Interfixated vertebral body replacement and insertion methods

1. An insertion instrument providing an ideal trajectory for placement of instruments during implantation of an interbody implant in a spinal surgery comprising:

a proximal region, a distal region, and an elongate tubular element, wherein the elongate tubular element comprises a proximal end, a distal end, and an inner bore extending between the proximal and distal ends;

a thumbwheel housing near the proximal end which contains a generally cylindrical thumbwheel with a lumen enclosed by a threaded surface;

an internal draw rod sized and dimensioned to be disposed within the inner bore of the elongate tubular element, wherein the internal draw rod comprises a proximal end, a distal end, and a threaded intermediate portion which passes through and engages the lumen of the thumbwheel, wherein rotation of the thumbwheel translates the internal draw rod;

an insertion head with an upper surface, a lower surface, a leading end, and a trailing end, a medial insertion arm and a lateral insertion arm extending distally from the leading end of the insertion head, wherein the medial insertion arm is in a fixed position and the lateral insertion arm is attached to the insertion head at a first pivot point such that translation of the draw rod causes the lateral insertion arm to pivot about the pivot point; and

a guide tube connected to the upper surface of the insertion head in an angled position, wherein the guide tube is generally cylindrical with a leading edge, a trailing edge and a lumen, and the leading edge of the guide tube is sized and positioned to align with a screw hole on an interbody implant.

2. The insertion instrument of claim 1 , wherein an angle between the guide tube and the upper surface of the insertion head in the angled position is adjustable.

3. The insertion instrument of claim 2 further comprising: an aperture extending through the insertion head from the upper surface to the lower surface, and a set screw recess extending distally from the trailing end of the insertion head perpendicular to and interconnecting with the aperture; and the guide tube connected to the insertion head at a second pivot point and the guide tube fixedly attached to a guide post sized and dimensioned to pass through the aperture in the insertion head, wherein a set screw inserted into the set screw aperture contacts the guide post to restrict movement of the guide tube.

4. The insertion instrument of claim 1 wherein the trailing edge of the guide tube has a surface.

5. The insertion instrument of claim 1 wherein the trailing edge of the guide tube has crenellations.