WO2025202887A1

WO2025202887A1 - Screw extender, screw extender sleeve, and screw extender system

Info

Publication number: WO2025202887A1
Application number: PCT/IB2025/053130
Authority: WO
Inventors: Morten Beyer
Original assignee: Neo Medical SA
Current assignee: Neo Medical SA
Priority date: 2024-03-27
Filing date: 2025-03-25
Publication date: 2025-10-02
Anticipated expiration: 2026-09-27

Abstract

The present invention concerns a screw extender including an elongated tubular body comprising a proximal end and a distal end, the distal end of the elongated tubular body being configured to receive a pedicle or spinal screw; an elongated attachment member attached to the elongated tubular body and extending beyond the proximal end of the elongated tubular body to a proximal end of the screw extender, and a clearance located directly opposite or directly facing the elongated attachment member and located directly opposite an outer surface of the screw extender defined by the proximal end of the elongated tubular body.

Description

SCREW EXTENDER, SCREW EXTENDER SLEEVE, AND SCREW EXTENDER SYSTEM CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims priority to international patent application number PCT/IB2024/052978 filed on March 27th 2024, the disclosure of which is hereby incorporated herein by reference in its entirety for all purposes.

FIELD OF THE INVENTION

The present invention concerns a screw extender and in particular to a spinal screw or pedicle screw extender that can be mounted or pre-mounted to a spinal screw or pedicle screw. The present invention further concerns a screw extender sleeve for receiving or for attachment to the screw extender. The present invention also concerns a screw extender system including the screw extender sleeve and the screw extender. The present invention further concerns a method for assembling the screw extender system, as well as a method for attaching an orthopedic rod to a spinal or pedicle screw using the spinal screw or pedicle screw extender and the screw extender sleeve.

BACKGROUND

Spinal screws and screw extenders are known in the art. For example, spinal screws and screw extenders are disclosed in US10058355B2, the disclosure of which is hereby incorporated herein by reference in its entirety for all purposes.

Spinal screws in association with an orthopedic rod are used to correct spinal deformity or to treat spinal trauma. An orthopedic or connecting rod is placed and held in the heads of a plurality of spinal screws implanted in vertebrae to treat a degenerative spine, correct a spinal deformity or to treat a spinal trauma. Prior to the insertion of the spinal screws into vertebrae, a passage or bore for receiving the shaft of the spinal screw is formed in the pedicle or vertebra using a succession of drilling tools such as tap, awl, pedicle finder, and probe.

A thin guide wire such as Kirschner-wire (or K-wire) can be placed in each of the passages or bores to guide the spinal screw into the passage or bore for insertion into the pedicle or vertebrae.

The spinal screw is attached to an instrument that is a screw extender (also known as a tower or tube). The instrument thus forms an extension of the spinal screw when attached to a head of the spinal screw. The screw extender allows implants and/or instruments, used in association with the spinal screw, to be guided inside and through the screw extender to the spinal screw when the spinal screw is implanted in a vertebrae. The screw extender facilitates, for example, orthopedic rod reduction and setscrew tightening in the spinal screw head when the spinal screw is implanted in the vertebrae. Setscrew tightening in the spinal screw head fixes the orthopedic or connecting rod inside the spinal screw head (see, for example, US10058355B2).

A shaft of the spinal screw typically includes a through-bore through which the guide wire is first passed and then passed through the screw extender attached to the spinal screw allowing the screw and the screw extender to be guided to the passage or bore formed in the pedicle or vertebrae. A screwdriver may then, for example, be passed inside the screw extender to engage the spinal screw and rotate the spinal screw into the pedicle or vertebrae.

However, multiple spinal screws are generally required and located in a plurality of different pedicles or vertebrae. This results in multiple screw extenders extending outwards from the patient's spine and occupying the space in which a surgeon works.

Depending on the required location of the spinal screws in the pedicles or vertebra, for example, to correct spinal deformity or to treat spinal trauma address, two screw extenders can cross and intersect in the same surgical working space. For example, final tightening of a setscrew in the spinal screw head of each of the surgical screws in the desired location is not possible because this effectively requires the screw extenders to intermingle in a cross-over position shown in Figure 12B. For example, in such a cross-over position, it is not possible to pass an instrument through and inside the screw extender SE from the proximal end to the distal end to permit the instrument access to the bone screw. For example, manipulation of a set screw located in a head of the bone screw is not impossible, or at the very least, severely hindered.

This can be avoided by the surgeon initially choosing a less-optimal location of the spinal screws in the pedicles or vertebra for correcting spinal deformity or treating spinal trauma, or by spreading apart adjacent vertebrae by distraction to move the screw extenders out of the intermingled cross-over position, or by bringing closer adjacent vertebrae by compression to move the screw extenders out of the intermingled cross-over position. However, each of these approaches can result in a less-optimal location of the spinal screws in the pedicles or vertebra for correcting spinal deformity or treating spinal trauma.

Alternatively, the surgeon removes a first screw extender from a first spinal screw (such removal may, for example, be also required at the moment of implantation of the spinal screws into the spine in addition to later stages of the surgical procedure), performs final setscrew tightening on a second spinal screw attached to a second screw extender, removes the second screw extender, and reattaches the first screw extender to the first spinal screw to perform final setscrew tightening on the first spinal screw attached to the first screw extender. However, this prolongs the duration of the surgical intervention for the patient and the surgeon. Moreover, in the case of minimal invasive surgery (MIS), the spinal screw head is internally located under bodily muscle and skin layers which renders the task of reattachment of the screw extender to the spinal screw more difficult for the surgeon and increases the complexity of the surgical intervention for the patient and the surgeon.

SUMMARY

The goal of the present invention is to provide a screw extender that overcomes the above-mentioned inconvenience. In particular, the goal of the present invention is to assure that the duration of a surgical spinal operation is not prolonged or minimally prolonged. Another goal of the present invention is to assure that an optimal location of the spinal screws in the pedicles or vertebra for correcting spinal deformity or treating spinal trauma is available to the surgeon and not hindered or modified as a result of screw extenders in an intermingled cross-over position. Another goal of the present invention is to assure that the complexity of the surgical intervention is not augmented for the patient and the surgeon.

The present invention addresses the above-mentioned limitations by providing a screw extender. In certain example embodiments, there is provided a screw extender that may include an elongated tubular body comprising a proximal end and a distal end, the distal end of the elongated tubular body being configured to receive a pedicle or spinal screw; an elongated attachment member attached to the elongated tubular body and extending beyond the proximal end of the elongated tubular body to a proximal end of the screw extender, and a clearance located directly opposite or directly facing the elongated attachment member and located directly opposite an outer surface of the screw extender defined by the proximal end of the elongated tubular body.

The present invention addresses the above-mentioned limitations by providing a screw extender system including the screw extender, and an elongated screw extender sleeve. In certain example embodiments, there may be provided an elongated screw extender sleeve that may include an elongated tubular body comprising a proximal end and a distal end, the elongated tubular body including a passage extending through the elongated tubular body from the proximal end and towards the distal end to receive at least one pedicle or spinal screw instrument, wherein the distal end of the elongated tubular body includes a chamber in communication with the passage, the chamber being configured to receive a proximal end of a pedicle or spinal screw through a distal entrance opening of the distal end of the elongated tubular body into the chamber.

The present disclosure also concerns a sleeve as an independent instrument or object.

In certain example embodiments, there may be provided a sleeve that may include an elongated tubular body comprising a proximal end and a distal end, the elongated tubular body including a passage extending through the elongated tubular body from the proximal end and towards the distal end to receive at least one pedicle or spinal screw instrument, wherein the distal end of the elongated tubular body includes a chamber in communication with the passage, the chamber being configured to receive a proximal end of a pedicle or spinal screw through a distal entrance opening of the distal end of the elongated tubular body into the chamber.

The present invention addresses the above-mentioned limitations by providing, for example, a screw extender according to claim 1, and a screw extender system including a screw extender and sleeve or screw extender sleeve according to claim 28, as well as, for example, a sleeve or screw extender sleeve according to claim 58. These feature are technically advantageous, for example, providing for one or more of the following advantages.

The screw extender according to the present disclosure advantageously allows two screw extenders to cross-over each other without generating the above-mentioned inconveniences for the surgeon and the patient (see, for example, Figures 12A and 12B).

A final setscrew tightening on each spinal screw attached to a screw extender can, for example, be performed without requiring a reattachment of a screw extender to a spinal screw. There is thus no prolongation of the duration of the surgical intervention for the patient and the surgeon due to reattachment of one or more screw extenders to one or more spinal screws.

Additionally, the complexity of the surgical intervention is not augmented or not significantly augmented for the patient and the surgeon.

It is assured that an optimal location of the spinal screws in the pedicles or vertebra for correcting spinal deformity or treating spinal trauma is available to the surgeon and not hindered or modified as a result of screw extenders in an intermingled cross-over position.

Moreover, the screw extenders of the present invention do not disrupt the Surgeon's current manner of operating on a patient but instead brings an additional option that renders the operation easier for the Surgeon. This allows the Surgeon to work more efficiently and more quickly permitting the duration of the operation to be reduced for the patient.

The present invention also concerns a kit of instruments including at least one or a plurality of the above-mentioned screw extenders, sleeves or screw extender systems. Such a kit can be provided sterile and for single use or could be re-sterilized, for example, in a hospital.

Other advantageous features can be found in the dependent claims.

These and/or other aspects, features, and/or advantages will become apparent and more readily appreciated from the following description of various example embodiments, taken in conjunction with the accompanying drawings showing some preferred embodiments. Thicknesses of layers/elements, and sizes of components/elements, are not necessarily drawn to scale or in actual proportion to one another, but rather are shown as example representations. Like reference numerals may refer to like parts throughout the several views. Each embodiment herein may be used in combination with any other embodiment(s) described herein.

A BRIEF DESCRIPTION OF THE DRAWINGS

Figure 1 is a perspective view showing a non-limiting and exemplary embodiment of a screw extender of the present disclosure and a spinal or bone screw attached thereto at a distal extremity of the screw extender.

Figure 2 is a perspective view showing a non-limiting and exemplary embodiment of a sleeve or screw extender sleeve of the present disclosure. Figure 3 is a perspective view showing a non-limiting and exemplary embodiment of a screw extender system of the present disclosure including the screw extender and screw extender sleeve in a nonassembled state.

Figure 4 is a perspective view showing a non-limiting and exemplary embodiment of the screw extender system of the present disclosure including the screw extender and screw extender sleeve in an assembled state.

Figure 5 is a cross-sectional view of the screw extender system of the present disclosure including the screw extender and screw extender sleeve in an assembled state.

Figure 6 is a perspective view showing a non-limiting and exemplary embodiment of a spinal surgery system of the present disclosure including the screw extender system and additional instruments and/or tools permitting insertion and tightening of a setscrew in a spinal screw head. The spinal surgery system can be used for rod implant insertion and a pre-tightening or final tightening of the setscrew in the screw head of the spinal screw.

Figure 7 is a cross-sectional view of the screw extender system of Figure 6 in which a setscrew driver and setscrew are located inside the screw extender system. The setscrew driver can be used, in such a position, for a pre-tightening of the setscrew in the screw head of the spinal screw.

Figure 8 is a perspective view showing elements of the spinal surgery system of Figure 6 in an assembled state. The spinal surgery system can be used for pre-tightening or final tightening of the setscrew in the screw head of the spinal screw.

Figure 9 is a perspective view showing the screw extender after a pre-tightening of the setscrew in the head of the spinal or bone screw with the rod implant positioned in head of the spinal or bone screw, and the screw extender sleeve temporarily removed from the screw extender. This allows a final tightening of a setscrew in an adjacent crossing screw extender to be performed with removal of any screw extender.

Figure 10 is a perspective view showing the screw extender after a re-attachment of the screw extender sleeve of the present disclosure to the screw extender of the present disclosure and following final tightening of the setscrew and release of the screw extender from the spinal screw.

Figure 11 is a perspective view showing a final state of the spinal screw in which a spinal implant rod is held by inside the head of the spinal screw by the setscrew position in a final tightened state.

Figure 12A is a perspective view showing a crossing-over of the screw extender of the present disclosure with another known prior art screw extender. Figure 12B is a perspective view showing a crossing-over and inter-mingling of two known prior art screw extenders that produce the inconveniences previously presented above.

Figure 13 is a perspective view showing a classical or standard screw extender of length LI. Figures 14A and 14B are schematic top views of exemplary embodiments of the screw extender of the present disclosure.

Figure 15 is a perspective view showing another non-limiting and exemplary embodiment of a sleeve or screw extender sleeve of the present disclosure.

DETAILLED DESCRIPTION OF THE SEVERAL EMBODIMENTS

The following detailed structural and/or functional description(s) is/are provided as examples only, and various alterations and modifications may be made. The example embodiments herein do not limit the disclosure and should be understood to include all changes, equivalents, and replacements within ideas and the technical scope herein. Hereinafter, certain examples will be described in detail with reference to the accompanying drawings. When describing various example embodiments with reference to the accompanying drawings, like reference numerals may refer to like components and a repeated description related thereto may be omitted.

An exemplary screw extender or abridged screw extender, abridged tower or abridged tube 1 according to the present disclosure is shown, for example, in Figure 1; and Figure 5 shows a cross- sectional view of the exemplary screw extender 1 or screw extender device 1 assembled to an exemplary sleeve or screw extender sleeve 3 of the present disclosure.

The screw extender 1 includes a distal end 5A and a proximal end 5B, proximal end 5B is configured to (removably) receive and hold a bone or spinal screw 7. The exemplary screw extender 1 is shown attached to the exemplary spinal screw 7 in Figures 1 and 5. The screw extender 1 is a screw extender for coupling or connection to a bone or spinal screw. The screw extender 1 is, for example, an orthopedic spinal surgery screw extender or an orthopedic screw extender.

The term distal end is generally used in the present disclosure to represent an end located furthest from the user or surgeon when the object in being used by the user or surgeon, or when the object is implanted in the human body, with the term proximal end being generally used to represent an end located closest to the user or surgeon when the object in being used by the user or surgeon, or when the object is implanted in the human body.

The bone or spinal screw 7 comprises an elongated threaded shaft 9 and a screw head 11 attached to a proximal end of the spinal screw 7. The head 11 may be attached to the proximal end of the elongated threaded shaft 9 to define or form, for example, a multi-axial articulation with the proximal end of the elongated threaded shaft 9, or a hinged articulation with the proximal end of the elongated threaded shaft 9. The bone or spinal screw 7 may alternatively be, for example, a mono-axial bone or spinal screw.

The bone or spinal screw 7 is, for example, a pedicle screw 7. The screw extender 1 may be, for example, a pedicle screw extender 1. The spinal screw 7 can, for example, be pre-assembled or pre-mounted to the distal end 5A of the screw extender 1 and/or to an elongated tubular body 15 of the screw extender 1. The spinal screw 7 can, for example, be provided already mounted to the screw extender 1 in packaging or sterile packaging (for example, in at least one surgical kit) and thus ready-to-use by a surgeon. The screw extender 1 may alternatively be provided not having the spinal screw 7 mounted or pre-mounted thereto.

The screw extender 1 includes the elongated tubular body 15 and an elongated attachment member or segment 17. In a non-limiting exemplary embodiment, the elongated tubular body 15 may have a cylindrical shape (see, for example, Figure 1). The screw extender 1 also includes, for example, an open expanse or a clearance 19. The open expanse or clearance 19 is or defines, for example, an object -free zone or free-space zone of the screw extender 1. The object-free zone is, for example, an elongated tubular body object-free zone.

The clearance 19 is configured to receive at least a portion of the sleeve 3 or screw extender sleeve 3 when the screw extender sleeve 3 is mounted onto and attached to the screw extender 1. When the screw extender sleeve 3 is not mounted onto the screw extender 1, the clearance 19 allows an object such as a classical or additional screw extender to be temporarily present and received unobstructed in the clearance 19.

The clearance 19 is schematically illustrated by the dashed-lined frame in Figures 1 and 14B solely for explanatory purposes. It is to be understood that the illustrated dashed-lined frame per se is not physically present in the screw extender 1.

The elongated tubular body 15 comprises a proximal end 21A and a distal end 21B. As mentioned, the distal end 21B of the elongated tubular body 15 is configured to receive the pedicle or spinal screw 7. The elongated tubular body 15 and the elongated attachment member 17 extend, for example, in an elongated longitudinal direction (Y direction, Figure 5, or in a direction of the longitudinal axis LA). In an exemplary and preferred embodiment, the elongated tubular body 15 extends a shorter distance dl in the elongated longitudinal direction than a distance of elongation d2 of the elongated attachment member 17 (see, for example, Figure 5).

The elongated tubular body 15 includes a passage or open-ended conduit 23 extending fully through the elongated tubular body 15 from the proximal end 21A to the distal end 21B. The passage 23 is delimited or defined by at least one wall 25 of the elongated tubular body, for example, an inner surface 27 of the wall 25. The wall 25 and/or the inner surface 27 may include an internal threading 29 configured to couple or engage with surgical instruments permitting the manipulation of implants and the pedicle or spinal screw 7. Such an instrument may include, for example, a setscrew driver 31 and such an implant may include, for example, a setscrew 33 (see Figures 6 and 7). The instruments (for example setscrew driver 31) and/or implants may, for example, include an external threading configured to threadably engage with the internal threading 29. The internal threading 29 may extend partially or at least partially on the inner surface 27 , as shown in the exemplary embodiment illustrated in Figure 5.

The elongated tubular body 15 includes first and second elongated or longitudinal lumens 35 extending to the distal end 21B (or outermost extremity thereof) of the elongated tubular body 15. The first and second elongated or longitudinal lumens 35 are configured to allow a pedicle or spinal screw connecting rod 37 (see for example Figures 6 and 7) to be received in the distal end 21B (or the distal end 21B and proximal end 21A) of the elongated tubular body 15. The first and second elongated or longitudinal lumens 35 extend to define an opening or aperture at the distal end 21B that allows the connecting rod 37 to pass or be displaced between the elongated tubular body 15 and the head 11 of the spinal screw 7. The first and second elongated or longitudinal lumens 35 are, for example, located opposite each other or in diametrically opposed positions on the elongated tubular body 15. The elongated tubular body 15 includes, for example, first and second (elongated) arms RMl, RM2 and the first and second elongated or longitudinal lumens 35 are located between the first and second (elongated) arms RMl, RM2. The internal threading 29, for example, is included or defined on inner surfaces of the first and second (elongated) arms RMl, RM2.

The first and second elongated or longitudinal lumens 35 may, for example, extend from the distal end 21B to the proximal end 21A. This, for example, facilitates lateral insertion for the surgeon of the connecting rod 37 into the screw extender and pedicle screw. The pedicle screw 7 may also include first and second elongated or longitudinal lumens 35B located between first and second (elongated) arms RSI, RS2. The first and second elongated or longitudinal lumens 35B are, for example, located such that when the screw extender and pedicle screw are coupled, the coupled elongated or longitudinal lumens form first and second closed elongated openings (see, for example, Figure 1). This, for example, permits traversal guiding of the displacement of the connecting rod 37 through the instrument and implant.

In the illustrated exemplary embodiment, the first and second elongated or longitudinal lumens 35 may, for example, form a U-shaped lumen whose opening is located at the distal end 21B. The first and second elongated or longitudinal lumens 35B of the pedicle screw 7 may, for example, also form a U- shaped lumen whose opening is located at the proximal end of the pedicle screw 7.

The pedicle or spinal screw connecting rod 37 is an elongated rod 37 that may be, for example, of cylindrical shape. The pedicle or spinal screw connecting rod 37 has a cross-sectional width or thickness allowing the rod 37 to be received inside the head 11 of a spinal or pedicle screw 7. The pedicle or spinal screw connecting rod 37 has a length allowing the rod 37 to be received inside at least the heads 11 of two spaced apart spinal or pedicle screws 7, for example, located in adjacent pedicles or vertebrae. The rod 37 has a length that permits the rod to be received in the heads of at least two spinal screws 7. A width or diameter of the rod 37 is such that it can be received inside a head of an implantable spinal or pedicle screw 7. In a non-limiting example, the rod 37 may, for example, have a length of between 30mm and 300 mm and a diameter or width between 4 and 7mm. The rod 37 can, for example, be a straight rod or alternatively be a bent rod. The rod 37, for example, comprises or consists solely of steel, stainless steel or titanium.

The first and second (elongated) arms RSI, RS2, and/or the wall 25 and/or the inner surface 27 thereof of the distal end 21B of the elongated tubular body 15 is, for example, configured to engage or connect with the head 11 of the pedicle or spinal screw 7.

The wall 25 and/or the inner surface 27 thereof of the distal end 21B of the elongated tubular body 15 is, for example, configured to engage with the head 11 of the pedicle or spinal screw 7 to permit a longitudinal axial displacement of the pedicle or spinal screw 7 relative to the elongated tubular body 15 to release to pedicle or spinal screw 7 from the distal end 21B of the elongated tubular body 15. This permits a release by relative axial displacement.

The wall 25 and/or the inner surface 27 thereof of the distal end 21B of the elongated tubular body 15 is, for example, configured to engage with a lateral surface LS of the head 11 of the pedicle or spinal screw 7 to attach the pedicle or spinal screw 7 to the distal end 21B of the elongated tubular body 15. Each of the wall 25 and/or the inner surface 27 thereof of the distal end 21B of the elongated tubular body 15 and the head 11 include a complementary engagement mechanism permitting the screw extender to releasably couple or engage with the bone screw 7. The engagement mechanisms may, for example, be located or included on respective arms of the head 11 and the elongated tubular body 15.

The wall 25 and/or the inner surface 27 thereof of the distal end 21B of the elongated tubular body 15 is, for example, configured to engage with the head 11 of the pedicle or spinal screw 7 by press-fit or form fit.

The spinal screw 7 can be, for example, attached to the distal end 21B of the elongated tubular body 15 by a non-frangible attachment or a non-breakable attachment. The spinal screw 7 can be, for example, removed or be removable from the distal end 21B of the elongated tubular body 15 by a non- frangible removal or a non-breakable removal.

The spinal screw 7 and the distal end 21B of the elongated tubular body 15 are configured to release the spinal screw 7 from the distal end 21B of the elongated tubular body 15 by an on-axis relative displacement of the spinal screw 7 relative to the distal end 21B, or by an axial displacement parallel to the longitudinal axis LA of the spinal screw 7 relative to the distal end 21B.

The distal end 21B of the elongated tubular body 15 may include, for example, in an exemplary embodiment, at least one or a plurality of ribs or elongated protrusions 39 configured to be received in at least one or a plurality of corresponding or complementary grooves or elongated depressions 41 (see for example Figure 11) of the head 11 of the spinal screw 7. The grooves or elongated depressions 41 are located to receive the ribs or elongated protrusions 39 so as longitudinally displace the pedicle or spinal screw 7 relative to the elongated tubular body 15 along or parallel to the longitudinal axis LA (Y-direction, Figure 5) of the pedicle or spinal screw 7 and the elongated tubular body 15.

The pedicle or spinal screw 7 is slidably received and guided in the distal end 21B of the elongated tubular body 15, and is slidably displaced and guided away from the distal end 21B of the elongated tubular body 15 to remove the pedicle or spinal screw 7 from the elongated tubular body 15.

In an alternative embodiment, the distal end 21B of the elongated tubular body 15 may include, for example, at least one or a plurality of grooves or elongated depressions, and the head 11 of the spinal screw 7 may include ribs or elongated protrusions.

The setscrew driver 31 when rotated on the internal threading 29 of the elongated tubular body 15 after final tightening of the setscrew 33 can push or pushes the spinal screw 7 away from the distal end 21B of the elongated tubular body 15 (and/or pushes the elongated tubular body 15 away from the spinal screw 7 when the spinal screw is attached to or fixed in a pedicle or vertebra) in a direction parallel to the longitudinal axis LA (Y-direction, Figure 5) to separate the spinal screw 7 from the elongated tubular body 15, as shown for example in Figure 10.

The pedicle or spinal screw 7 comprises or consists of, for example, a different material to that of the elongated tubular body 15 or that of the distal end 21B of the elongated tubular body 15, or that of screw extender 1. The pedicle or spinal screw 7 is made of, for example, a different material to that of the elongated tubular body 15 or that of the distal end 21B of the elongated tubular body 15 or that of screw extender 1. The pedicle or spinal screw 7 comprises or consists of, for example, a different material to that of the screw extender sleeve 3. The pedicle or spinal screw 7 is made of, for example, a different material to that of the screw extender sleeve 3.

The pedicle or spinal screw 7 may comprise or consist solely of, or be made of at least one metal, for example aluminum or stainless steel. The elongated tubular body 15 or the distal end 21B of the elongated tubular body 15 or the screw extender 1 may comprise or consist solely of, or be made of at least one polymer or plastic material for example polyamide, or polyetherimide, or polysulfone, or a member of the PAEK family, or the PEEK family or the PEKK family. The screw extender sleeve 3 may comprise or consist solely of or be made of at least one polymer or plastic material for example polyamide, or polyetherimide, or polysulfone, or a member of the PAEK family, or the PEEK family or the PEKK family.

The distal end 21B of the elongated tubular body 15 includes, or partially or fully defines or delimits a distal opening for receiving the head 4 of the pedicle screw 7 into the elongated tubular body 15.

The proximal end 21A of the elongated tubular body 15 includes, or partially or fully defines or delimits a proximal opening 43 (see for example, Figure 5, 7, 12A, 14A, 14B) of the elongated tubular body 15 and/or of the passage 23 of the elongated tubular body 15 for receiving pedicle or spinal screw instruments, such as the setscrew driver 31. The passage 23 extends between the distal and proximal openings and allows an instrument to pass fully through the elongated tubular body 15.

In another exemplary embodiment, the elongated attachment member 17 may, for example, be attached and extend from the elongated tubular body 15 so as to partially define or delimit the proximal opening 43, in addition to the elongated tubular body 15 also partially defining or delimiting or including the proximal opening 43.

The proximal end 21A of the elongated tubular body 15 includes an outer rim or platform 45 defining or including an outer surface 47 (see for example Figures 14A and 14B) of the proximal end 21B of the elongated tubular body 15. The outer rim or platform 45 (and/or the outer surface 47 thereof) may include, define or delimit the proximal opening 43 (or a portion thereof) of the elongated tubular body 15, and/or the proximal opening 43 (or a portion thereof) of the passage 23.

The outer surface 47 faces (at least partially) outwards in a direction of elongation of the elongated attachment member 17. The outer surface 47 faces, at least partially, outwards in a direction opposite to the direction of elongation of the spinal screw 7 from the elongated tubular body 15, when the spinal screw 7 is attached to the elongated tubular body 15.

The outer surface 47 faces outwards to a side of the screw extender where the proximal end of the elongated attachment member 17 is located.

The outer surface 47 includes an outer surface portion or platform surface 49 (see, for example, Figures 14A and 14B) that is separated from the elongated attachment member 17 by the proximal opening 43 and/or by the passage 23 of the elongated tubular body 15. The outer surface portion or platform surface 49 is, for example, located or laterally located on an opposite side of the elongated tubular body 15 to that of the elongated attachment member 17, and separated by the proximal opening 43 and/or by the passage 23.

The outer rim or platform 45 and/or the outer surface 47 is located (at least partially) opposite or facing the clearance 19.

In the exemplary embodiment in which the elongated attachment member 17 is attached and extends from the elongated tubular body 15 to partially define or delimit the proximal opening 43, in addition to the elongated tubular body 15 also partially defining or delimiting or including the proximal opening 43, the elongated attachment member 17 includes a distal portion or inner facing distal portion 17b that extends to the outer rim or platform 45. The distal portion 17b is, for example, located at a distal end DE of the elongated attachment member 17.

The distal portion 17b may include or define an outer surface 47b (see, for example, Figure 12A). The distal portion 17b (and/or the outer surface 47b thereof) may, for example, extend to the outer rim or platform 45, and the outer rim or platform 45 or the outer surface 47 thereof may extend to partially define or delimit the proximal opening 43. The distal portion 17b and/or the outer surface 47b thereof may, for example, extend to include, define or delimit a portion of the proximal opening 43 of the elongated tubular body 15, and/or of a portion of the passage 23. Alternatively, the distal portion 17b and/or the outer surface 47b thereof may, for example, extend to the outer rim or platform 45, and the outer rim or platform 45 or the outer surface 47 thereof may extend to fully define or delimit the proximal opening 43 of the elongated tubular body 15, and/or of a portion of the passage 23.

The clearance 19, for example, is or consists solely of a space (or airspace). The clearance 19 is, for example, an area devoid of material (or screw extender material) into which area or air space an object can be received therein unobstructed or can be passed through unobstructed. This allows an object or instrument such as a classical or additional screw extender to be temporarily received unobstructed and be present in the clearance 19.

The clearance 19 for example is or defines a cut-out region or a partially recessed region. The cut-out region or partially recessed region being a region in which screw extender material is absent, or a region devoid screw extender material that consists solely of an airspace.

The clearance 19 is, for example, located directly opposite or directly facing the elongated attachment member 17 and located directly opposite or facing the outer surface 47 of the screw extender 1 defined by the proximal end 21A of the elongated tubular body 15.

The clearance 19 is, for example, located directly opposite or directly facing the elongated attachment member 17 and located directly opposite or facing the passage 23 and/or in fluid (air) communication with the passage.

The clearance 19 is located above the outer surface 47 and/or the outer rim or platform 45 (see, for example, Figure 1) in a direction extending towards or facing towards the proximal end 5B of the screw extender 1. The clearance 19 may be located above or facing the outer surface 47b and/or the distal portion 17b or at least a portion thereof.

The clearance 19 is, for example, located (at least partially) directly opposite or directly facing the outer surface portion or platform surface 49 (and/or the outer surface 47b). The area above or directly above or directly facing or directly opposite the outer surface portion or platform surface 49 (and/or the outer surface 47b) is, for example, entirely devoid of material or screw extender material. The area above or directly above or directly facing or directly opposite the outer surface portion or platform surface 49 (and/or the outer surface 47b) is, for example, an airspace or consists solely of an airspace. The elongated attachment member 17 is attached to the elongated tubular body 15, for example, at the proximal end 21Aof the elongated tubular body 15. The elongated attachment member 17 extends beyond the proximal end 21A of the elongated tubular body 15 to or towards the proximal end 5B of the screw extender 1 (see, for example, Figure 1). The distal end DE of the elongated attachment member 17 is, for example, attached to the proximal end 21A of the elongated tubular body 15. The elongated attachment member 17 may, for example, extend from the first or second arms RMl, RM2 of the elongated tubular body 15.The elongated attachment member 17, for example, defines or delimits the proximal end 5B of the screw extender l.ln an embodiment, the elongated attachment member 17 extends, for example, from the outer rim or platform 45 of the proximal end 21A of the elongated tubular body 15. The elongated attachment member 17 may, for example, be attached to the elongated tubular body 15 at the outer rim or platform 45 of the proximal end 21A of the elongated tubular body 15.

The elongated attachment member 17 is configured to be removably coupled to the elongated screw extender sleeve 3. The elongated attachment member 17 is, for example, configured to slidably receive the elongated screw extender sleeve 3 (Figures 2 to 4) to guide a displacement of the elongated screw extender sleeve 3 relative to and/or along the elongated tubular body 15 of the screw extender 1.

The elongated attachment member 17 is, for example, configured to slidably receive and guide a displacement of the elongated screw extender sleeve 3 along the elongated attachment member 17 to the elongated tubular body 15, to receive the elongated tubular body 15 inside the elongated screw extender sleeve 3.

The elongated attachment member 17 may, for example, include at least one connection mechanism 51 configured to interact or cooperate with a corresponding or complementarity connection mechanism 53 of the elongated screw extender sleeve 3. This facilitates and quickens assembly of the screw extender to the sleeve 3.

In an embodiment, the immobilization mechanism 51 may, for example, include a projection or elongated projection 51, for example a ridge (see for example Figures 5 and 14B), configured to be received and guided by a connection mechanism 53 of the screw extender sleeve 3, the connection mechanism 53 may include, for example, a groove or elongated groove 53 (see, for example, Figure 2). Alternatively, the connection mechanisms 51, 53 may, for example, include at least one groove or elongated groove configured to receive and guide a complementary projection or elongated projection of the elongated screw extender sleeve 3.

The connection mechanism 51 may, for example, be located opposite or facing the clearance 19.

The elongated attachment member 17 includes an elongated body 55.

The elongated body 55 may have a thickness (in the X-direction and/or (substantially) perpendicular to a direction of elongated extension) and/or be made of a material permitting the elongated body 55 to be flexible and be movable by a user in a direction (X-direction) substantially perpendicular to the longitudinal axis LA of the screw extender 1.

The elongated body 55 comprises a first side or face SI and a second side or face S2 located opposite the first side or face SI. The first face SI faces towards, for example, the clearance 19 or the opening 43 defined by the proximal end 21A of the elongated tubular body 15. The first side or face SI (inner side or face) faces, for example, the clearance 19 and/or faces inwards towards the longitudinal axis LA of the screw extender 1. The second side or face S2 (outer side or face) faces, for example, outwards away from the longitudinal axis LA of the screw extender 1.

The connection mechanism 51 or the projection or elongated projection 51 is, for example, located on the first side or face SI.

The elongated attachment member 17 and/or the elongated body 55 may include at least one prehension tab or landing 57 located at the proximal end 5B of the screw extender 1 and at a proximal end PE of the elongated attachment member 17. The prehension tab 57 extends or protrudes from the elongated body 55 or an intermediate member or ridge 59 of the elongated body 55 (see, for example, Figure 1). The intermediate member or ridge 59 may, for example, extend from the distal end of the elongated attachment member 17 to the proximal end thereof. The prehension tab or landing 57 facilitates and quickens assembly and disassembly of the screw extender to the sleeve 3.

The elongated attachment member 17 includes at least attachment mechanism (or attachment and guiding mechanism) 61 configured to interact or cooperate with a corresponding or complementary attachment mechanism (or attachment and guiding mechanism) 63 of the elongated screw extender sleeve 3.

The attachment mechanism 61 may, for example, be located and/or extend from an outermost extremity of the proximal end of the elongated attachment member 17 and/or the screw extender 1. This facilitates and quickens assembly and disassembly of the screw extender to the sleeve 3.

The attachment 61 and corresponding attachment 63 may, for example, be configured to hold the screw extender attached to the sleeve 3 during a sliding displacement of the screw extender relative to the sleeve 3, and/or may, for example, be configured to axially guide the displacement of the screw extender relative to the sleeve 3.

In an embodiment, the attachment mechanism 61 may include, for example, at least one rail 61 having a complementary shape to that of the attachment mechanism 63 of the elongated screw extender sleeve 3, for example, at least one rail guide 63 or inner passage 63 of the sleeve 3. In an embodiment, the rail guide 63 may, for example, include or define the inner passage.

The at least one attachment mechanism 61 (or rail 61) can be, for example, located on the second side or face S2 and/or on the first face SI of the elongated attachment member 17.

The at least one rail 61 is, for example, configured to be received and guided by the at least one rail guide or inner passage 63 of the elongated screw extender sleeve 3. In the illustrated exemplary embodiment, the elongated attachment member 17 includes a first rail 61A and a second rail 61B (see for example Figure 1).

The first rail 61A is, for example, configured to be received and guided by a first rail guide or inner passage 63A of the elongated screw extender sleeve 3, and the second rail 61B is, for example, configured to be received and guided by a second rail guide or inner passage 63B of the elongated screw extender sleeve 3 (see, for example, Figure 2).

The connection mechanism 53 of the elongated screw extender sleeve 3 can be, for example, located between the first rail guide or inner passage 63A and the second rail guide or inner passage 63B of the elongated screw extender sleeve 3.

The first rail 61A and the second rail 61B may be, for example, separated by the intermediate ridge 59. The intermediate ridge 59 may, for example, include or define, a first elongated guiding surface GF1 that cooperates with a guiding surface of the first guide rail 63A, and a second elongated guiding surface GF2 that cooperates with a guiding surface of the second guide rail 63B to guide and/or centre a relative displacement of the elongated attachment member 17 relative to the sleeve 3.

The elongated attachment member 17 may, for example, include at least one immobilization mechanism 65 or elongated screw extender sleeve immobilization mechanism 65A (see, for example, Figure 5). The immobilization mechanism 65A is configured to engage an attachable instrument, for example, the elongated screw extender sleeve 3 to temporarily immobilize a displacement of the screw extender relative to, or along, the instrument or elongated screw extender sleeve 3.

In an exemplary embodiment, the immobilization mechanism 65A may, for example, comprise at least one protrusion or clip (for example, located on the inner surface SI of the elongated attachment member 17) configured to be received and removably held in a complementary depression or groove 65B (see, for example, Figure 2) located on the instrument or on the elongated screw extender sleeve 3. Alternatively, the immobilization mechanism 65A may, for example, comprise at least one depression or groove configured to receive a complementary protrusion or clip.

The immobilization mechanism 65A is, for example, located on the elongated attachment member 17 to be displaced and placed into an immobilization position by the sleeve 3 (see for example Figure 2) during the sliding movement of the screw extender relative to the sleeve 3. The sleeve 3 may include for example an activation mechanism 67 configured to act on the elongated attachment member 17 and/or the immobilization mechanism 65A during the relative (axial) sliding movement.

Attachment of the immobilization mechanism 65A can, for example, be activated by a ramp 67 (see for example Figure 2) during a sliding movement to displace and/or guide the immobilization mechanism 65A to the complementary immobilization mechanism 65B of the instrument or elongated screw extender sleeve 3.

Release of the immobilization mechanism 65A can be activated by the user laterally displacing the proximal end of the elongated body 55 in the direction (X-direction) substantially perpendicular to the longitudinal axis LA. This permits the immobilization mechanism 65A to be released or freed from the complementary immobilization mechanism 65B of the instrument or elongated screw extender sleeve 3, and the screw extender 1 and the elongated screw extender sleeve 3 to be slidably removed from one another.

As previously mentioned, in an exemplary and preferred embodiment, the elongated tubular body 15 extends a shorter distance dl in the elongated longitudinal direction or in a direction of the longitudinal axis LA of the elongated tubular body 15 than a distance of elongation d2 of the elongated attachment member 17 (see, for example, Figure 5).

The screw extender 1, the elongated attachment member 17 and the elongated tubular body 15 extend in the elongated longitudinal direction or in a direction of or parallel to the longitudinal axis LA. The elongated tubular body 15 may, for example, extend a distance dl that is less than half of a full distance d3 of extension of the screw extender 1 in the elongated longitudinal direction or in a direction of the longitudinal axis LA (see, for example, Figure 5).

The elongated tubular body 15 may, for example, extend a shorter distance in the elongated longitudinal direction, or in a direction of or parallel to the longitudinal axis LA, than the pedicle or spinal screw 7 (dl<ds). The elongated attachment member 17 may, for example, extend a longer distance in the elongated longitudinal direction or in a direction of or parallel to the longitudinal axis LA than the pedicle or spinal screw 7 (d2>ds).

The above-mentioned distances each being measured, for example, at outer most extremities of the concerned object.

The screw extender 1 includes the tubular section 15 or the elongated tubular body 15 that is, for example, compact or shorter in length dl than known screw extenders SE having a length LI, such as those shown in Figure 12B. The screw extender 1 can be considered to be a fractional tubular screw extender, or a mini or compact tubular screw extender 1 compared to such an additional or second screw extender SE of length or tubular length LI (see for example Figure 13). The tubular section 15 of the compact screw extender 1 is advantageously dimensionally shorter and economical in operation. Another aspect of the present disclosure concerns at least one kit (or a disposable single use sterilized kit) or an ensemble of kits (or disposable single use sterilized kits) including at least one screw extender 1, or at least one screw extender 1 and an at one additional screw extender SE of length or tubular length LI greater than the elongated distance of extension dl of the screw extender 1. A screw 7 may also be included mounted or non-mounted to the screw extender 1 and/or additional screw extender SE.

The screw extender 1 may, for example, be a disposable single use instrument.

The screw extender 1 assures a cross-over space in the headroom or empty-space above the elongated tubular body 15 that allows two screw extenders to cross-over each other unhindered and without generating inconveniences for the surgeon and the patient (see, for example, Figures 12A and 12B) such as those previously described. The two screw extenders can be a screw extender 1 according to the present disclosure and a known or classic screw extender (such as the screw extender SE shown in Figures 12B and 13). Alternatively, the two screw extenders can be two screw extenders 1 according to the present disclosure.

The unobstructed crossing that is assured by the screw extender 1 assures that an optimal location of the spinal screws in the pedicles or vertebra for correcting spinal deformity or treating spinal trauma is available to the surgeon and not hindered or modified as a result of screw extenders in an intermingled and obstructing cross-over position.

The screw extender 1 permits to avoid removals of a screw extenders from bone screws, and reattachments of the screw extenders to the bone screws during the surgical intervention.

Additionally, for example, a final setscrew tightening on each spinal screw attached to the screw extenders is performed first on one screw extender and then on the second screw extender without requiring a reattachment of a screw extender to the spinal screw. There is thus no prolongation of the duration of the surgical intervention for the patient and the surgeon due to reattachment of one or more screw extenders to one or more spinal screws.

This also assures that the complexity of the surgical intervention is not augmented for the patient and the surgeon, and that the duration of a surgical spinal operation is not prolonged or at the very least only minimally prolonged.

A further aspect of the present disclosure concerns a screw extender system 70 including the screw extender 1, and the sleeve 3 or elongated screw extender sleeve 3 (see, for example, Figures 3 and 4). The elongated sleeve 3 or screw extender sleeve 3 provides or easily and quickly restores the advantages of a classic screw extender SE to the screw extender 1 of the present disclosure. For example, the elongated screw extender sleeve 3 assures a prolongation of the elongated tubular body 15 of the screw extender 1 that permits access to the spinal screw 1 via the proximal extremity of the elongated screw extender sleeve 3 that is, for example, located outside the body of the patient during the surgical procedure.

Furthermore, the elongated sleeve 3 or screw extender sleeve 3 assures or is, for example, a counterforce or counter-torque sleeve for final tightening, or a torque transfer/release sleeve 3 or force transfer/release sleeve 3.

During final tightening of the setscrew 33 to the connecting rod 37 in the screw head 11 of the spinal screw 7 by, for example, a setscrew screwdriver, a force (or torque) is generated during rotation of the setscrew 33 in the screw-head 11. The tightening action can result, for example, in a relative rotation of the screw head 11 and/or the distal end of the screw extender relative to the sleeve 3 (for example, due to some material deformation resulting from the applied tightening force). The can result, for example, in the rod 37 contacting the distal end of sleeve 3 and/or the elongated lumens 119. The elongated screw extender sleeve 3 (for example, enclosing the connecting rod 37 at two separated locations) advantageously provides a counterforce (or counter-torque) to the connecting rod 37, and/or can receive the force or torque from the rod 37 and transfer or propagate the force (or torque) generated during rotation of the setscrew 33 in the screw-head 11 of the pedicle or spinal screw 7 away from the connecting rod 37 and longitudinally through the sleeve 3. This, for example, prevents or reduces the force (or torque) generated during rotation of the setscrew 33 being transferred to the screw extender 1 (connected to the head of the spinal 7) permitting to avoid damaging or breakage of the screw extender 1 (for example, in a zone surrounding or adjacent to the connection to the head of the spinal 7). A counter-force instrument or tool may, for example, also be used in association with the elongated screw extender sleeve 3. The counter-force instrument or tool may, for example, be releasably attached to the sleeve 3 at a proximal end of the sleeve 3. This further allows the provision of a counter-force (or counter-torque) to the connecting rod 37.

The counter-torque provided by the elongated screw extender sleeve 3 can, for example, also permit less material to be used in the fabrication of the instruments.

Details of the elongated sleeve 3 or screw extender sleeve 3 are described further below. Yet a further aspect of the present disclosure concerns the sleeve or screw extender sleeve 3 as an independent object or instrument to that of the screw extender 1 and the system 70.

Figure 2, for example, shows one exemplary embodiment of the sleeve 3, or the screw extender sleeve or sheath 3. The sleeve 3 or screw extender sleeve 3 may be, for example, a pedicle screw sleeve 3 or pedicle screw extender sleeve 3.

Figure 15, for example, shows another exemplary embodiment of the sleeve 3, or screw extender sleeve or sheath 3.

The sleeve 3 of the exemplary embodiment of Figure 15 may, for example, be used with a screw extender 1 that is identical to that previously described herein and whose elongated attachment member 17 or the body 55 thereof is different to that previously described, in that the elongated attachment member 17 and/or the body 55 thereof extends from the elongated tubular body 15 in a non-protruding lateral manner, that is, non-protruding in the lateral direction or X-direction or radial direction of the elongated tubular body 15. The elongated attachment member 17 or body 55 extends, for example, (vertically) level to or in alignment/parallel to the wall 25 (or the outer surface thereof) of the elongated tubular body 15; or the elongated attachment member 17 or body 55 extends (substantially) flush/aplomb to the outer surface of the wall of the elongated tubular body 15 and is non-protruding relative to the outer surface of the wall of the elongated tubular body 15. The prehension tab or landing 57 may be absent or extending in a longitudinal direction. An inner surface of the sleeve 3 may, for example, include or define a coupling and/or guiding mechanism or means such as an (elongated) ridge or groove configured to cooperate with a corresponding or complementary (elongated) ridge or groove located on the elongated attachment member 17.

The ridge may, for example, be the ridge 59 previously described. The attachment mechanism 61 may, for example, be absent from the elongated attachment member 17. The ridge 59 may, for example, cross-sectionally have or form a dove-tail shape to be received and guided in a complementary shaped elongated groove, the groove being included or defined for example on the inner surface of the sleeve 3 (or on the outer surface of the elongated attachment member 17 in an alternative embodiment for cooperation with a ridge provided on the inner surface of the sleeve 3).

The sleeve 3 may thus receive the proximal and distal end of the screw extender inside the sleeve 3 and receive the elongated attachment member 17 inside the proximal end 105B of the sleeve 3.

The sleeve 3 or screw extender sleeve 3 includes the elongated tubular body 103 comprising the proximal end 105B and the distal end 105A. The elongated tubular body 103 includes a passage 107 extending through the elongated tubular body 103 from the proximal end 105B and towards or to the distal end 105A to receive at least one pedicle or spinal screw instrument 31. The passage 107 is defined or delimited by, for example, an inner surface of the sleeve 3 or the elongated tubular body 103.

The passage 107 allows, for example, an instrument to be inserted through a proximal entrance opening APB of the proximal end 105B and passed through the passage 107 to a distal entrance opening APA of the distal end 105A.

The distal end 105A of the elongated tubular body 103 includes a chamber 109 or socket 109 in communication with the passage 107. The passage 107 or the inner surface of the sleeve 3 or the elongated tubular body 103 may, for example, define or delimit the chamber 109.

The passage 107 may, for example, laterally increase in width or diameter (in the Z-direction or X- direction) in the distal end of the 105A of the sleeve 3 to define or delimit the chamber 109.

The chamber 109 is, for example, configured to receive the proximal end 21A of the elongated tubular body 15 of the screw extender and/or the proximal end of the pedicle or spinal screw 7 through the distal entrance opening APA of the distal end 105A of the elongated tubular body 103 into the chamber 109 (see, for example, Figure 4).

The chamber 109 is, for example, configured to receive the screw-head 11 of the pedicle or spinal screw 7. The distal end 105A of the sleeve 3 is, for example, configured to receive and contact a pedicle or spinal screw connecting rod 37 held in the screw-head 11 to apply a counter-torque or counter force and/or to transfer or propagate a generated force or torque on the connecting rod 37 to the sleeve 3 and/or longitudinally through the sleeve 3. The generated force or torque is, for example, generated during rotation of a setscrew 33 in the screw-head 11 of the pedicle or spinal screw 7.

An inner surface 117 defining or delimiting the elongated tubular body 103 or the chamber 109 may, for example, be configured to non-directly couple or non-directly connect to a screw-head 11, or may be configured to indirectly couple or indirectly connect or attach to a screw-head (11) of the pedicle or spinal screw (7).

The inner surface 117 defining or delimiting the elongated tubular body 103 or the chamber 109 may alternatively, for example, be configured to contact the screw-head 11 by a non-attaching direct contact or a non-attaching temporarily or permanent direct contact with the screw-head 11. The inner surface 117 defining or delimiting the elongated tubular body 103 or the chamber 109 may, for example, be configured to contact the screw-head 11 by a non-binding/non-gripping direct contact or a non-binding/non-gripping temporarily or permanent direct contact with the screw-head 11.

The inner surface 117 defining or delimiting a distal portion of the chamber 109 is, for example, screwhead connection-less or screw-head connection-free, or screw-head direct connection-less or screwhead direct connection-free.

The chamber 109 is, for example, configured to receive and hold the pedicle or spinal screw 7 and the pedicle or spinal screw connecting rod 37 held in the screw-head 11 to apply a counter-torque or counter force and/or to transfer or propagate a generated force or torque on the connecting rod 37 to the sleeve 3 and/or longitudinally through the sleeve 3.

The elongated tubular body 103 of the sleeve 3 includes, for example, first and second elongated or longitudinal lumens 119A, 119B extending to the distal end 105A of the elongated tubular body 103 to allow a pedicle or spinal screw connecting rod 37 to be simultaneously received by the distal end 105A of the elongated tubular body 103 of the sleeve 3 and in the screw-head 11. The pedicle or spinal screw connecting rod 37 is, for example, simultaneously received, traverse to the longitudinal axis LA of the pedicle or spinal screw 7, by the distal end 105A of the elongated tubular body 103 of the sleeve 3 and in the screw-head 11.

The first and second elongated or longitudinal lumens 119A, 119B are, for example, configured to receive and contact the pedicle or spinal screw connecting rod 37 when the spinal screw 7 is located inside the chamber 109 and/or when the elongated tubular body 15 of the screw extender is located inside the chamber 109.

The first and second elongated or longitudinal lumens 119A, 119B are, for example, configured to receive and contact the pedicle or spinal screw connecting rod 37 during rotation of a setscrew 33 in a screw-head 11 to apply a counter-torque or counter force and/or to transfer or propagate a generated force or torque on the connecting rod 37 to the sleeve 3 and/or longitudinally through the sleeve 3. The elongated or longitudinal lumens 119A, 119B are, for example, located at the distal end 105A of the elongated tubular body 103. The first and second elongated or longitudinal lumens 119A, 119B are, for example, located opposite or facing one another.

The (or each) elongated or longitudinal lumen 119A, 119B extends in an elongated manner to the outermost extremity of the distal end 105A of the elongated tubular body 103 and includes an opening RO into the lumen 119A, 119B at the outermost extremity of the distal end 105A of the elongated tubular body 103, and includes a closed extremity CE located opposite the opening RO, the closed extremity CE being located in the distal end 105A of the elongated tubular body 103. The openings RO allows simultaneous insertion of the elongated rod 37 into the sleeve 3 at two separate locations on the rod 37, and the closed extremities CE hold or maintain the elongated rod 37 located in or at the distal end 105A of the elongated tubular body 103. The closed extremities CE define a surface that can contact the elongated rod 37 located in or at the distal end 105A of the elongated tubular body 103 to couple or retain the elongated rod 37 to the distal end 105A of the elongated tubular body 103.

This, for example, permits the elongated or longitudinal lumens 119 to contact and press on the rod 37 during rotation of the setscrew 33 in the screw-head 11 of the pedicle or spinal screw 7 during a tightening of the setscrew 33 and to provide a counter-force or counter-torque.

The elongated or longitudinal lumens 119A, 119B are, for example, located only at the distal end 105A of the elongated tubular body 103. The elongated or longitudinal lumens 119A, 119B are, for example, located in the distal half (for example, beyond LNG/2), distal quarter (for example, beyond LNG/4) or distal one-eight (for example, beyond LNG/8) or distal one-tenth (for example, beyond LNG/10) of the sleeve 3, where LNG is, for example, the axial length of the sleeve 3 in the axial direction LA (see, for example, Figure 5).

The elongated tubular body 103 includes at least one wall 115. The wall 115 includes or a surface thereof defines the elongated or longitudinal lumens 119A, 119B. The wall 115 includes or defines a recess that forms the elongated or longitudinal lumen. The recess extends in an elongated manner from the outermost extremity of the distal end 105A of the elongated tubular body 103 towards the proximal end 105B of the sleeve 3. The recess extends to a location of the distal end 105A where the wall 115 includes, or a surface thereof defines, a closure or stop SP of the recess that delimits the closed extremity CE of the lumen.

The closure or stop SP and a surface thereof may, for example, have a curved shape to receive and contact a curved surface of the rod 37.

The closed extremities CE or stops SP thereof may for example, be located at a distance DL from the outermost extremity OME of the distal end 105A of the sleeve 3 (see, for example, Figure 15) so that the outermost distal extremity (DIVIDE of the sleeve 3 does not extend beyond the head 11 of the spinal screw 7 when the rod 37 is in contact with the closed extremities CE or stops SP or surfaces thereof(see for example Figure 6).

The closed extremities CE or stops SP thereof may, for example, be located at a distance DL from the outermost extremity OME of the distal end 105A of the sleeve 3 (see, for example, Figure 15), where the distance DL is less than or equal to LNG/4, or LNG/8 or LNG/10; or is less than or equal to 2.5cm, 2cm, 1.75cm, 1.5cm, 1.25 cm or 1cm. LNG is, for example, the axial length of the sleeve 3 in the axial direction LA (see, for example, Figure 5).

The wall 115 includes or defines a first and second elongated contact surfaces CF1, CF2 located opposite one another that can contact the rod 37 when the rod 37 is in the lumens 119. The first and second elongated contact surfaces CF1, CF2 are, for example, separated by a distance that permits the rod 37 to be releasably positioned therein, and allows the sleeve 3 to seize the rod 37. The separation distance may be such that the rod 7 is receives inside the lumens as a slidably releasable form fit. At least one of the elongated contact surfaces CF1, CF2 may contact, for example, the rod 37 during tightening of the set screw in the head 11 of the spinal screw 7.

The first and second elongated or longitudinal lumens 119 are configured to allow the connecting rod 37 (see for example Figure 6) to be received in the distal end 105A (or only the distal end 105A) of the sleeve 3.

The first and second elongated or longitudinal lumens 119 extend to define an opening or aperture at the distal end 105A that allows the connecting rod 37 to pass or be displaced between the elongated tubular body 103 and the head 11 of the spinal screw 7. As mentioned, the first and second elongated or longitudinal lumens 119 are, for example, located opposite each other or in diametrically opposed positions on the elongated tubular body 103. The elongated tubular body 103 includes, for example, at least one or first and second (elongated) arms, and the first and second elongated or longitudinal lumens 119 are located between the at least one or the first and second arms.

The first and second elongated or longitudinal lumens 119 allows lateral insertion by the surgeon of the connecting rod 37 into the screw extender 1 and/or the first and second elongated or longitudinal lumens 35B of the spinal screw 7 that each have a closed extremity located at a distal end of the screw head 11 of the screw 7. The first and second elongated or longitudinal lumens 119 are, for example, located such that when the screw extender and/or pedicle screw are coupled to the sleeve 3, the coupled elongated or longitudinal lumens form first and second closed elongated openings (see, for example, Figure 6). This, for example, permits traversal guiding of the displacement of the connecting rod 37 through the instrument(s) and implant.

In the illustrated exemplary embodiment, the first and second elongated or longitudinal lumens 119 may, for example, form a U-shaped lumen whose opening RO is located at the distal end 105A. The sleeve 3 or screw extender sleeve 3 may, for example, optionally include an attachment or fixation device 131 (see for example Figure 15) located, for example, at a proximal end of the sleeve 3 and/or the elongated tubular body 103. The attachment or fixation device 131 is, for example, configured to attach or fix to a proximal end of an instrument or tool received and extending inside the sleeve 3 or passage 107 to the distal end of the sleeve 3 or the elongated tubular body 103. The attachment or fixation device 131 comprises, for example, a form-fit or press-fit member configured to attach or fix to a complementary or corresponding form-fit or press-fit member of the instrument or tool received and extending inside the sleeve 3 or passage 107 to the proximal end of the sleeve 3 or elongated tubular body 103.

The instrument or tool may alternatively be a counter-torque device or handle 133 (see for example Figure 6) configured to be removably attached to the attachment or fixation device 131 in a traverse manner.

The sleeve 3 or screw extender sleeve 3 is, for example, configured to internally receive and/or hold the elongated tubular body 15, and to internally and/externally receive and/or hold the elongated attachment member 17 (see, for example, Figure 4). The sleeve 3 can, for example, be configured to receive the screw extender 1 (or a portion thereof) inside the sleeve 3 as a slidably releasable form fit. In the exemplary embodiment of Figure 15, the sleeve 3 or screw extender sleeve 3 is, for example, configured to internally receive and/or hold the elongated tubular body 15, and to internally receive and/or hold the elongated attachment member 17.

As mentioned, the sleeve 3 and elongated tubular body 103 include the passage 107 extending through the elongated tubular body 103, for example, from the proximal end 105B towards or to the distal end 105A to receive a pedicle or spinal screw instrument, such as but not limited to the setscrew driver 31. The sleeve 3 and elongated tubular body 103 include the proximal entrance aperture or opening APB (see for example Figures 5 and 15) in communication with the passage 107 through which the spinal screw instrument may be introduced into the passage 107 (see, for example, Figure 6 to 8).

The distal end 105A of the elongated tubular body 103 includes the chamber or socket 109 configured to receive the proximal end of the pedicle or spinal screw 7; and/or the proximal end 21A and/or the distal end 21B of the elongated tubular body 15 of the screw extender device 1 that is holding (or not- holding) the pedicle or spinal screw 7.

The chamber or socket 109 is configured to receive the proximal end of the pedicle or spinal screw 7; and/or the proximal end 21A and/or the distal end 21B of the elongated tubular body 15 of the screw extender device 1, that is holding (or not-holding) the pedicle or spinal screw 7, through the distal entrance aperture or opening APA of the distal end 105A of the sleeve 3. The distal entrance aperture or opening APA is, in communication with the chamber 109. The chamber 109 is configured to receive an outermost extremity OE (see, for example, Figure 1) of the proximal end 21A of the elongated tubular body 15 of the screw extender device 1 holding (or not- holding) the pedicle or spinal screw 7. The outer rim or platform 45 (and surfaces 47, 49) is, for example, located at the outermost extremity OE of the proximal end 21A of the elongated tubular body 15.

The chamber or socket 109 includes, defines or delimits a space into which the proximal end 21A and/or the distal end 21B of the elongated tubular body 15 of the screw extender device 1 is received. The chamber or socket 109 communicates with the passage 107 extending to the proximal end 105B of the sleeve 3 . The passage 107 communicates with the passage 23 of the elongated tubular body 15 of the screw extender 1 when the proximal end 21A and/or the distal end 21B of the elongated tubular body 15 of the screw extender 1 is received and/or held in the chamber 109 and sleeve 3. This assures instrument access to a spinal screw 7 held in the screw extender 1 via the passage 107 of the sleeve 3. The screw extender sleeve 3 and/or the elongated tubular body 103 includes a pedicle or spinal screw receiving section 111, at the distal end 105A, that includes, delimits or defines the chamber or socket 109. The pedicle or spinal screw receiving section 111 includes the at least one wall 115, and the inner surface 117 of the wall 115 delimits or defines the chamber or socket 109.

The wall 115 includes or defines, for example, the distal entrance aperture or opening APA at the distal end 105A that is configured to allow the elongated tubular body 15 of the screw extender 1 to be introduced into the chamber 109 and sleeve 3. The wall 115, for example, includes, defines or delimits an outer elongated sheath that covers, encloses or surrounds the elongated tubular body 15 of the screw extender 1 (and/or the spinal screw 7) when introduced or present in the chamber 109 and sleeve 3 (see, for example, Figure 4).

The chamber 109 is configured to receive and hold the elongated tubular body 15 of the screw extender 1 holding the pedicle or spinal screw 7 and the connecting or implant rod 37 to generate a counterforce (or counter-torque) on the connecting rod 37 to counter a force (or torque) generated during rotation of the setscrew 33 in the screw-head 11 of the pedicle or spinal screw 7.

The elongated tubular body 103 and/or the spinal screw receiving section 111 of the sleeve 3 include the elongated or longitudinal lumens 119 (first and second lumens 119A, 119B) extending to the distal end 105A (or outermost extremity thereof) of the elongated tubular body 103 or of the spinal screw receiving section 111 to allow the pedicle or spinal screw connecting rod 37 to be simultaneously received (for example, traverse to the longitudinal axis LA of the sleeve 3) at two different and separate locations in the distal end 105A of the elongated tubular body 103 of the sleeve 3 (as well as in the distal end 5A of the screw extender 1) and in the pedicle or spinal screw 7 (see, for example, Figures 6 and 7). As mentioned, the wall 115 defines or delimits the elongated or longitudinal lumens 119. The elongated or longitudinal lumens 119 are located so as to overlap or align with the lumens 35 of the screw extender 1 and with opposingly facing elongated or longitudinal lumens EL of the spinal screw 7 when the screw extender 1 is assembled to the screw extender sleeve 3. This allows the connecting rod 37 to be received and passed through all the elongated or longitudinal lumens and to fully traverse the sleeve 3 and the screw extender 1 from one lateral side to the other later side of the sleeve 3 when the spinal screw 7 is attached to and absent from the screw extender 1 (see, for example, Figure 6).

This dual seizure and enclosing by the elongated or longitudinal lumens 119 of the sleeve 3 at separate locations on the surface of the connecting rod 37 allows a counter-torque or a counterforce to be generated on the connecting rod 37 by the elongated tubular body 103 and/or the sections of the wall 115 defining or delimiting the elongated or longitudinal lumens 119 that contact and press on the rod 37 during rotation of the setscrew 33 in the screw-head 11 of the pedicle or spinal screw 7 during a tightening of the setscrew 33 (see, for example, Figures 8 and 10).

In the exemplary embodiment, exemplary illustrated in Figure 2, the wall 115 may further define at least one lateral entrance aperture AL configured to receive and allow the elongated attachment member 17 (of for example the illustrated embodiment of Figure 1) to pass or slide through in a direction of the proximal end 105B of the sleeve 3 and/or to slide through to the proximal end 105B of the sleeve 3 (see, for example, Figure 4). For example, the lateral entrance aperture AL is located between the elongated or longitudinal lumens 119, and/or located between first and second wings WG of the wall 115. The first and second wings WG of the wall 115, for example, may extend towards each other to (partially) enclose or surround the elongated tubular body 15 of the screw extender 1 when located in the sleeve 3 to hold the elongated tubular body 15 inside the socket 109 of the sleeve 3.

The elongated tubular body 103 includes, for example, an (internal) interface or interconnection interface 121 (or a surface thereof) delimiting or defining (at least partially) the chamber 109. The interconnection interface 121 forms, delimits or defines an extremity the chamber 109 located opposite the entrance opening APA.

The interconnection interface 121 includes or defines a surface 123 located opposite the entrance opening AP. The surface 123 delimits or defines (at least partially) the chamber 109. The lateral entrance aperture AL extends from the distal end 105A to at least the interconnection interface 121 and/or surface 123.

The interconnection interface 121 and/or the surface 123 are, for example, located to contact and/or to be located (directly) in front of the proximal end 21A of the screw extender 1 when received inside the chamber 109. The interconnection interface 121 and the surface 123 are, for example, located to contact or to be located (directly) in front of the outer rim or platform 45, or the outer surface 47 or the outer surface portion 49 of the elongated tubular body 15 of the screw extender 1 when received inside the chamber 109.

At least a portion of the surface 123 and/or the interconnection interface 121 is located so as to enter the clearance 19 of the elongated tubular body 15 of the screw extender 1 when the screw extender 1 is received inside the chamber 109 of the screw extender sleeve 3.

The interconnection interface and/or the surface 123 form, delimit or define an opening 125 to the passage 107 of the elongated tubular body 103. The opening 125 and the passage 107 are located so as to align with the passage 23 of the screw extender 1 when the screw extender 1 is received inside the chamber 109 of the sleeve 3. This allows an instrument such as the setscrew driver 31 to be inserted into the sleeve 3 and displaced internally into the screw extender 1 and into the spinal screw 7 when attached thereto to carrying out surgical actions on the surgical implants.

The screw extender sleeve 3 may include, for example, an elongated attachment section 127 in addition to the spinal screw receiving section 111 (see for example Figure 2). The elongated attachment section 121 is connected to and extends from the spinal screw receiving section 111. The elongated attachment section 121 is located, for example, between (i) the spinal screw receiving section 111 and/or the chamber 109 and (ii) the proximal entrance aperture or opening APB of the screw extender sleeve 3.

The elongated attachment section 127 includes, for example, the interconnection interface 121 and the surface 123 located at a distal end 129 of the elongated attachment section 127.

A proximal end 129B of the elongated attachment section 127 may, for example, correspond to the proximal end 105B of the sleeve 3. The proximal end 129B may include, for example, the attachment or fixation device 131, that forms for example a counterforce prehension component 131 configured to receive a counter-force instrument or tool 133 (see for example Figure 6). The counterforce prehension component 131 may, for example, include a band or annular enclosure comprising an undulating or ripple outer surface configured to attached to a corresponding or complementary inner surface of the counter-force instrument 133.

The elongated attachment section 127 includes at least one wall 135 whose inner surface 137 (see for example Figure 5) for example defines or delimits the passage 107.

The elongated attachment section 127 is, for example, configured to receive and/or hold the elongated attachment member 17 of the screw extender 1.

The elongated attachment section 127 includes, for example, the at least one attachment mechanism (or attachment and guiding mechanism) 63 configured to interact or cooperate with the screw extender 1, or to couple the sleeve 3 to the screw extender 1. The elongated attachment section 127 includes the connection mechanism 53, described previously herein, which in an embodiment may include an elongated groove configured to receive and guide the elongated projection 51 of the screw extender device 1.

The connection mechanism 53 extends, for example, from the interconnection interface 121 and/or the surface 123 towards the proximal end of the elongated attachment section 127 and/or the sleeve 3. The interconnection interface 121 may, for example, include a portion of the connection mechanism 53. For example, an entrance 141 of the elongated groove 53 of the exemplary embodiment of Figure

2 is formed, delimited or defined by the interconnection interface 121 or surface 123.

As mentioned, the elongated attachment section 127 may also include the attachment mechanism 63, described earlier, for example, at least one rail guide or inner passage 63A, 63B configured to receive and guide at least one rail 61A, 61B of the screw extender 1, in one exemplary embodiment.

The attachment mechanism(s) 63 is, for example, located adjacent the connection mechanism 53 to allow both mechanisms to simultaneously cooperate with the corresponding mechanisms of the screw extender 1. The elongated attachment section 127 may for example include the first rail guide or inner passage 63A and the second rail guide or inner passage 63B in an exemplary embodiment, and the at least one groove or elongated groove 53 (for example) may be located between the first and second rail guides or inner passages 63A, 63B in an exemplary embodiment.

The rail guide or inner passage 63A, 63B can, for example, be formed, defined or delimited by a surface 143A, 143B of a landing 145A, 145B and an inner surface of an overarching or overhanging extension 149A, 149B overhanging the surface 143A, 143B of the landing 145A, 145B (see, for example, Figure 2).

The overarching or overhanging extension 149A, 149B may, for example, be located opposite one another. The first landing 145A and the second landing 145B may, for example, be separated by the connection mechanism 53.

The elongated attachment section 127 may also include the at least one immobilization mechanism 65B configured to engage with the complementary or corresponding immobilization mechanism 65A of the screw extender 1 to temporarily lock the screw extender sleeve 3 to the screw extender 1, or temporarily prevent a removal of the screw extender sleeve 3 from the screw extender 1.

The immobilization mechanism 65B is, for example, located after or at a proximal extremity of the connection mechanism 53, for example, between the connection mechanism 53 and the proximal entrance aperture or opening APB. This allows the screw extender 1 to be fully received by the sleeve

3 when the immobilization mechanism is activated.

The exemplary ramp 67 is, can be located between the immobilization mechanism 65B and the connection mechanism 53 so as to activate the immobilization mechanism 65A of the screw extender 1, during assembly of the screw extender 1 to the sleeve 3, for cooperation with the immobilization mechanism 65B of the sleeve 3.

The elongated tubular body 3 and/or the elongated attachment section 127 may, for example, include at least one lateral prehension recess 151, or a first and second lateral prehension recess 151A, 151B to facilitate handling of the sleeve 3 and attachment of the screw extender 1.

The screw extender sleeve 3 may be, for example, a disposable single use instrument.

The screw extender 1 is configured to slidably receive the elongated screw extender sleeve 3 (and vice versa) to guide a displacement of the elongated screw extender sleeve 3 relative to and/or along the elongated tubular body 15 of the screw extender to be received and held inside the chamber 109. This can be done while the spinal screw 7 is attached to the distal end of the screw extender, and while the rod 37 is positioned traverse in the head 11 of the screw 7.

An assembly method for assembling the screw extender 1 to the above described embodiment of the screw extender sleeve 3 (see for example Figure 2) comprises bringing the connection mechanism 51 of the screw extender 1 into connection or contact with the connection mechanism 53 of the screw extender sleeve 3, slidably moving the screw extender 1 relative to the screw extender sleeve 3 to bring the attachment mechanism 61 of the screw extender 1 into cooperation with the corresponding attachment mechanism 63 of the screw extender sleeve 3, slidably moving the screw extender 1 relative to the screw extender sleeve 3 to bring the immobilization mechanism 65A of the screw extender 1 into engagement or cooperation with the immobilization mechanism 65B of the screw extender sleeve 3 (see, for example, Figures 3 and 4).

The slidable movement of the screw extender 1 relative to the screw extender sleeve 3 can bring the immobilization mechanism 65A of the screw extender 1 into contact with the ramp 67 to deflect outwards the proximal end of the elongated attachment member 17 and guide of the immobilization mechanism 65A into cooperation with the immobilization mechanism 65B of the screw extender sleeve 3. As a result, the elongated attachment member 17 is held by the connection mechanism 53 and the attachment mechanism 63 of the screw extender sleeve 3, and the elongated tubular body 15 is located and held inside the chamber 109. The first and second elongated or longitudinal lumens 35 of the elongated tubular body 15 align with first and second elongated or longitudinal lumens 119A, 119B of the sleeve 3 to form a first and second sets of lumens each comprising two overlapping and aligned lumens in which the connecting rod 37 can pass through and be located.

The resulting assembled system 70 is, for example, shown in Figures 4 and 5.

The present disclosure also concerns a spinal instrument kit including or consisting solely of one or more screw extenders 1, and/or one or more screw extender sleeves 1. The spinal screw 7 may be included, in the kit, pre-mounted or pre-assembled to the screw extender 1. The sleeve 3 may be included, in the kit, pre-mounted or pre-assembled to the screw extender 1. The Kit may include further instruments and/or implants such as a setscrew driver 31 and a setscrew 33, for example, pre-mounted to the setscrew driver 31.

The elements of the kit can be provided sterile and in sterile packaging. The elements of the KIT can be provided for single-use, or alternatively can be provided as multiple-use elements that can be resterilized in a hospital.

The present disclosure also concerns an orthopaedic method. The method can, for example, include: providing the at least one screw extender 1 disclosed herein with the spinal screw 7 and the screw extender sleeve 3 attached or mounted thereto; boring or creating a passage or elongated passage into at least one pedicle or vertebra; and inserting a screwdriver into the screw extender sleeve 3 and the elongated tubular body 15 of the screw extender 1 to attach the screwdriver to the proximal end of the threaded shaft 9 of the spinal screw 7, rotating the threaded shaft of the spinal screw 7 into the passage or elongated passage of the pedicle or vertebra to attach the spinal screw 7 to the pedicle or vertebra.

The orthopaedic method may further include: inserting the connecting rod 37 into the head 11 of the spinal screw 7 or between at least two heads 11 of two spinal screws 7, the further spinal screw 7 being for example attached to a pedicle or vertebra in the same manner set out above, or in a manner where the classic screw extender SE is used with the spinal screw 7, inserting a setscrew driver 31 into the screw extender sleeve 3 and an elongated tubular body 15 of the screw extender 1 to attach the setscrew driver 31 to the setscrew 33 located in the head 11 of the spinal screw 7 (see for example Figure 6), attaching a handle HD to the proximal end of the setscrew driver 31, optionally attaching a torque limitation device TL to the setscrew driver 31 between the handle HD and the setscrew driver 31 (see for example Figure 8), the torque limitation device TL is used, for example, to perform an initial set screw tightening or pre-tightening in the head 11 to a torque level that is less than that of a final tightening of the set screw in the screw head 11, rotating the setscrew driver 31 to rotate the setscrew 33 towards the connecting rod 37 to contact the connecting rod 37 and locate the setscrew 33 in a pre-tightening position or pre-final tightening position in the head 11 (see for example Figures 7 and 8), the pre-tightening position allows for example the connecting rod 37 to be held or locked in position inside the head 11 with the screw extender 1 still attached to the spinal screw 7, removing the screw extender sleeve 3 (see for example Figures 9 and 12A).

This allows a second screw extender (a standard or known screw extender SE) that crosses the screw extender sleeve 3 to now be located unobstructed in the headroom or empty space above the elongated tubular body 15 from which the sleeve has been removed. This allows the two screw extenders to cross-over each other unhindered.

A final-tightening action of the setscrew to the connecting rod 37 can be carried out in the head 11 of the spinal screw 7 attached to the standard or known screw extender SE and the standard screw extender SE removed from the spinal screw.

The screw extender sleeve 3 is reattached to the screw extender 1.

A final-tightening action of the setscrew 33 to the connecting rod 37 can be carried out by further rotation of the setscrew driver 31 in the head 11 of the spinal screw 7 that is attached to the screw extender 1.

The counter torque device 131 may be attached to the sleeve 3 and held by the user during the finaltightening action (and optionally the pre-tightening action). This permits a counter-torque to be applied to the rod 37 via the distal end of the sleeve 3 and the elongated lumens 119 in which the rod 37 is positioned.

The screw extender 1 is removed from the spinal screw 7 by a continued rotation in the same rotational direction of the setscrew driver 31 that axially pushes apart the elongated tubular body 15 from the spinal screw 7 along the longitudinal axis LA, for example, pushes the screw extender in the direction of the user. The counter torque device 131 may also be attached and used during this action.

This results in a complete separation of the spinal screw 7 from the screw extender 1 (see for example Figures 10 and 11). The setscrew locks or holds the connecting rod 37 in the head 11 of the spinal screw (or screws) 7 (see for example Figure 11).

The orthopaedic method similarly benefits from the advantages previously evoked in relation to the screw extender 1, sleeve 3 and system 70.

It is to be understood that terms such as "first", "second", or "first" or "second" may simply be used to distinguish the component from other components in question, and do not limit the components in other aspects (e.g., importance or order). Terms, such as "first", "second", and the like, may be used herein to describe various components. Each of these terminologies is not used to define an essence, order or sequence of a corresponding component but used merely to distinguish the corresponding component from other component(s). For example, a "first" component may be referred to as a "second" component, and similarly, the "second" component may be referred to as the "first" component. "Or" as used herein may cover both "and" and "or."

It should be noted that if it is described that one component is "connected", "coupled", or "joined" to another component, at least a third component(s) may be "connected", "coupled", and "joined" between the first and second components, although the first component may be directly connected, coupled, or joined to the second component. Thus, terms such as "connected" and "coupled" cover both direct and indirect connections and couplings. It will be further understood that the terms "comprises/comprising" and/or "includes/including" when used herein, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components and/or populations thereof.

The word "about" when used herein means the identified value plus/minus 5%.

"On" as used herein covers both directly on, and indirectly on with intervening element(s) therebetween. Thus, for example, if element A is stated to be "on" element B, this covers element A being directly and/or indirectly on element B. Likewise, "supported by" as used herein covers both in physical contact with, and indirectly supported by with intervening element(s) therebetween.

Each embodiment herein may be used in combination with any other embodiment(s) described herein. While the disclosure has been illustrated and described with reference to certain preferred embodiments, it will be understood that the various embodiments are intended to be illustrative, not limiting. It will further be understood by those skilled in the art that various changes in form and detail may be made without departing from the true spirit and full scope of the disclosure, including the appended claims and their equivalents. It will also be understood that any of the embodiment(s) described herein may be used in combination with any other embodiment(s) described herein. The features of any one of the described embodiments may be included in any other of the described embodiments. The methods steps are not necessary carried out in the exact order presented above and can be carried out in a different order. Accordingly, it is intended that the invention not be limited to the described embodiments, and be given the broadest reasonable interpretation in accordance with the language of the appended claims.

Claims

1. Screw extender (1) including:

- an elongated tubular body (15) comprising a proximal end (21A) and a distal end (21B), the distal end (21B) of the elongated tubular body (15) being configured to receive a pedicle or spinal screw (7);

- an elongated attachment member (17) attached to the elongated tubular body (15) and extending beyond the proximal end (21A) of the elongated tubular body (15) to a proximal end (5B) of the screw extender (1), and

- a clearance (19) located directly opposite or directly facing the elongated attachment member (17) and located directly opposite an outer surface (47) of the proximal end (21A) of the screw extender (15) or defined by the proximal end (21A) of the elongated tubular body (15).

2. Screw extender (1) according to claim 1, wherein the outer surface (47) includes an outer surface portion or platform surface (49) separated from the elongated attachment member (17) by a proximal opening (43) or passage (23) of the elongated tubular body 15, and the clearance (19) is located directly opposite the outer surface portion or platform surface (49).

3. Screw extender (1) according to the previous claim, wherein an area directly facing or directly opposite the outer surface portion or platform surface (49) is entirely devoid of screw extender material.

4. Screw extender (1) according to any one of the previous claims, wherein the screw extender (1), the elongated attachment member (17) and the elongated tubular body (15) extend in an elongated longitudinal direction (LA), and the elongated tubular body (15) extends a shorter distance (dl) in the elongated longitudinal direction (LA) than the elongated attachment member.

5. Screw extender (1) according to any one of the previous claims, wherein the screw extender (1) and the elongated tubular body (15) extend in an elongated longitudinal direction (LA), and the elongated tubular body (15) extends a distance (dl) that is less than half of a full distance (d3) of extension of the screw extender (1) in the elongated longitudinal direction (LA).

6. Screw extender (1) according to any one of the previous claims, wherein the screw extender (1), the elongated attachment member (17) and the elongated tubular body (15) extend in an elongated longitudinal direction (LA), and the elongated tubular body (15) extends a shorter distance (dl) in the elongated longitudinal direction (LA) than the pedicle or spinal screw (7), and the elongated attachment member (17) extends a longer distance (d2) in the elongated longitudinal direction (LA) than the pedicle or spinal screw (7).

7. Screw extender (1) according to any one of the previous claims, wherein the elongated attachment member (17) extends from an outer rim or platform (45) of the proximal end (21A) of the elongated tubular body (15).

8. Screw extender (1) according to any one of the previous claims, wherein an outer rim or platform (45) of the proximal end (21A) of the elongated tubular body (15) defines the outer surface (47) of the proximal end (21A) of the elongated tubular body (15) opposite which the clearance (19) is located.

9. Screw extender (1) according to any one of the previous claims, wherein the elongated tubular body (15) partially defines or delimits a proximal opening (43) of a passage (23) of the elongated tubular body (15) for receiving pedicle or spinal screw instruments (31).

10. Screw extender (1) according to any one of the previous claims, wherein the elongated attachment member (17) is configured to slidably receive an elongated screw extender sleeve (3) to guide a displacement of the elongated screw extender sleeve (3) relative to and/or along the elongated tubular body (15).

11. Screw extender (1) according to any one of the previous claims, wherein the elongated attachment member (17) includes at least one screw extender connection mechanism (51) configured to cooperate with at least one connection mechanism (53) of an elongated screw extender sleeve, the at least one screw extender connection mechanism (51) being located opposite the clearance (19).

12. Screw extender (1) according to the previous claim, wherein the at least one screw extender connection mechanism (51) comprises a projection or elongated projection configured to be received and guided by a groove or elongated groove of an elongated screw extender sleeve (3).

13. Screw extender (1) according to any one of the previous claims, wherein the elongated attachment member (17) includes at least one immobilization mechanism (65A) configured to engage an attachable elongated screw extender sleeve (3) to temporarily immobilize a displacement of the screw extender (1) relative to the elongated screw extender sleeve (3).

14. Screw extender (1) according to any one of the previous claims, wherein the elongated attachment member (17) includes at least one screw extender attachment mechanism (61) configured to cooperate with at least one attachment mechanism (63) of an elongated screw extender sleeve (3) and configured to guide or linearly guide a movement of the screw extender (1) relative to the elongated screw extender sleeve (3).

15. Screw extender (1) according to the previous claims, wherein the at least one screw extender attachment mechanism (61) includes at least one rail (61A, 61B) having a complementary shape to that of at least one rail guide or inner passage (63A, 63B) of an elongated screw extender sleeve (3), the at least one rail (61A, 61B) being configured to be received and guided by the at least one rail guide or inner passage (63A, 63B) of the elongated screw extender sleeve (3).

16. Screw extender (1) according to any one of the previous claims, wherein the elongated attachment member (17) includes at least one prehension tab or landing (57) located at a proximal end (5B) of the screw extender (1), the at least one tab or landing (57) protruding from an elongated body (55) of the elongated attachment member (17).

17. Screw extender (1) according to any one of the previous claims, wherein the elongated attachment member (17) includes an elongated body (55) comprising a first face (SI) and a second face (S2) located opposite the first face (SI), the first face (SI) facing towards the clearance (19).

18. Screw extender (1) according to the previous claim, wherein the first face (SI) of the elongated body (55) of elongated attachment member (17) includes the at least one screw extender connection mechanism (51), and the second face (S2) and the first face (SI) include the at least one screw extender attachment mechanism (61).

19. Screw extender (1) according to the previous claim, wherein the at least one screw extender attachment mechanism (61) includes a first rail (61A) and a second rail (62B), wherein the first rail (61A) and the second rail (62B) are separated by at least one intermediate ridge (59).

20. Screw extender (1) according to the previous claim, wherein the at least one prehension tab or landing (57) extends or protrudes from the at least one intermediate ridge (59).

21. Screw extender (1) according to any one of the previous claims, wherein the elongated tubular body (15) includes a passage (23) extending fully through the elongated tubular body (15) from the proximal end (21A) to the distal end (21B), and wherein the elongated tubular body (15) includes elongated or longitudinal lumens (35) extending to the distal end (21B) of the elongated tubular body (15) to allow a pedicle or spinal screw connecting rod (37) to be received in the distal end (21B) of the elongated tubular body (15).

22. Screw extender (1) according to the previous claim, wherein the passage (23) is delimited or defined by at least one wall (25) of the elongated tubular body (15), the at least one wall (25) including internal threading (29) configured to couple or engage with at least one surgical instrument (31) permitting manipulation of an implant (33) in the pedicle or spinal screw (7).

23. Screw extender (1) according to the previous claim, wherein a distal end of the at least one wall (25) is configured to engage with a head (11) of the pedicle or spinal screw (7) and configured to longitudinally axially displace the pedicle or spinal screw (7) to release to pedicle or spinal screw (7) from the distal end (21) of the elongated tubular body (15).

24. Screw extender (1) according to the previous claim, wherein the distal end of the at least one wall (25) is configured to engage with the head (11) of the pedicle or spinal screw (7) by press-fit or form fit.

25. Screw extender (1) according to any one of the previous claims, further including the pedicle or spinal screw (7) pre-assembled to the distal end (21B) of the elongated tubular body (15).

26. Screw extender (1) according to the previous claim, wherein the pedicle or spinal screw (7) comprises or consists of a different material to that of the screw extender (1). l. Screw extender (1) according to the previous claim, wherein the screw extender (1) is a disposable single use instrument.

28. Screw extender system (70) including the screw extender (1) according to any one of the previous claims, and an elongated screw extender sleeve (3).

29. Screw extender system (70) according to the previous claim, wherein the elongated screw extender sleeve (3) includes:

- an elongated tubular body (103) comprising a proximal end (105B) and a distal end (105A), the elongated tubular body (103) including a passage (107) extending through the elongated tubular body (103) from the proximal end (105B) and towards the distal end (105A) to receive at least one pedicle or spinal screw instrument (31), wherein the distal end (105A) of the elongated tubular body (103) includes a chamber (109) in communication with the passage (107), the chamber (109) being configured to receive a proximal end of the screw-head (11) of a pedicle or spinal screw (7) through a distal entrance opening (APA) of the distal end (105A) of the elongated tubular body (103) into the chamber (109).

30. Screw extender system (70) according to the previous claim, wherein the chamber (109) is configured to receive the screw-head (11) of the pedicle or spinal screw (7) and the distal end (105A) of the sleeve (3) is configured to receive and contact a pedicle or spinal screw connecting rod (37) held in the screw-head (11) to apply a counter-torque or counter force and/or to transfer or propagate a generated force or torque on the connecting rod (37) to and/or longitudinally through the sleeve (3), the generated force or torque being generated during rotation of a setscrew (33) in the screw-head (11) of the pedicle or spinal screw (7).

31. Screw extender system (70) according to the previous claim 29 or 30, wherein an inner surface (117) defining or delimiting the elongated tubular body (103) or the chamber (109) is configured to non-directly couple or non-directly connect to the screw-head (11) of the pedicle or spinal screw (7), or is configured to indirectly couple or indirectly connect or attach to the screw-head (11) of the pedicle or spinal screw (7).

32. Screw extender system (70) according to any one of the previous claims 29 to 31, wherein an inner surface 117 defining or delimiting the elongated tubular body (103) or the chamber (109) is configured to contact the screw-head (11) of the pedicle or spinal screw (7) by a non-attaching direct contact or a non-attaching temporarily or permanent direct contact with the screw-head (11), or an inner surface 117 defining or delimiting the elongated tubular body (103) or the chamber (109) is configured to contact the screw-head (11) of the pedicle or spinal screw (7) by a non-binding direct contact with the screw-head (11).

33. Screw extender system (70) according to any one of the previous claims 29 to 32, wherein an inner surface (117) defining or delimiting a distal portion of the chamber (109) is screw-head connection- less or screw-head connection-free, or screw-head direct connection-less or screw-head direct connection-free.

34. Screw extender system (70) according to any one of the previous claims 29 to 33, wherein the chamber (109) is configured to receive and hold the pedicle or spinal screw (7) and a pedicle or spinal screw connecting rod (37) held in the screw-head (11) to apply a counter-torque or counter force and to transfer a generated torque on the connecting rod (37) to and longitudinally through the sleeve (3), the generated torque being generated during rotation of a setscrew (33) in a screw-head (11) of the pedicle or spinal screw (7).

35. Screw extender system (70) according to any one of claim 29 to 34, wherein the elongated tubular body (103) of the sleeve (3) includes first and second elongated or longitudinal lumens (119A, 119B), located solely in the distal end (105A) of the elongated tubular body (103) of the sleeve (3), and extending to an outermost extremity (OMDE) of the distal end (105A) of the elongated tubular body (103) to allow a pedicle or spinal screw connecting rod (37) to be simultaneously received by the distal end (105A) at separated locations of the elongated tubular body (103) of the sleeve (3) and to be received in a screw-head (11) of the pedicle or spinal screw (7).

36. Screw extender system (70) according to the previous claim, wherein the first and second elongated or longitudinal lumens (119A, 119B) are configured to contact the pedicle or spinal screw connecting rod (37) during rotation of a setscrew (33) in a screw-head (11) of the pedicle or spinal screw (7) to apply a counter-torque or counter force and to transfer or propagate a generated force or torque on the connecting rod (37) longitudinally through the sleeve (3), the generated force or torque being generated during rotation of a setscrew (33) in the screw-head (11).

37. Screw extender system (70) according to any one of claim 29 to 36, including an attachment or fixation device (131) located at a proximal end of the sleeve (3) and/or the elongated tubular body (103), the attachment or fixation device (131) being configured to attach or fix to a proximal end of an instrument or tool received and extending inside the sleeve (3) or passage (107) to the proximal end of the sleeve (3) or the elongated tubular body (103).

38. Screw extender system (70) according to the previous claim, wherein attachment or fixation device (131) comprises a form-fit or press-fit member configured to attach or fix to a complementary or corresponding form-fit or press-fit member of the instrument or tool received and extending inside the sleeve (3) or passage (107) to the proximal end of the sleeve (3) or elongated tubular body (103).

39. Screw extender system (70) according to any one of the previous claims 29 to 38, wherein the distal end (105A) of the elongated tubular body (103) includes the chamber (109) in communication with the passage (107), the chamber (109) being configured to receive the proximal end (21A) and the distal end (21B) of the elongated tubular body (15) of the screw extender device (1) holding the pedicle or spinal screw (7) through a distal entrance opening (APA) of the distal end (105A) of the elongated tubular body (103).

40. Screw extender system (70) according to the previous claim, wherein the chamber (109) is configured to receive an outermost extremity (OE) of the proximal end (21A) of the elongated tubular body (15) of the screw extender device (1) holding a pedicle or spinal screw (7).

41. Screw extender system (70) according to the previous claim, wherein the chamber (109) is configured to receive and hold the elongated tubular body (15) of the screw extender (1) holding the pedicle or spinal screw (7) and the pedicle or spinal screw connecting rod (37) to generate a counterforce on the connecting rod (37) to counter a force generated during rotation of a setscrew (33) in the screw-head (11) of the pedicle or spinal screw (7).

42. Screw extender system (70) according to any one of claim 29 to 31, wherein the elongated tubular body (103) of the screw extender sleeve (3) includes first and second elongated or longitudinal lumens (119A, 119B) extending to the distal end (105A) of the elongated tubular body (103) to allow the pedicle or spinal screw connecting rod (37) to be simultaneously received at separated locations in the distal end (105A) of the elongated tubular body (103) of the screw extender sleeve (3) and to be received in the pedicle or spinal screw (7).

43. Screw extender system (70) according to any one of the previous claims 29 to 42, wherein the chamber (109) is configured to receive and hold the elongated tubular body (15) of the screw extender device (1) holding the pedicle or spinal screw (7) and the pedicle or spinal screw connecting rod (37) to generate a counter-torque or counterforce to counter a torque or force generated during rotation of the setscrew (33) in the screw-head (11) of the pedicle or spinal screw (7).

44. Screw extender system (70) according to any one of the previous claims 29 to 43, wherein the chamber (109) is formed, delimited or defined by at least one wall (115) of the elongated tubular body (103) of the screw extender sleeve (3).

45. Screw extender system (70) according to any one of the previous claims 29 to 44, further including an elongated attachment section (127) located between the chamber (109) and a proximal entrance aperture or opening (APB) of the screw extender sleeve 3 that is in communication with the passage (107) and through which a spinal screw instrument (131) can be introduced into the passage (107); the elongated attachment section (127) being configured to receive the at least one elongated attachment member (17) of the screw extender device (1).

46. Screw extender system (70) according to the previous claim, wherein the elongated attachment section (127) includes the at least one connection mechanism (53) configured to cooperate with the at least one screw extender connection mechanism (51) of the screw extender (1).

47. Screw extender system (70) according to the previous claim, wherein the at least one connection mechanism (53) includes at least one groove or elongated groove configured to receive and guide at least one elongated projection of the screw extender (1).

48. Screw extender system (70) according to any one of the previous claims 45 to 47, wherein the elongated attachment section (127) includes the at least one attachment mechanism (63) configured to cooperate with the at least attachment mechanism (61) of the screw extender (1) to receive and guide the at least one attachment mechanism (61) of the screw extender (1).

49. Screw extender system (70) according to the previous claim, wherein the at least one attachment mechanism (63) of the screw extender sleeve (3) includes at least one rail guide or inner passage (63A, 63B) configured to receive and guide at least one attachment mechanism (61) of the screw extender (1).

50. Screw extender system (70) according to any one of the previous claims 47 to 49, wherein the at least one attachment mechanism (63) of the screw extender sleeve (3) includes a first rail guide or inner passage (63A) and a second rail guide or inner passage (63B), and the at least one connection mechanism (53) of the screw extender sleeve (3) includes at least one groove or elongated groove (53), the at least one groove or elongated groove (53) is located between the first and second rail guides or inner passages (63A, 63B).

51. Screw extender system (70) according to any one of the previous claims 29 to 50, further including at least one immobilization mechanism (65B) configured to engage with the screw extender (1) to temporarily prevent a removal of the screw extender sleeve (3) from the screw extender (1).

52. Screw extender system (70) according to any one of the previous claims 29 to 51, wherein the proximal end (105B) of the elongated tubular body (103) includes a counterforce prehension component (131) configured to receive a counter-force instrument (133).

53. Screw extender system (70) according to any one of the previous claims 29 to 52, wherein the elongated tubular body (103) includes an interconnection interface (121) forming, delimiting or defining a portion of the chamber (109) located opposite or facing the distal entrance opening (APA) of the distal end (105A) of the elongated tubular body (103).

54. Screw extender system (70) according to the previous claim, wherein the interconnection interface (121) defines a surface (123) located on the screw extender sleeve (3) so as to enter into the clearance (19) of the screw extender (1) when the screw extender (1) is received inside the chamber (109).

55. Screw extender system (70) according to the previous claim 53 or 54, wherein the interconnection interface (121) defines a surface (123) delimiting or defining an opening (125) of the passage (107) of the elongated tubular body (103) located to align with a passage (23) of the screw extender (1) when the screw extender (1) is received inside the chamber (107).

56. Screw extender system (70) according to any one of the previous claims 29 to 55, wherein the elongated tubular body (103) includes at least one lateral prehension recess (151A, 151B).

57. Screw extender system (70) according to any one of the previous claims 29 to 56, wherein the screw extender sleeve (3) is a disposable single use instrument.

58. Sleeve (3) or Screw extender sleeve (3) including:

- an elongated tubular body (103) comprising a proximal end (105B) and a distal end (105A), the elongated tubular body (103) including a passage (107) extending through the elongated tubular body (103) from the proximal end (105B) and towards the distal end (105A) to receive at least one pedicle or spinal screw instrument (31), wherein the distal end (105A) of the elongated tubular body (103) includes a chamber (109) in communication with the passage (107), the chamber (109) being configured to receive a proximal end of a screw head (111) of a pedicle or spinal screw (7) through a distal entrance opening (APA) of the distal end (105A) of the elongated tubular body (103) into the chamber (109).

59. Sleeve (3) or Screw extender sleeve (3) according to the previous claim, wherein the chamber (109) is configured to receive the screw-head (11) of the pedicle or spinal screw (7) and the distal end (105A) of the sleeve (3) is configured to receive and contact a pedicle or spinal screw connecting rod (37) held in the screw-head (11) to apply a counter-torque or counter force and/or to transfer or propagate a generated force or torque on the connecting rod (37) to and/or longitudinally through the sleeve (3), the generated force or torque being generated during rotation of a setscrew (33) in the screw-head (11) of the pedicle or spinal screw (7).

60. Sleeve (3) or Screw extender sleeve (3) according to the previous claim 58 or 59, wherein an inner surface 117 defining or delimiting the elongated tubular body (103) or the chamber (109) is configured to non-directly couple or non-directly connect to the screw-head (11) of the pedicle or spinal screw (7), or is configured to indirectly couple or indirectly connect or attach to the screw-head (11) of the pedicle or spinal screw (7).

61. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 60, wherein an inner surface 117 defining or delimiting the elongated tubular body (103) or the chamber (109) is configured to contact the screw-head (11) of the pedicle or spinal screw (7) by a non-attaching direct contact or a non-attaching temporarily or permanent direct contact with the screw-head (11), or an inner surface 117 defining or delimiting the elongated tubular body (103) or the chamber (109) is configured to contact the screw-head (11) of the pedicle or spinal screw (7) by a non-binding direct contact with the screw-head (11).

62. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 61, wherein an inner surface 117 defining or delimiting a distal portion of the chamber (109) is screw-head connection-less or screw-head connection-free, or screw-head direct connection-less or screw-head direct connection-free.

63. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 62, wherein the chamber (109) is configured to receive and hold the pedicle or spinal screw (7) and a pedicle or spinal screw connecting rod (37) held in the screw-head (11) to apply a counter-torque or counter force and to transfer or propagate a generated torque on the connecting rod (37) to and longitudinally through the sleeve (3), the generated torque being generated during rotation of a setscrew (33) in a screw-head (11) of the pedicle or spinal screw (7).

64. Sleeve (3) or Screw extender sleeve (3) according to any one of claim 58 to 63, wherein the elongated tubular body (103) of the sleeve (3) includes first and second elongated or longitudinal lumens (119A, 119B), located solely in the distal end (105A) of the elongated tubular body (103) of the sleeve (3), and extend to an outermost extremity (OMDE) of the distal end (105A) of the elongated tubular body (103) to allow a pedicle or spinal screw connecting rod (37) to be simultaneously received by the distal end (105A) at separated locations of the elongated tubular body (103) of the sleeve (3) and to be received in a screw-head (11) of the pedicle or spinal screw (7).

65. Sleeve (3) or Screw extender sleeve (3) according to the previous claim, wherein the first and second elongated or longitudinal lumens (119A, 119B) are located in a distal one-eight or a distal one- tenth of the sleeve (3).

66. Sleeve (3) or Screw extender sleeve (3) according to the previous claim 64, wherein a closed extremity (CE) of each of the first and second elongated or longitudinal lumens (119A, 119B) is located at a distance (DL) from an outermost extremity (OME) of the distal end (105A) of the sleeve or the screw extender sleeve (3) so that an outermost distal extremity (OMDE) of the sleeve or the screw extender sleeve (3) does not extend beyond a head (11) of a spinal screw (7) when present in the sleeve or the screw extender sleeve (3) and when a connecting rod (37) is present in the head (11) and in contact with the closed extremities (CE).

67. Sleeve (3) or Screw extender sleeve (3) according to the previous claim 64, wherein a closed extremity (CE) of each of the first and second elongated or longitudinal lumens (119A, 119B) is located at a distance (DL) from an outermost extremity (OME) of the distal end (105A) of the sleeve or screw extender sleeve (3), wherein the distance (DL) is less than or equal to LNG/8 or less than or equal to LNG/10; wherein LNG is an axial length of the sleeve screw extender sleeve (3).

68. Sleeve (3) or Screw extender sleeve (3) according to the previous claim, wherein the first and second elongated or longitudinal lumens (119A, 119B) are configured to contact the pedicle or spinal screw connecting rod (37) during rotation of a setscrew (33) in a screw-head (11) of the pedicle or spinal screw (7) to apply a counter-torque or counter force and transfer or propagate a generated force or torque on the connecting rod (37) longitudinally through the sleeve (3), the generated force or torque being generated during rotation of a setscrew (33) in the screw-head (11).

69. Sleeve (3) or Screw extender sleeve (3) according to any one of claim 58 to 68, including an attachment or fixation device (131) located at a proximal end of the sleeve (3) and/or the elongated tubular body (103), the attachment or fixation device (131) being configured to attach or fix to a proximal end of an instrument or tool received and extending inside the sleeve (3) or passage (107) to the proximal end of the sleeve (3) or the elongated tubular body (103).

70. Sleeve (3) or Screw extender sleeve (3) according to the previous claim, wherein attachment or fixation device (131) comprises a form-fit or press-fit member configured to attach or fix to a complementary or corresponding form-fit or press-fit member of the instrument or tool received and extending inside the sleeve (3) or passage (107) to the proximal end of the sleeve (3) or elongated tubular body (103).

71. Sleeve (3) or screw extender sleeve (3) according to any one of the previous claims 58 to 70, wherein the distal end (105A) of the elongated tubular body (103) includes a chamber (109) in communication with the passage (107), the chamber (109) being configured to receive the proximal end (21A) and the distal end (21B) of an elongated tubular body (15) of the screw extender device (1) holding the pedicle or spinal screw (7) through a distal entrance opening (APA) of the distal end (105A) of the elongated tubular body (103).

72. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 71, wherein the chamber (109) is configured to receive an outermost extremity (OE) of the proximal end (21A) of the elongated tubular body (15) of the screw extender device (1) holding a pedicle or spinal screw (7).

73. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 72, wherein the chamber (109) is configured to receive and hold the elongated tubular body (15) of a screw extender (1) holding the pedicle or spinal screw (7) and the pedicle or spinal screw connecting rod (37) to generate a counterforce on the connecting rod (37) to counter a force generated during rotation of a setscrew (33) in the screw-head (11) of the pedicle or spinal screw (7).

74. Sleeve (3) or Screw extender sleeve (3) according to any one of claim 58 to 73, wherein the elongated tubular body (103) of the screw extender sleeve (3) includes first and second elongated or longitudinal lumens (119A, 119B) extending to the distal end (105A) of the elongated tubular body (103) to allow the pedicle or spinal screw connecting rod (37) to be simultaneously received at separate locations in the distal end (105A) of the elongated tubular body (103) of the screw extender sleeve (3) and to be received in the pedicle or spinal screw (7).

75. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 74, wherein the chamber (109) is configured to receive and hold the elongated tubular body (15) of the screw extender (1) holding the pedicle or spinal screw (7) and the pedicle or spinal screw connecting rod (37) to generate a counter-torque or counterforce to counter a torque or force generated during rotation of the setscrew (33) in the screw-head (11) of the pedicle or spinal screw (7).

76. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 75, wherein the chamber (109) is formed, delimited or defined by at least one wall (115) of the elongated tubular body (103) of the screw extender sleeve (3).

77. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 76, further including an elongated attachment section (127) located between the chamber (109) and a proximal entrance aperture or opening (APB) of the screw extender sleeve 3 that is in communication with the passage (107) and through which a spinal screw instrument (131) can be introduced into the passage (107); the elongated attachment section (127) being configured to receive at least one elongated attachment member (17) of the screw extender (1).

78. Sleeve (3) or Screw extender sleeve (3) according to the previous claim, wherein the elongated attachment section (127) includes at least one at least one connection mechanism (53) configured to cooperate with at least one screw extender connection mechanism (51) of the screw extender (1).

79. Sleeve (3) or Screw extender sleeve (3) according to the previous claim, wherein the at least one connection mechanism (53) includes at least one groove or elongated groove configured to receive and guide at least one elongated projection of the screw extender (1).

80. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 79, wherein the elongated attachment section (127) includes at least one attachment mechanism (63) configured to cooperate with at least attachment mechanism (61) of the screw extender device to receive and guide the at least one attachment mechanism (61) of the screw extender (1).

81. Sleeve (3) or Screw extender sleeve (3) according to the previous claim, wherein the at least one attachment mechanism (63) of the screw extender sleeve (3) includes at least one rail guide or inner passage (63A, 63B) configured to receive and guide at least one attachment mechanism (61) of the screw extender (1).

82. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claim 79 to 81, wherein the at least one attachment mechanism (63) of the screw extender sleeve (3) includes a first rail guide or inner passage (63A) and a second rail guide or inner passage (63B), and the at least one connection mechanism (53) of the screw extender sleeve (3) includes at least one groove or elongated groove (53), the at least one groove or elongated groove (53) is located between the first and second rail guides or inner passages (63A, 63B).

83. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 82, further including at least one immobilization mechanism (65B) configured to engage with the screw extender (1) to temporarily prevent a removal of the screw extender sleeve (3) from the screw extender (1).

84. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 83, wherein the proximal end (105B) of the elongated tubular body (103) includes a counterforce prehension component (131) configured to receive a counter-force instrument (133).

85. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 74, wherein the elongated tubular body (103) includes an interconnection interface (121) forming, delimiting or defining a portion of the chamber (109) located opposite or facing a distal entrance opening (APA) of the distal end (105A) of the elongated tubular body (103).

86. Sleeve (3) or Screw extender sleeve (3) according to the previous claim, wherein the interconnection interface (121) defines a surface (123) located on the screw extender sleeve (3) so as to enter into a clearance (19) of the screw extender (1) when the screw extender (1) is received inside the chamber (109).

87. Sleeve (3) or Screw extender sleeve (3) according to the previous claim 82 or 86, wherein the interconnection interface (121) defines a surface (123) delimiting or defining an opening (125) of the passage (107) of the elongated tubular body (103) located to align with a passage (23) of the screw extender (1) when the screw extender (1) is received inside the chamber (107).

88. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 87, wherein the elongated tubular body (103) includes at least one lateral prehension recess (151A, 151B).

89. Sleeve (3) or Screw extender sleeve (3) according to any one of the previous claims 58 to 88, wherein the sleeve (3) or screw extender sleeve (3) is a disposable single use instrument.

90. Spinal instrument kit or package including or consisting solely of at least one or a plurality of screw extenders (1) according to anyone of the previous claims, and/or at least one or a plurality of sleeves (3) or screw extender sleeves (3).

91. Spinal instrument kit according to previous claim, wherein the kit element or elements are provided sterile and in sterile packaging.

92. Spinal instrument kit according to any one of the previous claims 90 to 91, wherein the elements of the kit are single-use, or multiple-use elements that can be re-sterilized.