Spinal fixation element rotation instrument

An instrument for rotating a spinal fixation element having a notch at a proximal end comprising:

• a first lever arm, wherein a distal end of the first lever arm is adapted to couple to the spinal fixation element;
• and
• a second lever arm rotatably coupled to the first lever arm at the distal end thereof, a distal end of the second lever arm being adapted to couple to the spinal fixation element, wherein the second lever arm rotates relative to the first lever arm, about a central axis of the distal ends of the first lever arm and the second lever arm to rotate the spinal fixation element from an initial position to a rotated position,
• wherein the first lever arm includes a first ratchet and the second lever arm includes a second ratchet forming a dual ratchet mechanism that prevents the spinal fixation element from rotating back toward the initial position;
• a first switch provided on a proximal end of the first lever arm, wherein the first switch allows the first ratchet to rotate clockwise when the first switch is at a first position, and the first switch allows the first ratchet to rotate counterclockwise when the first switch is at a second position;
• a second switch provided on a proximal end of the second lever arm, wherein the second switch allows the second ratchet to rotate clockwise when the second switch is at a first position, and the second switch allows the second ratchet to rotate counterclockwise when the second switch is at a second position;
• wherein a first hole is formed in the distal end of the first lever arm, and a second hole is formed at the distal end of the second lever arm, and
• an extension element having a proximal end that couples to the instrument by fitting through the first hole and the second hole, a distal end with a grabbing tip coupled to a carrier of the extension element for grabbing the spinal fixation element so that the spinal fixation element may be rotated by the instrument, a retractable sleeve surrounding the carrier, wherein in a retracted position of the retractable sleeve the grabbing tip is in an extended position and wherein in an advanced position the retractable sleeve is advanced over the carrier and the grabbing tip to prevent decoupling of the spinal fixation element from the extension element.