trans sacral spinal implant 900 for insertion from an anterior target site on the surface of the sacrum into the sacrum comprises a first body 920 having a leading end 922 a trailing end 924 a longitudinal axis 926 not shown through the leading and trailing ends a length 928 not shown parallel to the longitudinal axis 926 and a sidewall 930 surrounding the longitudinal axis 926 and extending from the leading end 922 to the trailing end 924 the first body 920 having an interior surface 932 and an opposite exterior surface 934 and an exterior thread 936 on the exterior surface 934 of the first body 920 the first body 920 including at least one aperture 910 extending from the exterior surface to the interior surface the leading end 922 of the first body 920 forming a substantially flat distal surface that is substantially perpendicular to the exterior surface of the first body in some examples a spinal implant 900 comprises an aperture on a radial surface and on a top distal face 922 in another example and example with reference to fig1 a threaded spinal cage 1000 is configured as an expandable u201c flower u201d e g with a plurality of u201c petals u201d 1010 at a distal end 1020 of the implant that spread as an internal metal plug 1030 comprised as part of the cage 1002 interfaces with and engages internal threads in.