods disclosed herein can be performed in any of a variety of sequences. In addition, as the described methods are merely exemplary embodiments, various other methods that include additional steps or include fewer steps are also within the scope of the present disclosure.

While the methods illustrated and described herein generally involve attaching spinal rods to multiple vertebrae, it will be appreciated that the connectors and methods herein can be used with various other types of fixation or stabilization hardware, in any bone, in non-bone tissue, or in non-living or non-tissue objects. The connectors disclosed herein can be fully implanted, or can be used as part of an external fixation or stabilization system. The devices and methods disclosed herein can be used in minimally-invasive surgery and/or open surgery.

The devices disclosed herein and the various component parts thereof can be constructed from any of a variety of known materials. Exemplary materials include those which are suitable for use in surgical applications, including metals such as stainless steel, titanium, or alloys thereof, polymers such as PEEK, ceramics, carbon fiber, and so forth. The various components of the devices disclosed herein can be rigid or flexible. One or more components or portions of the device can be formed from a radiopaque material to facilitate visualization under fluoroscopy and other imaging techniques, or from a radiolucent material so as not to interfere with visualization of other structures. Exemplary radiolucent materials include carbon fiber and high-strength polymers.

Claim 1:
A connector for connecting a first and second spinal rod, comprising:
a body (<NUM>) that defines first (<NUM>) and second (<NUM>) rod-receiving recesses, the body having proximal and distal ends that define a proximal-distal axis extending there between;
a rod pusher (<NUM>) slidably disposed within a tunnel (<NUM>) formed in the body and configured to translate with respect to the body along a rod pusher axis, wherein the tunnel extends between the first rod-receiving recess and the second rod-receiving recess, and wherein the rod pusher includes a first bearing surface (244A) configured to contact and bear against the first spinal rod disposed in the first rod-receiving recess and a second bearing surface (224B) configured to contact and bear against the second rod disposed in the second rod-receiving recess;
a bias element configured to bias the rod pusher along the rod pusher axis towards the first rod-receiving recess; and
a set screw (<NUM>) configured to be threadably received in the body to lock the first spinal rod within the first rod-receiving recess and to lock the second spinal rod within the second rod-receiving recess, wherein the connector is configured such that tightening the set screw within the body causes a surface of the set screw to bear against the second spinal rod disposed in the second rod-receiving recess to urge the rod pusher towards the first rod-receiving recess and to lock the first spinal rod in the first rod-receiving recess.