US20080269805A1 - Methods for correcting spinal deformities - Google Patents

Abstract

The present application discloses methods for treating spinal deformities. One embodiment includes inserting an elongated corrective member into the patient. During insertion, the corrective member is operatively attached to a first vertebral member that applies a first corrective force to correct a first vertebral member alignment. The corrective member is further inserted into the patient and subsequently operatively attached to a second vertebral member that applies a second corrective force to correct a second vertebral member alignment. The corrective member is further inserted and subsequently operatively attached to a third vertebral member that applies a third corrective force to correct a third vertebral member alignment. The embodiment may further include operatively attaching the corrective member to additional vertebral members to correct further misalignment. In one embodiment, a second member is attached to the vertebral members after they have been aligned to maintain the alignment.

Description

BACKGROUND
• The present application is directed to methods for correcting spinal deformities and, more particularly, to methods of applying a corrective force to one or more of the vertebral members.
• The spine is divided into four regions comprising the cervical, thoracic, lumbar, and sacrococcygeal regions. The cervical region includes the top seven vertebral members identified as C1-C7. The thoracic region includes the next twelve vertebral members identified as T1-T12. The lumbar region includes five vertebral members L1-L5. The sacrococcygeal region includes nine fused vertebral members that form the sacrum and the coccyx. The vertebral members of the spine are aligned in a curved configuration that includes a cervical curve, thoracic curve, and lumbosacral curve. Intervertebral discs are positioned between the vertebral members and permit flexion, extension, lateral bending, and rotation.
• Various deformities may affect the normal alignment and curvature of the vertebral members. Scoliosis is one example of a deformity of the spine in the coronal plane, in the form of an abnormal curvature. While a normal spine presents essentially a straight line in the coronal plane, a scoliotic spine can present various lateral curvatures in the coronal plane. The types of scoliotic deformities include thoracic, thoracolumbar, lumbar or can constitute a double curve in both the thoracic and lumbar regions. Scoliosis may also include abnormal translation and rotation in the axial and sagittal planes. Schuermann's kyphosis is another example of a spinal deformity that affects the normal alignment of the vertebral members in one or more planes. Further, a fracture of one or more of the vertebral members may cause misalignment along the spine. The term “deformity” and the like is used herein to describe the various types of spinal misalignment.
SUMMARY
• The present application discloses methods for treating spinal deformities. One embodiment of a method includes inserting a longitudinal corrective member into the patient. During insertion, the corrective member is operatively attached to a first vertebral member that applies a first corrective force to correct a first vertebral member alignment. The corrective member is further inserted into the patient and subsequently operatively attached to a second vertebral member that applies a second corrective force to correct a second vertebral member alignment. The corrective member is further inserted and subsequently operatively attached to a third vertebral member that applies a third corrective force to correct a third vertebral member alignment. The embodiment may further include operatively attaching the corrective member to additional vertebral members to correct further misalignment. In one embodiment, a second member is attached to the vertebral members after they have been aligned to maintain the alignment.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a schematic coronal view of an example of a scoliotic spine.
• FIG. 2 is a sectional view in the axial plane of a pair of anchors attached to a vertebral member according to one embodiment.
• FIG. 3 is a schematic view of anchors attached to the vertebral members along a section of the spine according to one embodiment.
• FIG. 4 is a perspective view of an extender in an open orientation and attached to an anchor according to one embodiment.
• FIG. 5 is a perspective view of an extender in a closed orientation and attached to an anchor according to one embodiment.
• FIG. 6 is a perspective view of a corrective rod and a handle according to one embodiment.
• FIG. 7A is a top view of a corrective rod in a first rotational position according to one embodiment.
• FIG. 7B is a top view of a corrective rod in a second rotational position according to one embodiment.
• FIG. 8 is a perspective view of a corrective rod in a first rotational position being inserted percutaneously into a patient according to one embodiment.
• FIG. 9 is a perspective view of a corrective rod inserted within a patient and in a second rotational position according to one embodiment.
• FIGS. 10A-10F are schematic views illustrating a method of sequentially treating vertebral members according to one embodiment.
• FIG. 11 is a schematic view of anchors attached to the vertebral members along a section of the spine according to one embodiment.
• FIG. 12 is a schematic view of vertebral rods attached to anchors along a section of the spine according to one embodiment.
DETAILED DESCRIPTION
• The present application is directed to methods for correcting a spinal deformity. One embodiment of the method includes initially attaching anchors to the vertebral members positioned along a length of a deformed spine. The anchors are positioned along the deformed spine in a first lateral row. An elongated corrective member is than inserted into the patient and through each of the anchors sequentially along the deformed spine. The corrective member is manipulated sequentially to move the vertebral members into alignment. The shape of the corrective member and the movement to fit within the anchors produces a corrective force. This movement sequentially translates the vertebral members at the various spinal levels to treat the spinal deformity. In one embodiment, a second member is inserted into the patient through a second lateral row of anchors. The second rod is secured to the anchors thus causing the vertebral members to remain in the aligned position.
• FIG. 1 illustrates a patient's spine that includes a portion of the thoracic region T, the lumbar region L, and the sacrum S. This spine has a scoliotic curve with an apex of the curve being offset a distance X from its correct alignment N in the coronal plane. The spine is deformed laterally and rotationally so that the axes of thevertebral members90 are displaced from the sagittal plane passing through a centerline of the patient. In the area of the lateral deformity, each of thevertebral members90 includes a concave side and a convex side. One or more of thevertebral members90 may be further misaligned due to rotation as depicted by the arrows R. As a result, the axis of thevertebral members90 which are normally aligned along the coronal plane are non-coplanar and extend along multiple planes.
• Correction of the spinal deformity initially requires placing anchors within thevertebral members90.FIG. 2 illustrates one embodiment that includesanchors20 within the pedicles of thevertebral member90. Theanchors20 are positioned on each lateral side of thespinous process91 and include ashaft21 that extends into thevertebral member90, and ahead22 positioned on the exterior.Head22 may be fixedly connected to theshaft21, or provide movement in one or more planes.Head22 further includes areceiver23 to receive a rod as will be explained in detail below. A set screw (not illustrated) is sized to engage with thehead22 to capture the rod within thereceiver23.
• In one embodiment, a pair ofanchors20 is positioned within each of thevertebral members90 along the deformed section of the spine. In another embodiment, asingle anchor20 is positioned within one or more of thevertebral members90. Thesingle anchor20 is positioned within either pedicle location.
• FIG. 3 schematically illustrates thevertebral members90 that form the deformed spine. One ormore anchors20 are mounted tovertebral members90 along a section of the spine. In one embodiment as illustrated inFIG. 3, each of thevertebral members90 includes at least oneanchor20. In another embodiment, one or more of thevertebral members90 does not include anchors20. Theanchors20 are arranged to form first and second rows A, B. The first row A is formed byanchors20apositioned at a first lateral position of thevertebral members90. Eachanchor20ais positioned at substantially the same lateral position within the respectivevertebral member90. Second row B is formed byanchors20bpositioned at a second lateral position. Likewise, eachanchor20bis positioned at substantially the same lateral position within eachvertebral member90. In one embodiment, rows A and B extend along the spine in a substantially parallel manner.
• Anextender30 may be connected to one or more of theanchors20 along one of the rows A, B. Theextenders30 may function both as a reduction device, as well as a translation and rotation device as will be described in detail below.FIG. 4 illustrates one embodiment of anextender30 attached to ananchor20.Extender30 includes atubular element33 with adistal end31 and aproximal end32. Thetubular element33 includes a length such that theproximal end32 extends outward from the patient when thedistal end31 is mounted to theanchor20.
• Thedistal end31 includes a pair of opposinglegs39 that connect to the head of theanchor20. Thelegs39 form an opening that aligns with thereceiver23 to form awindow36. Thedistal end31 may further include threads adapted for threading engagement with a corresponding portion of thebone anchor20, or to an element coupled to one or more bone anchors20. The threads couple theextender30 to theanchor20. In a specific embodiment, the threads are engaged with a threaded projection associated with a bone screw, such as, for example, an externally threaded nut used with a pedicle screw. One embodiment of a pedicle screw is used in association with the CD-Horizon Legacy Spinal System manufactured by Medtronic Sofamor Danek of Memphis, Tenn.
• A slidingmember34 is movably positioned on the exterior of thetubular element33 and located in proximity to thedistal end31. Slidingelement34 includes contact edges35 that form an upper edge of thewindow36. Theproximal end32 includes a fitting38 that is operatively connected to the slidingelement34. Rotation of the fitting38 in first and second directions causes the slidingelement34 to move downward and upward respectively along thetubular element33. One example of anextender30 is the Sextant Perc Trauma Extender available from Medtronic Sofamor Danek of Memphis, Tenn.
• FIG. 4 illustrates theextender30 in an open orientation with the slidingelement34 positioned towards an intermediate section of thetubular element33. The open orientation gives thewindow36 an enlarged size.FIG. 5 illustrates theextender30 in a closed orientation with the slidingelement34 positioned towards thedistal end31. Movement between the open and closed orientations is caused by rotation of the fitting38.
• Acorrective rod50 is then sequentially inserted along the spine and attached to theanchors20 at the various spinal levels. Thecorrective rod50 may be inserted in a top-to-bottom direction or a bottom-to-top direction.FIG. 6 illustrates one embodiment of thecorrective rod50 attached to aninserter60. Thecorrective rod50 includes an elongated shape with atip51 and asecond end52. In one embodiment, thetip51 may be sharpened to facilitate insertion and movement through the patient. The length of therod50 may vary depending upon the length of the deformed spinal segment to be corrected. As illustrated inFIGS. 7A and 7B, the ends51,52 may include a locking aspect to attach with theinserter60. In one embodiment, the locking aspect includes one or more flat sections and a narrow neck section. These sections maintain the orientation of thecorrective rod50 relative to theinserter60 during insertion and rotation.
• Thecorrective rod50 includes a pre-bent shape to apply specific corrective forces to the individualvertebral members90. In one embodiment, the shape of thecorrective rod50 is determined by studying the flexibility of the spinal deformity prior to the procedure. The shape of therod50 corresponds to the needed displacement to translate and/or rotate thevertebral members90 into alignment. A greater amount of bend at thetip51 allows for a greater amount of translation and rotation of thevertebral members90.Rod50 may be bent in one, two, or three dimensions depending on the amount of correction needed for thevertebral members90 in the coronal, sagittal, and axial planes.
• The curvature of therod50 may be more pronounced within a first plane than in a second plane.FIG. 7A illustrates an elevational view of therod50 along a first rotational plane.Rod50 is substantially straight with a line M extending through thetip51 and thesecond end52. This orientation may be used for initial insertion of therod50 into the patient.FIG. 7B illustrates therod50 in a second rotational plane. Therod50 is curved away from the line M. This curvature applies a corrective force as will be explained below. In one embodiment, the first plane is offset by about 90 degrees from the second plane.
• Thecorrective rod50 may be attached to aninserter60 for insertion and positioning within the patient. As illustrated inFIG. 6,inserter60 includes aneck61 with a curved shape for percutaneously inserting therod50 into the patient. Ahandle62 may be positioned at the end of theneck61.Handle62 is sized for grasping and manipulating by the surgeon.
• Thecorrective rod50 is inserted into the patient P as illustrated inFIG. 8. The insertion begins with inserting thetip51 into the patient and through afirst anchor20 attached to a firstvertebral member90. In the embodiment ofFIG. 8, thetip51 is moved through a first window formed by the first anchor andfirst extender30A. After moving through the window, thecorrective rod50 is further inserted into the patient. Insertion into a second window formed by the second anchor andextender30B at a secondvertebral member90 may require therod50 to be rotated and laterally moved relative to thevertebral members90 because the curvature of the spine causes thesecond anchor20 to be misaligned with thefirst anchor20. The rotation and lateral movement of therod50 during the insertion applies a force to translate and/or rotate the secondvertebral member90 into alignment with the firstvertebral member90.FIG. 9 illustrates thehandle60 andcorrective rod50 being rotated approximately 90° relative to the position inFIG. 9.
• This process continues as thetip51 is moved sequentially through a third window formed at thethird extender30C, and through a fourth window formed at thefourth extender30D. The insertion of thetip51 into each window and the accompanying rotation of thecorrective rod50 applies a corrective force to thatvertebral member90 to translate and/or rotate thevertebral member90 into alignment.
• In one embodiment as illustrated inFIGS. 8 and 9, the insertion process is performed percutaneously by the surgeon manipulating thehandle62 of theinserter60 which remains on the exterior of the patient. In one embodiment, movement of therod50 through the patient P is performed using fluoroscopy imaging techniques.
• In one embodiment, thewindows36 formed at thevarious anchors20 by theextenders30 are in the open orientation prior to and during insertion of thecorrective rod50. In one embodiment, thewindow36 is moved to the closed orientation once thetip51 has moved through the window. The reduction includes rotating the fitting38 on theproximal end32 of theextender30. As best illustrated inFIGS. 4 and 5, rotation of the fitting38 causes the slidingmember34 to move distally along thetubular element33. This movement causes thecontact edge35 on the slidingmember34 to contact and move thecorrective rod50 distally towards theanchor20. In one embodiment, thewindows36 are completely closed with therod50 being seated within theanchors20. In another embodiment, thewindows36 may only be partially closed. In another embodiment, thewindows36 may remain in the open orientation until therod50 is positioned through each of theanchors20.
• In one embodiment, thecorrective rod50 is rotated at each spinal level as part of the insertion process of moving thetip51 through eachanchor20. As illustrated inFIG. 8, therod50 may be originally inserted into the patient P while in a first rotational position. This first orientation may include thehandle62 being in a vertical orientation that is spaced away from the patient P. During the insertion, therod50 may ultimately end up in a different rotational position as illustrated inFIG. 9. The amount of rotation between the initial insertion and final position may vary depending upon the application. In one embodiment as illustrated inFIGS. 8 and 9, the amount of rotation is about 90 degrees. Other embodiments may include rotation of about 180 degrees.
• In another embodiment, thecorrective rod50 remains substantially within the same rotational position during insertion into the patient. Once therod50 is positioned through each of theanchors20, therod50 is rotated to apply the additional corrective force to thevertebral members90 due to the curvature of therod50.
• FIGS. 10A-10F illustrates the sequential steps of correcting the deformed spine. As illustrated inFIG. 10A,corrective rod50 is initially inserted through the first window formed by anchor andextender20/30A attached to the firstvertebral member90A. Once inserted, thecorrective rod50 is further manipulated to move thetip51 through the second window formed by anchor andextender20/30B attached to the secondvertebral member90B. Thecorrective rod50 is rotated once it is positioned within the windows of anchor/extenders20/30A,20/30B, to align the first and secondvertebral members90A,90B as illustrated inFIG. 10B.
• Thecorrective rod50 is next inserted through a third window formed by anchor andextender20/30C attached to a thirdvertebral member90C as illustrated inFIG. 10C. After thecorrective rod50 is within the third window of anchor/extender20/30C and prior to insertion into a subsequent window formed by anchor/extender20/30D, thecorrective rod50 is again rotated to align the first threevertebral members90A,90B,90C as illustrated inFIG. 10D.
• Thecorrective rod50 is than moved in a manner to insert thetip51 through the fourth window of anchor/extender20/30D attached to the fourthvertebral member90D as illustrated inFIG. 10E. Once inserted, thecorrective rod50 is rotated to align the first fourvertebral members90A,90B,90C,90D as illustrated inFIG. 10F. This sequential process continues with the remainingvertebral member90E,90F of the deformed spine being individually aligned by moving thecorrective rod50 through the windows associated with anchor/extenders20/30E and20/30F and rotating thecorrective rod50.
• Theextenders30 attached to theanchors20 are also used during the sequential process to apply forces to thevertebral members90. Once the corrective rod is inserted through the first two windows formed by anchors/extenders20/30A and20/30B as illustrated inFIG. 10A, the windows may be substantially closed. The closing action may force the corrective rod to seat within the anchors. The reduced window size also causes the rotational force of thecorrective rod50 to be applied to thevertebral members90A,90B. The windows remain open enough to allow for thecorrective rod50 to be inserted into the other subsequent windows.
• The windows may be closed or opened sequentially at eachvertebral member90 prior to rotation of thecorrective rod50. As illustrated inFIG. 10C, window formed at anchor/extender20/30C is closed prior to rotation as illustrated inFIG. 10D. Likewise, window formed at anchor/extender20/30D is closed prior to rotation illustrated inFIG. 10F.
• Thecorrective rod50 aligns thevertebral members90 as schematically illustrated inFIG. 11. For purposes of clarity, thecorrective rod50 and theextenders30 are removed from this Figure.
• With thecorrective rod50 remaining within one of the anchor rows A, B, asecond rod60 is inserted within the second row. In one embodiment, prior to insertion of thesecond rod60,extenders30 are attached to theanchors20 of the second row. In one embodiment, attachment of theextenders30 to the second row ofanchors20 may occur prior to insertion of thecorrective rod50. In another embodiment, theextenders30 are attached after thecorrective rod50 has been inserted and alignment of thevertebral members90.
• Thesecond rod60 maintains thevertebral members90 within their new alignment. The process of inserting thesecond rod60 may be similar to insertion of thecorrective rod50. The surgeon percutaneously inserts thesecond rod60 into the patient and moves thesecond rod60 through each of theanchors20. Foranchors20 with associatedextenders30, thewindows36 are reduced in size towards the closed orientation after insertion of thesecond rod60.
• Once thesecond rod60 is positioned, set screws may be attached to theanchors20 to maintain the position of therod60. In anchors20 withextenders30, the set screws may be inserted through the interior of theextenders30. The set screws engage with threads on theanchors20 and maintain thesecond rod60 attached to theanchors20. In one embodiment, the set screws may include threads that engage with the head portions of the bone anchors20 via a driving tool to maintain therod60 in engagement with theanchors20. In one embodiment, a driving tool is inserted through the interior of theextenders30. The tool includes a drive shaft including a distal end portion that is positioned within a tool receiving recess in the set screw, and a handle for imparting rotational force onto the drive shaft.
• In one embodiment, thecorrective rod50 remains within the patient after the surgical procedure. Thecorrective rod50 maintains the alignment of thevertebral members90.
• In another embodiment, once thesecond rod60 is attached along one anchor row, thecorrective rod50 may be removed. Removal may initially require one or more of thewindows36 to be moved towards the open orientation. Removal requires the surgeon to manipulate thehandle62 and pull thecorrective rod50 from eachanchor20 and from the patient P. In one embodiment, athird rod70 is then inserted to replace thecorrective rod50.Third rod70 is shaped to maintain thevertebral members90 in proper alignment. The insertion and attachment method is similar to that described above with reference to thesecond rod60.FIG. 12 illustrates one embodiment with thesecond rod60 inserted within theanchors20aof row A, and thethird rod70 within theanchors20bof row B.
• In one embodiment as described above, thecorrective rod50 is rotated after initial insertion to provide an additional amount of corrective force to be applied to thevertebral members90. In another embodiment, threading thecorrective rod50 through thewindows36 provides an adequate amount of corrective force and aligns thevertebral members90. In this embodiment, thecorrective rod50 is not rotated to a second rotational position.
• In the embodiment described above,extenders30 are attached to one or more of theanchors20. Theextenders30 may be attached to each of theanchors20 along one or both anchor rows A, B, or along less than eachanchor20. In one embodiment, noextenders30 are attached to theanchors20 and the one or more rods are inserted directly into thereceivers23 in theanchors20.
• In the embodiments ofFIGS. 11 and 12, two anchor rows A, B are attached to thevertebral members90. In another embodiment, a single anchor row is attached to thevertebral members90. In one embodiment with a single anchor row, thecorrective rod50 is removed after thevertebral members90 are moved into alignment, and replaced with a second rod. In another embodiment with a single anchor row, thecorrective rod50 remains attached to thevertebral members90 and within the patient.
• In one embodiment,rods60,70 are attached to thevertebral members90 to maintain the alignment. Various other members may be used to maintain the alignment of thevertebral members90. The members may include but are not limited to a plate, bar, cable, tether, or other suitable elongate implant capable of maintaining thevertebral members90 in the corrected alignment.
• In one embodiment, therods50,60,70 are formed of a biocompatible material, such as, for example, stainless steel or titanium. However, other materials are also contemplated, including, for example, titanium alloys, metallic alloys such as chrome-cobalt, polymer based materials such as PEEK, composite materials, or combinations thereof. In one embodiment, one or more ofrods50,60,70 include an injectable construction that is inserted into the patient and afterwards filled with a hardening polymer.
• Rods60,70 may be substantially straight within the plane illustrated inFIG. 11. In another embodiment, therods60,70 are bent or contoured, either outside of the patient's body or in-situ, to more closely match the position, orientation and alignment of thevertebral members90.
• In the embodiment described above, theextenders30 include slidingmembers34 to adjust the size of thewindows36. In another embodiment,extenders30 are cylindrical tubes that do not include slidingmembers34. A distal end of the tubes may be threaded to engage with theanchors20, and the interior be substantially open to insert a set screw.
• The devices and methods may be used to treat various abnormal spinal curvatures such as scoliosis. The devices and methods may also be used to treat other spinal deformities including kyphotic deformities such as Scheurmann's kyphosis, fractures, congenital abnormalities, degenerative deformities, metabolic deformities, deformities caused by tumors, infections, trauma, and other abnormal spinal curvatures.
• In one embodiment, the devices and methods are configured to reposition and/or realign thevertebral members90 along one or more spatial planes toward their normal physiological position and orientation. The spinal deformity is reduced systematically in all three spatial planes of the spine, thereby tending to reduce surgical times and provide improved results. In one embodiment, the devices and methods provide three-dimensional reduction of a spinal deformity via a posterior surgical approach. However, it should be understood that other surgical approaches may be used, including, a lateral approach, an anterior approach, a posterolateral approach, an anterolateral approach, or any other surgical approach.
• Theanchors20 described above are some embodiments that may be used in the present application. Other examples include spinal hooks configured for engagement about a portion of avertebral member90, bolts, pins, nails, clamps, staples and/or other types of bone anchor devices capable of being anchored in or tovertebral member90. In one embodiment, anchors20 include fixed angle screws.
• In still other embodiments, bone anchors may allow the head portion to be selectively pivoted or rotated relative to the threaded shank portion along multiple planes or about multiple axes. In one such embodiment, the head portion includes a receptacle for receiving a spherical-shaped portion of a threaded shank therein to allow the head portion to pivot or rotate relative to the threaded shank portion. A locking member or crown may be compressed against the spherical-shaped portion via a set screw or another type of fastener to lock the head portion at a select angular orientation relative to the threaded shank portion. The use of multi-axial bone anchors may be beneficial for use in the lower lumbar region of the spinal, and particularly below the L4 vertebral member, where lordotic angles tend to be relatively high compared to other regions of the spinal column. Alternatively, in regions of the spine exhibiting relatively high intervertebral angles, theanchors20 may include a fixed angle.
• In one embodiment, the treatment of the deformity is performed percutaneously. In other embodiments, the treatment is performed with an open approach, semi-open approach, or a muscle-splitting approach.
• Spatially relative terms such as “under”, “below”, “lower”, “over”, “upper”, and the like, are used for ease of description to explain the positioning of one element relative to a second element. These terms are intended to encompass different orientations of the device in addition to different orientations than those depicted in the figures. Further, terms such as “first”, “second”, and the like, are also used to describe various elements, regions, sections, etc and are also not intended to be limiting. Like terms refer to like elements throughout the description.
• As used herein, the terms “having”, “containing”, “including”, “comprising” and the like are open ended terms that indicate the presence of stated elements or features, but do not preclude additional elements or features. The articles “a”, “an” and “the” are intended to include the plural as well as the singular, unless the context clearly indicates otherwise.
• The present invention may be carried out in other specific ways than those herein set forth without departing from the scope and essential characteristics of the invention. The present embodiments are, therefore, to be considered in all respects as illustrative and not restrictive, and all changes coming within the meaning and equivalency range of the appended claims are intended to be embraced therein.

Claims (23)

1. A method of treating a patient with a spinal deformity comprising the steps of:

inserting an elongated corrective member into the patient;

moving the corrective member through a first anchor attached to a first vertebral member;

further inserting the corrective member into the patient and moving the corrective member through a second anchor attached to a second vertebral member and applying a first corrective force to align the second vertebral member with the first vertebral member; and

further inserting the corrective member into the patient and moving the corrective member through a third anchor attached to a third vertebral member and applying a second corrective force to align the third vertebral member with the first and second vertebral members.

2. The method ofclaim 1, further comprising attaching the anchors at a common position to each of the first, second, and third vertebral members prior to inserting the corrective member.

3. The method ofclaim 1, wherein the steps of moving the correcting member through the second and third anchors comprises laterally moving the corrective member and rotating the corrective member within the patient.

4. The method ofclaim 1, wherein the step of moving the corrective member through the second anchor comprises moving the corrective member through a window formed between the second anchor and an extender.

5. The method ofclaim 4, further comprising reducing a size of the window to apply the first corrective force to the second vertebral member.

6. The method ofclaim 1, wherein the step of applying the first corrective force to align the second vertebral member with the first vertebral member causes translation and rotation of the second vertebral member.

7. The method ofclaim 1, further comprising inserting a second member into the patient after aligning the vertebral members and attaching the second member to the vertebral members to maintain the alignment.

8. The method ofclaim 1, further comprising removing the corrective member from the patient after aligning the vertebral members.

9. The method ofclaim 1, wherein the step of inserting the elongated corrective member into the patient is performed percutaneously.

10. A method of treating a patient with a spinal deformity comprising the steps of:

inserting an elongated corrective member into the patient;

operatively attaching the corrective member to a first vertebral member and applying a first corrective force to correct a first vertebral member alignment;

subsequently operatively attaching the corrective member to a second vertebral member and applying a second corrective force to correct a second vertebral member alignment; and

subsequently operatively attaching the corrective member to a third vertebral member and applying a third corrective force to correct a third vertebral member alignment.

11. The method ofclaim 10, wherein the step of correcting the first, second, and third vertebral member alignment includes applying a rotational force to at least one of the vertebral members.

12. The method ofclaim 10, wherein the step of correcting the first, second, and third vertebral member alignment includes applying a translational force to at least one of the vertebral members.

13. The method ofclaim 10, wherein the step of percutaneously inserting the corrective member into the patient comprises rotating the corrective member.

14. The method ofclaim 10, wherein the step of percutaneously inserting the corrective member into the patient comprises laterally moving the corrective member.

15. The method ofclaim 10, further including attaching a second member to the vertebral members after applying the third corrective force to correct the third vertebral member alignment.

16. The method ofclaim 10, further comprising attaching an anchor to each of the vertebral members prior to percutaneously inserting the corrective member.

17. A method of treating a patient with a spinal deformity comprising the steps of:

inserting an elonated corrective member into the patient; and

sequentially attaching the corrective member to a plurality of vertebral members forming a spinal segment and aligning the vertebral members by applying a different corrective force to each of the vertebral members.

18. The method ofclaim 17, further comprising rotating at least one of the plurality of vertebral members.

19. A method of treating a patient with a spinal deformity comprising the steps of:

inserting an elongated corrective member into the patient;

applying a first corrective force to a first vertebral member by moving the corrective member through a first anchor attached to the first vertebral member;

applying a second corrective force to a second vertebral member by moving the corrective member through a second anchor attached to the second vertebral member;

applying a third corrective force to a third vertebral member by moving the corrective member through a third anchor attached to the third vertebral member;

after applying the third corrective force, inserting a second member into the patient and attaching the second member to each of the vertebral members to maintain a corrected alignment of the vertebral members.

20. The method ofclaim 19, further comprising removing the corrective member from the patient after attaching the second member to each of the vertebral members.

21. The method ofclaim 19, further comprising moving the corrective member through a window formed between the first anchor and an extender attached to the first anchor.

22. A method of treating a patient with a spinal deformity comprising the steps of:

inserting an elongated corrective member into the patient;

applying a first corrective force at a first spinal level by inserting the corrective rod a first amount and moving the corrective member along a first spinal segment;

applying a second corrective force at a second spinal level by inserting the corrective rod a second amount and moving the corrective member along a second spinal segment; and

applying a third corrective force at a third spinal level by inserting the corrective rod a third amount and moving the corrective member along a third spinal segment;

wherein each of the first, second, and third corrective forces are different.

23. The method ofclaim 22, further comprising attaching the corrective rod to at least one vertebral member within each of the first, second, and third spinal segments.

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