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

Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes correction, fusion, fixation, discectomy, laminectomy and implantable prosthetics. As part of these surgical treatments, spinal constructs, such as, for example, bone fasteners, plates and interbody devices can be used to provide stability to a treated region. For example, during surgical treatment, interbody implants can be delivered to a surgical site for fixation with bone to immobilize a joint. The bone fasteners extend through a plate and/or an interbody device and into bone to fix at least a portion of the plate and/or the interbody device to the bone. This disclosure describes an improvement over these prior art technologies.

According to <CIT>, an intervertebral spacer inserter includes a sleeve having a longitudinal axis, a hollow sleeve bore extending through the sleeve along the longitudinal axis, a sleeve tip end and an opening of a passage disposed in the sleeve tip end. The passage extends into the sleeve to the sleeve shaft along a passage axis that intersects the longitudinal axis at an angle less than about <NUM>°. A sliding tip with an elongated slot is in contact with the sleeve tip end and is moveable with respect to the sleeve tip end between a first position with the opening accessible through the elongated slot and disposed adjacent a first end of the elongated slot and a second position with the opening accessible through the elongated slot and disposed adjacent a second end of the elongated slot opposite the first end.

<CIT> discloses a method for promoting spinal fusion using a spinal implant comprises providing a spinal implant, wherein the spinal implant comprises an anterior wall, a posterior wall and two lateral walls configured to extend between the anterior wall and the posterior wall. In some embodiments, the spinal implant further comprises at least one internal chamber generally positioned between the anterior wall, the posterior wall and the two lateral walls, wherein the internal chamber being is adapted to receive at least one graft and/or other fill material. In some embodiments, at least a portion of the graft and/or other fill material delivered into the internal chamber is configured to exit through the one or more of the openings of the anterior wall.

<CIT> discloses an instrument for inserting a spinal implant into an intervertebral space. The instrument includes an elongated body having inner and outer shafts configured to longitudinally translate with respect to each other, a holding tip which is configured to articulate with respect to the elongated body in response to the longitudinal translation of the inner and outer shafts, and a driveshaft assembly configured to cooperate with the articulation of the holding tip and secure a spinal implant to the instrument. A spinal implant and a system for inserting a spinal implant into an intervertebral space including an insertion instrument and a spinal implant are also disclosed.

<CIT> discloses an inserter instrument and an implant device. An interconnection between an implant and an instrument may include a threaded connection and a gripping connection. Motion of the gripping connection is coordinated with motion of the threaded connection. One implant includes a threaded hole and an adjacent angled pocket, both of which extend into the implant through an instrument-facing surface. One instrument includes a threaded rod and an adjacent pivoting finger, both of which protrude from an end face of the instrument. When the implant is connected to this instrument, the instrument-facing surface abuts the end face, the threaded rod engages the threaded hole, and the finger extends into the pocket along an angle of the pocket.

The invention provides a surgical instrument according to claim <NUM>, and a surgical system according to claim <NUM>.

The exemplary embodiments of the spinal system and related methods of use disclosed are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of a surgical system and a method for treating a spine. In some embodiments, the systems and methods of the present disclosure comprise medical devices including surgical instruments and implants that are employed with a surgical treatment, as described herein, for example, with a cervical, thoracic, lumbar and/or sacral region of a spine. Methods do not form part of the invention but represent background information that is useful for understanding the invention.

In some embodiments, the present surgical system includes a spinal implant having graft containment overhangs. The overhangs grip the graft to prevent graft loss during impaction. In some embodiments, the implant includes a porous lattice optimized for strength, while allowing a large graft volume to be disposed between the graft containment overhangs. In some embodiments, the implant includes screw pockets that are completely enclosed to prevent bone screws that are inserted into the pockets from interfering with graft, and vice versa.

In some embodiments, the implant includes a solid body having edges, markers, a nose and inserter and bone screw attachment geometry. The implant includes a core configured to be positioned within a cavity of the body. The core includes a structural lattice that reduces stiffness and opacity, while maintaining strength. The implant includes top and bottom caps that are each coupled to the body when the core is positioned within the body. In some embodiments, at least one of the caps includes a trabecular like structure having an interconnected porosity that is optimized for ingrowth and ongrowth. In some embodiments, the caps are fused with the core and the body to prevent delamination of the implant. In some embodiments, the structural lattice of the core is a diamond lattice that is produced by 3D printing to provide exceptional buildability, exceptional strength, reduced internal stress, and fit within a variety of spinal implant type geometries.

The surgical system includes an inserter configured to insert the implant between vertebrae during a surgical procedure using a selected surgical approach and/or at a selected angle. For example, in some embodiments, a single implant can be inserted between vertebrae using four different surgical approaches (e.g., an approach for Anterior Lumbar Interbody Fusion (ALIF), an approach for Oblique Lateral Interbody Fusion at L5-S1 (OLIF <NUM>-<NUM>), an approach for Oblique Lateral Interbody Fusion at L2-L5 (OLIF <NUM>-<NUM>), and an approach for Direct Lateral Interbody Fusion (DLIF)) with a single inserter, as discussed herein. Indeed, the inserter includes attachment geometry that is low profile, suitable for navigation, and allows multiple insertion angles and designs. That is, a single inserter may be used to deliver several different implants to a target site using different surgical approaches and/or at different angles. In some embodiments, the inserter includes a ratchet mechanism that prevents undesired disengagement of the implant from the inserter before and during any impaction.

In some embodiments, the implant includes an arced surface configured for engagement with an arced surface of the inserter to couple the inserter to the implant. In some embodiments, a peg and a shaft of the inserter are positioned within cavities, such as, for example, threaded cavities of the implant when the arced surface of the inserter engages the arced surface of the implant. Lines that intersect end points of the arced surface of the implant and an arced center of the arced surface of the implant can be flipped. As such, if the implant is attached to a handle of the inserter, the given angle of attachment will change. Indeed, the arced surface of the implant can be flipped after the inserter is coupled to the implant to couple the inserter to the implant such that the insertion angle of the inserter changes. In some embodiments, the peg and the shaft of the inserter are configured to be positioned in the threaded cavities of the implant before and after the inserter is flipped. In some embodiments, the geometry of an implant configured for use in an OLIF <NUM>-<NUM> procedure and the geometry of an implant configured for use in an OLIF <NUM>-<NUM> procedure allow both implants to be inserted using a single inserter, thus allowing for further instrument consolidation. That is, the arced surface of the single inserter can match the arced surface of the implant configured for use in an OLIF <NUM>-<NUM> procedure and the arced surface of the implant configured for use in an OLIF <NUM>-<NUM> procedure. The peg and the rod of the inserter are positioned in the threaded cavities of the implant configured for use in an OLIF <NUM>-<NUM> when the arced surface of the inserter engages the arced surface of the implant configured for use in an OLIF <NUM>-<NUM> procedure and the rod and peg of the inserter are positioned in the threaded cavities of the implant configured for use in an OLIF <NUM>-<NUM> procedure when the arced surface of the inserter engages the arced surface of the implant configured for use in an OLIF <NUM>-<NUM> procedure. In some embodiments, the peg of the inserter provides connection strength between the inserter and the implant.

In some embodiments, the inserter engages the implant such that access to outer bone screws that extend through the implant are accessible when the inserter engages the implant, as discussed herein. In some embodiments, the inserter includes flat contacts that engage a surface of the implant while the rod and peg of the inserter are positioned in the threaded cavities of the implant to couple the inserter to the implant.

In some embodiments, the features of the inserter and the features of the implants are reversed. For example, the implant can include one or a plurality of pegs, such as, for example, threaded pegs that extend outwardly from a body of the implant. The pegs may be received within cavities of the inserter. An arced surface of the inserter engages an arced surface of the implant when the pegs are received within the cavities to couple the inserter to the implant. In some embodiments, this allows use of larger threads. In some embodiments, a sleeve including a female thread form is rotatably positioned within one of the cavities of the inserter such that the female thread form mates with a male thread form of one of the pegs of the inserter to couple the inserter to the implant, as discussed herein.

In some embodiments, the arced surface of the inserter and the arced surface of the implant can be reversed. For example, in some embodiments, the inserter can include a concavely curved surface that engages a convexly curved surface of the implant to couple the inserter to the implant. Alternatively, the inserter can include a convexly curved surface that engages a concavely curved surface of the implant to couple the inserter to the implant.

In some embodiments, the arced surface of the implant can include two or more cavities configured for disposal of the peg of the inserter and the shaft of the inserter. For example, in one embodiment, the implant includes two cavities configured for disposal of the peg of the inserter and the shaft of the inserter. In one embodiment, the implant includes three cavities configured for disposal of the peg of the inserter and the shaft of the inserter such that one of the cavities is empty or unoccupied when the peg of the inserter and the shaft of the inserter are disposed in the two other cavities. This allows the implant to be disposed at three different angles relative to the inserter, as discussed herein. In some embodiment, the cavities are all positioned along the same arc path of the implant, the arc path of the implant coinciding with an arc center of the inserter. In some embodiments, at least one of the cavities is threaded.

In some embodiments, the arced surface of the inserter includes a central cutout configured for disposal of a tab, such as, for example, a plate that is coupled to the implant such that the inserter can be used to insert the implant with the plate attached to the implant, as discussed herein. In some embodiments, the arced surface of the inserter includes a central cutout configured to allow access to an intrinsic screw that extends into or through the implant such that the intrinsic screw can be rotated relative to the implant while the intrinsic screw extends into or through the implant and the inserter is attached to the implant.

In some embodiments, the inserter includes a ratchet knob comprising a first member or plate, such as, for example, a floating plate that engages grooves on a second plate of the inserter. In particular, a spring pushes the floating plate such that extensions of the floating plate engage the grooves on the second plate to prevent undesired loosening of the implant upon impaction. As a user rotates the ratchet knob, the float plate rides in the grooves, creating resistance similar to a ratchet, as discussed herein.

The surgical system of the present disclosure may be employed to treat spinal disorders such as, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor and fractures. In some embodiments, the surgical system of the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. The disclosed surgical system may be alternatively employed in a surgical treatment with a patient in a prone or supine position, and/or employ various surgical approaches to the spine, including anterior, posterior, posterior mid-line, direct lateral, postero-lateral, and/or antero-lateral approaches, and in other body regions. The surgical system of the present disclosure may also be alternatively employed with procedures for treating the lumbar, cervical, thoracic, sacral and pelvic regions of a spinal column. The surgical system of the present disclosure may also be used on animals, bone models and other non-living substrates, such as, for example, in training, testing and demonstration.

The surgical system of the present disclosure may be understood more readily by reference to the following detailed description of the embodiments taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this application is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting. In some embodiments, as used in the specification and including the appended claims, the singular forms "a," "an," and "the" include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from "about" or "approximately" one particular value and/or to "about" or "approximately" another particular value. Similarly, when values are expressed as approximations, by use of the antecedent "about," it will be understood that the particular value forms another embodiment. It is also understood that all spatial references, such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure. For example, the references "upper" and "lower" are relative and used only in the context to the other, and are not necessarily "superior" and "inferior".

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

The following discussion includes a description of a surgical system including implants, related components and methods of employing the surgical system in accordance with the principles of the present disclosure. Alternate embodiments are also disclosed. Reference is made in detail to the exemplary embodiments of a surgical system <NUM>, which are illustrated in the accompanying figures.

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

Surgical system <NUM> is employed, for example, with a fully open surgical procedure, a minimally invasive procedure including percutaneous techniques, and mini-open surgical techniques to deliver and introduce instrumentation and/or one or more spinal implants, such as, for example, one or more components of a bone fastener, at a surgical site of a patient, which includes, for example, a spine. The spinal implant can include one or more components of one or more spinal constructs, such as, for example, interbody devices, interbody cages, bone fasteners, spinal rods, tethers, connectors, plates and/or bone graft, and can be employed with various surgical procedures including surgical treatment of a cervical, thoracic, lumbar and/or sacral region of a spine.

Surgical system <NUM> includes an implant, such as a spinal implant <NUM> and an instrument, such as a surgical instrument <NUM> configured to insert implant <NUM> into an intervertebral space defined by adjacent vertebrae, as discussed herein. Instrument <NUM> may be used to insert implant <NUM> and/or other implants that are similar to implant <NUM> into an intervertebral space defined by adjacent vertebrae. For example, instrument <NUM> is shown in <FIG> with instrument <NUM> coupled to implant <NUM> to allow instrument <NUM> to insert implant <NUM> into an intervertebral space. Instrument <NUM> is shown in <FIG> with instrument coupled to an implant <NUM> that is similar to implant <NUM> to allow instrument <NUM> to insert implant <NUM> into an intervertebral space. However, it should be understood that instrument <NUM> may be used to insert implants in addition to implants <NUM>, <NUM> into an intervertebral space, as discussed herein.

Instrument <NUM> includes a sleeve <NUM> extending along a longitudinal axis X1 between a proximal end <NUM> and an opposite distal end <NUM>. An inner surface <NUM> of sleeve <NUM> defines a passageway <NUM>. Passageway <NUM> is coaxial with axis X1. End <NUM> is coupled to a handle <NUM> of instrument <NUM> such that a body <NUM> of handle <NUM> is fixed relative to sleeve <NUM>. In some embodiments, handle <NUM> has a maximum diameter that is greater than a maximum diameter of sleeve <NUM> to facilitate gripping of handle <NUM> by a hand of a medical practitioner, for example. In some embodiments, handle <NUM> includes gripping features, such as, for example, indentations and/or protrusions configured to facilitate gripping. An inner surface <NUM> of handle <NUM> defines a channel <NUM> that is coaxial with passageway <NUM> and axis X1. Channel <NUM> is in communication with passageway <NUM> such that a shaft <NUM> of instrument <NUM> extends through channel <NUM> and into passageway <NUM>. Shaft <NUM> is rotatable relative to sleeve <NUM> and handle <NUM> about axis X1, as discussed herein. In some embodiments, passageway <NUM> has a diameter that is slightly greater than a diameter of shaft <NUM> such that an outer surface <NUM> of shaft <NUM> directly engages surface <NUM> of sleeve <NUM> when shaft <NUM> is positioned within passageway <NUM>. It is envisioned that the engagement of surface <NUM> with surface <NUM> maintains the orientation of shaft <NUM> relative to sleeve <NUM> and/or handle <NUM> such that shaft <NUM> remains coaxial with axis X1 when shaft <NUM> is positioned within passageway <NUM>. That is, the engagement of surface <NUM> with surface <NUM> prevents shaft <NUM> from extending at an acute angle relative to axis X1 when shaft <NUM> is positioned within passageway <NUM>. In some embodiments, passageway <NUM> has a diameter that is greater than a diameter of shaft <NUM> such that surface <NUM> of shaft <NUM> is spaced apart from surface <NUM> of shaft <NUM> when sleeve <NUM> is positioned within passageway <NUM>. In some embodiments, passageway <NUM> has a uniform diameter along an entire length of passageway <NUM> and/or channel <NUM> has a uniform diameter along an entire length of channel <NUM>. In some embodiments, passageway <NUM> and/or channel <NUM> may be variously shaped, such as, for example, circular, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered.

A proximal end <NUM> of shaft <NUM> is coupled to a knob <NUM> and an opposite distal end <NUM> of shaft <NUM> includes a mating surface <NUM>, such as, for example, a male thread form configured to engage an implant to couple the implant to shaft <NUM>. In particular, the male thread form of mating surface <NUM> is configured to mate with a female thread form of an implant to couple the implant to shaft <NUM>, as discussed herein. Proximal end <NUM> of shaft <NUM> is fixed to knob <NUM> such that rotation of knob <NUM> about axis X1 also rotates shaft <NUM> about axis X1, as discussed herein. In some embodiments, knob <NUM> is integrally and/or monolithically formed with shaft <NUM>. In some embodiments, shaft <NUM> is welded to knob <NUM>. It is envisioned that shaft <NUM> can be cannulated or non-cannulated, depending upon the requirements of a particular application.

Distal end <NUM> of sleeve <NUM> defines an engagement portion <NUM> comprising an engagement surface <NUM> extending from a first end <NUM> to an opposite second end <NUM>. In some embodiments, engagement portion <NUM> comprises a peg <NUM> extending outwardly from end <NUM> and an opening <NUM> extending through end <NUM>. In some embodiments, engagement portion <NUM> does not include a peg or any other structure extending from engagement surface <NUM> and engagement portion <NUM> includes only opening <NUM>, wherein opening <NUM> can be variously positioned relative to engagement surface <NUM>. Opening <NUM> is in communication with passageway <NUM> such that shaft <NUM> can be translated axially along axis X1 within passageway <NUM> to move mating surface <NUM> through opening <NUM> for engagement with an implant, as discussed herein. Peg <NUM> is permanently fixed relative to surface <NUM>. In some embodiments, opening <NUM> is coaxial with passageway <NUM> and axis X1 and peg <NUM> extends at an acute angle relative to axis X1. Peg <NUM> has a solid configuration that is free of any gaps or openings to provide strength and rigidity to peg <NUM>. In some embodiments, peg <NUM> has a beveled tip <NUM> to facilitate insertion of peg <NUM> into a cavity of an implant, for example, to couple instrument <NUM> to the implant, as discussed herein. In some embodiments, the beveled tip is biased toward one side. In some embodiments, peg <NUM> is cone shaped. In some embodiments, peg <NUM> is cylindrical. In some embodiments, peg <NUM> has a radius for smooth transition. In some embodiments, peg <NUM> is variously shaped, such as, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered.

Handle <NUM> includes a member, such as, for example, a plate <NUM> that is coupled to body <NUM> of handle <NUM> such that plate <NUM> is fixed relative to body <NUM>. Plate <NUM> has a diameter that is greater than a diameter of channel <NUM>. An end surface <NUM> of plate <NUM> directly engages an end surface <NUM> of body <NUM> to couple plate <NUM> to body <NUM>. In some embodiments, end surface <NUM> is integrally and/or monolithically formed with end surface <NUM>. In some embodiments, end surface <NUM> is welded to end surface <NUM> or otherwise coupled to end surface <NUM> to fix plate <NUM> relative to body <NUM>. Plate <NUM> includes an aperture <NUM> extending through a thickness of plate <NUM> that is defined by a distance between end surface <NUM> and an opposite end surface <NUM>. Aperture <NUM> is coaxial with shaft <NUM> and axis X1. Proximal end <NUM> of shaft <NUM> extends through aperture <NUM>, as best shown in <FIG>. Plate <NUM> includes a plurality of spaced apart grooves, such as, for example, openings <NUM> that are positioned radially about aperture <NUM>. That is, openings <NUM> extend circumferentially about aperture <NUM>. Openings <NUM> extend parallel to axis X1 and are each configured for disposal of an extension <NUM> of knob <NUM> to prevent rotation of shaft <NUM> relative to handle <NUM> and sleeve <NUM> about axis X1, as discussed herein.

In some embodiments, openings <NUM> include a bevel 158a to facilitate insertion of extensions <NUM> into openings <NUM>. That is, tapered bevels 158a of openings <NUM> that extend into end surface <NUM> have a greater diameter than cylindrical second portions of openings <NUM> that are positioned between end surface <NUM> and end surface <NUM>. In some embodiments, extensions <NUM> included tapered tips 160a configured to facilitate insertion of extensions <NUM> into openings <NUM>. In some embodiments, tips 160a terminate in a sharp point. In some embodiments, at least one of openings <NUM> extends through end surface <NUM> without extending through end surface <NUM>. In some embodiments, at least one of openings <NUM> extends through end surface <NUM> and end surface <NUM>. In some embodiments, plate <NUM> has a uniform thickness. In some embodiments, aperture <NUM> and/or openings <NUM> variously shaped, such as, for example, circular, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered.

Knob <NUM> includes a hub <NUM> comprising a cylindrical body <NUM>. Proximal end <NUM> of shaft <NUM> is coupled to a distal end of hub <NUM> such that end <NUM> is fixed relative to hub <NUM>, as best shown in <FIG>. In some embodiments, end <NUM> is integrally and/or monolithically formed with hub <NUM>. In some embodiments, end <NUM> is welded to hub <NUM> such that rotation of hub <NUM> also rotates shaft <NUM>. A gripping portion <NUM> of knob <NUM> includes a disc <NUM> that is fixed to hub <NUM>. In some embodiments, disc <NUM> is integrally and/or monolithically formed with gripping portion <NUM> such that rotation of gripping portion <NUM> also rotates disc <NUM>. In some embodiments, disc <NUM> is welded to gripping portion <NUM>. In some embodiments, disc <NUM> is integrally and/or monolithically formed with hub <NUM> such that rotation of gripping portion <NUM> also rotates disc <NUM> and hub <NUM>. In some embodiments, disc <NUM> is welded to hub <NUM>. Gripping portion <NUM> further includes a member, such as, for example, a plate <NUM> that is fixed to hub <NUM>, a member, such as, for example, a plate <NUM> and gripping portion <NUM>. In some embodiments, plate <NUM> is integrally and/or monolithically formed with hub <NUM>, plate <NUM> and/or gripping portion <NUM> such that rotation of plate <NUM> also rotates hub <NUM>. In some embodiments, plate <NUM> is welded to hub <NUM>.

An inner surface <NUM> of gripping portion <NUM> defines a cavity <NUM>. A floating member or plate, such as, for example, a plate <NUM> is movably disposed in cavity <NUM>. Extensions <NUM> extend outwardly from a distal end of plate <NUM>. Plate <NUM> includes an aperture <NUM> and plate <NUM> includes an aperture <NUM>. Apertures <NUM>, <NUM> are each coaxial with axis X1 such that apertures <NUM>, <NUM> are aligned with aperture <NUM> of plate <NUM> and end <NUM> of shaft <NUM> extends through apertures <NUM>, <NUM>, <NUM> for connection with hub <NUM>.

Extensions <NUM> are configured to move through grooves, such as, for example, openings <NUM> in plate <NUM> and into openings <NUM> of plate <NUM>. In particular, knob <NUM> is rotatable between a first configuration in which extensions <NUM> are spaced apart from openings <NUM> or only tips 160a of extensions <NUM> are positioned within openings <NUM> and a second configuration in which extensions <NUM> are disposed in the openings <NUM>. That is, extensions <NUM> are spaced apart from openings <NUM> or are only partially positioned within openings <NUM> when knob <NUM> is in the first configuration and extensions <NUM> are fully disposed in the openings <NUM> when knob <NUM> is in the second configuration. In some embodiments, cylindrical portions 160b of extensions <NUM> are positioned in openings <NUM> when extensions <NUM> are fully disposed in the openings <NUM> and knob <NUM> is in the second configuration. Cylindrical potions 160b of extensions <NUM> are positioned in openings <NUM> and tips 160a of extensions <NUM> are positioned outside of openings <NUM> when knob <NUM> is in the first configuration and the second configuration. Knob <NUM> is rotatable relative to sleeve <NUM> and handle <NUM> when knob <NUM> is in the first configuration. Knob <NUM> is prevented from rotating relative to <NUM> and handle <NUM> when knob <NUM> is in the second configuration. As such, shaft <NUM> is rotatable relative to sleeve <NUM> and handle <NUM> when knob <NUM> is in the first configuration and shaft <NUM> is prevented from rotating relative to sleeve <NUM> and handle <NUM> when knob <NUM> is in the second configuration. Indeed, when only tips 160a of extensions <NUM> are positioned within openings <NUM>, the tapered configuration of tips 160a allows tips 160a to move in and out of adjacent openings <NUM> as knob <NUM> is rotated relative to sleeve <NUM> and handle <NUM>. When extensions <NUM> are inserted further into openings <NUM> such that cylindrical portions 160b of extensions are positioned within openings <NUM>, knob <NUM> prevented from being rotated relative to sleeve <NUM> and handle <NUM> since extensions <NUM> are prevented from moving from one of openings <NUM> to another one of openings <NUM>.

In some embodiments, knob <NUM> is biased to the second configuration by a biasing member, such as, for example, a spring <NUM> that is positioned about hub <NUM>. That is, spring <NUM> has a first end <NUM> that directly engages disc <NUM> and an opposite second end <NUM> that directly engages plate <NUM> to move plate <NUM> away from disc <NUM> such that extensions <NUM> move through openings <NUM> and into openings <NUM>. In some embodiments, the force exerted by spring <NUM> to plate <NUM> is sufficient to move knob <NUM> from the first configuration to the second configuration. In some embodiments, the force exerted by spring <NUM> to plate <NUM> is insufficient to move knob <NUM> from the first configuration to the second configuration. For example, in one embodiment, knob <NUM> will remain in the first configuration unless and until mating surface <NUM> mates with a mating surface of an implant, such as, for example, implant <NUM> or implant <NUM>. When mating surface <NUM> mates with the mating surface of the implant, rotation of knob <NUM> relative to sleeve <NUM> and handle <NUM> causes shaft <NUM> to translate axially relative to sleeve <NUM> and handle <NUM>. As shaft <NUM> translates axially relative to sleeve <NUM> and handle <NUM>, knob <NUM> translates axially relative to plate <NUM> to move knob <NUM> toward plate <NUM> such that extensions <NUM> are fully disposed in the openings <NUM> and knob <NUM> is in the second configuration.

In assembly, operation and use, surgical system <NUM>, similar to the systems and methods described herein, is employed with a surgical procedure for treatment of a spinal disorder affecting a section of a spine of a patient, as discussed herein. The components of surgical system <NUM> are employed with a surgical procedure for treatment of a condition or injury of an affected section of the spine, such as, for example, vertebrae.

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

An incision is made in the body of a patient and a cutting instrument creates a surgical pathway for implantation of components of surgical system <NUM>. A preparation instrument can be employed to prepare tissue surfaces of vertebrae as well as for aspiration and irrigation of a surgical region. Instrument <NUM> is coupled to an implant, such as, for example, an implant <NUM>, that is configured to be inserted into a target site, such as, for example, an intervertebral space IS between a first vertebra V1 and a second vertebra V2, as shown in <FIG>. As shown in <FIG>, implant <NUM> includes opposite first and second vertebral engaging surfaces <NUM>, <NUM>. Vertebral engaging surface <NUM> is configured to engage an endplate of vertebra V1 and vertebral engaging surface <NUM> is configured to engage an endplate of vertebra V2. Implant <NUM> includes a posterior surface <NUM> and an anterior surface <NUM> opposite surface <NUM>. Surfaces <NUM>, <NUM> each extend from surface <NUM> to surface <NUM>. Surface <NUM> defines a cavity <NUM> and a cavity <NUM> that is spaced apart from cavity <NUM>. Cavity <NUM> includes a female thread form 202a and cavity <NUM> includes a female thread form 204a.

In one embodiment, implant <NUM> is configured for use in an ALIF procedure. Implant <NUM> is connected to instrument <NUM> by inserting peg <NUM> into cavity <NUM> such that opening <NUM> is aligned with cavity <NUM>, as shown in <FIG>. Knob <NUM> in the first configuration when peg <NUM> is inserted into cavity <NUM> such that knob <NUM> is able to translate shaft <NUM> relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> and/or the direction shown by arrow B in <FIG>. Knob <NUM> is translated relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> to move shaft <NUM> from a first position in which mating surface <NUM> is positioned entirely within passageway <NUM> to a second position in which mating surface <NUM> extends through opening <NUM> and into cavity <NUM>, as shown in <FIG>. Knob <NUM> is rotated about axis X1 in a first rotational direction, such as, for example, clockwise as knob <NUM> is translated relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> such that the male thread form of mating surface <NUM> mates with female thread form 202a. When the male thread form of mating surface <NUM> mates with female thread form 202a, further rotation of knob <NUM> relative to sleeve <NUM> and handle <NUM> in the first rotational direction causes shaft <NUM> to translate axially relative to sleeve <NUM> and handle <NUM> in the direction shown by arrow A in <FIG>. Because knob <NUM> is in the first configuration, knob <NUM> is rotatable relative to sleeve <NUM> and handle <NUM> to translate shaft <NUM> axially relative to sleeve <NUM> and handle <NUM>. As shaft <NUM> translates axially relative to sleeve <NUM> and handle <NUM> in the direction shown by arrow A in <FIG>, knob <NUM> translates axially relative to plate <NUM> in the direction shown by arrow A in <FIG> to move knob <NUM> toward plate <NUM> such that extensions <NUM> are fully disposed in the openings <NUM> and knob <NUM> is in the second configuration.

Implant <NUM> is guided into intervertebral space IS using instrument <NUM>. Once implant <NUM> is selectively positioned within intervertebral space IS knob <NUM> is rotated relative to sleeve <NUM> and handle <NUM> about axis X1 in a second rotational direction, such as, for example, counterclockwise. Knob <NUM> is rotated relative to sleeve <NUM> and handle <NUM> about axis X1 in the second rotational direction with a force sufficient to overcome the force of spring <NUM> to move knob <NUM> from the second configuration to the first configuration. As knob <NUM> moves from the second configuration to the first configuration, shaft <NUM> moves from the second position in which mating surface <NUM> extends through opening <NUM> and into cavity <NUM> to the first position in which mating surface <NUM> is positioned entirely within passageway <NUM>. Peg <NUM> is removed from cavity <NUM> when shaft <NUM> is in the first position.

Upon completion of a procedure, as described herein, the surgical instruments, assemblies and non-implanted components of surgical system <NUM> are removed and the incision(s) are closed. One or more of the components surgical system <NUM> can be made of radiolucent materials such as polymers. Radiomarkers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. In some embodiments, surgical system <NUM> may include one or a plurality of spinal rods, plates, connectors and/or bone fasteners for use with a single vertebral level or a plurality of vertebral levels.

One or more bone screws, as described herein, may be engaged with tissue in various orientations, such as, for example, series, parallel, offset, staggered and/or alternate vertebral levels. In some embodiments, one or more of the bone screws may comprise multi-axial screws, sagittal adjusting screws, pedicle screws, mono-axial screws, uni-planar screws, facet screws, fixed screws, tissue penetrating screws, conventional screws, expanding screws, wedges, anchors, buttons, clips, snaps, friction fittings, compressive fittings, expanding rivets, staples, nails, adhesives, posts, fixation plates and/or posts.

Surgical system <NUM> may include an agent, which may be disposed, packed, coated or layered within, on or about the components and/or surfaces of surgical system <NUM>. The agent may include bone growth promoting material, such as, for example, bone graft to enhance fixation of the components and/or surfaces of surgical system <NUM> with vertebrae. The agent may include one or a plurality of therapeutic agents and/or pharmacological agents for release, including sustained release, to treat, for example, pain, inflammation and degeneration.

As shown above, instrument <NUM> was used to insert implant <NUM> in connection with an ALIF procedure. To demonstrate that instrument <NUM> can be used to insert implant <NUM> using different approaches, implant <NUM> is connected to instrument <NUM> by inserting peg <NUM> into cavity <NUM> such that opening <NUM> is aligned with cavity <NUM>, as shown in <FIG> wherein implant <NUM> is configured for use in an OLIF <NUM>-<NUM> procedure. As shown in <FIG>, implant <NUM> includes screw holes 195a, 195b that are accessible when peg <NUM> is inserted into cavity <NUM> and opening <NUM> is aligned with cavity <NUM> such that a fastener 205a can be inserted into and/or removed from hole 195a and a fastener 205b can be inserted into and/or removed from hole 195b when peg <NUM> is inserted into cavity <NUM> and opening <NUM> is aligned with cavity <NUM>. Knob <NUM> is in the first configuration when peg <NUM> is inserted into cavity <NUM> such that knob <NUM> is able to translate shaft <NUM> relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> and/or the direction shown by arrow B in <FIG>. Knob <NUM> is translated relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> to move shaft <NUM> from a first position in which mating surface <NUM> is positioned entirely within passageway <NUM> to a second position in which mating surface <NUM> extends through opening <NUM> and into cavity <NUM>, as shown in <FIG>. Knob <NUM> is rotated about axis X1 in a first rotational direction, such as, for example, clockwise as knob <NUM> is translated relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> such that the male thread form of mating surface <NUM> mates with female thread form 204a. When the male thread form of mating surface <NUM> mates with female thread form 204a, further rotation of knob <NUM> relative to sleeve <NUM> and handle <NUM> in the first rotational direction causes shaft <NUM> to translate axially relative to sleeve <NUM> and handle <NUM> in the direction shown by arrow A in <FIG>. Because knob <NUM> is in the first configuration, knob <NUM> is rotatable relative to sleeve <NUM> and handle <NUM> to translate shaft <NUM> axially relative to sleeve <NUM> and handle <NUM>. As shaft <NUM> translates axially relative to sleeve <NUM> and handle <NUM> in the direction shown by arrow A in <FIG>, knob <NUM> translates axially relative to plate <NUM> in the direction shown by arrow A in <FIG> to move knob <NUM> toward plate <NUM> such that extensions <NUM> are fully disposed in the openings <NUM> and knob <NUM> is in the second configuration.

It should be appreciated that instrument <NUM> can be used to insert other implants, in addition to implant <NUM>, for use in a variety of techniques, such as, for example, ALIF, OLIF <NUM>-<NUM>, OLIF <NUM>-<NUM> and DLIF. For example, instrument <NUM> is shown in <FIG> connected to implant <NUM> to insert implant <NUM> in connection with an DLIF procedure. Instrument <NUM> is shown in <FIG> connected to implant <NUM> to insert implant <NUM> in connection with an OLIF <NUM>-<NUM> procedure. Instrument <NUM> is shown in <FIG> connected to implant <NUM> to insert implant <NUM> in connection with an OLIF <NUM>-<NUM> procedure. Instrument <NUM> is shown in <FIG> connected to implant <NUM> to insert implant <NUM> in connection with an ALIF procedure. However, it is envisioned that instrument <NUM> can be connected to a variety of implants that are the same or similar to implants <NUM>, <NUM>, <NUM> for use in a variety of different procedures and/or approaches.

In the embodiments discussed above, instrument <NUM> includes shaft <NUM> and peg <NUM> that are inserted into cavities of implants to connect instrument <NUM> to the implants. In other embodiments, implants are disclosed that include projections or extensions that are received within cavities of an instrument to couple the implant to the instrument. For example, in one embodiment, shown in <FIG>, surgical system <NUM> includes an implant <NUM> that is similar to implants <NUM>, <NUM>, <NUM> and an instrument <NUM> that is similar to instrument <NUM> and is configured to connect to implant <NUM> to insert implant <NUM> within a target area with a body of a patient, as discussed herein.

Implant <NUM> includes a body <NUM> having opposite first and second vertebral engaging surfaces <NUM>, <NUM>. As shown in <FIG> body <NUM> of implant <NUM> can be provided with a variety of shapes and sizes. An end surface <NUM> of body <NUM> extends from vertebral engaging surface <NUM> to vertebral engaging surface <NUM>. Implant <NUM> includes a peg <NUM> extending from surface <NUM> and a peg <NUM> extending from surface <NUM> such that peg <NUM> is spaced apart from peg <NUM>. Peg <NUM> includes a male thread form 218a and peg <NUM> includes a male thread form 220a.

Instrument <NUM> includes sleeve <NUM>. Rather than having shaft <NUM> positioned in passageway <NUM>, instrument <NUM> includes an inner sleeve <NUM> rotatably positioned within <NUM> such that sleeve <NUM> can translate axially relative to axis X1 in opposite directions relative to sleeve <NUM>. In one embodiment, an outer surface of sleeve <NUM> directly engages surface <NUM> when sleeve <NUM> is positioned in passageway <NUM>. A proximal end of sleeve <NUM> is coupled to knob <NUM> to allow knob <NUM> to move sleeve <NUM> relative to sleeve <NUM> and handle <NUM> in the same manner as knob <NUM> moves shaft <NUM> relative to sleeve <NUM> and handle <NUM> in the embodiments of instrument <NUM> discussed above. Engagement portion <NUM> of instrument <NUM> is similar to engagement portion <NUM> of instrument <NUM> except that engagement portion <NUM> of instrument <NUM> includes an aperture <NUM> in place of peg <NUM>. Sleeve <NUM> includes an inner surface <NUM> that defines a female thread form <NUM> configured to engage male thread form 218a or male thread form 220a to couple implant <NUM> to instrument <NUM>, as discussed herein.

In assembly, operation and use, instrument <NUM> is coupled to an implant, such as, for example, implant <NUM>, that is configured to be inserted into a target site, such as, for example, intervertebral space IS. In one embodiment, implant <NUM> is configured for use in an ALIF procedure. Implant <NUM> is connected to instrument <NUM> by inserting peg <NUM> into aperture <NUM> such that opening <NUM> is aligned with peg <NUM>. Knob <NUM> in the first configuration when peg <NUM> is inserted into aperture <NUM> such that knob <NUM> is able to translate sleeve <NUM> relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> and/or the direction shown by arrow B in <FIG>. Knob <NUM> is translated relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> to move sleeve <NUM> from a first position in which sleeve <NUM> is positioned entirely within passageway <NUM> to a second position in which sleeve <NUM> extends through opening <NUM> and engages peg <NUM>.

Knob <NUM> is rotated about axis X1 in a first rotational direction, such as, for example, clockwise as knob <NUM> is translated relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> such that the female thread form <NUM> mates with male thread form 220a. When female thread form <NUM> mates with male thread form 220a, further rotation of knob <NUM> relative to sleeve <NUM> and handle <NUM> in the first rotational direction causes sleeve <NUM> to translate axially relative to sleeve <NUM> and handle <NUM> in the direction shown by arrow A in <FIG>. Because knob <NUM> is in the first configuration, knob <NUM> is rotatable relative to sleeve <NUM> and handle <NUM> to translate sleeve <NUM> axially relative to sleeve <NUM> and handle <NUM>. As sleeve <NUM> translates axially relative to sleeve <NUM> and handle <NUM> in the direction shown by arrow A in <FIG>, knob <NUM> translates axially relative to plate <NUM> in the direction shown by arrow A in <FIG> to move knob <NUM> toward plate <NUM> such that extensions <NUM> are fully disposed in the openings <NUM> and knob <NUM> is in the second configuration.

Implant <NUM> is guided into intervertebral space IS using instrument <NUM>. Once implant <NUM> is selectively positioned within intervertebral space IS knob <NUM> is rotated relative to sleeve <NUM> and handle <NUM> about axis X1 in a second rotational direction, such as, for example, counterclockwise. Knob <NUM> is rotated relative to sleeve <NUM> and handle <NUM> about axis X1 in the second rotational direction with a force sufficient to overcome the force of spring <NUM> to move knob <NUM> from the second configuration to the first configuration. As knob <NUM> moves from the second configuration to the first configuration, sleeve <NUM> moves from the second position in which sleeve <NUM> extends through opening <NUM> and engages peg <NUM> to the first position in which sleeve <NUM> is positioned entirely within passageway <NUM>.

As shown above, instrument <NUM> was used to insert implant <NUM> in connection with an ALIF procedure. To demonstrate that instrument <NUM> can be used to insert implant <NUM> using different approaches, implant <NUM> is connected to instrument <NUM> by inserting peg <NUM> into aperture <NUM> such that opening <NUM> is aligned with peg <NUM>. Knob <NUM> in the first configuration when peg <NUM> is inserted into aperture <NUM> such that knob <NUM> is able to translate sleeve <NUM> relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> and/or the direction shown by arrow B in <FIG>. Knob <NUM> is translated relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> to move sleeve <NUM> from a first position in which sleeve <NUM> is positioned entirely within passageway <NUM> to a second position in which sleeve <NUM> extends through opening <NUM> and engages peg <NUM>. Knob <NUM> is rotated about axis X1 in a first rotational direction, such as, for example, clockwise as knob <NUM> is translated relative to sleeve <NUM> and handle <NUM> along axis X1 in the direction shown by arrow A in <FIG> such that female thread form <NUM> mates with male thread form 218a. When the female thread form <NUM> mates with male thread form 218a, further rotation of knob <NUM> relative to sleeve <NUM> and handle <NUM> in the first rotational direction causes sleeve <NUM> to translate axially relative to sleeve <NUM> and handle <NUM> in the direction shown by arrow A in <FIG>. Because knob <NUM> is in the first configuration, knob <NUM> is rotatable relative to sleeve <NUM> and handle <NUM> to translate sleeve <NUM> axially relative to sleeve <NUM> and handle <NUM>. As sleeve <NUM> translates axially relative to sleeve <NUM> and handle <NUM> in the direction shown by arrow A in <FIG>, knob <NUM> translates axially relative to plate <NUM> in the direction shown by arrow A in <FIG> to move knob <NUM> toward plate <NUM> such that extensions <NUM> are fully disposed in the openings <NUM> and knob <NUM> is in the second configuration.

Implant <NUM> is guided into intervertebral space IS using instrument <NUM>. Once implant <NUM> is selectively positioned within intervertebral space IS knob <NUM> is rotated relative to sleeve <NUM> and handle <NUM> about axis X1 in a second rotational direction, such as, for example, counterclockwise. Knob <NUM> is rotated relative to sleeve <NUM> and handle <NUM> about axis X1 in the second rotational direction with a force sufficient to overcome the force of spring <NUM> to move knob <NUM> from the second configuration to the first configuration. As knob <NUM> moves from the second configuration to the first configuration, shaft <NUM> moves from the second position in which sleeve <NUM> extends through opening <NUM> to the first position in which sleeve <NUM> is positioned entirely within passageway <NUM>. It should be appreciated that instrument <NUM> can be used to insert other implants, in addition to implant <NUM>, for use in a variety of techniques, such as, for example, ALIF, OLIF <NUM>-<NUM>, OLIF <NUM>-<NUM> and DLIF.

As discussed above, engagement portion <NUM> can be variously configured for engagement with a plurality of different implants. That is, the configuration of engagement portion <NUM> can be adapted to match the configuration of an implant. For example, in one embodiment, shown in <FIG>, engagement surface <NUM> is concavely curved from end <NUM> to end <NUM>. In some embodiments, engagement surface <NUM> is continuously curved from end <NUM> to end <NUM> and/or engagement surface <NUM> has a continuous radius of curvature. The configuration of engagement surface <NUM> in <FIG> could be used in connection with implants that include a convexly curved surface that engages engagement surface <NUM>, such as, for example, engagement surface <NUM> of implant <NUM>. In another embodiment, shown in <FIG>, engagement surface <NUM> includes a first planar portion 138a, a second planar portion 138b and a third planar portion 138c between portion 138a and portion 138b. Peg <NUM> extends from portion 138a and opening <NUM> extends through portion 138b. Portion 138c extends at an acute angle relative to portion 138a and portion 138c. In one embodiment, shown in <FIG>, engagement surface <NUM> is convexly curved from end <NUM> to end <NUM>. In some embodiments, engagement surface <NUM> is continuously curved from end <NUM> to end <NUM> and/or engagement surface <NUM> has a continuous radius of curvature. The configuration of engagement surface <NUM> in <FIG> could be used in connection with an implant <NUM> that include a concavely curved surface <NUM>, <FIG>, configured for engagement with engagement surface <NUM>, as shown in <FIG>.

The implants discussed above each include two threaded cavities along an engagement surface (e.g., cavities <NUM>, <NUM> along surface <NUM>) for disposal of peg <NUM> and shaft <NUM>, respectively. However, it is envisioned that the implants discussed herein may include three or more threaded cavities along an engagement surface. In some embodiments, the threaded cavities are all on an arc path defined by the engagement surface. For example, cavities <NUM>, <NUM> of implant <NUM> are on an arc path of surface <NUM> and coincide with an arc center of surface <NUM>. It is envisioned that providing an implant with at least three cavities will allow a medical practitioner greater options for connecting an implant to instrument <NUM>. For example, the three of more cavities allow instrument <NUM> to be attached to the implant at different angles or at the same angle in different ways. In one embodiment, shown in <FIG>, an implant <NUM> includes an anterior surface <NUM> that includes spaced apart threaded cavities <NUM>, <NUM>, <NUM> along an arc path of surface <NUM>. In one embodiment, shown in <FIG>, peg <NUM> is disposed in cavity <NUM> and end <NUM> of shaft <NUM> is disposed in cavity <NUM> such that an axis X2 of implant <NUM> is disposed at an angle α1 relative to axis X1. In one embodiment, shown in <FIG>, peg <NUM> is disposed in cavity <NUM> and end <NUM> of shaft <NUM> is disposed in cavity <NUM> such that axis X2 of implant <NUM> is disposed at an angle α2 relative to axis X1. In one embodiment, shown in <FIG>, peg <NUM> is disposed in cavity <NUM> and end <NUM> of shaft <NUM> is disposed in cavity <NUM> such that axis X2 of implant <NUM> is disposed at angle α2 relative to axis X1. In one embodiment, shown in <FIG>, peg <NUM> is disposed in cavity <NUM> and end <NUM> of shaft <NUM> is disposed in cavity <NUM> such that axis X2 parallel and/or coaxial with axis X1. In some embodiments, angle α1 is about <NUM> degrees and angle α2 is about <NUM> degrees.

In some embodiments, shown in <FIG>, engagement surface <NUM> includes a gap <NUM> between end <NUM> and end <NUM>. That is, end <NUM> is spaced apart from end <NUM> by gap <NUM>. In one embodiment, shown in <FIG>, gap <NUM> is configured for disposal of a plate <NUM> that is coupled to an implant <NUM> to allow implant <NUM> to be inserted with instrument <NUM> while plate <NUM> is attached to implant <NUM>. That is, plate <NUM> can be coupled to implant <NUM> before instrument <NUM> engages implant <NUM> to deliver implant <NUM> to a target site. In one embodiment, shown in <FIG>, gap <NUM> is configured to allow access to a screw hole <NUM> of an implant <NUM> while instrument <NUM> is attached to implant <NUM>. That is, a fastener can be inserted through hole <NUM> and into tissue, such as, for example, bone while instrument <NUM> is attached to implant <NUM>, to secure implant <NUM> relative to tissue. Once the fastener is inserted through hole <NUM> and into tissue, instrument <NUM> can be removed from implant <NUM>. Likewise, in one embodiment, shown in <FIG>, gap <NUM> is configured to allow access to a screw hole <NUM> of an implant <NUM> while instrument <NUM> is attached to implant <NUM>. That is, a fastener can be inserted through hole <NUM> and into tissue, such as, for example, bone while instrument <NUM> is attached to implant <NUM>, to secure implant <NUM> relative to tissue. Once the fastener is inserted through hole <NUM> and into tissue, instrument <NUM> can be removed from implant <NUM>.

As discussed herein, instrument <NUM> can be used for insertion of a plurality of different implants. In one embodiment, shown in <FIG>, system <NUM> includes an implant <NUM> having a solid body <NUM> extending along a longitudinal axis X3 between an end wall <NUM> and an opposite end wall <NUM>. Body <NUM> includes a side wall <NUM> and a side wall <NUM> opposite side wall <NUM>. Walls <NUM>, <NUM> each extend from wall <NUM> to wall <NUM>. In some embodiments, at least one of walls <NUM>, <NUM> is planar from wall <NUM> to wall <NUM>. In some embodiments, at least one of walls <NUM>, <NUM> extends parallel to axis X3. In some embodiments, at least one of walls <NUM>, <NUM> is convexly curved from wall <NUM> to wall <NUM>. In some embodiments, at least one of walls <NUM>, <NUM> has a continuous radius of curvature from wall <NUM> to wall <NUM>. However, it is envisioned that walls <NUM>, <NUM> can be variously shaped and/or curved to match the shape and/or curve of an engagement surface of an instrument that engages one of walls <NUM>, <NUM>, such as, for example, engagement surface <NUM> of instrument <NUM>. In some embodiments, walls <NUM>, <NUM> each have a maximum length that is less than maximum lengths of walls <NUM>, <NUM>. In some embodiments, wall <NUM> extends perpendicular to wall <NUM>, wall <NUM> extends perpendicular to wall <NUM>, wall <NUM> extends perpendicular to wall <NUM> and wall <NUM> extends perpendicular to wall <NUM>.

Inner surfaces of walls <NUM>, <NUM>, <NUM>, <NUM> define a cavity <NUM>. In some embodiments, body <NUM> includes a scaffold <NUM> positioned within cavity <NUM>. Scaffold <NUM> includes a top wall <NUM> and an opposite bottom wall <NUM>. Wall <NUM> is connected to wall <NUM> by a plurality of spaced apart ribs <NUM>. Scaffold <NUM> is connected to wall <NUM> by a support <NUM> and is connected to wall <NUM> by a support <NUM>. Scaffold <NUM> is spaced apart from wall <NUM> and wall <NUM> and is only connected to walls <NUM>, <NUM> by supports <NUM>, <NUM>. Scaffold <NUM> includes an opening <NUM> that extends through wall <NUM> and an opening <NUM> that extends through wall <NUM>. Openings <NUM>, <NUM> extend perpendicular to axis X3. Scaffold <NUM> includes a plurality of apertures <NUM> extending through a thickness of wall <NUM> and a plurality of apertures <NUM> extending through a thickness of wall <NUM>. In some embodiments, body <NUM> includes a window <NUM> that extends through wall <NUM> and a window <NUM> that extends through wall <NUM>. In some embodiments, apertures <NUM>, apertures <NUM>, window <NUM> and/or window <NUM> may be variously shaped, such as, for example, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. In some embodiments, wall <NUM> and/or wall <NUM> may be disposed at alternate orientations, relative to axis X3, such as, for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered. In some embodiments, apertures <NUM> and/or apertures <NUM> may be variously shaped, such as, for example, circular, oval, oblong, triangular, square, hexagonal, polygonal, honeycomb-shaped, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered.

Body <NUM> includes a cavity <NUM> and a cavity <NUM> that is spaced apart from cavity <NUM>. Cavities <NUM>, <NUM> each extend into wall <NUM>. In some embodiments, cavity <NUM> is in communication with a passageway <NUM> defined by a cylindrical wall <NUM> of body <NUM> that is coupled to wall <NUM>, as best shown in <FIG>. Wall <NUM> includes a closed end <NUM> such that cavity <NUM> and passageway <NUM> are not in communication with cavity <NUM>. That is, an object must be inserted through wall <NUM> to be inserted into cavity <NUM> and passageway <NUM>. Likewise, cavity <NUM> is in communication with a passageway <NUM> defined by a cylindrical wall <NUM> of body <NUM> that is coupled to wall <NUM>, as best shown in <FIG>. Wall <NUM> includes a closed end <NUM> such that cavity <NUM> and passageway <NUM> are not in communication with cavity <NUM>. That is, an object must be inserted through wall <NUM> to be inserted into cavity <NUM> and passageway <NUM>. Cavities <NUM>, <NUM> and passageways <NUM>, <NUM> are configured for engagement with components of an instrument, such as, for example, peg <NUM> and shaft <NUM> of instrument <NUM>, as discussed herein. As such, passageways <NUM>, <NUM> each include a female thread form configured to mate with the male thread form of mating surface <NUM> to connect instrument with implant <NUM>, as discussed herein. Walls <NUM>, <NUM> are permanently fixed relative to body <NUM>. That is, walls <NUM>, <NUM> are incapable of moving relative to walls <NUM>, <NUM>, <NUM>, <NUM> such that wall <NUM> does not move when peg <NUM> is positioned in passageway <NUM> to allow mating surface <NUM> to engage the female thread form of passageway <NUM> and/or wall <NUM> does not move when peg <NUM> is positioned in passageway <NUM> to allow mating surface to engage the female thread form of passageway <NUM>. Indeed, having walls <NUM>, <NUM> permanently fixed relative to body <NUM> allows instrument <NUM> to be manipulated relative to implant <NUM> to couple implant <NUM> to instrument <NUM>, as discussed herein. In contrast to systems that include instruments that are configured to move an implant relative to the instrument when the implant is coupled to the instrument, implant <NUM> will be fixed to instrument <NUM> when instrument <NUM> is connected to implant <NUM>. As such, a medical practitioner must manually manipulate handle <NUM> while implant <NUM> is fixed to instrument <NUM> to selectively position implant <NUM> within a patient. In some embodiments, cavity <NUM>, cavity <NUM>, passageway <NUM>, passageway <NUM>, opening <NUM>, opening <NUM> and/or passageway <NUM> may be disposed at alternate orientations, relative to axis X3, such as, for example, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered.

In some embodiments, body <NUM> includes a tunnel <NUM> having an end <NUM> that is fixed to wall <NUM> and an opposite end <NUM>. Tunnel <NUM> extends at an oblique angle relative to axis X3 and is positioned between cavity <NUM> and cavity <NUM> and includes an opening <NUM> that extends through end <NUM> and wall <NUM> and an opening <NUM> that extends through end <NUM>. Tunnel <NUM> extends continuously from opening <NUM> to opening <NUM> such that tunnel <NUM> is free of any gaps or openings between opening <NUM> and opening <NUM> and a bore, such as, for example, a passageway <NUM> defined by an inner surface of tunnel <NUM> is not in communication with cavity <NUM>, cavity <NUM>, cavity <NUM>, passageway <NUM> or passageway <NUM>. Passageway <NUM> is configured for disposal of a fastener, such as, for example, a bone screw such that the bone screw extends through openings <NUM>, <NUM> for engagement with tissue, such as, for example, bone, as discussed herein. It is envisioned that body <NUM> can include one ore more tunnels in addition to tunnel <NUM> wherein the additional tunnels are each configured for disposal of an additional bone screw such that implant <NUM> can be attached to bone using more than one bone screw. In some embodiments, tunnel <NUM> may be disposed at alternate orientations, relative to axis X3, such as, for example, parallel, transverse, perpendicular and/or other angular orientations such as acute or obtuse, co-axial and/or may be offset or staggered.

A core <NUM> is positioned in cavity <NUM> such that core <NUM> surrounds scaffold <NUM> and is viewable through windows <NUM>, <NUM>. Core <NUM> includes a body <NUM> having a lattice configuration that reduces stiffness and opacity, while maintaining strength. Body <NUM> extends from an inner surface of wall <NUM> to scaffold <NUM>, from an inner surface of wall <NUM> to scaffold <NUM>, from an inner surface of wall <NUM> to scaffold <NUM> and from an inner surface of wall <NUM> to scaffold <NUM>. In some embodiments, an uppermost surface of body <NUM> is flush with an uppermost surface of body <NUM> and a lowermost surface of body <NUM> is flush with a lowermost surface of body <NUM> when core <NUM> is positioned within cavity <NUM>. Core <NUM> extends a central channel <NUM> that extends through a thickness of body <NUM> defined by the distance between the uppermost and lowermost surfaces of body <NUM>. Channel <NUM> is aligned with openings <NUM>, <NUM> when core <NUM> is positioned within cavity <NUM>. In some embodiments, core <NUM> is fused with body <NUM>. In some embodiments, core <NUM> is welded to body <NUM>. In some embodiments, core <NUM> is integrally and/or monolithically formed with body <NUM>.

In some embodiments, the lattice configuration of body <NUM> is a diamond lattice the provides exceptional buildability, strength, reduced internal stress and fits within a variety of spinal implant type geometries. That is, the lattice configuration of body <NUM> is formed from a plurality of diamonds <NUM> that are coupled together to form body <NUM>. The parameters of diamonds <NUM> are shown in <FIG>. However, it is envisioned that the parameters of diamonds <NUM> can be altered by changing x, y and z values of diamonds <NUM> in a user interface, as shown in <FIG>. In some embodiments, the lattice configuration of body <NUM> is formed using 3D printing.

Implant <NUM> includes a cap <NUM> coupled to top ends of walls <NUM>, <NUM>, <NUM>, <NUM> and scaffold <NUM> and a cap <NUM> coupled to opposite bottom ends of walls <NUM>, <NUM>, <NUM>, <NUM> and scaffold <NUM>. Cap <NUM> includes an opening <NUM> that is aligned with opening <NUM> and channel <NUM> when cap <NUM> is coupled to bodies <NUM>, <NUM> and cap <NUM> includes an opening <NUM> that is aligned with opening <NUM> and channel when cap <NUM> is coupled to bodies <NUM>, <NUM>. Opening <NUM> is surrounded by a plurality of apertures <NUM> and opening <NUM> is surrounded by a plurality of apertures <NUM>. Apertures <NUM> are aligned with apertures <NUM> when cap <NUM> is coupled to bodies <NUM>, <NUM> and apertures <NUM> are aligned with apertures <NUM> when cap <NUM> is coupled to bodies <NUM>, <NUM>. In some embodiments, apertures <NUM> have the same size and shape as apertures <NUM> and/or apertures <NUM> have the same size and shape as apertures <NUM>. In some embodiments, caps <NUM>, <NUM> are fused with body <NUM> and/or body <NUM>. In some embodiments, caps <NUM>, <NUM> are welded to body <NUM> and/or body <NUM>. In some embodiments, caps <NUM>, <NUM> are integrally and/or monolithically formed with body <NUM> and/or body <NUM>.

Wall <NUM> and cap <NUM> define a ledge <NUM> that extends from ribs <NUM> of scaffold <NUM> to openings <NUM>, <NUM> and wall <NUM> and cap <NUM> define a ledge <NUM> that extends from ribs <NUM> to openings <NUM>, <NUM>. Ledge <NUM> extends circumferentially about openings <NUM>, <NUM> such that ledge <NUM> surrounds openings <NUM>, <NUM>. Likewise, ledge <NUM> extends circumferentially about openings <NUM>, <NUM> such that ledge <NUM> surrounds openings <NUM>, <NUM>. Implant <NUM> includes a cavity <NUM> defined by inner surfaces of ribs <NUM>. Openings <NUM>, <NUM>, <NUM>, <NUM> each have a maximum diameter D1 that is less than a maximum diameter D2 of cavity <NUM>, as shown in <FIG>. Cavity <NUM> defines a graft containment area. In particular, it is envisioned that a material, such as, for example, bone graft BG can be inserted through openings <NUM>, <NUM> and into cavity <NUM> or through openings <NUM>, <NUM> and into cavity <NUM> to position bone graft BG between ledge <NUM> and ledge <NUM>, as shown in <FIG>.

In one embodiment, shown in <FIG>, system <NUM> includes an implant <NUM> that is similar to implant <NUM>. Wall <NUM> of implant <NUM> includes a recessed portion <NUM> configured for disposal of at least a portion of engagement portion <NUM> of instrument <NUM>. Implant <NUM> further includes a threaded bore <NUM> positioned between wall <NUM> of implant <NUM> and cavity <NUM> of implant <NUM> and a threaded bore <NUM> positioned between wall <NUM> of implant <NUM> and cavity <NUM> of implant <NUM>. Bores <NUM>, <NUM> are each configured for disposal of a fastener, such as, for example, a bone screw. Bores <NUM>, <NUM> each extend at an oblique angle relative to axis X3 such that bores <NUM>, <NUM> each extend through ledges <NUM>, <NUM> of implant <NUM>. In some embodiments, bore <NUM> includes an opening 356a that extends through cap <NUM> of implant <NUM> and an opening 356b that extends through cap <NUM> of implant <NUM> and wall <NUM> of implant <NUM>. Bore <NUM> is free of any gaps or openings such that bore <NUM> is not in communication with cavity <NUM> of implant <NUM>. In some embodiments, bore <NUM> includes an opening 358a that extends through cap <NUM> of implant <NUM> and an opening 358b that extends through cap <NUM> of implant <NUM> and wall <NUM> of implant <NUM>. Bore <NUM> is free of any gaps or openings such that bore <NUM> is not in communication with cavity <NUM> of implant <NUM>. In some embodiments, walls <NUM>, <NUM> of implant <NUM> each have a maximum length that is greater than maximum lengths of walls <NUM>, <NUM> of implant <NUM>. In some embodiments, implant <NUM> is rounded at an interface between wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM>, at an interface between wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM>, at an interface between wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM> and at an interface between wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM>.

In one embodiment, shown in <FIG>, system <NUM> includes an implant <NUM> that is similar to implants <NUM>, <NUM>. Wall <NUM> of implant <NUM> has a height that is greater than a height of side wall <NUM> of implant <NUM> such that cap <NUM> of implant <NUM> is positioned at an angle α3 relative to cap <NUM> of implant <NUM>, as shown in <FIG>. Angle α3 provides implant <NUM> with a wedge-like shape. In some embodiments, angle α3 is between <NUM> degrees and <NUM> degrees. In some embodiments, angle α3 is between <NUM> degree and <NUM> degrees. In some embodiments, angle α3 is between <NUM> degree and <NUM> degrees. In some embodiments, angle α3 is between <NUM> degrees and <NUM> degrees. In some embodiments, angle α3 is between <NUM> degrees and <NUM> degrees. In some embodiments, angle α3 is between <NUM> degrees and <NUM> degrees. However, it is envisioned that angle α3 can be selected to be any angle that achieves proper lordosis when implant <NUM> is positioned between adjacent vertebrae. In some embodiments, walls <NUM>, <NUM> of implant <NUM> each have a maximum length that is less than maximum lengths of walls <NUM>, <NUM> of implant <NUM>. In some embodiments, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>.

In one embodiment, shown in <FIG>, system <NUM> includes an implant <NUM> that is similar to implants <NUM>, <NUM>, <NUM>. Wall <NUM> of implant <NUM> has a height that is greater than a height of side wall <NUM> of implant <NUM> such that cap <NUM> of implant <NUM> is positioned at an angle α4 relative to cap <NUM> of implant <NUM>, as shown in <FIG>. Angle α4 is less than angle α3. In some embodiments, angle α4 is between <NUM> degrees and <NUM> degrees. In some embodiments, angle α4 is between <NUM> degree and <NUM> degrees. In some embodiments, angle α4 is between <NUM> degree and <NUM> degrees. In some embodiments, angle α4 is between <NUM> degree and <NUM> degrees. However, it is envisioned that angle α4 can be selected to be any angle that achieves proper lordosis when implant <NUM> is positioned between adjacent vertebrae. In some embodiments, walls <NUM>, <NUM> of implant <NUM> each have a maximum length that is less than maximum lengths of walls <NUM>, <NUM> of implant <NUM>. In some embodiments, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>.

In one embodiment, shown in <FIG>, system <NUM> includes an implant <NUM> that is similar to implants <NUM>, <NUM>, <NUM>, <NUM>. Wall <NUM> of implant <NUM> includes a recessed portion <NUM> configured for disposal of at least a portion of engagement portion <NUM> of instrument <NUM>. Implant <NUM> further includes a threaded bore <NUM> positioned between wall <NUM> of implant <NUM> and cavity <NUM> of implant <NUM> and a threaded bore <NUM> positioned between wall <NUM> of implant <NUM> and cavity <NUM> of implant <NUM>. Bores <NUM>, <NUM> are each configured for disposal of a fastener, such as, for example, a bone screw. Bores <NUM>, <NUM> each extend at an oblique angle relative to axis X3 such that bores <NUM>, <NUM> each extend through ledges <NUM>, <NUM> of implant <NUM>. In some embodiments, bore <NUM> includes an opening 356a that extends through cap <NUM> of implant <NUM> and an opening 356b that extends through wall <NUM> of implant <NUM>. Bore <NUM> is free of any gaps or openings such that bore <NUM> is not in communication with cavity <NUM>. In some embodiments, bore <NUM> includes an opening 358a that extends through cap <NUM> of implant <NUM> and an opening 358b that extends through wall <NUM> of implant <NUM>. Bore <NUM> is free of any gaps or openings such that bore <NUM> is not in communication with cavity <NUM>. In some embodiments, neither bore <NUM> nor bore <NUM> extend through cap <NUM> of implant <NUM>, as shown in <FIG>. In some embodiments, walls <NUM>, <NUM> of implant <NUM> each have a maximum length that is greater than maximum lengths of walls <NUM>, <NUM> of implant <NUM>. In some embodiments, implant <NUM> is rounded at an interface between wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM>, at an interface between wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM>, at an interface between wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM> and at an interface between wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM>. In some embodiments, walls <NUM>, <NUM>, <NUM>, <NUM> of implant <NUM> each have a height from cap <NUM> of implant <NUM> to cap <NUM> of implant <NUM> that is greater than heights of walls <NUM>, <NUM>, <NUM>, <NUM> of implant <NUM> from cap <NUM> of implant <NUM> to cap <NUM> of implant <NUM>.

In one embodiment, shown in <FIG>, system <NUM> includes an implant <NUM> that is similar to implants <NUM>, <NUM>, <NUM>, <NUM>, <NUM>. Wall <NUM> of implant <NUM> has a height that is greater than a height of side wall <NUM> of implant <NUM> such that cap <NUM> of implant <NUM> is positioned at an angle α5 relative to cap <NUM> of implant <NUM>, as shown in <FIG>. Angle α5 provides implant <NUM> with a wedge-like shape. In some embodiments, angle α5 is between <NUM> degrees and <NUM> degrees. In some embodiments, angle α5 is between <NUM> degree and <NUM> degrees. In some embodiments, angle α5 is between <NUM> degree and <NUM> degrees. In some embodiments, angle α5 is between <NUM> degrees and <NUM> degrees. In some embodiments, angle α5 is between <NUM> degrees and <NUM> degrees. In some embodiments, angle α5 is between <NUM> degrees and <NUM> degrees. However, it is envisioned that angle α5 can be selected to be any angle that achieves proper lordosis when implant <NUM> is positioned between adjacent vertebrae. In some embodiments, walls <NUM>, <NUM> of implant <NUM> each have a maximum length that is less than maximum lengths of walls <NUM>, <NUM> of implant <NUM>. In some embodiments, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>. In some embodiments, wall <NUM> of implant <NUM> includes a planar portion 264a, a planar portion 264b and a planar portion 264c positioned between planar portion 264a and planar portion 264b. Planar portion 264b extends at an acute angle relative to planar portion 264a and planar portion 264c extends at an acute angle relative to planar portion 264b. In some embodiments, planar portions 264a, 264b, 264c are configured for engagement with planar portions 138a, 138b, 138c of instrument <NUM> shown in <FIG>.

In one embodiment, shown in <FIG>, system <NUM> includes an implant <NUM> that is similar to implants <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>. Side wall <NUM> of implant <NUM> has a height that is greater than a height of side wall <NUM> of implant <NUM> such that cap <NUM> of implant <NUM> is positioned at an angle α6 relative to cap <NUM> of implant <NUM>, as shown in <FIG>. Angle α6 provides implant <NUM> with a wedge-like shape. Angle α6 is less than angle α5. In some embodiments, angle α6 is between <NUM> degrees and <NUM> degrees. In some embodiments, angle α6 is between <NUM> degree and <NUM> degrees. In some embodiments, angle α6 is between <NUM> degree and <NUM> degrees. In some embodiments, angle α6 is between <NUM> degree and <NUM> degrees. However, it is envisioned that angle α6 can be selected to be any angle that achieves proper lordosis when implant <NUM> is positioned between adjacent vertebrae. In some embodiments, walls <NUM>, <NUM> of implant <NUM> each have a maximum length that is less than maximum lengths of walls <NUM>, <NUM> of implant <NUM>. In some embodiments, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>, wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM> and wall <NUM> of implant <NUM> extends at an acute angle relative to wall <NUM> of implant <NUM>. In some embodiments, wall <NUM> of implant <NUM> includes a planar portion 264a, a planar portion 264b and a planar portion 264c positioned between planar portion 264a and planar portion 264b. Planar portion 264b extends at an acute angle relative to planar portion 264a and planar portion 264c extends at an acute angle relative to planar portion 264b. In some embodiments, planar portions 264a, 264b, 264c are configured for engagement with planar portions 138a, 138b, 138c of instrument <NUM> shown in <FIG>.

Claim 1:
A surgical instrument (<NUM>) comprising:
a sleeve (<NUM>) extending along a longitudinal axis (X1) between opposite proximal and distal ends (<NUM>, <NUM>), an inner surface (<NUM>) of the sleeve (<NUM>) defining a passageway (<NUM>), the distal end (<NUM>) defining an engagement portion (<NUM>), the engagement portion (<NUM>) comprising an engagement surface (<NUM>) extending from a first end (<NUM>) to an opposite second end (<NUM>), the engagement portion (<NUM>) comprising a peg (<NUM>) extending outwardly from the first end (<NUM>), the engagement portion (<NUM>) comprising an opening (<NUM>) extending through the second end (<NUM>), the opening (<NUM>) being in communication with the passageway (<NUM>);
a knob (<NUM>) coupled to the proximal end (<NUM>) of the sleeve (<NUM>); and
a shaft (<NUM>) comprising a proximal end (<NUM>) and an opposite distal end (<NUM>), the distal end (<NUM>) of the shaft (<NUM>) comprising a mating portion (<NUM>), the mating portion (<NUM>) extending through the opening (<NUM>), the proximal end (<NUM>) of the shaft (<NUM>) being coupled to the knob (<NUM>), the knob (<NUM>) being rotatable relative to the sleeve (<NUM>) to rotate the shaft (<NUM>) relative to the sleeve (<NUM>), wherein:
the surgical instrument (<NUM>) includes a first member (<NUM>) positioned between the sleeve (<NUM>) and the knob (<NUM>), the first member (<NUM>) being fixed relative to the sleeve (<NUM>), the first member (<NUM>) including a plurality of first openings (<NUM>);
the knob (<NUM>) comprises a second member including a plurality of second openings (<NUM>) and a third member (<NUM>) comprising a plurality of extensions (<NUM>) that are aligned with the second openings, the shaft (<NUM>) being fixed to the second member (<NUM>); and
the knob (<NUM>) is rotatable between a first configuration in which the extensions (<NUM>) are spaced apart from the first openings (<NUM>) and a second configuration in which the extensions (<NUM>) are disposed in the first openings (<NUM>), the knob (<NUM>) being rotatable relative to the sleeve (<NUM>) when the knob (<NUM>) is in the first configuration, the knob (<NUM>) resisting rotation relative to the sleeve (<NUM>) when the knob (<NUM>) is in the second configuration.