Surgical instruments and methods

Abstract

A surgical instrument (10) includes a first component (14) comprising at least a portion of a first ball joint (22) and a first lock (96) capable of engaging a first bone element (98) fixed to a first vertebra. A second component (16) includes at least a portion of a second ball joint (34) and a second lock (146) capable of engaging a second bone element (98a) fixed to a second vertebra. A linkage mechanism (62) is capable of engaging simultaneously with the ball joint to lock the second component relative to the first component fixed to the first vertebra. Surgical systems and methods are disclosed.

Description

Technical Field

[0001] This application claims the benefit of U.S. Provisional Patent Application Serial No. 18 / 519,625, filed November 27, 2023, the entire contents of which are incorporated herein by reference.

[0002] This disclosure relates generally to medical devices for treating musculoskeletal disorders, and more specifically to surgical systems, surgical instruments and methods for treating the spine. Background Technology

[0003] Spinal disorders and conditions, such as scoliosis and other curvatures, kyphosis, degenerative disc disease, herniated discs, osteoporosis, spondylolisthesis, stenosis, tumors, and fractures, can be caused by factors including trauma, disease, and degenerative conditions resulting from injury and aging. Spinal disorders often lead to symptoms including deformities, pain, nerve damage, and partial or complete loss of mobility.

[0004] Non-surgical treatments (such as medication, rehabilitation, and exercise) may be effective but may not relieve the symptoms associated with these conditions. Surgical treatments for these spinal conditions include pediatric treatment, deformity surgery, correction, fusion, fixation, discectomy, laminectomy, vertebral body resection, and implantable prostheses. As part of these surgical treatments, spinal implants (e.g., bone fasteners, spinal rods, and intervertebral devices) can be used to provide stability to the treated area. Surgical instruments can be used to prepare the tissue surface and fix the vertebrae via bone mounting devices. Surgical treatments may employ surgical instruments to deliver and manipulate implants to engage with the vertebrae to position and align one or more vertebrae. This disclosure describes improvements to these prior art. Summary of the Invention

[0005] In one embodiment, a method for treating the spine is provided. The method includes the steps of: registering a plurality of vertebrae, including at least a first vertebra and a second vertebra; fixing a first bone element to the first vertebra; fixing a second bone element to the second vertebra; engaging a first lock of a surgical instrument with the first bone element in a locking orientation, the surgical instrument including a first member having at least a portion of a first ball joint and a first lock, the surgical instrument further including a second member and a linkage mechanism, the second member including at least a portion of a second ball joint and a second lock; engaging the second lock with the second bone element in a locking orientation; and simultaneously engaging the ball joint to lock the second member relative to the first member. In some embodiments, surgical systems, instruments, constructions, and implants are disclosed.

[0006] In one embodiment, the method includes: registering a plurality of vertebrae, the plurality of vertebrae including at least a first vertebra, a second vertebra, a third vertebra, a fourth vertebra, a fifth vertebra, and a sixth vertebra; manually fixing a first bone pin to the first vertebra; fixing a second bone pin to the second vertebra via robot guidance; engaging a first lock of a surgical instrument with the first bone pin in a locking orientation, the surgical instrument including a first arm having at least a portion of a first ball joint and a first lock, the surgical instrument further including a second arm and a linkage mechanism, the second arm including at least a portion of a second ball joint and a second lock; engaging the second lock with the second bone pin in a locking orientation; simultaneously engaging the ball joint to lock the second arm relative to the first arm; and fixing a first bone fastener to a third vertebra disposed between the first and second vertebrae.

[0007] In one embodiment, a surgical instrument is provided. The surgical instrument includes a first component comprising at least a portion of a first ball joint and a first lock capable of engaging with a first bone element fixed to a first vertebra. A second component includes at least a portion of a second ball joint and a second lock capable of engaging with a second bone element fixed to a second vertebra. A linkage mechanism is capable of simultaneously engaging with the ball joint to lock the second component relative to the first component fixed to the first vertebra. Attached Figure Description

[0008] This disclosure will become more apparent from the detailed description of the following figures, in which: Figure 1 This is a perspective view of components of one embodiment of a surgical system based on the principles of this disclosure; Figure 2 yes Figure 1 Perspective view of the component shown; Figure 3 yes Figure 1 Perspective view of the component shown; Figure 4 yes Figure 1 A cross-sectional view of the component shown; Figure 5 yes Figure 4 A cross-sectional view of the component shown; Figure 6 yes Figure 1 A cross-sectional view of the component shown; Figure 7 yes Figure 1 A cross-sectional view of the component shown; Figure 8 yes Figure 1 A cross-sectional view of the component shown; Figure 9 yes Figure 1 Plan view of the component shown; Figure 10 This is a perspective view of components of one embodiment of a surgical system based on the principles of this disclosure; Figure 11 yes Figure 10 An enlarged perspective view of the component shown; Figure 12 yes Figure 1 Side view of the component; Figure 13 yes Figure 1 Side view of the component shown; Figure 14 yes Figure 1 Side view of the component shown; Figure 15 yes Figure 1 Side view of the component shown; Figure 16 yes Figure 1 Side view of the component shown; Figure 17 yes Figure 1 Side view of the component shown; Figure 18 yes Figure 1 Side view of the component shown; Figure 19 yes Figure 1 Side view of the component shown; Figure 20 This is a perspective view of components of one embodiment of a surgical system based on the principles of this disclosure; Figure 21 yes Figure 20 A perspective view of the components of the system shown; Figure 22 yes Figure 20 A perspective view of the components of the system shown; Figure 23 yes Figure 20 Side view of the components of the system shown; Figure 24 yes Figure 20 A perspective view of the components of the system shown; Figure 25 yes Figure 20 A perspective view of the components of the system shown; Figure 26 yes Figure 20 A perspective view of the components of the system shown; Figure 27 yes Figure 20 A perspective view of the components of the system shown; Figure 28 yes Figure 20 A perspective view of the components of the system shown; Figure 29 yes Figure 20A perspective view of the components of the system shown; Figure 30 yes Figure 20 A perspective view of the components of the system shown; Figure 31 yes Figure 20 A perspective view of the components of the system shown; Figure 32 yes Figure 20 A perspective view of the components of the system shown; Figure 33 This is a perspective view of components of one embodiment of a surgical system based on the principles of this disclosure; Figure 34 yes Figure 33 A perspective view of the components of the system shown; Figure 35 yes Figure 33 A perspective view of the components of the system shown; Figure 36 yes Figure 33 A perspective view of the components of the system shown; Figure 37 yes Figure 33 A perspective view of the components of the system shown; Figure 38 yes Figure 33 A perspective view of the components of the system shown; Figure 39 yes Figure 33 A perspective view of the components of the system shown; and Figure 40 yes Figure 33 A perspective view of the components of the system shown. Detailed Implementation

[0009] Exemplary embodiments of the disclosed surgical systems and related methods of use are discussed in relation to medical devices, implants, and surgical instruments for treating musculoskeletal disorders, and more specifically, in relation to surgical systems (including surgical instruments and related components) for accessing the spine to facilitate its treatment and methods for treating the spine. In some embodiments, the surgical system includes a surgical instrument with lockable features that facilitate vertebral fixation via bone mounting. In some embodiments, the surgical instrument is configured to connect a first vertebral segment to a second vertebral segment to stabilize the vertebral segment and adjacent vertebral segments, thereby increasing stiffness relative to unconnected or individually stabilized vertebral segments. In some embodiments, the surgical instrument includes one or more locks to fix the first vertebral segment relative to the second vertebral segment. In some embodiments, the surgical instrument includes a lockable linkage mechanism and arm with multiaxial movement, which connects to bone mounting components to fix selected vertebrae. In some embodiments, the surgical system can be used in conjunction with surgical navigation and / or robotics. In some embodiments, this surgical system can be used in conjunction with surgical procedures including pediatric spinal treatment and / or deformity correction. In some embodiments, the surgical system and methods disclosed herein are used in conjunction with spinal treatments, such as those involving the cervical, thoracic, lumbar, and / or sacral regions of the spine.

[0010] In some embodiments, this surgical system includes a surgical instrument having a linkage mechanism connected to a first ball joint supporting a first arm for relative multiaxial movement. The first arm is lockable to a bone mounting element fixed to a first vertebral surface. The linkage mechanism is connected to a second ball joint supporting a second arm for relative multiaxial movement. The second arm is lockable to a bone mounting element fixed to a second vertebral surface. The linkage mechanism is simultaneously engaged with the ball joint to lock the second arm relative to the first arm fixed to the first vertebral surface. In some embodiments, this surgical instrument advantageously improves the modularity of the instrument components and their interconnection, attachment, and ease of use with surgical devices, surgical navigation systems, robots, and / or vertebrae. In some embodiments, this surgical instrument advantageously facilitates the attachment of one or more bone mounting elements to various locations having vertebrae (such as articular facets, pedicles, laminae, and / or vertebral bodies). In some embodiments, this surgical instrument advantageously facilitates the attachment of one or more bone mounting elements to various locations having vertebral surfaces (such as vertebrae, including articular facets, pedicles, laminae, and / or vertebral bodies) and / or adjacent tissues and joints. In some embodiments, this surgical instrument advantageously facilitates the attachment of one or more bone mounting elements to vertebral, sacral, and / or iliac bone regions, as described herein.

[0011] In some embodiments, the surgical system includes surgical instruments, such as a surgical mount, which includes a first ball joint and a second ball joint, each ball joint including a ball component and a socket capable of connecting to an eccentric linkage mechanism. In some embodiments, the surgical mount includes a frame and a first arm and a second arm connected to the frame. In some embodiments, each arm includes a ball component of a ball joint. In some embodiments, each ball joint in the linkage mechanism and the ball joint is configured to selectively lock and unlock the arm of the surgical mount relative to the frame. In some embodiments, the linkage mechanism is configured to lock the ball joint by a selected locking force. In some embodiments, the linkage mechanism includes a first bending link and a second bending link, and a lever including a first handle and a second handle. In some embodiments, the linkage mechanism secures the arm in a locked position and an unlocked position. In the unlocked position, the arm is capable of selective movement relative to the frame. In some embodiments, in the unlocked position, the ball component of the arm is captured within a portion of the joint including a socket. In some embodiments, in the unlocked position, a gap exists between the ball component and the socket for arm movement. In some embodiments, in the unlocked position, the ball joint has a degree of freedom to articulate relative to the locking linkage. In some embodiments, the lever can be switched so that both the ball joint and the socket engage for locking.

[0012] In some embodiments, the surgical instrument includes a linkage mechanism having a first link and a second link. In some embodiments, a portion of the linkage mechanism is bent at its end. In some embodiments, the link adjusts the force required to move the linkage mechanism to an eccentric position, taking into account adjustable clamping forces on the joint. In some embodiments, the surgical instrument includes a first end cap and a second end cap. In some embodiments, each of the end caps includes a socket. In some embodiments, the linkage mechanism includes a centrally located linkage mechanism capable of being positioned in locked and unlocked positions. In some embodiments, a lever is depressurized to close the gap between each ball joint and the socket. In some embodiments, the lever includes an eccentric lever configured to hold the surgical instrument in a locked and / or unlocked position. In some embodiments, a force is applied to the lever to elastically deform and elongate the linkage mechanism. In some embodiments, the linkage mechanism is eccentrically positioned relative to the link and locked to a closed position. In some embodiments, the eccentric mechanism maintains the arm locked and unlocked for ease of use. In some embodiments, a pin can be used to calibrate the linkage mechanism by applying a variable force to the ball joint.

[0013] In some embodiments, each arm includes a lock disposed at its distal end. In some embodiments, each lock includes an eccentric linkage mechanism and a plate. In some embodiments, the plate is configured to capture a bone element, such as a pin. In some embodiments, the plate is movable relative to the linkage mechanism. In some embodiments, the plate is configured to rotate (e.g., tilt) to engage the pin. In some embodiments, the lock is oriented in a locked position and an unlocked position. In some embodiments, in the unlocked position, the pin translates freely through an engagement socket disposed at the distal end of the arm. In some embodiments, the plate is vertically positioned relative to a through-hole of the engagement socket to facilitate free translation of the pin. In some embodiments, the linkage mechanism includes an eccentric lever. In some embodiments, when depressed, the lever is configured to translate the plate to a selected orientation to engage the pin in the locked position, thereby preventing pin translation. In some embodiments, the plate is oriented in an inclined position to capture the pin. In some embodiments, the lever is depressed to place the pin in the unlocked position, thereby disengaging the plate from the pin. In some embodiments, the lever facilitates vertical positioning of the plate relative to the engagement socket.

[0014] In some embodiments, the surgical system includes surgical instruments that advantageously improve registration capability and spinal stability. In some embodiments, one or more components of the surgical system avoid one or more disadvantages associated with mounting a robot to a patient prior to registration during robot-assisted procedures, such as fixing one or more vertebrae of the patient relative to the robotic system. In some embodiments, one or more components of the surgical system avoid one or more disadvantages associated with operating at more than two vertebral levels above and below the surgical mount, such as avoiding excessive movement of selected spinal segments during robot-assisted procedures. In some embodiments, one or more components of the surgical system avoid one or more disadvantages associated with positioning the surgical mount during image registration, such as avoiding movement and achieving a maximum number of spinal levels within a single registration. In some embodiments, one or more components of the surgical system avoid interference with the surgical mount during registration, such as disadvantages associated with the radiopaqueness of the surgical mount, which can lead to inaccuracies such as registration failure.

[0015] In some embodiments, the surgical system includes a surgical instrument that advantageously improves registration capability by attaching a robot to the patient's bones (e.g., vertebrae) and registering the level above the initial surgical mount to avoid interference with registration by the surgical mount. In some embodiments, once registered, the surgeon can drive a pin into the spinal segment via robot guidance, e.g., at two vertebral levels above the robot / surgical mount level, and then attach the pin to the robot / surgical mount level via the surgical mount itself, which includes a low-force mount. In some embodiments, the surgical system extends the permissible level of robot operation and allows the surgeon to operate at two vertebral levels above the pin, e.g., at four vertebral levels above the initial position of the robot / surgical mount. In some embodiments, the surgical mount is configured to drive the pin into the vertebrae to connect selected vertebral levels. In some embodiments, the surgical mount can be held in place with the vertebrae until all desired vertebral levels are connected. In some implementations, this surgical mount avoids interference with registration, allowing the surgeon to operate at two vertebral levels relative to the fixed vertebral body.

[0016] In some embodiments, the surgical instrument is configured to be secured to a fixed surface, such as an operating table, during surgical procedures. In some embodiments, the arm of the surgical instrument is configured to be mounted to an operating table and / or a robot. In some embodiments, the surgical instrument optionally includes a retractor blade.

[0017] In some implementations, the surgical instrument is configured for use with navigation-guided and / or robotic systems, including, for example, Mazor. ™ A robotic system and its components (Medtronic PLC, Minneapolis, Minnesota, USA) having surgical components that connect to the patient's spine. In some embodiments, this surgical instrument includes aesthetic and / or ergonomic features.

[0018] In some embodiments, the surgical instruments of this disclosure include a surgical mount configured for placement at a surgical site and use in conjunction with methods for treating the spine. In some embodiments, the surgical mount is configured to connect a first vertebral segment or body to a second vertebral segment or body to stabilize the vertebral segment or body and adjacent vertebral segments or bodies to increase stiffness relative to unconnected or individually stabilized vertebral segments or bodies. In some embodiments, the surgical mount is connected to selected vertebrae positioned higher or lower relative to the surgical mount. In some embodiments, the method includes the step of connecting pins to a minimally invasive surgical technique (MIST) bridging point and vertebral tissue (e.g., the spinous processes of thoracic vertebrae T11 and T12). In some embodiments, the method includes the step of registering one or more components of a surgical system using robotic and / or navigation guidance. See, for example, similar surgical navigation systems, robotic systems, and related components and uses described herein, the entire contents of which are incorporated herein by reference. In some implementations, registration includes performing an O-arm for surgical planning and / or a C-arm for fluoroscopic registration. In some implementations, registration is performed at the vertebral level, including the thoracic vertebrae T6 to T10.

[0019] In some embodiments, an incision is made in the patient's skin using a surgical scalpel. In some embodiments, after the incision is made, a cannula is placed using a dilator. In some embodiments, the method includes the step of securing a first pin to the thoracic vertebra T10. In some embodiments, during fixation, a pin actuator is used to insert the first pin (e.g., a Schanz pin) through the cannula into the pedicle of the thoracic vertebra T10. In some embodiments, the method includes the step of securing a second pin to the thoracic vertebra T8 in the same manner as the first pin. In some embodiments, the method includes the step of connecting the first and second arms of the surgical mount to the thoracic vertebrae T10 and T8. In some embodiments, the actuator tightens the pin positioned with the thoracic vertebra T8 to stabilize the pin, thereby ensuring no spinal movement. In some embodiments, the method includes the step of securing a third pin to the thoracic vertebra T6. In some embodiments, the third pin is secured in the same manner as the first and second pins. In some embodiments, the method includes the step of connecting the first and second arms of the surgical mount to the thoracic vertebrae T8 and T6. In some embodiments, the arms are connected in the same manner as described above, thereby ensuring no spinal movement.

[0020] In some embodiments, the method includes the step of securing a bone fastener (e.g., a bone screw) to the right side of the thoracic vertebra T7. In some embodiments, the method includes the step of securing a bone screw to the right side of the thoracic vertebra T9. In some embodiments, the method includes the step of securing a bone screw to the left side of the thoracic vertebra T6. In some embodiments, the method includes the step of securing a bone screw to the left side of the thoracic vertebra T7. In some embodiments, the method includes the step of removing a surgical mount, including a first and second arm, from the surgical site to ensure no spinal movement. In some embodiments, the method includes the step of removing a third pin to ensure no spinal movement. In some embodiments, a selected amount of force is applied to the third pin to remove it. In some embodiments, the method includes the step of securing a bone screw to the right side of the thoracic vertebra T6. In some embodiments, a drill is used to drill 30 mm into the thoracic vertebra T6. In some embodiments, the method includes the step of re-registering components of the surgical system. In some embodiments, a C-arm is used for re-registration of the components. In some embodiments, the method includes the step of comparing the planned trajectory of the bone screw with the actual placement of the bone screw. In some embodiments, the comparison step includes visual comparison.

[0021] In some embodiments, the patient may be positioned on the operating table in a prone or lateral decubitus position prior to the surgical procedure. In some embodiments, the surgical level for treatment includes vertebrae at the thoracic level, such as T6 to T10. In some embodiments, bone fasteners may be delivered to the surgical site via robotic guidance and include screw rods with dimensions of 6.5 mm × 40 mm.

[0022] In some embodiments, the surgical instrument of this disclosure includes a surgical mount configured for insertion into a surgical site and for use with methods for treating the spine. In some embodiments, the surgical mount is attached to a selected vertebra. In some embodiments, the method includes the step of securing a bone mount element (e.g., a first pin) to the lowest pedicle of the selected vertebra. In some embodiments, the pin is manually secured. In some embodiments, the first pin is secured via robot guidance, similar to that described herein. In some embodiments, the method includes the step of attaching a short bone mount (SBM) bridging portion to the pin. In some embodiments, the method includes the step of aligning the vertebral level using robot and / or navigation guidance. In some embodiments, the method includes the step of securing a second pin. In some embodiments, the second pin is secured via robot guidance. In some embodiments, the method includes the step of positioning the surgical mount with the first and second pins. In some embodiments, the surgical mount engages the pins with minimal force. In some embodiments, the method includes the step of securing screws and / or rods between and above the second pins. In some embodiments, the method includes the step of securing a third pin. In some embodiments, the third pin is secured via robot guidance. In some embodiments, the method includes the step of positioning a second surgical mount at the surgical site. In some embodiments, the method includes the step of securing bone screws and / or rods between and above the third pin. In some embodiments, the method includes the step of securing a fourth pin. In some embodiments, the fourth pin is secured via robot guidance. In some embodiments, the method includes the step of securing a third surgical mount at the surgical site. In some embodiments, the method includes the step of securing bone screws and / or rods between and below the fourth pin. In some embodiments, the method includes the step of removing the pins and surgical mount from the surgical site. In some embodiments, the method includes the step of removing the robot from the surgical site. In some embodiments, the method includes the step of securing bone screws and / or rods into pinholes formed by the pins.

[0023] This disclosure is more readily understood by referring to the following detailed description of embodiments, which forms part of this disclosure, in conjunction with the accompanying drawings. It should be understood that this application is not limited to the specific apparatus, methods, conditions, or parameters described and / or shown herein, and that the terminology used herein is merely for illustrative purposes of particular embodiments and not for limitation. Furthermore, in some embodiments, unless the context explicitly requires otherwise, the singular forms “a” and “said” as used in the specification and including the appended claims include the plural, and reference to a particular numerical value includes at least that particular value. A range may be expressed herein as “about” or “approximately” one particular value and / or “about” or “approximately” another particular value. When expressing such a range, another embodiment includes from one particular value and / or to another particular value. Similarly, when a value is expressed as an approximation using the antecedent “about,” it should be understood that the particular value forms another embodiment. It should also be understood that all spatial references (e.g., horizontal, vertical, top, upper, lower, bottom, left, and right) are for illustrative purposes only and may vary within the scope of this disclosure. For example, the terms “upper” and “lower” are relative and are used only in a different context, and are not necessarily “upper” and “lower”.

[0024] As used herein and including in the appended claims, “treatment” for a disease or condition means performing a procedure that may include administering one or more medications to a patient (human, normal person, or other person or other mammal), using an implantable device, and / or using an instrument for treating the disease (e.g., a microsurgical discectomy instrument for removing portions of a bulging or herniated disc and / or osteophyte) to relieve the signs or symptoms of the disease or condition. Relief may occur before or after the signs or symptoms of the disease or condition appear. Therefore, treatment includes preventing the disease or adverse condition (e.g., preventing the development of the disease in a patient who may be susceptible but has not yet been diagnosed with it). Furthermore, treatment does not require complete relief of signs or symptoms, does not require a cure, and specifically includes procedures that have only a minor effect on the patient. Treatment may include suppressing the disease, such as preventing its progression, or alleviating the disease, such as causing it to regress. For example, treatment may include reducing acute or chronic inflammation; reducing and relieving pain and promoting the regeneration of new ligaments, bone, and other tissues; serving as an adjunct to surgical procedures; and / or any reparative procedure. Furthermore, as used in the specification and appended claims, the term "tissue" includes soft tissue, ligaments, tendons, cartilage, and / or bone, unless otherwise specifically stated.

[0025] The following discussion includes a description of a surgical system based on the principles of this disclosure and related methods of using the surgical system. Alternative embodiments are also disclosed. See the exemplary embodiments of this disclosure illustrated in the accompanying drawings for details. Go to Figures 1 to 19The following is an example of the components of the surgical system 10.

[0026] Components of the surgical system 10 may be manufactured from bio-acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics, and bone materials and / or composites thereof. For example, components of the surgical system 10 may be made individually or collectively from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, grade 5 titanium, superelastic titanium alloys, cobalt-chromium alloys, stainless steel alloys, superelastic metal alloys (e.g., nickel-titanium), and superelastic plastic metals such as GUMMETAL. ® ), ceramics and their composites such as calcium phosphate (e.g., SKELITE), ™ Thermoplastic plastics such as polyaryletherketone (PAEK) (including polyetheretherketone (PEEK), polyetherketoneketone (PEKK), and polyetherketone (PEK)), carbon-PEEK composites, PEEK-BaSO4 polymer rubber, polyethylene terephthalate (PET), fabrics, silicones, polyurethanes, silicone-polyurethane copolymers, polymer rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermosetting elastomers, elastomer composites, rigid polymers (including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene), epoxy resins, bone materials (including autologous grafts, allogeneic grafts, xenografts, or transgenic cortical and / or cortical cancellous bone), as well as tissue growth or differentiation factors, and partially absorbable materials (e.g., metal and calcium-based ceramic composites, PEEK and calcium-based ceramic composites, PEEK and calcium-based ceramic composites, PEEK and calcium-based ceramic composites). Composites of absorbable polymers, fully absorbable materials (e.g., calcium-based ceramics, such as calcium phosphate, such as hydroxyapatite (HA), coral HA, biphasic calcium phosphate, tricalcium phosphate or fluorapatite, tricalcium phosphate (TCP), HA-TCP, calcium sulfate) or other absorbable polymers (such as polylactide, polyglycolic acid, polytyrosine carbonate, polycaprolactone and combinations thereof), biocompatible ceramics, mineralized collagen, bioactive glass, porous metals, bone granules, bone fibers, pulverized bone fragments, bone morphogenetic proteins (BMPs) (such as BMP-2, BMP-4, BMP-7, rhBMP-2 or rhBMP-7), demineralized bone matrix (DBM), transforming growth factor (TGF) (e.g., TGF-β), osteoblasts, growth and differentiation factors (GDF), insulin-like growth factor 1, platelet-derived growth factor, fibroblast growth factor or any combination thereof.

[0027] Various components of the surgical system 10 may have material composites comprising the materials described above to achieve various desired properties, such as strength, stiffness, elasticity, compliance, biomechanical properties, durability, and radiopaqueness or imaging preference. Components of the surgical system 10 may also be made individually or collectively of heterogeneous materials (such as combinations of two or more of the materials described above). Components of the surgical system 10 may be integrally formed, integrally connected, or include fastening elements and / or instruments, as described herein.

[0028] Surgical system 10 includes surgical instruments, such as surgical mount 12. In some embodiments, surgical mount 12 is configured to connect a first vertebra to a second vertebra to stabilize the vertebra and / or adjacent vertebrae, thereby increasing stiffness relative to unconnected or individually stabilized vertebrae. In some embodiments, surgical mount 12 improves the modularity of instrument components and their ease of interconnection and attachment with surgical devices, surgical navigation systems, robots, and / or vertebrae. Surgical mount 12 includes components containing arms 14 and 16. Arms 14 and / or 16 are configured for multiaxial movement relative to frame 42 and are configured to provide selective orientation, positioning, and / or fixation of support for bone elements, surgical instruments, and / or patient anatomy, such as for engagement and / or fixation with surrounding tissues (e.g., vertebral surfaces, including the vertebrae).

[0029] Arm 14 includes end portion 18 and end portion 20, and defines a longitudinal axis AA, such as Figure 2 As shown. Arm 14 can have various cross-sectional configurations, such as arcuate, cylindrical, elliptical, rectangular, polygonal, wavy, irregular, uniform, non-uniform, consistent, variable, and / or U-shaped. In some embodiments, arm 14 includes a cross-section configured to aid visualization during X-ray and / or fluorescence fluoroscopy. In some embodiments, arm 14 can have alternative surface configurations, such as rough, wavy, corrugated, porous, semi-porous, pitted, polished, and / or textured.

[0030] End portion 18 includes at least a portion of ball joint 22, including ball component 24, such as Figure 4As shown. The ball-shaped member 24 is configured to engage with a portion of the ball joint 22 (e.g., a socket 26 formed by a portion of the end cap 28 and a portion of the plate 78 of the link 64), as described herein. The socket 26 is movable relative to the ball member 24 between a non-locking orientation and a locking orientation via the linkage mechanism 62 described herein. In the non-locking orientation, the socket 26 is movable relative to the ball member 24, and in the locking orientation, the socket 26 is secured together with the ball member 24 to lock the arm 16 relative to the arm 14, frame 42, vertebral surface, and / or implant, as described herein. In some embodiments, the ball joint 22 alternatively includes a condylar or elliptical joint, a saddle joint, a flexor joint, and / or a pivot joint. In some embodiments, the ball member 24 comprises a ball. In some embodiments, the ball member 24 may have an elliptical, conical, hemispherical, and / or oval shape.

[0031] Arm 16 includes end portion 30 and end portion 32, and defines a longitudinal axis BB, such as Figure 2 As shown. Arm 16 may have various cross-sectional configurations, such as arcuate, cylindrical, elliptical, rectangular, polygonal, wavy, irregular, uniform, non-uniform, consistent, variable, and / or U-shaped. In some embodiments, arm 16 includes a cross-section configured to aid visualization during X-ray and / or fluorescence fluoroscopy. In some embodiments, arm 16 may have alternative surface configurations, such as rough, wavy, corrugated, porous, semi-porous, pitted, polished, and / or textured. In some embodiments, the surgical mount 12 may include one or more arms.

[0032] End portion 30 includes at least a portion of ball joint 34, including ball component 36, such as Figure 4 As shown. The ball-shaped member 36 is configured to engage with a portion of the ball joint 34 (e.g., a socket 38 formed by a portion of the end cap 40 and a portion of the plate 88 of the link 66), as described herein. The socket 38 is movable relative to the ball member 36 between a non-locking orientation and a locking orientation via the linkage mechanism 62 described herein. In the non-locking orientation, the socket 38 is movable relative to the ball member 36, and in the locking orientation, the socket 38 is secured together with the ball member 36 to lock the arm 16 relative to the arm 14, frame 42, vertebral surface, and / or implant, as described herein. In some embodiments, the ball joint 34 alternatively includes a condylar or elliptical joint, a saddle joint, a flexor joint, and / or a pivot joint. In some embodiments, the ball member 36 comprises a ball. In some embodiments, the ball member 36 may comprise an elliptical, conical, hemispherical, and / or oval shape.

[0033] The sockets 26 and 38 are supported by the frame 42, allowing them to move relative to the frame 42 between a non-locking orientation and a locking orientation. The frame 42 includes end portions 44 and 46 and defines a longitudinal axis CC, such as... Figure 2 As shown. Frame 42 includes side 48 and side 50, as... Figure 3 and Figure 4 As shown. Side 48 is secured to side 50 via a rotatable fastener 52. An opening 54 is formed on the surface of the end portion 56 of side 48 and the end cap 28, which is configured to accommodate the spherical member 24 of arm 14. An opening 58 is formed on the surface of the end portion 60 of side 48 and the end cap 40, which is configured to accommodate the spherical member 36 of arm 16. In some embodiments, the surfaces of the end portions 56, 60 and / or the end caps 28, 40 may include various surface configurations, including arcuate, conical, concave, and / or planar.

[0034] In one implementation scheme, such as Figure 10 and Figure 11 As shown, the surgical mounting frame 12 may include one or more ball joints 222, similar to ball joints 22, 34 as described herein. Ball joint 222 includes a socket 226, which includes a portion of an end cap 228 and a portion of a plate 278, similar to plates 78, 88 as described herein. Similar to those described herein, the components of the socket 226 are movable for engagement with ball components 24, 36. The end cap 228 is aligned along the longitudinal axis CC with a frame 42 configured as an in-line central linkage mechanism.

[0035] The surgical mounting frame 12 includes a linkage mechanism 62 attached to the sides 48, 50 of the frame 42 via fasteners 52. The linkage mechanism 62 is configured to move the sockets 26, 38 between a non-locking orientation and a locking orientation relative to the frame 42, components of the system 10, and / or the vertebral fixation arms 14 and / or 16. The linkage mechanism 62 includes links 64 and 66, as... Figure 4 and Figure 9 As shown. Link 64 is connected to link 66 via connector plate 68. Links 64 and 66 include curvature for connection to frame 42 and for easy locking. In some embodiments, link 64 and / or link 66 may have alternative configurations, such as linear, wavy, irregular, uniform, non-uniform, consistent, and / or angled.

[0036] Link 64 includes end 70, intermediate portion 72, and end 74, as follows: Figure 9 As shown. End 74 of the joint plate 68, as... Figure 6As shown. Link 64 includes a plate 78 attached to link 64 via pin 79. The plate 78 moves via link 64 to pull the surface of end cap 28 to secure it with ball member 24, thereby positioning the socket 26 in a locking orientation. Link 66, similar to link 64, includes an end 80, a middle portion 82, and an end 84. End 84 engages the end 86 of plate 68, as... Figure 6 As shown. Link 66 includes a plate 88 attached to link 66 via pin 89. Plate 88 is movable via link 66 to pull the surface of end cap 40 to secure it with ball member 36, thereby positioning the socket 38 in a locking orientation. In some embodiments, plates 78, 88 may have various cross-sectional configurations, such as arcuate, cylindrical, elliptical, rectangular, polygonal, wavy, irregular, uniform, non-uniform, consistent, and / or variable.

[0037] The linkage mechanism 62 includes a lever 90, which includes handles 92 and 94. The lever 90 engages the outer surface 91 of the side 50 and is connected to the linkage mechanism 62 via fasteners 52. The lever 90 is connected to links 64 and 66 and is capable of being positioned relative to the frame 42 as follows: Figure 6 The non-locking orientation of the confinement surface 93 shown and the position as described Figure 8 The locking orientation of the limiting surfaces 95 shown rotates between them.

[0038] In the non-locking orientation, the spherical parts 24 and 36 are movable within the sockets 26 and 38, and the handle 94 is movable to the limiting surface 93 to prevent the central pivot CP1 from rotating in the clockwise direction and to prevent the lever 90 from rotating beyond the limiting surface 93. Figure 6 As shown. In the non-locking orientation, the pin connector 69 of pin 79 and link 64, as well as the plate 68, measure length A, such that a gap exists between the end cap 28 and the ball-shaped member 24, as... Figure 6 As indicated by arrow D, this gap facilitates multi-axial movement of arm 14 relative to frame 42. The pin connector 71 of pin 89 and link 66, as well as plate 68, measure length A, resulting in a gap between end cap 40 and ball joint 36, as indicated by arrow E. This gap facilitates multi-axial movement of arm 16 relative to frame 42.

[0039] To move the ball joints 22 and 34 to the locking orientation, a force is applied to press the handle 92 down in the downward direction, as... Figure 7 As indicated by arrow F, this is used to move lever 90 to the limiting surface 95 to prevent the central pivot CP1 from rotating in the counter-clockwise direction and to prevent lever 90 from rotating beyond the limiting surface 93. Links 64 and 66 rotate together with plate 68 and elastically deform beyond the eccentric position, causing linkage 62 to move beyond the central axis G, as shown in the image. Figure 7 and Figure 8As shown. Links 64 and 66 simultaneously pull end caps 28 and 40 inward to eliminate the gap between end caps 28 and 40 and spherical components 24 and 36, causing end caps 28 and 40 to frictionally engage spherical components 24 and 36. Links 64 and 66 rotate and deform under tension, causing pin 79 and pin connector 69 to measure length B, and pin 89 and pin connector 71 to measure length B, as shown. Figure 8 As shown. Length B is greater than length A, such that links 64 and 66 are positioned eccentrically to releasably secure link mechanism 62 and ball joints 22 and 34 in a locking orientation.

[0040] The end 20 of arm 14 includes a lock 96, such as Figures 12 to 17 As shown. Lock 96 is configured to engage with a bone element (e.g., bone pin 98). Lock 96 includes links 100, 102, and 104 connected in series with arm 14. Links 100, 102, and 104 are connected to form an eccentric linkage and connection with plate 106 to move plate 106 between a non-locking orientation and a locking orientation using pin 98. The inner surface 108 of plate 106 frictionally engages pin 98 to secure arm 14 to pin 98.

[0041] Link 100 includes end 110, intermediate portion 112, and end 114, as follows: Figure 14 As shown. End 110 includes a lever 116. Part 112 is connected to part 118 of arm 14 for rotation at pivot point P1. End 114 is connected to end 122 of link 102 for relative rotation at pivot point P2. Link 102 includes end 122, intermediate part 124, and end 125. Part 124 is connected to part 126 of arm 14 for rotation at pivot point P3. End 125 is connected to end 128 of link 104 for relative rotation at pivot point P4. Link 104 includes end 128 and end 130. End 130 is connected to end 132 of plate 106 for relative rotation at pivot point P5. In some embodiments, pivots P1 to P5 may include pivot pins and / or hinge pins.

[0042] Links 100, 102, and 104 are connected to form an eccentric linkage mechanism, for example, measuring length L1 between pivots P1 and P2, such as... Figure 16 As shown. Length L2 is measured between pivots P2 and P3, and length L3 is measured between portion 118 and portion 126 of arm 14. Length L4 is measured between pivots P1 and P3, as shown. Figure 14As shown. Lengths L1 and L2 are greater than length L3, and a selected amount of force is applied to orient links 100 and 102 in an eccentric orientation. Length L3 is less than lengths L1 and L2 to facilitate the management of the force applied to arm 14. When a selected amount of force is applied to pivot P2 via lever 116, arm 14 will deform at portion 127, such that pivot P2, for example, is in... Figure 14 The non-locking orientation shown or in, for example Figure 16 The locking orientation shown is set in an eccentric orientation of plate lock 106. In the eccentric orientation, portion 127 is connected to pivot P2 via links 100, 102 and includes tension to hold pivot P2 in the eccentric orientation in the unlocked and / or locked orientations of links 100, 102, 104 and lock 96.

[0043] Plate 106 includes an inner surface 108, such as Figure 14 As shown. Surface 108 defines an opening 134 configured to accommodate a pin 98. Surface 108 is configured to frictionally engage with the pin 98 to secure the arm 14 to the pin 98. In some embodiments, surface 108 may have alternative surface configurations, such as rough, wavy, corrugated, porous, semi-porous, pitted, one or more teeth, polished, and / or textured.

[0044] The end portion 20 of arm 14 includes an engagement socket 136 configured to accommodate a pin 98. The socket 136 includes an opening 138 configured to accommodate the pin 98 and lateral openings 140 and 142 configured to accommodate the end portion 144 of plate 106 when plate 106 frictionally engages the pin 98, as shown below. Figure 16 As shown.

[0045] In non-locked orientations, such as Figure 12 , Figure 14 and Figure 15 As shown, pivot P2 is positioned in an eccentric orientation, and plate 106 is provided with a socket 136 positioned horizontally and / or at zero angle relative to socket 136. Links 100, 102, 104 and lock 96 are held in an unlocked orientation via tension of portion 127 and connection to pivot P2, as described herein. Pin 98 translates freely relative to plate 106 in the unlocked orientation and passes through opening 134. To position links 100, 102, 104 and lock 96 in a locked orientation, pin 98 is fixed to arm 14, as... Figure 16 and Figure 17 As shown, a force is applied to lever 116, causing the connected links 100 and 102 to translate pivot P2 from an eccentric orientation corresponding to the non-locking orientation to an eccentric orientation corresponding to the locking orientation, as... Figure 14As indicated by arrow H in the diagram. When links 100 and 102 rotate to an eccentric orientation corresponding to the locking orientation, link 104 connected thereto causes plate 106 to rotate, such that the inner surface 108 frictionally engages the pin 98 in opening 134 to secure the pin 98 to arm 14. Links 100, 102, 104 and lock 96 are held in the locking orientation by tension of portion 127 and connection to pivot P2, as described herein. In some embodiments, plate 106 is angled relative to socket 136 to frictionally engage pin 98 in the locking orientation. In some embodiments, plate 106 is angled relative to socket 136 in the range of 10 to 75 degrees to frictionally engage pin 98 in the locking orientation. In some embodiments, plate 106 is angled relative to socket 136 at 45 degrees to frictionally engage pin 98 in the locking orientation.

[0046] The end 32 of arm 16 includes a lock 146, such as Figure 1 , Figure 18 and Figure 19 As shown, similar to the arm 14, links 100, 102, 104, and lock 96 described herein, their frictional engagement, for example, of pin 98a, secures the arm 16 to pin 98a. In a non-locking orientation, as Figure 18 As shown, pivot P7 is positioned in an eccentric orientation, and plate 154 is provided with a socket 186 positioned horizontally and / or at zero angle relative to socket 186. Links 148, 150, 152 and lock 146 are held in an unlocked orientation via tension of portion 157 and connection to pivot P7, similar to portion 127 and pivot P2 described herein. Pin 98a translates freely relative to plate 154 in the unlocked orientation and passes through opening 184. To position links 148, 150, 152 and lock 146 in a locked orientation, pin 98a is fixed to arm 16, as... Figure 19 As shown, a force is applied to lever 164, causing the connected links 148 and 150 to translate pivot P7 from an eccentric orientation corresponding to the non-locking orientation to an eccentric orientation corresponding to the locking orientation, as... Figure 18As indicated by arrow I in the diagram. When links 148 and 150 rotate to an eccentric orientation corresponding to the locking orientation, link 152 connected thereto rotates plate 154, causing surface 156 of plate 154 to frictionally engage pin 98a with opening 184, thereby securing pin 98a to arm 16. Links 148, 150, 152 and lock 146 are held in the locking orientation by tension of portion 157 and connection to pivot P7, similar to portion 127 and pivot P2 described herein. In some embodiments, plate 154 is angled relative to socket 186 to frictionally engage pin 98a in the locking orientation. In some embodiments, plate 154 is angled relative to socket 186 in the range of 10 to 75 degrees to frictionally engage pin 98a in the locking orientation. In some embodiments, plate 154 is angled relative to socket 186 in the range of 45 degrees to frictionally engage pin 98a in the locking orientation.

[0047] In some embodiments, the surgical mounting bracket 12 can be used with a variety of surgical instruments (e.g., actuators, extenders, reducers, dilators, retractors, clamps, forceps, lifters, and drills), which may optionally be sized and calibrated and arranged as a kit. In some embodiments, the surgical system 10 may include a surgical navigation component using microsurgical and image-guided techniques, such as a transmitter and sensors, which can be used to track the introduction and / or delivery of components of the surgical system 10, including surgical instruments, to the surgical site. See, for example, the surgical navigation components and their uses described in U.S. Patent Nos. 6,021,343, 6,725,080, and 6,796,988, the entire contents of each of these references are incorporated herein by reference.

[0048] In assembly, operation, and use, the surgical system 10, similar to the systems and methods described herein, employs surgical procedures to treat spinal conditions affecting a segment of the spine in a patient, such as those described herein. The surgical system 10 may also be used in conjunction with other surgical procedures. In some embodiments, the surgical system 10 is used to implant components into a patient, such as bone fasteners, rods, intervertebral devices, and plates.

[0049] In use, for treating selected segments of the vertebrae, such as Figures 20 to 32As shown, medical practitioners access the surgical site, including the vertebral V, by cutting and retracting tissue, for example. In some embodiments, the surgical system 10 includes percutaneous implantation. In some embodiments, the surgical system 10 can be used with any existing surgical method or technique, including open surgery, micro-open surgery, or minimally invasive surgery, thereby enabling access to the vertebral V through a micro-incision or a sleeve that provides a protective pathway to the area. Once access to the surgical site is achieved, specific surgical procedures can be performed to treat spinal conditions.

[0050] An incision is made in the patient's skin using a surgical scalpel, and an expander 301 is used to position the cannula 300 to create one or more pathways. Bone elements (e.g., pins) are translated through the pathways and connected to vertebral tissue, including selected vertebrae, such as the spinous processes (not shown) of thoracic vertebrae T11 and T12, and a bone mount bridging portion 302, such as... Figure 20 As shown. In some embodiments, bridging 302 includes a minimally invasive surgical technique bridging component. In some embodiments, bridging 302 is configured to connect the surgical mount 12 to the robot R. In some embodiments, the surgical mount 12 is optionally mounted to an operating table, a navigation guidance NG (including a navigation reference system) for tracking, or is not mounted.

[0051] The pin is manually attached to the vertebral tissue using a freehand surgical technique. A short mounting bracket connector 304 is attached to the bridging portion 302. The patient's spine, including the vertebral surface described herein, is registered with navigation-guided NG and robotic R systems, as described herein. Figure 21 and Figure 22 As shown. See, for example, similar surgical navigation and robotic systems, components, and uses thereof described in U.S. Patent No. 10,751,127, the entire contents of which are incorporated herein by reference. In some embodiments, the Schanz arm may be attached to the robot R. Registration includes implementing an O-arm for surgical planning and / or a C-arm for fluoroscopic registration. In some embodiments, registration is performed at the vertebral level, including the thoracic vertebrae T6 to T10.

[0052] An incision is made in the patient's skin, and the cannula 300 is positioned and aligned with the end effector of the robot R to position the cannula 300 and the dilator 301 at the incision site to create a passage. The pin 298 is translated through the passage and aligned at the T10 thoracic vertebra. The pin actuator 306 is implemented via the robot R to secure the pin 298 to the pedicle of the T10 thoracic vertebra, as... Figures 22 to 23 As shown. Similar to pin 298, pin 298a is fixed to the T8 thoracic vertebra, as... Figures 24 to 25 As shown.

[0053] Pin 298 is provided with a lock 96 to secure arm 14 to pin 298, as described herein. Lever 116 is depressed, causing connected links 100, 102 to translate pivot P2 from an eccentric orientation corresponding to the non-locking orientation to an eccentric orientation corresponding to the locking orientation. When links 100, 102 rotate to the eccentric orientation corresponding to the locking orientation, connected link 104 causes plate 106 to rotate, causing surface 108 to frictionally engage pin 298 with an opening 134 to secure pin 298 to arm 14, as described herein. Figure 26 As shown and described herein. Arm 16, similar to arm 14, is secured to pin 298a. Pin 298a is stabilized via actuator 306, and arm 16 of surgical mounting bracket 12 is secured to pin 298a.

[0054] When arm 14 reaches the desired positioning relative to arm 16 and / or vertebrae, handle 92 is depressed to move ball joints 22, 34 to a locking orientation, as described herein, to fix the relative position of arm 14 relative to arm 16 and / or vertebrae. Links 64, 66 rotate together with plate 68 and elastically deform beyond the eccentric position, causing linkage 62 to move beyond the central axis. Links 64, 66 simultaneously pull end caps 28, 40 inward to eliminate gaps between end caps 28, 40 and ball joints 24, 36, such that end caps 28, 40 frictionally engage ball joints 24, 36. In some embodiments, surgical mount 12 provides stability for thoracic vertebrae T10, T8 and pins 298, 298a.

[0055] Similar to pin 298, pin 298b is used for fixation of the T6 thoracic vertebra, such as... Figure 27 As shown. Arms 14a, 16a of a surgical mount 12a, similar to a surgical mount 12, are connected to thoracic vertebrae T8 and T6 via pins 298a, 298b. An incision is made in the patient's skin for bone fasteners (e.g., bone screws 308), such that cannula 300 is positioned and aligned with the end effector of robot R to position cannula 300 and dilator 301 at the incision site to form a passage. Bone screw 308 is translated through the passage and aligned at thoracic vertebra T7. Actuation is performed via robot R to secure bone screw 308 to the right side of thoracic vertebra T7, as shown. Figure 27 As shown.

[0056] In some implementations, a bone screw 308a, similar to bone screw 308, is fixed to the right side of the thoracic vertebra T9, such as... Figures 27 to 28 As shown. Similar to bone screw 308, bone screw 308b is fixed to the left side of thoracic vertebra T6, as... Figure 28 As shown. Similar to bone screw 308, bone screw 308c is used for fixation on the left side of thoracic vertebra T7, as... Figure 28 As shown.

[0057] To remove arms 14a and 16a from pins 298a and 298b, similar to arms 14 and 16 described herein, levers 116a and 164a are engaged to position locks 96a and 146a in a non-locking orientation, thereby releasing arms 14a and 16a from them. Figures 29 to 30 As shown. The surgical mount 12a is removed from the surgical site. In some embodiments, pin 298b is removed, and bone screw 308d, similar to bone screw 308, is fixed to the right side of the thoracic vertebra T6, as shown. Figures 31 to 32 As shown. Arms 14 and 16 are configured in a non-locking orientation for removal from pins 298 and 298a, similar to those described herein. The surgical mounting bracket 12 is then removed from the surgical site.

[0058] In some embodiments, the components of the surgical system 10 are re-registered. In some embodiments, a C-arm is used for re-registration. In some embodiments, the planned trajectory of the bone screw is compared with the actual placement of the bone screw. Upon completion of the procedure, the incision site is closed. In some embodiments, one or more surgical mounts 12 may be used during the surgical procedure.

[0059] In one implementation scheme, such as Figures 33 to 40 As shown, a method similar to that described in this article for treating selected segments of vertebra V1 includes pin 398 and fixation of the lowest pedicle of vertebra V1, such as... Figure 33 As shown. Pin 398 is manually driven into V1 via a freehand surgical technique. Bone mount bridging portion 400 is attached to pin 398. In some embodiments, a spinous process clamp (not shown) is attached to the bone mount bridging portion 400 and vertebra V1 prior to pin 398 attachment. The patient's vertebra V1 is registered with navigation guidance and robot R, similar to that described herein.

[0060] An incision is made in the patient's skin using a surgical scalpel, and the cannula, along with the end effector of robot R, is positioned and aligned to place the cannula and dilator at the incision site to create a passage. Pin 398a is translated through the passage and aligned at vertebra V4. The actuator is applied via robot R to secure pin 398a to vertebra V4, as... Figure 34 As shown.

[0061] Similar to the arm-to-pin fixation described herein, arms 14, 16 are fixed to pins 398, 398a. When arm 14 reaches the desired positioning relative to arm 16 and / or vertebrae, handle 92 is depressed to move ball joints 22, 34 to a locking orientation, as described herein, to fix the relative position of arm 14 relative to arm 16 and / or vertebrae. In some embodiments, a spinous process clamp (not shown) may be used as an alternative to pins 398, 398a to connect vertebrae together via surgical mount 12.

[0062] In some embodiments, the bone screw 402a is translated through a selected pathway and aligned between and above vertebrae V1 to V5, as described herein. In some embodiments, the actuator is implemented via a robot R to secure the bone screw 402a to adjacent V1 to V5, as described herein. Figure 35 As shown. For example, pin 398b, similar to pin 398, is fixed to vertebra V7, as... Figure 36 As shown. The surgical mounting bracket 12a is secured to pins 398a and 398b via arms 14a and 16a, similar to the arm-to-pin fixation described herein. Bone screws 402b, similar to bone screws 402a, are positioned and secured between and above pins 398b at vertebral V6 to V8, as shown. Figure 37 As shown. Similar to pin 398, pin 398c is fixed to vertebral V10, as... Figure 38 As shown. The surgical mounting bracket 12b is secured to pins 398b and 398c via arms 14b and 16b, similar to the arm-to-pin fixation described herein. Bone screws 402c, similar to bone screws 402a, are positioned and secured between and below pins 398c at vertebral V9 to V10, as shown. Figure 39 As shown.

[0063] To remove arms 14 and 16 from pins 398 and 398a, levers 116 and 164 are engaged to position locks 96 and 146 in a non-locking orientation, thereby releasing arms 14 and 16, similar to that described herein. Arms 14a and 16a are removed from pins 398a and 398b, and arms 14b and 16b are removed from pins 398b and 398c, in a manner similar to that described herein. Pins 398, 398a, 398b, and 398c are removed from the surgical site via robot R. In some embodiments, a bone screw 402d, similar to bone screw 402a, is positioned and secured in the pinhole formed by pins 398, 398a, 398b, and 398c.

[0064] One or more components of the surgical system 10 may be made of a radiation-permeable material such as a polymer. Radiopaque markers may be included for identification under X-ray, fluoroscopy, CT, or other imaging techniques. In some embodiments, the surgical system 10 allows for access to, observation of, and repair of spinal degeneration or injury using surgical navigation, microsurgery, and image-guided techniques as described herein. In some embodiments, the surgical system 10 may include implants and / or spinal structures that may include one or more plates, rods, connectors, and / or bone fasteners for use at a single or multiple vertebral levels.

[0065] In some embodiments, the surgical system and related methods of use of this disclosure can be described with reference to the following numbered paragraphs: A method for treating the spine, the method comprising the steps of: registering a plurality of vertebrae, including at least a first vertebra and a second vertebra; fixing a first bone element to the first vertebra; fixing a second bone element to the second vertebra; engaging a first lock of a surgical instrument with the first bone element in a locking orientation, the surgical instrument including a first member having at least a portion of a first ball joint and a first lock, the surgical instrument further including a second member and a linkage mechanism, the second member including at least a portion of a second ball joint and a second lock; engaging the second lock with the second bone element in a locking orientation; and simultaneously engaging the ball joint to lock the second member relative to the first member.

[0066] According to paragraph

[00105] , the method for treating the spine, wherein the first ball joint includes a first ball component and a first socket, the first socket being movable relative to the first ball component in a non-locking orientation and fixed to the first ball component in a locking orientation to lock the second component relative to the first component fixed to the first vertebra.

[0067] According to paragraph

[00106] , the method for treating the spine, wherein the step of fixing the second bone element to the second vertebra includes: aligning the second bone element to the second vertebra via robot guidance.

[0068] According to paragraph

[00107] , the method for treating the spine, wherein the step of fixing the first bone element to the first vertebra includes: aligning the first bone element to the first vertebra via robot guidance.

[0069] According to paragraph

[00108] , the method for treating the spine further includes the following steps: fixing a first bone fastener to a third vertebra disposed between the first vertebra and the second vertebra, fixing a third bone element to a fourth vertebra, and fixing a second bone fastener to a fifth vertebra disposed between the fourth vertebra and the second vertebra.

[0070] According to paragraph

[00109] , the method for treating the spine, wherein the step of fixing the third bone element to the fourth vertebra includes: aligning the third bone element to the fourth vertebra via robot guidance.

[0071] A method for treating the spine, the method comprising the steps of: aligning a plurality of vertebrae, the plurality of vertebrae including at least a first vertebra, a second vertebra, a third vertebra, a fourth vertebra, a fifth vertebra, and a sixth vertebra; manually fixing a first bone pin to the first vertebra; fixing a second bone pin to the second vertebra via robot guidance; engaging a first lock of a surgical instrument with the first bone pin in a locking orientation, the surgical instrument including a first arm having at least a portion of a first ball joint and the first lock, the surgical instrument further including a second arm and a linkage mechanism, the second arm including at least a portion of a second ball joint and a second lock; engaging the second lock with the second bone pin in a locking orientation; simultaneously engaging the ball joint to lock the second arm relative to the first arm; and fixing a first bone fastener to a third vertebra disposed between the first vertebra and the second vertebra.

[0072] According to paragraph

[00111] , the method for treating the spine further includes the steps of: fixing a third bone element to the fourth vertebra and fixing a second bone fastener to the fifth vertebra disposed between the fourth vertebra and the third vertebra.

[0073] According to paragraph

[00112] , the method for treating the spine, wherein the step of fixing the third bone element to the fourth vertebra includes: aligning the third bone element to the fourth vertebra via robot guidance.

[0074] According to paragraph

[00113] , the method for treating the spine, wherein the step of fixing the second bone fastener to the fifth vertebra includes: aligning the second bone fastener to the fifth vertebra via robot guidance.

[0075] According to paragraph

[00114] , the method for treating the spine further includes the steps of: fixing a fourth bone element to the sixth vertebra and fixing a third bone fastener to the seventh vertebra disposed between the sixth vertebra and the fifth vertebra.

[0076] According to paragraph

[00115] , the method for treating the spine, wherein the step of fixing the fourth bone element to the sixth vertebra includes: aligning the fourth bone element to the sixth vertebra via robot guidance.

[0077] A surgical instrument comprising: a first component including at least a portion of a first ball joint and a first lock capable of engaging with a first bone element fixed to a first vertebra; a second component including at least a portion of a second ball joint and a second lock capable of engaging with a second bone element fixed to a second vertebra; and a linkage mechanism capable of simultaneously engaging with the ball joint to lock the second component relative to the first component fixed to the first vertebra.

[0078] According to the surgical instrument described in paragraph

[00117] , the first ball joint includes a first ball component and a first socket movable relative to the first ball component.

[0079] According to the surgical instrument described in paragraph

[00118] , wherein the first socket is movable relative to the first spherical member in a non-locking orientation and is fixed to the first spherical member in a locking orientation to lock the second member relative to the first member fixed to the first vertebra.

[0080] According to the surgical instrument described in paragraph

[00119] , the surgical instrument further includes a frame that supports the first socket, such that the first socket is translatable relative to the frame between the non-locking orientation and the locking orientation.

[0081] According to the surgical instrument described in paragraph

[00120] , the linkage mechanism includes a lever and a first arcuate link connected to the first ball joint and a second arcuate link connected to the second ball joint, the lever being rotatable between a non-locking orientation and a locking orientation to lock the second member relative to the first member fixed to the first vertebra.

[0082] According to the surgical instrument described in paragraph

[00121] , the lever is rotatable to the locking orientation, such that the lever is positioned in an eccentric position to tension the link and secure the ball joint.

[0083] According to the surgical instrument described in paragraph

[00122] , wherein the first lock includes a plate having an inner surface defining an opening configured for disposing of the first bone element, the inner surface being capable of frictionally engaging with the first bone element to secure the first member to the first bone element.

[0084] According to the surgical instrument described in paragraph

[00123] , wherein the first lock includes a plurality of links connected to the plate to move the plate between a non-locking orientation and a locking orientation, such that the inner surface can frictionally engage with the first bone element to secure the first member to the first bone element.

[0085] A surgical instrument comprising: a first component including at least a portion of a first ball joint and a first lock capable of engaging with a first bone element fixed to a surface of a first vertebra; a second component including at least a portion of a second ball joint and a second lock capable of engaging with a second bone element fixed to a surface of a second vertebra; and a linkage mechanism capable of simultaneously engaging with the ball joint to lock the second component relative to the first component fixed to the surface of the first vertebra.

[0086] According to the surgical instrument described in paragraph

[00125] , the first ball joint includes a first ball component and a first socket movable relative to the first ball component.

[0087] According to the surgical instrument described in paragraph

[00126] , wherein the first socket is movable relative to the first spherical member in a non-locking orientation and is fixed to the first spherical member in a locking orientation to lock the second member relative to the first member fixed to the surface of the first vertebra.

[0088] The surgical instrument according to any one of paragraphs [00105 or 00106] further includes a frame supporting the first socket such that the first socket is linearly translatable relative to the frame between the non-locking orientation and the locking orientation.

[0089] The surgical instrument according to any one of the preceding paragraphs [00125 to 00128], wherein the linkage mechanism includes a lever and a first arcuate link connected to the first ball joint and a second arcuate link connected to the second ball joint, the lever being rotatable between a non-locking orientation and a locking orientation to lock the second member relative to the first member fixed to the surface of the first vertebra.

[0090] According to the surgical instrument described in paragraph

[00129] , the lever is rotatable to the locking orientation, such that the lever is positioned in an eccentric position to tension the link and secure the ball joint.

[0091] The surgical instrument according to any one of the preceding paragraphs [00125 to 00130], wherein the first lock comprises a plate having an inner surface defining an opening configured for disposing of the first bone element, the inner surface being capable of frictionally engaging with the first bone element to secure the first member to the first bone element.

[0092] According to the surgical instrument described in paragraph

[00131] , wherein the first lock includes a plurality of links connected to the plate to move the plate between a non-locking orientation and a locking orientation, such that the inner surface can frictionally engage with the first bone element to secure the first member to the first bone element.

[0093] It should be understood that various modifications and / or combinations can be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but rather as illustrative of various embodiments only. Those skilled in the art will be able to conceive of other modifications within the scope and spirit of the appended claims.

[0094] The techniques of this disclosure are described in the following embodiments. Prior to the embodiments.

[0095] Example 1. A method for treating the spine, the method comprising the following steps: Registration includes at least the first and second vertebrae and multiple vertebrae; Fix the first bone element to the first vertebra; Fix the second bone element to the second vertebra; The surgical instrument is engaged with the first bone element in a locking orientation with a first lock of a surgical instrument, the surgical instrument including a first member having at least a portion of a first ball joint and a first lock, the surgical instrument also including a second member and a linkage mechanism, the second member including at least a portion of a second ball joint and a second lock; Engage the second lock with the second bone element in a locking orientation; and Simultaneously engage the ball joint to lock the second member relative to the first member.

[0096] Example 2. A method for treating the spine according to Example 1, wherein the first ball joint includes a first ball component and a first socket, the first socket being movable relative to the first ball component in a non-locking orientation and fixed to the first ball component in a locking orientation to lock the second component relative to the first component fixed to the first vertebra.

[0097] Example 3. The method for treating the spine according to Example 1, wherein the step of fixing the second bone element to the second vertebra includes: aligning the second bone element to the second vertebra via robot guidance.

[0098] Example 4. The method for treating the spine according to Example 1, wherein the step of fixing the first bone element to the first vertebra includes: aligning the first bone element to the first vertebra via robot guidance.

[0099] Example 5. The method for treating the spine according to Example 1, the method further includes the following steps: fixing a first bone fastener to a third vertebra disposed between the first vertebra and the second vertebra, fixing a third bone element to a fourth vertebra, and fixing a second bone fastener to a fifth vertebra disposed between the fourth vertebra and the second vertebra.

[0100] Example 6. The method for treating the spine according to Example 5, wherein the step of fixing the third bone element to the fourth vertebra includes: aligning the third bone element to the fourth vertebra via robot guidance.

[0101] Example 7. A method for treating the spine, the method comprising the following steps: Register multiple vertebrae, wherein the multiple vertebrae include at least the first vertebra, the second vertebra, the third vertebra, the fourth vertebra, the fifth vertebra, and the sixth vertebra; The first bone pin is manually fixed to the first vertebra; The second vertebral pin was fixed to the second vertebra under robot guidance; The surgical instrument includes a first lock engaged with the first bone pin in a locking orientation. The surgical instrument includes a first arm having at least a portion of a first ball joint and the first lock. The surgical instrument also includes a second arm and a linkage mechanism, the second arm having at least a portion of a second ball joint and a second lock. Engage the second lock with the second bone pin in a locking orientation; Simultaneously engaging the ball joint to lock the second arm relative to the first arm; and The first bone fastener is fixed to the third vertebra located between the first vertebra and the second vertebra.

[0102] Example 8. The method for treating the spine according to Example 7, the method further comprising the steps of: fixing a third bone element to the fourth vertebra, and fixing a second bone fastener to the fifth vertebra disposed between the fourth vertebra and the third vertebra.

[0103] Example 9. The method for treating the spine according to Example 8, wherein the step of fixing the third bone element to the fourth vertebra includes: aligning the third bone element to the fourth vertebra via robot guidance.

[0104] Example 10. A method for treating the spine according to Example 8, wherein the step of fixing the second bone fastener to the fifth vertebra includes: aligning the second bone fastener to the fifth vertebra via robot guidance.

[0105] Example 11. The method for treating the spine according to Example 8, the method further comprising the steps of: fixing a fourth bone element to the sixth vertebra, and fixing a third bone fastener to the seventh vertebra disposed between the sixth vertebra and the fifth vertebra.

[0106] Example 12. The method for treating the spine according to Example 11, wherein the step of fixing the fourth bone element to the sixth vertebra includes: aligning the fourth bone element to the sixth vertebra via robot guidance.

[0107] Example 13. A surgical instrument, the surgical instrument comprising: A first component, comprising at least a portion of a first ball joint and a first lock capable of engaging with a first bone element, the first bone element being fixed to a first vertebra; The second component includes at least a portion of the second ball joint and a second lock capable of engaging with the second bone element, the second bone element being fixed to the second vertebra; and A linkage mechanism capable of engaging simultaneously with the ball joint to lock the second member relative to the first member fixed to the first vertebra.

[0108] Example 14. The surgical instrument according to Example 13, wherein the first ball joint includes a first ball component and a first socket movable relative to the first ball component.

[0109] Example 15. The surgical instrument according to Example 14, wherein the first socket is movable relative to the first spherical member in a non-locking orientation and is fixed to the first spherical member in a locking orientation to lock the second member relative to the first member fixed to the first vertebra.

[0110] Example 16. The surgical instrument according to Example 15, the surgical instrument further comprising a frame supporting the first socket such that the first socket is translatable relative to the frame between the non-locking orientation and the locking orientation.

[0111] Example 17. The surgical instrument according to Example 13, wherein the linkage mechanism includes a lever and a first arcuate link connected to the first ball joint and a second arcuate link connected to the second ball joint, the lever being rotatable between a non-locking orientation and a locking orientation to lock the second member relative to the first member fixed to the first vertebra.

[0112] Example 18. The surgical instrument according to Example 17, wherein the lever is rotatable to the locking orientation, such that the lever is positioned in an eccentric position to tension the link and secure the ball joint.

[0113] Example 19. The surgical instrument according to Example 13, wherein the first lock includes a plate having an inner surface defining an opening configured for disposing of the first bone element, the inner surface being capable of frictionally engaging with the first bone element to secure the first member to the first bone element.

[0114] Example 20. The surgical instrument according to Example 19, wherein the first lock includes a plurality of links connected to the plate to move the plate between a non-locking orientation and a locking orientation, such that the inner surface can frictionally engage with the first bone element to secure the first member to the first bone element.

Claims

1. A surgical instrument (10), said surgical instrument comprising: A first component (14) includes at least a portion of a first ball joint (22) and a first lock (96) capable of engaging with a first bone element (98), the first bone element being fixed to the surface of a first vertebra. The second component (16) includes at least a portion of the second ball joint (34) and a second lock (146) capable of engaging with the second bone element (98a), the second bone element being fixed to the surface of the second vertebra; and A linkage mechanism (62) is capable of engaging simultaneously with the ball joint to lock the second member relative to the first member fixed to the surface of the first vertebra.

2. The surgical instrument according to claim 1, wherein the first ball joint comprises a first ball component (24) and a first socket (26) movable relative to the first ball component.

3. The surgical instrument of claim 2, wherein the first socket is movable relative to the first spherical member in a non-locking orientation and is fixed to the first spherical member in a locking orientation to lock the second member relative to the first member fixed to the surface of the first vertebra.

4. The surgical instrument according to any one of claims 2 or 3, further comprising a frame (42) supporting the first socket such that the first socket is linearly translatable relative to the frame between the non-locking orientation and the locking orientation.

5. The surgical instrument according to any one of the preceding claims, wherein the linkage mechanism comprises a lever (90) and a first bow-shaped link (64) connected to the first ball joint and a second bow-shaped link (66) connected to the second ball joint, the lever being rotatable between a non-locking orientation and a locking orientation to lock the second member relative to the first member fixed to the surface of the first vertebra.

6. The surgical instrument of claim 5, wherein the lever is rotatable to the locking orientation, such that the lever is positioned in an eccentric position to tension the link and secure the ball joint.

7. The surgical instrument according to any one of the preceding claims, wherein the first lock comprises a plate (106) having an inner surface defining an opening configured for disposing of the first bone element, the inner surface being capable of frictionally engaging with the first bone element to secure the first member to the first bone element.

8. The surgical instrument of claim 7, wherein the first lock comprises a plurality of links (100, 102, 104) connected to the plate to move the plate between a non-locking orientation and a locking orientation, such that the inner surface can frictionally engage with the first bone element to secure the first member to the first bone element.

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