STEERABLE RASP/TRIAL INSERTER

1 . A surgical instrument for traumatizing a pair of vertebral endplates, the surgical instrument comprising:

an elongated member having a length, a width, a proximal end portion and a distal end portion,

a guide member positioned adjacent to the elongated member, wherein the guide member has a length, a width, distal end portion and a proximal end portion;

a removable insert pivotably coupled to the distal end portion of the guide member, the removable insert having height between a top surface and an opposite bottom surface, a distal end portion and an arcuate proximal end portion positioned between the top surface and the opposite bottom surface, wherein the arcuate proximal end portion includes a plurality of gear teeth;

at least one drive member pivotably coupled to the distal end portion of the elongated member, wherein the at least one drive member has a first partially circular surface with a plurality of projections that slippingly engage the plurality of gear teeth of the removable insert;

an actuating mechanism coupled to the proximal end portions of the elongated member and the guide member configured to move the elongated member relative to the guide member; and

a handle coupled to the actuator mechanism and threadingly coupled to the guide member or the elongated member, the handle having an impaction surface.

2 . The instrument of claim 1 wherein the top surface of the removable insert is generally smooth.

3 . The instrument of claim 1 wherein the top surface of the removable insert has a plurality of teeth.

4 . The instrument of claim 1 , wherein the height is in a range between 4 mm and 20 mm.

5 . The instrument of claim 1 further comprising a locking member coupled to the handle, and coupled to the elongated member or the guide member.

6 . A surgical instrument for spine surgery, comprising:

an elongated member having a length, a width, a proximal end portion and a distal end portion,

a guide member slidingly positioned adjacent to the elongated member, wherein the guide member has a length, a width, distal end portion and a proximal end portion;

a removable insert pivotably coupled to the distal end portion of the guide member, the removable insert having a top surface, an opposite bottom surface, a distal end portion and an arcuate proximal end portion positioned between the top surface and bottom surface, wherein the arcuate proximal end portion includes a plurality of pins extending between the top surface and the opposite bottom surface;

a pawl member that extends along a curved longitudinal axis and is integral to the distal end portion of the elongated member, wherein the pawl member slippingly engages the plurality of pins of the removable insert;

an actuating mechanism coupled to the proximal end portions of the elongated member and the guide member configured to move the elongated member relative to the guide member; and

a handle coupled to the actuator mechanism and having an impaction surface with a width that is greater than the width of the elongated member or the width of the guide member.

7 . The instrument of claim 6 wherein the top surface of the removable insert is generally smooth.

8 . The instrument of claim 6 wherein the top surface of the removable insert has a plurality of teeth.

9 . A surgical instrument for spine distraction, comprising:

an elongated member having a length, a width, a proximal end portion and a distal end portion,

a guide member positioned adjacent to the elongated member, wherein the guide member has a length, a width, distal end portion and a proximal end portion;

an insert pivotably coupled to the distal end portion of the guide member, the insert having a top surface, an opposite bottom surface, a distal end portion and an arcuate proximal end portion positioned between the top surface and the opposite bottom surface, wherein the arcuate proximal end portion includes a plurality of engagement members;

at least one drive member coupled to the distal end portion of the elongated member, wherein the at least one drive member has a first surface that slippingly engages the plurality of engagement members of the a removable insert; and

an actuating mechanism coupled to the proximal end portions of the elongated member and the guide member configured to move the elongated member relative to the guide member.

10 . The instrument of claim 9 wherein the engagement members are a plurality of pins extending between the top surface and the opposite bottom surface.

11 . The instrument of claim 9 further comprising a plurality of projections located on the first surface of the elongated member.

12 . The instrument of claim 9 wherein the first surface of the elongated member extends along curved longitudinal axis.

13 . The instrument of claim 9 further comprising a plurality of projections located on the first surface of the elongated member.

14 . The instrument of claim 9 further comprising a handle coupled to the actuator mechanism.

15 . A surgical instrument for spine surgery, comprising:

an elongated member having a length, a width, a proximal end portion and a distal end portion,

a guide member slidingly positioned adjacent to the elongated member, wherein the guide member has a length, a width, distal end portion and a proximal end portion;

an insert pivotably coupled to the distal end portion of the guide member, the insert having height between a top surface and an opposite bottom, a distal end portion and an arcuate proximal end portion positioned between the top surface and the opposite bottom surface, wherein the arcuate proximal end portion includes a plurality of engagement members;

at least one drive member coupled to the distal end portion of the elongated member, wherein the drive member has a first generally arcuate surface that slippingly engages the plurality of engagement members of the insert; and

an actuating mechanism coupled to the proximal end portions of the elongated member and the guide member configured to move the guide member relative to the elongated member.

16 . The instrument of claim 15 wherein the engagement members are a plurality of gear teeth.

17 . The instrument of claim 15 wherein the engagement members are a plurality of pins extending between the top surface and the opposite bottom surface.

18 . The instrument of claim 15 further comprising a plurality of projections located on the first surface of the drive member.

19 . The instrument of claim 15 further comprising a handle coupled to the actuator mechanism.

20 . A surgical kit for spine surgery, comprising:

an insertion instrument, the instrument comprising:

a guide member having a proximal end portion and a distal end portion;

an elongated member slidingly positioned adjacent to the guide member, the elongated member having a means for pivoting the insert member from a first position to a second position;

an actuating means for translating the elongated member relative to the guide member,

a means for locking the first position and the second position of the insert; and

a handle means coupled to the actuating means having a means for absorbing and transferring an impaction force to the insert member,

a plurality of insert members, each having a means for removably attaching to the distal end portion of the guide member, wherein each insert has a top surface and a bottom surface, and a different height between the top surface and the bottom surface.

21 . The surgical kit of claim 20 wherein the top surface and the bottom surface of the insert members have a means for traumatizing bone.

22 . A method of traumatizing a pair of adjacent vertebral endplates comprising:

providing a surgical instrument having a pivoting distal insert, a proximal handle portion and a body portion positioned between the distal insert and the proximal handle portion, the distal insert having a first angular position relative to the body and the distal insert having a textured top and bottom surfaces;

placing a leading end of the distal insert in a first position between two adjacent vertebral endplates;

moving the distal insert to a second position between the adjacent vertebral endplates by impacting the proximal end portion of the surgical instrument;

pivoting the distal insert to a second angular position relative to the body by rotating the handle about the body;

locking the second angular position of the distal insert; and

moving the distal insert to a third position between the adjacent vertebral endplates by impacting the proximal end portion of the surgical instrument.

23 . The method of claim 22 further comprising the steps of:

removing the distal insert from between the adjacent vertebral endplates;

detaching the distal insert from the surgical instrument; and

replacing the distal insert with a second distal insert chosen from a kit having a plurality of distal inserts.

24 . The method of claim 22 further comprising the steps of:

placing a leading end of the second distal insert in a first position between two adjacent vertebral endplates;

moving the second distal insert to a second position between the adjacent vertebral endplates by impacting the proximal end portion of the surgical instrument;

pivoting the second distal insert to a second angular position relative to the body by rotating the handle about the body;

locking the second angular position of the second distal insert; and

moving the second distal insert to a third position between the adjacent vertebral endplates by impacting the proximal end portion of the surgical instrument.