Tool and system for aligning and applying fastener to implanted anchor

Abstract

A fastener cartridge installs clamping fasteners, e.g., a set screw and a lock nut, to fix a linking rod or cable in the head of an anchor assembly. The cartridge carries one or more fasteners, or pairs of inner and outer fasteners, and applies them onto the anchor head without cross-threading. A separate holder mechanism aligns and guides the cartridge with a centering body into which the fastener cartridge fits. One cartridge has a box wrench that externally grips and turns the nut, and a central shaft coaxial with the box wrench that positions and rotates a clamp screw in coordination with the nut. Preferably, these are configured, by springs, detents or offset positioning surfaces, to install the inner lock screw coaxially with but ahead of the outer nut to fix a linking member anchor assemblies prior to fitting, e.g., compressions and distractions of the spine and final tightening. The holder mechanism has a distal jaw that grips the anchor head and positions the centering body on-axis, aligning it to avoid cross-threading the fasteners. The holder may have an elongated handle projecting to a side of the centering body for manipulating the holder in a surgical wound, or the holder may have a coaxially disposed and/or telescopically interfitted handle. The handle also actuates a jaw to grip the anchor head and center the assembly. Fastener cartridges may be manually gripped or turned with a wrench remote from the wound. A floating assembly enhances alignment of threads and coordination of fasteners.