Instrument for use with a bone anchoring device

1. An instrument for use with a receiving part for connecting a bone anchoring element to a rod, the receiving part comprising two legs that define a recess for receiving the rod, the instrument comprising:

a tube having a first end, a second end, and a longitudinal axis that extends between the first end and the second end, and defining a coaxial internal channel that opens towards the first end and the second end; and

two protruding portions monolithically formed with the tube and positioned diametrically opposite to one another for engagement with the recess of the receiving part to prevent rotational movement of the tube relative to the receiving part, wherein the tube comprises two diametrically opposite intermediate portions at the first end that are positioned circumferentially between the protruding portions in a manner such that the first end of the tube forms a closed ring;

wherein an outer diameter of the first end of the tube at the intermediate portions measured along a first direction that intersects the longitudinal axis is less than an outer diameter of another region of the tube adjacent where the protruding portions connect measured along a direction that intersects the longitudinal axis and that is parallel to the first direction, to facilitate positioning of the intermediate portions in a coaxial central passage of the receiving part when the protruding portions are advanced into the recess of the receiving part;

wherein each of the protruding portions has a first region that extends radially outwardly from an outer surface of the tube at the first end and a second region that extends axially away from the first end in a direction opposite the second end, and wherein an axial length of each of the protruding portions is less than an axial length of a region of the tube between the protruding portions and the second end of the tube.

2. The instrument of claim 1 , wherein each of the protruding portions has an end face with a cylindrical recess having a diameter that substantially corresponds to a diameter of the rod.

3. The instrument of claim 1 , further comprising an inner shaft with a drive portion at one end, the inner shaft being movable axially in the internal channel of the tube.

4. The instrument of claim 3 , wherein the internal channel and the inner shaft each comprises a substantially cylindrically shaped portion.

5. The instrument of claim 1 , wherein the tube is a first tube, and the instrument further comprises a second tube positioned at least partially around the first tube.

6. The instrument of claim 5 , wherein the second tube extends around an outside of each of the protruding portions.

7. The instrument of claim 5 , wherein the first tube and second tube are formed monolithically with one another.

8. The instrument of claim 5 , wherein the first tube and the second tube are separable from one another.

9. The instrument of claim 1 , further comprising a grip portion for holding the tube.

10. The instrument of claim 1 , wherein an axial length of the entire tube is greater than the axial length of each of the protruding portions.

11. A system comprising:

a receiving part for connecting a bone anchoring element to a rod, the receiving part comprising two legs that define a recess for receiving the rod; and

an instrument for use with the receiving part, the instrument comprising a tube having a first end, a second end, and a longitudinal axis that extends between the first end and the second end, and defining a coaxial internal channel that opens towards the first end and the second end, and two protruding portions monolithically formed with the tube and positioned diametrically opposite to one another, the tube further comprising two diametrically opposite intermediate portions at the first end that are positioned circumferentially between the protruding portions in a manner such that the first end of the tube forms a closed ring;

wherein the protruding portions are configured to engage and extend at least partially into the recess of the receiving part when the instrument is attached to the receiving part to prevent rotational movement of the tube relative to the receiving part, while the intermediate portions are configured to be positioned in a coaxial central passage of the receiving part; and

wherein each of the protruding portions has a first region that extends radially outwardly from an outer surface of the tube at the first end and a second region that extends axially away from the first end in a direction opposite the second end, and wherein an axial length of each of the protruding portions is less than an axial length of a region of the tube between the protruding portions and the second end of the tube.

12. The system of claim 11 , wherein the legs of the receiving part each comprises an inner thread, and wherein the instrument further comprises an inner shaft that is movable axially in the internal channel of the tube to advance a fixation element having an outer thread corresponding to the inner thread of the legs into the recess of the receiving part.

13. The system of claim 11 , wherein an axial length of each of the protruding portions corresponds substantially to an axial distance between a free end of the legs of the receiving part and a rod that is fully inserted into the recess of the receiving part.

14. The system of claim 11 , wherein a width of each of the protruding portions in a circumferential direction of the tube is substantially equal to or slightly smaller than a width of the recess of the receiving part.

15. The system of claim 11 , wherein a thickness of each of the protruding portions in a radial direction corresponds substantially to a thickness of the legs of the receiving part in the radial direction.

16. The system of claim 11 , wherein an outer diameter of the first end of the tube measured at the intermediate portions is less than an outer diameter of another region of the tube adjacent where the protruding portions connect.

17. The system of claim 11 , wherein the tube is a first tube, and the instrument further comprises a second tube positioned at least partially around the first tube and configured to extend around an outside of the receiving part when the instrument is attached to the receiving part.

18. The system of claim 11 , further comprising:

the bone anchoring element comprising a shank and a head that defines a tool recess for a driving tool for driving the shank into bone;

wherein the internal channel of the tube of the instrument is sized to accommodate the driving tool therethrough to engage the tool recess on the head when the bone anchoring element is assembled to the receiving part and the instrument is attached to the receiving part.

19. A method for coupling a rod to a bone with a bone anchoring device comprising a bone anchoring element, a receiving part connected to the bone anchoring element and comprising two legs that define a recess for receiving the rod, and a fixation element, and using an instrument comprising a tube having a first end, a second end, and a longitudinal axis that extends between the first end and the second end, and defining a coaxial internal channel that opens towards the first end and the second end, and two protruding portions monolithically formed with the tube and positioned diametrically opposite to one another, the tube further comprising two diametrically opposite intermediate portions at the first end that are positioned circumferentially between the protruding portions in a manner such that the first end of the tube forms a closed ring, wherein each of the protruding portions has a first region that extends radially outwardly from an outer surface of the tube at the first end and a second region that extends axially away from the first end in a direction opposite the second end, and wherein an axial length of each of the protruding portions is less than an axial length of a region of the tube between the protruding portions and the second end of the tube, the method comprising:

anchoring the bone anchoring element to bone;

inserting the rod in the recess;

attaching the instrument to the receiving part such that the protruding portions engage and extend at least partially into the recess of the receiving part to prevent rotational movement of the tube relative to the receiving part, while the intermediate portions are positioned in a coaxial central passage of the receiving part; and

using the instrument to advance the fixation element into the recess to lock the rod relative to the receiving part.

20. An instrument for use with a receiving part for connecting a bone anchoring element to a rod, the receiving part comprising two legs that define a recess for receiving the rod, the instrument comprising:

a first tube having a first end, a second end, and a longitudinal axis that extends between the first end and the second end, and defining a coaxial internal channel that opens towards the first end and the second end;

at least one protruding portion monolithically formed with the first tube that is engageable with the recess of the receiving part to prevent rotational movement of the first tube relative to the receiving part; and

a second tube positioned around at least the first end of the first tube;

wherein the first end of the first tube and a portion of the second tube that extends around the first end of the first tube both form a closed ring, wherein the at least one protruding portion has a first region that extends radially outwardly from an outer surface of the first tube at the first end and a second region that extends axially away from the first end in a direction opposite the second end, and wherein an axial length of the at least one protruding portion is less than an axial length of a region of the first tube between the at least one protruding portion and the second end of the first tube.