Tulip SIDECAR Device, System, and Method

Abstract

Disclosed are devices and systems for securing an adapter device to a tulip structure of a pedicle screw. The devices and systems may be configured to receive a spinal rod and may include one or more of an adapter, a set screw, a locking nut, and a tool useful for securing the adapter to the tulip and / or the spinal rod to the adapter and / or tulip. Additional embodiments of the devices and systems may include a tulip configured to engage with the adapter and other system components, and / or an adapter-to-adapter device for connecting to the adapter.

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of U.S. Provisional Patent Application No. 63 / 398,398, filed August 16, 2022, and U.S. Provisional Patent Application No. 63 / 488,592, filed March 6, 2023, which are incorporated herein by reference in their entirety for all purposes.

[0002] The disclosed processes, methods, and systems are directed to spinal fixation hardware.

[0003] Background technology Pedicle anchor screws typically include or can be equipped with a structure having a slotted, hemispherical opening for receiving and securing a spinal rod. Often referred to as a "tulip" due to their flower-like resemblance, these slotted structures can allow the slot to be rotated and tilted relative to the body of the pedicle screw. This polyaxial functionality is useful for receiving a spinal rod. The slotted opening of the tulip contains internal threads configured to receive a set screw. The set screw is used to securely lock, anchor, or secure the rod within the tulip.

[0004] Many procedures can benefit from the placement of additional spinal rods. In these cases, the additional rods are secured to existing rods via connectors. Such rod-to-rod connections can be problematic. For example, because the rods are cylindrical, it can be difficult to prevent rotational movement of the second rod, or the existing rod may break or be destroyed, which can affect stability.

[0005] What is needed is an apparatus and system for placement of additional spinal rods that avoids rod-to-rod attachment and securely holds the additional rods.

[0006] Summary of the Invention Disclosed herein are methods and systems for securing one or more spinal rods to pedicle screw tulips. In various aspects, a device for engaging a tulip with a spinal rod is disclosed, the device including a channel that can be configured to receive and retain the spinal rod and a yoke that can be configured to engage with the tulip. The device can include an adapter set screw for securing the spinal rod within the channel, and the adapter set screw can include threads that correspond to the threads in the channel. In some embodiments, the adapter set screw can include a recess for receiving a threaded post and / or a tool. The device can also include a tulip set screw for securing the spinal rod within the tulip, which can include a threaded post and / or a recess for receiving a tool. The device can further include a locking nut mounted to the threaded post and configured to further secure the device to the tulip. In various embodiments, one or more surfaces of one or more components can include features, the surface features useful for maintaining a mechanical interface with the surface of a second component, and the surface features can be selected from splines, knurls, interruptions, and protrusions.

[0007] In various aspects, a system for engaging a tulip structure is disclosed, the system including an adapter configured to engage the tulip and including a channel configured to receive and retain a spinal rod, an adapter set screw, and a tulip set screw. In various embodiments, the adapter set screw and / or the tulip set screw may include a threaded post. In some embodiments, the system may further include a locking nut for securing the adapter to the tulip, the locking nut being configured to be mounted to the threaded post. The system may further include one or more tools for engaging one or more of the screws and / or nuts. The disclosed system may include one or more surfaces of one or more components having surface features useful for maintaining a mechanical interface with a surface of a second component, the surface features may be selected from splines, knurls, interruptions, and protrusions.

[0008] In various aspects, a threaded fastening device for connecting a first component and a second component is disclosed. The device includes a first coupling assembly proximate a first end and a first fastener surface, the first fastener surface including threads configured to mate with an internally threaded portion of a channel in the second component. In various embodiments, the first coupling assembly may be a threaded post extending from the first end away from the fastener or a threaded channel extending from the first end to the interior of the fastener. In threaded post embodiments, the post may be configured to receive a locking nut, and in threaded channel embodiments, the channel may be configured to receive a locking screw. In many embodiments, the second component may be an adapter, such as a SideCAR adapter, and the first component may be a SideCAR-to-SideCAR adapter.

[0009] In various aspects, an adapter device for engaging a tulip screw is disclosed, the adapter device including a yoke coupled to the tulip screw, the yoke defining a first channel between the tulip and the yoke capable of receiving a first spinal rod, a second channel extending from the yoke capable of receiving a second spinal rod, and an engagement mechanism extending from the device and engaging the first spinal rod.

[0010] In various aspects, an adapter coupled to a tulip screw is disclosed, the adapter including an engagement structure for engaging a first spinal rod held by the tulip screw and a channel extending from the adapter away from the tulip screw and shaped to receive a second spinal rod.

[0011] In various aspects, a device for engaging a tulip screw is disclosed, the device including a yoke extending over an upper portion of the tulip screw and an engagement structure for securing the device to a spinal rod, the engagement structure being axially spaced from the yoke.

[0012] In various aspects, a rotationally adjustable adapter coupled to a tulip screw is disclosed, the rotationally adjustable adapter including a yoke extending over the top of the tulip screw, an extension extending from a side of the yoke away from the tulip screw, the extension defining a first portion of a fitting, and a rotationally adjustable channel shaped to receive a spinal rod and defining a second portion of the fitting, the second portion mating with the first portion to define the fitting, the rotationally adjustable channel being rotatable and tiltable relative to the rod within the tulip to define multiple paths for the spinal rod. [Brief explanation of the drawings]

[0013] [Figure 1A]FIG. 1 is an exploded view of one embodiment of the disclosed device and system. [Figure 1B] FIG. 1B is a cross-sectional view of the embodiment shown in FIG. 1A. [Figure 2A] 1A-1C illustrate one embodiment of the disclosed devices and systems engaged with spinal rods and pedicle screws. [Figure 2B] FIG. 2B is a side elevation view of the embodiment of FIG. 2A showing the distance between spinal rods ("D") and the height offset between the rods ("h"). [Figure 3] 10A-10C illustrate one embodiment of the disclosed devices and systems including a locking nut configured to engage the threaded post of a tulip set screw. [Figure 4] 10A-10C illustrate one embodiment of the disclosed devices and systems including a locking nut configured to engage the threaded post of a tulip set screw. [Figure 5] FIG. 1 illustrates one embodiment of the disclosed device and system, showing the distance between spinal rods and the height offset between the rods. [Figure 6] 1A-1C illustrate one embodiment of the disclosed devices and systems engaged with spinal rods and pedicle screws. [Figure 7] FIG. 1 illustrates a top perspective view of one embodiment of the disclosed device and system engaged with a spinal rod and pedicle screws. [Figure 8] 1A-1C illustrate one embodiment of the disclosed tulip set screw, yoke, and lock nut. [Figure 9] 1A-1C illustrate one embodiment of the disclosed tulip set screw. [Figure 10] FIG. 1 is a cross-sectional view of one embodiment of the disclosed tulip set screw, lock nut, and tool. [Figure 11] 10A-10C illustrate one embodiment of the disclosed tool engaging an adapter or tulip set screw. [Figure 12]FIG. 10 is a cross-sectional view of one embodiment of the disclosed tool and tulip set screw, showing the tool receiving the threaded post of the set screw. [Figure 13] 1 illustrates one embodiment of the disclosed lock nut having a hexagonal recess for receiving and engaging a similarly shaped tool. [Figure 14] FIG. 1 illustrates one embodiment of the disclosed adapter yoke and tulip set screw, which also shows the snap mechanism. [Figure 15] 10A-10C illustrate one embodiment of the disclosed adapter and set screw having surface features to maintain a secure interface with the adapter. [Figure 16] 1 illustrates one embodiment of the disclosed lock nut having surface features for maintaining a secure interface with a corresponding surface. [Figure 17] 1 illustrates one embodiment of the disclosed locking nut including a threaded post for engaging a set screw. [Figure 18] FIG. 10 shows one embodiment of the disclosed adapter or tulip set screw that includes a channel through the screw, threaded in this embodiment, for receiving the threaded post of another set screw or locking nut. [Figure 19] FIG. 10 shows one embodiment of the disclosed adapter or tulip set screw that includes a channel through the screw, threaded in this embodiment, for receiving the threaded post of another set screw or locking nut. [Figure 20] FIG. 1 is a perspective view of another embodiment of the disclosed device and system. [Figure 21A] FIG. 21 is a cross-sectional view of the embodiment of FIG. 20. [Figure 21B] FIG. 21 is a perspective view of the locking nut and tulip set screw of the embodiment of FIG. 20. [Figure 22] FIG. 21 is a perspective view of the tulip set screw of the embodiment of FIG. 20. [Figure 23] FIG. 21 is an elevational view of the tulip set screw of the embodiment of FIG. 20. [Figure 24] FIG. 21 is a top view of the tulip set screw of the embodiment of FIG. 20. [Figure 25] FIG. 21 is a perspective view of the lock nut of the embodiment of FIG. 20. [Figure 26] FIG. 10 is a top perspective view of an adapter including a snap feature and locking nut of one embodiment of a SideCAR adapter. [Figure 27] FIG. 27 is a rear perspective view of the adapter and locking nut of the embodiment of FIG. 26. [Figure 28] 28 is a cross-sectional view of FIG. 26 taken along line 28-28. [Figure 29] FIG. 27 is a cross-sectional view of the adapter of FIG. 26 with a tulip set screw, a locking nut, and an adapter set screw engaged with the tulip set screw. [Figure 30A] FIG. 27 is a close-up perspective view of the adapter showing the chamfered edges of the embodiment of FIG. 26. [Figure 30B] FIG. 27 is a side perspective view of the assembled disclosed device and system of FIG. 26 with the spinal rod positioned within the SideCAR and the tulip shown as a translucent feature, illustrating an example of an applied load to the system. [Figure 30C] FIG. 30C shows a finite element analysis illustrating stress concentrations for an adapter with chamfered edges under the applied load of FIG. 30B. [Figure 30D] FIG. 30C shows a finite element analysis illustrating stress concentrations for an adapter without chamfered edges under the applied load of FIG. 30B. [Figure 31A] FIG. 10 is a side perspective view of an adapter having channels disposed at an offset angle. [Figure 31B] FIG. 31B is a side perspective view of an adapter having channels at a different offset angle than that shown in FIG. 31A. [Figure 32] 1A and 1B illustrate a spinal column showing an embodiment of the disclosed devices and systems installed thereon. [Figure 33A]FIG. 10 is a top perspective view of an embodiment of an adapter in which the channel is axially offset from the yoke. [Figure 33B] FIG. 33B shows a spinal column illustrating an embodiment of the disclosed devices and systems installed, including an embodiment of an adapter, where the channel is axially offset from the yoke, similar to that seen in FIG. 33A. [Figure 34] FIG. 1 is a perspective view of one embodiment of the disclosed device and system, showing a rod disposed in a tulip and a SideCAR, the disclosed SideCAR device including an outrigger structure. [Figure 35] FIG. 35 is a side view of the embodiment of FIG. 34. [Figure 36] FIG. 35 is a top view of FIG. [Figure 37] FIG. 1 is a perspective view of one embodiment of the disclosed apparatus and system, in which the SideCAR includes structure for receiving a removable outrigger structure, also shown. [Figure 38] FIG. 38 is an elevational view of one embodiment of FIG. 37. [Figure 39] FIG. 38 is a top view of one embodiment of FIG. 37. [Figure 40] FIG. 40 is a cross-sectional view taken along line 40-40 of FIG. 39. [Figure 41] FIG. 1 is a perspective view of one embodiment of the disclosed device and system, wherein the disclosed SideCAR device includes an outrigger structure and engagement mechanism. [Figure 42] FIG. 42 is an elevational view of the embodiment of FIG. 41. [Figure 43] FIG. 42 is a top view of the embodiment of FIG. 41. [Figure 44] FIG. 44 is a cross-sectional view taken along line 44-44 of FIG. 41. [Figure 45] FIG. 1 is a perspective view of one embodiment of the disclosed device and system, wherein the disclosed SideCAR device includes an engagement structure for installing and securing an extension mechanism. [Figure 46] FIG. 46 is an elevational view of the embodiment of FIG. 45. [Figure 47] FIG. 46 is a top view of the embodiment of FIG. 45. [Figure 48]FIG. 48 is a cross-sectional view taken along line 48-48 of FIG. 47. [Figure 49] FIG. 1 is a perspective view of one embodiment of the disclosed device and system, wherein the disclosed SideCAR device includes an engagement structure for installing and securing an extension mechanism. [Figure 50] FIG. 50 is an elevational view of the embodiment of FIG. 49. [Figure 51] FIG. 50 is a top view of the embodiment of FIG. 49. [Figure 52] FIG. 1 is a perspective view of one embodiment of the disclosed device and system, wherein the disclosed SideCAR includes a rotationally adjustable channel for defining a range of spinal rod paths. [Figure 53] FIG. 53 is a front elevation view of the embodiment of FIG. 52. [Figure 54] 54 is a cross-sectional view of the embodiment of FIG. 52 taken along line 54-54. [Figure 55] FIG. 53 is a perspective view of the embodiment of FIG. 52 with the channel rotated to a second position. [Figure 56] FIG. 53 is a front elevation view of the embodiment of FIG. 52 with the channel rotated to a second position. [Figure 57] FIG. 53 is a top view of the embodiment of FIG. 52 with the channel rotated to a second position.

[0014] MODE FOR CARRYING OUT THE INVENTION Disclosed herein are devices, systems, and methods for securing an additional spinal rod to existing or previously installed hardware, particularly a tulip structure, a spinal rod, or a combination of both a tulip structure and a spinal rod. The disclosed devices, systems, and methods may include (1) an adapter body, (2) an adapter set screw, (3) a tulip set screw, and (4) a locking nut or locking screw. Additional examples may include (5) an outrigger structure, (6) an engagement mechanism or structure, and / or other mechanisms / devices that can connect a SideCAR to an existing spinal rod. The adapter is designed to fit and securely connect various tulip designs, accept various reduction tool configurations, and position a second rod at a predetermined offset from the existing rod and tulip. The disclosed devices and systems may be referred to as "SideCAR" devices and systems.

[0015] Rods, screws, and specialized hardware (such as complex-shaped mechanical nuts and rod-to-rod connectors) are used in orthopedic surgery and spinal fixation procedures. To create complex fixation geometries, surgeons typically connect to and construct from rods using rod-to-rod connectors. Because spinal rods are generally cylindrical, rod-to-rod connectors can allow radial movement of a second rod around an existing rod. Rod breakage or fracture also compromises complex fixation based on rod-to-rod connections. The disclosed SideCAR devices, systems, and methods provide a secure connection to existing fixation hardware. In most embodiments, the disclosed systems and devices are configured to connect to pedicle screws, such as the tulip structure of an existing pedicle screw.

[0016] The disclosed devices, systems, and methods are useful for attaching, connecting, and fitting to or onto existing tulip structures. This can be performed during an initial fixation procedure or revision surgery, where broken hardware is repaired or replaced or reshaped. The surgeon can install SideCAR into an existing tulip structure without removing the existing rods secured by the tulip. Additional rods are then attached to the SideCAR device to reinforce the existing structure. The addition of SideCAR-based rods can be performed in a single initial fixation procedure or as part of a revision procedure (where SideCAR, new rods, and other hardware are added to an existing tulip, and the rods were constructed during a previous spinal fixation procedure).

[0017] Although devices may be described as existing or previously installed, such references may be for identification purposes only. It is understood that the referenced structures and devices may be implemented or installed in various orders. For example, a reference to an existing structure does not require that the structure be installed prior to the surgical procedure; in some embodiments, the disclosed devices and systems may be installed simultaneously with the existing structure.

[0018] As mentioned above, the SideCAR system of the present disclosure may be compatible with devices commonly used to install, remove, or adjust tulip structures and rod-to-rod connections. For example, a device such as a reduction device may be able to couple to the tulip or rod with the SideCAR installed to adjust the position of the spinal rod or tulip. In many embodiments, a reduction instrument / tool ​​may be configured to securely and reversibly adhere, attach, engage, and / or connect to the tulip to assist in the insertion and placement of the spinal rod. In some instances, the reduction instrument or tool may directly engage with the SideCAR adapter.

[0019] The present devices, systems, and methods greatly assist surgeons in placing / attaching secondary rods without requiring removal of the existing tulip and existing rod, which benefits patients by reducing the surgical time and complexity required to connect or affect an existing rod.

[0020] The disclosed devices, systems, and methods can be designed to attach, connect, or fit any tulip product, spinal rod, or related hardware. Pedicle screws and tulips from various manufacturers may have different designs, structures, and configurations. In some embodiments, the disclosed devices and systems may also include novel tulip designs. These novel tulip designs may have specific features to adapt, match, and / or fit compatible SideCAR structures and systems. For example, novel tulip and adapter designs may optimize various geometric and complementary features (e.g., rails, slots, etc.) on the respective tulip and SideCAR structures. These complementary features may help enable efficient connection / attachment. In one embodiment, the complementary features may include a press fit, snap fit, or interlocking structure. Additional complementary structures and shapes may enable secure and / or removable attachment of the tulip to the SideCAR (for use in revision procedures, for example) without the need for additional fastening hardware such as locking nuts.

[0021] Returning to the figures, FIGS. 1A-1B illustrate one embodiment of the disclosed SideCAR device 200 and system 100. In this embodiment, the system 100 may include a SideCAR adapter 202, a tulip pedicle screw 102, a tulip set screw 250, an adapter set screw 240, and a locking nut 270. The inset is one embodiment of the tulip set screw 250 showing a threaded post 252 for receiving and securing the locking nut 270. Also note that the tulip set screw 250 includes a recess 256 around the threaded post 252. This recess 256 is configured to engage with a tool (e.g., a set tool 130) for manipulating the tulip set screw 250, as shown in FIGS. 11-12.

[0022] Adapter - SideCAR Adapter 1A-1B , the SideCAR adapter 202 includes a yoke 206 for engaging the tulip 104 and a U-shaped channel or slot 208 for receiving the secondary rod 120. The channel 208 may include internal threads 210 for receiving the threads 244 of the adapter set screw 240. In some embodiments, the yoke 206 may include a tab, lip, or snap structure 218 for engaging with a corresponding lip, tab, or snap structure 112 of the tulip 104. The adapter 202 may define an opening 228, as shown in FIG. 8 , defined in the upper outer surface 204 of the adapter 202 and extending through the yoke 206. The opening 228 may be designed to allow access to the tulip 104 when the yoke 206 engages the tulip 104 or to receive SideCAR hardware (e.g., a locking nut 270, a tulip set screw 250, etc.). The adapter 202 may be connected to the tulip 104 solely by the yoke 206, which snaps into the tulip 104, or may connect directly to the tulip 104 and / or by connecting with existing hardware. In other examples, the yoke 206 may be combined with additional SideCAR hardware, such as a lock nut 270 or tulip set screw 250, to connect the adapter 202 to the tulip 104.

[0023] 2A-2B show a perspective view of one embodiment of a SideCAR device 200 installed on a tulip system 102 including a tulip 104 that holds an existing spinal rod 118, with the pedicle screw 108 located below the tulip 104 also visible in this view. As is readily apparent, the SideCAR 202 can be variously configured to hold a secondary rod 120 at various horizontal offsets 145 or distances D from the existing rod 118. The secondary rod 120 can be positioned at a vertical offset 145 or height h that is above or below the existing rod 118. The horizontal 151 (to modify D) and vertical 149 (to modify h) directions of configurability / adjustability are also indicated in FIG. 5 by directional arrows 151 and 149, respectively.

[0024] The secondary rod 120 can be positioned within a U-shaped adapter channel 208, as shown in FIG. 30B. The adapter channel 208 may have a shape or profile similar to the tulip channel 105. Positioning the secondary rod 120 relative to an existing rod 118 can be accomplished by creating a family of SideCAR adapters 202 having a similar design but with various horizontal 147, angled 155, axial, or vertical offsets 145 from the yoke 206 or existing rod 118 to the channel 208. In some examples, as shown in FIGS. 31A and 31B, the adapter channel 208 can define an angular offset 155 relative to the yoke 206, such as being angularly offset inward in FIG. 31A and angularly offset outward in FIG. 31B. In some examples, as shown in Figures 33A and 33B, the SideCAR adapter 202 may extend from the tulip 104 at an angle relative to the tulip such that the channel 208 of the SideCAR 202 is axially offset 157 from the yoke 206 or channel 105 of the tulip 104.

[0025] Figure 32 shows a spine 124 illustrating an embodiment in which the disclosed device and system 200 is installed. Figure 33B shows a spine 124 illustrating an embodiment in which the disclosed device and system 200 is installed, including an embodiment of an adapter 202 in which the channel 208 is axially offset 157 from the yoke 206, similar to that seen in Figure 33A.

[0026] In various embodiments, adjustable SideCAR adapters are disclosed. In these embodiments, the surgeon can select and set the desired offset between the rods 118, 120 before and / or during the procedure. The selected offset may be set at a discrete, preset position, or in some embodiments, the adapter offset may be configured with continuous adjustability within a given range defined by the adapter, with different adapters having different ranges for horizontal offset (D) 147, vertical offset (h) 145, or other offset settings. For example, as shown in FIGS. 52-57 , components of the adapter 1202, such as the channel 1208, may be rotatable relative to the adapter 1202 to adjust the trajectory direction of the spinal rod within the channel 1208 by an angle 1299. The variation in offset and range of possible configurations of the SideCAR adapter provides additional flexibility to the medical professional installing the SideCAR and can assist in aligning the spinal rod system for a variety of different patient or clinical needs.

[0027] The SideCAR adapter 202 may be secured to the tulip 104 by engaging one or more sides 110, structures 112, or locations on the tulip 104 for additional support and stability. For example, the adapter yoke 206 may include one or more snap structures 218 that may engage with corresponding snap or engagement structures 112 on the tulip 104. The snap structure 218 may be a section or portion of the adapter yoke 206. The snap structure 218 may define a detent 222 or other mechanism configured to receive or engage the tulip 104.

[0028] The adapter yoke 206 may extend downwardly from the top 114 of the tulip 104 to various distances. In some embodiments, the tulip 104 may include one or more structures, holes, lips, recesses, etc. 112 that may be accessible for future adjustment. For example, FIGS. 6 and 7 show holes and features 113 on the sides of the tulip 104 that may accept an adjustment tool, such as a reduction tool / instrument; the yoke 206 may not extend all the way to these holes 113. In some examples, the disclosed SideCAR device 200 may accept the adjustment tool directly, such as in the yoke 206 or adjacent to a channel 208 in the adapter 202. In other embodiments, the yoke 206 may extend all the way to or below such holes 113 (or other structures) to help secure the SideCAR adapter 202 to the tulip 104, in one example using a snap-on structure 218, which may help reduce movement of the SideCAR adapter 202 relative to the tulip 104. The SideCAR adapter 202 can be installed on all existing tulips 104, or on only a selected group of existing tulips 104, as shown in Figure 32 or Figure 33B.

[0029] Referring to the snap structure 218, the snap detents 222 may define an entrance angle 224 and an exit angle 226, as shown in the example illustrated in FIG. 28 . Generally, angles greater than 90 degrees relative to the yoke 206 may facilitate engagement and disengagement, while angles approximately or equal to 90 degrees may prohibit or limit engagement or disengagement without applying torque or deformation to the SideCAR adapter 202. Limiting disengagement may enhance retention of the SideCAR adapter 202 on the tulip 104. Angles less than 90 degrees may provide improved retention characteristics. Thus, in some examples, the entrance angle 224 of the snap detents 222 may be greater than 90 degrees, while the exit angle 226 may be approximately 90 degrees or less relative to the side of the yoke 206.

[0030] In some examples, as may be seen in FIGS. 26-29 , an opening or cut 220 may be defined in the adapter 202 around the yoke snap structure 218. In one example, the cut or opening 220 may be U-shaped and point toward the tulip 104 when viewed from the side. The thickness of the snap structure 218 of the adapter 202 around the snap detent 222 may also vary. As shown in FIG. 28 , the yoke snap structure 218 may have a thickness 221 that is less than the thickness 205 of the surrounding SideCAR adapter 202. The variation in the cut 220 around the yoke snap structure 218 and / or the thickness 221 of the yoke snap structure 218 can increase the flexibility or allowable deformation of the yoke snap structure 218. The increased flexibility or allowable deformation can make installation or removal of the SideCAR adapter 202 on the tulip 104 easier.

[0031] The SideCAR adapter 202 may define or include multiple edges and points 230 where portions of the SideCAR adapter 202 intersect. These intersections 230 may be subject to stress concentrations after installation or during movement. In one example, a load 236 may be applied to the secondary rod 120 creating a stress concentration, with greater stress indicated by darker shading around sharp edges 232 as shown in FIG. 30D , the direction of the load is indicated by arrows 236 in FIG. 30B . To reduce the stress concentration, the intersections 230 may include or define chamfered edges 234 or other stress reduction features. When the stress reduction feature is a chamfered edge 234, the intersection surface defines a rounded edge rather than a sharp corner 232, as shown in FIGS. 26-30C . The chamfered edge 234 can result in reduced stress concentrations at the edges 230 and a reduced risk of the adapter 202 being damaged during or after installation.

[0032] Also disclosed are SideCAR-to-SideCAR adapters. In these embodiments, the SideCAR-to-SideCAR adapter connects to a previously installed SideCAR adapter to extend the possible connections. In these embodiments, similar devices and mechanisms, such as those that aid in the attachment / connection / fit between the tulip and the SideCAR adapter 202, are useful with the disclosed SideCAR-to-SideCAR adapters. For example, the adapter set screw 240 and lock nut 270 described above for the tulip 104 to SideCAR adapter 202 connection are useful for securing the SideCAR-to-SideCAR adapter to the SideCAR adapter 202. These embodiments further expand the range of options available to spine surgeons for establishing fixation hardware configurations during initial or revision surgery.

[0033] Adapter Set Screw The disclosed devices and systems may include an adapter set screw 240 for insertion into the adapter channel 208 to secure the secondary rod 120 disposed therein, as shown in at least FIG. 4 . The adapter set screw 240 includes external threads 244 designed to correspond to and engage with the internal threads 210 of the adapter channel 208. In various embodiments, the adapter set screw 240 may include structure 246 for engaging with a set tool 130, which may be useful for threading and securing the adapter set screw 240 into the adapter channel 208 and contacting the secondary rod 120. In various embodiments, the adapter set screw 240 may further include a threaded post, which may be configured to receive a locking nut, which may be the same as or similar to the locking nut 270.

[0034] As described above, various embodiments of the devices and systems can include a second device, a SideCAR-to-SideCAR adapter. In these embodiments, the adapter set screw 240 can include one or more features for engaging and securing the SideCAR-to-SideCAR adapter to the SideCAR adapter 202, such as a channel or threaded post for engaging with a corresponding feature on the second locking nut.

[0035] Tulip Set Screw The disclosed devices and systems may include a tulip set screw 250 for insertion into the tulip 104 and securing the existing rod 118. Various examples of the tulip set screw 250 are shown in at least Figures 8-12 and 18-19. The tulip set screw 250 includes threads 254 that correspond to and engage with the internal threads 106 of the tulip 104. The tulip set screw 250 may further engage or be received within the opening 228 of the SideCAR adapter 202.

[0036] In various embodiments, the tulip set screw 250 may include a recess 256 for receiving a set tool 130, which may be useful for threading and securing the tulip set screw 250 into the tulip channel 208 and contacting the existing rod 118. The tulip set screw 250 may further include a threaded post 252, which may be configured to receive a locking nut 270. The tulip set screw 250, in some embodiments, may include a channel 258 for engaging with the threaded post of the locking nut 270. For example, the channel 258 of the tulip set screw 250 may define threads 260. In these embodiments, the channel 258 may extend through the set screw 250 or may terminate within the body of the set screw 250. Furthermore, the recess 256 for receiving the set tool 130 and the channel 258 for engaging with the locking nut 270 may be defined by the same opening. For example, as shown in FIG. 21, the lower portion of the opening may define a recess 256 and the upper portion of the opening may define threads 254 for receiving a feature of a locking nut 270 .

[0037] Lock nut The disclosed devices and systems may include a locking nut 270. Various examples of the locking nut 270 may be shown in the figures. The locking nut 270 may be designed to engage with the tulip set screw 250 and tighten the SideCAR with the tulip. In some embodiments, the locking nut 270 may include a central channel 272 having internal threads 274 configured to correspond to and engage with the threads 254 on the threaded post 252 of the tulip set screw 250. In other examples, the locking nut 270 may define external threads 276 and may be received within the channel 258 of the tulip set screw 250. In further examples, the locking nut 270 may be received within the opening 228 of the SideCAR adapter 202 and extend through the opening 228 to engage with the tulip set screw 250. The locking nut 270 may also engage with the threads of the SideCAR opening 228.

[0038] The locking nut 270 may include an external chamfer 278 for engaging with a corresponding chamfer on a surface of another device, such as a SideCAR adapter. The chamfer 278 may aid in tightening the nut 270 and / or SideCAR adapter 250 onto the tulip 104. In some embodiments, the locking nut 270 may include a threaded post 275 for engaging with a set screw 250 having a corresponding channel 258.

[0039] Set tools The disclosed devices and systems may include one or more tools 130 to assist in installing the tulip set screw 250, adapter set screw 240, and locking nut 270. As shown in FIGS. 10-12 , the disclosed tool 130 may include a central channel 132 for receiving a threaded post on the tulip set screw 250. The tool 130 may have a variety of exterior configurations, such as hex, cam, Torx, star, etc., and the adapter set screw 240, tulip set screw 250, and locking nut 270 may include corresponding recesses for receiving and engaging the tool 130. In various embodiments, separate tools 130 may be designed to engage the adapter set screw 240, tulip set screw 250, and locking nut 270. In most embodiments, the disclosed tool 130 is sized to fit a reduction device, such as a new reduction device or a reduction device configured to accommodate an existing tulip 104.

[0040] The disclosed tool 130 may include one or more additional features. In some embodiments, the tool 130 may include or be configured to include a handle, a torque driver, and / or a torque wrench for tightening a screw or nut to a specified torque value.

[0041] As disclosed above, the SideCAR device and system 100 may include one or more snap-fit, press-fit, or similar structures / mechanisms. The snap-fit ​​structures / mechanisms may be configured to cooperate with threads and mating between the SideCAR 202 and the tulip 104. In most embodiments, the SideCAR adapter 202 is configured with a yoke 206 designed to fit a particular tulip 104. This may help ensure a snug and secure fit between the tulip 104 and the SideCAR adapter 202. These features may also be configured to cooperate with set screws 240 or 250 to allow the SideCAR 202 to fit other SideCAR hardware.

[0042] Any of the features, components, and / or parts, including their arrangements and configurations, shown in any one of Figures 1A-33, alone or in any combination, can be included in any of the other example devices, features, components, and parts shown in the other figures described herein. Similarly, any of the features, components, and / or parts, including their arrangements and configurations, shown and described with reference to the other figures, alone or in any combination, can be included in the example devices, features, components, and parts shown in Figures 1A-33.

[0043] SideCAR with rod engagement mechanism and structure 34-51 , additional examples of SideCAR adapters may include engagement mechanisms or structures to assist in contacting and / or engaging a spinal rod 120 positioned within the tulip channel 105. In some embodiments, these engagement mechanisms and structures may include outrigger structures. In many embodiments, these engagement mechanisms can securely and reversibly engage, contact, and / or grip an existing spinal rod 118. The mechanisms can aid in coupling the SideCAR with an existing spinal rod 118, as well as the tulip 104, and can help improve fixation of the SideCAR adapter to existing hardware. The disclosed rod engagement mechanisms can also aid in adjusting or orienting one or more of the existing spinal rod 118, SideCAR, and secondary spinal rod 120.

[0044] The SideCAR adapters described herein may include all or some of the rod engagement mechanisms described above. For example, as shown in FIG. 34 , additional examples may include a tulip screw 102, an existing spinal rod 118, a secondary spinal rod 120, an adapter set screw 240, a tulip set screw 250, a locking nut or screw 270, and / or a SideCAR adapter. In other examples, the SideCAR may include only the adapter set screw 240 and can be attached to existing hardware simply by snapping onto one or both of the tulip 104 and the existing spinal rod 118.

[0045] In one example, as shown in FIGS. 34-40 , a SideCAR adapter system 400 can include a sideCAR adapter 402 and a rod engagement mechanism that can include one or more outrigger structures 480. In some of these embodiments, the outrigger structures 480 can be integral with or formed with the SideCAR adapter 402, as shown in FIGS. 34-36 . In other examples of SideCAR adapter systems 500, the outrigger structures 580 can be removably attached, as shown in FIGS. 37-40 . In many embodiments, the outrigger structures 480 can extend from the SideCAR adapter 402 to contact / engage with an existing spinal rod 118. In some embodiments, the outrigger structures 480 can be removably clipped or snapped onto the existing spinal rod 118, for example, when the SideCAR adapter 402 is coupled to the tulip 104.

[0046] The outrigger structure 480 may include an arm-like structure 482 that extends downward toward the pedicle screw or tulip 104 or tulip channel 105. The outrigger structure 480 may also extend axially outward from the adapter yoke 406. The downwardly extending portion 482 of the outrigger structure may bifurcate to define two or more portions 484 separated by a gap 486. An existing spinal rod 118 disposed in the tulip channel 105 may be configured to receive the gap 486, and the portions 484 may be configured to flex around, retain, and secure the spinal rod 118. The SideCAR adapter 402 may also be secured to the tulip 104 in any of the manners described above.

[0047] The SideCAR adapter 402 and outriggers 480 can be configured to maintain the position of the existing spinal rod 118 and prevent or resist movement of the existing spinal rod 118 relative to the new spinal rod 120 placed within the SideCAR channel 408. In other examples, the outriggers 480 can be of a specific offset, or a combination thereof, to elevate or move the existing spinal rod 118 relative to the tulip 104 to adjust the position of the existing spinal rod 118. In some examples, the outriggers 480 can further extend at an angle relative to the tulip 104 to match a curve in the length of the existing spinal rod 118 and / or to effect a curve on the new or existing spinal rod 120.

[0048] As described above, the outrigger structure 480 may be integrally formed with the SideCAR adapter 402, as shown in FIGS. 34-36. In some examples, the outrigger 580 may be a separate, removable component, as shown in FIGS. 37-40. The removable outrigger 580 may similarly define an arm portion 582. The arm portion 582 may similarly branch into two or more portions 584. Similar to the SideCAR adapter 402, an existing spinal rod 118 disposed within the tulip channel 105 may be received within the gap 586, and the portion 584 may be configured to flex around, retain, and secure the spinal rod 118. The SideCAR adapter 502 may define a recess 516 within the yoke 506 for receiving and securing the removable outrigger structure 580, as shown in FIG. 40. The tulip set screw 250 and / or lock nut 270 may be useful for securing the removable outrigger 580 to the SideCAR adapter 502 and thus the SideCAR system 500 to the existing spinal rod 118.

[0049] Any of the features, components, and / or parts, including their arrangements and configurations, shown in any one of Figures 34-40, alone or in any combination, can be included in any of the other example devices, features, components, and parts shown in the other figures described herein. Similarly, any of the features, components, and / or parts, including their arrangements and configurations, shown and described with reference to the other figures, alone or in any combination, can be included in the example devices, features, components, and parts shown in Figures 34-40.

[0050] In some embodiments, the rod-engaging structure may extend outward from the side of the adapter yoke but may not grip the existing rod. In some embodiments, the rod-engaging structure may not contact the existing rod. In these embodiments, an additional or second engagement device / structure may secure the existing rod and rod-engaging structure.

[0051] As shown in FIGS. 41-44 , some examples of the SideCAR system 600 can include a first engagement structure 680 similar to the outrigger structures described above, while including an additional, or second, engagement mechanism 690 that can secure the SideCAR adapter 602 to an existing spinal rod 118. In some embodiments, the first rod-engaging structure 680 can extend outward from the side of the adapter yoke 606 but may not grip the existing rod 118. In some embodiments, the rod-engaging structure 680 may not contact the existing rod 118. In these embodiments, a second engagement device / structure 690 can secure the existing rod 118 and the rod-engaging structure 680.

[0052] The first engagement structure 680 may extend axially from the yoke 606, parallel to the existing rod 118. The first engagement structure 680 may be spaced from or contact the side of the tulip 104. In most embodiments, the first engagement structure 680 may define a recess, channel, and / or other surface 684 shaped to fit and / or interface with the existing spinal rod 118. The first engagement structure 680 may further define a receptacle 686, such as a groove or opening, for receiving and / or securing a second engagement structure 690. In some embodiments, as shown in FIGS. 41-44 , an additional engagement feature 690 may then couple and secure the first engagement structure 680 to the existing spinal rod 118.

[0053] The second engagement structure 690 may surround one or both of the existing spinal rod 118 and the first engagement structure 680. In other examples, the second engagement structure 690 may only partially surround one or both of the first engagement structure 680 and the existing spinal rod 118. For example, the second engagement structure 690 may be a band, cable, tie, or similar structure, and may couple the outrigger 680 or the SideCAR adapter 602 to the existing spinal rod 118. In some embodiments, the second engagement structure 690 may be a clip or retaining ring having a mechanism for engaging the rod 118 and a mechanism for engaging the SideCAR adapter 602.

[0054] Any of the features, components, and / or parts, including their arrangements and configurations, shown in any one of Figures 41-44, alone or in any combination, can be included in any of the other example devices, features, components, and parts shown in the other figures described herein. Similarly, any of the features, components, and / or parts, including their arrangements and configurations, shown and described with reference to the other figures, alone or in any combination, can be included in the example devices, features, components, and parts shown in Figures 41-44.

[0055] In some embodiments, as shown in Figures 45-51, the rod-engaging structures may be components separate from and connected to the SideCAR adapter. These rod-engaging structures may connect to or engage with, but not grip, an existing spinal rod 118. The SideCAR adapter may include or define additional features for receiving or engaging the engagement structures. For example, the additional features of the SideCAR adapter may include secondary openings, fasteners, slots, or similar structures.

[0056] 45-48 , the SideCAR system 700 can include an engagement structure or assembly 780. The engagement structure 780 can include a hook 790. The hook 790 can be received in a secondary opening 784 defined by the SideCAR adaptor 702. The hook 790 can be included to additionally or alternatively secure the SideCAR adaptor 702 to an existing spinal rod 118. The hook 790 can be a structure that extends at one end 791 under the existing spinal rod 118 and is attached at an opposite end 792 to the SideCAR adaptor 702. In one example, the hook 790 can be a J-shaped hook.

[0057] In one example, the SideCAR adaptor 702 can define an axially extending feature 782 that defines a secondary opening 784. The secondary opening 784 can be horizontally offset from the existing spinal rod 118, for example, in the horizontal direction 151.

[0058] The fastening portion 792 of the engagement structure 790 can be inserted into the secondary opening 784. The fastening portion 792 of the engagement structure 790 can, in one example, be smooth on a first side 793 and can define threads or other coupling mechanisms 795 on a second side. For example, the hook 790 can contact or be inserted into the secondary opening 784 with the smooth surface 793 facing the smooth portion 788 and can include a series of grooves or threads 795 on the opposite side configured to face the center of the secondary opening. The secondary opening 784 can further define threads 786 that correspond to the threads 795 of the fastening portion 792 of the engagement structure 790. A fastener 799 can be inserted into the secondary opening 784 to engage with one or both of the SideCAR secondary opening 784 and the hook 790. The fastener 799 can secure the hook 790 to the SideCAR adapter 702. In other examples, the fastener 799 may be a nut or bolt that engages only with the engagement structure 790, while the secondary opening 784 of the SideCAR adapter 702 may be countersunk so that the fastener 799 cannot pass through the secondary opening 784. The fastener 799 can be turned to pull the hook 790 through the opening 784 and secure the engagement assembly 780 to the SideCAR 702.

[0059] The engagement assembly 780 can be positioned to apply a lifting force to the existing spinal rod 118. The lifting force can assist in adjusting the existing spinal rod 118. The engagement assembly 780 can also apply a downward force to the SideCAR adapter 702 to secure the SideCAR adapter 702 to existing hardware. The position of the engagement assembly 780 can be adjusted by raising or lowering the hook 790 within the secondary aperture 784. By adjusting the position of the hook 790 and / or the tulip set screw 250, the position of the existing spinal rod 118 relative to the tulip 104 can also be adjusted. The engagement assembly 780 and / or the tulip set screw 250 can allow for fine adjustment of the position of the existing spinal rod 118. The SideCAR adapter 702, in this example, may or may not engage with the tulip set screw 102. In one example, the SideCAR system 700 may not include a locking nut 270 or similar mechanism.

[0060] Any of the features, components, and / or parts, including their arrangements and configurations, shown in any one of Figures 45-48, alone or in any combination, can be included in any of the other example devices, features, components, and parts shown in the other figures described herein. Similarly, any of the features, components, and / or parts, including their arrangements and configurations, shown and described with reference to the other figures, alone or in any combination, can be included in the example devices, features, components, and parts shown in Figures 45-48.

[0061] In some embodiments, the engagement structure 880 may be movable relative to the SideCAR adapter 802. The engagement structure 880 may be connected or otherwise engaged to the SideCAR adapter 802 and may be movable. For example, as shown in FIGS. 49-51 , the SideCAR adapter 802 may include or be connected to a rotatable engagement structure 880. The engagement structure 880 may engage with one or both of the spinal rods 118, 120. When the engagement structure 880 receives or engages both spinal rods 118, 120, the engagement structure 880 can create a positional relationship between the spinal rods. The shape or length of the engagement structure 880 may define the positional relationship between the spinal rods 118, 120. The positional relationship may define a fixed spacing or arrangement between the rods 118, 120. The engagement structure 880 may position one or both rods 118, 120 above the tulip channel 105 or the adapter channel 208. The engagement structure 880 may further adjust the position of the spinal rods 118 , 120 relative to the adapter 802 .

[0062] In one example, the engagement structure 880 may include a cantilever beam 882. The cantilever beam 882 can help secure the SideCAR adapter 802 to existing hardware or help adjust the position of the spinal rods 118, 120. The cantilever beam 882 may be shown in FIGS. 49-51. The cantilever beam 882 may rotate about a connection point 884 with the SideCAR adapter 802. The connection point 884 may be a pin or axle extending through a portion of the SideCAR adapter 802. Alternatively, the connection point 884 may be a feature integral with or defined by the SideCAR adapter 802. The pin or axle 884 may act as a fulcrum for the cantilever beam 882. The cantilever beam 882 may be shaped to receive the secondary spinal rod 120 and the existing spinal rod 118. For example, the engagement structure 880 may be curved at either end 885, 886 to match or receive the shape of the secondary spinal rod 120 or the existing spinal rod 118. The engagement structure 880 may extend below both the existing spinal rod 118 and the secondary spinal rod 120. In other examples, the engagement structure 880 may extend above or on opposite sides of both spinal rods 118, 120.

[0063] When the secondary spinal rod 120 is inserted into the SideCAR channel 808, the adapter set screw 240 can seat the secondary spinal rod 120 within the SideCAR channel 808. When the adapter set screw 240 is rotatably moved downward, the adapter set screw 840 can adjust the secondary spinal rod 120 downward. When the engagement structure 880 is rotated, the end 886 of the cantilever beam 882 near the existing spinal rod 118 can move upward. The engagement structure 880 can grip the existing spinal rod 118 to secure the SideCAR adapter 802 to the existing spinal rod 118 or to define the positional relationship between the spinal rods 118, 120. Further tightening of the adapter set screw 840 can increase the pressure of the engagement structure 880 against the existing spinal rod 120 to provide fixation. In another example, as shown in FIG. 50 , the tulip set screw 250 may not be included, and tightening the adapter set screw 240 can move the existing spinal rod 118 upward. In other examples, adjusting the position of the tulip set screw 250 and the adapter set screw 240 may allow for fine adjustment of the position of the spinal rods 118, 120 relative to one another.

[0064] Any of the features, components, and / or parts, including their arrangements and configurations, shown in any one of Figures 49-51 may be included, alone or in any combination, in any of the other example devices, features, components, and parts shown in the other figures described herein. Similarly, any of the features, components, and / or parts, including their arrangements and configurations, shown and described with reference to the other figures may be included, alone or in any combination, in the example devices, features, components, and parts shown in Figures 49-51.

[0065] SideCAR with Rotation Adjustable Channel 52-57, some embodiments of the SideCAR system 1000 may include a rotationally adjustable channel 1208. The rotationally adjustable channel 1208 may allow the adapter 1202 to assume a variety of positions, thereby defining multiple angled paths for the second or new spinal rod 120.

[0066] The adapter 1202 of this example may include a yoke 1206, an extension 1234, a joint 1280, a rotationally adjustable channel 1208, a collar 1290, and an adapter set screw 240. The joint 1280 may provide continuous adjustment of the rotationally adjustable channel 1208 over a wide range of positions and angles. In other embodiments, the joint 1280 may define a subset of predetermined positions and angles 1299. In most embodiments, a medical professional installing the SideCAR adapter 1202 can adjust the rotationally adjustable channel 1208 about the joint 1280 to achieve the desired position or angle 1299 and then fix the channel position or angle 1299.

[0067] In one example, as shown in FIG. 53 , the yoke 1206 can connect to an existing tulip 104, and a portion of the yoke 1206 can extend down the side of the tulip 104. An extension 1234 can extend radially outward from the yoke 1206. The extension 1234 can define a portion of a fitting 1280 at an end 1236 of the extension 1234 that is positioned away from the yoke 1206. In one example, as shown in FIG. 54 , the fitting 1280 can be a ball-and-socket joint having a ball portion 1282 of the fitting 1280 defined by the extension 1234 and a socket 1284 defined by the rotationally adjustable channel 1208.

[0068] The rotationally adjustable channel 1208 may define channel walls 1212 that form a U-shaped opening 1216 for receiving a spinal rod, such as the secondary spinal rod 120 described above. The rotationally adjustable channel 1208 may further define an opening 1284 at the bottom 1214 of the U-shaped opening 1216 and extending through the channel 1206. The opening 1284 defines a socket that may receive the ball 1282 of the extension 1234 to define the fitting 1280.

[0069] The collar 1290 may be inserted into the U-shaped opening 1216. The collar 1290 may have an outer width or diameter sufficient to mate with the inner surface or wall 1212 of the channel 1208. The collar 1290 may further be a solid part or may define an opening having an inner diameter or width smaller than the diameter of the ball portion 1282 of the fitting 1280. The collar 1290 may act to set the position of the rotationally adjustable channel 1206 relative to the yoke 1206 and prevent the ball portion 1282 of the fitting 1280 from lifting relative to the channel 1208. The collar 1290 may rotate with or separately from the channel 1208, as shown in FIGS. 55-57. The top surface 1292 of the collar 1290 may define a shape that matches the profile of the U-shaped channel 1208. The spinal rod 120 may contact the upper surface 1292 of the collar 1290 when the spinal rod 120 is inserted into the U-shaped channel 1208 .

[0070] The adapter set screw 240 can be inserted into the U-shaped channel 1208 to secure the spinal rod 120 within the channel 1208. The channel wall 1212 can further define a mechanism 1296, such as on the exterior, for receiving a tool, such as a reduction tool, directly into the adapter 1202. The tool can adjust the position of the rotationally adjustable channel 1208 to define an angled path, as can be seen in FIG. 57 . The multiple angled paths of the spinal rod 120 defined by the rotationally adjustable channels can allow the SideCAR adapter 1202 to account for various positions of the tulip screw 102 within a patient or various anatomical variations between patients.

[0071] Any of the features, components, and / or parts, including their arrangements and configurations, shown in any one of Figures 52-57, alone or in any combination, can be included in any of the other example devices, features, components, and parts shown in the other figures described herein. Similarly, any of the features, components, and / or parts, including their arrangements and configurations, shown and described with reference to the other figures, alone or in any combination, can be included in the example devices, features, components, and parts shown in Figures 52-57.

[0072] In various embodiments, mating surfaces, particularly those that interface a moving structure / device (e.g., a screw or nut) with a stationary device / structure (e.g., the tulip 104 or SideCAR 202), can have one or more surface patterns or structures to maintain a secure and reliable engagement of the mating surfaces. In some embodiments, the surfaces can include splines or knurling, which are useful for creating a more secure mechanical engagement during installation. In some configurations, the surface features can be adjusted to provide different resistance forces, such as requiring less torque for installation and more torque for removal. In some embodiments, the surface features can be present on any interface of the tulip or SideCAR adapter structure 100 and can include substructures, such as a gradual ramp in the installation direction and a steeper ramp in the removal direction.

[0073] While multiple embodiments are disclosed, still other embodiments of the present invention will become apparent to those skilled in the art from the following detailed description. As will become apparent, the present invention is capable of modification in various obvious aspects, all without departing from the spirit and scope of the present invention. Accordingly, the detailed description is to be regarded as illustrative in nature and not restrictive.

[0074] All references disclosed herein, whether patent or non-patent, are incorporated herein by reference in their entirety as if each were included by citation. In the event of a conflict between a reference and the specification, the present specification, including definitions, will control.

[0075] Although the present disclosure has been described with a certain degree of particularity, it will be understood that the disclosure is made by way of example and that changes in detail or structure may be made without departing from the spirit of the present disclosure as defined in the appended claims.

Claims

1. 1. A device for engaging a tulip with a spinal rod, comprising: a channel configured to receive and retain the spinal rod; a yoke configured to engage the tulip; An apparatus comprising:

2. The device of claim 1 , further comprising an adapter set screw for securing the spinal rod within the channel, the adapter set screw including threads that correspond to threads within the channel.

3. The apparatus of claim 2 , wherein the adapter set screw comprises an adapter-threaded post.

4. 4. The apparatus of claim 2 or claim 3, wherein the adapter set screw includes a recess for receiving a tool.

5. 5. The device of claim 1, further comprising a tulip set screw for securing the spinal rod within the tulip.

6. The apparatus of claim 5 , wherein the tulip set screw comprises a tulip threaded post.

7. 7. The apparatus of claim 5 or claim 6, wherein the tulip set screw includes a recess for receiving a tool.

8. 8. The device of claim 5, further comprising a locking nut mounted to the tulip threaded post and configured to secure the device to the tulip.

9. 1. A system for engaging a tulip structure, comprising: an adapter configured to engage the tulip and including a channel configured to receive and retain the spinal rod; Adapter set screw; Tulip set screw and A system comprising:

10. The system of claim 9 , wherein the adapter set screw and / or the tulip set screw comprises a threaded post.

11. 11. The system of claim 9 or claim 10, comprising a lock nut for securing the adapter to the tulip.

12. The system of claim 11 , wherein the locking nut is configured to be mounted to the threaded post of the tulip set screw.

13. 13. The system of claim 9, further comprising a tool for engaging one or more of the adapter set screw or the tulip set screw.

14. 14. The apparatus of claim 1 or the system of claim 9, wherein at least one surface of one component comprises surface features, said surface features being useful for maintaining a mechanical interface with a surface of a second component.

15. 15. The device or system of claim 14, wherein the surface features are selected from splines, knurls, interruptions, and protrusions.

16. A threaded fastening device for fastening a first component and a second component, comprising: a first coupling assembly proximate the first end; a first fastener surface having threads configured to threadably engage with the internally threaded portion of the channel of the second component; and A screw-type fastening device comprising:

17. 17. The threaded fastener of claim 16, wherein the first coupling assembly is a threaded post extending from the first end away from the fastener and configured to receive a locking nut.

18. 17. The threaded fastener of claim 16, wherein the first coupling assembly is a threaded channel extending from the first end to an interior of the fastener and configured to receive a locking screw.

19. 19. The threaded fastening device according to any one of claims 16 to 18, wherein the second component is a SideCAR adapter.

20. 20. The threaded fastening device according to any one of claims 16 to 19, wherein the first component is a SideCAR to SideCAR adapter.

21. 1. An adapter device for engaging a tulip screw, comprising: a yoke coupled to the tulip screw, the yoke defining a first channel between the tulip and the yoke capable of receiving a first spinal rod; a second channel capable of receiving a second spinal rod extending from the yoke; an engagement mechanism extending from the device and engaging the first spinal rod; An adapter device comprising:

22. 22. The adapter device of any one of claims 21 to 23, wherein the engagement mechanism includes a first engagement structure and a second engagement structure, the first engagement structure coupled to the second engagement structure, and the second engagement structure engaging the first spinal rod.

23. 23. The adapter device of any one of claims 21-22, wherein the engagement mechanism removably couples to the first spinal rod.

24. 24. An adapter device according to any one of claims 21 to 23, wherein a portion of the engagement mechanism is rotatable relative to the yoke.

25. 25. The adapter device of any one of claims 21 to 24, wherein the engagement mechanism engages the second spinal rod.

26. 26. An adapter device according to any one of claims 22 or 25, wherein part of the engagement mechanism is integral with the adapter device.

27. 22. The adapter device of claim 21, wherein a portion of the engagement mechanism is removably coupled to the adapter device.

28. 28. The adapter device of any one of claims 21 to 27, wherein the yoke defines a snap structure for releasably engaging the tulip screw.

29. 29. An adapter device according to any one of claims 21 to 28, wherein the second channel is offset from the yoke.

30. 30. The adapter device of claim 29, wherein the offset is one or more of an axial offset, an angular offset, a vertical offset, or a horizontal offset.

31. An adapter coupled to a tulip screw, said adapter comprising: an engagement structure for engaging a first spinal rod held by the tulip screw; a channel extending from the adapter away from the tulip screw and shaped to receive a second spinal rod; An adapter comprising:

32. 1. A device for engaging a tulip screw, said device comprising: a yoke extending over the top of the tulip screw; an engagement structure for securing the device to a spinal rod, the engagement structure being axially spaced from the yoke; An apparatus comprising:

33. a rotationally adjustable adapter coupled to a tulip screw, said rotationally adjustable adapter comprising: a yoke extending over the top of the tulip screw; an extension extending from a side of the yoke away from the tulip screw, the extension defining a first portion of a joint; a rotationally adjustable channel shaped to receive a spinal rod and defining a second portion of a joint, said second portion mating with said first portion to define said joint; Equipped with The rotatable channel is rotatable and can be tilted relative to the rod within the tulip to define multiple paths for the spinal rod. Rotation adjustable adapter.

Images