Anchor extenders for minimally invasive surgical procedures

Abstract

Systems for positioning a connecting element adjacent the spinal column in minimally invasive surgical procedures include one or more extenders removably engaged to one or more anchors engaged to a bony segment. The anchor extenders provide a reference to the respective anchor locations within the patient even when the anchor is obstructed by skin and/or tissue of the patient. An inserter can be movably mounted to the one or more anchor extenders, or an inserter can be employed without mounting to the one or more anchor extenders. In either form, the inserter is operable to position a stabilization element relative to the anchors for engagement to the anchors to stabilize the bony segment to which the anchors are engaged. At least one of the one or more anchor extenders includes a reduction assembly that is operable to move one or more portions of the bony segment while maintaining the minimally invasive character of the procedure.

1 - 18 . (canceled) 
     
     
         19 . A surgical instrument assembly, comprising:
 a first anchor including a bone engaging portion and a proximal receiving portion;   a second anchor including a bone engaging portion and a proximal receiving portion;   a first extender including an inner member received within an outer member, said inner and outer members extending along a longitudinal axis and being axially movable relative to one another, said inner member being releasably engaged to said proximal receiving portion of said first anchor, wherein said outer member of said first extender includes a proximal hub portion, said proximal hub portion including a laterally extending portion along one side thereof and an abutment surface along an opposite side thereof, said abutment surface including an extension member extending transversely to said longitudinal axis and outwardly from said abutment surface;   a second extender including an inner member received within an outer member, said inner and outer members extending along a longitudinal axis and being axially movable relative to one another, said inner member being releasably engaged to said proximal receiving portion of said second anchor, said outer member of said second extender includes a proximal hub portion, said proximal hub portion including a laterally extending portion along one side thereof and an abutment surface along an opposite side thereof, said abutment surface including a receptacle extending transversely to said longitudinal axis, wherein said extension member of said first extender is received in said receptacle of said second extender; and   an installation instrument pivotally mounted to said laterally extending portions of said first and second extenders.   
     
     
         20 . The assembly of  claim 19 , wherein said laterally extending portions each include a mounting surface facing opposite said abutment surface and said installation instrument is pivotally mounted to each of said first and second extenders along said mounting surfaces. 
     
     
         21 . The assembly of  claim 20 , wherein for each of said first and second extenders said abutment surface is parallel to said mounting surface. 
     
     
         22 . The assembly of  claim 21 , wherein said abutment surface and said mounting surface of each of said first and second extenders are each angled about 4 degrees relative to said longitudinal axis. 
     
     
         23 . The assembly of  claim 20 , wherein said laterally extending portions each include a wall portion extending around said mounting surface that is tapered toward said mounting surface. 
     
     
         24 . A surgical instrument assembly, comprising:
 a first anchor including a bone engaging portion and a proximal receiving portion;   a second anchor including a bone engaging portion and a proximal receiving portion; a third anchor including a bone engaging portion and a proximal receiving portion;   a first extender including an inner member received within an outer member, said inner and outer members extending along a longitudinal axis and being axially movable relative to one another, said inner member being releasably engaged to said proximal receiving portion of said first anchor, wherein said outer member of said first extender includes a proximal hub portion, said proximal hub portion including a mounting surface along one side thereof and an abutment surface along an opposite side thereof, said abutment surface including an extension member extending therefrom transversely to said longitudinal axis and outwardly from said abutment surface;   a second extender including an inner member received within an outer member, said inner and outer members extending along a longitudinal axis and being axially movable relative to one another, said inner member being releasably engaged to said proximal receiving portion of said second anchor, said outer member of said second extender includes a proximal hub portion, said proximal hub portion including first and second abutment surfaces on opposite sides thereof, said first and second abutment surfaces each including a receptacle extending therein transversely to said longitudinal axis;   a third extender including an inner member received with an outer member, said inner and outer members extending along a longitudinal axis and being axially movable relative to one another, said inner member being releasably engaged to said proximal receiving portion of said third anchor, wherein said outer member of said third extender includes a proximal hub portion, said proximal hub portion including a mounting surface along one side thereof and an abutment surface along an opposite side thereof, said abutment surface including an extension member extending therefrom transversely to said longitudinal axis and outwardly from said abutment surface, wherein said extension member of said first extender is received in said receptacle of said first abutment surface of said second extender and said extension member of said third extender is received in said receptacle of said second abutment surface of said second extender; and   an installation instrument pivotally mounted to said mounting surfaces of said first and third extenders.   
     
     
         25 . The assembly of  claim 24 , wherein:
 said first and second abutment surfaces of said second extender extend parallel to said longitudinal axis of said second extender; and   said abutment surface of each of said first and third extenders forms an angle of about 8 degrees relative to said longitudinal axis of said respective first and third extender.   
     
     
         26 . The assembly of  claim 19 , wherein said abutment surfaces engage one another when said installation instrument is pivotally mounted to said laterally extending portions of said first and second extenders. 
     
     
         27 . The assembly of  claim 19 , wherein said abutment surfaces are planar. 
     
     
         28 . The assembly of  claim 19 , wherein said inner members each include a pair of arms, said arms each including a distal engaging member configured to engage a respective one of said receiving portions, said engaging members of a respective one of said inner members being biased apart from one another. 
     
     
         29 . The assembly of  claim 19 , wherein said inner members each include a pair of arms, said arms each have a concavely curved inner surface such that said inner surfaces of a respective one of said inner members form a pathway configured to receive an enlarged portion of a connecting element. 
     
     
         30 . The assembly of  claim 19 , wherein said inner members each include a pair of arms comprising proximal ends that engage one another and distal ends that are spaced apart from one another, said proximal ends of said arms defining an externally threaded end portion configured to engage a threaded inner surface of a respective one of said outer members. 
     
     
         31 . The assembly of  claim 19 , wherein said inner members each include indicia configured to show relative positioning of a respective one of said inner members relative to a respective one of said outer members. 
     
     
         32 . The assembly of  claim 19 , wherein:
 proximal ends of said inner members each include at least one aperture; and   said hub portions each include a locking member that is pivotable relative to an outer surface of a respective one of said outer members; and   said locking members are movable between a first position in which said locking members are spaced apart from said apertures and said inner members are movable relative to said outer members and a second position in which said locking members are disposed in said apertures and said inner members are fixed relative to said outer members.   
     
     
         33 . The assembly of  claim 24 , wherein said abutment surfaces engage one another when said installation instrument is pivotally mounted to said mounting surfaces of said first and third extenders. 
     
     
         34 . The assembly of  claim 24 , wherein said inner members each include a pair of arms, said arms each including a distal engaging member configured to engage a respective one of said receiving portions, said engaging members of a respective one of said inner members being biased apart from one another. 
     
     
         35 . The assembly of  claim 24 , wherein:
 proximal ends of said inner members each include at least one aperture; and   said hub portions each include a locking member that is pivotable relative to an outer surface of a respective one of said outer members; and   said locking members are movable between a first position in which said locking members are spaced apart from said apertures and said inner members are movable relative to said outer members and a second position in which said locking members are disposed in said apertures and said inner members are fixed relative to said outer members.   
     
     
         36 . A surgical instrument assembly, comprising:
 a first anchor including a bone engaging portion and a proximal receiving portion; and   a first extender comprising an inner member received within an outer member, said inner and outer members extending along a longitudinal axis and being axially movable relative to one another, a proximal end of said inner member comprising at least one aperture, said inner member including a pair of arms, said arms each including a distal engaging member configured to engage said receiving portion, said engaging members being biased apart from one another, said engaging members being releasably engaged to said receiving portion, said outer member including a proximal hub portion, said proximal hub portion including a laterally extending portion along one side thereof and a planar abutment surface along an opposite side thereof, said abutment surface including an extension member extending transversely to said longitudinal axis and outwardly from said abutment surface, said hub portion including a locking member positioned between said abutment surface and said laterally extending portion, said locking member being pivotable relative to an outer surface of the outer member,   wherein said locking member is movable between a first position in which said locking member is spaced apart from said aperture and said inner member is movable relative to said outer member and a second position in which said locking member is disposed in said aperture and said inner member is fixed relative to said outer member.   
     
     
         37 . The assembly of  claim 36 , wherein proximal ends of said arms engage one another to define an externally threaded end portion configured to engage a threaded inner surface of a respective one of said outer members. 
     
     
         38 . The assembly of  claim 37 , wherein said inner member is axially movable relative to said outer member in a first direction by rotating said inner member relative to said outer member in a second direction and said inner member is axially movable relative to said outer member in a third direction that is opposite the first direction by rotating said inner member relative to said outer member in a fourth direction that is opposite the second direction.