Spinal implant

• US 20030139812A1
• Filed: 11/08/2002
• Published: 07/24/2003
• Est. Priority Date: 11/09/2001
• Status: Abandoned Application

• Current Assignee: Zimmer Spine, Inc. (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Zimmer Spine, Inc. (Zimmer Biomet Holdings, Inc.)
• Inventors: Wagner, Erik J., Krueger, David J., Garcia, Javier
• Application Number:
  US10/291,245
• Publication Number:
  US 20030139812A1
• Time in Patent Office: Days
• US Class Current: 623/17.11
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/88 Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices A61B17/7074 takes precedence
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61F 2/28 Bones joints A61F2/30
• CPC Class Codes: A61F 2/30965 Reinforcing the prosthesis by embedding particles or fibres during moulding or dipping
• CPC Class Codes: A61F 2/4455 for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages intervertebral discs A61F2/442
• CPC Class Codes: A61F 2/447 substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
• CPC Class Codes: A61F 2/4611 of spinal prostheses
• CPC Class Codes: A61F 2002/2835 Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30062 (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/3008 radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: A61F 2002/30331 made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2002/30387 Dovetail connection
• CPC Class Codes: A61F 2002/30433 using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/30492 using a locking pin
• CPC Class Codes: A61F 2002/305 Snap connection
• CPC Class Codes: A61F 2002/30777 : Oblong apertures
• CPC Class Codes: A61F 2002/30785 : parallel
• CPC Class Codes: A61F 2002/30789 : perpendicular with respect to each other
• CPC Class Codes: A61F 2002/3082 : Grooves
• CPC Class Codes: A61F 2002/30904 : serrated profile, i.e. saw-toothed
• CPC Class Codes: A61F 2002/30922 : Hardened surfaces
• CPC Class Codes: A61F 2002/30952 : using CAD-CAM techniques or NC-techniques
• CPC Class Codes: A61F 2002/4627 : with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0033 : made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2220/0041 : using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2250/0098 : radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00293 : containing a phosphorus-containing compound, e.g. apatite
• CPC Class Codes: A61F 2310/00359 : Bone or bony tissue
• CPC Class Codes: A61F 2310/00616 : Coating made of titanium oxide or hydroxides
• CPC Class Codes: A61F 2310/00796 : Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite

Abstract

A spinal implant may be made of two or more implant members. In an embodiment, implant members may be joined together by a rotational connection that inhibits separation of the members as well as axial movement of the members relative to each other. Implant members may be coupled together by a pin or pins, adhesive, or other fasteners to inhibit separation and/or rotation of the members relative to each other.

Claims

1. A spinal implant, comprising:

a first member; and

a second member rotationally coupled to the first member.

2. The spinal implant of claim 1, wherein the first member is coupled to the second member by a rotational dovetail joint.

3. The spinal implant of claim 1, wherein the first member comprises bone.

4. The spinal implant of claim 1, wherein the first member comprises polyether ether ketone.

5. The spinal implant of claim 1, wherein the first member comprises polyether ether ketone, and further comprising X-ray sensitive material in the first member to allow X-ray detection of the implant.

6. The spinal implant of claim 1, wherein the first member comprises metal.

7. The spinal implant of claim 1, wherein the first member comprises titanium.

8. The spinal implant of claim 1, wherein a surface of the first member that is configured to contact a vertebra is treated to promote osseointegration of the first member with the vertebra.

9. The spinal implant of claim 1, wherein the first member comprises a channel formed in a side surface of the first member along a portion of a length of the first member.

10. The spinal implant of claim 1, wherein the first member comprises a channel formed in a side surface of the first member along a portion of a length of the first member, and wherein a surface of the channel is configured to couple to an implant inserter.

11. The spinal implant of claim 1, wherein an end of the implant comprises a tapered surface.

12. The spinal implant of claim 1, wherein the first member comprises a surface configured to contact a bone, and wherein the surface comprises roughening to promote fusion of the surface with the bone.

13. The spinal implant of claim 1, wherein the first member comprises a surface configured to contact a bone, and wherein the surface comprises serrations to inhibit backout of the first member relative to the bone.

14. The spinal implant of claim 13, wherein serration height varies along a length of the first member.

15. The spinal implant of claim 13, wherein frequency of the serrations varies along a length of the first member.

16. The spinal implant of claim 1, further comprising an opening through the first member and an opening at least partially through the second member, wherein the opening through the first member aligns with the opening at least partially through the second member when the first member is rotationally coupled to the second member.

17. The spinal implant of claim 1, further comprising means for fastening the first member to the second member to inhibit rotation of the first member relative to the second member.

18. The spinal implant of claim 17, wherein the fastening means comprises a fastener positioned through an opening in the first member into an opening at least partially through the second member.

19. The spinal implant of claim 17, wherein the fastening means comprises an adhesive.

20. The spinal implant of claim 1, further comprising a fastener configured to couple the first member and the second member.

21. The spinal implant of claim 1, wherein a posterior height of the spinal implant is different than an anterior height of the spinal implant.

22. The spinal implant of claim 1, wherein the first member comprises a tapered anterior end to facilitate insertion of the implant between vertebrae.

23. The spinal implant of claim 1, wherein the first member comprises a substantially flat posterior surface.

24. A spinal implant, comprising:

a first member comprising a first mating face;

a second member comprising a second mating face and a third mating face, wherein the second mating face is complementary to the first mating face of the first member;

a third member comprising a fourth mating face, wherein the fourth mating face is complementary to the third mating face of the second member; and

wherein the first member couples to the second member, and the second member couples to the third member.

25. The spinal implant of claim 24, wherein the first and second mating faces form a joint.

26. The spinal implant of claim 24, wherein the third and fourth mating faces form a joint.

27. The spinal implant of claim 24, wherein the first and second mating faces form a dovetail joint.

28. The spinal implant of claim 24, wherein the third and fourth mating faces form a dovetail joint.

29. The spinal implant of claim 24, wherein the first and second mating faces define a joint, and wherein the joint resists movement of the first and second mating faces relative to one another in at least one direction relative to a longitudinal axis of the second member.

30. The spinal implant of claim 24, wherein the third and fourth mating faces define a joint, and wherein the joint resists movement of the third and fourth mating faces relative to one another in at least one direction relative to a longitudinal axis of the second member.

31. The spinal implant of claim 24, wherein the first member comprises bone.

32. The spinal implant of claim 24, wherein the first member comprises polyether ether ketone.

33. The spinal implant of claim 24, wherein the first member comprises polyether ether ketone, and further comprising X-ray sensitive material in the implant to allow X-ray detection of the implant.

34. The spinal implant of claim 24, wherein the first member comprises metal.

35. The spinal implant of claim 24, wherein the first member comprises titanium.

36. The spinal implant of claim 24, wherein the first member comprises a surface configured to couple to bone, and wherein the surface comprises roughening.

37. The spinal implant of claim 24, wherein the first member comprises a surface configured to couple to bone, and wherein the surface comprises serrations.

38. The spinal implant of claim 24, wherein the first member comprises a surface configured to couple to bone, wherein the surface comprises serrations, and wherein serration height varies along a length of the first member.

39. The spinal implant of claim 24, wherein the first member comprises a surface configured to couple to bone, wherein the surface comprises serrations, and wherein frequency of the serrations vary along a length of the first member.

40. The spinal implant of claim 24, wherein a surface of the first member that is configured to contact a vertebra is treated to promote osseointegration of the first member with the vertebra.

41. The spinal implant of claim 24, further comprising an opening through the first member and an opening at least partially through the second member, wherein the opening through the first member aligns with the opening at least partially through the second member when the first member is coupled to the second member.

42. The spinal implant of claim 24, further comprising a fastener, an opening through the first member, and an opening at least partially through the second member, wherein the opening through the first member aligns with the opening at least partially through the second member when the first member is coupled to the second member, and wherein the fastener is positionable in the opening through the first member and the opening at least partially through the second member to fix the first member to the second member.

43. The spinal implant of claim 24, further comprising an opening through the first member and an opening at least partially through the second member, wherein the opening through the first member is substantially normal to an interface between the first member and the second member, and wherein the opening at least partially through the second member aligns with the opening through the first member.

44. The spinal implant of claim 24, further comprising fastening means for fixing the first member to the second member and the second member to the third member.

45. The spinal implant of claim 44, wherein the fastening means comprises at least one pin that is configured to press fit into the first member.

46. The spinal implant of claim 44, wherein the fastening means comprises adhesive.

47. The spinal implant of claim 24, wherein an anterior height of the spinal implant differs from a posterior height of the spinal implant so that the spinal implant has a lordotic angle.

48. The spinal implant of claim 24, wherein an anterior height of the spinal implant differs from a posterior height of the spinal implant so that the spinal implant has a lordotic angle, wherein the lordotic angle is greater than about 0°

, and wherein the lordotic angle is less than about 12°

.

49. The spinal implant of claim 48, wherein the anterior height is greater than the posterior height.

50. The spinal implant of claim 24, wherein an anterior end of the first member comprises at least one tapered surface to facilitate insertion between vertebrae.

51. A spinal implant, comprising:

a first member comprising a first portion at a first end of the first member, wherein the first portion is recessed relative to a second portion at a second end of the first member;

a second member comprising a first portion and a second portion that are complementary to the first portion and the second portion of the first member; and

wherein the first member couples to the second member.

52. The spinal implant of claim 51, wherein the first member comprises bone.

53. The spinal implant of claim 51, wherein the first member comprises polyether ether ketone.

54. The spinal implant of claim 51, wherein the first member comprises polyether ether ketone, and further comprising X-ray sensitive material in the first member to allow X-ray detection of the implant.

55. The spinal implant of claim 51, wherein the first member comprises metal.

56. The spinal implant of claim 51, wherein the first member comprises titanium.

57. The spinal implant of claim 51, wherein the first member and the second member are keyed to facilitate proper positioning of the first member relative to the second member.

58. The spinal implant of claim 51, further comprising a fastener configured to fix the first member to the second member to inhibit movement of the first member relative to the second member.

59. The spinal implant of claim 51, further comprising fastening means for joining the first member to the second member.

60. The spinal implant of claim 59, wherein the fastening means comprises a fastener that is press fit into an opening that extends through the first member and at least partially into the second member.

61. The spinal implant of claim 59, wherein the fastening means comprises an adhesive.

62. The spinal implant of claim 51, wherein the first member comprises a channel formed in a side of the first member, and wherein a surface of the first member that defines the channel is configured to couple to an implant inserter.

63. The spinal implant of claim 51, wherein the first member comprises a surface configured to contact a bone, and wherein the surface comprises roughening to promote fusion of the first member to the bone.

64. The spinal implant of claim 51, wherein the first member comprises a surface configured to contact a bone, and wherein the surface comprises serrations to inhibit backout of the first member relative to the bone.

65. The spinal implant of claim 64, wherein serration height varies along a length of the first member.

66. The spinal implant of claim 64, wherein frequency of the serrations varies along a length of the first member.

67. The spinal implant of claim 51, wherein an anterior portion of the first member comprises a tapered surface, the tapered surface configured to facilitate insertion of the first member between a first bone and second bone.

68. A spinal implant, comprising:

a first member comprising a first portion at a first end of the first member, wherein the first portion of the first member is recessed relative to a second portion at a second end of the first member;

a second member comprising a first portion at a first end of the second member, wherein the first portion of the second member is recessed relative to a second portion at a second end of the second member; and

a third member positioned between the first member and the second member, wherein a shape of the third member is complementary to a shape of the first member and a shape of the second member.

69. The spinal implant of claim 68, wherein the first member comprises bone.

70. The spinal implant of claim 68, wherein the first member comprises polyether ether ketone.

71. The spinal implant of claim 68, wherein the first member comprises polyether ether ketone, and further comprising X-ray sensitive material in the implant to allow X-ray detection of the implant.

72. The spinal implant of claim 68, wherein the first member comprises metal.

73. The spinal implant of claim 68, wherein the first member comprises titanium.

74. The spinal implant of claim 68, wherein a surface of the first member that is configured to contact a vertebra is treated to promote osseointegration of the first member with the vertebra.

75. The spinal implant of claim 68, wherein the first member comprises a channel formed in a side surface of the first member along a portion of a length of the first member, and wherein a surface of the first member that defines the channel is configured to couple to an implant inserter.

76. The spinal implant of claim 68, and wherein the surface comprises roughening.

77. The spinal implant of claim 68, wherein the first member comprises a surface configured to contact a bone, and wherein the surface comprises serrations.

78. The spinal implant of claim 77, wherein serration height varies along a length of the first member.

79. The spinal implant of claim 77, wherein frequency of the serrations varies along a length of the first member.

80. The spinal implant of claim 68, further comprising a fastener that joins the first member to the third member.

81. The spinal implant of claim 68, further comprising means for fastening the first member to the third member and the third member to the second member.

82. The spinal implant of claim 81, wherein the means comprises adhesive.

83. The spinal implant of claim 81, wherein the means comprises at least one pin press fit into the spinal implant.

84. The spinal implant of claim 68, wherein the first member comprises a tapered anterior end to facilitate insertion between a first bone and a second bone.

85. A spinal implant, comprising:

a first member, the first member comprising;

a first mating face having a single protrusion; and

a first opening;

a second member, the second member comprising;

a second mating face having a single groove; and

a second opening;

a pin; and

wherein the single protrusion of the first mating face is configured to mate with the single groove of the second mating face to couple the first member to the second member, and wherein the first opening of the first member and the second opening of the second member align with one another such that the pin is positionable through the first opening and the second opening substantially normal to an interface between the first member and the second member.

86. The spinal implant of claim 85, wherein the first member comprises bone.

87. The spinal implant of claim 85, wherein the second member comprises bone.

88. The spinal implant of claim 85, wherein the first member comprises polyether ether ketone.

89. The spinal implant of claim 85, wherein the second member comprises polyether ether ketone.

90. The spinal implant of claim 85, wherein the implant comprises polyether ether ketone, and further comprising X-ray sensitive material in the implant to allow X-ray detection of the implant.

91. The spinal implant of claim 85, wherein the first member comprises metal.

92. The spinal implant of claim 85, wherein the first member comprises titanium.

93. The spinal implant of claim 85, wherein a surface of the first member that is configured to contact a vertebra is treated to promote osseointegration of the first member with the vertebra.

94. The spinal implant of claim 85, wherein the second member comprises metal.

95. The spinal implant of claim 85, wherein the second member comprises titanium.

96. A spinal implant, comprising:

a first member, the first member comprising;

a first mating face having a first protrusion;

a second mating face having a second protrusion; and

at least one opening through the first member;

a second member, the second member comprising;

a third mating facing having a first groove; and

at least one opening in the second member; and

a third member, the third member comprising;

a fourth mating facing having a second groove; and

at least one opening in the third member; and

wherein the first protrusion of the first mating face is configured to mate with the first groove of the third mating face to couple the first member to the second member, the second protrusion of the second mating face is configured to mate with the second groove of the fourth mating face to couple the first member to third member.

97. The spinal implant of claim 96, further comprising at least one pin, and wherein an opening of the first member, an opening of the second member, and an opening of the third member align with one another such that a pin positioned through the first opening, the second opening, and the third opening is substantially normal to an interface between the first member and the second member and an interface between the first member and the third member.

98. The spinal implant of claim 96, wherein a surface of the first member that is configured to contact a vertebra is treated to promote osseointegration of the first member with the vertebra.

99. A spinal implant, comprising:

a single implant member;

a tapered surface on an anterior end of the implant, wherein the tapered surface is configured to pack bone graft material into a disc space during insertion of the implant between vertebrae; and

one or more vertical passages through a height of the implant.

100. The spinal implant of claim 99, wherein the implant member comprises bone.

101. The spinal implant of claim 99, wherein the implant member comprises polyether ether ketone.

102. The spinal implant of claim 99, wherein the implant comprises polyether ether ketone, and further comprising X-ray sensitive material in the implant to allow X-ray detection of the implant.

103. The spinal implant of claim 99, wherein the implant member comprises metal.

104. The spinal implant of claim 99, wherein the implant member comprises titanium.

105. The spinal implant of claim 99, wherein a surface of the implant member that is configured to contact a vertebra is treated to promote osseointegration of the implant member with the vertebra.

106. The spinal implant of claim 99, further comprising at least one horizontal passage through a side of the implant, wherein a first vertical passage intersects a first horizontal passage.

107. The spinal implant of claim 99, further comprising a rib separating a first vertical passage from a second vertical passage.

108. The spinal implant of claim 99, wherein the implant comprises a surface configured to contact a bone, and wherein the surface comprises roughening to promote fusion of the surface with the bone.

109. The spinal implant of claim 99, wherein the implant comprises a surface configured to contact a bone, and wherein the surface comprises serrations to inhibit backout of the implant relative to the bone.

110. The spinal implant of claim 109, wherein serration height varies along a length of the implant.

111. The spinal implant of claim 109, wherein frequency of the serrations varies along a length of the implant.

112. The spinal implant of claim 99, wherein the implant comprises a channel formed in a side surface of the implant along a portion of a length of the implant, and wherein a surface of the channel is configured to couple to an implant inserter.

113. The spinal implant of claim 99, wherein an anterior height of the spinal implant differs from a posterior height of the spinal implant so that the spinal implant has a lordotic angle.

114. The spinal implant of claim 99, wherein an anterior height of the spinal implant differs from a posterior height of the spinal implant so that the spinal implant has a lordotic angle, wherein the lordotic angle is greater than about 0°

, and wherein the lordotic angle is less than about 12°

.

115. The spinal implant of claim 114, wherein the anterior height is greater than the posterior height.

116. A method of forming a multiple piece bone implant, comprising:

forming a first implant member from a first bone piece;

forming a first joint half in the first member;

forming a channel in at least one side of the first implant member, the channel configured to accept a portion of an insertion instrument;

forming a second implant member from a second bone piece;

forming a second joint half in the second member;

forming a channel in at least one side of the second implant member, the channel configured to accept a portion of the insertion instrument;

mating the first joint half of the first member with the second joint half of the second member to couple the first member to the second member; and

placing a fastener through the first member into the second member.

117. The method of claim 116, further comprising texturing a surface of the first member to inhibit backout of the implant from a disc space when the implant is placed in the disc space.

118. The method of claim 116, further comprising tapering at least one surface of the implant so that the implant is able to establish a desired angle between vertebrae when the implant is placed in a disc space between the vertebrae.

119. A method, comprising:

inserting a first implant in a first disc space between two vertebrae;

packing bone graft material in a space proximate the first implant; and

inserting a second implant in a second disc space between the two vertebrae.

120. The method of claim 119, wherein the bone graft material comprises cancellous bone.

121. The method of claim 119, wherein the second implant comprises a tapered anterior end to facilitate insertion between the two vertebrae.

122. The method of claim 119, wherein inserting the second implant forces the bone graft material between the second implant and the first implant.

123. The method of claim 119, wherein inserting the second implant forces the bone graft material between the second implant and remaining disc.

124. A method, comprising:

positioning a distractor in a first disc space between two vertebrae;

removing portions of bone proximate a second disc space;

coupling a first implant to a first implant inserter;

positioning the first implant in the second disc space;

releasing the first implant from the first implant inserter; and

removing the distractor from the first disc space.

125. The method of claim 124, further comprising:

removing portions of bone proximate the first disc space;

coupling a second implant to a second implant inserter;

positioning the second implant in the first disc space; and

releasing the second implant from the second implant inserter.

126. The method of claim 124, further comprising:

removing portions of bone proximate the first disc space;

packing bone graft material in a space proximate the first implant;

coupling a second implant to a second implant inserter;

positioning the second implant in the first disc space; and

releasing the second implant from the second implant inserter.

127. The method of claim 126, wherein the bone graft material comprises cancellous bone.

128. A distractor, comprising:

a body having an opening, wherein the opening is configured to allow the body to be removably attached to a shaft;

wherein the body comprises a first surface and a second surface, and wherein a width between the first surface and the second surface allows for insertion of the body between a pair of vertebrae; and

wherein the body comprises a third surface and a fourth surface, and wherein a width between the third surface and the fourth surface is configured to establish a desired separation distance between the vertebrae during use.

129. The distractor of claim 128, wherein a portion of the first surface tapers towards the second surface so that the width between the first surface and the second surface varies.

130. The distractor of claim 128, wherein a portion of the first surface tapers towards the second surface so that the width between the first surface and the second surface varies, and wherein the body is narrower at an end opposite to an end of the body with the opening.

131. The distractor of claim 128, wherein a portion of a wall of the body defining the opening is configured to interact with a portion of a shaft inserted into the opening to allow for rotation of the body.

132. The distractor of claim 128, wherein a portion of a wall of the body defining the opening is configured to form an interference fit with a portion of a shaft inserted into the opening to allow for rotation of the body.

133. The distractor of claim 128, wherein a cross-sectional shape of a portion of the opening is oval.

134. The distractor of claim 128, wherein edges of the body between the first surface and the third and fourth surfaces are rounded to facilitate rotation of the body during use.

135. The distractor of claim 128, wherein a portion of the opening is configured to form an interference fit with a first portion of a shaft inserted into the opening to allow for rotation of the body, wherein the body comprises a cavity adjacent to the opening, and wherein the cavity is sized to allow a second portion of the shaft, which is inserted into the cavity, to rotate in the cavity so that the shaft couples to the body.

136. A distractor, comprising:

a tip, wherein the tip comprises surfaces defining a first width that allows for insertion of the tip in a space between vertebrae, and wherein the tip comprises surfaces defining a second width that allows a desired separation distance to be established between the vertebrae during use; and

a shaft, wherein the shaft is configured to be coupled to and removed from the tip during use.

137. The distractor of claim 136, wherein the first width tapers towards an end of the tip opposite from an end of the tip that couples to the shaft.

138. The distractor of claim 136, wherein the shaft comprises indicia.

139. The distractor of claim 136, wherein a portion of the shaft is configured to engage a portion of the tip that defines an opening to removably couple the shaft to the tip.

140. The distractor of claim 136, wherein the tip comprises a cavity and an opening in communication with the cavity, wherein the shaft comprises an outer member and an inner member, wherein the inner member is configured to rotate relative to the outer inner member, wherein a portion of the inner member is sized to fit through the opening into the cavity, and wherein a portion of the outer member is configured to reside in the cavity and interact with a wall of the tip that defines the cavity to allow for rotational movement of the tip when the outer shaft is rotated.

141. The distractor of claim 136, wherein the shaft comprises an outer shaft, an inner shaft, and an activator, and wherein engaging the activator moves the inner shaft relative to the outer shaft to allow the shaft to be attached to the tip.

142. The distractor of claim 136, wherein the shaft comprises an outer shaft, an inner shaft, and an activator, and wherein engaging the activator moves the inner shaft relative to the outer shaft to allow the shaft to be removed from the tip.

143. The distractor of claim 136, comprising a handle coupled to the shaft.

144. The distractor of claim 136, comprising a handle coupled to the shaft, and wherein the handle is removable from the shaft.

145. The distractor of claim 136, wherein the

146. A distractor, comprising:

a body having a first surface, a second surface, a third surface and a fourth surface, wherein a width between the first surface and the second surface allows for insertion of the body between a pair of vertebrae; and

wherein a width between the third surface and the fourth surface is configured to establish a desired separation distance between the vertebrae during use; and

a shaft attached to the body.

147. The distractor of claim 146, further comprising a handle coupled to the shaft.

148. The distractor of claim 146, further comprising a handle that is configured to be coupled and removed from the shaft.

149. The distractor of claim 146, wherein a portion of the shaft comprises indicia.

150. The distractor of claim 146, wherein a portion of the first surface tapers towards the second surface so that the width between the first surface and the second surface varies, and wherein the body is narrower at an end opposite to an end of the body where the shaft couples to the body.

151. The distractor of claim 146, wherein edges of the body between the first surface and the third and fourth surfaces are rounded to facilitate rotation of the body during use.

152. A method of distracting vertebrae, comprising;

inserting a tip of a distractor between the vertebrae, wherein the tip is coupled to a shaft;

rotating the shaft to rotate the tip so that the tip establishes a desired separation distance between the vertebrae; and

removing the shaft from the tip.

153. The method of claim 152, wherein removing the shaft from the tip comprises turning an activator to align an end portion of the shaft with an opening in the tip, and withdrawing the shaft from the tip.

154. The method of claim 152, further comprising inserting the shaft into the tip, rotating the shaft to rotate the tip, and removing the tip from between the vertebrae.

155. An implant inserter comprising:

a first arm and a second arm configured to hold an implant;

a locking member configured to apply a force that moves the first arm towards the second arm; and

an impact surface.

156. The implant inserter of claim 155, wherein a portion of the first arm and a portion of the second arm are positioned in an outer shaft.

157. The implant inserter of claim 155, wherein a width of the first arm and a width of the second arm are sized to reside in grooves formed in sides of an implant.

158. The implant inserter of claim 155, wherein a portion of the first arm and a portion of a second arm are configured to contact a posterior surface of an implant.

159. The implant inserter of claim 155, further comprising indicia configured to indicate an insertion depth of an implant into a disc space when the implant is coupled to the first arm and the second arm.

160. An implant inserter, comprising:

a first member comprising a first arm;

a second member comprising a second arm; and

a locking member configured to couple the first member to the second member, such that engaging the locking member allows the first arm and the second arm to securely grasp an implant positioned between the first arm and the second arm, and such that disengaging the locking member allows the first arm and the second arm to release an implant positioned between the first arm and the second arm.

161. The implant inserter of claim 160, wherein a width of the first arm and a width of the second arm are sized to reside in grooves formed in sides of an implant.

162. The implant inserter of claim 160, wherein a portion of the first arm and a portion of a second arm are configured to contact a posterior surface of an implant.

163. The implant inserter of claim 160, further comprising indicia configured to indicate an insertion depth of an implant into a disc space when the implant is coupled to the first arm and the second arm.

164. A method of inserting an implant in a disc space, comprising:

gripping the implant with arms of an insertion instrument;

positioning the implant above a disc space between vertebrae using the insertion instrument;

inserting the implant between the vertebrae; and

releasing the implant from the insertion instrument.

165. The method of claim 164, wherein inserting the implant between the implant comprises impacting the insertion instrument to drive the implant between the vertebrae.

166. The method of claim 164, wherein gripping the implant comprises rotating a locking member to move a first arm towards a second arm when the first arm and second arm are positioned on opposite sides of the implant.

167. A chisel for preparing a space for an implant, comprising:

a guide configured to be placed between adjacent bones;

a pair of chisel blades in working relation to the guide, wherein the chisel blades are configured to remove bone from the adjacent bones during use to form channels in the adjacent bones for an implant;

a handle coupled to the chisel blades, wherein reciprocation of the handle allows for movement of the chisel blades relative to the guide to remove bone from the adjacent bones.

168. The chisel of claim 167, further comprising indicia adjacent to the chisel blades to indicate an insertion depth of the chisel blades into a space between the adjacent bones.

169. The chisel of claim 167, wherein the handle comprises an indicator for determining an insertion depth of the chisel blades into a space between the adjacent bones.

170. The chisel of claim 167, wherein the handle is coupled to an outer shaft, and wherein the guide is coupled to an inner shaft.

171. The chisel of claim 167, wherein the inner shaft is coupled to the handle when the chisel is in a first position, and wherein the chisel comprises a release that uncouples the inner shaft from the handle to allow the handle to be reciprocated relative to the guide.

172. The chisel of claim 167, wherein the handle includes an impact surface to facilitate insertion of the guide into a space between the adjacent bones.

173. The chisel of claim 167, wherein the handle comprises a bar configured to attach to a slap hammer, and wherein the slap hammer is used to detach the chisel from the adjacent bones.

174. The chisel of claim 167, wherein the chisel blades are removably coupled to an outer shaft.

175. The chisel of claim 167, wherein the chisel blades comprise a first portion having a color that is distinct from a color of a second portion of the chisel blades, and wherein the position of the first color and second color on the chisel blades are configured to provide an indication of safe insertion depth of the chisel blades during use.

176. The chisel of claim 167, wherein the guide is removably coupled to a shaft, and wherein the handle is able to move towards or away from the guide to reciprocate the chisel blades.

177. The chisel of claim 167, wherein the handle is coupled to an outer shaft, wherein the guide is coupled to an inner shaft, and wherein an extension from the shaft interacts with the handle to limit a range of motion of the chisel blades relative to the guide.

178. A chisel for forming channels in adjacent vertebrae, comprising:

a guide comprising a first guide member positionable between the adjacent vertebrae during use, and a second guide member positionable between the adjacent vertebrae during use;

a first chisel blade configured to move relative to the guide, wherein the first chisel blade is located between the first guide member and the second guide member, and wherein a portion of the first chisel blade extends beyond the first guide member and the second guide member so that the chisel blade is able to cut a channel in a first vertebrae during use; and

a second chisel blade configured to move relative to the guide, wherein the second chisel blade is located between the first guide member and the second guide member, and wherein a portion of the second chisel blade extends beyond the first guide member and the second guide member so that the chisel blade is able to cut a channel in a second vertebrae during use.

179. The chisel of claim 178, further comprising a handle coupled to the chisel blades, wherein the handle is configured to reciprocate to relative to the guide to allow the chisel blades to cut channels in the vertebrae.

180. The chisel of claim 179, wherein the handle comprises an indicator to inform a user of an insertion depth of the first chisel blade and second chisel blade in a disc space.

181. The chisel of claim 178, wherein the first chisel blade comprises indicia to indicate an insertion depth of the first chisel blade into a disc space.

182. The chisel of claim 178, wherein the guide is coupled to an inner shaft, wherein the first chisel blade and the second chisel blade are coupled to an outer shaft and to a handle, and wherein an extension from the inner shaft interacts with a portion of the handle to limit a range of motion of the handle relative to the guide.

183. A method of forming grooves in vertebrae, comprising:

inserting a guide of a chisel between the vertebrae; and

simultaneously impacting chisel blades of the chisel against each vertebra to form channels in the vertebrae.

184. The method of claim 183, wherein the chisel blades are located above the guide during insertion of the guide between the vertebrae and held in a fixed position, and wherein the chisel blades are released from the fixed position so the chisel blades are able to impact the vertebrae to form channels.

185. The method of claim 183, wherein the chisel comprises an indicator, and monitoring an insertion depth of the chisel blades into the vertebrae using the indicator.