CA2602499A1 - Low profile spinal tethering devices - Google Patents

Low profile spinal tethering devices Download PDF

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Publication number
CA2602499A1
CA2602499A1 CA002602499A CA2602499A CA2602499A1 CA 2602499 A1 CA2602499 A1 CA 2602499A1 CA 002602499 A CA002602499 A CA 002602499A CA 2602499 A CA2602499 A CA 2602499A CA 2602499 A1 CA2602499 A1 CA 2602499A1
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Canada
Prior art keywords
staple
tether
bone
spinal anchoring
pathway
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CA002602499A
Other languages
French (fr)
Other versions
CA2602499C (en
Inventor
Hassan A. Serhan
Michael A. Slivka
Mathew Hannen
Peter Newton
Michael Nilsson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
DePuy Spine LLC
Original Assignee
Depuy Spine, Inc.
Hassan A. Serhan
Michael A. Slivka
Mathew Hannen
Peter Newton
Michael Nilsson
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Publication date
Application filed by Depuy Spine, Inc., Hassan A. Serhan, Michael A. Slivka, Mathew Hannen, Peter Newton, Michael Nilsson filed Critical Depuy Spine, Inc.
Publication of CA2602499A1 publication Critical patent/CA2602499A1/en
Application granted granted Critical
Publication of CA2602499C publication Critical patent/CA2602499C/en
Active legal-status Critical Current
Anticipated expiration legal-status Critical

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0642—Surgical staples, i.e. penetrating the tissue for bones, e.g. for osteosynthesis or connecting tendon to bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7053—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant with parts attached to bones or to each other by flexible wires, straps, sutures or cables
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/701—Longitudinal elements with a non-circular, e.g. rectangular, cross-section
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7022—Tethers, i.e. longitudinal elements capable of transmitting tension only, e.g. straps, sutures or cables
    • A—HUMAN NECESSITIES
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • A61B17/704—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other the longitudinal element passing through a ball-joint in the screw head
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8695—Washers
    • A—HUMAN NECESSITIES
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    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875—Screwdrivers, spanners or wrenches
    • A61B17/8877—Screwdrivers, spanners or wrenches characterised by the cross-section of the driver bit
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    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875—Screwdrivers, spanners or wrenches
    • A61B17/8894—Screwdrivers, spanners or wrenches holding the implant into or through which the screw is to be inserted
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1604—Chisels; Rongeurs; Punches; Stamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1655—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for tapping
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B2017/0647—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks
    • A61B2017/0648—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks threaded, e.g. tacks with a screw thread
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/564—Methods for bone or joint treatment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/567—Joint mechanisms or joint supports in addition to the natural joints and outside the joint gaps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B2017/681—Alignment, compression, or distraction mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8665—Nuts
    • A61B2017/867—Nuts with integral locking or clamping means

Abstract

Methods and devices for treating spinal deformities are provided. In one exemplary embodiment, a low-profile spinal anchoring device is provided for receiving a spinal fixation element, such as a tether, therethrough. The device generally includes a staple body that is adapted to seat a spinal fixation element, a fastening element for fixing the staple body to bone, and a locking assembly for coupling a spinal fixation element to the staple body. In one embodiment, the locking assembly includes a washer that is adapted to couple to the staple body such that the spinal fixation is disposed therebetween, and a locking nut that is adapted to engage the staple body to mate the washer to the staple body.

Claims (72)

1. A spinal anchoring device, comprising:
a staple body defining a central opening formed therethrough and a pathway extending across the central opening for seating a tether;
a fastening element adapted to extend through a central opening formed in the staple body to mate the staple body to bone; and a locking assembly adapted to engage the staple body such that a tether extending through the pathway is positioned between the locking assembly and the staple body.
2. The spinal anchoring device of claim 1, wherein a central opening of the staple body has a substantially spherical surface formed therearound for seating a complementary spherical surface formed on the fastening element.
3. The spinal anchoring device of claim 1, wherein the staple body includes opposed arms extending from opposed sides of a superior surface, the pathway extending between the opposed arms.
4. The spinal anchoring device of claim 3, wherein the opposed arms include threads formed on an external surface thereof for mating with corresponding threads formed on the locking assembly.
5. The spinal anchoring device of claim 1, wherein the locking assembly comprises a washer adapted to couple to the staple body such that a tether extending through the pathway is positioned between the washer and the staple body, and a locking nut adapted to engage the staple body to lock the washer to the staple body.
6. The spinal anchoring device of claim 5, wherein the staple body includes opposed arms formed on a superior surface thereof, and wherein the washer includes opposed openings formed therethrough for receiving the opposed arms on the staple body.
7. The spinal anchoring device of claim 6, wherein the opposed arms on the staple body include threads formed thereon for mating with corresponding threads formed on the locking nut.
8. The spinal anchoring device of claim 6, wherein the washer includes a strut extending there across and adapted to be positioned between the opposed arms.
9. The spinal anchoring device of claim 1, wherein the fastening element comprises a bone screw having a head and a shank, and wherein the head of the bone screw includes a flange formed adjacent and distal to a proximal end of the shank of the bone screw, the flange having a diameter that is greater than a diameter of the central opening formed in the staple body.
10. The spinal anchoring device of claim 9, wherein the flange includes a substantially spherical inferior surface that is adapted to correspond to a substantially spherical surface formed around the central opening of the staple body.
11. The spinal anchoring device of claim 9, wherein the head of the bone screw further includes a proximal extension that is adapted to extend into the pathway of the staple body.
12. The spinal anchoring device of claim 11, wherein the proximal extension includes a recess formed therein for receiving a tool adapted to drive the bone screw into bone.
13. The spinal anchoring device of claim 1, further comprising a deformable clip adapted to be disposed around a tether and positioned within the pathway such that the locking assembly is adapted to deform the clip to engage the tether when the locking assembly is mated to the staple body.
14. A spinal anchoring device, comprising:
a staple having at least one bone-engaging member formed on an inferior surface thereof, and opposed arms extending from a superior surface thereof and defining a pathway therebetween for seating a tether;
a fastening element adapted to mate the staple to bone; and a locking assembly adapted to engage the opposed arms of the staple to lock a tether disposed in the pathway between the locking assembly and the staple.
15. The spinal anchoring device of claim 14, wherein the locking assembly includes a locking nut having threads formed on an internal surface thereof for mating with corresponding threads formed on an external surface of the opposed arms of the staple.
16. The spinal anchoring device of claim 15, wherein the locking assembly further includes a washer adapted to be positioned between the locking nut and the superior surface of the staple.
17. The spinal anchoring device of claim 14, further comprising a tether-engaging feature formed on at least one of the staple, the fastening element, and the locking assembly.
18. The spinal anchoring device of claim 17, wherein the tether-engaging feature comprises at least one groove formed on the superior surface of the staple and positioned in the pathway, and at least one complementary ridge formed on the locking assembly such that the at least one ridge and at least one groove are adapted to engage a tether seated in the pathway.
19. The spinal anchoring device of claim 17, wherein the tether-engaging feature comprises a head formed on a proximal end of the fastening element and adapted to extend into the pathway such that the head alters a path of a tether seated in the pathway.
20. The spinal anchoring device of claim 17, wherein the tether-engaging feature comprises a protrusion formed on an inferior surface of the locking assembly such that the protrusion is adapted to alters a path of a tether seated in the pathway.
21. A tether for use with a spinal anchoring device, comprising:
a substantially flat elongate member having a cross-sectional width that is at least two times greater than a cross-sectional height thereof, the tether being formed from a biocompatible polymeric material.
22. The tether of claim 21, wherein the substantially flat elongate member has a tensile strength that is in the range of about 1 GPa to 5 GPa.
23. The tether of claim 21, wherein the substantially flat elongate member has a tensile modulus that is in the range of about 10 GPa to 5 GPa.
24. The tether of claim 21, wherein the material is selected from the group consisting of an ultra-high molecular weight polyethylene, poly(ethylene terephthalate), poly(L-lactic acid), and combinations thereof.
25. A method for correcting spinal deformities, comprising:
implanting an anchoring element in bone;
positioning a substantially flat elongate tether through the anchoring element;
and applying a locking element to the anchoring element to engage the tether.
26. The method of claim 25, wherein the anchoring element comprises a staple and a fastening element.
27. The method of claim 26, wherein implanting an anchoring element in bone comprises impacting the staple into bone, and inserting the fastening element through the staple and into a bone hole to secure the staple to bone.
28. The method of claim 26, wherein implanting an anchoring element in bone comprises inserting the fastening element into a bone hole to drive the staple into bone.
29. The method of claim 26, wherein the staple includes opposed arms formed thereon and defining a pathway therebetween for receiving the tether, and wherein the locking element is adapted to engage the opposed arms.
30. The method of claim 29, wherein applying a locking element to the anchoring element comprises positioning a washer around the opposed arms of the staple such that the tether is positioned between the washer and the staple, and mating the locking nut to the opposed arms.
31. A method for correcting spinal deformities, comprising:
implanting a staple in bone;
positioning a tether through a non-linear pathway formed in the staple;
applying a locking assembly to the staple to engage the tether and substantially prevent movement thereof relative to the staple.
32. The method of claim 31, wherein the staple is adapted to penetrate bone, and wherein a fastening element extends through the staple to fix the staple to bone.
33. The method of claim 32, wherein the staple is impacted into bone prior to inserting the fastening element therethrough.
34. The method of claim 32, wherein the fastening element is used to drive the staple into bone.
35. The method of claim 32, wherein the locking assembly includes a washer that is adapted to couple to the staple such that the tether is disposed between the washer and the staple, and a locking nut that is adapted to engage the staple to lock the washer and tether relative to the staple.
36. The method of claim 35, wherein the staple includes opposed arms formed thereon that define the pathway therebetween.
37. A method for correcting spinal deformities, comprising:
impacting at least one bone-penetrating member formed on an inferior surface of a staple body into a vertebra;
inserting a fastening element through the staple body and into the vertebrae to attach the staple to the vertebra;
positioning a tether on a superior surface of the staple such that the tether extends over a head of the fastening element; and applying a locking mechanism to the staple to maintain the tether in a substantially fixed position relative to the staple.
38. The method of claim 37, wherein the staple body includes a pathway for seating the tether, and wherein the head of the fastening element alters the pathway.
39. The method of claim 37, wherein the tether is substantially planar.
40. The method of claim 37, wherein the tether is maintained between the locking mechanism and the staple body in a non-linear pathway.
41. The method of claim 37, wherein the staple includes opposed arms formed on the superior surface thereof, and wherein the tether extends between the opposed arms.
42. The method of claim 41, wherein the locking mechanism is adapted to mate to the opposed arms.
43. The method of claim 42, wherein the locking mechanism includes a washer and a locking nut adapted to engage the opposed arms and lock the tether between the washer and the staple body.
44. The method of claim 43, wherein the washer includes an outer portion adapted to be positioned around the opposed arms, and a strut extending between opposed sides of the outer portion and adapted to be positioned between the opposed arms.
45. A spinal anchoring system, comprising:
a substantially flat elongate tether;
an anchoring device that is adapted to mate to bone and that includes a pathway formed therethrough for seating the substantially flat elongate tether such that the tether is maintained in a substantially fixed position.
46. The spinal anchoring system of claim 45, wherein the tether has a cross-sectional width that is greater than a cross-sectional height.
47. The spinal anchoring system of claim 45, wherein the anchoring device includes at least one tether-engaging feature that is adapted to extend into the pathway to maintain the tether in a substantially fixed position.
48. The spinal anchoring system of claim 47, wherein the tether-engaging feature comprises a clip adapted to be disposed around the tether.
49. The spinal anchoring system of claim 45, wherein the anchoring device comprises a staple adapted to penetrate bone and defining the pathway, a fastening element adapted to mate the staple to bone, and a locking assembly adapted to engage the staple to maintain the tether in a substantially fixed position between the locking assembly and the staple.
50. The spinal anchoring system of claim 49, wherein the staple includes opposed arms, and wherein the locking assembly is adapted to receive the opposed arms therethrough to mate to the staple.
51. The spinal anchoring system of claim 50, wherein the locking assembly comprises a washer and a locking nut, and wherein the locking nut includes a mating element formed thereon and adapted to mate to a complementary mating element formed on the opposed arms.
52. The spinal anchoring system of claim 51, wherein the washer includes at least one ridge formed on an inferior surface thereof for extending into at least one corresponding complementary groove formed in a superior surface of the staple, the at least one ridge and the at least one groove being adapted to engage the tether therebetween.
53. The spinal anchoring system of claim 51, wherein the washer includes a strut extending thereacross and adapted to be received between the opposed arms of the staple.
54. The spinal anchoring system of claim 49, wherein the fastening element comprises a bone screw having a head and a threaded shank, and wherein the staple includes a central opening formed therein for receiving the bone screw.
55. The spinal anchoring system of claim 54, wherein the head of the bone screw includes a substantially spherical inferior surface that is adapted to sit within a complementary substantially spherical superior surface formed around the central opening of the staple.
56. The spinal anchoring system of claim 54, wherein the head of the bone screw is adapted to extend into the pathway of the staple body.
57. A spinal anchoring system, comprising:
a flexible tether having a cross-sectional width that is greater than a cross-sectional height; and a spinal anchoring device adapted to engage bone and having first and second components defining a pathway extending therebetween for receiving the flexible tether such that the tether is maintained in a substantially fixed position.
58. The spinal anchoring system of claim 57, wherein the first component comprises a staple having bone-penetrating members formed thereon, and the second component comprises a locking assembly that is adapted to mate to the staple to engage the tether therebetween.
59. The spinal anchoring system of claim 58, further comprising a fastening element adapted to mate the staple to bone.
60. The spinal anchoring system of claim 59, wherein the staple includes a central opening formed therethrough for receiving the fastening element such that a proximal end of the fastening element is disposed within the pathway.
61. The spinal anchoring system of claim 58, wherein the locking assembly comprises a locking nut adapted to engage the staple and a washer adapted to be positioned between the locking nut and the staple.
62. The spinal anchoring system of claim 61, wherein the washer and the locking nut are adapted to mate to one another.
63. The spinal anchoring system of claim 58, wherein the staple includes opposed arms and the pathway extends between the opposed arms, and wherein the locking assembly includes an outer portion adapted to be positioned around the opposed arms and a strut extending between the outer portion and adapted to be positioned between the opposed arms.
64. A spinal anchoring system, comprising:
a substantially planar elongate flexible tether; and a spinal anchoring device adapted to mate to bone, the spinal anchoring device having a non-linear pathway formed therethrough for receiving the tether, the spinal anchoring device being adapted to maintain the tether in a substantially fixed position.
65. The spinal anchoring system of claim 64, wherein the spinal anchoring device comprises a staple adapted to penetrate bone, a fastening element adapted to be received within an opening formed in the staple for mating the staple to bone, and a locking mechanism adapted to engage the staple and the tether.
66. The spinal anchoring system of claim 64, wherein the non-linear pathway comprises a tortuous pathway.
67. A tool for implanting a spinal anchoring device, comprising:
an elongate shaft having proximal and distal ends with an inner lumen extending therebetween, the distal end including opposed deflectable members separated by an elongate slot, the opposed deflectable members including a substantially cylindrical portion having a recess formed in a distal surface thereof.
68. The tool of claim 68, wherein the recess is substantially rectangular.
69. The tool of claim 68, wherein the recess extends between the opposed deflectable members such that it separates a distal-most portion of the opposed deflectable members.
70. The tool of claim 68, further comprising a handle formed on the proximal end of the elongate shaft.
71. An inserter system, comprising:
a fastener inserter tool having an elongate shaft with a substantially cylindrical member formed on the distal end thereof and including opposed arms;
a wrench having a hollow elongate shaft that is adapted to be slidably disposed over the fastener inserter tool, and having a distal end with a socket member formed thereon and adapted to receive a locking element.
72. The inserter system of claim 71, wherein the socket member of the wrench includes a hexagonal socket formed therein.
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