Devices and systems for spinal surgery

Abstract

An extender assembly for spinal surgery includes a base, an extension, and a blade. The base includes a frame, an engagement mechanism coupled to the frame and rotatable relative to the frame between a first rotational orientation and a second rotational orientation, and a jaw mechanism coupled to the frame and including first and second jaws movable for engaging a shank of a screw. The extension is configured to releasably engage the base and includes a jaw drive mechanism configured to move the first and second jaws when the extension is engaged with the base. The blade is configured to releasably engage the base. In the first rotational orientation of the engagement mechanism, the extension is locked in engagement with the base and wherein, in the second rotational orientation of the engagement mechanism, the blade is locked in engagement with the base.

Description

DEVICES AND SYSTEMS FOR SPINAL SURGERYCROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. Provisional Patent Application Serial No.63 / 658,242, filed 10 June 2024 and U.S. Provisional Patent Application Serial No. 63 / 808,912, filed 20 May 2025, the entire content of which is incorporated herein by referenceFIELD

[0002] This disclosure relates to spinal surgery and, more particularly, to devices and systems facilitating spinal surgical procedures.BACKGROUND

[0003] Spinal disorders such as scoliosis and other curvature abnormalities, kyphosis, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, tumors, and fracture may result from trauma, disease, and / or degenerative conditions and may cause patient pain, deformity, nerve damage, and / or loss of mobility.

[0004] Surgical treatment of such spinal disorders includes correction, fusion, fixation, discectomy, laminectomy and / or implantable prosthetics. With respect to correction, for example, surgical treatment may include implantation of a system of screws, rods, and / or plates to provide spinal stabilization and maintain spinal correction.SUMMARY

[0005] As used herein, the term “distal” refers to the portion that is described which is farther from an operator (whether a human surgeon or a surgical robot), while the term “proximal” refers to the portion that is being described which is closer to the operator. Terms including “generally,” “about,” “substantially,” and the like, as utilized herein, are meant to encompass variations, e.g., manufacturing tolerances, material tolerances, use and environmental tolerances, measurement variations, design variations, and / or other variations and tolerances, up to and including plus or minus 10 percent. Further, any or all of the aspects described herein, to the extent consistent, may be used in conjunction with any or all of the other aspects described herein.

[0006] Provided in accordance with aspects of this disclosure is an extender assembly for spinal surgery including a base, an extension, and a blade. The base includes a frame, an engagement mechanism coupled to the frame and rotatable relative to the frame between a first rotational orientation and a second rotational orientation, and a jaw mechanism coupled to the frame and including first and second jaws movable relative to one another and the frame between an open position and a closed position for engaging a shank of a screw. The extension is configured toreleasably engage the base and includes a jaw drive mechanism configured to move the first and second jaws between the open and closed positions when the extension is engaged with the base. The blade is configured to releasably engage the base. In the first rotational orientation, the extension is locked in engagement with the base and, in the second rotational orientation, the blade is locked in engagement with the base.

[0007] In an aspect of this disclosure, the jaw drive mechanism includes a jaw drive shaft having a driver at a distal end and a lever at a proximal end. With the extension engaged with the base, the driver is engaged with the jaw mechanism such that rotation of the lever rotates the jaw drive shaft and the driver to rotate the first and second jaws of the base between the closed and open positions.

[0008] In another aspect of this disclosure, wherein the extension further includes an engagement drive mechanism configured to rotate the engagement mechanism between the first and second rotational orientations. In such aspects, the engagement drive mechanism includes an engagement drive shaft having a driver at a distal end and a lever at a proximal end. With the extension engaged with the base, rotation of the lever rotates the engagement drive shaft and the driver to rotate the engagement mechanism of the base between the first and second rotational orientations.

[0009] In yet another aspect of this disclosure, the base further includes a lockout mechanism configured to inhibit movement of the first and second jaws from the closed position to the open position in a locked condition of the lockout mechanism and to permit movement of the first and second jaws from the closed position to the open position in an unlocked condition of the lockout mechanism. In such aspects, engagement and disengagement of the extension with the base may transition the lockout mechanism between the locked and unlocked conditions, respectively.

[0010] A spinal surgical system provided in accordance with this disclosure includes at least one extender assembly, e.g., according to any of the aspects detailed above or otherwise herein. In aspects, the at least one extender assembly includes first and second extender assemblies. The system further includes a retractor mechanism including at least one retractor arm (and, in aspects, first and second retractor arms) each configured to engage the blade of one of the at least one extender assemblies with the blade engaged with the base and the extension disengaged from the base. The retractor mechanism is operable to move the first extender assembly in at least two degrees of freedom and, in aspects, three degrees of freedom.

[0011] A method of spinal surgery provided in accordance with this disclosure includes engaging an extension with a base; manipulating, from the extension, a jaw mechanism of the base to capture, with first and second jaws of the jaw mechanism, a shank of a screw; driving the screw into tissue; sliding a blade over the extension and into position about the base; disengaging the extension from the base; engaging the blade with the base; and removing the extension. In aspects, the methodfurther includes supporting the blade, having the base engaged therewith, on an arm of a retractor mechanism.

[0012] In aspects of this disclosure, disengaging the extension from the base and engaging the blade with the base are performed in a single action, e.g., rotating a lever of the extension from a first position to a second position.BRIEF DESCRIPTION OF THE DRAWINGS

[0013] The above and other aspects and features of the present disclosure will become more apparent in light of the following detailed description when taken in conjunction with the accompanying drawings wherein like reference numerals identify similar or identical elements.

[0014] FIG. 1 shows a system for treating the spine in accordance with this disclosure installed on a patient’s spine;

[0015] FIGS. 2A and 2B are perspective and side views, respectively, of an extender assembly provided in accordance with this disclosure and configured for use, for example, with the system of FIG. 1;

[0016] FIGS. 3A-3E are progressive, exploded views of the extender assembly of FIGS. 2A and 2B;

[0017] FIG. 4 A is a perspective view of the extender assembly of FIGS. 2A and 2B in a locked condition defining a first height of the extender assembly;

[0018] FIG. 4B is a perspective view of the extender assembly of FIGS. 2A and 2B in an unlocked condition enabling height adjustment of the extender assembly;

[0019] FIG. 4C is a perspective view of the extender assembly of FIGS. 2A and 2B in an unlocked condition defining a second height of the extender assembly;

[0020] FIGS. 5A and 5B are perspective views of the extender assembly of FIGS. 2A and 2B defining first and second heights, respectively, in respective locked and unlocked conditions, with parts removed to illustrate internal operating features of the extender assembly;

[0021] FIGS 6A and 6B are perspective views of the extender assembly of FIGS. 2A and 2B in closed and open conditions, respectively;

[0022] FIGS. 7A and 7B are top views of the extender assembly of FIGS. 2A and 2B in the closed and open conditions, respectively;

[0023] FIGS. 8A and 8B are perspective views of the extender assembly of FIGS. 2A and 2B in the closed and open conditions, respectively, and with parts removed to illustrate internal operating features of the extender assembly;

[0024] FIGS. 9-18 are perspective views illustrating use of an extender assembly in accordance with this disclosure during installation of one or more spinal screws and retraction of tissue at a surgical site;

[0025] FIG. 19 is a perspective view of another extender assembly in accordance with this disclosure including a base, an extension, and a blade;

[0026] FIG. 20 is a perspective view of the extender assembly of FIG. 19 with the base, extension, and blade disengaged from one another;

[0027] FIG. 21 is an enlarged, perspective view of the base of the extender assembly of FIG. 19;

[0028] FIG. 22 is an exploded, perspective view of the base of the extender assembly of FIG. 19;

[0029] FIGS. 23 A, 23B, and 23C are front, side, and rear views of the extension of the extender assembly of FIG 19;

[0030] FIG. 24 is an exploded, perspective view of the extension of the extender assembly of FIG. 19;

[0031] FIGS. 25A, 25B, and 25C are front views of different length blades configured for use with the extender assembly of FIG. 19;

[0032] FIG. 26 is a longitudinal, cross-sectional view of the blade of the extender assembly of FIG. 19;

[0033] FIG. 27 is a perspective view of a guided retractor assembly provided in accordance with this disclosure with a medial lateral arm disengaged;

[0034] FIG. 28 is a perspective view of the guided retractor assembly of FIG. 27 with the medical lateral arm engaged and supporting a medial lateral blade;

[0035] FIGS. 29-31 are perspective views progressively illustrating engagement of the extension of the extender assembly of FIG. 19 with the base thereof;

[0036] FIGS. 32 and 33 are perspective views illustrating engagement of the extender assembly of FIG. 19 with a spinal screw and engagement of a driving tool with the spinal screw and extender assembly of FIG. 19, respectively;

[0037] FIGS. 34-37 are perspective views progressively illustrating engagement of the blade with the base of the extender assembly of FIG. 19 and subsequent disengagement of the extension therefrom;

[0038] FIG. 38 is a perspective view illustrating the base of the extender assembly of FIG. 19 engaging a spinal screw with the blade engaged thereon and the extension removed therefrom;

[0039] FIGS. 39 and 40 are perspective views illustrating engagement of an alignment spacer between a pair of extender assemblies in accordance with this disclosure wherein each extenderassembly includes a base engaging a spinal screw with a blade engaged to the base and the extension removed therefrom;

[0040] FIG. 41 is a perspective view of a releasable attachment assembly configured for use with any of the retractor assemblies detailed herein or any other suitable retractor assembly;

[0041] FIGS. 42A-42C are perspective views of the releasable attachment assembly of FIG. 41 including a directionally lockable ratchet mechanism in neutral, first, and second configurations, respectively;

[0042] FIGS. 43A and 43B are perspective views of the releasable attachment assembly of FIG. 41 illustrating rotation of the beam thereof relative to the arm thereof;

[0043] FIGS. 44A-44C are perspective views of the releasable attachment assembly of FIG. 41 including a directionally lockable rotation mechanism in neutral, first, and second configurations, respectively;

[0044] FIGS. 45A and 45B are perspective views of a blade assembly in unlocked and locked conditions, respectively;

[0045] FIGS. 46A and 46B are perspective views illustrating engagement of a tool with the blade assembly of FIGS. 45 A and 45B;

[0046] FIGS. 47A and 47B are perspective views illustrating engagement of the releasable attachment assembly of FIG. 41 with a retractor assembly; and

[0047] FIGS. 48A-49B are perspective views illustrating manipulation of the releasable attachment assembly of FIG. 41 into position relative to the retractor assembly of FIGS. 47A and 47B.DETAILED DESCRIPTION

[0048] Referring to FIG. 1, a system for treating the spine in accordance with this disclosure is generally identified by reference numeral 10 and shown installed on a patient’s spine “S.” System 10 includes one or more polyaxial screw assemblies 100, one or more fixed angle screw assemblies 200, one or more connectors 300, and one or more rods 400. Each of the screw assemblies 100, 200 is anchored in a vertebrae “V” of the patient’s spine “S.” Each of the one or more connectors 300 connects a screw assembly 100, 200 or a rod 400 with another screw assembly 100, 200 or rod 400. Each rod 400 is received within one or more screw assemblies 100, 200 and generally extends along at least a portion of a length of the patient’s spine “S ”

[0049] Although screw assemblies 100, 200 are shown anchored in pedicle bone, it is also contemplated that screw assemblies 100, 200 can be anchored in cortical bone, or in any other suitable bone, whether vertebral or otherwise. Further, although polyaxial screw assemblies 100 and fixed angle screw assemblies 200 are shown in certain locations, it is understood that polyaxial screwassemblies 100, fixed angle screw assemblies 200, and / or any other suitable screw assemblies may be used, in any suitable location. For example and without limitation, uniaxial screw assemblies, e.g., confining movement of the screw to within one plane, are also contemplated in accordance with this disclosure. As another example without limitation, the screw assemblies can be installed at a sagittal trajectory, a transverse trajectory, and / or at any suitable location and / or trajectory.

[0050] Each screw assembly 100, 200 includes, for example, a screw 110 (FIG. 11) and a receiver 120. With additional reference to FIG. 11, screw 110 includes a head 112 and a shank 114 extending distally from head 112. Head 112 may define a generally spherical configuration, or any other suitable configuration, and includes a socket 116 defined therein opposite shank 114. Socket 116 may define a star-shaped configuration or any other suitable configuration for at least partial complementary receipt of a driving tool 700 (FIG. 14) for rotationally driving shank 114 of screw 110 into tissue, e g., a pedicle of a vertebral body Shank 114 includes helical threading 118 to facilitate driving of shank 114 into and retention of shank 114 within tissue, although other configurations are also contemplated. Screw 110 may be formed from a metallic material such as, for example, titanium or cobalt chrome. Other suitable metallic materials forming screw 110 such as, for example, stainless steel, are also contemplated, as are configurations wherein screw 110 is formed from multiple materials, e.g., wherein head 112 is formed from a first material and wherein shank 114 is formed from a second, different material.

[0051] Receiver 120 is configured to retain head 112 of screw 110 therein and may be formed at least partially from a metallic material such as, for example, titanium, cobalt chrome, or stainless steel and / or at least partially from a polymeric material such as, for example, polyether ether ketone (PEEK), ultra-high-molecular-weight polyethylene (UHMWPE), polyethylene, carbon fiber reinforced PEEK, carbon composite, polylactic acid (PLA), or polyglycolic acid (PGA). Receiver 120 may be integral, e.g., monolithically formed or permanently engaged, with head 112 of screw 110 or may be releasably engagable with head 112 of screw 110. In either configuration, with receiver 120 receiving head 112 of screw 110 therein, receiver 120 may allow polyaxial angulation of screw 110 relative to receiver 120, may limit screw 110 to uniaxial angulation relative to receiver 120, or may maintain screw 110 in fixed angular orientation relative to receiver 120. Further, receiver 120 may include or be configured to connect to one or more connectors 300, rods 400, and / or other suitable components of system 10.

[0052] Turning to FIGS. 2A-3E, an extender assembly provided in accordance with this disclosure is shown generally identified by reference numeral 500. As detailed below, extender assembly 500 is selectively extendable to vary a height thereof, is configured to releasably engage a screw 110 (FIG. 11), is configured to operably receive first and second driving tools 600, 700 (FIGS. 11 and 14, respectively), and is configured to operably couple to a retractor assembly 800 (FIGS. 17and 18). Extender assembly 500 generally includes an outer sleeve 520, an inner frame 540, an extension lock mechanism 560, and a jaw mechanism 580. Outer sleeve 520 encloses internal operable components of extender assembly 500 and enables coupling of extender assembly 500 with retractor assembly 800 (FIGS. 17 and 18). Inner frame 540 operably supports internal operable components of extender assembly 500. Extension lock mechanism 560 enables selective adjustment of a height of extender assembly 500 and selective locking and unlocking of extender assembly 500 at a desired height. Jaw mechanism 580 enables the opening and closing of jaws 582 relative to one another for positioning extender assembly 500 and engaging extender assembly 500 with a head 112 of a screw 110 (see FIG. 11).

[0053] Outer sleeve 520 of extender assembly 500 includes a body 522 having a proximal end 523a and a distal end 523b, and an arm 524 extending from body 522 near or at proximal end 523a thereof. As shown, arm 524 extends from body 522 in substantially perpendicular orientation relative to body 522, although other configurations are also contemplated. Body 522 defines an internal cavity 526 having first and second substantially cylindrical cavity portions 527a, 527b disposed on either side of a central cavity portion 527c. Internal cavity 526 is closed at proximal end 523a of body 522 and open at distal end 523b of body 522. However, first, second, and third apertures 528a, 528b, 528c extend through closed proximal end 523a of body 522 into communication with cavity portions 527a, 527b, 527c, respectively.

[0054] Arm 524 of outer sleeve 520 defines a first slot 532 and a second slot 534 that partially intersects and is disposed in substantially perpendicular orientation relative to first slot 532. In aspects, first slot 532 is disposed in substantially perpendicular orientation relative to a longitudinal extent (e.g., between proximal and distal ends 523a, 523b) of body 522, while second slot 534 is disposed in substantially parallel orientation relative to the longitudinal extent of body 522.

[0055] Continuing with reference to FIGS. 2A-3E, an engagement assembly 535 is operably disposed within second slot 534 of arm 524 of outer sleeve 520. Engagement assembly 535 includes an engagement shaft 536 rotatably disposed within second slot 534 and a lever 537 extending from arm 524 and engaged with engagement shaft 536, e g., via a bolt assembly 538 including a bolt 538a, spring 538b, and ball 538c, such that rotation of lever 537 relative to arm 524 rotates engagement shaft 536 relative to arm 524. Engagement shaft 536 defines a notch 539 on one side thereof.

[0056] In a disengaged rotational position of engagement shaft 536, notch 539 is oriented towards first slot 532 such that engagement shaft 536 does not extend into (or extends minimally into) first slot 532, thereby allowing insertion and removal of a component into and from first slot 532. In an engaged rotational position of engagement shaft 536, on the other hand, notch 539 is not oriented towards first slot 532 such that a portion of engagement shaft 536 extends into (or extends further into) first slot 532, thereby frictionally engaging a component disposed within first slot 532to retain the component in engagement with arm 524. In aspects, as detailed below, the component may be a portion of retractor assembly 800 (FIGS. 17 and 18) to enable releasable engagement of extender assembly 500 with retractor assembly 800 (FIGS. 17 and 18).

[0057] Inner frame 540 of extender assembly 500 is configured for slidable receipt within body 522 of outer sleeve 520 and includes first and second barrels 542, 544 configured for slidable receipt within cavity portions 527a, 527b, respectively, of internal cavity 526 of body 522 of outer sleeve 520. First and second barrels 542, 544 are spaced-apart from one another and fixedly connected by a crossbar 546. First barrel 542 includes a plurality of recesses 548 defined within a side wall thereof on one side thereof and spaced-apart along at least a portion of a length of first barrel 542. Second barrel 544 is configured to slidably receive a guide post 550 engaged with body 522 of outer sleeve 520 via a bolt 552 extending through aperture 528b and into cavity portion 527b to guide slidable movement of body 522 of outer sleeve 520 about and relative to inner frame 540. Crossbar 546 defines an opening 547 extending longitudinally therethrough between first and second barrels 542, 544.

[0058] With additional reference to FIGS. 4A-5B, extension lock mechanism 560 of extender assembly 500 includes a ratchet shaft 562 and a lock lever 564. Ratchet shaft 562 is slidably received within first barrel 542 of inner frame 540 and slidably and rotatably disposed about a guide shaft 563 engaged within first barrel 542 of inner frame 540. Lock lever 564 is disposed externally, e.g., proximally, of body 522 of outer sleeve 520. Ratchet shaft 562 includes a plurality of protrusions 566 extending from a side wall thereof on one side thereof and spaced-apart along at least a portion of a length of ratchet shaft 562. Ratchet shaft 562 is engaged with lock lever 564 through body 522 of outer sleeve 520 via a bolt assembly 568 including a bolt 568a extending through aperture 528a and into cavity portion 527a, a spring 568b, and a ball 568c, such that rotation of lock lever 564 relative to body 522 of outer sleeve 520 rotates ratchet shaft 562 within and relative to first barrel 542 of inner frame 540.

[0059] In an unlocked rotational position of ratchet shaft 562, protrusions 566 are misaligned with, e g., not oriented towards, recesses 548 of first barrel 542 such that protrusions 566 and recesses 548 do not engage one another and, thus, sliding of outer sleeve 520 (including ratchet shaft 562 engaged thereto) relative to inner frame 540 is permitted. In a locked rotational position of ratchet shaft 562, on the other hand, protrusions 566 are aligned with, e.g., oriented towards, recesses 548 of first barrel 542 such that at least one protrusion 566 is engaged within a corresponding recess 548 to thereby engage ratchet shaft 562 with inner frame 540 and inhibit sliding of outer sleeve 520 (including ratchet shaft 562 engaged thereto) relative to inner frame 540. The longitudinal extents of protrusions 566 and recesses 548 enable selective locking of outer sleeve 520 relative to inner frame 540 in a plurality of different positions corresponding to different heights of extender assembly500, e.g., a plurality of incremental positions between a fully retracted position wherein outer sleeve 520 further overlaps inner frame 540 and a fully extended position wherein outer sleeve 520 further extends from inner frame 540.

[0060] As noted above, guide post 550 is slidably received within second barrel 544 of inner frame 540 and engaged with body 522 of outer sleeve 520 to guide slidable movement of body 522 of outer sleeve 520 about and relative to inner frame 540, e.g., during height adjustment using extension lock mechanism 560.

[0061] Referring to FIGS. 2A-3E and 6A-8B, jaw mechanism 580 of extender assembly 500 includes first and second jaws 582, an actuation sleeve 584, and a drive assembly 586. Each jaw 582 includes a base 583a and a body 583b extending from the base 583a. Each body 583b defines a recess portion 588 in an open position of jaw mechanism 580 (see FIGS. 6B and 7B), e.g., to enable positioning of jaws 582 about a screw 110 on shank 114 thereof adjacent head 112 (see FIG. 11). Recess portions 588 cooperate to define an at least partially enclosed passage 589 in a closed position of jaw mechanism 580 (FIGS. 6A and 7A), e.g., to capture screw 110 (see FIG. 11). Bolts 590 rotatably engage bases 583a of first and second jaws 582 with the respective first and second barrels 542, 544 of inner frame 540.

[0062] Actuation sleeve 584 is slidably disposed between body 522 of outer sleeve 520 and inner frame 540 and includes, at a distal end portion thereof, a distal collar 585 disposed between first and second jaws 582 and inner frame 540. Distal collar 585 defines first and second outer passages 592 that are slidably disposed about bolts 590 to permit distal collar 585 to slide about bolts 590 between and relative to jaws 582 and inner frame 540. Outer passages 592 of distal collar 585 define inner cam surfaces 593a configured to cooperate with outer cam surfaces 593b defined on bases 583a of jaws 582 such that sliding of distal collar 585 about bolts 590 and relative to jaws 582 pivots jaws 582 to rotate relative to one another between the open position (FIGS. 6B, 7B, and 8B) and the closed position (FIGS. 6A, 7A, and 8A). In aspects, a more distal position of distal collar 585 corresponds to the closed position of jaws 582 (FIG. 8A) while a more proximal position of distal collar 585 corresponds to the open position of jaws 582 (FIG. 8B). Distal collar 585 further includes a threaded central passage 594 disposed between outer passages 592. Distal collar 585 is fixed relative to actuation sleeve 584 such that distal collar 585 and actuation sleeve 584 move together between the proximal and distal positions.

[0063] Drive assembly 586 includes a threaded shaft 596, inner and outer extension shafts 598a, 598b, and a driver head 599. Threaded shaft 596 is threadingly engaged with threaded central passage 594 of distal collar 585 such that rotation of threaded shaft 596 translates distal collar 585 along threaded shaft 596 and relative to inner frame 540 and jaws 582. Threaded shaft 596 and / or inner extension shaft 598a extend through opening 547 of crossbar 546 of inner frame 540 and arepinned or otherwise engaged with one another such that rotation of inner extension shaft 598a relative to crossbar 546 of inner frame 540 rotates threaded shaft 596 relative to crossbar 546 of inner frame 540.

[0064] Inner and outer extension shafts 598a, 598b extend through central cavity portion 527c of cavity 526 of body 522 of outer sleeve 520 in rotatably fixed but telescopically slidable relation relative to one another. For example, inner and outer extension shafts 598a, 598b may define complementary shape configurations, e.g., hexagonal, star-shaped, or other suitable shape configurations, such that rotation of outer extension shaft 598b imparts rotation to inner extension shaft 598a regardless of the slidable positioning of inner and outer extension shafts 598a, 598b relative to one another, e.g., regardless of whether outer extension shaft 598b is further overlapping inner extension shaft 598a or further extends from inner extension shaft 598a. Outer extension shaft 598b is engaged with driver head 599 via a bolt 598c extending through third aperture 528c at proximal end 523 a of body 522 of outer sleeve 520 such that rotation of driver head 599 rotates outer extension shaft 598b, thereby rotating inner extension shaft 598a and threaded shaft 596 to translate distal collar 585 along threaded shaft 596 to pivot jaws 582 relative to one another between the open position (FIGS. 6B and 7B) and the closed position (FIGS. 6A and 7A), depending upon the direction of rotation of driver head 599. The slidable engagement of inner and outer extension shafts 598a, 598b enables the actuation of jaws 582 between the open position (FIGS. 6B and 7B) and the closed position (FIGS. 6A and 7A) at any height of extender assembly 500, e.g., at any telescopic position of inner and outer extension shafts 598a, 598b relative to one another. Driver head 599 is configured to receive any suitable driving tool 600 (FIG. 11), e.g., with a complementary cavity for receipt of driver head 599, to enable driving tool 600 (FIG. 11) to actuate jaws 582 between the open position (FIGS. 6B and 7B) and the closed position (FIGS. 6A and 7A). Alternatively, driver head 599 may define a cavity configured to receive a complementary driver head of driving tool 600 (FIG. 11).

[0065] Turning to FIGS. 9-18, the use and operation of extender assembly 500 during a spinal surgical procedure is detailed. Although necessarily detailed in one particular order hereinbelow, it is understood that the use and operation of extender assembly 500 may be performed in any suitable order without departing from this disclosure. Extender assembly 500 as shown in FIGS. 9-11 and 13-18 is similar to and may include any of the features of extender assembly 500 detailed above, and vice versa. Extender assembly 500 as shown in FIGS. 9-11 and 13-18 differs from extender assembly 500 as shown in FIGS. 2A-8B in that drive assembly 586, rather than extending through center cavity portion 527c of body 522 of outer sleeve 520 and between barrels 542, 544 of inner frame 520, extends through second cylindrical cavity portion 527b of body 522 of outer sleeve 520 and second barrel 544 of inner frame 540 to operably couple driver head 599 with jaws 582 via distal collar 585. In this configuration, aperture 528c at proximal end 523a of body 522 of outer sleeve 520 is vacant.Other suitable jaw mechanisms 580 are also contemplated for use with either configuration of extender assembly 500.

[0066] As shown in FIGS. 9-11, with jaws 582 of jaw mechanism 580 of extender assembly 500 in the closed position, a driving tool 600 is engaged with driver head 599 and driven, e.g., rotated, to thereby drive jaw mechanism 580 to translate distal collar 585 proximally to pivot jaws 582 to the open position. Thereafter, extender assembly 500 is manipulated such that a screw 110 to be engaged is disposed between jaws 582 with jaws 582 disposed on shank 114 adjacent head 112 of screw 110. Once this position has been achieved, driving tool 600 is driven, e.g., rotated, in the opposite manner to thereby drive jaw mechanism 580 to translate distal collar 585 distally to pivot jaws 582 to the closed position to capture screw 110 within passage 589 defined by jaws 582 in the closed position. Although screw 110 is captured by jaws 582, passage 589 enables rotation of screw 110 relative to jaws 582, e g , to enable driving screw 110 into tissue such as a pedicle of a vertebrae “V” of a patient’s spine “S” (FIG. 15). Once screw 110 is engaged by extender assembly 500, driving tool 600 may be disengaged from driver head 599 and removed. Driving tool 600 may be a manually driven tool or any other suitable tool. In aspects, rather than use of a driving tool 600, driver head 599 may be configured to be grasped and rotated directly by a user, e.g., without the use of a driving tool.

[0067] With reference to FIGS. 12-15, with jaws 582 of jaw mechanism 580 of extender assembly 500 engaging screw 110, another driving tool 700 may be engaged with socket 116 of head 112 of screw 110. Driving tool 700 may be, in aspects, a powered driving tool, although manual driving tools are also contemplated. In aspects, driving tool 700 is a navigated driving tool, although non-navigated driving tools are also contemplated.

[0068] In aspects, a stabilization collar 720 is provided to stabilize extender assembly 500 during use of driving tool 700 to drive screw 110 into tissue, e.g., a pedicle of a vertebrae “V” of a patient’s spine “S.” Stabilization collar 720, more specifically, is configured for rotational and slidable positioning about shaft 710 of driving tool 700 and to engage extender assembly 500, e.g., via docking of a protrusion 722 of stabilization collar 720 within aperture 528c defined within proximal end 523a of body 522 of outer sleeve 520, when driving tool 700 is engaged with screw 110. Thus, as shaft 710 of driving tool 700 is driven, e.g., rotated, to drive screw 110 into tissue, resulting vibrations and / or other movement of extender assembly 500 can be reduced or eliminated without impacting the functionality of driving tool 700.

[0069] With additional momentary reference to FIGS. 4A-5C, before and / or after use of driving tool 700 to drive screw 110 into tissue, the height of extender assembly 500 may be adjusted. More specifically, to adjust the height of extender assembly 500, lock lever 564 is rotated, e.g., about 90 degrees, from the locked position to the unlocked position to thereby rotate ratchet shaft 562 fromthe locked rotational position (see FIG. 4A and 5B) to the unlocked rotational position (see FIGS. 4B, 4C, and 5A). With lock lever 564 in the unlocked position (and ratchet shaft 562 correspondingly in the unlocked rotational position), outer sleeve 520 may be further extended from or further overlapped onto inner frame 540 to thereby vary a height of extender assembly 500 to a desired height. Once the desired height is reached, lock lever 564 is rotated back, e.g., about 90 degrees in the opposite direction, from the unlocked position to the locked position to thereby rotate ratchet shaft 562 from the unlocked rotational position to the locked rotational position such that outer sheeve 520 and inner frame 540 are engaged with one another defining the desired height of extender assembly 500

[0070] Turning to FIG. 16, the above may be repeated to install one or more other screws 110 and extender assemblies 500. For example, with the first screw 110 and extender assembly 500 installed as detailed above, a second screw 110 and extender assembly 500 may be installed on an adjacent vertebrae “V” similarly as detailed above. The heights of the first and second extender assemblies 500 may then be adjusted relative to the skin surface level “L” of the patient, e.g., such that at least arms 524 of outer sleeves 520 of extender assemblies 500 are disposed adjacent to and above, e.g., externally of, the skin surface level “L.”

[0071] Referring to FIGS. 17 and 18, with the first and second extender assemblies 500 installed and adjusted to the appropriate height, a retractor assembly 800 may be engaged with the first and second extender assemblies 500 to enable selective distraction and / or retraction of tissue at the surgical site, e.g., distraction of the adjacent vertebrae “V” connected to the first and second screws 110 and extender assemblies 500.

[0072] With additional reference to FIGS. 2A, 2B, and 3D, in order to engage the retractor assembly 800 with the first and second extender assemblies 500, levers 537 of first and second extender assemblies 500 are rotated, e.g., about 90 degrees, to (if not already disposed in) the disengaged position, corresponding to the disengaged rotational positions of engagement shafts 536, wherein the engagement shafts 536 do not extend into (or extend minimally into) the first slots 532 of the arms 524 of the outer sleeves 520 of extender assemblies 500. As such, first slots 532 are unobstructed and each is capable of receiving one of the mounting arms 810, 820 of retractor assembly 800. Once mounting arms 810, 820 of retractor assembly 800 are received within first slots 532 of extender assemblies 500, levers 537 are rotated back, e.g., about 90 degrees in the opposite direction, to the engaged position, corresponding to the engaged rotational position of engagement shafts 536, wherein the engagement shafts 536 extend into (or extend further into) the first slots 532 of the arms 524 of the outer sleeves 520 of the extender assemblies 500 to frictionally engage and retain mounting arms 810, 820 of retractor assembly 800 therein.

[0073] With retractor assembly 800 engaged with extender assemblies 500 as detailed above, retractor assembly 800 may be operated, e.g., by actuation of a ratchet mechanism 830 of retractor assembly 800, to incrementally advance either or both mounting arms 810, 820 apart from one another, thereby retracting, or distracting, the adjacent vertebrae “V” connected to the first and second screws 110 and extender assemblies 500 to achieve a desired spacing, decompress the intervertebral space, relieve disc pressure, and / or realign one or more vertebrae “V.” One or more accessories such as, for example, retractor panels 840 may be attached to retractor assembly 800 to facilitate retraction of tissue prior to or after the ratcheting actuation of retractor assembly 800. Thereafter, the remainder of a spinal surgical procedure may be performed such as, for example, a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) and / or other suitable spinal surgical procedure(s).

[0074] Once the desired spinal surgical procedure(s) are completed, retractor assembly 800 may be removed, e.g., by rotating levers 537 to the disengaged position and removing mounting arms 810, 820 of retractor assembly 800 from first slots 532 of extender assemblies 500. Next, driving tool 600 (FIG. 11) is engaged with the driver head 599 of the first extender assembly 500 and driven to pivot jaws 582 of first extender assembly 500 to the open position to release first extender assembly 500 from first screw 110 and enable withdrawal of first extender assembly 500 from the surgical site. This may then be repeated with the second extender assembly 500, e.g., wherein driving tool 600 (FIG. 11) is engaged with the driver head 599 of the second extender assembly 500 and driven to pivot jaws 582 of second extender assembly 500 to the open position to release second extender assembly 500 from second screw 110 and enable withdrawal of second extender assembly 500 from the surgical site.

[0075] Referring back to FIG. 1, in conjunction with FIGS. 17 and 18, with extender assemblies 500 removed, receivers 120 may be attached to heads 112 of screws 110 and connected to one another, e.g., via one or more connectors 300 and / or rods 400, e.g., to define system 10 including a plurality of screw assemblies 100, 200, one or more connectors 300, and / or one or more rods 400. In aspects, receiver(s) 120 may alternatively or additionally be installed on head(s) 112 of screw(s) 110 before engagement of extender assembly(s) 500 with screw(s) 110 and / or while extender assembly (s) 500 are engaged with screw(s) 110.

[0076] Turning to FIGS. 19-24, another extender assembly provided in accordance with this disclosure is shown generally identified by reference numeral 900. Extender assembly 900 includes a base 910, an extension 950, and a blade 990 and is configured to releasably engage a spinal screw 110 (FIGS. 32 and 33), operably receive a driving tool 700 (FIG. 33), and operably couple to a retractor assembly, e.g., retractor assembly 800 (FIGS. 17 and 18) and / or retractor assembly 1000 (FIGS. 27 and 28). Each of extension 950 and blade 990 are configured to releasably engage base910. More specifically, extension 950 is engaged with base 910 during driving the spinal screw 110 (FIGS. 32 and 33) into bone while blade 990 is engaged with base 910 after positioning of the spinal screw 110 (FIGS. 32 and 33) and in order to facilitate retraction of tissue at the surgical site, e.g., via engagement of blade 990 with a retractor assembly such as retractor assembly 800 (FIGS. 17 and 18) or retractor assembly 1000 (FIGS. 27 and 28).

[0077] Referring to FIGS. 21 and 22, base 910 of extender assembly 900 includes a frame 912, an engagement mechanism 922, a jaw mechanism 932, and a lockout mechanism 942. Frame 912 operably supports engagement mechanism 922, jaw mechanism 932, and lockout mechanism 942. Engagement mechanism 922 enables the selective engagement of frame 912 with extension 950 and blade 990. Jaw mechanism 942 enables the opening and closing of jaws 934a relative to one another for positioning extender assembly 900 and engaging extender assembly 900 with a head 112 of a screw 110 (see FIGS 32 and 33). Lockout mechanism 942, in a locked condition, inhibits operation of engagement mechanism 922 and / or jaw mechanism 932.

[0078] Frame 912 of base 910 of extender assembly 900, more specifically, defines first and second substantially cylindrical lumens 914a, 914b disposed on either side of a central lumen 914c. Further, frame 912 defines a pair of screw holes 916 at the distal end thereof for pivotably supporting jaws 934a of jaw mechanism 932 relative to frame 912.

[0079] Engagement mechanism 922 includes an engagement shaft 924 rotatably received within first cylindrical lumen 914a of frame 912 and an end cap 926 engaged about the proximal end of shaft 924. End cap 926 includes an engagement protrusion 928 protruding radially outwardly from end cap 926 relative to a rotation axis of engagement shaft 924 such that rotation of engagement shaft 924 within first cylindrical lumen 914a and relative to frame 912 likewise rotates engagement protrusion 928 relative to frame 912. End cap 926 further includes a receiver 929 defined at the proximal end thereof, e.g., to enable rotation of end cap 926 and, thus, engagement shaft 924, as detailed below. As also detailed below, in a first rotational position of engagement shaft 924, corresponding to a first orientation of engagement protrusion 928, extension 950 is locked in engagement about frame 912 and, in a second rotational position of engagement shaft 924, offset 90 degrees relative to the first rotational position and corresponding to a second orientation of engagement protrusion 928, extension 950 is unlocked from frame 912 and blade 990 is locked in engagement with frame 912.

[0080] Continuing with reference to FIGS. 21 and 22, jaw mechanism 932 of base 910 of extender assembly 900 includes first and second jaws 934a, a cam driver 934b, a jaw actuation shaft 936, and an end cap 938. First and second jaws 934a are pivotably coupled to frame 912 via pivot screws 935 engaged within screw holes 916 of frame 912. Cam driver 934b interfaces with corresponding cam surfaces of jaws 934a such that rotation of cam driver 934b rotates jaws 934aabout pivot screws 935 and relative to frame 912 between an open position of jaw mechanism 932 (FIG. 32), e.g., to enable positioning of jaws 934a about a screw 110 on shank 114 thereof adjacent head 112 of screw 110 (see FIG. 32), and a closed position of jaw mechanism 932 (FIG. 33), e.g., to capture screw 110 distally of head 112 thereof (see FIG. 33). Jaw actuation shaft 936 is rotatably received within second cylindrical lumen 914b of frame 912, is engaged with cam driver 934b at a distal end of jaw actuation shaft 936 and includes end cap 938 engaged about the proximal end of jaw actuation shaft 936. End cap 938 includes a receiver 939 defined at the proximal end thereof, e.g., to enable rotation of end cap 938 and, thus, jaw actuation shaft 936, e.g., to open or close jaws 934a, as detailed below.

[0081] Lockout mechanism 942 of base 910 includes a lockout shaft 944 slidably received within central lumen 914c of frame 912, a biasing spring 946, e.g., a coil compression spring, disposed within central lumen 914c and biasing lockout shaft 944 proximally relative to frame 912, and an end cap 948 engaged about a proximal end of lockout shaft 944. An anti-rotation pin 943a is received within a longitudinally extending slot 918 defined within frame 912 and through a transverse aperture 943b defined within lockout shaft 944 to inhibit rotation of lockout shaft 944 and, thus, end cap 948 relative to frame 912 while permitting sliding motion of lockout shaft 944 and, thus, end cap 948 relative to frame 912, e.g., against or under the bias of biasing spring 946. End cap 948 of lockout mechanism 942 is shaped complementary to end cap 926 of engagement mechanism 922 and / or end cap 938 of jaw mechanism 932 such that, with end cap 948 overlapping end cap 926 of engagement mechanism 922 and / or end cap 938 of jaw mechanism 932, that end cap 926, 938 is rotationally locked relative to end cap 948 due to the complementary engagement therebetween, thereby inhibiting rotation of engagement shaft 924 and / or jaw actuation shaft 936 relative to lockout shaft 944 and, thus, frame 912. Once end cap 948 is displaced distally relative to end caps 926, 938 so as to no longer overlap end caps 926, 938, end caps 926, 938 are free to rotate relative to end cap 946 and, thus, engagement shaft 924 and jaw actuation shaft 936 are permitted to rotate relative to lockout shaft 944 and frame 912.

[0082] With reference to FIGS. 23A-24, extension 950 of extender assembly 900 includes an elongate body 962, an engagement drive mechanism 972, and a jaw drive mechanism 982. As noted above, extension 950 is configured to releasably engage base 910. When engaged with base 910, extension 950 is operable to operate base 910, e.g., to rotate engagement shaft 924 of engagement mechanism 922 between the first and second rotational orientations and to move jaws 934a between the open and closed positions.

[0083] Elongated body 962 of extension 950 includes a proximal housing 964 and pair of distal legs 966 extending distally from proximal housing 964 in parallel, spaced-apart relation relative to one another. Proximal housing 964 defines first and second substantially cylindrical lumens 965a,965b oriented such that distal legs 966 and lumens 965, 965b are oriented transverse relative to one another. Distal legs 966 are configured to receive frame 912 of base 910 therebetween upon engagement of extension 950 about base 910. In aspects, distal legs 966 define different configurations such that extension 950 is slidable into engagement about base 910 in only one orientation. Further, one of distal legs 966 defines an engagement recess 967 (FIG. 23 A).

[0084] With momentary additional reference to FIGS. 21 and 22, upon slidable engagement of extension 950 about base 910, either or both distal legs 966 contact and urge end cap 948 of lockout mechanism 942 distally against the bias of biasing spring 946 such that end cap 948 is displaced distally from end caps 926, 938 so as to no longer overlap end caps 926, 938, thereby unlocking end caps 926, 938 and enabling rotation of engagement shaft 924 and jaw actuation shaft 936 relative to lockout shaft 944 and frame 912. Further, in order to enable the slidable engagement of extension 950 about base 910, engagement shaft 924 of engagement mechanism 922 of base 910 is disposed in the second rotational position, corresponding to the second orientation of engagement protrusion 928. Once extension 950 is positioned about base 910, engagement shaft 924 is returned to the first rotational position, corresponding to the first orientation of engagement protrusion 928, wherein engagement protrusion 928 is received within engagement recess 967 of one of the distal legs 966 of elongated body 962 of extension 950, thereby locking extension 950 in engagement about base 910.

[0085] Returning reference to FIGS. 23A-24, engagement drive mechanism 972 of extension 950 includes an engagement drive shaft 974, a driver 976 disposed at a distal end of engagement drive shaft 974, and a lever assembly 978 disposed at a proximal end of engagement drive shaft 974. Engagement drive shaft 974 is rotatably disposed within first cylindrical lumen 965a of proximal housing 964 of elongated body 962 with driver 976 extending distally from proximal housing 964 and lever assembly 978 extending proximally from proximal housing 964. When extension 950 is engaged on base 910, driver 976 is configured for receipt within receiver 929 of end cap 926 of engagement mechanism 922 of base 910 such that driver 976 and receiver 929 are rotationally engaged with one another. Thus, rotation of engagement drive shaft 974 rotates engagement shaft 926.

[0086] Lever assembly 978 includes a lever 979a and a spring plunger 979b. Lever 979a is engaged to the proximal end of engagement drive shaft 974 such that lever 979a is rotatable relative to elongated body 962 about a longitudinal axis of engagement drive shaft 974 to thereby rotate engagement drive shaft 974 and, thus, driver 976 relative to elongated body 962. More specifically, lever 979a is rotatable from a first position (FIG. 31), wherein lever 979a is aligned with elongated body 962, and a second position (FIGS. 29 and 30), wherein lever 979a is disposed transverse to elongated body 962. With extension 950 engaged about base 910, rotation of lever 979a betweenthe first and second positions rotates engagement protrusion 928 of base 910 (see FIG. 21) between the first and second orientations, thus enabling locking and unlocking of extension 950 from base 910 and blade 990 from base 910 (see FIG. 20) via rotation of lever 979b.

[0087] Spring plunger 979b is disposed on lever 979a and is oriented offset and parallel to engagement drive shaft 974. In the first position of lever 979a, wherein lever 979a is aligned with elongated body 962 (see FIG. 31), spring plunger 979b extends into a recess (not shown) defined within elongated body 962, thereby maintaining lever 979a in the first position. Thus, in order to rotate lever 979a from the first position to the second position, sufficient force is required to overcome the engagement of spring plunger 979b with elongated body 962, thus maintaining lever 979a in the first position and inhibiting accidental rotation of lever 979a.

[0088] Jaw drive mechanism 982 of extension 950 includes a jaw drive shaft 984, a driver 986 disposed at a distal end of jaw drive shaft 984, and a lever assembly 988 disposed at a proximal end of jaw drive shaft 984. Jaw drive shaft 984 is rotatably disposed within second cylindrical lumen 965b of proximal housing 964 of elongated body 962 with driver 986 extending distally from proximal housing 964 and at least a portion of lever assembly 988 extending proximally from proximal housing 964. Referring also to FIGS. 21 and 22, when extension 950 is engaged on base 910, driver 986 is configured for receipt within receiver 939 of end cap 938 of jaw mechanism 932 of base 910 such that driver 986 and receiver 939 are rotationally engaged with one another. Thus, rotation of jaw drive shaft 984 rotates jaw actuation shaft 936.

[0089] Returning to FIGS. 23A-34, a proximal end portion of jaw drive shaft 984 defines a flat 985 or other suitable engagement feature to enable rotational coupling of jaw drive shaft 984 with lever assembly 988. Lever assembly 988 includes a lever 989a and a spring plunger 989b. Lever 989a includes a lever flag 989c and a lever flagpole 989d supporting lever flag 989c along one side thereof. Lever flagpole 989d extends into second cylindrical lumen 965b of proximal housing 964 and defines a flat 989e or other suitable engagement feature configured to rotationally engage flat 985 or other suitable engagement feature of jaw drive shaft 984 within second cylindrical lumen 914b to thereby engage lever assembly 988 and jaw drive shaft 984 in fixed rotational orientation relative to one another and to rotationally couple lever assembly 988 to proximal housing 964, thus permitting rotation of lever assembly 988 relative to proximal housing 964, e.g., to correspondingly rotate jaw drive shaft 984. Accordingly, lever flag 989c is rotatable from a first position (FIGS. 31 and 33), wherein lever flag 989c is aligned with elongated body 962, to a second position (FIG. 32), wherein lever flag 989c is disposed transverse to elongated body 962.

[0090] With additional reference to FIGS. 21 and 22, with extension 950 engaged about base 910, rotation of lever flag 989c between its first and second positions rotates jaw actuation shaft 936between its first and second positions, thus enabling opening and closing of first and second jaws 934a via rotation of lever flag 989c.

[0091] Spring plunger 989b is disposed on lever flag 989c and is oriented offset and parallel to lever flagpole 989d (and jaw drive shaft 984). In the first position of lever flag 989c, wherein lever flag 989c is aligned with elongated body 962 (see FIG. 31), spring plunger 989b extends into a recess (not shown) defined within elongated body 962, thereby maintaining lever flag 989c in the first position. Thus, in order to rotate lever flag 989c from the first position to the second position, sufficient force is required to overcome the engagement of spring plunger 989b with elongated body 962, thus maintaining lever flag 989c in the first position and inhibiting accidental rotation of lever flag 989c.

[0092] Referring again to FIGS. 23A-23C, lever assembly 978 of engagement drive mechanism 972 and lever assembly 988 of jaw drive mechanism 982 are longitudinally offset relative to one another with lever flag 989c of lever assembly 988 of jaw drive mechanism 982 disposed between proximal housing 964 of elongated body 962 and lever 979a of engagement drive mechanism 972, thus defining a low profile configuration. Further, in the first positions of lever 979a and lever flag 989c, elongated body 962, lever 979a, and lever flag 989c are aligned with one another along a longitudinal axis of elongated body 962.

[0093] FIGS. 25A-25C illustrates a plurality of different size blade 990a, 990b, 990c configured for use as blade 990 of extender assembly 900 (see FIG. 20). Blades 990a, 990b, 990c define relatively small, medium, and large blade body lengths, respectively, although other suitable blade body lengths and / or other blade configurations are also contemplated. Each blade 990a, 990b, 990c includes a blade body 992 and an attachment handle 994 extending from the blade body 992 at an angle relative thereto. Attachment handles 994 facilitate attachment of blades 990a, 990b, 990c to a suitable retractor assembly, e.g., retractor assembly 800 (FIGS. 17 and 18) and / or retractor assembly 1000 (FIGS. 27 and 28), as detailed below.

[0094] As described in greater detail hereinbelow, and with additional momentary reference to FIGS. 34-37, the blade body 992 of each blade 990a, 990b, 990c is configured for slidable positioning about base 910 of extender assembly 900 and, in aspects, is configured to slide over extension 950 of extender assembly 900 and into positioning about base 910 of extender assembly 900. Further, each blade body 992 defines an engagement aperture 996 configured to receive engagement protrusion 928 of base 910 in the second orientation of engagement protrusion 928 to thereby lock blade body 992 in engagement about base 910. As the second orientation of engagement protrusion 928 corresponds to the unlocked condition of extension 950, the locking of lock blade body 992 in engagement about base 910 by moving engagement protrusion 928 to thesecond orientation unlocks extension 950 to allow removal of extension 950 leaving blade body 992 locked in engagement with base 910.

[0095] With additional reference to FIG. 26, in aspects, at least some of the blades 990a, 990b, 990c, e.g., medium and large blade 990b, 990c, respectively, each include a cutout 998 defined within a proximal portion of blade body 922 and, in aspects, also defined within a portion of attachment handle 994. Cutouts 998 enable increased superior-inferior instrument angulation for instrumentation inserted through the blade 990b, 990c, as indicated by arrow “A”.

[0096] Referring back to FIGS. 25A-25C, in aspects, attachment handles 994 may extend from blade bodies 992 at obtuse angles (defined between a distally facing surface of the attachment hand 994 and the rear face of the blade body), thus facilitating access to a surgical site, e.g., the intradiscal space, while maintaining a low profile. In other aspects, attachment handles 994 are orthogonal to blade bodies 992.

[0097] Turning to FIGS. 27 and 28, another retractor assembly provided in accordance with this disclosure is shown generally identified by reference numeral 1000. Retractor assembly 1000 includes a fixed shaft 1010, a fixed elbow 1022, a sliding elbow 1024, a first arm assembly 1030, a second arm assembly 1060, and a releasable attachment assembly 1090. Fixed elbow 1022 is integrally formed with or otherwise fixedly engaged with an end of fixed shaft 1010. In aspects, fixed elbow 1022 defines an orthogonal angle relative to fixed shaft 1010. Sliding elbow 1024 is slidably disposed about fixed shaft 1010 to enable sliding elbow 1024 to translate along fixed shaft 1010, e.g., towards and away from fixed elbow 1022.

[0098] First arm assembly 1030 is pivotably coupled to fixed elbow 1022 and extends perpendicularly from fixed shaft 1010. More specifically, first arm assembly 1030 is pivotable relative to fixed elbow 1022 and fixed shaft 1010 about a pivot axis that is parallel to fixed shaft 1010. Similarly, second arm assembly 1060 is pivotably coupled to sliding elbow 1024 and extends perpendicularly from fixed shaft 1010. That is, second arm assembly 1060 is pivotable relative to sliding elbow 1024 and fixed shaft 1010 about a pivot axis that is parallel to fixed shaft 1010 and, in aspects, coaxial with the pivot axis about which first arm assembly 1030 pivots relative to fixed elbow 1022.

[0099] In aspects, a rack 1016 defined along at least a portion of fixed shaft 1010 is configured for incremental engagement by a ratchet assembly 1026 of sliding elbow 1024, thus enabling incremental locking of sliding elbow 1024 and, thus, second arm assembly 1060 at a plurality of positions along the length of fixed shaft 1010 and relative to first arm assembly 1030. A lever 1027 of ratchet assembly 1026 enables disengagement of ratchet assembly 1026 from rack 1016, e.g., to enable sliding of sliding elbow 1024 along fixed shaft 1010, upon depression of lever 1027, whilerelease of lever 1027 locks ratchet assembly 1026 with rack 1016, thereby retaining sliding elbow 1024 in position along fixed shaft 1010.

[0100] First and second arm assemblies 1030, 1060 each include a base 1032, 1062 and an extension 1034, 1064 extending from the respective base 1032, 1062. Bases 1032, 1062 are pivotably coupled to elbows 1022, 1024, respectively, as detailed above, and include racked attachment portions 1036, 1066, respectively. Racked attachment portions 1036, 1066 enable ratcheted engagement of releasable attachment assembly 1090 with either first arm assembly 1030 or second arm assembly 1060.

[0101] Extensions 1034, 1064 of first and second arm assemblies 1030, 1060, respectively, are rotatably coupled to respective bases 1032, 1062 about axes orthogonal to the pivot axes of bases 1032, 1062 relative to respective elbows 1022, 1024 and, thus, relative to the longitudinal axis of fixed shaft 1010. Extensions 1034, 1064 may be configured to rotate through ranges of motion of at least 90 degrees, e.g., at least 45 degrees in each direction from a neutral position. Actuators 1038, 1068 disposed on extensions 1034, 1064, respectively, enable releasable locking of the rotational orientations of respective extensions 1034, 1064 relative to respective bases 1032, 1062. More specifically, actuators 1038, 1068 may be actuated, e g., slid along extensions 1034, 1064, to unlock and enable rotation of extensions 1034, 1064 and released to lock the rotational positions of extensions 1034, 1064. In aspects, extensions 1034, 1064 are selectively lockable at incremental rotational positions relative to respective bases 1032, 1062.

[0102] With additional momentary reference to FIGS. 20 and 25A-25C, each extension 1034, 1064 includes a support end 1039, 1069 configured to receive an attachment handle 994 of a blade 990 to fixedly support the blade 990 thereon. Thus, rotation of extensions 1034, 1064 rotate the attached blades 990 in the same manner. Likewise, pivoting of bases 1032, 1062 relative to elbows 1022, 1024 pivot the attached blades 990 in the same manner.

[0103] Turning back to FIGS. 27 and 28, releasable attachment assembly 1090 includes a frame 1092 including first and second shafts 1093a, 1093b joined at an orthogonal angle relative to one another at ends thereof, thus defining a L-shaped configuration. First shaft 1093a includes a ratchet assembly 1094 configured to engage the attachment portion 1036, 1066 of either of the first or second arm assemblies 1030, 1060, respectively and enable incremental extension and retraction of releasable attachment assembly 1090 relative to the attached arm assembly 1030, 1060. More specifically, this ratcheted movement of releasable attachment assembly 1090 enables movement of second shaft 1093b of releasable attachment assembly 1090 towards and away from fixed shaft 1010. An actuator 1096 enables the engagement of releasable attachment assembly 1090 with first or second arm assemblies 1030, 1060 and incremental movement of releasable attachment assembly1090 relative to first or second arm assemblies 1030, 1060, e.g., via depression of an actuator 1096 of releasable attachment assembly 1090.

[0104] With particular reference to FIG. 29, second shaft 1093b of releasable attachment assembly 1090 is configured to support a blade 1990 thereon. More specifically a slider 1999a coupled to blade 1990 may be configured to slide along second shaft 1093b to position blade 1990 in a desired position therealong. Additionally or alternatively, a knob 1999b or other suitable mechanism may enable selective tilting of blade 1990 relative to second shaft 1093b about the longitudinal axis of second shaft 1093b.

[0105] Turning to FIGS 29-40 the assembly and use of extender assembly 900 is detailed. With initial reference to FIGS. 29-31, extension 950 of extender assembly 900 is first engaged with base 910 of extender assembly 900. This is accomplished by rotating lever 979a to the second position (FIGS. 29 and 30) and advancing extension 950 about base 910 such that distal legs 966 receive base 910 therebetween. Extension 950 is advanced further about base 910 until driver 976 and receiver 929 are engaged with one another, driver 986 and receiver 939 are engaged with one another, and proximal housing 964 urges lockout shaft 944 distally such that end cap 948 is displaced distally, thereby enabling actuation of engagement shaft 924 and jaw actuation shaft 936. Once extension 950 is positioned in this manner, lever 979a may be rotated back to the first position (FIG. 31) to lock extension 950 in engagement with base 910.

[0106] Referring to FIGS. 32 and 33, with extension 950 engaged about base 910, extender assembly 900 may be utilized to capture a spinal screw 110 and facilitate driving the spinal screw 100 into spinal tissue, e.g., bone. More specifically, lever flag 989c is rotated from the first position (FIGS. 29-31 and 33) to the second position (FIG. 32) to move first and second jaws 934a from the closed position (FIGS. 29-31 and 33) to the open position (FIG. 32) for positioning jaws 934a about screw 110 and, thereafter, back to the first position to move jaws 934a back to the closed position (FIGS. 29-33) for capturing screw 110 therebetween, similarly as detailed above with respect to extender assembly 500 (see FIGS. 9-11).

[0107] With screw 110 captured by jaws 934a, driving tool 700 is engaged with socket 116 of head 112 of screw 110 to drive screw 110 into tissue, similarly as detailed above with respect to extender assembly 500 (FIGS. 9-15). In aspects, a stabilization collar 1720 is engaged about lever 979a in rotational fixed relation relative thereto to guide and stabilize driving tool 700, as also detailed above with respect to extender assembly 500 (FIGS. 9-15).

[0108] With reference to FIGS. 34-37, once screw 110 is positioned within tissue and still engaged by base 910 of extender assembly 900, extension 950 can be disengaged from base 910 and removed and replaced with blade 990. Initially, as shown in FIGS. 34 and 35, blade 990 is slid distally over extension 950 and into position about base 910. With additional reference to FIG. 36,once blade 990 is positioned about base 910, lever 979a is rotated from the first position (FIG. 35) to the second position (FIGS. 36) to thereby rotate engagement protrusion 928 from the first orientation to the second orientation, thereby unlocking extension 950 from base 910 and locking blade 990 with base 910. Referring also to FIG. 37, with extension 950 unlocked from base 910 and blade 990 locked with base 910, extension 950 may be withdrawn proximally from about base 910 and from within blade 990, leaving base 910 engaged with screw 110 and blade 990 engaged with base 910.

[0109] Turning to FIGS. 38-40, in aspects, the above process may be repeated such that another screw 110 having a base 910 engaged therewith and a blade 990 engaged on the base 910 is provided in proximity to the other screw 110, base 910, and blade 990 engagement and oriented such that the blades 990 face one another. In aspects, a spacer 1800 is slidably engaged between the blades 990 to maintain spacing and alignment of the blades 990 relative to one another.

[0110] Referring also to FIGS. 27 and 28, the screw 110, base 910, and blade 990 engagement s) may be coupled to a retractor assembly, e.g., retractor assembly 1000. More specifically, attachment handles 994 of blades 990 may be slid onto support ends 1039, 1049 of extensions 1034, 1064 of first and second arm assemblies 1030, 1060, respectively, of retractor assembly 1000.

[0111] With general reference to FIGS. 41-46B, another releasable attachment assembly, e.g., configured for use with retractor assembly 1000 (FIGS. 27 and 28) or any other suitable retractor assembly, in shown in accordance with this disclosure generally identified by reference numeral 4100. In aspects, releasable attachment assembly 4100 is configured as a medial arm assembly of a retractor assembly configured for positioning between opposing lateral arms thereof, although other arm assembly configurations are also contemplated. Thus, releasable attachment assembly 4100 is also referred to herein as an arm assembly 4100

[0112] Referring in particular to FIG. 41, arm assembly 4100 includes a frame 4102 having an arm 4110 and a beam 4120 disposed at an orthogonal angle relative to one another, thus defining a L-shaped configuration. More specifically, arm 4110 and beam 4120 are connected at ends thereof via a rotatable coupler 4130 to enable rotation of beam 4120 relative to arm 4110 about a longitudinal axis of arm 4110. Arm 4110 extends from rotatable coupler 4130 to a second end thereof defining a retractor coupler 4140 configured to engage arm assembly 4100 with an arm of a retractor assembly, e.g., retractor assembly 4700 (FIGS. 47A-49B).

[0113] With reference to FIGS. 42A-42C, arm 4110 defines an extendable length and includes an outer sleeve 4116 connected to retractor coupler 4140 and an inner shaft 4118 connected to rotatable coupler 4130. Inner shaft 4118 is telescopically extendable from and retractable into outer sleeve 4116 to vary the length of arm 4110, e.g., the distance between retractor coupler 4140 and rotatable coupler 4130 along the longitudinal axis of arm 4110. More specifically, releasableattachment assembly 4100 includes a directionally lockable ratchet mechanism 4150 operably coupling inner shaft 4118 and outer sleeve 4116 with one another. Directionally lockable ratchet mechanism 4150 includes a selector 4152, a plurality of annually ratchet teeth 4154 disposed about inner shaft 4118 along at least a portion of a length thereof, and a pinion drive 4156 supported on outer sleeve 4116. In a neutral position of selector 4152 (FIG. 42A), pinion drive 4156 is disengaged from ratchet teeth 4154 such that inner shaft 4118 is freely telescopically extendable from and retractable into outer sleeve 4116 to vary the length of arm 4110.

[0114] In a first offset position of selector 4152 (FIG. 42B), wherein selector 4152 is slid along outer sleeve 4116 from the neutral position (FIG. 42A) towards retractor coupler 4140 to the first offset position of selector 4152 (FIG. 42B), pinion drive 4156 is engaged with ratchet teeth 4154 in a first one-way fashion to enable inner shaft 4118 to be ratcheted into outer sleeve 4116 to shorten the length of arm 4110. However, in this first offset position, extension of inner shaft 4118 from outer sleeve 4116 to increase the length of arm 4110 is inhibited.

[0115] In a second offset position of selector 4152 (FIG. 42C), wherein selector 4152 is slid along outer sleeve 4116 from the neutral position (FIG. 42A) towards rotatable coupler 4130 to the second offset position of selector 4152 (FIG. 42C), pinion drive 4156 is engaged with ratchet teeth 4154 in a second, opposite one-way fashion to enable inner shaft 4118 to be ratcheted in extension from outer sleeve 4116 to increase the length of arm 4110. However, in this second offset position, retraction of inner shaft 4118 into outer sleeve 4116 to shorten the length of arm 4110 is inhibited.

[0116] In aspects, indicia are selectively exposed / covered via movement of selector 4152 to indicate the position of selector 4152 and, thus, the movement enabled in the various positions of selector 4152. For example, as shown in FIGS. 42A-42C, both arrows of a double arrow may be exposed through a window in the neural position (FIG. 42A), only the arrow pointing towards retractor coupler 4140 may be exposed through the window in the first offset position (FIG. 42B), and only the arrow pointing towards rotatable coupler 4130 may be exposed through the window in the second offset position. Thus, the exposed arrow(s) indicate the direction of movement that is permitted based on the position of selector 4152.

[0117] In additional or alternative aspects, pinion drive 4156 includes a socket 4158 configured to receive a driver of a rotary tool to facilitate rotation of pinion drive 4156 in a first rotational direction, thereby driving retraction of inner shaft 4118 into outer sleeve 4116 to shorten the length of arm 4110 (in the first offset position of selector 4152 (FIG. 42B)), and in a second rotational direction, thereby driving extension of inner shaft 4118 from outer sleeve 4116 to increase the length of arm 4110 (in the second offset position of selector 4152 (FIG. 42C)).

[0118] Referring to FIGS. 43A and 43B, rotatable coupler 4130 enables rotation of beam 4120 relative to arm 4110 about a longitudinal axis of arm 4110, as noted above. Beam 4120 may befreely rotatable relative to arm 4110 or, in aspects, may be selectively lockable in one or more rotatable positions relative to arm 4110, e.g., incrementally at pre-defined rotational positions or continuously at any rotational position. In aspects, rotation of beam 4120 is selectively directionally enabled similarly as detailed below with respect to directionally lockable rotation mechanism 4160 (FIGS. 44A-44C).

[0119] Turning to FIGS. 44A-44C, beam 4120 is rotatable about a longitudinal axis thereof and relative to arm 4110 and rotatable coupler 4130 via a directionally lockable rotation mechanism 4160. Directionally lockable rotation mechanism 4160 includes a selector 4162 and a reversible lock assembly 4164. In a neutral position of selector 4162 (FIG. 44A), reversible lock assembly 4164 is decoupled from beam 4120 such that beam 4120 is freely rotatable about the longitudinal axis thereof in either direction.

[0120] In a first rotated position of selector 4162 (FIG. 44B), wherein selector 4162 is rotated in a first direction from the neutral position (FIG. 44A) to the first rotated position (FIG. 44B), reversible lock assembly 4164 is coupled with beam 4120 to define a one-way clutch that enables rotation of beam 4120 about the longitudinal axis thereof in the first direction but inhibits such rotation in the second, opposite direction.

[0121] In a second rotated position of selector 4162 (FIG. 44C), wherein selector 4162 is rotated in as second, opposite direction from the neutral position (FIG. 44A) to the second rotated position of selector 4162 (FIG. 44C), reversible lock assembly 4164 is coupled with beam 4120 to define an opposite one-way clutch that enables rotation of beam 4120 about the longitudinal axis thereof in the second direction but inhibits such rotation in the first direction.

[0122] In aspects, indicia are visible via movement of selector 4162 to indicate the position of selector 4162 and, thus, the movement enabled in the various positions of selector 4162. For example, as shown in FIGS. 44A-44C, arrows pointing up and down may be visible on either side of selector 4162 with selector in the vertical, neutral position (FIG. 44A), only an arrow pointing in a first direction may be visible in the first rotational position (FIG. 44B), and only an arrow pointing in a second, opposite direction may be visible in the second rotational position. Thus, the visible arrow(s) indicate the direction of movement that is permitted based on the position of selector 4162.

[0123] With reference to FIGS. 41 and 45A-45B, a blade assembly 4500 configured for operable mounting on beam 4120 of releasable attachment assembly 4100 is shown. Blade assembly 4500 includes a base assembly 4510 and a blade 4520 depending from base assembly 4510. Base assembly 4510 includes a housing 4512 defining a slot 4514 configured to receive a portion ofbeam 4120 therein in rotationally fixed orientation, e.g., via complementary geometric shapes of slot 4514 and beam 4120 such as, for example, rectangular or other suitable polygonal shape, while permitting base assembly 4510 to slide along the length ofbeam 4120. Base assembly 4510 further includes alocking foot 4516 pivotably coupled to housing 4512 and a thumbscrew 4518 configured to drive pivoting of locking foot 4516 relative to housing 4512. It is noted that thumbscrew 4518 need not be operated by a hand of a user but, rather, may additionally or alternatively be rotated by a tool engaged therewith. Rotation of thumbscrew 4518 in a first direction urges locking foot 4156 to pivot relative to housing 4512 and into slot 4514 to capture beam 4120 therebetween and frictionally retain blade assembly 4500 in longitudinal position along beam 4120. Rotation of thumbscrew 4518 in a second, opposite direction releases locking foot 4516 to enable blade assembly 4500 to slide longitudinally along beam 4120.

[0124] Referring also to FIGS 46 A and 46B, in aspects, a tool 4600 is configured to engage blade assembly 4500 to facilitate manipulation of blade assembly 4500 and / or releasable attachment assembly 4100 (FIG. 41). Tool 4600, more specifically, includes a handle 4610 including a rotation knob 4620 mounted at a proximal end portion thereof and a shaft 4630 extending distally from a distal end portion of handle 4610. Shaft 4630 includes a driver 4640 disposed at the distal end portion thereof. Drive 4640 is shaped complementary to an inner slot 4522 of blade 4520 of blade assembly 4500 to enable slidable receipt of driver 4640 into engagement with blade 4520 in fixed rotational orientation. Tool 4600 further includes an engagement protrusion 4642 seated within driver 4640 and coupled to rotation knob 4620 such that rotation of rotation knob 4620 relative to handle 4610 between a first position and a second position rotates engagement protrusion 4642 relative to driver 4640 between an unlocked position, wherein engagement protrusion 4642 is recessed within or substantially flush relative to driver 4640, and a locked position, wherein engagement protrusion 4642 protrudes outwardly from driver 4640, respectively.

[0125] The unlocked position of engagement protrusion 4642 enables driver 4640 to be slide into engagement with blade 4520 and, once driver 4640 is positioned within blade 4520, rotation of engagement protrusion 4642 to the locked position may be affected to engage engagement protrusion 4642 within an engagement aperture 4524 of blade 4520 to thereby lock driver 4640 in engagement with blade 4520. In aspects, blade 4520 includes a plurality of engagement apertures 4524 spaced along a length of blade 4520 to enable locking of driver 4640 in engagement with blade 4520 at plural different positions along the length of blade 4520. With driver 4640 engaged to blade 4520, tool 4600 may be manipulated to thereby manipulate blade 4520 accordingly.

[0126] Turning to FIGS. 47A-49B, the installation and use of releasable attachment assembly 4100 with a retractor assembly 4700 is shown. Retractor assembly 4700 is similar to and may include any of the features of retractor assembly 1000 (FIGS. 27 and 28) detailed above, except as explicitly contradicted below.

[0127] Referring initially to FIGS. 47A and 47B, to couple releasable attachment assembly 4100 to an arm 4730 of retractor assembly 4700, releasable attachment assembly 4100 is oriented witharm 4100 extending substantially vertically and with retractor coupler 4140 substantially aligned with attachment portion 4736 of arm 4730 of retractor assembly 4700. Thereafter, releasable attachment assembly 4100 is advanced towards retractor assembly 4700 until retractor coupler 4140 is disposed about attachment portion 4736, although other suitable engagements are also contemplated.

[0128] Once retractor coupler 4140 is disposed about attachment portion 4736, releasable attachment assembly 4100 may be rotated from the substantially vertical orientation of arm 4100 to an angled orientation (e.g., of between about 15 degrees and about 45 degrees) to thereby retain retractor coupler 4140 in engagement about attachment portion 4736, e g., inhibiting withdrawal of releasable attachment assembly 4100 from engagement with retractor assembly 4700.

[0129] With reference to FIGS. 48A and 48B, with releasable attachment assembly 4100 engaged to retractor assembly 4700, blade assembly 4500 may be engaged with beam 4120 at a suitable position along the length thereof, as detailed above, and tool 4600 may be engaged with blade assembly 4500, as also detailed above.

[0130] Referring also to FIGS. 49A and 49B, tool 4600 may be manipulated to rotate releasable attachment assembly 4100 relative to retractor assembly 4700 to thereby rotate blade 4520 into position, e.g., within the incision in tissue between the opposing bases 910 engaged with screws 110. Further, arm 4110 of releasable attachment assembly 4100 may be adjusted to define a suitable length, as detailed above, e g., to further retract (or lessen the retraction of) tissue at the incision with blade 4520. Additionally or alternatively, beam 4120 may be rotated about its longitudinal axis, as detailed above, to angle blade 4520 towards or away from the incision in tissue to retract tissue surrounding the incision as desired. Finally, once the desired position is achieved, tool 4600 may be disengaged and removed.

[0131] Aspects of this disclosure may be further described by reference to the following numbered examples:

[0132] Example 1. An extender assembly for spinal surgery, comprising: an inner frame; an outer sleeve including a body disposed about the inner frame and an arm extending from the body, the arm configured to releasably engage a retractor mechanism; an extension lock mechanism configured to transition between a locked condition, fixing the outer sleeve relative to the inner frame, and an unlocked condition, permitting sliding of the outer sleeve relative to the inner frame to vary a height of the extender assembly; a jaw mechanism coupled to a distal end portion of the inner frame, the jaw mechanism including first and second jaws movable between an open position and a closed position for engaging a shank of a screw.

[0133] Example 2. The extender assembly according to example 1, wherein the arm of the outer sleeve defines a slot configured to receive an arm of the retractor mechanism.

[0134] Example 3. The extender assembly according to example 2, further comprising an engagement mechanism coupled to the arm of the outer sleeve, the engagement mechanism configured to transition from a disengaged condition, permitting insertion of the arm of the retractor mechanism into the slot of the arm of the outer sleeve, and an engaged condition, engaging the arm of the retractor mechanism within the slot of the arm of the outer sleeve.

[0135] Example 4. The extender assembly according to example 3, wherein the engagement mechanism includes a lever supported on the arm of the outer sleeve and an engagement shaft coupled to the lever and extending through the arm of the outer sleeve, the lever configured to rotate the engagement shaft relative to the arm of the outer sleeve between a first position, corresponding to the disengaged condition of the engagement mechanism, and a second position, corresponding to the engaged condition of the engagement mechanism wherein the engagement shaft engages the arm of the retractor mechanism within the slot of the arm of the outer sleeve

[0136] Example 5. The extender assembly according to any preceding paragraph, wherein the extension lock mechanism is configured to releasably lock the outer sleeve relative to the inner frame at a plurality of incremental heights of the extender assembly.

[0137] Example 6. The extender assembly according to example 5, wherein the extension lock mechanism includes a lock shaft defining a first plurality of engaging components along a length of the lock shaft and a barrel defining a second plurality of engaging components along a length of the barrel, the lock shaft disposed within the barrel and rotatable between a first orientation, corresponding to the locked condition, wherein at least one engaging component of the plurality of first engaging components is engaged with at least one engaging component of the plurality of second engaging components, and a second orientation, corresponding to the unlocked condition, wherein the first and second pluralities of engaging components are disengaged from one another.

[0138] Example 7. The extender assembly according to example 6, wherein the lock shaft is rotatably and slidably supported on a guide shaft engaged with the inner frame.

[0139] Example 8. The extender assembly according to any preceding example, wherein the extension lock mechanism includes a lever supported by the body of the outer sleeve and configured to transition the extension lock mechanism between the locked condition and the unlocked condition.

[0140] Example 9. The extender assembly according to any preceding example, wherein the jaw mechanism includes a driver head supported at a proximal end portion of the outer sleeve, and wherein rotation of the driver head moves the first and second jaws between the open position and the closed position.

[0141] Example 10. The extender assembly according to example 9, wherein the jaw mechanism further includes an extendable drive assembly coupled between the driver head and the first andsecond jaws and configured to enable rotation of the driver head to move the first and second jaws at a plurality of different heights of the extender assembly.

[0142] Example 11. The extender assembly according to example 9 or 10, wherein the jaw mechanism further includes a threaded shaft coupled to the driver head and a collar engaged about the threaded shaft, wherein rotation of the driver head rotates the threaded shaft to translate the collar along the threaded shaft to cam the first and second jaws between the open position and the closed position.

[0143] Example 12. The extender assembly according to any preceding paragraph, further comprising a stabilization collar configured to slidably and rotatably receive a shaft of a driving tool and to releasably dock to the outer sleeve to stabilize the extender assembly during use of the driving tool.

[0144] Example 13. The extender assembly according to example 12, wherein the driving tool is configured to engage the screw to drive the screw into tissue while the screw is engaged by the jaw mechanism of the extender assembly.

[0145] Example 14. The extender assembly according to example 13, wherein a height of the extender assembly is adjustable while the driving tool is engaged with the screw and the stabilization collar is docked to the outer sleeve.

[0146] Example 15. A spinal surgical system, comprising: a first extender assembly according to any one of examples 1-14; a second extender assembly according to any one of example s 1-14; and a retractor mechanism including first and second retractor arms configured to engage the arms of the outer sleeves of the first and second extender assemblies, respectively, wherein the retractor mechanism is operable to move the first and second retractor arms relative to one another to thereby move the first and second extender assemblies relative to one another.

[0147] Example 16. A method of spinal surgery, comprising: manipulating a jaw mechanism of an extender assembly to capture, with first and second jaws of the jaw mechanism, a shank of a screw; adjusting a height of the extender assembly; docking a driving tool to the extender assembly; engaging the driving tool with a head of the screw; and operating the driving tool to drive the screw into tissue.

[0148] Example 17. The method according to example 16, further comprising: inserting an arm of a retractor mechanism through a slot defined in the extender assembly; and engaging an engagement mechanism of the extender assembly with the arm of the retractor mechanism to retain the arm within the slot.

[0149] Example 18. The method according to example 16, wherein manipulating the jaw mechanism includes: engaging another driving tool with a driver head mounted on the extenderassembly; and operating the driving tool to drive the driver head to thereby move the first and second jaws between an open position and a closed position to capture the screw.

[0150] Example 19. The method according to example 16, wherein adjusting a height of the extender assembly includes: unlocking the extender assembly; sliding an outer sleeve of the extender assembly about and relative to an inner frame of the extender assembly to achieve a desired height; and locking the extender assembly.

[0151] Example 20. The method according to example 16, wherein docking the driving tool to the extender assembly includes: positioning a stabilization collar about a shaft of the driving tool; and engaging the stabilization collar with the extender assembly such that the driving tool is rotatable and slidable relative to both the stabilization collar and the extender assembly.

[0152] Example 21. An extender assembly for spinal surgery, comprising: a base, including: a frame; an engagement mechanism coupled to the frame and rotatable relative to the frame between a first rotational orientation and a second rotational orientation; and a jaw mechanism coupled to the frame and including first and second jaws movable relative to one another and the frame between an open position and a closed position for engaging a shank of a screw; an extension configured to releasably engage the base, wherein the extension includes a jaw drive mechanism configured to move the first and second jaws between the open and closed positions when the extension is engaged with the base; and a blade configured to releasably engage the base, wherein, in the first rotational orientation of the engagement mechanism, the extension is locked in engagement with the base and wherein, in the second rotational orientation of the engagement mechanism, the blade is locked in engagement with the base.

[0153] 22. The extender assembly according to paragraph 21, wherein the jaw drive mechanism includes ajaw drive shaft having a driver at a distal end and a lever at a proximal end, wherein, with the extension engaged with the base, the driver is engaged with the jaw mechanism such that rotation of the lever rotates the jaw drive shaft and the driver to thereby rotate the first and second jaws of the base between the closed and open positions.

[0154] Example 23. The extender assembly according to example 22, wherein the jaw mechanism includes ajaw actuation shaft having a receiver at a proximal end and coupled to a cam driver at distal end, wherein, with the extension engaged with the base, the driver is engaged with receiver such that rotation of the lever rotates the jaw drive shaft, the driver, the receiver, the jaw actuation shaft, and the cam driver to thereby cam the first and second jaws between the closed and open positions.

[0155] Example 24. The extender assembly according to any one of examples 21-23, wherein the extension further includes an engagement drive mechanism configured to rotate the engagement mechanism between the first and second rotational orientations.

[0156] Example 25. The extender assembly according to example 24, wherein the engagement drive mechanism includes an engagement drive shaft having a driver at a distal end and a lever at a proximal end, wherein with the extension engaged with the base, rotation of the lever rotates the engagement drive shaft and the driver to rotate the engagement mechanism of the base between the first and second rotational orientations.

[0157] Example 26. The extender assembly according to example 25, wherein the engagement mechanism includes an engagement shaft having a receiver at a proximal end and protrusion coupled thereto, wherein, with the extension engaged with the base, the driver is engaged with the receiver such that rotation of the lever rotates the engagement drive shaft, the driver, the receiver, the engagement shaft, and the protrusion to thereby move the protrusion into and out of engagement with the extension.

[0158] Example 27 The extender assembly according to any one of examples 21-26, wherein the base further includes a lockout mechanism configured to inhibit movement of the first and second jaws from the closed position to the open position in a locked condition of the lockout mechanism and to permit movement of the first and second jaws from the closed position to the open position in an unlocked condition of the lockout mechanism.

[0159] Example 28. The extender assembly according to example 27, wherein engagement of the extension with the base transitions the lockout mechanism from the locked condition to the unlocked condition and wherein disengagement of the extension from the base transitions the lockout mechanism from the unlocked condition to the locked condition.

[0160] Example 29. The extender assembly according to any one of examples 21-28, wherein the blade includes a blade body and an attachment handle.

[0161] Example 30. The extender assembly according to example 29, wherein the blade includes a cutout defined in a portion of the blade body and a portion of the attachment handle to facilitate angled instrumentation insertion through the blade.

[0162] Example 31. A spinal surgical system, comprising: a first extender assembly according to any one of paragraphs 1-10; and a retractor mechanism including a first retractor arm configured to engage the blade of the first extender assembly with the blade engaged with the base and the extension disengaged from the base, wherein the retractor mechanism is operable to move the first extender assembly in at least two degrees of freedom.

[0163] Example 32. The spinal surgical system according to example 31, wherein a first degree of freedom of the at least two degrees of freedom is pivoting about a first axis and wherein a second degree of freedom of the at least two degrees of freedom is rotation about a second axis perpendicular to the first axis.

[0164] Example 33. The spinal surgical system according to example 31 or 32, wherein the retractor mechanism is operable to move the first extender assembly in three degrees of freedom.

[0165] Example 34. The spinal surgical system according to example 33, wherein a first degree of freedom of the three degrees of freedom is pivoting about a first axis, a second degree of freedom of the three degrees of freedom is rotation about a second axis perpendicular to the first axis, and wherein a third degree of freedom of the three degrees of freedom is translation along a third parallel to the first axis.

[0166] Example 35. The spinal surgical system according to any one of examples 31-34, further comprising: a second extender assembly according to any one of paragraphs 21-30, wherein the retractor mechanism further includes a second retractor arm configured to engage the blade of the second extender assembly with the blade engaged with the base and the extension disengaged from the base, wherein the retractor mechanism is operable to move at least one of the first or second retractor arms relative to one another to thereby move the first and second extender assemblies relative to one another.

[0167] Example 36. A method of spinal surgery, comprising: engaging an extension with a base; manipulating, from the extension, a jaw mechanism of the base to capture, with first and second jaws of the jaw mechanism, a shank of a screw; driving the screw into tissue; sliding a blade over the extension and into position about the base; disengaging the extension from the base; engaging the blade with the base; and removing the extension.

[0168] Example 37. The method according to example 36, further comprising supporting the blade, having the base engaged therewith, on an arm of a retractor mechanism.

[0169] Example 38. The method according to example 37, further comprising manipulating the retractor mechanism to move the blade in a plurality of degrees of freedom.

[0170] Example 39. The method according to example 36, wherein disengaging the extension from the base and engaging the blade with the base are performed in a single action.

[0171] Example 40. The method according to example 39, wherein the single action is rotating a lever of the extension from a first position to a second position.

[0172] Example 41. An arm assembly configured to engage a retractor assembly, the arm assembly comprising: an arm defining a first end portion, a second end portion, and a longitudinal axis; a beam disposed orthogonal to the arm; a rotatable coupler coupling the first end portion of the arm with an end portion of the beam to enable rotation of the beam about a longitudinal axis of the arm; a retractor coupler disposed at the send end portion of the arm and configured to couple the arm to a retractor assembly, wherein the arm includes an outer sleeve and an inner shaft configured to telescope relative to the outer sleeve to vary a length of the arm, and wherein the beam is configured to rotate about a longitudinal axis thereof.

[0173] Example 42. The arm assembly according to example 41, further comprising a directionally lockable ratchet mechanism coupled between the inner shaft and the outer sleeve of the arm, the directionally lockable ratchet mechanism including a selector movable between a neutral position, a first position, and a second position, the directionally lockable ratchet mechanism configured such that: in the neutral position of the selector, the inner shaft is permitted to telescope into and out of the outer sleeve; in the first position of the selector, the inner shaft is permitted to telescope into the outer sleeve and is inhibited from telescoping out of the outer sleeve; and in the second position of the selector, the inner shaft is inhibited from telescoping into the outer sleeve and is permitted to telescope out of the outer sleeve.

[0174] Example 43. The arm assembly according to example 42, further comprising indicia configured to indicate the permitted telescoping directions of the inner shaft in each of the neutral position, the first position, and the second position of the selector.

[0175] Example 44. The arm assembly according to example 42 or 43, wherein the directionally lockable ratchet mechanism includes a pinion drive configured to receive a tool to facilitate rotation of the pinion drive to thereby telescope the inner shaft relative to the outer sleeve.

[0176] Example 45. The arm assembly according to any one of examples 41-44, further comprising a directionally lockable rotation mechanism coupled to the beam, the directionally lockable rotation mechanism including a selector movable between a neutral position, a first position, and a second position, the directionally lockable rotation mechanism configured such that: in the neutral position of the selector, the beam is rotatable in each of a first direction and a second direction; in the first position of the selector, the beam is permitted to rotate in the first direction and inhibited from rotating in the second direction; and in the second position of the selector, the beam is inhibited from rotating in the first direction and permitted to rotate in the second direction.

[0177] Example 46. The arm assembly according to example 45, further comprising indicia configured to indicate the permitted rotating directions of the beam in each of the neutral position, the first position, and the second position of the selector.

[0178] Example 47. The arm assembly according to any one of example s 41-46, wherein, with the retractor coupler coupled to the retractor assembly, the arm assembly is rotatable about the retractor coupler and relative to the retractor assembly.

[0179] Example 48. The arm assembly according to any one of examples 41-47, further comprising a blade assembly configured to engage the beam.

[0180] Example 49. The arm assembly according to example 48, wherein the blade assembly is slidable along the beam and selectively lockable in position along the beam.

[0181] Example 50. The arm assembly according to example 48 or 49, wherein the blade assembly is configured to receive a tool in engagement therewith for manipulating the arm assembly.

[0182] While several aspects of the disclosure have been detailed above and are shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description and accompanying drawings should not be construed as limiting, but merely as exemplifications of particular aspects. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

Claims

WHAT IS CLAIMED IS:

1. An extender assembly (900) for spinal surgery, comprising: a base (910), including: a frame (912); an engagement mechanism (922) coupled to the frame (912) and rotatable relative to the frame (912) between a first rotational orientation and a second rotational orientation; and a jaw mechanism (932) coupled to the frame (912) and including first and second jaws (934a) movable relative to one another and the frame (912) between an open position and a closed position for engaging a shank (114) of a screw (110); an extension (950) configured to releasably engage the base (910), wherein the extension (950) includes a jaw drive mechanism (982) configured to move the first and second jaws (934a) between the open and closed positions when the extension (950) is engaged with the base (910); and a blade (990, 990a, 990b, 990c) configured to releasably engage the base (910), wherein, in the first rotational orientation of the engagement mechanism (922), the extension (950) is locked in engagement with the base (910) and wherein, in the second rotational orientation of the engagement mechanism (922), the blade (990, 990a, 990b, 990c) is locked in engagement with the base (910).

2. The extender assembly according to claim 1, wherein the jaw drive mechanism (982) includes a jaw drive shaft (984) having a driver (986) at a distal end and a lever (988) at a proximal end, wherein, with the extension (950) engaged with the base (910), the driver (986) is engaged with the jaw mechanism (932) such that rotation of the lever (988) rotates the jaw drive shaft (984) and the driver (986) to thereby rotate the first and second jaws (934a) of the base (910) between the closed and open positions.

3. The extender assembly according to claim 2, wherein the jaw mechanism (932) includes a jaw actuation shaft (936) having a receiver (939) at a proximal end and coupled to a cam driver (934b) at distal end, wherein, with the extension (950) engaged with the base (910), the driver (986) is engaged with receiver (939) such that rotation of the lever (988) rotates the jaw drive shaft (984), the driver (986), the receiver (939), the jaw actuation shaft (936), and the cam driver (934b) to thereby cam the first and second jaws (934a) between the closed and open positions.

4. The extender assembly according to any one of claims 1-3, wherein the extension (950) further includes an engagement drive mechanism (942) configured to rotate the engagement mechanism (922) between the first and second rotational orientations.

5. The extender assembly according to claim 4, wherein the engagement drive mechanism (972) includes an engagement drive shaft (974) having a driver (976) at a distal end and a lever (978) at a proximal end, wherein with the extension (950) engaged with the base (910), rotation of the lever (978) rotates the engagement drive shaft (974) and the driver (976) to rotate the engagement mechanism (922) of the base (910) between the first and second rotational orientations.

6. The extender assembly according to claim 5, wherein the engagement mechanism (922) includes an engagement shaft (924) having a receiver (929) at a proximal end and protrusion (928) coupled thereto, wherein, with the extension (950) engaged with the base (910), the driver (976) is engaged with the receiver (929) such that rotation of the lever (978) rotates the engagement drive shaft (974), the driver (976), the receiver (929), the engagement shaft (924), and the protrusion (928) to thereby move the protrusion (928) into and out of engagement with the extension (950).

7. The extender assembly according to any one of claims 1-6, wherein the base (910) further includes a lockout mechanism (942) configured to inhibit movement of the first and second jaws (943a) from the closed position to the open position in a locked condition of the lockout mechanism (942) and to permit movement of the first and second jaws (943a) from the closed position to the open position in an unlocked condition of the lockout mechanism (942).

8. The extender assembly according to claim 7, wherein engagement of the extension (950) with the base (910) transitions the lockout mechanism (942) from the locked condition to the unlocked condition and wherein disengagement of the extension (950) from the base (910) transitions the lockout mechanism (942) from the unlocked condition to the locked condition.

9. The extender assembly according to any preceding claim, wherein the blade (990, 990a, 990b, 990c) includes a blade body (992) and an attachment handle (994).

10. The extender assembly according to claim 9, wherein the blade (990, 990a, 990b, 990c) includes a cutout (998) defined in a portion of the blade body (929) and a portion of the attachment handle (994) to facilitate angled instrumentation insertion through the blade (990, 990a, 990b, 990c).

11. A spinal surgical system, comprising: a first extender assembly (900) according to any one of claims 1-10; and a retractor mechanism (800, 1000) including a first retractor arm (1030, 1060) configured to engage the blade (990, 990a, 990b, 990c) of the first extender assembly (900) with the blade (990, 990a, 990b, 990c) engaged with the base (910) and the extension (950) disengaged from the base (910), wherein the retractor mechanism (800, 1000) is operable to move the first extender assembly (1030, 1060) in at least two degrees of freedom.

12. The spinal surgical system according to claim 11, wherein a first degree of freedom of the at least two degrees of freedom is pivoting about a first axis and wherein a second degree of freedom of the at least two degrees of freedom is rotation about a second axis perpendicular to the first axis.

13. The spinal surgical system according to claim 11 or 12, wherein the retractor mechanism (800, 1000) is operable to move the first extender assembly (900) in three degrees of freedom.

14. The spinal surgical system according to claim 13, wherein a first degree of freedom of the three degrees of freedom is pivoting about a first axis, a second degree of freedom of the three degrees of freedom is rotation about a second axis perpendicular to the first axis, and wherein a third degree of freedom of the three degrees of freedom is translation along a third parallel to the first axis.

15. The spinal surgical system according to any one of claims 11-14, further comprising: a second extender assembly (900) according to any one of claims 1-10, wherein the retractor mechanism (800, 1000) further includes a second retractor arm (1030, 1060) configured to engage the blade (990, 990a, 990b, 990c) of the second extender assembly (900) with the blade (990, 990a, 990b, 990c) engaged with the base (910) and the extension (950) disengaged from the base (910), wherein the retractor mechanism (800, 1000) is operable to move at least one of the first or second retractor arms (1030, 1060) relative to one another to thereby move the first and second extender assemblies (900) relative to one another.

Images