CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority benefit to U.S. Provisional Patent

Application No. 62/976,596, filed February 14, 2020, the entirety of which is hereby incorporated by reference herein.

Field

[0002] Some embodiments described herein relate generally to systems and methods for performing spinal fusion and, in particular, to bone ties and bone tie inserters.

Description of the Related Art

[0003] Traumatic, inflammatory, and degenerative disorders of the spine can lead to severe pain and loss of mobility. According to some studies, back and spinal musculoskeletal impairments are the leading causes of lost work productivity in the United States. Pain as a result of some type of spinal impairment may have its source in a variety of pathologies or clinical conditions.

[0004] One source for back and spine pain is related to degeneration of the facets of the spine or facet arthritis. Bony contact or grinding of degenerated facet joint surfaces may play a role in some pain syndromes. While many technological advances have focused on the spinal disc and artificial replacement or repair of the disc, little advancement in facet repair has been made. Facet joint and disc degeneration frequently occur together. Thus, there is a need to address the clinical concerns raised by degenerative facet joints.

[0005] The current standard of care to address the degenerative problems with the facet joints is to fuse the two adjacent vertebrae together. By performing this surgical procedure, the relative motion between the two adjacent vertebrae is stopped, thus stopping motion of the facets and any potential pain generated as a result thereof. This surgical procedure has a high rate of morbidity and can potentially lead to further clinical complications such as adjacent segment disorders. This procedure is also not reversible. Therefore, if the patient has an unsatisfactory result, they may be subject to additional surgical fusion procedures. [0006] Another source for back and spine pain is related to imbalances, malalignments, deficiencies, or deformities of the spine. The current standard of care to address these types of problems is to use hardware such as rods and screws to achieve correction or improvement of the condition.

SUMMARY

[0007] Devices and methods are disclosed for treating the vertebral column. In some embodiments, a bone tie for securing or fusing facets is provided. In some embodiments, a bone tie inserter is provided. In some embodiments, a method of use to treat the spine is provided.

[0008] In some embodiments, a bone tie for treating the spine is provided. The bone tie can include a proximal end and a distal end. The bone tie can include a head section comprising a rounded head. The bone tie can include a neck section extending proximally from the head section.

[0009] In some embodiments, the bone tie can include a body section extending proximally from the neck section, wherein the body section comprises one or more gears. In some embodiments, the bone tie can include a fastener section, wherein the fastener section comprises a ratchet. In some embodiments, the bone tie can include a body section extending proximally from the neck section, wherein the body section comprises a groove. In some embodiments, the head section comprises a flange. In some embodiments, the head section comprises a radiopaque marker.

[0010] In some embodiments, a bone tie inserter for placing a bone tie for treating the spine is provided. The bone tie inserter can include a bone tie advancer. The bone tie advancer can include a shaft. The bone tie advancer can include an advancer portion comprising a curved surface configured to guide a rounded head of a bone tie. The bone tie inserter can include a bone tie retriever. The bone tie retriever can include a shaft. The bone tie retriever can include a retriever portion configured to receive the rounded head. In some embodiments, the rounded head of the bone tie is configured to pivot and/or rotate within the retriever portion.

[0011] In some embodiments, the bone tie inserter can include the bone tie. In some embodiments, the advancer portion comprises a curve. In some embodiments, the retriever portion comprises a ledge. In some embodiments, the retriever portion comprises a channel. In some embodiments, the retriever portion is configured to receive the rounded head of a bone tie. In some embodiments, the advancer portion comprises a channel configured to receive a neck section extending proximally from the rounded head.

[0012] In some embodiments, a method of treating bone portions is provided. The method can include forming a lumen in a first bone portion. The method can include forming a lumen in a second bone portion. The method can include advancing a rounded head of a bone tie with a bone tie advancer through the lumen of the first bone portion and into the lumen of the second bone portion. In some embodiments, the bone tie advancer is removably coupled to the rounded head or a neck section extending from the rounded head. The method can include advancing the rounded head of the bone tie into a retriever portion of a bone tie retriever. In some embodiments, the retriever portion comprises a channel to receive the rounded head. The method can include withdrawing the bone tie retriever from the second bone portion, wherein the bone tie is configured to pivot and/or rotate as the bone tie retriever is withdrawn.

[0013] In some embodiments, the bone tie advancer comprises a channel to receive the neck section of the bone tie. In some embodiments, the bone tie advancer comprises a curve. In some embodiments, the bone tie advancer comprises a rounded section to abut the rounded head of the bone tie. In some embodiments, the bone tie retriever comprises an opening, wherein the neck section pivots, or pivots and rotates, from extending from the channel to extending through the opening. In some embodiments, the bone tie retriever comprises one or more retention features configured to retain the bone tie. In some embodiments, the bone tie retriever comprises a ledge. In some embodiments, the ledge facilitates pivoting and/or rotating of the rounded head of the bone tie.

[0014] In some embodiments, a method of treating vertebrae is provided. The method can include positioning a bone tie around a transverse process of a first vertebra. The method can include positioning the bone tie around a transverse process of a second vertebra. The method can include tightening the bone tie, wherein the bone tie is configured to correct or improve the condition of a coronal plane deformity.

[0015] In some embodiments, the bone tie comprises a fastener section comprising a ratchet, wherein the bone tie comprises one or more gears configured to engage the ratchet. In some embodiments, the bone tie comprises a rounded head configured to be guided around the transverse processes. In some embodiments, tightening the bone tie comprises applying a torque to the vertebrae. In some embodiments, the coronal plane deformity is lateral scoliosis.

[0016] In some embodiments, a method of treating vertebrae is provided. The method can include positioning a bone tie around a spinous process of a first vertebra. The method can include positioning the bone tie around a transverse process of a second vertebra. The method can include tightening the bone tie, wherein the bone tie is configured to achieve rotational correction or rotational improvement.

[0017] In some embodiments, the transverse process is to the right of the spinous process. In some embodiments, the transverse process is to the left of the spinous process. In some embodiments, the first vertebra is a superior vertebra and the second vertebra is an inferior vertebra. In some embodiments, the first vertebra is an inferior vertebra and the second vertebra is a superior vertebra. In some embodiments, the method can include positioning a second bone tie around the spinous process of the first vertebra, positioning the second bone tie around a second transverse process of the second vertebra, and tightening the second bone tie, wherein the bone tie is configured to achieve rotational correction or rotational improvement. In some embodiments, the transverse process is to the right of the spinous process and the second transverse process is to the left of the spinous process.

[0018] In some embodiments, a method of treating vertebrae is provided. The method can include positioning a bone tie around a lamina of a first vertebra. The method can include positioning a bone tie around a lamina of a second vertebra. The method can include tightening the bone tie, wherein the bone tie is configured to correct or improve the condition of a sagittal plane deformity.

[0019] In some embodiments, the sagittal plane deformity is deficient lordosis. In some embodiments, the bone tie is tensioned to set the sagittal correction or improvement.

[0020] In some embodiments, a method of treating vertebrae is provided. The method can include forming a straight or linear lumen through a first vertebra and a second vertebra. In some embodiments, the lumen is through the lamina or articular process of the second vertebra. The method can include advancing a bone tie into the lumen. The method can include tightening the bone tie. [0021] In some embodiments, the lumen is through the vertebral body of the first vertebra. In some embodiments, the lumen is through the pedicle of the first vertebra. In some embodiments, the bone tie is configured to facilitate fusion. In some embodiments, the method can include inserting an implant between a portion of the first vertebra and the second vertebra.

BRIEF DESCRIPTION OF THE DRAWINGS

[0022] The structure and method of use will be better understood with the following detailed description of embodiments, along with the accompanying illustrations, in which:

[0023] Figure 1 is a perspective front view of an embodiment of a bone tie.

[0024] Figure 2 is a perspective back view of the bone tie of Figure 1.

[0025] Figure 3 is a perspective view of a proximal portion of the bone tie of

Figure 1.

[0026] Figure 4 is a perspective view of a distal portion of the bone tie of Figure

1.

[0027] Figure 5 is an enlarged perspective view of a distal portion of the bone tie of Figure 1.

[0028] Figure 6 is a perspective front view of an embodiment of a bone tie advancer.

[0029] Figure 7 is a perspective front view of a distal portion of the bone tie advancer of Figure 6.

[0030] Figure 8 is a perspective back view of a distal portion of the bone tie advancer of Figure 6.

[0031] Figure 9 is a perspective front view of an embodiment of a bone tie retriever.

[0032] Figure 10 is a perspective front view of a distal portion of the bone tie retriever of Figure 9.

[0033] Figure 11 is a front view of a distal portion of the bone tie retriever of Figure 9. [0034] Figure 12 is a cross-sectional view of the distal portion of the bone tie retriever of Figure 9.

[0035] Figure 13 is a cross-sectional view of the distal portion of the bone tie retriever of Figure 9.

[0036] Figure 14 is a view of the bone tie of Figure 1, the bone tie advancer of Figure 6, and the bone tie retriever of Figure 9 within the vertebrae.

[0037] Figure 15 is an enlarged view of Figure 14.

[0038] Figure 16 is a cross-sectional view of the bone tie of Figure 1 and the bone tie retriever of Figure 9 within the vertebrae.

[0039] Figure 17 is a side view of the bone tie of Figure 1, the bone tie advancer of Figure 6, and the bone tie retriever of Figure 9.

[0040] Figure 18 is a perspective view of the bone tie of Figure 1, the bone tie advancer of Figure 6, and the bone tie retriever of Figure 9.

[0041] Figure 19 is a perspective view of the bone tie of Figure 1 and the bone tie retriever of Figure 9.

[0042] Figure 20 is a perspective view of the bone tie of Figure 1 and the bone tie retriever of Figure 9.

[0043] Figure 21 is a distal view of the bone tie of Figure 1 and the bone tie retriever of Figure 9.

[0044] Figure 22 is a flow chart for a method of using the bone tie.

[0045] Figure 23 is a view of the bone tie around the transverse processes of adjacent vertebrae.

[0046] Figure 24 is a view of the spine with a coronal plane deformity.

[0047] Figure 25 is a view of the bone tie positioned to correct a coronal plane deformity.

[0048] Figure 26 is a flow chart for a method of using the bone tie.

[0049] Figure 27 is a view of the bone tie around the spinous process of a first vertebra and around the transverse process of a second adjacent vertebra.

[0050] Figure 28 is a view of the spine with a rotational deformity.

[0051] Figure 29 is a view of the bone tie positioned to correct a rotational deformity. [0052] Figure 30 is a flow chart for a method of using the bone tie.

[0053] Figure 31 is a view of the bone tie around the lamina of adjacent vertebrae.

[0054] Figure 32 is a view of the spine with a sagittal plane deformity.

[0055] Figure 33 is a view of the bone tie positioned to correct a sagittal plane deformity.

[0056] Figure 34 is a flow chart for a method of using the bone tie.

[0057] Figure 35 is a view of the bone tie through the pedicle of a first vertebra and the lamina of a second vertebra.

[0058] Figure 36 is a view of the spine with a lumen being formed through the pedicle of a first vertebra and the lamina of a second vertebra.

[0059] Figure 37 is a view of the bone tie positioned through the lumen.

[0060] Figure 38 is another view of the bone tie positioned through the lumen.

DETAILED DESCRIPTION

[0061] Although certain preferred embodiments and examples are disclosed below, it will be understood by those in the art that the disclosure extends beyond the specifically disclosed embodiments and/or uses of the invention and obvious modifications and equivalents thereof. Thus, it is intended that the scope should not be limited by the particular disclosed embodiments described below.

[0062] The systems and methods described herein relate to embodiments of bone ties, embodiments of bone tie inserters, and methods of use. The bone tie inserter can facilitate insertion of a bone tie, as described herein. The bone tie can be inserted within a bone lumen, such as a bone lumen between adjacent vertebrae. The bone tie can be advanced by a bone tie advancer. The bone tie can be received by a bone tie retriever. In some embodiments, the bone tie pivots and/or rotates as the bone tie is withdrawn from the bone lumen between adjacent vertebrae.

[0063] The methods can include wrapping the bone tie around transverse processes of adjacent vertebrae to correct coronal plane deformity. The methods can include wrapping the bone tie around the spinous process of one vertebra and around the transverse process of a second adjacent vertebra to achieve rotational correction. The methods can include wrapping the bone tie around the lamina of adjacent vertebrae to achieve sagittal correction. The methods can include applying tension to the bone tie to set the sagittal correction. The methods can include passing the bone tie through a lumen in a vertebral body or a pedicle of the inferior vertebra and the lamina or articular process of the superior vertebra.

1. Anatomy of the Spine

[0064] The vertebral column comprises a series of alternating vertebrae and fibrous discs that provide axial support and movement to the upper portions of the body. The vertebral column typically comprises thirty-three vertebrae, with seven cervical (C1-C7), twelve thoracic (T1-T12), five lumbar (L1-L5), five fused sacral (S1-S5) and four fused coccygeal vertebrae. Each typical thoracic vertebra includes an anterior body with a posterior arch. The posterior arch comprises two pedicles and two laminae that join posteriorly to form a spinous process. Projecting from each side of the posterior arch is a transverse, superior and inferior articular process. The facets of the superior and inferior articular processes form facet joints with the articular processes of the adjacent vertebrae. The facet joints are true synovial joints with cartilaginous surfaces and a joint capsule.

[0065] The orientation of the facet joints vary, depending on the level of the vertebral column. In the Cl and C2 vertebrae, the facet joints are parallel to the transverse plane. In the C3 to C7 vertebrae, the facets are oriented at a 45 degree angle to the transverse plane and parallel to the frontal plane, respectively. This orientation allows the facet joints of the cervical vertebrae to flex, extend, lateral flex and rotate. At a 45 degree angle in the transverse plane, the facet joints of the cervical spine can guide, but do not limit, the movement of the cervical vertebrae. For the thoracic vertebrae, the facets are oriented at a 60 degree angle to the transverse plane and a 20 degree angle to the frontal plane, respectively. This orientation is capable of providing lateral flexion and rotation, but only limited flexion and extension. For the lumbar region, the facet joints are oriented at 90 degree angles to the transverse plane and a 45 degree angle to the frontal plane, respectively. The lumbar vertebrae are capable of flexion, extension and lateral flexion, but little, if any, rotation because of the 90 degree orientation of the facet joints in the transverse plane. The actual range of motion along the vertebral column can vary considerably with each individual vertebra. Vertebrae VI and V2, as used herein, can refer to any vertebrae within the vertebral column of a patient. In some embodiments, VI is superior to V2. In some embodiments, V2 is superior to VI. In some embodiments, VI is adjacent to V2. In some embodiments, VI and V2 are separated by one or more additional vertebrae.

[0066] In addition to guiding movement of the vertebrae, the facet joints also contribute to the load-bearing ability of the vertebral column. One study by King et al. Mechanism of Spinal Injury Due to Caudocephalad Acceleration, Orthop. Clin. North Am., 6:19 1975, found facet joint load-bearing as high as 30% in some positions of the vertebral column. The facet joints may also play a role in resisting shear stresses between the vertebrae. Over time, these forces acting on the facet joints can cause degeneration and arthritis.

2. Bone Tie

[0067] FIGS. 1-5 depict views of an embodiment of a bone tie 100. Figure 1 illustrates a perspective front view. Figure 2 illustrates a perspective back view. Figure 3 illustrates a perspective view of a proximal portion of the bone tie 100. Figure 4 illustrates a perspective view of a distal portion of the bone tie 100. Figure 5 illustrates an enlarged perspective view of a distal portion of the bone tie 100.

[0068] The bone tie 100 can be a generally elongate member. The bone tie 100 can comprise a proximal end 102 and a distal end 104. The bone tie 100 can include a length between the proximal end 102 and the distal end 104. The proximal end 102 can be configured to be near the hands of the user when the user is manipulating the bone tie inserter as described herein. The distal end 104 can be configured to be inserted into a bone lumen as described herein. The distal end 104 can be configured to be the first portion of the bone tie 100 that is inserted in the lumen. The distal end 104 can be the leading end of the bone tie 100. In some methods of use, the proximal end 102 extends away from the vertebrae during insertion of the bone tie 100. In some methods of use, the proximal end 102 is held by the user. In some methods of use, the proximal end 102 is unconstrained during insertion of the bone tie 100. In some methods of use, only a portion of the bone tie 100 near the distal end 104 is grasped and manipulated by the bone tie inserter as described herein. In some methods

-Si- of use, a portion of the bone tie 100 near the proximal end 102 is retained along the bone tie inserter.

[0069] The bone tie 100 can include one or more sections along the length of the bone tie 100. The sections can have a different shape, configuration, or function than an adjacent section of the bone tie 100. In some embodiments, one or more non-adjacent sections can have the same shape, configuration, or function as another section of the bone tie 100. In some embodiments, one or more additional sections are provided. In some embodiments, one or more of the sections provided herein are omitted.

[0070] The bone tie 100 can include a fastener section 106. The fastener section 106 can be located at or near the proximal end 102. The fastener section 106 can include any mechanism configured to secure the fastener section 106 to another section of the bone tie 100. The fastener section 106 can include a mechanism that allows the bone tie 100 to be secured in a single direction of travel such as a ratchet. The fastener section 106 can include a mechanism that allows the bone tie 100 to be secured in two directions of travel such as a pair of gears.

[0071] The bone tie 100 can include a first section 108. The first section 108 can be closer to the proximal end 102 than the distal end 104. The first section 108 can have a first cross-sectional shape. The first section 108 can extend distally from the fastener section 106. The bone tie 100 can include a second section 110. The second section 110 can be closer to the proximal end 102 than the distal end 104. The second section 110 can have a second cross-sectional shape. The second section 110 can extend distally from the first section 108. The bone tie 100 can include a third section 112. The third section 112 can be closer to the distal end 104 than the proximal end 102. The third section 112 can have a third cross-sectional shape. The third section 112 can extend distally from the second section 110.

[0072] The bone tie 100 can include a neck section 114. The neck section 114 can be closer to the distal end 104 than the proximal end 102. The neck section 114 can taper from the third section 112 toward the distal end 104. The neck section 114 can extend distally from the third section 112. The neck section 114 can facilitate manipulation of the distal portion of the bone tie 100 by the bone tie inserter, as described herein. The neck section 114 can be shaped to interface with the bone tie inserter. The neck section 114 can be shaped to form a mechanical interfit or coupling as described herein. [0073] The bone tie 100 can include a head section 116. The head section 116 can be located at or near the distal end 104. The neck section 114 can taper toward the head section 116. The head section 116 can extend distally from the neck section 114. The head section 116 can facilitate manipulation of the distal portion of the bone tie 100 by the bone tie inserter, as described herein. The head section 116 can be shaped to be grasped or cupped by the bone tie inserter. The head section 116 can be shaped to pivot and/or rotate relative to the bone tie inserter.

[0074] Figure 2 is a perspective back view of the bone tie 100. The bone tie 100 can have a smooth surface along the first section 108, the second section 110, and the third section 112. The bone tie 100 can have a continuous surface along the first section 108, the second section 110, and the third section 112.

[0075] Figure 3 illustrates a perspective view of a proximal portion of the bone tie 100. The bone tie can include the proximal end 102, the fastener section 106, first section 108, and the second section 110.

[0076] The fastener section 106 can include a lumen 118. The lumen 118 can be oriented perpendicular to a longitudinal axis 150 of the bone tie 100. The bone tie 100 can include a ratchet 122 disposed within the lumen 118. The ratchet 122 is configured to deflect to allow one or gears to travel through the lumen 118 in one direction, but limit or prevent travel in another direction. The fastener section 106 can form an enlarged end of the bone tie 100. The fastener section 106 can be generally rectangular or cuboid. The fastener section 106 can have a width larger than the first section 108. The fastener section 106 can have a thickness larger than the first section 108. The fastener section 106 can include rounded edges or comers. The fastener section 106 can have any shape to accommodate the ratchet 122 disposed therewithin. The fastener section 106 can have any shape to accommodate any fastener mechanism described herein.

[0077] The first section 108 can have the first cross-sectional shape. The first cross-sectional shape can be generally rectangular or cuboid. The first cross-sectional shape can have rounded edges or comers. The first section 108 can include a width and a thickness. The first section 108 can include a groove 124. The groove 124 can reduce the thickness of the first section 108. The groove 124 can taper from the fastener section 106. The groove 124 can taper to the second section 110. [0078] The second section 110 can have the second cross-sectional shape. The second cross-sectional shape can be generally rectangular or cuboid. The second cross- sectional shape can have rounded edges or comers. The second section 110 can include a groove 126. The groove 124 of the first section 108 can extend to the groove 126 of the second section 110. The second section 110 can include one or more gears 128. The gears 128 can be ramped surfaces. The gears 128 can form a rack. The gears 128 can be wedge surfaces. The gears 128 can be inclined upward toward the proximal end 102. The gears 128 can be inclined downward toward the distal end 104. The gears 128 can be disposed within the groove 126 of the second section 110. The first section 108 and the second section 110 can include a constant width. The first section 108 and the second section 110 can include a constant thickness. The first section 108 and the second section 110 can include a constant thickness measured along the edges of the first section 108 and the second section 110.

[0079] Figure 4 illustrates a perspective view of a distal portion of the bone tie 100. The bone tie can include the second section 110, the third section 112, the neck section 114, the head section 116, and the distal end 104.

[0080] The third section 112 can have a third cross-sectional shape. The third cross-sectional shape can be generally rectangular or cuboid. The third cross-sectional shape can have rounded edges or corners. In some embodiments, the first cross-sectional shape and the third cross-sectional shape are the same or similar. The third section 112 can include a width and a thickness. The third section 112 can include a groove 130. The groove 130 can reduce the thickness of the third section 112. The groove 130 can taper from the second section 110. The groove 130 can taper to the neck section 114.

[0081] Two or more of the first section 108, the second section 110, and the third section 112 can include a constant width. Two or more of the first section 108, the second section 110, and the third section 112 can include a constant thickness. Two or more of the first section 108, the second section 110, and the third section 112 can include a constant thickness measured along the edges of the respective sections. The bone tie 100 can have a constant width along a substantial portion of the length. The bone tie 100 can have a constant thickness along a substantial portion of the length.

[0082] Figure 5 illustrates an enlarged view of the distal portion of the bone tie 100. The bone tie 100 can include the neck section 114. The neck section 114 tapers along the width. The neck section 114 tapers from a larger width near the third section 112 to a smaller width near the head section 116. The neck section 114 can include a groove 132. The groove 132 can reduce the thickness of the neck section 114. The groove 132 of the neck section 114 can extend from the groove 130 of the third section 112.

[0083] The neck section 114 can lie in a plane along the longitudinal axis 150 of the bone tie 100 or the neck section 114 can include a curve 134. The curve 134 can have a constant radius of curvature. Two or more of the first section 108, the second section 110, and the third section 112 can be planar. The bone tie 100 can lie in a plane along a substantial portion of the length. The curve 134 can extend from the plane of the bone tie. The curve 134 can extend upward from the grooves 124, 126, 130, 132 of the bone tie 100. The curve 134 can extend upward from the gears 128 of the second section 110. The curve 134 can extend away from the longitudinal axis 150 of the bone tie 100.

[0084] The bone tie 100 can include the head section 116. The head section 116 can include a head 136. The head 136 can be rounded. The head 136 can be spherical. The head 136 can extend to the distal end 104 of the bone tie 100. The head section 116 can include a flange 138. The flange 138 can be positioned on the head 136. The flange 138 can be a rounded bill that extends from the head 136. The flange 138 can include a first tapered surface 140 and a second tapered surface 142. The first tapered surface 140 and the second tapered surface 142 can have different slopes. The second tapered surface 142 can form a ledge by which the head section 116 or head 136 can be grasped. The first tapered surface 140 and the second tapered surface 142 extend to the neck section 114.

[0085] The bone tie 100 can include a marker 144. The marker 144 can facilitate visualization of the bone tie 100, or a portion thereof. In the illustrated embodiment, the head 136 can include the marker 144. The head 136 can include a bore 146. The bore 146 can extend from an edge of the head 136 inward toward or past the center of the head 136. The marker 144 can be disposed within the bore 146. The marker 144 can be a radiopaque marker. The marker 144 can be formed of a metal or other radiopaque material. The marker 144 can identify the distal end 104 of the bone tie 100. In some embodiments, the bone tie 100 comprises a non-radiopaque material. In some embodiments, one or more radiopaque markers may be embedded in or on the bone tie 100 to assist in placement or monitoring of the bone tie 100 under radiographic visualization. [0086] The bone tie 100 can be a flexible fastening band. The bone tie 100 can include the proximal end portion 102 and the distal end portion 104. In some embodiments, the head section 116 can be removed. The neck section 114 can be advanced through the lumen 118. When the neck section 114 is advanced, the ratchet 122 can extend into the groove 132. The third section 112 can be advanced through the lumen 118. When the third section 112 is advanced, the ratchet 122 can extend into the groove 130. The second section 110 can be advanced through the lumen 118. When the second section 110 is advanced, the ratchet 122 can extend into the groove 126. The ratchet 122 can engage the gears 128. The ratchet 122 can allow the second section 110 to travel through the lumen 118 in one direction, but limit travel through the lumen 118 in the opposite direction.

[0087] The bone tie 100 can be configured for altering the motion at the facet joints of the vertebral column. In some embodiments, the bone tie 100 can prevent motion of the facet joint. In some embodiments, the bone tie 100 can limit or reduce motion of the facet joint. In some embodiments, the bone tie 100 can limit motion to a range depending on the tightening of the loop of the bone tie 100. In some methods of use, the bone tie promotes fusion of the facet joints.

[0088] The bone tie 100 can be configured for altering the spacing at the facet joints of the vertebral column. In some embodiments, the bone tie 100 can reduce the spacing. In some embodiments, the bone tie 100 can maintain the anatomical spacing. The bone tie 100 can be a retaining member for anchoring a prosthesis or implant within the facet joint. In some embodiments, the bone tie 100 can pass through a central opening of the prosthesis or implant when the prosthesis or implant is inserted within the facet joint space. The bone tie 100 can be adapted for securing the location of the prosthesis or implant with respect to at least one of the articular surfaces.

[0089] The prosthesis or implant can have any shape or configuration. The prosthesis or implant can be substantially disc shaped. The first side of the prosthesis or implant can be concave, convex, or flat. The second side of the prosthesis or implant can be concave, convex, or flat. The shape can be determined based on a shape of a bone portion that the first side and the second side are configured to contact. In some embodiments, the prosthesis or implant fits entirely within the joint disc space. The prosthesis or implant can include any biocompatible material, e.g., stainless steel, titanium, PEEK, nylon, etc. [0090] The bone tie 100 can have a width of 0.5 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, 4 mm, or any range of the foregoing values. The width of the bone tie 100 can vary along the length of the bone tie 100. The bone tie 100 can have a thickness of 0.5 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, 4 mm, or any range of the foregoing values. The thickness of the bone tie 100 can vary along the length of the bone tie 100. The bone tie 100 can have a length of 10 mm, 20 mm, 30 mm, 40 mm, 50 mm, 60 mm, 70 mm, 80 mm, 90 mm, 100 mm, 110 mm, 120 mm, 130 mm, 140 mm, 150 mm, 160 mm, 170 mm, 180 mm, 190 mm, 200 mm, or any range of the foregoing values. For example, the bone tie 100 can have a length of 175 mm. In some embodiments, the second section 110 or the gears 128 can have a length of 5 mm, 10 mm, 15 mm, 20 mm, 25 mm, 30 mm, 35 mm, 40 mm, 45 mm, 50 mm, 60 mm, 65 mm, 70 mm, 75 mm, 80 mm, or any range of the foregoing values.

[0091] The bone tie 100 can be manufactured from any of a variety of materials known in the art, including but not limited to a polymer such as polyetheretherketone (PEEK), polyetherketoneketone (PEKK), polyethylene, fluoropolymer, hydrogel, or elastomer; a ceramic such as zirconia, alumina, or silicon nitride; a metal such as titanium, titanium alloy, cobalt chromium or stainless steel; or any combination of the materials described herein. The bone tie 100 can include any biocompatible material, e.g., stainless steel, titanium, PEEK, nylon, etc. In some embodiments, the bone tie 100 comprises at least two materials. The bone tie 100 can include a reinforcement piece disposed within the bone tie 100. By selecting a particular configuration and the one or more materials for the bone tie 100, the bone tie 100 can be designed to have the desired flexibility and resiliency.

[0092] In some embodiments, the bone tie 100 can form a unitary structure. The bone tie 100 can be integrally formed from the proximal end 102 to the distal end 104. In some embodiments, the bone tie 100 can include one or more unitarily formed sections along the length of the bone tie 100. One or more of the fastener section 106, the first section 108, the second section 110, the third section 112, the neck section 114, and the head section 116 can be unitarily formed. In some embodiments, the bone tie 100 can include one or more separately formed sections along the length of the bone tie 100. One or more of the fastener section 106, the first section 108, the second section 110, the third section 112, the neck section 114, and the head section 116 can be separately formed. In some embodiments, the marker 144 is separately formed. In some embodiments, the bone tie 100 can form a monolithic structure. The bone tie 100 can be monolithically formed or separately formed. The bone tie 100 can be formed of the same or similar material. The sections of the bone tie 100 can be formed of the same or similar construction. In some embodiments, the bone tie 100 is formed from an injection molding process.

[0093] In some embodiments, the shape of the first section 108, the second section 110, and/or the third section 112 can be determined based on the shape of an artificial lumen formed through an articular process of a vertebra. In some embodiments, the shape of the artificial lumen is cylindrical, the shape of the head 136 can be rounded or spherical to allow the head 136 to slideably advance through the artificial lumen. In some embodiments, the shape of the artificial lumen has a cross-sectional dimension or diameter greater than the cross-sectional dimension or diameter of the head 136 to allow the head 136 to slideably advance through the artificial lumen. The head 136 can have a larger cross-sectional dimension or diameter than the first section 108, the second section 110, the third section 112, and the neck section 114 to allow the first section 108, the second section 110, the third section 112, and the neck section 114 to easily slide within the artificial lumen.

[0094] In some embodiments, the characteristic of the bone tie 100 can vary along the length of the bone tie 100. The characteristics can vary between one or more of the fastener section 106, the first section 108, the second section 110, the third section 112, the neck section 114, and the head section 116. In some embodiments, each section has different characteristics. In some embodiments, the flexibility of the bone tie 100 varies along the length of the bone tie 100. In some embodiments, the torsional strength of the bone tie 100 varies along the length of the bone tie 100. In some embodiments, the resistance to deformation or elongation of the bone tie 100 varies along the length of the bone tie 100. In some embodiments, the characteristic of the bone tie 100 vary based, at least in part, on the shape of the various sections.

[0095] In some embodiments, the characteristic of the bone tie 100 vary based on the material of the various sections. In some embodiments, the characteristic of the bone tie 100 vary along the length based, at least in part, on a reinforcement piece. The reinforcement piece can be separately formed from or integrally formed with the bone tie 100. The reinforcement piece can comprise a different material or material property. In some embodiments, the reinforcement piece is disposed within a section of the bone tie 100. The reinforcement piece can be disposed within the fastener section 106, the first section 108, the second section 110, the third section 112, the neck section 114, the head section 116, any combination of the foregoing, or disposed only within one or more sections of the foregoing. The reinforcement piece can increase the strength of a section of the bone tie 100. In some embodiments, the reinforcement piece has a substantially uniform shape. The shape, material, or other characteristics of the reinforcement piece can be selected depending on the desired bending and/or torsion characteristics of the material chosen. The reinforcement piece can increase or decrease bending strength. The reinforcement piece can increase or decrease torsion strength. Any shape, material, or other property of the reinforcement piece can be selected to achieve the desired bending and/or torsion strength of the bone tie 100. In some embodiments, the reinforcement piece is radiopaque. In some embodiments, the reinforcement piece is radiolucent.

3. Bone Tie Advancer

[0096] FIGS. 6-8 depict views of an embodiment of a bone tie advancer 200. Figure 6 illustrates a perspective front view. Figure 7 illustrates a perspective front view of a distal portion. Figure 8 illustrates a perspective back view of a distal portion. The bone tie advancer 200 can include a proximal end 202 and a distal end 204.

[0097] The bone tie advancer 200 can include a proximal handle 206. The proximal handle 206 can be any shape configured to be gripped by the user. The proximal handle 206 can include one or more grooves designed to accommodate the fingers of the user. The proximal handle 206 can be shaped for right-handed use, left-handed use, or ambidextrous use. The proximal handle 206 can include an impact cap 208. The impact cap 208 can have a flat proximal end to allow a force to be applied.

[0098] The bone tie advancer 200 can include a shaft 210. The shaft 210 can extend distally from the proximal handle 206. The shaft 210 can include an upper portion 212. The upper portion 212 can be cylindrical. The upper portion 212 can have one or more cylindrical sections of varying diameters. The upper portion 212 can include a stepped surface. The upper portion 212 can have any cross-sectional shape including round, square, rectangular, polygonal, oval, or any other shape. The upper portion 212 can be an elongate member. The upper portion 212 can lie along a longitudinal axis 250. [0099] The shaft 210 can include a tapered portion 214. The tapered portion 214 can be distal to the upper portion 212 of the shaft 210. The tapered portion 214 can have a narrower cross-section toward the distal end 204. The tapered portion 214 can be frusto- conical. The tapered portion 214 can have a reduced cross-section relative to the upper portion 212 of the shaft 210 to enable the shaft 210 to be positioned relative to the patient’s anatomy. The tapered portion 214 can lie along the longitudinal axis 250. The tapered portion 214 can taper inward relative to the longitudinal axis 250. The upper portion 212 and the tapered portion 214 can be coaxial.

[0100] The shaft 210 can include a curved portion 216. The curved portion 216 can be distal to the tapered portion 214 of the shaft 210. The curved portion 216 can have a substantially constant width. The curved portion 216 can have a reduced cross-section relative to the upper portion 212 of the shaft 210 to enable the shaft 210 to be positioned relative to the patient’s anatomy. The curved portion 216 can be shaped to be inserted within the artificial lumen of the bone portions. The curved portion 216 can be shaped according to the lumen-forming tool that creates the lumen in the bone portions. The curved portion 216 can have a constant radius of curvature. The curved portion 216 can curve away from the longitudinal axis 250 of the upper portion 212. The curved portion 216 can extend laterally from the longitudinal axis 250 of the upper portion 212.

[0101] Figures 7 and 8 are enlarged views of the distal portion of the bone tie advancer 200. The curved portion 216 can include a rounded surface 218. The rounded surface 218 can extend distally from the tapered portion 214. The rounded surface 218 can be proximal-facing. The shaft 210 can include a planar surface 220. The planar surface 220 can be distal-facing. The planar surface 220 can form the outside curve of the curved portion 216. The rounded surface 218 can form the inside curve of the curved portion 216. The planar surface 220 can extend along at least a portion of the curved portion 216. The planar surface 220 can extend along at least a portion of the tapered portion 214.

[0102] The shaft 210 can include an advancer portion 222. The advancer portion 222 can be configured to interface with the bone tie 100. The advancer portion 222 can be located at or near the distal end 204 of the bone tie advancer 200. The advancer portion 222 can include a curved surface 224. The curved surface 224 can correspond to the curvature of the head 136. The curved surface 224 can cup the head 136. The curved surface 224 can curve around the distal-facing portion of the head 136. The curved surface 224 can allow the force of the bone tie advancer 200 to be transferred to the head 136. The curved surface 224 can allow movement of the bone tie advancer 200 to be transferred to the head 136. The curved surface 224 can form the distal end 204 of the bone tie advancer 200. The advancer portion 222 can include a tapered surface 226. The tapered surface 226 can be proximal- facing. The tapered surface 226 can allow visualization and clearance relative to the patient’s anatomy. The advancer portion 222 can include retaining arms 230. The retaining arms 230 can extend proximally from the curved surface 224 and can be separately formed from or integrally formed with the curved surface 224. The retaining arms 230 can engage the flange 138. The retaining arms 230 can engage the second tapered surface 142 of the flange 138. The retaining arms 230 can engage the neck section 114. The interior portion of the retaining arms 230 can be rounded, tapered, or any other shape corresponding to the flange 138, second tapered surface 142 and/or neck section 114. The retaining arms 230 can facilitate secure engagement of the bone tie 100 for insertion of the bone tie 100 within the artificial lumen of the bone portions.

[0103] The advancer portion 222 can include a channel 228. The channel 228 can correspond to the shape of the neck section 114 of the bone tie 100. The neck section 114 of the bone tie 100 can be disposed within the channel 228 when the curved surface 224 abuts the head 136. The channel 228 can be formed by three sides. The three sides can include rounded edges. The three sides can have any shape to accept the bone tie 100. The channel 228 can include an open side. The open side can be distal-facing. The channel 228 can surround a portion of the neck section 114 of the bone tie 100. When the neck section 114 of the bone tie 100 is disposed within the channel 228, the curved surface 224 can align and abut the head 136. The channel 228 can increase the contact between the advancer portion 222 and the bone tie 100.

4. Bone Tie Retriever

[0104] FIGS. 9-13 depict views of an embodiment of a bone tie retriever 300. Figure 9 illustrates a perspective front view. Figure 10 illustrates a perspective front view of a distal portion. Figure 11 illustrates a front view of a distal portion. Figure 12 illustrates a cross-sectional view of the distal portion. Figure 13 illustrates a cross-sectional view of the distal portion. The bone tie retriever 300 can include a proximal end 302 and a distal end 304.

[0105] The bone tie retriever 300 can include a proximal handle 306. The proximal handle 306 can be any shape configured to be gripped by the user. The proximal handle 306 can include one or more grooves designed to accommodate the fingers of the user. The proximal handle 306 can be shaped for right-handed use, left-handed use, or ambidextrous use. The proximal handle 306 can include an impact cap 308. The impact cap 308 can have a flat proximal end to allow a force to be applied. The proximal handles 206, 306 can be the same or similar. The proximal handles 206, 306 can be mirror images. In some embodiments, the proximal handle 206 can be designed for use with the right hand of the user and the proximal handle 306 can be designed for use with the left hand of the user. The proximal handles 206, 306 can be different. The proximal handles 206, 306 can include a different visual indicator to indicate the different functions of the bone tie advancer 200 and the bone tie retriever 300. In some embodiments, the proximal handles 206, 306 can be different colors or include a visual marking.

[0106] The bone tie retriever 300 can include a shaft 310. The shaft 310 can extend distally from the proximal handle 306. The shaft 310 can include an upper portion 312. The upper portion 312 can be cylindrical. The upper portion 312 can have one or more cylindrical sections of varying diameters. The upper portion 312 can include a stepped surface. The upper portion 312 can have any cross-sectional shape including round, square, rectangular, polygonal, oval, or any other shape. The upper portion 312 can be an elongate member. The upper portion 312 can lie along a longitudinal axis 350. The upper portions 212, 312 can be the same or substantially similar. The shaft 310 can include a retriever portion 314. The retriever portion 314 can be distal to the upper portion 312 of the shaft 310.

[0107] Figure 10 illustrates an enlarged view of a distal portion of the bone tie retriever 300. The retriever portion 314 can be shaped to receive the head 136 of the bone tie 100. The retriever portion 314 can include a channel 316. The channel 316 can include a rounded portion 320. The rounded portion 320 can include a curvature corresponding to the head 136 of the bone tie 100. The channel 316 can be concave along the longitudinal axis 350. [0108] The channel 316 can include a ledge 318. The ledge 318 can be flat, curved, or tapered. The ledge 318 can include a curvature that corresponds to the curvature of the head 136. The ledge 318 can be dimensioned to allow for pivotal and/or rotational movement of the head 136 within the channel 316. In some embodiments, the ledge 318 can have a curved or poly-axial surface configured to accept the head 136. In some embodiments, the ledge 318 can be concave. In some embodiments, the ledge 318 can have a concavity that corresponds to a convexity of the head 136. The concavity of the ledge 318 can allow the head 136 to pivot and/or rotate while still retaining the head 136 within the channel 316. The ledge 318 can allow the head 136, and thus the bone tie 100, to pivot 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, 90°, 100°, 110°, 120°, 130°, 140°, 150°, 160°, 170°, 180°, or any range of the foregoing values. In particular embodiments, the ledge 318 can allow the head 136, and thus the bone tie 100, to pivot 60°, 70°, 80°, 90°, or any range of the foregoing values. The ledge 318 can allow the head 136 to abut and rotate against the ledge 318.

[0109] The retriever portion 314 can include an opening 322. The opening 322 can be located at or near the distal end 304. The ledge 318 surrounds the opening 322. The ledge 318 can be shaped to allow the neck section 114 to pass through the opening 322. The ledge 318 can be shaped to prevent the head 136 from passing through the opening 322. The ledge 318 can be sized according to the corresponding bone tie 100.

[0110] The retriever portion 314 can include one or more retention features 324. In the illustrated embodiment, the retriever portion 314 includes two retention features 324. The one or more retention features 324 narrow the channel 316 near the distal end 304. The channel 316 extends through the one or more retention features 324. The one or more retention features 324 can be disposed near the ledge 318. The one or more retention features 324 can function to retain the head 136 when the head 136 is seated against the ledge 318.

[0111] In some embodiments, the channel 316 may be dimensioned to allow entry of the head 136, or the head 136 and neck section 114, in generally one particular orientation. In some embodiments, the channel 316 may be dimensioned to allow entry of the head 136, or the head 136 and neck section 114, in a range of orientations. In some embodiments, the channel 316 may be dimensioned to allow entry of the head 136 wherein the neck section 114 is generally perpendicular to the longitudinal axis 350 of the shaft 310. In some embodiments, the channel 316 may be dimensioned to allow retention of the head 136 wherein the neck section 114 is generally parallel to or coaxial with the longitudinal axis 350. In some embodiments, the channel 316 is configured to allow the neck section 114 to pass between the one or more retention features 324. In some embodiments, the retriever portion 314 is configured to allow the neck section 114 to pivot, or pivot and rotate, from extending between the one or more retention features 324 to extending into the opening 322. In some embodiments, the retriever portion 314 is configured to allow the neck section 114 to pivot, or pivot and rotate, from the opening 322 to the channel 316. In some embodiments, the channel 316 is configured to prevent or limit the head 136 from passing between the one or more retention features 324.

5. Methods of Use

[0112] Figures 14 and 15 illustrate the bone tie 100, the bone tie advancer 200, and the bone tie retriever 300 in relation to vertebrae during methods of use. Figures 14 and 15 illustrate the bone tie 100, the bone tie advancer 200, and the bone tie retriever 300. The proximal ends are visible and the distal ends are disposed within lumens in the vertebrae. Figure 15 is a close-up view of Figure 14. Figure 16 is a cross-sectional view illustrating a placement of the bone tie 100 and the bone tie retriever 300 in relation to the vertebrae.

[0113] The bone tie 100 can be configured to stabilize or fuse adjacent vertebrae. The bone tie 100 can be used to fuse a vertebra VI and vertebra V2 via the inferior articular process IAP1A of vertebra VI and the superior articular process SAP2A of vertebra V2. In some methods of use, a second bone tie 100 can be used to fuse a vertebra VI and vertebra V2 via the inferior articular process IAP1B of vertebra VI and the superior articular process SAP2B of vertebra V2. In some embodiments, vertebra VI and vertebra V2 are fused using only one of bone tie 100. In some embodiments, one bone tie 100 can be used to stabilize vertebra VI and vertebra V2 via one of the inferior articular process IAP1A of vertebra VI and the superior articular process SAP2A of vertebra V2, or, via the inferior articular process IAP1B of vertebra VI and the superior articular process SAP2B of vertebra V2. In some embodiments, two bone ties 100 can be used to stabilize vertebra VI and vertebra V2 via both of the inferior articular process IAP1A of vertebra VI and the superior articular process SAP2A of vertebra V2, and, the inferior articular process IAP1B of vertebra VI and the superior articular process SAP2B of vertebra V2. The methods described herein can be repeated for any pair of an inferior articular process and a superior articular process.

[0114] In some methods of use, a lumen is formed through the articular processes. The lumen can be formed with a lumen-forming tool, such as a drill, tissue punch, or reamer. The lumen is formed through one or more articular processes of the vertebrae to facilitate implantation of the bone tie 100. In some embodiments, at least a portion of the lumen has a curved or non-linear configuration. In some embodiments, at least a portion of the lumen has a straight or linear configuration. In some methods of use, two or more lumens are formed. A drill or other device can be used to form a lumen in superior articular process SAP of vertebra V2 and inferior articular process IAP of vertebra VI. Specifically, the drill can be used to form the lumen in a facet of superior articular process SAP of vertebra V2 and to form the lumen in a facet of inferior articular process IAP of vertebra VI. In some embodiments, one lumen-forming tool forms one or more lumens. In some embodiments, two lumen-forming tools are utilized to form two lumens.

[0115] In some methods of use, a portion of the surface of the facet of SAP and IAP can be prepared for fusion. In some methods of use, a portion of the surface of the facet can be ground, scored, roughened, or sanded, such that the surface of the facet can better adhere to any substances to aid in fusion and/or otherwise fuse more readily to an implant or prosthesis. In some methods of use, the surgical procedure can include preparing the area near and/or around the vertebra by, for example, removing all or a portion of ligaments, cartilage, and/or other tissue. In some methods of use, the area near and/or around a facet joint can be prepared by removing all or a portion of the facet joint capsule. The implant or prosthesis, if provided, can be inserted between the superior articular process SAP of vertebra V2 and inferior articular process IAP of vertebra VI.

[0116] Figure 16 illustrates a cross-sectional view of the vertebrae. The bone tie 100, the bone tie advancer 200 (not shown in Figure 16), and the bone tie retriever 300 can be located within lumens as described herein. The first lumen 400 can be curved. The first lumen 400 can extend from a first vertebra toward a second vertebra. The first lumen 400 can extend through the facet joint space. The second lumen 402 can be straight. The second lumen 402 can extend downward from a surface of the second vertebra. The second lumen 402 can extend only through the second vertebra. The second lumen 402 can intersect the first lumen 400.

[0117] The bone tie 100 can be positioned within and adjacent to the bone tie advancer 200. As the bone tie advancer 200 is moved by the user, the head section 116 and the neck section 114 is correspondingly moved. The bone tie 100 can be advanced through the first lumen 400 by the bone tie advancer 200. The bone tie 100 can be advanced through the facet joint space by the bone tie advancer 200. The bone tie 100 can be advanced through at least a portion of the second lumen 402 by the bone tie advancer 200. In some embodiments, the bone tie 100 and the bone tie advancer 200 can have a bend or curve to facilitate directing the head 136 of the bone tie 100 into the lumen 400. In some embodiments, the bone tie 100 and the bone tie advancer 200 can have a bend or curve corresponding to the curvature of the first lumen 400. The bone tie 100 and the bone tie advancer 200 can have any shape that allows the passage through the first lumen 400 and into the second lumen 402.

[0118] The bone tie 100 is advanced until the head 136 of bone tie 100 is positioned near the bone tie retriever 300. The bone tie 100 is advanced until the head 136 of bone tie 100 is inserted into the channel 316. The bone tie 100 and the bone tie advancer 200 can have any shape that allows the passage of the head 136 into the channel 316. The bone tie 100 can be advanced until the head 136 abuts the inside wall of the retriever portion 314. The bone tie 100 can be advanced until any further advancement is prevented by the retriever portion 314.

[0119] During advancement, the head 136 of the bone tie 100 can be monitored under radiographic visualization. The head 136 can include one or more markers 144. In the illustrated embodiment, the head 136 can include a bore 146 configured to receive the marker 144. The marker 144 can facilitate visualization of the head 136 because the marker 144 can be radiopaque. The marker 144 can facilitate placement of the head 136 relative to the lumens 400, 402. The marker 144 can facilitate placement of the head 136 relative to the retriever portion 314.

[0120] Figures 17-18 illustrate the bone tie 100, the bone tie advancer 200, and the bone tie retriever 300 during methods of use. Figure 17 is a side view of the bone tie 100, the bone tie advancer 200, and the bone tie retriever 300. Figure 18 is a perspective view of the bone tie 100, the bone tie advancer 200, and the bone tie retriever 300.

[0121] The bone tie 100 can be coupled to the bone tie advancer 200. Figure 17 illustrates the bone tie 100 coupled to the bone tie advancer 200. Figure 18 is an enlarged view of the distal portion. The bone tie 100 can include the neck section 114 and the head section 116. The bone tie advancer 200 can include the advancer portion 222. The advancer portion 222 can couple to the head section 116 of the bone tie 100. The advancer portion 222 can couple to the head 136 of the bone tie 100. The advancer portion 222 can include a curved surface 224 that can grasp the head 136. The advancer portion 222 can couple to the neck section 114 of the bone tie 100. The advancer portion 222 can include a channel 228 that can grasp a portion of the neck section 114. The advancer portion 222 can couple to the bone tie 100 prior to insertion of the bone tie 100, or after bone tie 100 has been inserted, into a lumen in a bone portion. The movement of the bone tie advancer 200 can cause movement of the bone tie 100.

[0122] The bone tie advancer 200 can move the head 136 of the bone tie 100 toward the bone tie retriever 300. The retriever portion 314 can include the channel 316. The channel 316 can be concave along the longitudinal axis 350 of the shaft 310. The channel 316 can be shaped to receive the head 136 of the bone tie 100. The head 136 can be inserted proximal to the one or more retention features 324. The head 136 can be inserted along the length of the channel 316. The head 136 can be inserted proximal to the ledge 318. The head 136 can be inserted proximal to the opening 322.

[0123] The head 136 enters the channel 316 when advanced by the bone tie advancer 200. The neck section 114 enters the channel 316 when advanced by the bone tie advancer 200. In some methods of use, the bone tie advancer 200 enters the channel 316. In some methods of use, the bone tie advancer 200 does not enter the channel 316.

[0124] The bone tie advancer 200 can be used to advance the bone tie 100 through the first lumen 400. The first lumen 400 can be curved. The bone tie advancer 200 can include the curved portion 216. The curved portion 216 can have the same or similar curvatures as the curved lumen 400. The curved lumen 400 can be formed in the bone to allow passage of the bone tie advancer 200. The user manipulates the proximal handle 206 to align the advancer portion 222 with the opening of the first lumen 400. The user can pivot and/or rotate and translate the bone tie advancer 200 to move the bone tie advancer 200 and the bone tie 100 through the first vertebra VI. The user can pivot and/or rotate and translate the bone tie advancer 200 to move the bone tie advancer 200 and the bone tie 100 through the facet joint space. The user can pivot and/or rotate and translate the bone tie advancer 200 to move the bone tie advancer 200 and the bone tie 100 into the second vertebra V2.

[0125] The bone tie retriever 300 can be inserted into the second lumen 402. The second lumen 402 can be generally straight. The second lumen 402 can extend distally beyond the first lumen 400. The second lumen 402 can extend to a depth to allow the channel 316 of the bone tie retriever 300 to align with the first lumen 400 when the bone tie retriever 300 is within the second lumen 402. The second lumen 402 can be any size or depth in order to accommodate the retriever portion 314 therewithin. The retriever portion 314 can be positioned within the second lumen 402 such that when the head section 116 is advanced from the first lumen 400, the head section 116 is inserted along the length of the channel 316. In some embodiments, the retriever portion 314 can be positioned within the second lumen 402 such that when the head section 116 is advanced from the first lumen 400, the head section 116, or the head section 116 and at least a portion of the neck section 114, is inserted along the length of the channel 316. The retriever portion 314 can be positioned such that the head 136 is inserted proximal to the one or more retention features 324. In some embodiments, the distal end 304 of the bone tie retriever 300 can be recessed below the first lumen 400 when the bone tie retriever 300 is received within the second lumen 402.

[0126] Figures 19-21 illustrate the bone tie 100 and the bone tie retriever 300 during methods of use. Figure 19 is a perspective view of the bone tie 100 and the bone tie retriever 300 in a first orientation. Figure 20 is a perspective view of the bone tie 100 and the bone tie retriever 300 in a second orientation. Figure 21 is a distal view of the bone tie 100 and the bone tie retriever 300 in the second orientation.

[0127] Figure 19 is a perspective view of the bone tie 100 and the bone tie retriever 300 in a first orientation. In some methods of use, the head 136 of the bone tie 100 is inserted into the bone tie retriever 300 in generally one particular orientation. In some methods of use, the neck section 114 of the bone tie 100 is perpendicular to the longitudinal axis 350 of the bone tie retriever 300 when the bone tie 100 is inserted into the bone tie retriever 300. In some methods of use, the head 136 of the bone tie 100 is inserted into the bone tie retriever 300 in a range of orientations. In some methods of use, the neck section 114 of the bone tie 100 is generally skewed to the longitudinal axis 350 of the bone tie retriever 300 when the bone tie 100 is inserted into the bone tie retriever 300. In some methods of use, the neck section 114 of the bone tie 100 can be any angle to the longitudinal axis 350 of the bone tie retriever 300 including 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, 90°, 100°, 110°, 120°, 130°, 140°, 150°, 160°, 170°, 180°, or any range of the foregoing values. In particular methods of use, the neck section 114 of the bone tie 100 can be any angle to the longitudinal axis 350 of the bone tie retriever 300 including 60°, 70°, 80°, 90°, 100°, 110°, 120°, or any range of the foregoing values.

[0128] Figure 20 is a perspective view of the bone tie 100 and the bone tie retriever 300 in a second orientation. Figure 21 is a distal view of the bone tie 100 and the bone tie retriever 300 in the second orientation. In some methods of use, the neck section 114 of the bone tie 100 is generally aligned with the longitudinal axis 350 of the bone tie retriever 300 when the bone tie 100 is pivoted. In some methods of use, the neck section 114 of the bone tie 100 can be any angle to the longitudinal axis 350 of the bone tie retriever 300 including 0°, 5°, 10°, 15°, 20°, 25°, 30°, 35°, 40°, 45°, 50°, 55°, 60°, or any range of the foregoing values.

[0129] In some methods of use, the head 136 of the bone tie 100 is configured to slide within the channel 316. In some methods of use, the head 136 slides distally within the channel 316. The channel 316 can include the ledge 318. The ledge 318 can include a curvature that corresponds to the curvature of the head 136. The ledge 318 can be dimensioned to allow for pivotal and/or rotational movement of the head 136 within the channel 316. In some embodiments, the ledge 318 can have a curved or poly-axial surface configured to accept the head 136. In some embodiments, the ledge 318 can be concave. In some embodiments, the ledge 318 can have a concavity that corresponds to a convexity of the head 136. The ledge 318 can allow the head 136 to abut and rotate against the ledge 318. The one or more retention features 324 can allow the head 136 to be seated and rotate within the distal portion of the bone tie retriever 300. As the head 136 slides distally, the neck section 114 slides between the one or more retention features 324.

[0130] The concavity of the ledge 318 can allow the head 136 to pivot and/or rotate while still retaining the head 136 within the channel 316. The ledge 318 can allow the head 136, and thus the bone tie 100, to pivot and/or rotate. In some methods of use, the bone tie 100 can pivot approximately 90°. In some methods of use, the bone tie 100 pivots 30°, 40°, 50°, 60°, 70°, 80°, 90°, 100°, 110°, 120°, 130°, 140°, 150°, or any range of the foregoing values.

[0131] In some embodiments, the channel 316 may be dimensioned to allow retention of the head 136 when the neck section 114 is generally parallel or coaxial to the longitudinal axis 350 of the shaft 310. In some embodiments, the channel 316 is configured to allow the neck section 114 to pass between the one or more retention features 324. In some embodiments, the retriever portion 314 is configured to allow the neck section 114 to pivot, or pivot and rotate, from extending between the one or more retention features 324 into the opening 322. The opening 322 can be located at or near the distal end 304. The ledge 318 surrounds the opening 322. The ledge 318 can be shaped to support the head 136 when the bone tie 100 is pivoted and/or rotated. The ledge 318 and/or the one or more retention features 324 can be shaped to constrain the head 136 when the bone tie 100 is pivoted and/or rotated.

[0132] The bone tie 100 can be retracted by the bone tie retriever 300. The bone tie retriever 300 can be pulled distally from the second lumen 402. The neck section 114 can pivot and/or rotate to extend distally from the bone tie retriever 300 as the bone tie 100 is pulled proximally. The one or more retention features 324 can limit or prevent lateral movement of the head 136 when the bone tie is in the second orientation relative to the bone tie retriever 300. The one or more retention features 324 can facilitate retention of the head 136 within the channel 316. The bone tie retriever 300 can pull the bone tie 100 through the second lumen 402. The bone tie retriever 300 can pull the bone tie 100 until the distal end 104 of the bone tie 100 is outside of the lumen 402.

[0133] In some methods of use, the proximal end 102 and the distal end 104 can be outside of the vertebrae after use of the bone tie advancer 200 and bone tie retriever 300. The bone tie 100 can form a curved shape. In some methods of use, a portion of the second section 110 can be disposed within the lumens 400, 402. In some methods of use, a portion of the third section 112 can be disposed within the lumens 400, 402. In some methods of use, a portion of the second section 110 and a portion of the third section 112 can be disposed within the lumens 400, 402 when the proximal end 102 and the distal end 104 are outside of the vertebrae.

[0134] In some methods of use, the head section 116 can be removed. The bone tie 100 can be cut or severed near the neck section 114. The bone tie 100 can be cut or severed to remove the head section 116. The bone tie 100 can be cut or severed to remove the head section 116 and a portion of the neck section 114. The head section 116 can be discarded. The head section 116 and a portion of the neck section 114 can be discarded. The neck section 114 can be advanced through the lumen 118 of the fastener section 106. While the neck 114 is being advanced, the ratchet 122 can extend into the groove 132. The third section 112 can be advanced through the lumen 118. While the third section 112 is being advanced, the ratchet 122 can extend into the groove 130. The second section 110 can be advanced through the lumen 118. While the second section 110 is being advanced, the ratchet 122 can extend into the groove 126. The ratchet 122 can engage the one or more gears 128. The ratchet 122 can allow the second section 110 to travel through the lumen 118 in one direction, but limit or prevent travel in the opposite direction.

[0135] The bone tie 100 can form a loop. The fastener section 106 can be secured to the second section 110. Securing the fastener section 106 can be based on the type of fastener member used. By way of example, securing the fastener section 106 can include inserting the opposite end of the bone tie 100 into the lumen 118 of the fastener section 106, and advancing the opposite end through the fastener section 106. The fastener section 106 can engage the one or more gears 128 of the second section 110. The one or more gears 128 can be shaped to allow each gear 128 to displace the ratchet 122 of fastener section 106 in only one direction.

[0136] After the bone tie 100 is secured, superior articular process SAP of vertebra V2 can fuse to inferior articular process IAP of vertebra VI. Fusing can include one or more of bone material from superior articular process SAP of vertebra V2, bone material from inferior articular process IAP of vertebra VI, and/or the implant or prosthesis that fuses superior articular process SAP of vertebra V2 to inferior articular process IAP of vertebra VI. In some embodiments, after superior articular process SAP of vertebra V2 is fused to inferior articular process IAP of vertebra VI, the bone tie 100 is not removed. In some embodiments, after superior articular process SAP of vertebra V2 is fused to inferior articular process IAP of vertebra VI, all or a portion of the bone tie 100 can be removed. In some embodiments, the bone tie 100 can be removed after fusion of superior articular process SAP of vertebra V2 to inferior articular process IAP of vertebra VI has started, but has not finished. In some embodiments, the bone tie 100 may comprise a bioabsorbable or bioresorbable material.

[0137] In use, the bone tie 100 can be configured to stabilize a first vertebra and/or a second vertebra by securing an articular process of the first vertebra to an articular process of a second vertebra. More specifically, the bone tie 100 can be configured to stabilize the first vertebra and/or a second vertebra by securing an articular process of the first vertebra to an articular process of a second vertebra. The bone tie 100 can be placed into a suitable position relative to the first vertebra and/or the second vertebra, and a distal portion of the bone tie 100 can be inserted into the lumen of the fastener section 106. The bone tie 100 can be configured to substantially encircle at least a portion of the first vertebra and the second vertebra. In some methods of use, the bone tie 100 forms a loop about the articular process of the first vertebra and the articular process of the second vertebra. In some methods of use, the neck section 114 and the third section 112 can be advanced through the fastener section 106 such that the area disposed within the loop formed by the bone tie 100 is reduced.

[0138] As the bone tie 100 is tightened, the bone tie 100 exerts a compressive force on the articular process of the first vertebra and the articular process of the second vertebra. In some methods of use, the implant or prosthesis can be disposed between the articular process of the first vertebra and the articular process of the second process such that a desired distance between the articular process of the first vertebra and the articular process of the second process is maintained. The implant or prosthesis can be retained within a loop or other defined segment of the bone tie 100. In some methods of use, the excess portion of the second section 110 and/or the third section 112 can be removed once the bone tie 100 is tightened. In some embodiments, the excess portion of the bone tie 100 can be removed from the space around the vertebrae. The excess portion of the bone tie 100 can be removed by cutting or breaking the excess portion of the bone tie 100. The excess portion can be removed without loosening or removing the loop formed by the bone tie 100 around the first vertebra and the second vertebra. [0139] Figure 22 is a flow chart for a method of using the bone tie 100. Figure 23 illustrates a view of the vertebrae. Figure 24 is a view of the spine with a coronal plane deformity. Figure 25 is a view of the bone tie 100 positioned to correct a coronal plane deformity. The bone tie 100 can be positioned around the transverse processes of adjacent vertebrae. The bone tie 100 can be positioned via the bone tie advancer 200. The bone tie 100 can be captured by the bone tie retriever 300. In some embodiments, the surgeon can position the bone tie 100 without the bone tie advancer 200. In some embodiments, the surgeon can capture the bone tie 100 without the bone tie retriever 300. In some embodiments, the surgeon can position the bone tie manually, depending on the anatomical location of fixation and the patient’s anatomy. Manual positioning can be by hand and/or by use of one or more of various tools.

[0140] The bone tie 100 can be configured to correct a deformity of adjacent vertebrae. The bone tie 100 can be configured to provide a torque or rotational force. The bone tie 100 can be configured to stabilize the vertebrae in a corrected position. The bone tie 100 can be configured to fuse the vertebrae in a corrected position. The bone tie 100 can be anchored to one or more specific anatomical locations to provide the appropriate torque. The bone tie 100 can include one or more fastener portions to anchor the bone tie 100 to the spinous process and/or the transverse process with one or more fasteners. The bone tie 100 can include one or more fastener portions to anchor the bone tie 100 to any anatomical portion of vertebra VI and/or any anatomical portion of vertebra V2 with one or more fasteners.

[0141] The bone tie 100 can be used to fuse the vertebra VI and vertebra V2 via the transverse process TP1A of vertebra VI and the transverse process TP2A of vertebra V2. In some methods of use, a second bone tie 100 can be used to fuse the vertebra VI and vertebra V2 via the transverse process TP1B of vertebra VI and the transverse process TP2B of vertebra V2. In some embodiments, the rotational alignment of vertebra VI and vertebra V2 is corrected using only one bone tie 100. In some embodiments, one bone tie 100 can be used to correct vertebra VI and vertebra V2 via the right transverse process TP1A of vertebra VI and the right transverse process TP2A of vertebra V2, or, via the left transverse process TP1B of vertebra VI and the left transverse process TP2B of vertebra V2. For an example reference herein, the transverse processes TP1A, TP2A are on the right when viewed from the front of the patient and the transverse processes TP IB, TP2B are on the left when viewed from the front of the patient. In some embodiments, two bone ties 100 can be used to stabilize vertebra VI and vertebra V2. In some embodiments that utilize two bone ties 100, one bone tie 100 is positioned around the transverse process TP1A of vertebra VI and the transverse process TP2A of vertebra V2 (shown in Figure 23) and another bone tie is positioned around the transverse process TP1B of vertebra VI and the transverse process TP2B of vertebra V2 (not shown). In some embodiments that utilize two bone ties 100, two bone ties 100 are positioned around the transverse process TP1A of vertebra VI and the transverse process TP2A of vertebra V2. Other configurations are contemplated. In some embodiments, the two bone ties 100 exert the same rotational force. In some embodiments, the two bone ties 100 exert a different rotational force. The methods described herein can be repeated for any pair of transverse processes.

[0142] In some methods of use, a pathway is formed around the transverse processes. The pathway can be formed with any tool, such as a dilator or retractor. The pathway can be formed via a posterior approach to the spine. The pathway can be formed via a lateral approach to the spine. The pathway can be formed via minimally invasive surgical techniques. The pathway can be formed via any of a variety of approaches to the spine. The pathway is formed around two or more transverse processes of vertebrae to facilitate implantation of the bone tie 100. In some embodiments, at least a portion of the pathway has a curved or non-linear configuration. In some embodiments, at least a portion of the pathway has a straight or linear configuration. In some methods of use, two or more pathways are formed. In some embodiments, one tool forms one or more pathways. In some embodiments, two tools are utilized to form two pathways.

[0143] In some methods of use, a portion of the surface of the transverse process can be prepared for receiving bone tie 100. In some methods of use, a portion of the surface of the transverse process can be ground, scored, roughened, or sanded, such that the surface of the transverse process can better receive the bone tie 100. In some methods of use, the surgical procedure can include preparing the area near and/or around the transverse processes by, for example, removing all or a portion of ligaments, cartilage, and/or other tissue.

[0144] In some methods, the facet joint is prepared prior to securing the bone tie 100 around the transverse processes. In some methods of use, the area near and/or around a facet joint can be prepared by removing all or a portion of the facet joint capsule. The implant or prosthesis, if provided, can be inserted between the superior articular process SAP of vertebra V2 and inferior articular process IAP of vertebra VI.

[0145] In some methods of use, a portion of the vertebra can be prepared for fusion. In some methods of use, an intervertebral implant is inserted between the superior and inferior vertebrae. The intervertebral implant can be a cage configured to be packed with material to promote fusion. The intervertebral implant can comprise a metal or polymer material. The intervertebral implant can comprise bony material from the patient, a donor, or a synthetic source. In some methods of use, the area near and/or around the intervertebral disc space can be prepared by removing all or a portion of the intervertebral disc.

[0146] The bone tie 100 can be advanced around a first transverse process of a first vertebra. The bone tie 100 can be advanced around a second transverse process of a second vertebra. The bone tie 100 can be advanced by the bone tie advancer 200. In some embodiments, the bone tie 100 and the bone tie advancer 200 can have a bend or curve to facilitate directing the head 136 of the bone tie 100 around the transverse processes. In some embodiments, the bone tie 100 and the bone tie advancer 200 can have a bend or curve corresponding to the curvature of the transverse process. In some embodiments, the bone tie advancer 200 is selected from a plurality of bone tie advancers 200 having different curvatures. The bone tie 100 and the bone tie advancer 200 can have any shape that allows the passage around the transverse processes. The bone tie 100 and the bone tie advancer 200 can have any shape that allows the passage of the head 136 around the transverse processes.

[0147] During advancement, the head 136 of the bone tie 100 can be monitored under radiographic visualization. The head 136 can include one or more markers 144. In the illustrated embodiment, the head 136 can include the bore 146 configured to receive the marker 144. The marker 144 can be radiopaque. The marker 144 can facilitate placement of the head 136 relative to the transverse process. The marker 144 can facilitate placement of the head 136 relative to the retriever portion 314 if the bone tie retriever 300 is utilized. The bone tie 100 can be retracted by the bone tie retriever 300 from a position below the transverse process to a position above the transverse process. The bone tie retriever 300 can be pulled to facilitate forming the loop around the transverse processes. [0148] The bone tie 100 is configured to form a loop around the transverse processes. In some embodiments, the bone tie 100 is configured to form a loop around the transverse processes on one side of the spine such as the right side. The bone tie 100 is configured to bring the transverse processes together. In some embodiments, the bone tie 100 is configured to form a u-shaped configuration until the bone tie 100 is secured. The u- shaped configuration can extend underneath the transverse processes. A portion of the bone tie 100 is underneath the transverse processes while the head 136 and the fastener section 106 can be above the transverse processes.

[0149] In some methods of use, the head section 116 can be removed after the bone tie 100 is positioned underneath the transverse processes. The bone tie 100 can be cut or severed near the neck section 114. The bone tie 100 can be cut or severed to remove the head section 116 and a portion of the neck section 114. The head section 116 can be discarded.

[0150] The bone tie 100 can be fastened to form a loop. The neck section 114 can be advanced through the lumen 118 of the fastener section 106. While the neck 114 is being advanced, the ratchet 122 can extend into the groove 132. The third section 112 can be advanced through the lumen 118 of the fastener section 106. While the third section 112 is being advanced, the ratchet 122 can extend into the groove 130. The second section 110 can be advanced through the lumen 118 of the fastener section 106. While the second section 110 is being advanced, the ratchet 122 can extend into the groove 126. The ratchet 122 can engage the one or more gears 128. The ratchet 122 can allow the second section 110 to travel through the lumen 118 of the fastener section 106 in one direction, but limit or prevent travel in the opposite direction.

[0151] The bone tie 100 can be tightened in one direction. The bone tie 100 can be tightened by advancing a portion of the bone tie 100 through the fastener section 106. The fastener section 106 can be tightened along the length of the bone tie 100. In some methods of use, the neck section 114, the third section 112, and at least a portion of the second section 100 can be advanced through the fastener section 106 such that the area disposed within the loop formed by the bone tie 100 is reduced. The fastener section 106 can engage the one or more gears 128 of the second section 110. The one or more gears 128 can be shaped to allow each gear 128 to displace the ratchet 122 of fastener section 106 in only one direction. The bone tie 100 can be tightened until flush with the transverse processes. The bone tie 100 can be tightened until the transverse processes are moved into the desired positon. The bone tie 100 can be tightened until no further tightening is allowed.

[0152] The bone tie 100 can be tightened to exert a force on the vertebrae. The bone tie 100 can be tightened to exert a torque on the vertebrae. The bone tie 100 can be tightened to correct a condition of the vertebrae. The bone tie 100 can apply a force to the transverse processes to correct a deformity. The bone tie 100 can correct a coronal plane deformity. The bone tie 100 can apply a force to the transverse processes to correct a scoliosis. The bone tie 100 can apply a force to the transverse processes to correct lateral scoliosis.

[0153] In some methods, the bone tie 100 remains in place to correct the deformity. In some methods, the bone tie 100 is removed after the deformity is corrected. In some methods, the bone tie 100 is removed and replaced. In some methods, the bone tie 100 is replaced with another bone tie that further corrects the coronal plane deformity. In some methods, the bone tie 100 is replaced with another bone tie that exerts a stronger force or torque. In some embodiments, the bone tie 100 may comprise a bioabsorbable or bioresorbable material.

[0154] In use, the bone tie 100 can be configured to stabilize the first vertebra and the second vertebra by securing the transverse process of the first vertebra to the transverse process of the second vertebra. The bone tie 100 can be placed into a suitable position relative to the first vertebra and the second vertebra. The bone tie 100 can be placed into a suitable position that allows a distal portion of the bone tie 100 to be inserted into the lumen 118 of the fastener section 106. In some embodiments, the fastener section 106 is positioned near one of the transverse processes once the bone tie 100 is tightened. In some embodiments, the fastener section 106 is positioned between the transverse processes once the bone tie 100 is secured. In some embodiments, the fastener section 106 is positioned over the top or exposed surface of the transverse processes once the bone tie 100 is tightened. The bone tie 100 can be configured to substantially encircle at least a portion of the first vertebra and the second vertebra. In some methods of use, the bone tie 100 forms a loop about the transverse process of the first vertebra and the transverse process of the second vertebra.

[0155] As the bone tie 100 is tightened, the bone tie 100 exerts a compressive force on the transverse process of the first vertebra and the transverse process of the second vertebra. In some methods of use, this compressive force is spaced a distance away from the intervertebral disc. The compressive force can therefore apply a torque to the spinal column to correct a deformity or scoliosis of the patient.

[0156] Figure 26 is a flow chart for a method of using the bone tie 100. Figure 27 illustrates a view of the vertebrae. Figure 28 is a view of the spine with a rotational deformity. Figure 29 is a view of the bone tie 100 positioned to correct or improve the condition of a rotational deformity. The bone tie 100 can be positioned around the spinous process of the first vertebra and around the transverse process of the second vertebra. The bone tie 100 can be positioned via the bone tie advancer 200, for instance to wrap around the transverse process. The bone tie 100 can be captured by the bone tie retriever 300, for instance to wrap around the transverse process. In some embodiments, the surgeon can position the bone tie 100 without the bone tie advancer 200. In some embodiments, the surgeon can capture the bone tie 100 without the bone tie retriever 300. In some embodiments, the surgeon can position the bone tie 100 manually around the spinous process. In some embodiments, the surgeon can position the bone tie 100 manually around the transverse process. Manual positioning can be by hand and/or by use of one or more of various tools.

[0157] The bone tie 100 can be configured to provide a rotational correction. The bone tie 100 can be configured to provide a torque on adjacent vertebrae. The bone tie 100 can be anchored to one or more specific anatomical locations to provide the appropriate torque. The bone tie 100 can include one or more fastener portions to anchor the bone tie 100 to the spinous process and/or the transverse process with one or more fasteners. The bone tie 100 can include one or more fastener portions to anchor the bone tie 100 to any anatomical portion of vertebra VI and/or any anatomical portion of vertebra V2 with one or more fasteners. Examples of bone ties can be found in U.S. Application Nos. 13/033791, 13/403698, and 16/751883 which are hereby incorporated in their entirety. Additional examples of bone ties including those with anchoring portions can be found in U.S. Application Nos. 13/804407 and 13/804521 which are hereby incorporated in their entirety. The bone tie 100 can pull the spinous process toward the transverse process. The bone tie 100 can pull the transverse process toward the spinous process. The bone tie 100 can pull the transverse process and the spinous process together. The bone tie 100 can be configured to stabilize the vertebrae in a rotationally corrected position. The bone tie 100 can be configured to facilitate the fusion of the vertebrae in a rotationally corrected position.

[0158] The bone tie 100 can be used to couple the vertebra VI and vertebra V2 via the spinous process SP1 of vertebra VI and the transverse process TP2A of vertebra V2. The transverse process TP2A of vertebra V2 is located on the right of the patient when viewed from the front. The bone tie 100 can be used to pull the spinous process SP1 of vertebra VI toward the right if coupled with the transverse process TP2A of vertebra V2, when viewed from the front of the patient. The bone tie 100 can be used to pull the spinous process SP1 of vertebra VI toward the left if coupled with the transverse process TP2B of vertebra V2, when viewed from the front of the patient. The bone tie 100 can be used to pull the spinous process SP2 of vertebra V2 toward the right if coupled with the transverse process TP1A of vertebra VI. The bone tie 100 can be used to pull the spinous process SP2 of vertebra V2 toward the left if coupled with the transverse process TP1B of vertebra VI.

[0159] In some methods, two bone ties 100 can be used to couple the vertebra VI and vertebra V2 via the spinous process SP1 of vertebra VI and the transverse processes TP2A, TP2B of vertebra V2. In some methods, two bone ties 100 can be used to couple the vertebra VI and vertebra V2 via the spinous process SP2 of vertebra V2 and the transverse processes TP1A, TP1B of vertebra VI. The bone ties 100 can apply equal forces. The bone ties 100 can apply unequal forces. The bone ties 100 can be used to align the spinous process SP1 of vertebra VI with the spinous process SP2 of vertebra V2 by applying equal forces. The bone ties 100 can be used to correct the rotation of the spinous process SP1 of vertebra VI by applying unequal forces.

[0160] In some methods, two bone ties 100 can be used to couple the vertebra VI, vertebra V2, and vertebra V3 via the spinous process SP1 of vertebra VI and the transverse processes, TP2A of vertebra V2 and TP3A of vertebra V3 (not shown). The bone tie 100 can be used to pull the spinous process SP1 of vertebra VI toward the right if coupled with the transverse process TP2A of vertebra V2 and the transverse process TP3A of vertebra V3, when viewed from the front of the patient. In some methods, two bone ties 100 can be used to couple the vertebra VI, vertebra V2, and vertebra V3 via the spinous process SP1 of vertebra VI and the transverse processes, TP2B of vertebra V2 and TP3B of vertebra V3. The bone tie 100 can be used to pull the spinous process SP1 of vertebra V 1 toward the left if coupled with the transverse process TP2B of vertebra V2 and the transverse process TP3B of vertebra V3 when viewed from the front of the patient.

[0161] In some embodiments, the rotational correction of vertebra VI and vertebra V2 is corrected using only one bone tie 100. In some embodiments, one bone tie 100 can be used to correct vertebra VI and vertebra V2 via coupling the spinous process to either the right transverse process or the left transverse process. In some embodiments, two bone ties 100 can be used to correct vertebra VI and vertebra V2 via both of the right and left transverse processes. In some embodiments, two bone ties 100 can be used to correct vertebra VI and vertebra V2 via two right transverse processes or two left transverse processes. The methods described herein can be repeated for any pair of spinous process and transverse process.

[0162] In some methods of use, a pathway is formed around the transverse process. In some methods of use, a pathway is formed around the spinous process. The pathway can be formed with any tool, such as a dilator or retractor. The pathway can be formed via a posterior approach to the spine. The pathway can be formed via a lateral approach to the spine. The pathway can be formed via minimally invasive surgical techniques. The pathway can be formed via any of a variety of approaches to the spine. The pathway is formed around the transverse process and the spinous process to facilitate implantation of the bone tie 100. In some embodiments, at least a portion of the pathway has a curved or non-linear configuration. In some embodiments, at least a portion of the pathway has a straight or linear configuration.

[0163] In some methods of use, a portion of the surface of the transverse process can be prepared for coupling with the bone tie 100. In some methods of use, a portion of the surface of the spinous process can be prepared for coupling with the bone tie 100. In some methods of use, a portion of the surface of the transverse process and/or spinous process can be ground, scored, roughened, or sanded, such that the surface of the transverse process and/or spinous process can better receive the bone tie 100. In some methods of use, the surgical procedure can include preparing the area near and/or around the transverse process and/or spinous process by, for example, removing all or a portion of ligaments, cartilage, and/or other tissue. [0164] In some methods, the facet joint is prepared prior to securing the one or more bone ties 100 around the transverse process and spinous process. In some methods of use, the area near and/or around a facet joint can be prepared by removing all or a portion of the facet joint capsule. The implant or prosthesis, if provided, can be inserted between the superior articular process SAP of vertebra V2 and inferior articular process IAP of vertebra VI.

[0165] In some methods of use, a portion of the vertebra can be prepared for fusion. In some methods of use, an intervertebral implant is inserted between the superior and inferior vertebrae. The intervertebral implant can be a cage configured to be packed with material to promote fusion. The intervertebral implant can comprise a metal or polymer material. The intervertebral implant can comprise bony material from the patient, a donor, or a synthetic source. In some methods of use, the area near and/or around the intervertebral disc space can be prepared by removing all or a portion of the intervertebral disc.

[0166] The bone tie 100 can be advanced around the transverse process of the first vertebra. The bone tie 100 can be advanced around the spinous process of the second vertebra. The bone tie 100 can be advanced by the bone tie advancer 200. In some embodiments, the bone tie 100 and the bone tie advancer 200 can have a bend or curve to facilitate directing the head 136 of the bone tie 100 around the transverse process. In some embodiments, the bone tie 100 and the bone tie advancer 200 can have a bend or curve to facilitate directing the head 136 of the bone tie 100 around the spinous process. The bone tie 100 and the bone tie advancer 200 can have any shape that allows the passage around the transverse process and/or the spinous process.

[0167] During advancement, the head 136 of the bone tie 100 can be monitored under radiographic visualization. During advancement, the surgeon can directly monitor the head 136 of the bone tie 100. The spinous process can be exposed such that the surgeon can visualize the pathway around the spinous process. The transverse process can be exposed such that the surgeon can visualize the pathway around the transverse process. The surgeon can manually pass the bone tie 100 around the spinous process. The surgeon can manually pass the bone tie 100 around the transverse process. The bone tie 100 can be pulled by the distal end 104 to facilitate forming the loop around the transverse process and the spinous process. The bone tie 100 can be pushed by the proximal end 102 to facilitate forming the loop around the transverse process and the spinous process.

[0168] The bone tie 100 is configured to form a loop around the transverse process and the spinous process. In some embodiments, the bone tie 100 is configured to form a loop around the transverse process on one side of the spine such as the right side. In some embodiments, the bone tie 100 is configured to form a u-shaped configuration around the transverse process until the bone tie 100 is tightened. The u-shaped configuration can extend underneath the transverse process. In some embodiments, the bone tie 100 is configured to form a u-shaped configuration around the spinous process until the bone tie 100 is tightened. The u-shaped configuration can extend around the spinous process.

[0169] In some methods of use, the head section 116 can be removed after the bone tie 100 is positioned underneath the transverse process. In some methods of use, the head section 116 can be removed after the bone tie 100 is positioned around the spinous process. The head section 116 can facilitate movement by the bone tie advancer 200 underneath the transverse process. The head section 116 can facilitate capture by the bone tie receiver 300 underneath the transverse process. In some methods, the bone tie advancer 200 and the bone tie receiver 300 can be utilized when passage of the bone tie 100 is visually obstructed. In some methods of use, the head section 116 can be removed after the bone tie 100 is positioned around the transverse process and/or the spinous process. The bone tie 100 can be cut or severed. The head section 116 can be discarded after positioning around the transverse process and around the spinous process.

[0170] The bone tie 100 can form a loop by inserting the distal end into the lumen 118 of the fastener section 106. The loop can be subsequently reduced in diameter. The second section 110 of the bone tie 100 can be advanced through the lumen 118 of the fastener section 106 to engage the ratchet 122 with the gears 128. The ratchet 122 can allow the second section 110 to travel through the lumen 118 in one direction through the fastener section 106, but limit or prevent travel of the second section 110 through the fastener section 106 in the opposite direction.

[0171] The loop of the bone tie 100 can be tightened. The bone tie 100 can be tightened by further advancing a portion of the bone tie 100 through the fastener section 106. In some methods of use, the neck section 114, the third section 112, and at least a portion of the second section 100 can be advanced through the fastener section 106 such that the area disposed within the loop formed by the bone tie 100 is reduced by tightening. The fastener section 106 can be secured when the ratchet 122 engages a gear 128.

[0172] The bone tie 100 can be tightened to achieve rotational correction. The bone tie 100 can be tightened to exert a torque on the vertebrae. The bone tie 100 can be tightened to correct a rotational condition of the vertebrae. The bone tie 100 can apply a torque to the spinous process to correct a deformity. The bone tie 100 can correct a spinous process deformity.

[0173] In some methods, the bone tie 100 remains in place to correct the rotational deformity. In some methods, the bone tie 100 is removed after the rotational deformity is corrected. In some methods, the bone tie 100 is removed and replaced. In some methods, the bone tie 100 is replaced with another bone tie that further corrects the rotational deformity. In some methods, the bone tie 100 is replaced with another bone tie that exerts a stronger torque.

[0174] In use, the bone tie 100 can be configured to stabilize the first vertebra and the second vertebra by securing the transverse process of the first vertebra to the spinous process of the second vertebra or vice versa. The bone tie 100 can be placed into a suitable position relative to the first vertebra and the second vertebra. The bone tie 100 can be placed into a suitable position that allows a distal portion of the bone tie 100 to be inserted into the lumen 118 of the fastener section 106. In some embodiments, the fastener section 106 is positioned near the transverse process once the bone tie 100 is tightened. In some embodiments, the fastener section 106 is positioned between the transverse process and the spinous process once the bone tie 100 is tightened. In some embodiments, the fastener section 106 is positioned over the top or exposed surface of the transverse process or spinous process once the bone tie 100 is tightened. The bone tie 100 can be configured to substantially encircle at least a portion of the first vertebra and the second vertebra. In some methods of use, the bone tie 100 forms a loop at least partially around the transverse process of the first vertebra and the spinous process of the second vertebra. In some methods of use, the bone tie 100 forms a loop at least partially around the spinous process of the first vertebra and the transverse process of the second vertebra. [0175] As the bone tie 100 is tightened and subsequently secured, the bone tie 100 exerts a rotational force on the spinous process. The spinous process can move as a result of the force. As the bone tie 100 is tightened and subsequently secured, the bone tie 100 exerts a rotational force on the transverse process. The transverse process can move as a result of the force. In some embodiments the spinous process and the transverse process are brought together. In some methods of use, the force by the bone tie 100 is spaced a distance away from the intervertebral disc producing a torque. The torque can achieve rotational correction of the spinal column. The torque can correct a rotational deformity of the patient.

[0176] Figure 30 is a flow chart for a method of using the bone tie 100. Figure 31 illustrates a view of the vertebrae. Figure 32 is a view of the spine with a sagittal plane deformity. Figure 33 is a view of the bone tie positioned to correct or improve the condition of a sagittal plane deformity. The bone tie 100 can be positioned around the lamina of adjacent vertebrae. The bone tie 100 can be positioned via the bone tie advancer 200. The bone tie advancer 200 can facilitate passing the bone tie 100 under the lamina. The bone tie 100 can be captured by the bone tie retriever 300. The bone tie retriever 300 can facilitate retrieval of the bone tie 100 once the bone tie 100 is passed under the lamina. The bone tie advancer 200 and the bone tie retriever 300 can be utilized when the pathway around the anatomy is obstructed or difficult. In some embodiments, the surgeon can position the bone tie 100 without the bone tie advancer 200. In some embodiments, the surgeon can position the bone tie 100 without the bone tie retriever 300. In some embodiments, the surgeon can position the bone tie 100 manually around one or more of the lamina of adjacent vertebrae. Manual positioning can be by hand and/or by use of one or more of various tools.

[0177] The bone tie 100 can be configured to achieve a sagittal correction. The bone tie 100 can be configured to correct lordosis. The bone tie 100 can be configured to provide a torque or rotational force. The bone tie 100 can be configured to correct the curvature of the spine. The bone tie 100 can be configured to reduce bowing of the spine. The bone tie 100 can be anchored to one or more specific anatomical locations to provide the appropriate torque. The bone tie 100 can include one or more fastener portions to anchor the bone tie 100 to the spinous process and/or the transverse process with one or more fasteners. The bone tie 100 can include one or more fastener portions to anchor the bone tie 100 to any anatomical portion of vertebra VI and/or any anatomical portion of vertebra V2 with one or more fasteners.

[0178] The bone tie 100 can be used to align vertebra VI and vertebra V2 via the lamina of vertebra VI and the lamina of vertebra V2. The bone tie 100 can be used to align vertebra VI and vertebra V2 via the lamina to the right of the spinous process SP1 of vertebra VI and the lamina to the right of the spinous process SP2 of vertebra V2. The bone tie 100 can be used to align vertebra VI and vertebra V2 via the lamina to the left of the spinous process SP1 of vertebra VI and the lamina to the left of the spinous process SP2 of vertebra V2.

[0179] In some methods of use, a second bone tie 100 can be used to align vertebra VI and vertebra V2 via the lamina of vertebra VI and the lamina of vertebra V2. The first bone tie 100 can be used to align vertebra VI and vertebra V2 via the lamina to the right of the spinous process SP1 of vertebra VI and the lamina to the right of the spinous process SP2 of vertebra V2. The second bone tie 100 can be used to align vertebra VI and vertebra V2 via the lamina to the left of the spinous process SP1 of vertebra VI and the lamina to the left of the spinous process SP2 of vertebra V2. In some embodiments, the two bone ties 100 exert the same force. In some embodiments, the two bone ties 100 exert a different force.

[0180] The bone tie 100 can be used to align vertebra VI and vertebra V2 via the lamina in a crossing pattern. The bone tie 100 can be used to align the vertebra VI and vertebra V2 via the lamina to the right of the spinous process SP1 of vertebra VI and the lamina to the left of the spinous process SP2 of vertebra V2. The bone tie 100 can be used to align the vertebra VI and vertebra V2 via the lamina to the left of the spinous process SP1 of vertebra VI and the lamina to the right of the spinous process SP2 of vertebra V2.

[0181] In some embodiments, the sagittal correction of vertebra V 1 and vertebra V2 is achieved using only one bone tie 100. In some embodiments, the sagittal correction of vertebra VI and vertebra V2 is achieved using two or more of bone ties 100 (e.g., two bone ties 100, three bone ties 100, four bone ties 100, etc.). One or more bone tie 100 can be positioned to the right of the spinous processes, SP1, SP2. One or more bone ties 100 can be positioned to the left of the spinous processes, SP1, SP2. Two or more bone ties 100 can be positioned to the right of the spinous processes, SP1, SP2, in spaced apart locations. Two or more bone ties 100 can be positioned on the left of the spinous processes, SP1, SP2, in spaced apart locations. The methods described herein can be repeated for any two or more lamina and at any number of locations along the spine.

[0182] In some methods of use, a pathway is formed around the lamina. The pathway can be formed with any tool, such as a dilator or retractor. The pathway can be formed via a posterior approach to the spine. The pathway can be formed via a lateral approach to the spine. The pathway can be formed via minimally invasive surgical techniques. The pathway can be formed via any of a variety of approaches to the spine. The pathway is formed around the lamina of the vertebrae to facilitate implantation of the bone tie 100. In some embodiments, at least a portion of the pathway has a curved or non-linear configuration. In some embodiments, at least a portion of the pathway has a straight or linear configuration. In some methods of use, two or more pathways are formed.

[0183] In some methods of use, a portion of the surface of the lamina can be prepared to receive the bone tie 100. In some methods of use, a groove can be formed in a portion of the surface of the lamina to receive the bone tie 100. In some methods of use, a portion of the surface of the lamina can be ground, scored, roughened, or sanded, such that the surface of the lamina can better receive the bone tie 100. In some methods of use, the surgical procedure can include preparing the area near and/or around the lamina by, for example, removing all or a portion of ligaments, cartilage, and/or other tissue.

[0184] In some methods, the facet joint is prepared prior to securing the one or more bone ties 100 around the lamina of adjacent vertebrae. In some methods of use, the area near and/or around a facet joint can be prepared by removing all or a portion of the facet joint capsule. The implant or prosthesis, if provided, can be inserted between the superior articular process SAP of vertebra V2 and inferior articular process IAP of vertebra VI.

[0185] In some methods of use, a portion of the vertebra can be prepared for fusion. In some methods of use, an intervertebral implant is inserted between the superior and inferior vertebrae. The intervertebral implant can be a cage configured to be packed with material to promote fusion. The intervertebral implant can comprise a metal or polymer material. The intervertebral implant can comprise bony material from the patient, a donor, or a synthetic source. In some methods of use, the area near and/or around the intervertebral disc space can be prepared by removing all or a portion of the intervertebral disc. [0186] The bone tie 100 can be advanced around the first lamina of the first vertebra. The bone tie 100 can be advanced around the second lamina of the second vertebra. The bone tie 100 can be moved by the bone tie advancer 200. In some embodiments, the bone tie 100 and the bone tie advancer 200 can have a bend or curve to facilitate directing the head 136 of the bone tie 100 around the lamina. In some embodiments, the bone tie advancer 200 is selected from a plurality of bone tie advancers 200 having different curvatures. The different curvatures can correspond to different anatomy. The curvature for the bone tie advancer 200 configured to move around the lamina can be different from the curvature for the bone tie advancer configured to move around the transverse process. The bone tie 100 and the bone tie advancer 200 can have any shape that allows the passage around the lamina. The bone tie 100 and the bone tie advancer 200 can have any shape that allows the passage of the head 136 to form a loop around the lamina.

[0187] During advancement, the head 136 of the bone tie 100 can be monitored under radiographic visualization. During advancement, the head 136 of the bone tie 100 can be visually inspected by the surgeon. The bone tie 100 can be pulled to facilitate forming the loop around the lamina. The bone tie 100 can be pushed to facilitate forming the loop around the lamina.

[0188] The bone tie 100 is configured to form a loop around the lamina. In some embodiments, the bone tie 100 is configured to form a loop around the lamina on one side of the spine such as the right side. In some embodiments, the bone tie 100 is configured to form a u-shaped configuration. The u-shaped configuration can extend underneath the lamina. In some methods of use, the head section 116 can be removed after the bone tie 100 is positioned underneath the lamina. The bone tie 100 can be cut or severed once the bone tie 100 is in the u-shaped configuration. The head section 116 can be discarded.

[0189] The bone tie 100 can form a loop by advancing a portion of the bone tie 100 through the fastener section 106. The neck section 114 can be advanced through the lumen 118 of the fastener section 106. The third section 112 can be advanced through the lumen 118 of the fastener section 106. The second section 110, or a portion thereof, can be advanced through the lumen 118 of the fastener section 106. The ratchet 122 can engage the one or more gears 128. The ratchet 122 can allow the second section 110 to travel through the lumen 118 in one direction to tighten the loop. [0190] The bone tie 100 can be tightened around the lamina of adjacent vertebrae. The bone 100 can be tightened to exert a force on the vertebrae. The force can bring the vertebrae together. The force can achieve sagittal correction. The force can restore lordosis. The force can correct the curvature of the spine. The bone tie 100 can be tightened to exert a torque on the vertebrae. The torque can cause a rotational correction of the vertebrae. The torque can correct the sagittal alignment.

[0191] In some methods, the bone tie 100 remains in place for sagittal correction. In some methods, the bone tie 100 is removed after a period of time. In some methods, the bone tie 100 is removed after fusion of vertebrae. In some methods, the bone tie 100 is removed and replaced with another bone tie that exerts a stronger force or torque.

[0192] In use, the bone tie 100 can be configured to stabilize the first vertebra and/or a second vertebra by securing the lamina of the first vertebra to the lamina of the second vertebra. The bone tie 100 can be placed into a suitable position relative to the first vertebra and/or the second vertebra. The bone tie 100 can be placed into a suitable position that allows a distal portion of the bone tie 100 to be inserted into the lumen 118 of the fastener section 106 by the surgeon. In some embodiments, the fastener section 106 is positioned near one of the lamina. In some embodiments, the fastener section 106 is positioned between the lamina of adjacent vertebrae. In some embodiments, the fastener section 106 is positioned over the top or exposed surface of the lamina. The bone tie 100 can be configured to substantially encircle at least a portion of the first vertebra and the second vertebra.

[0193] As the bone tie 100 is tightened, the bone tie 100 exerts a compressive force on the lamina of the first vertebra and the lamina of the second vertebra. In some methods of use, this compressive force can allow for sagittal correction. The compressive force can restore lordosis. In some embodiments, the method can include applying tension to the bone tie 100 to set sagittal correction. The bone tie 100 can be tightened to achieve the desired correction. The bone tie 100 can be tightened to achieve the desired lordosis.

[0194] Figure 34 is a flow chart for a method of using the bone tie 100. Figure 35 illustrates a view of the vertebrae. Figure 36 is a view of the spine with a lumen being formed through the pedicle of a first vertebra and the lamina of a second vertebra. Figure 37 is a view of the bone tie 100 positioned through the lumen. Figure 38 is another view of the bone tie 100 positioned through the lumen. The bone tie 100 can be positioned through one or more vertebrae. The bone tie 100 can be positioned through a vertebral body. The bone tie 100 can be positioned through a pedicle. The bone tie 100 can be positioned through a lamina. The bone tie 100 can be positioned through an articular process. The bone tie 100 can be positioned through a vertebral body or a pedicle of an inferior vertebra. The bone tie 100 can be positioned through a lamina or articular process of a superior vertebrae. Other configurations are contemplated. Manual positioning can be by hand and/or by use of one or more of various tools.

[0195] The bone tie 100 can be configured to stabilize or fuse adjacent vertebrae. The bone tie 100 can be used to fuse vertebra VI and vertebra V2 via lumens formed in vertebra VI and vertebra V2. In some embodiments, a lumen is formed through the vertebral body or the pedicle of the inferior vertebra. In some embodiments, a lumen is formed through the lamina or articular process of the superior vertebrae. In some embodiments, a lumen is formed through any portions of the vertebra VI and vertebra V2. In some embodiments, a lumen is formed through any aligned or coaxial portions of the vertebra VI and vertebra V2. In some embodiments, a lumen is formed through any portions of the vertebra VI and vertebra V2 connected via a straight or linear pathway. In some embodiments, a lumen is formed through any portions of the vertebra VI and vertebra V2 connected via a curved or non-linear pathway. The pathway can be formed via a posterior approach to the spine. The pathway can be formed via a lateral approach to the spine. The pathway can be formed via minimally invasive surgical techniques. The pathway can be formed via any of a variety of approaches to the spine.

[0196] In some methods of use, a second bone tie 100 can be used to fuse vertebra VI and vertebra V2 via a second lumen formed in vertebra VI and vertebra V2. The second lumen can join similar portions of the vertebra VI and vertebra V2. In some embodiments, a second lumen is formed through the vertebral body or the pedicle of the inferior vertebra. In some embodiments, a second lumen is formed through the lamina or articular process of the superior vertebrae.

[0197] In some embodiments, vertebra VI and vertebra V2 are fused using only one bone tie 100. In some embodiments, one bone tie 100 can be used to stabilize vertebra VI and vertebra V2 by inserting the bone tie 100 through a formed lumen. In some embodiments, one bone tie 100 can be used to stabilize vertebra VI and vertebra V2 on the right side of the spinous processes. In some embodiments, one bone tie 100 can be used to stabilize vertebra VI and vertebra V2 on the left side of the spinous processes. In some embodiments, two bone tie 100 can be used to stabilize vertebra VI and vertebra V2 by inserting each bone tie 100 through a formed lumen. In some embodiments, two bone ties 100 can be used to stabilize vertebra VI and vertebra V2 on both the right and left sides of the spinous processes. The methods described herein can be repeated for any pair of vertebrae and at any number of locations along the spine.

[0198] In some methods of use, a lumen is formed through the vertebral body. In some methods of use, a lumen is formed through the pedicle. In some methods of use, a lumen is formed through the lamina. In some methods of use, a lumen is formed through the articular process. In some methods of use, a lumen is formed through any portion of the inferior vertebra. In some methods of use, a lumen is formed through any portion of the superior vertebra. The lumen can be formed with a lumen-forming tool, such as a drill, tissue punch, or reamer. The lumen-forming tool can form a linear lumen. The lumen-forming tool can form a non-linear lumen. The lumen is formed through the vertebrae to facilitate implantation of the bone tie 100. In some embodiments, at least a portion of the lumen has a curved or non-linear configuration. In some embodiments, at least a portion of the lumen has a straight or linear configuration. In some methods of use, two or more lumens are formed. In some embodiments, one lumen-forming tool forms one or more lumens. In some embodiments, two lumen-forming tools are utilized to form two lumens.

[0199] In some methods of use, a portion of the vertebra can be prepared for fusion. In some methods of use, a portion of the vertebra can be ground, scored, roughened, or sanded, such that the portion of the vertebra can better adhere to any substances to aid in fusion and/or otherwise fuse more readily to an implant or prosthesis. In some methods of use, an intervertebral implant is inserted between the superior and inferior vertebrae. The intervertebral implant can be a cage configured to be packed with material to promote fusion. The intervertebral implant can comprise a metal or polymer material. The intervertebral implant can comprise bony material from the patient, a donor, or a synthetic source. In some methods of use, a facet implant is inserted between the superior articular process and the inferior articular process. The facet implant can be a disk configured to be packed with material to promote fusion. The facet implant can comprise a metal or polymer material. The facet implant can comprise bony material from the patient, a donor, or a synthetic source. In some methods of use, the surgical procedure can include preparing the area near and/or around the vertebra by, for example, removing all or a portion of ligaments, cartilage, and/or other tissue. In some methods of use, the area near and/or around the intervertebral disc space can be prepared by removing all or a portion of the intervertebral disc. In some methods of use, the area near and/or around the facet joint can be prepared by removing all or a portion of the facet joint capsule. The implant or prosthesis, if provided, can be inserted between portions of the vertebrae.

[0200] The bone tie 100, the bone tie advancer 200, and the bone tie retriever 300 can be located within lumens as described herein. In some embodiments, a straight lumen is formed between the inferior vertebra and the superior vertebra. The bone tie advancer 200 can be shaped to move the bone tie 100 through this lumen. The bone tie 100 can be positioned within and adjacent to the bone tie advancer 200. As the bone tie advancer 200 is moved by the user, the head section 136 and the neck section 114 is correspondingly moved. The bone tie 100 can be advanced through the straight lumen by the bone tie advancer 200. The bone tie 100 can be advanced through the vertebral body by the bone tie advancer 200. The bone tie 100 can be advanced through the pedicle by the bone tie advancer 200. The bone tie 100 can be advanced through the lamina by the bone tie advancer 200. In some embodiments, the bone tie 100 and the bone tie advancer 200 can have a bend or curve to facilitate directing the head 136 of the bone tie 100 into the lumen. In some embodiments, the bone tie 100 and the bone tie advancer 200 can have straight or liner portion to facilitate directing the head 136 of the bone tie 100 into the lumen. The bone tie 100 and the bone tie advancer 200 can have any shape that allows the passage through the lumen formed in the vertebrae. In some embodiments, the bone tie 100 is advanced manually by the surgeon. In some embodiments, the bone tie 100 is advanced without the bone tie advancer 200.

[0201] The bone tie retriever 300 can be positioned to receive the head 136 of the bone tie 100. The bone tie 100 is advanced by the bone tie advancer 200 until the head 136 of bone tie 100 is positioned near the bone tie retriever 300. The bone tie 100 is further advanced until the head 136 of bone tie 100 is inserted into the channel 316 of the bone tie retriever 300. The bone tie 100 and the bone tie advancer 200 can have any shape that allows the passage of the head 136 into the channel 316. The bone tie 100 can be advanced until the head 136 abuts the inside wall of the retriever portion 314. The bone tie 100 can be advanced until any further advancement is prevented by the retriever portion 314. The bone tie 100 can be retracted by the bone tie retriever 300. The bone tie retriever 300 can be pulled to pull the head 136 of the bone tie 100 distally. The bone tie retriever 300 can be moved in any orientation to move the head 136 of the bone tie 100. The neck section 114 can pivot and/or rotate to extend distally from the bone tie retriever 300 as the bone tie 100 is pulled proximally. In some embodiments, the bone tie 100 is retrieved manually by the surgeon. In some embodiments, the bone tie 100 is retrieved without the bone tie retriever 300.

[0202] During advancement, the head 136 of the bone tie 100 can be monitored under radiographic visualization. The head 136 of the bone tie 100 can be monitored under radiographic visualization during passage through the lumen. The head 136 of the bone tie 100 can be monitored under radiographic visualization when the view of the bone tie 100 is obstructed. The head 136 of the bone tie 100 can be monitored under radiographic visualization when the head 136 cannot be visualized by the surgeon. The marker 144 on the head 136 can facilitate placement of the head 136 relative to the lumen. The marker 144 can facilitate placement of the head 136 relative to the retriever portion 314.

[0203] The bone tie 100 can form a straight shape through the lumen extending between the vertebrae. The bone tie 100 can extend through the vertebral body or pedicle of the inferior vertebrae. The bone tie 100 can extend through the lamina or articular process of the superior vertebrae. In some methods of use, a portion of the second section 110 can be disposed within the lumen. In some methods of use, a portion of the third section 112 can be disposed within the lumen. In some methods of use, a portion of the second section 110 and a portion of the third section 112 can be disposed within the lumen when the proximal end 102 and the distal end 104 are outside of the vertebrae.

[0204] In some methods of use, the head section 116 can be removed to allow for tightening of the bone tie 100. The head section 116 can be removed after the bone tie 100 is passed through the lumen. The head section 116 can be removed after the bone tie 100 wraps around a portion of the patient’s anatomy. The head section 116 can be discarded in preparation for tightening the bone tie 100. [0205] In some methods, the neck section 114 can be advanced through the lumen 118 of the fastener section 106 after the head section 116 is severed. While the neck 114 is being advanced, the ratchet 122 can extend into the groove 132. In some embodiments, the neck 114 does not include gears. The neck 114 can slide in both directions relative to the fastener section 106. The bone tie 100 can form a loop once a portion of the bone tie 100 enters the lumen 118 of the fastener section 106.

[0206] The third section 112 can be advanced through the lumen 118 of the fastener section 106. While the third section 112 is being advanced, the ratchet 122 can extend into the groove 130. In some embodiments, the third section 112 does not include gears. The third section 112 can slide in both directions relative to the fastener section 106.

[0207] The second section 110 can be advanced through the lumen 118 of the fastener section 106. While the second section 110 is being advanced, the ratchet 122 can extend into the groove 126. The ratchet 122 can engage the one or more gears 128 located in the second section 110. The ratchet 122 can allow the second section 110 to travel through the lumen 118 of the fastener section 106 in one direction to further tighten the bone tie 100. The ratchet 122 can allow the second section 110 to travel through the lumen 118 of the fastener section 106 in one direction to reduce the diameter of the loop of the bone tie 100. The ratchet 122 can allow the second section 110 to travel through the lumen 118 of the fastener section 106 in one direction to apply a tension or force or torque on the underlying anatomy. The ratchet 122 can allow the second section 110 to travel through the lumen 118 of the fastener section 106 in one direction to correct a rotational alignment. The ratchet 122 can allow the second section 110 to travel through the lumen 118 of the fastener section 106 in one direction to bring the vertebrae together.

[0208] The ratchet 122 can limit or prevent travel in the opposite direction. The ratchet 122 can limit or prevent travel that can loosen the bone tie 100. The ratchet 122 can limit or prevent travel that can increase the diameter of the loop of the bone tie 100. The ratchet 122 can limit or prevent travel that can lessen the tension or force or torque on the underlying anatomy. The ratchet 122 can limit or prevent movement of the vertebrae. The ratchet 122 can limit or prevent rotation of the vertebrae. The bone tie 100 can be tightened to achieve the desired clinical outcome. [0209] The bone tie 100 is secured by the ratchet 122 engaging a gear 128. Once the desired tension in the bone tie 100 is achieved, the bone tie 100 will maintain this tension by engagement of the ratchet 122 with the gear 128. The bone tie 100 will only be able to be further tensioned. The bone tie 100 is not configured to loosen under normal anatomical loads.

[0210] After the bone tie 100 is secured, the superior vertebra can fuse to inferior vertebra. Fusion can include one or more bone material from the superior vertebra and/or bone material from the inferior vertebra. Fusion can include an implant or prosthesis positioned between adjacent vertebrae. In some embodiments, after vertebrae are fused, the bone tie 100 is removed. In some embodiments, after vertebrae are fused, the bone tie 100 is not removed. In some embodiments, the bone tie 100 may comprise a bioabsorbable or bioresorbable material.

[0211] In use, the bone tie 100 can be configured to stabilize the first vertebra and the second vertebra by securing a portion of the first vertebra to a portion of a second vertebra. More specifically, the bone tie 100 can be configured to stabilize the first vertebra and the second vertebra by securing the vertebral body or pedicle of the first vertebra to the lamina or articular process of a second vertebra. The bone tie 100 can be placed into a suitable position relative to the first vertebra and the second vertebra. The bone tie 100 can be configured to extend through the lumen to substantially encircle at least a portion of the first vertebra and the second vertebra. In some methods of use, the bone tie 100 extends through a straight lumen between the vertebrae. In some methods of use, the bone tie 100 forms a loop after extending through the straight lumen. In some methods of use, the bone tie 100 forms a loop through the vertebral body of the inferior vertebra. In some methods of use, the bone tie 100 forms a loop through the pedicle of the inferior vertebra. In some methods of use, the bone tie 100 forms a loop though the lamina of the superior vertebra. In some methods of use, the bone tie 100 forms a loop though the articular process of the superior vertebra. In some methods of use, the bone tie 100 forms a loop around a portion of the spine after extending through the lumen.

[0212] As the bone tie 100 is tightened, the bone tie 100 exerts a compressive force on the first vertebra and the second vertebra. In some methods of use, this compressive force is spaced a distance away from the intervertebral disc. The compressive force can therefore apply a torque to the spinal column to correct a deformity or scoliosis of the patient or improve the condition of a deformity or scoliosis of the patient. In some methods, the bone tie 100 can be configured to provide a torque or rotational force. In some methods, the compressive force does not apply a torque. The bone tie 100 can be configured to stabilize the vertebrae in a corrected position. The bone tie 100 can be configured to fuse the vertebrae in a corrected position. The bone tie 100 can be anchored to one or more specific anatomical locations to provide the appropriate torque. The bone tie 100 can include one or more fastener portions to anchor the bone tie 100 to the spinous process and/or the transverse process with one or more fasteners. The bone tie 100 can include one or more fastener portions to anchor the bone tie 100 to any anatomical portion of vertebra VI and/or any anatomical portion of vertebra V2 with one or more fasteners.

[0213] In some methods of use, the implant or prosthesis can be disposed between the first vertebra and the second vertebrae such that a desired distance between the first vertebra and the second vertebrae is maintained. In some methods of use, the excess portion of the second section 110 and/or the third section 112 can be removed once the bone tie 100 is tightened. The excess portion of the bone tie 100 can be removed by cutting or breaking the excess portion of the bone tie 100. The excess portion can be removed without loosening or removing the loop formed by the bone tie 100 around the first vertebra and the second vertebra.

[0214] The method can include tightening the bone tie 100. The method can include advancing the bone tie 100 along the ratchet 122. Each of gears 128 can be wedge shaped to allow each of gears 128 to displace the ratchet 122 of the fastener section 106 in only one direction. In some embodiments, gears 128 can be other shapes including rectangular in cross-section. The gears 128 can extend along a portion of the length of the bone tie 100. As each gear 128 passes through the ratchet 122, the shape of the gear 128 prevents loosening of the bone tie 100. Travel of the bone tie 100 can be limited to the distance or length of the gear 128.

[0215] The bone tie 100 can have any shape. The bone tie 100 can have a shape to conform to a portion of the bone. In some methods, the fastener section 106 can be configured to remain within the body of the patient. The fastener section 106 can be near the proximal end 102. The fastener section 106 can have a shape configured to conform to the shape of the bone. The fastener section 106 can have a flat surface configured to engage bone. The ratchet 122 can be disposed within a lumen. The lumen can prevent encroachment of tissue relative to the ratchet 122. The fastener section 106 can have an enlarged head configured to distribute forces to the bone. The fastener section 106 can have an enlarged head configured to prevent subsidence into bone.

[0216] In some methods, the first section 108 can be configured to remain within the body of the patient. The first section 108 can be closer to the proximal end 102 than the distal end 104. The first section 108 can have a first cross-sectional shape configured to conform to the shape of the bone. The first section 108 can be rounded. The rounded surface or edges may facilitate engagement with a rounded lumen or pathway. The first section 108 can have a flat surface configured to contact bone. The flat surface can be configured to distribute forces to the bone. The flat surface can prevent subsidence into bone. The flat surface can be on a back side of the bone tie 100.

[0217] In some methods, the second section 110 can be configured to remain within the body of the patient. In some methods, a portion of the second section 110 can be configured to remain within the body of the patient. In some methods, a portion of the second section 110 is cut after tightening to remove excess length of the bone tie 100. The second section 110 can be closer to the proximal end 102 than the distal end 104. The second section 110 can have a first cross-sectional shape configured to conform to the shape of the bone. The second section 110 can be rounded. The rounded surface or edges may facilitate engagement with a rounded lumen or pathway. The second section 110 can have a flat surface configured to contact bone. The flat surface can be configured to distribute forces to the bone. The flat surface can prevent subsidence into bone. The flat surface can be on a back side of the bone tie 100. The flat surface can be opposite the gears 128. The gears 128 can be disposed within a groove 126. The groove 126 can prevent encroachment of tissue relative to the gears 128. The second section 110 can have raised edges relative to the gears 128. The raised edges can slide along corresponding groves in the lumen 118 of the fastener section 106. The raise edges can facilitate alignment of the gears 128 with the ratchet 122.

[0218] In some methods, the third section 112, or a portion thereof, can be configured to remain within the body of the patient. In some methods, the third section 112 is cut after tightening to remove excess length of the bone tie 100. The third section 112 can have raised edges relative to the groove 130. The raised edges can slide along corresponding groves in the lumen 118 of the fastener section 106. The raised edges of the second section 110 and the third section 112 can be continuous.

[0219] The first section 108, the second section 110, and the third section 112 can be any portion of the length of the bone tie 100. In some embodiments, the second section 110 is at least 30% of the length of the bone tie 100. In some embodiments, the third section 112 is at least 30% of the length of the bone tie 100. Other configurations are contemplated. The first section 108 can be 5% of the total length, 10% of the total length, 15% of the total length, 20% of the total length, 25% of the total length, 30% of the total length, 35% of the total length, 40% of the total length, 45% of the total length, 50% of the total length, or any range of the foregoing values. The second section 110 can be 5% of the total length, 10% of the total length, 15% of the total length, 20% of the total length, 25% of the total length, 30% of the total length, 35% of the total length, 40% of the total length, 45% of the total length, 50% of the total length, 55% of the total length, 60% of the total length, 65% of the total length, 70% of the total length, 75% of the total length, 80% of the total length, 85% of the total length, 90% of the total length, 95% of the total length, or any range of the foregoing values. The third section 112 can be 5% of the total length, 10% of the total length, 15% of the total length, 20% of the total length, 25% of the total length, 30% of the total length, 35% of the total length, 40% of the total length, 45% of the total length, 50% of the total length, or any range of the foregoing values. In some embodiments, the length of second section 110 can be about equal to the length of the third section 112. In some embodiments, the length of second section 110 can be greater than the length of the third section 112. In some embodiments, the length of second section 110 can be less than the length of the third section 112.

[0220] The bone tie 100 can be configured to loop around at least a portion of the anatomy. In some embodiments, the bone tie 100 completely encircles the anatomy. In some embodiments, the bone tie 100 completely encircles the transverse process. In some embodiments, the bone tie 100 completely encircles the spinous process. In some embodiments, the bone tie 100 completely encircles the lamina. In some embodiments, the bone tie 100 partially encircles the anatomy of the patient. The bone tie 100 can contact or wrap around 5% of the anatomy of the patient, 10% of the anatomy of the patient, 15% of the anatomy of the patient, 20% of the anatomy of the patient, 25% of the anatomy of the patient, 30% of the anatomy of the patient, 35% of the anatomy of the patient, 40% of the anatomy of the patient, 45% of the anatomy of the patient, 50% of the anatomy of the patient, 55% of the anatomy of the patient, 60% of the anatomy of the patient, 65% of the anatomy of the patient, 70% of the anatomy of the patient, 75% of the anatomy of the patient, 80% of the anatomy of the patient, 85% of the anatomy of the patient, 90% of the anatomy of the patient, 95% of the anatomy of the patient, 100% of the anatomy of the patient, or any range of the foregoing values.

[0221] The first section 108 can have a uniform shape. The first section 108 can have a substantially cuboidal shape or a substantially cylindrical shape. The second section 110 can have a uniform shape. The second section 110 can have a substantially cuboidal shape or a substantially cylindrical shape. The third section 112 can have a uniform shape. The third section 112 can have a substantially cuboidal shape or a substantially cylindrical shape. The first section 108 and the third section 112 can have the same or similar shape.

[0222] The bone tie 100 can be disposed around a portion of the vertebra. The bone tie 100 can be disposed around a portion of the inferior vertebra. The bone tie 100 can be disposed around a portion of the superior vertebra. The bone tie 100 can be disposed around a portion of the inferior vertebra and around a portion of the superior vertebra. The bone tie 100 can be disposed through a portion of the vertebra. The bone tie 100 can be disposed through a portion of the inferior vertebra. The bone tie 100 can be disposed through a portion of the superior vertebra. The bone tie 100 can be disposed through a portion of the inferior vertebra and through a portion of the superior vertebra.

[0223] The bone tie 100 can be utilized alone. The bone tie 100 can be utilized in connection with another bone tie 100. The bone tie 100 can be utilized in connection with an implant. The bone tie 100 can be utilized in connection with an interbody implant. The bone tie 100 can be utilized in connection with a facet implant. The bone tie 100 can be utilized in connection with fusion material. The bone tie 100 can be utilized in connection with bone grafts. The bone tie 100 can be utilized in connection with any substance. The bone tie 100 can be utilized in connection with any biologic and/or chemical substance, including, but not limited to, medicine, adhesives, etc., and/or a bone graft, including, but not limited to, autograft, allograft, xenograft, alloplastic graft, a synthetic graft, and/or combinations of grafts, medicines, and/or adhesives. While exemplary references are made with respect to vertebra, in some embodiments another bone can be involved. While specific reference may be made to a specific vertebra and/or subset and/or grouping of vertebrae, it is understood that any vertebra and/or subset and/or grouping, or combination of vertebrae can be used. The bone tie 100 can deliver a substance. The bone tie 100 can be packed with a substance after tightening. The lumen that the bone tie 100 extends through can be packed with a substance. The bone tie 100 can be configured to retain, carry and/or otherwise deliver a substance to aid in fusion, such as, for example, medicines, adhesives, bone graft, and/or combinations of substances.

[0224] The bone tie 100 can have several advantages. The bone tie 100 can allow for simplified subsequent removal techniques versus traditional hardware. The bone tie 100 can be easily cut to be removed. The bone tie 100 can be removed after fusion. The bone tie 100 can be adjusted during a procedure to adjust the tension on the underlying anatomy. The bone tie 100 can be adjusted during a procedure to increase or decrease the tension on the underlying anatomy. The bone tie 100 can be removed during a procedure to adjust the tension on the underlying anatomy. The bone tie 100 can be removed during a procedure to decrease the tension on the underlying anatomy. The bone tie 100 can removed and replaced with another bone tie 100. The bone tie 100 can absorb over time within the body of the patient. The bone tie 100 can be advantageously tightened in one direction. The bone tie 100 can maintain the tension under normal anatomical loads.

[0225] The bone tie 100 can be utilized to correct or improve the condition of a variety of ailments. The bone tie 100 can be utilized to correct or improve the condition of a coronal plane deformity. The bone tie 100 can be utilized to correct or improve the condition of a lateral scoliosis. The bone tie 100 can be utilized to achieve rotational correction. The bone tie 100 can be utilized to achieve sagittal correction. The bone tie 100 can be utilized to restore lordosis. The bone tie 100 can be tensioned to set sagittal correction. The bone tie 100 can be tensioned to set lordosis.

[0226] The bone tie 100 can be utilized in combination with navigation systems to achieve desired trajectories. The bone tie 100 can be utilized in combination with guidance systems to achieve desired trajectories. The bone tie 100 can be utilized in combination with probes to achieve desired trajectories. The probe can facilitate forming an operative channel through the tissue of a patient to access a portion of the patient’s spine. In operation, the probe can be inserted into a patient. In some embodiments, the probe is inserted into an anchorable location, such as a collagenous tissue, bone, or vertebral disc. In some embodiments, the probe comprises at least one electrode. In some embodiments, the at least one electrode is capable of stimulating a nerve to provoke an electromyographic response in the nerve.

[0227] In some embodiments described herein, the bone tie 100 can be used to stabilize and/or fixate a first vertebra to a second vertebra. The bone tie 100 can be configured to reduce pain associated with a bone portion. The bone tie 100 can be configured to reduce further degradation of a spine. The bone tie 100 can be configured to reduce further degradation of a specific vertebra of a spine. The bone tie 100 can be configured to reduce movement until the first vertebra and the second vertebra have fused. The bone tie 100 can be configured to stabilize the first vertebra and second vertebra by securing an articular process of the first vertebra to an articular process of a second vertebra.

[0228] Although this invention has been disclosed in the context of certain preferred embodiments and examples, it will be understood by those skilled in the art that the present invention extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention and obvious modifications and equivalents thereof. In addition, while several variations of the invention have been shown and described in detail, other modifications, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combinations or sub-combinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the invention. It should be understood that various features and aspects of the disclosed embodiments can be combined with, or substituted for, one another in order to form varying modes of the disclosed invention. For all the embodiments described above, the steps of the methods need not be performed sequentially. Thus, it is intended that the scope of the present invention herein disclosed should not be limited by the particular disclosed embodiments described above, but should be determined only by a fair reading of the claims that follow.