CA2704192A1 - Spinal implants and methods - Google Patents
Spinal implants and methods Download PDFInfo
- Publication number
- CA2704192A1 CA2704192A1 CA2704192A CA2704192A CA2704192A1 CA 2704192 A1 CA2704192 A1 CA 2704192A1 CA 2704192 A CA2704192 A CA 2704192A CA 2704192 A CA2704192 A CA 2704192A CA 2704192 A1 CA2704192 A1 CA 2704192A1
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- CA
- Canada
- Prior art keywords
- spacer
- spinal implant
- axis
- retention member
- transverse
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
- A61B17/7067—Devices bearing against one or more spinous processes and also attached to another part of the spine; Tools therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
- A61B17/7065—Devices with changeable shape, e.g. collapsible or having retractable arms to aid implantation; Tools therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
Abstract
The present invention provides a spinal implant for placement between adjacent processes of the human spine. In some embodiments the spinal implant includes a spacer and one or more retention members. In some embodiments, the retention members are fixed relative to the spacer and in other embodiments the retention members are deployable from a first or compact or stowed position to a second or expanded or deployed position. In some embodiments the spacer is expandable from a first size to a second size. In some embodiments the spacer has a tapered body.
Description
CROSS-REFERS NCE 'IFO REL.! a ED APPLICATIONS
This application is a continuation--in--part of 1).S. Patent Application No.
12/013,351, entitled "SPINAL LMPLAN`L S ANi) METHODS" and filed on Jam. 11, 2008 which is a continuation-in-par of U.S. Patent Application No. I L/293,438, e. titled iSIN'TT'RSPI OU
DISTRACTION DEVICES AND ASSOCIATED METHODS OF Ili SE;R I ION" and flied on Dec. 02,200-5, which is of ?,S, Patent Application No. 11.._:
entitled "IN'T RSPII ;OUS DISTRACTION DES; IC:t S AND ASSOCIATED METHODS
OF INSERTION and filed on Oct. 25, 2005 each of which is incorporated n full b reference herein, The present application s also a, continuation-in-part of U.S. Patent Application No.
11/934,604, eà titled :S Nà US P 3CLSS IMPL1\N ITS AND ASSOCIATED MI 7-T ODS"
and filed Nov. 02, 2007 which is incorporated in full by reference herei 0.
The present application further claims the benefit of U.S. Provisional Pat nt Application No. 60/884,581, entitled " SP SPINAL STABILIZATION" and filed Vii.Ãn. 11, 200?, U.S. Provisional P=atent Application N~o. 60/62 1 ,712, entitled "INTERS PIN 1 S
DISTRACTION DEVICES AND ASSOCIATED M TRai ` S ? INSERTION," and tiled on. Oct, 25, 2004, US. Provisional Patent Application No. 60.1"63 ) 112, entitled " TNTERSPI OLFS DISTRACTION DEVICES AND ASSOCIATED METHODS OF
INSERTION. " and, filed on Dec. 3.2004 U.S. Provisional Patent Application No.
60/639,938, entitled "IN I.E.RSI INOUSDISTRACTION DEVICES AND ASSOCIATED
MflE11HODS OF INSERTION aid filed or Dec. 29,2004', U.S. Provisional Patent Application 'o. 60/654,483, entit ed "INTERSPINOUS DISTRACTION DEVICES AND
i V t 5 7 2L'2005; ASSOCIATED lklEI'IlOI)S OF iNSE T'ION,jt andfled on Feb.
US, Provisional I
P tent < :cation . {..' l.a to ~ : 'I ,:. ' bi s) ,i ?:: DEVICES
AND ASSOCIATED Mj1]_:T1-].ODS OF FNSERTION," and filed on Apr. 14, 2005; U.S.
Provisional Patent A pl=cation No. 60/ 178,360, entitled "[N<I a RS.P . US
DISTRACTION
DEVICES AND ASSOCIATE I) METHODS OF INSERTION, , .amd fled on May 6,2005.;
and U S. Provisional <'v p..lhs:.atio , No. 60/912,273. entitled 'F, ]0.v e3 _;f ] I ITI
l E MMOVAB E OR ADJUSTABLE SPIKES" and ailed April 17. 2007, each of which is incorporated in full by reference herein.
This application is a continuation--in--part of 1).S. Patent Application No.
12/013,351, entitled "SPINAL LMPLAN`L S ANi) METHODS" and filed on Jam. 11, 2008 which is a continuation-in-par of U.S. Patent Application No. I L/293,438, e. titled iSIN'TT'RSPI OU
DISTRACTION DEVICES AND ASSOCIATED METHODS OF Ili SE;R I ION" and flied on Dec. 02,200-5, which is of ?,S, Patent Application No. 11.._:
entitled "IN'T RSPII ;OUS DISTRACTION DES; IC:t S AND ASSOCIATED METHODS
OF INSERTION and filed on Oct. 25, 2005 each of which is incorporated n full b reference herein, The present application s also a, continuation-in-part of U.S. Patent Application No.
11/934,604, eà titled :S Nà US P 3CLSS IMPL1\N ITS AND ASSOCIATED MI 7-T ODS"
and filed Nov. 02, 2007 which is incorporated in full by reference herei 0.
The present application further claims the benefit of U.S. Provisional Pat nt Application No. 60/884,581, entitled " SP SPINAL STABILIZATION" and filed Vii.Ãn. 11, 200?, U.S. Provisional P=atent Application N~o. 60/62 1 ,712, entitled "INTERS PIN 1 S
DISTRACTION DEVICES AND ASSOCIATED M TRai ` S ? INSERTION," and tiled on. Oct, 25, 2004, US. Provisional Patent Application No. 60.1"63 ) 112, entitled " TNTERSPI OLFS DISTRACTION DEVICES AND ASSOCIATED METHODS OF
INSERTION. " and, filed on Dec. 3.2004 U.S. Provisional Patent Application No.
60/639,938, entitled "IN I.E.RSI INOUSDISTRACTION DEVICES AND ASSOCIATED
MflE11HODS OF INSERTION aid filed or Dec. 29,2004', U.S. Provisional Patent Application 'o. 60/654,483, entit ed "INTERSPINOUS DISTRACTION DEVICES AND
i V t 5 7 2L'2005; ASSOCIATED lklEI'IlOI)S OF iNSE T'ION,jt andfled on Feb.
US, Provisional I
P tent < :cation . {..' l.a to ~ : 'I ,:. ' bi s) ,i ?:: DEVICES
AND ASSOCIATED Mj1]_:T1-].ODS OF FNSERTION," and filed on Apr. 14, 2005; U.S.
Provisional Patent A pl=cation No. 60/ 178,360, entitled "[N<I a RS.P . US
DISTRACTION
DEVICES AND ASSOCIATE I) METHODS OF INSERTION, , .amd fled on May 6,2005.;
and U S. Provisional <'v p..lhs:.atio , No. 60/912,273. entitled 'F, ]0.v e3 _;f ] I ITI
l E MMOVAB E OR ADJUSTABLE SPIKES" and ailed April 17. 2007, each of which is incorporated in full by reference herein.
2 a itELl OF THE INVENTION
The present #_n4 t i .ion r~-,lates to spina i implants and associated me thuds.
BACKGROUND
A:'l e ve tetra of the human spine are arranged in a colurnm with one vertebra on top of the next An in.ervertebrai disc lies between adjacent vertebrae, to trans .it force between the adjacent vertebrae and pro-vide a cusp ion between them. The discs all:
s.~ the spine to flex and twist, With age, spinal discs begin to break down, or degenerate zresulti the loss of fluid in the discs and consequentl res ltin in them becoming less fexible.
Likewise, the disks become thinner allowing the vertebrae, to move closer together.
Degeneration may also result in tears or cracks in the outer laver, or annulus, of the disc. The disc may begin to bulge outwardly. In more severe cases, the inner material of the disc, or nucle.is. may actually extrude OW of the d sc= in addition to degenerative changes in the di sc, the spine may undergo changes due to trauma - room automobile accidents, falls, heavy fling, and othe r activities, .Ej kil. therniod e, in a process known as sp. inal stenosis, the spinal canal narrows dae to excessive bone growth, thickening of t-ss_e in th.e canal (such as liga nnent), or both. In all of these conditions, the spaces ,t -eugh which the spinal cord and the spinal nerve roots pass may become narrowed leading to pressure on the nerve tissue which can cause pain, numbness, weakness, or even paralysis in various parts of the body Finally, the facet joints between adjacent vertebrae may degenerate and cause localized and.: or radiating pain. All of the above conditions are E ollectively' reaerre to here n as spine disease.
Conventionally, s: rgeons treat spine disease by attempting to rQszore the normal spacing between adjacent ve; tebrae. This ::ay be stiff cient to relieve pressure from affected new tissue. -However, it is often necessary tt also surgically remove disc niatei'iaal, bone, or other tissues that impinge on the i rve tissue arid./or to deb ride the facet joints. Most often, the restoration of vertebral spacing is accomplished. by inserting a rigid spacer made of bome., S
irietal. or plastic into die disc space. bet ~ en the adjacent vertebrae and allowing the v r .enrae to grow tugetl e;', or fuse, into a single piece of bone. The vertebrae are typically stabilized Est, n this fusion process with the use of bone plates and{or pedicle screws fastened to the adjacent. \ertehrae.
[T,41 Although techniques for placing inter verteb al spacers. plates, and pe icle scre w fixation s}'.. r: .. have become loss invasive in recent y'e.ars, they still require the placement of hardware deep within the surgical site adjacent to the spine. Recovery from Such surgery can t _iire several days of hospitalization and lonk, slow rehabilitation to normal activity y levels, [13] More r'ece`:tl ', nivest`.gators have promoted the. use of motion preserv, , on implants and techniques in which adjac_cut. vertebrae are permitted to move relative to ore another.
One sucl: implant that has met with only limited success is the art ficial disc implant. These ' AC i ll include either a flexible material or `ca two-piece articulating joint inserted in the disc space. Another such implant is the spinous process spacer. which is inserted between dIe posteriorly extending s ainou r processes of adjacent vertebrae to act as an extension stop a d to maintain.. a minimum spacing between the sp nous roc: ssv _ when the spine is in extension. "P he spinous process spacer allows the adjacent pinous processes o move ii art as the spine is fete..
BRIEF DESCRIPTION OFTHE DRAWINGS
[ [6] Various e ;gym aple.s of the present invention will be discussed with reference to the appended drawings. These drawings depict only illustrative examples of the invention and are not to be considered limiting of its scope.
111 11 FIG. I is a perspective view of a spinal implant according to thepresent invention; FIG. 21 is a cross sectional view of the spinal implant of FIG. I showing the i iaplanà >
a first position;
[119] FIG. 3 is a cross sectional view of the spinai implant of FIG. I showing the implant in a second position r-,,,"101 FIG. $ s an elec ationi viewo a spinal implaant c`ac c ?rfling tto3 tiie preseTit inven io3n1 showing the implant in a first position;
[111 i i 1~I G. 5 i s an elevation view of the spinal implant of FIG. 4 showing the implant in a second P('`ition;
[1 l2] 1`10. 6 is a perspective view of a spinal implant according to the present invention [ 13] FIG. 7 is a cross sectional view of the implant of FIG.
['114 FIG. 8 i a i erspc . .;i e view o i spi gal imp= nt c3c e riling Gt) Ã
e present ink enti n [1':151 :FIG. 9 is a perspective view of a spacer component of the spinal implant of FIG, t in a first position 5] FIG. 10 is a perspective view = of a spacer component of the spinal implant of FIG. 8 in, a second position;
1111 71 1IG. I i is an elevation view of a core component of the spinal implant o E .i_?. in a first position;
:T.-:l 8] FIG. 12 is a perspective view of a spinal implant according to the present invention;
t ] FIG. 13 is a perspective -,6,ew of fl?.pinal 3.mp'a t of FIG. 12 illustrating one method of insertion, ',t3; FIG 14 is aperspecÃtte.. 4-ieZip tj the spi_Ãial it:mp ant of FIG, 12 ilia strathig another[ [21 ] FIG. 15 is a perspective view of an altos ativ;
e. con figuration for the retention method of iinsertion-, members 1the, spinal si ma~lp:E~?I?Ã of !.:FIG'. of 12s 22 FIB. 16 is perspective view of a spinal implant according to the present iÃnventÃon;
[ 2 3J FIG. 17 is an elevation vie j eta spinal implant according to the present invention in a first position:
... .o~~ view r of the ~' E 1241 '1~~. 18 is an ~ ~,. ai~'~' >,at ~Ã spinal . FIG, implant of FIG. 17 ina second position-, [ " T 25 ] 1 IG. 19 is a tae pectin detail view o f one end of the spinal implant of FI G. 17 showing the first and second positions superimposed on one another [# 1126 G, 20 is a perspective view of a spinal im am according to the present invention, [l27] FIG. 2 1 is a perspective view of t' e spinal implant of MG. .F. 20 shown implanted in a3 first position;
[x_28] FIGS, 22 is a perspective view of the spinal implant of FIG. 20 shown "'Implanted in a.
second position;
291 FIG . 2 is a perspective vi,ew n spinal implant according to the resent in t o i ~i f: st position-0] FIG. 24 is a perspective view of the spinal implant of FIG. 23 in a second position-, 3I FIG , 23 is perspective view of a spinal implant according to the present invention in a first position;
[f.1.32,] FIG. 26 is a perspective v eww of t:I.e spinal implant of FIG, 2-4 in -a second position, [T-33] FIG, 27 is a perspe.,tive view ofthe spii al i.Ã plant of FIG. 26 ina third position;
[1T34.l FIG, 28 is a cross sectional view of a spinal implant according to :h f resent invention in a first position;
FIG. 29 is a cross sectional view of the spinal implant of FIG. 28 in a second position;;
r;.~6, FIG. ill is a perspective view of :i spinal 1.nplsnt c1c..oxEsxf'gl to tie present invention. in ia. fast pos ti~un;
[1137] FIG. 3.1 is a side elevation view of the spinal implant of FIG. "30 Ã -the first position, [11,38] FIG. 32 is a font elevation view of the spinal implant of FIG. 30 in the first position [1139] FIG. 331s r perspe t ve view of the spinal implant of FIG. 30 in iT
second position, r'" ,, FIG. 34 is a pers1-~ectiv e view of c spinal i pl ntt accord ng to the present invention in [1!1401 .'.tom a first position;
[1'41] FIG. 35 is a perspective view of the spinal implant of FIG. 34 in a second position _ '- fits. 36 is a perspective of the spinal i;itpiai t of FIG. 4 in a third position;
"> FG. 37 r x"f a tve view of { the Agr ?pix)a l inml pli} qt o' ~~tf`~IG, 34 ui-nplanted "a spine;
r is a p e.sA pc c-S iiL 4 FIG. 38 is a perspective view of a spinal implant according to the present inve.intioIn;
145] FiG. 9 is a front elevation view of the spinal implant cis FIG. 38 implanted in a spine;
11146] FIG. 40 is a cross sectional view of a spinal implant according to the present invention implanted in a spine;
[1:47] FIG. 41 is a cross sectional view of aspinal implant according to p rose invention implanted in a spine., [ 4481 I FIG, 42 is a .t c.r t el anon vie i cni,I~ 1 i t c3t'a spinal i cipl . t ac rdin to the t resent invention being implanted in a spine J49J FIG, 4" is a front elevation view of the fully assembled implant of FIG.
42 imp.tn ed in a spine;
t}.j IKIG. 44 is a perspective view of a spinal implant acc rding, to the present invention : n a f St position;
[1511 FIG. 45 is a perspective view o the. spinal implant of FIG, 44 in a second position;
[!,,,521 FIC G. $6 is a perspective view of the spinal implant of FIG. 44 in a third position', [1'53' SIG, . 4`7 is a perspective view of a spinal implant a cordi :i to the present invention III
a first position;
[ 54 FIG, 48 is a perspective view of the spinal implant od FIG. 47 it a second position;
X55] i' G, 49 is a perspective view of a spinal implant a ;cor-dii g to the present invention in a first position [ 156] FIG. 50 is aside elevation view of i e spinal i, 1plsnt of Fat3. 491n a second position;
[1[57] FIG. 5? 1 is a perspec tive view of a spinal implant according to the present invention iti ofirst position;
[9T58 FIG. 52 is a perspective view of tl .e spinal implant of FIG. 51 in a second position, z> .t =I .F. 53 is ? . . ?e ti 'e view of a spinal implant according to tic present invention in a first position }60] FIG. 54 is a perspective view of the spinal implant of 1'IG..5 3 in a second position.
[ 'I FIG. 55 is an exploded perspective view of a spinal implant accorciing to the present.
invention j~ 621 =I .i. 56 is a tiont e evati:~n vie ' sit tl]e. pinal implant chi G, `
5 ilk a first ` ositiÃn;
3I FIG. 57 is a rent elevatioF view ofthe s i -: mpla à o I .55 Ã~ a sycE nd posit on $4] FIG , 58 is an exploded perspective view of a spinal inF lant. according to the present invention [ 6' FIG. 59 is an exploded perspective view of a spinal implant according to the present invention;
[1.7661 i'iG. 60 is a right perspective view of a spinal implant according to the present invention', J67] FIG. 6 1 is a left perspective view of the sr "nai implant o ' FM. 60 [x1681 FIt:. 62 is a lest pers .echiv e view of a spinal implant according to the present invention;
r-,69] FI . 63 is a ri, hi perspective view of the spinal implant of FIG. t. .
[1.701 FtG. 64 is a perspective view of a spina' implant according to the present inverition;
[14:711 FIG. 65 is a perspective view of a spinal implant according to the present invention;
172 i FIG. 66 is a front elevation vit, ' of the spinal m )_lant o F G, 65 [J': T. FIG. 67 is ,a front elevation view of a spinal imp lanat according to the present [ ` 4 FIG. 68 is a flow Ãliati F'a i of a mmethodof inserting a spinal imp" t nz according to -tile present nve ration;
EE 751 FIG, 69 is a front elevation view of a spinal implant according to the present i3: vv'tion1.; and [IR6] ".IG. 70 is a perspective view of awn alternative embodiment of the spina implant of FIG. 69.
ILLSTRATIVE EX.AMPE.
: I ':.il ` It I IIII
N7 a tr# (}d. a.ent- of spin l aà is? tss m$Lcordi g to [ a spacer and one or more retention :embers. Throughout this specification, the spinal implant will be referred to in the context of a sphious process immplant. However, it is to be understood that the cps.n nn ant rnay be configured for insertion into the cervical, horn cIL, aà d or lnmbau spine between adjacent Sprott s processes, trCan \Aersse processes, andsro} other vertebral structures. The spacer may be provided in a variety of'sizes to accommodate ees o pa correction. h spacer.
anatomical variation amongst paÃ3L_: and aryi#a deg may include openings to facilitate tissue ingrowth to archon the spacer to the Vertebral bodies such as tissue Ãi -growth from the spine. For example, the spacer may be configured for tissue in-growth from superior and inferior spinous p:iocesses to cause.
fusion of the d . n lid?xr`ou processes. The openings may be relatively large and/or o"21municate to a hollow interior of the spacer. A. hollow interior may h configured to receive bone growth promoting subsÃances such ar by packing the substances into the hollow interior. `F he openings as be iclatii' ,'`,v small and oi: comprise pores or F lte:"co nec ing pores over <3: feast a portion of the spacer surface. The openings may be filled with bone growth promoting sÃ.ibst8tccs, [178, The spacer may have a: y suitable cross-sectional shape. For example, it may be cylindrical, w ed ge shaped. .'D-draped. C -shaped, H-shaped, include separated cantilevered hear ic. an.d/or any other sums le I .pe. ']'he shape may include chamfers, fillets, fats, reef cuts, and/or other features to accommodate anatomical features such as for examuic. the laminae and/or facets, 1.791 The spacer r aq be Ãncoirtpressible, moderately compressible, highly compressible, convertible from compressible to ineo pressible_ arid) or anyother configuration. For example., the spacer iliay be conip esL i bi into a comp of c 3nf tguration for Inserdorl between adjacent bones and then, expandable to space the bones apart. The spacer m .
be allowed to flex to provide a resilient cushion between the bonesThe spacer m -y be locked in the expanded coriditjoii to prevent it from returning to the compact L on iir Lion.
The retention member may extend transversely from f he spacer re'a`ti'L"e to a spacer ! ,E3 lon zt .dinal axis to maintain the spacer between adjacent spinous processes.
A single retention member may extend in one or more directions or multiple extensions arlay be provided that extend in multiple dÃaections. Ohio ori3 ore retention members may be fixed relative to the spacer longitudinally and/or radially~. One or more retention members may be adjustable relative to the spacer and/or other Teter tion m ambers longitudinally and or radially to allow the retention mer,. bera to be positioned relative to the spit ious processes. The retentinn aiernbers may be dt plo a :e tliroo i and or fior within the spacer to allow the spacer to be placed and th ctention met bers deployed in a mirii ally invasive MWUICI,.
The retention rrcmhers may incna e ore or more screws, pins, nails b s-,Ins s't iples. hook:, plates, wings, bars, ex-tensi ns, lrlament;s, Wires, loops, ban as, straps, cables, cords, Nsutures, an d.eor otl cr stiitahle r tea itioi, ,-,i'. aocr. The retentl+n metvpers o'ias lse n' a~#e > Firetztlsa metal alloys, pops-.:aers and/or other suitable materials. The retention members rnay grip bone and/or soft tissue, abut gone and/or soft tissue, facilitate tissue ingrowth and. ox ongrow th, and./or otherwise retain the im-plarit.
j$ i ] 1'hc retention i .temb rs ma cooperate ith fa t ner=s enga :able L itp the sp moos p r cess's n or o tis e. Such F` _ ten rs may include one or more pins, nails, rivets, bolts, stapes, hooks, sutures, wises; straps, clamps, spikes, teeth, adhesives, and/or tither suitabk The fasteners may be integrated Into the retention members or they may be modular. The retention members and/or fasteners, may he adj ,:stable, eplÃaceable, and/o temovahk and i ay be ennployed in one direction and1 or on one side of the implant or in m ultiple directions and/or on multiple sides of the implant to allow tailoring of the kind and quality of fixation of adjacent bones. For example, the implant may be placed such that it acts only as a spacer between adjacent bones, as an elastic restraint between adjacent hones, or as a rigid fixation between adj 3.centi bones. The spacer, retention members, aad'aor fasteners may advantageously be trade of different i aterials.
8 cla ma he used t stabilize. the spinal implant wid/or to provide: other benefits.
For t .ample. sires, straps, sands, cables, cords, and/or other elongated members may encircle the p`dicies, laminae, sp n'was processes, transverse pro ss , and/or other spinal ses. t u ctur The cerciage may be relatively inextensible to provide a hard chcL k to s ine flexion or the cerclagc ma e .relatively extensile to pro=wide inc easÃng resistance to flexion. The cerclage may be Ãe.1;tiv ely flexible and drapeable such ; s a woven fabric or it i:aaa.y be relatively rigid s ich as a metal fiend. The cerciage may have shape memory properties that cause it to resume a prior set shape after implantation. The cerelage may be independent of the s i sous process implant or may, engage it. For exa iple, the cerciage may pass through a hollow interior of the spinous process implant and/or engage tie extension.
[T.83] The implant may be supplemented a th bone growth promoting substances to thcilitate fusion of adjacent vertebrae between spinous processes, laminae, transverse processes, facets, and/or other spinal structures. The bone growth promoting substances may be spaced from the its pliant. placed adjacent the implant, sandwiched beLween the Implant dedying bone, placed inside the implant, coated onto the implant, and/or othe wi a ail up placed relative to the implant. If it is coated onto the implant it may cover the entire implant or only selected portions of the implant such as the spacer, retention >
.embers, fasteners, and/or other portions.
[I'ls4] As used herein, bone growth pr motin substances may includebone paste, hom e chips, bone straps, structural bone grafts, platelet derived growth factors, bone i .arrow aspirate, stern Cells, bone growth proteins, bone growth peptides. bone attachment proteins, bone altaclu-nent peptides, ya roxyiapatite. calcium phosphate, stalins, and"
'or other suitt0ble bone prornoill',zig substances.
i. 851 The spinal implant . ;nd any associated cerciage or other components ;..may be made of any suitable hiocompatib.ie r aterial including among others metals, iesorbabie cerar .iits, non-resorbable cera mt.ics, resorbahle polyrrers,and no.-resorbable polymers.
Sortie spc .tic e unples include stainless steel, titanium and its alloys n lading is + l-titanitari alloys, tantalum; hydroxylapatite, Calcium phosphate, bone, zirco ia, alumina, car bons bioglass, polyesters, polMlacti:c acid, po hg hcolic acid, p ' olefris, pol yami:des, pol im des.
pr3l ateti po(?ketones, fluropolymers, and/or other suitable bioco patihle rnaterrials 'and combinations thereof 1 The spinal implant may he used to treat spine disease in a variety of surgical techniques inch ding superspinous ligament sacrificing posterior approac es, superspi ioaps ligament preserving posterior approaches, lateral approaches, and/or other suitable approaches. The s itial implant may be used to treat spine disease by (sing a(acent vertebrae or by preserving T11011"10 11 between act.jaeent vertebrae. It may include only an extension stop such as a spacer, only a flexion stop such as flexible cerelage elements, or l both a flexion and extension Stop, The spÃrous process à à . lant à a be used to reduce loads on the -facet Joints, it irease s Ãtaous process spacing, reduce toads on the disc, increase disc spacing. ant/cÃ- otherwise treat spire disease. Techniques for the spinal implant may iricltude leaving the tissues at the surgical site unmodified or modifying tissues such as trimming, rasping, roughening, and/or otherwise à odÃ~ying tissues at the implant site.
(1 71 F 'or example, FIGS. 1-3) illustrate a spinal 100 including spacer 102 an a plurality of retention members in the fo : of first and second plate extensions 104, 105 and deployable retention members 106, 108, and 110. The spacer 102 has a, generally cyh ndnca body 112 having a proximal end 114, a distal end 11 6., and. a longitudinal specs axis 118 extending therehetwe :n. The distal end 116 tapers toaÃr. edge to facilitate inserting the spacer 102 bet x,een two bones, e.g. ad;a e, t spmous processes The distal end is defined by r superior facet 120, an inferior facet 122,aand lateral facets 124 (orie shown).
X88; '11e ate: extension 104 projects radially outwardly rroiia the spacer 102) adjacent the proximal end and the second plane extension 105 projects radially outwardly 1"rolm the spacer 10.2 opposite the 1-first plate extension 104, The plate extensions 104, 105 may be integral with the spacer 102 as shown in FIGS. 1-3 or modula and separable from the, spacer 102. The plate extensions 104, 1005 provide an. insert on stop by abutting the spinous processes 126, 128.
[ 189] The deployable retention it e ribe=s 106, 108, 1.10 maybe pre-installed within the spacer 102 or inserted into the spacer 102 i.ntrauperatively. Preferably they are pre-installed and retracted within the spacer 102 as Si' o n in FIG. 2i. Each deployable retention member 106,108, 110 is directed ià to a channel 130, 132, 134 that communicates from the interior. of the spacer 1Ã02 out throu'h the 0i tal end 116 to the exterior of the: spacer 102. The eplo able re :r Lion ; iet l ers 106, 1 # N. 10 are joined at their proxiirtai ends 136 so that they Move together. The interior of the spacer includes a cavity 1.37 that houses the deployable retention members 106, 108. 110 in the un-deployed position. The cavity 137 is threaded and receive an actuator screw 138 in axial translating [~:{90] In use, the spinal implant 100 is inserted l etween adjacent spinous processes 126, 128 as shown. The actuator screw 138 is then rotated so that it translates along the spacer axis 118 and pushes the deployab. _ retention members 1,0 6, 108, 110 distally "I
sough the channels 130, 132. 134. The spacer 102 includes a pair of sockets B9 at its proximal end 114 for receiving a tool for applying a counter torque to the spacer 102 while the actuator screw 138 is rotated. The channels 1311. 132, 134 may be curved to cause the deployable retention members 106, 108, 110 to bend a uy from the spacer axis 118 and -rip the spinous processes 126, 12$ and/or surrounding soft tissue. The deployableretention members 106, 108. 110 may also be pro- beiit and then elastically straightened as they are loaded into the win-deployed position of l;10s. 2. Upon being deployed, they may then return to their pie. bent shape. The deployable retention members 106, 108. 110 may advantageously be made of a sitperelastic material such as Nitinol. They may also respond to the patient's body temperature to change shape from the straight c ontigur'ation of .' 1G. 2 to the cur ''ed configuration of FIG. 3. Soft tissue may also grow arouncd, adhere to, scar around, and, or otherwise grip the deployable ,retention members 106, 108, 1.10 over time.
Deployable retention member 110 is split at its distal end to form a loop 140 that opens upon being deployed from the spacer 1,02 to facilÃtatte tissue growth into aid around the loop 1411 for increased retention strength A plurality of holes 1,42 are formed through the plate extensions 104, 105 for receiving fasteners for attaching the plate extensions 104, 105 to the surrounding is bone and/or soft tissue. Such fasteners may i.nclucde any of the fasteners listed ve. A pin 144 is shown, In one of the holes 142 in FIG, 3.
' 9l] l1~ ; . 4 - 5 illustrate a spinal implant 200 similar isi fora and function to that of FIGS.
1-3. The spinal implant 200 includes aspacer 202, deployable retention members :1Ã = w and spacer end pieces 20 . The spacer 202 and end pieces 206 are general ly cylindrical and are aligned til i? a spacer axis 208 ud by a threaded shaft 210 that three Viably engages the end pieces 206. The threaded shaft 2 10 is mounted to the spacer -20-` . or axial rot-a-6 on and includes a drv .r engaging end 212. The deployable retention members 210 are ixed in the spacer 02 and are slidably received in cliennels h 14 in the end pieces 206.
E9 In use, the spinal implant .200 is inserted between adjacent `}'ones such as s pivl.ious processes 220, 22. A driver (not shoni) is engaged with the r.t r engaging end 212 of the threaded shalt 2110 and rotated to move the end pieces ''0i toward the spacer 20Ã2 causing the retention members 204 to extend out of the channels 214 away- from the spacer axis 208 as shown FIG. 5. A tool (not shown) i ay he engaged with one or more sockets 2.124 in one of the end pieces '406 or notches 226 in the spacer 202 to apply a counter torque while the threaded shale 2 10 is rotated.
~ 9 3 ] I' IGS. i - . i li :i:str rte spinall impl ant 300 similar Ãn form find funcÃion to that f : I s' .
1-3. The spinal implant 300 i nclFudes a spaces 302_ a core X3 4, and deployable r. tent on members 306 e\.t ncdn g ions the core 30$. The. deployable Ã=t~.tention Ãn ;i bci s 306 include plurality of wires projecting in a radial array from a cot ll space. axis 308 at each end of the core 304. In the illustrative exa iple, which h . been designed for interspinÃius place i,ent, there. are no wires projecting anteriorly to avoid impingement with the facets and/or other spinal structures. The core 304 and deployable retention members 306 are.
received in passage wky 309 through the spacer 302 parallel to the sparer acs 308.
[ 4] h use, the spacer 302 is positioned between adjacent bones such as spinous processes 310,312. The core 30' and d e p l a y a b l , c retention riei':ithcrs 306 maybe . rt:a 1\ pr -nmerted as show a a in FIG. 7 such that after the spacer 3302 is positioned the core is advanced to deploy the dcp'oyab k retention member 3136. lterrativei'v, the core and deployable retention members 306 may be separate from the spacer _302 and. inserted after the spacer is placed . in either case, a t ithc 314 may o,stiorally be used to hold the z ci ~'<`a le rete lion members 306 an sor core 304 prior to deployment. Asshow :n inIG, 7, the tube 314 may be engaged with the spacer 3102 in alignment with the pas:sagewaiy. 309 and the core 304 and deployable retention members 306 pushed from the tube 314 into the passageway 309 unti the deployable retention members 306 .ep'o from the opposite end of the passageway 309, The tube 314 may be withdrawn to per i.it the remaining deployable retention.
members 306 `to deploy.
[195] ERGS. 8.11 illustrate a spinal implant 400 similar in form and f tnction to that of FIGS. 1-3. The spinal hnplant 400 includes a generally cylindrical hollow spacer 402 hat ira :
a -first end 404, a second end 406, and a spacer axis 408 extending from the first end 404 to the second end 406. Acore 410 is positionahle within the spaacer 402 a; ong th-he spacer a is 408. Optioonally, : plurality of .eployabl . retention members 412 project radially away fron z tie spacer axis 408 a each end of the core $10. The spacer 402 is made of a compressible material such as a su rel_.s is metal orpolymir such. that it can be compressed to. facilitate insertion. For exarirple, as shown in FIG. 9, the prongs 420 of a tool (not shown) may be inserted into the spacer 402 and spread apart to stretch the spacer 402 into a flattened tCi elliptical shape; The spacer 402 may teen be inserted and the prongs removed spacer 402 to recover to its original shape. Depending on the modulus of the 402 and x]G.ah bones, loads exerted or. ~zbY t17~: surrounding 434, it may recover to its t4 full ~~ pre-insertion and distract tl e bones or it ma).- tilt' recover partially. The core 4 0 may then be inserted to niintait? the spacer a ccr 02 at its recovered height. The core 4 10 may be sized to press into the spacer 402 and thereby prevent any compression of the spacer 402 post--insertion or the core may be sized to allow a predetermined amount of compression of the spacer 402 it) provide a resilient spaces (. The optionual deployable retention members. 412 rfiay be omitted arid the s final implant 400 used in the condition shown in FIG, 10. Preferably', the core 410 includes :yep oya b1e retention i? ea?mb ,rs 412 in the form of filaments t. at can be deployed as an array, of loops pr"~~ acting radially o?.atwardt\x i'ro'n the spacer axis 408 at each end of the core 410, The retention members 412 may retain the space 402 in place by physically blocking witl?d.aa. w,al. The retention members 412 r aay` also retain the spacer $02 due to tissue growth around the retaining members 412.
{1:96] G. 1. 1 illustrates one way of arrangin the deployable retention members 412. A
plurality of 422 are mounted of the con. 410 with at last o_, oi'tl e rings 422 being ax tlTi translatable along the core 410, 1l"he rings are conneclea by a plurality of iiamen'.s 424 spiraling around the core 410.
[1r 7] In use, the spacer 402 is inserted between a jacent bones such as adjacent spir.ious processes and the core 410 is inserted into the spacer 402. t e t r ring } 2.
is it:F ve toward another ring 422 causing the filar ents 424 to bend away from the core and form the array of loops as shown in FIG. 8. Alternatively. the retaining members 412 may be {ode d down ra:a!lel tl spacer axis 408 similar to the embodiment of Fski. 718 98] FIG&. 1244 illustrate a spinal implant 500 similar In fonrn and function to that of FIGS. 1-3. The spinal impIant SOO includes a spacer 502 having a generally cylindrical hollow body 504 including a first end 506, a second, end 508, any a spacer axis '+ 10 extending from the first end 506 to the second end 508. The ends of the spacer 502 are tapered to facilitate insertion between adjacent ,ones. A plurality of channels 5121 extend through the body 504 from the first end 506 to the second end 508 generally parallel to the spacer axis 510 Deployable retention members 514 are enMgageahle with channels 512 in axially slidat le .el;tionship. In the illustrative exam p e of FIGS. 12- i4, the channels -512 and deployable retention members g 14 have complimentary rectangular cross sectional shapes, The deployable retention members 514 are curved to extend radially away` trot i the spacer axis 510 and grip the spinous processes.
[T.-99] in. use, the deployable retention members 514 on ~raighte `e and :
'tr~;C t l tallow the spinal implant 500 to be inserted between the spinous `l leis may be accomplished io a variety of ways. As shown in FIG. 13, the deployable retention members iii 7 tlte ` et rs:~ to s tr~~ g.its.>~.They 514 ma -v- be withdrawn partway through the channels 512 1orc i~, May include a siop to 'prevent them from being withdrawn completely. After the s pacer 502 is inserted between the spinous processes, the. deployable retention members 514 niayy be. feed through the channels 512 and allowed. to resume their curved conf gur tion.
Alternatively the deployable retention members 514 may he separated from the spacer 502 completely and not introduced until after the spacer 502 has been inserted. As shown in FIG.
14, the deployable retentioan e Aber: 51.4 may be straightened &ndthe spinal implant 500 inserted through a tribe 520 and into the space between the sp .ous processes. l-IG. A2 illi_astrawh the spinal implant 500 post-insertion with the deployable retention members 514 fully deployed.
100 FIG, 1 illu-st aces a spinal implant 600 sa u ar w that of FIG'S. 1'-14. S
.i al :implaà t 600 has deployable retention member: 602 Ã,_ the form of wires rather than the rectangular ribbon-like dq, vatic retention members 514 of FAGS 2=14, ( 101] FIG. 16 illustrates a spinal implant 700 sÃ,m l to that w ,"FIGS. 12-14. S ..Tai implant, 700 includes a spacer 702 having a passageway 704 through the spacer 702 parallel to a -sparer axis 706. After the spacer 702 is inserted between adjacent spinous processes, <a pre t=Yr} i a ~. :gtea.
eddci~lt~y~able retention. ~a-aer~>:~ea= `~ ~38 in the form of a ~~~arc. < 2s inserted through the passageway 704 rr m a 'first end 'to a second erd of he pass, gewa;' so that it e 3erges from the second end and returns to its preformed shape to extend transverse to the spacer axis 706 beyond the outer surface of the spacer 702. The end of the deployable reternic n member may also extend transverse to spacer axis 706 at the first end of the spacer axis so that the deployable retention member may e vaens: on both sides of a process to capture the process.
Alternatively,, a set screw or other mechanism may be provided to fix the deployable retention member 708 in the passageway 704 after the deployable retention member 708 has been deployed. In the illustrative embodiment the deployable retention member 708 is preformed into a coil.
[f1021 FIGS. 17-19 illustrate a spinal implant 800 similar to the previous embodiments.
The spinal implant 800 includes spacer 802 1{avin and second en ins ls04, 6 and a spacer axis 808 extending therebetween. The spacer 802 may be wedge shaped, cylindrical, elliptical, rectangular; and/or any other suitable shape. I lie shapemaay be.
based on anatomical cox sider'ations. Deployable retention m embers are provided in the form o fa t:=t`r n al portion 810; S.: 2 <:._.: nd ng tron ea3ii h u d 804 8 't? of ht.
pwicer 8 32. I he ter- aiÃaaal portions 810, 81.2 have a compact posit oa: or shape closer to the ' pac4r axis 808 as slt a,siy it FIG, 17 and an expanded position or shape A tier from the spak, axis 808 as shown FIG.
18. FIG. 19 illustrates the compact and expanded positions superimposed for corÃ.parison, in the itlustrative embodiment of FIGS. 17-19 the teri-ninal portions 8 1 a 812 are provided as coils such as a conventional helical spring coil and the .o r acà posit of corresponds to a o.i~
being tightly wound and the expanded position corresponds to the coil being loosely wound.
Ho,vever, the terminal portions 810, 812 may be shaped s a Mange, solid disc, protrusion, 'bar, or the le as a matter of design cho ce. The spinal implant 800 is implanted with at least one of the terminal onions 810, 812 in the co_ mpact position. Once placed, one or b (All terminal portions are allowed to expand. For exar ip le, the coils may unwind due to their own spring tension. A,lternativel , the coils may be activated, such as e-o, by heat, to expand.
The spacer 802 separates adjacent spinous processes and the expanded terminal portions 8 Ã 0, 812 maintain the spacer 802 between the spinous processes..
he separate devices, in the illustrative 1031 While the terminal portions 910, 11.2 ma y embodiment of FIGS, 17-19, the terminal portions 810, 812 are connec.te :
through a passageway 81.4 formed through the spacer 802 along the spacer axis 808. In this ii_i ti` . SÃ? Ãat, the terminal portions 810. 812 ;re the ends o fa continuous coil placed within tl-t passageway 814. Tlhie coil ina ~~. he designed to be in tension such that the ternminal portions tend to seat against the spinous processes to bold the spacer 802 firmly in place.
104_ The ter ai.Ã anon port ons 810, 812 may be formed of any number o f mate:
ials, but suerelastic materials suchs shape memory ;;Metal alloys or polymers are advantageous. In particular, shape me Tory mwerials can be designed having a first small shape to allow less traumatic inipLantation of the device. Once implanted, activation of the shape memo>y, i .ateria.l would cause th fermi ial portions 810, 812 to move from the compact Position to 1]
the expanded position. Moreover, for a continuous coil embodiment. the coil may be configured to retract and thereby seat the teririinal portions against the, spinous process.
1 J5] The spacer 8()2 may he provided with one or more surface grooves 816 to receive, e.g., the prongs of at sargtcal distraction t0<~. so that the spacer may be placed along the prongs after the spinous processes have been distracted.
[ " 11 s] rIGS.'20-22 illustrate an alternative arrangement to that of FIGS.
17-19 in which a, spinal implant 900 includes a spacer 902 and a coil 904 wrapp eel around the outside of the spacer 902. The coil 904 nmy have shape memory properties allowing it to be transformed from a compa.:t position to an expanded or it may always be biased toward the exuanded position. In the case where it is always biased toward the expanded position, the coil 904 miiav be maintained in the compact position by a sleeve 906 or other surrounding structure. The spinal implant 900 is placed between adjacent bones, e.g. pii edit p_i .es 910, 912, in tine compact position (FIG. 21) and allowed, or activated, to s :ms 'on to the expanded position (FIG. 22) to ? i:aintaÃn the ..-weer 902 bet peen the bones.
AI ernat vc ,, the spacer 902 may be removed after the spit al i mplant is implanted or the spacer 902 may be omitted entirely such diatjust the coil 904 serves as both a spacer and retention member.
[j;:11 07] FIt,GS. 23-24 illustrate a spinal implant TOO,) including a spacer 1002 I t\ ing a proxin-sal end 1004. a distal end 1006, and a spacer axis 10Ã 8 extending there.lietv een.
Optionally, the distal end 1006 i,;.`. ' be tapered as s i:own to insertion between adjacent bones. The spinal implant 1000 includes one or more deployable retention members .
mounted for rotation to the spacer 100:2 for rota i o o n between a compact or stowed position (FIG, 23) and an expanded or deployed position FIG. 24). In the illustrative embodiment of FIGS. 2' -24, the deployable retention members are in the form of wires 101L()mounted to IY) brackets 1012 e: tendig ridiall)- aww.a;,` from the spacer axis 1008 The wires 1:310 e te: d between the brackets 101 ' generally parallel to the spacer axis 1008 and then bend transverse to the spacer axis 10108 at the proximal and distal ends 1004, I1}O6. The spacer I002 includes an annular groove 101 4 `adjacent the distal end and file wire 11110 are curved distally to engage the groove 14 in the co pact or stowed position, As shown in FIG, 23, the groove 1014 rimayr receive the wires 1010 so that their curved portions are completely recessed to ease implantation. The proximal ends of the wires 10:10 are positioned behind the proximal end 1004 of the s pae r 1002 in the compact or stowed position to case implantation, Ater the spinal implant 1000 is inserted bet,.w peen adjacent bones, e.g. spinous processes, the wires 10 are rot ated from he st -v4,cd position to the d elo-yed position to maintain the spacer 1.002 between the bones. In the illustrative e embodiment of FIGS. the proxirnaJ ends of the wires can be accused after implantation. to rotate the wires 1010. The wires may maintain their position. due to friction with the brackets, 1012 or an.
locking mechan: ~r a may be provided. For example, deems 1016 may be provided to receive the wires and help maintain them in position e.g. in the deployed position [!j 0 8 1 FIGS. 25-2 .illustrate a spinal inipk t 1100 including a spacer 11:
' ba 11 g. a first end 1104, a second end 1106 and a spacer axis 1108 extending lierel~eà we ei .
One or more deployable retention members in the form of end pieces are mounted to the spacer 1102 for rotation betwveen a stowed, position nearer the space, axis 11 08 and a deployed position further from the spacer axis. For example, the spinal implant may include a pair of outer end pieces 111 tt and a pair of inner end pieces 1112 with one outer and one inner end pied: at each end of the spacer. The outer end pic c; 111 0 are mounted fS r rotation about an axis 1.111 offset frctri the spacer axis 1108 so that à ie ,iii?w' e nearer to or further from m the spacer axis 1108 as they rotate. For example, the outer and pieces I 110 may be mounted on a common shaft 1116 so that they rotate together. The inner end pieces 11. 12 may b sini laxly mounted fo rotation about an offset axis 1118 on, a common shat 1120.
Preferably the inner pieces 1112 are mounted ona shaft 1120 that is o?-set, from both the spacer axis 1108 andthe shaft 1116 that the outer end pieces I l 10 are n ounted on so that the inner and outer end' piece,, I 1 ` 2, 1110 none away from the, spacer axis 108 in differeiit directions. in the example of FIGS. 25-27, the inner end z i;ec, s 1112 have been relieve; e,g, to Jnclu& notches 1122 (FIG. 27); to clear the shaft of the outer end pieces 1 110 so that they may. be rotated to a t. ed position. that is coaxial with the spacer 1102. as shown in FIG, 25.
In use, the spinal implant 1100 is inserted between adjacent bo es, e.g. .pinous processes, in the sto'~ved position of FIG 25. Once the spacer 1.102 is in the desired location one .i or-- of the outer and inner end pieces 1110, 1 112 may be rotated to the deployed position to maintain the spacer 1102, in e osii C)n. Driver engaging sockets 1 124 are provided to f.ic l . ,ate rotating the end pieces. Any number of end pieces may he provided yip to and including an implant 100 in which the entire spacer is made up of a series of end pieces. The end pieces may be selectively rotated to achieve the desired it with the td#acent bones. The end pieces may be mounted to separate sha!-Is or oherL%ise mounted for independent rotation, The end pieces may, be mounted to a shaft so that they slip when, a torque threshold is met.
For exam le, the end pieces may be mounted for predetermined slipping such that if a plurality of end pieces are being rotated together on a common shaft and one abuts a bone, the abutting end piece ,,.,ip on the shatIl and thereby permit the other end pieces to be rotated fully into the deployed position.
[1:'l O ] FIG&. 28-29 illustrate a spinal implant 1.200 similar to that of FIGS, 25-27. The spinal implant 12040 includes a spacer 1202, a proximal end 1 204_ a disc l end I206~ and a spacer axis 1208 extending therebet s-eet. A fixed retention member in the Ã
mn of a paL or bar shaped extension 1210 extends radially away from the sparer axis 1208 adjacent the proximal end 1204.. deployable retention nwmbea in the form of an end piece 1212 is mounted at the distal end I 206. The end. Isere 1212 is tapered as shown try facilitate insertion bettween adjacent bones. The end piece 1212 is mounted to the spacer 1202 for rotation about an end piece rotation axis 1 2- 14 transverse to the spacer axis 1208.
For example, the distal end 1206 of the spacer may include a distal face 1216 transverse to the spacer axis 1208 and a tru n.ion 1218 projecting outwardly normal to the distal face 1 .16.
The end piece 1212 in iudes a complimentary proximal face 1220 with a soci e. -for r : i tr the triir.iion 1218. 1 'he end piece 1212 is rotatable about the natation axis 1214 from a compact or stowed p sition as sl,.own in FIG, 28 in which the end piece 1212 extends generally parallel to the spacer this 1288 to an expanded or deployed position as shown in FIG. 29 in which the end piece 212 extends genera-fly transverse to the spacer a xis 1208, To facilitate rotation. of fe end piece 1.21'2, a shaft 1 224 extends from title end piece 1212 through a pass i c.wa y 1226 in the spacer 12ÃI2 to the proximal end 12114.
The ;b,.alt. P'4 may extent parallel to the rotctio # axis 1214 or it may bend as shown. A bent shaft may include a flexible por ion, a universal joint, a bevel gear, and/o, some.
other arrangement to permit transmitting torque through the bend. A driver engaging socket 1228 is provided at the end of the shaft to engage a tool for ro ati 4 the end piece.
110 FIGS. 10-33 illustrate a spinal implant 1300 similar to that of FIGS. 28-29. The spinal implant 1300 in :hide s a spacer 1302 havÃn a proximal end 13104, a distal end 1X06, 7c wid a spacer axis 1308 extending therebe_iween. A plurality of deployable retention members aro provided at each end its the ,form end pieces 1310, 1.312 mounted for rotation about axes transverse to the spacer a' s 308. As re vealed through the broken away portion of the spaces 1302 in FIG. 30, the end pieces are mounted to gem f 14 that engage additional gears 1316 on a drive shaft 131 . As the drive shaft 1318 is rotated, t ht end pieces 13 0, 1312 rotate away fotn``i the spacer axis 1308 from the stowed position of FIGS, 30-32 to the deployed position of FIG. 33.
[ 111_] FIGS. 34-37 illustrate another spinal implant 1400 including a spacer 11402 having a f first end 1404, a second end 1406, and .a spacer axis 1408 extending th erehetween. The spacer 402 is in the form of a cylinder, rectangle, ",,edge, cone, and/or some other suitable shape and is compressible transverse to the spacer ax's 140:8. In the illustrative example of F16S, 34-357 t ho spacer is hollow and made of an elastic t? at:eriL 1, preferably a superelast c and/or shape memory material. The spinal implant 1400 includes one or mo:r: a ..:s 1410 extending away from the ends 1404, 1406 of the spacer 1402. The arms are also pr i rably made of an ciastÃc material such as a sup :relastic and or shape memory material. 1.11 zi compact or stowed position. ("'G, 34), the spacer 1402 is compressed radially to-ward the spacer axis 1.408 and the arms 1410 extend outwardly generally parallel to the spacer axis 1408. In an expanded or deployed. position ([1G. 3$) the spacer 1402 is expanded away from the spacer axis 1408 and the arms 1410 extend transverse to the spacer axis 140. In use, the s,p nal implant 1400.1s inserted between adjacent bones, e.g. sp no is processes 1420. 1422, in the compact position and >?.+ n allowed or activated to transition to the expwided position (FIG. 37). In the illustrative example of FIGS, 34-37, the arms 1410 have a pre-for med shape i which they arch or curve by ck over the spacer 1402 to grip the spirtou processes.
in the illustrative example, the arms 1410 also have holes 14224 to receWe fasteners similar to the embodiment of FIGS. 1-3. The spacer 1402 may also receive a core (not shown) to maintain a minimum expanded height similar to, the embodiment of IGS. 9-12.
11,21 1 HGS. 8-3 tl.lustrate a :spinal .11 1ant 1:00Ãnckdmg a spiacv:.r ?. 02 l tà ing one or more holes l504 to receive fas>enors similar to the em3 l odiment of FIGS. 1-
The present #_n4 t i .ion r~-,lates to spina i implants and associated me thuds.
BACKGROUND
A:'l e ve tetra of the human spine are arranged in a colurnm with one vertebra on top of the next An in.ervertebrai disc lies between adjacent vertebrae, to trans .it force between the adjacent vertebrae and pro-vide a cusp ion between them. The discs all:
s.~ the spine to flex and twist, With age, spinal discs begin to break down, or degenerate zresulti the loss of fluid in the discs and consequentl res ltin in them becoming less fexible.
Likewise, the disks become thinner allowing the vertebrae, to move closer together.
Degeneration may also result in tears or cracks in the outer laver, or annulus, of the disc. The disc may begin to bulge outwardly. In more severe cases, the inner material of the disc, or nucle.is. may actually extrude OW of the d sc= in addition to degenerative changes in the di sc, the spine may undergo changes due to trauma - room automobile accidents, falls, heavy fling, and othe r activities, .Ej kil. therniod e, in a process known as sp. inal stenosis, the spinal canal narrows dae to excessive bone growth, thickening of t-ss_e in th.e canal (such as liga nnent), or both. In all of these conditions, the spaces ,t -eugh which the spinal cord and the spinal nerve roots pass may become narrowed leading to pressure on the nerve tissue which can cause pain, numbness, weakness, or even paralysis in various parts of the body Finally, the facet joints between adjacent vertebrae may degenerate and cause localized and.: or radiating pain. All of the above conditions are E ollectively' reaerre to here n as spine disease.
Conventionally, s: rgeons treat spine disease by attempting to rQszore the normal spacing between adjacent ve; tebrae. This ::ay be stiff cient to relieve pressure from affected new tissue. -However, it is often necessary tt also surgically remove disc niatei'iaal, bone, or other tissues that impinge on the i rve tissue arid./or to deb ride the facet joints. Most often, the restoration of vertebral spacing is accomplished. by inserting a rigid spacer made of bome., S
irietal. or plastic into die disc space. bet ~ en the adjacent vertebrae and allowing the v r .enrae to grow tugetl e;', or fuse, into a single piece of bone. The vertebrae are typically stabilized Est, n this fusion process with the use of bone plates and{or pedicle screws fastened to the adjacent. \ertehrae.
[T,41 Although techniques for placing inter verteb al spacers. plates, and pe icle scre w fixation s}'.. r: .. have become loss invasive in recent y'e.ars, they still require the placement of hardware deep within the surgical site adjacent to the spine. Recovery from Such surgery can t _iire several days of hospitalization and lonk, slow rehabilitation to normal activity y levels, [13] More r'ece`:tl ', nivest`.gators have promoted the. use of motion preserv, , on implants and techniques in which adjac_cut. vertebrae are permitted to move relative to ore another.
One sucl: implant that has met with only limited success is the art ficial disc implant. These ' AC i ll include either a flexible material or `ca two-piece articulating joint inserted in the disc space. Another such implant is the spinous process spacer. which is inserted between dIe posteriorly extending s ainou r processes of adjacent vertebrae to act as an extension stop a d to maintain.. a minimum spacing between the sp nous roc: ssv _ when the spine is in extension. "P he spinous process spacer allows the adjacent pinous processes o move ii art as the spine is fete..
BRIEF DESCRIPTION OFTHE DRAWINGS
[ [6] Various e ;gym aple.s of the present invention will be discussed with reference to the appended drawings. These drawings depict only illustrative examples of the invention and are not to be considered limiting of its scope.
111 11 FIG. I is a perspective view of a spinal implant according to thepresent invention; FIG. 21 is a cross sectional view of the spinal implant of FIG. I showing the i iaplanà >
a first position;
[119] FIG. 3 is a cross sectional view of the spinai implant of FIG. I showing the implant in a second position r-,,,"101 FIG. $ s an elec ationi viewo a spinal implaant c`ac c ?rfling tto3 tiie preseTit inven io3n1 showing the implant in a first position;
[111 i i 1~I G. 5 i s an elevation view of the spinal implant of FIG. 4 showing the implant in a second P('`ition;
[1 l2] 1`10. 6 is a perspective view of a spinal implant according to the present invention [ 13] FIG. 7 is a cross sectional view of the implant of FIG.
['114 FIG. 8 i a i erspc . .;i e view o i spi gal imp= nt c3c e riling Gt) Ã
e present ink enti n [1':151 :FIG. 9 is a perspective view of a spacer component of the spinal implant of FIG, t in a first position 5] FIG. 10 is a perspective view = of a spacer component of the spinal implant of FIG. 8 in, a second position;
1111 71 1IG. I i is an elevation view of a core component of the spinal implant o E .i_?. in a first position;
:T.-:l 8] FIG. 12 is a perspective view of a spinal implant according to the present invention;
t ] FIG. 13 is a perspective -,6,ew of fl?.pinal 3.mp'a t of FIG. 12 illustrating one method of insertion, ',t3; FIG 14 is aperspecÃtte.. 4-ieZip tj the spi_Ãial it:mp ant of FIG, 12 ilia strathig another[ [21 ] FIG. 15 is a perspective view of an altos ativ;
e. con figuration for the retention method of iinsertion-, members 1the, spinal si ma~lp:E~?I?Ã of !.:FIG'. of 12s 22 FIB. 16 is perspective view of a spinal implant according to the present iÃnventÃon;
[ 2 3J FIG. 17 is an elevation vie j eta spinal implant according to the present invention in a first position:
... .o~~ view r of the ~' E 1241 '1~~. 18 is an ~ ~,. ai~'~' >,at ~Ã spinal . FIG, implant of FIG. 17 ina second position-, [ " T 25 ] 1 IG. 19 is a tae pectin detail view o f one end of the spinal implant of FI G. 17 showing the first and second positions superimposed on one another [# 1126 G, 20 is a perspective view of a spinal im am according to the present invention, [l27] FIG. 2 1 is a perspective view of t' e spinal implant of MG. .F. 20 shown implanted in a3 first position;
[x_28] FIGS, 22 is a perspective view of the spinal implant of FIG. 20 shown "'Implanted in a.
second position;
291 FIG . 2 is a perspective vi,ew n spinal implant according to the resent in t o i ~i f: st position-0] FIG. 24 is a perspective view of the spinal implant of FIG. 23 in a second position-, 3I FIG , 23 is perspective view of a spinal implant according to the present invention in a first position;
[f.1.32,] FIG. 26 is a perspective v eww of t:I.e spinal implant of FIG, 2-4 in -a second position, [T-33] FIG, 27 is a perspe.,tive view ofthe spii al i.Ã plant of FIG. 26 ina third position;
[1T34.l FIG, 28 is a cross sectional view of a spinal implant according to :h f resent invention in a first position;
FIG. 29 is a cross sectional view of the spinal implant of FIG. 28 in a second position;;
r;.~6, FIG. ill is a perspective view of :i spinal 1.nplsnt c1c..oxEsxf'gl to tie present invention. in ia. fast pos ti~un;
[1137] FIG. 3.1 is a side elevation view of the spinal implant of FIG. "30 Ã -the first position, [11,38] FIG. 32 is a font elevation view of the spinal implant of FIG. 30 in the first position [1139] FIG. 331s r perspe t ve view of the spinal implant of FIG. 30 in iT
second position, r'" ,, FIG. 34 is a pers1-~ectiv e view of c spinal i pl ntt accord ng to the present invention in [1!1401 .'.tom a first position;
[1'41] FIG. 35 is a perspective view of the spinal implant of FIG. 34 in a second position _ '- fits. 36 is a perspective of the spinal i;itpiai t of FIG. 4 in a third position;
"> FG. 37 r x"f a tve view of { the Agr ?pix)a l inml pli} qt o' ~~tf`~IG, 34 ui-nplanted "a spine;
r is a p e.sA pc c-S iiL 4 FIG. 38 is a perspective view of a spinal implant according to the present inve.intioIn;
145] FiG. 9 is a front elevation view of the spinal implant cis FIG. 38 implanted in a spine;
11146] FIG. 40 is a cross sectional view of a spinal implant according to the present invention implanted in a spine;
[1:47] FIG. 41 is a cross sectional view of aspinal implant according to p rose invention implanted in a spine., [ 4481 I FIG, 42 is a .t c.r t el anon vie i cni,I~ 1 i t c3t'a spinal i cipl . t ac rdin to the t resent invention being implanted in a spine J49J FIG, 4" is a front elevation view of the fully assembled implant of FIG.
42 imp.tn ed in a spine;
t}.j IKIG. 44 is a perspective view of a spinal implant acc rding, to the present invention : n a f St position;
[1511 FIG. 45 is a perspective view o the. spinal implant of FIG, 44 in a second position;
[!,,,521 FIC G. $6 is a perspective view of the spinal implant of FIG. 44 in a third position', [1'53' SIG, . 4`7 is a perspective view of a spinal implant a cordi :i to the present invention III
a first position;
[ 54 FIG, 48 is a perspective view of the spinal implant od FIG. 47 it a second position;
X55] i' G, 49 is a perspective view of a spinal implant a ;cor-dii g to the present invention in a first position [ 156] FIG. 50 is aside elevation view of i e spinal i, 1plsnt of Fat3. 491n a second position;
[1[57] FIG. 5? 1 is a perspec tive view of a spinal implant according to the present invention iti ofirst position;
[9T58 FIG. 52 is a perspective view of tl .e spinal implant of FIG. 51 in a second position, z> .t =I .F. 53 is ? . . ?e ti 'e view of a spinal implant according to tic present invention in a first position }60] FIG. 54 is a perspective view of the spinal implant of 1'IG..5 3 in a second position.
[ 'I FIG. 55 is an exploded perspective view of a spinal implant accorciing to the present.
invention j~ 621 =I .i. 56 is a tiont e evati:~n vie ' sit tl]e. pinal implant chi G, `
5 ilk a first ` ositiÃn;
3I FIG. 57 is a rent elevatioF view ofthe s i -: mpla à o I .55 Ã~ a sycE nd posit on $4] FIG , 58 is an exploded perspective view of a spinal inF lant. according to the present invention [ 6' FIG. 59 is an exploded perspective view of a spinal implant according to the present invention;
[1.7661 i'iG. 60 is a right perspective view of a spinal implant according to the present invention', J67] FIG. 6 1 is a left perspective view of the sr "nai implant o ' FM. 60 [x1681 FIt:. 62 is a lest pers .echiv e view of a spinal implant according to the present invention;
r-,69] FI . 63 is a ri, hi perspective view of the spinal implant of FIG. t. .
[1.701 FtG. 64 is a perspective view of a spina' implant according to the present inverition;
[14:711 FIG. 65 is a perspective view of a spinal implant according to the present invention;
172 i FIG. 66 is a front elevation vit, ' of the spinal m )_lant o F G, 65 [J': T. FIG. 67 is ,a front elevation view of a spinal imp lanat according to the present [ ` 4 FIG. 68 is a flow Ãliati F'a i of a mmethodof inserting a spinal imp" t nz according to -tile present nve ration;
EE 751 FIG, 69 is a front elevation view of a spinal implant according to the present i3: vv'tion1.; and [IR6] ".IG. 70 is a perspective view of awn alternative embodiment of the spina implant of FIG. 69.
ILLSTRATIVE EX.AMPE.
: I ':.il ` It I IIII
N7 a tr# (}d. a.ent- of spin l aà is? tss m$Lcordi g to [ a spacer and one or more retention :embers. Throughout this specification, the spinal implant will be referred to in the context of a sphious process immplant. However, it is to be understood that the cps.n nn ant rnay be configured for insertion into the cervical, horn cIL, aà d or lnmbau spine between adjacent Sprott s processes, trCan \Aersse processes, andsro} other vertebral structures. The spacer may be provided in a variety of'sizes to accommodate ees o pa correction. h spacer.
anatomical variation amongst paÃ3L_: and aryi#a deg may include openings to facilitate tissue ingrowth to archon the spacer to the Vertebral bodies such as tissue Ãi -growth from the spine. For example, the spacer may be configured for tissue in-growth from superior and inferior spinous p:iocesses to cause.
fusion of the d . n lid?xr`ou processes. The openings may be relatively large and/or o"21municate to a hollow interior of the spacer. A. hollow interior may h configured to receive bone growth promoting subsÃances such ar by packing the substances into the hollow interior. `F he openings as be iclatii' ,'`,v small and oi: comprise pores or F lte:"co nec ing pores over <3: feast a portion of the spacer surface. The openings may be filled with bone growth promoting sÃ.ibst8tccs, [178, The spacer may have a: y suitable cross-sectional shape. For example, it may be cylindrical, w ed ge shaped. .'D-draped. C -shaped, H-shaped, include separated cantilevered hear ic. an.d/or any other sums le I .pe. ']'he shape may include chamfers, fillets, fats, reef cuts, and/or other features to accommodate anatomical features such as for examuic. the laminae and/or facets, 1.791 The spacer r aq be Ãncoirtpressible, moderately compressible, highly compressible, convertible from compressible to ineo pressible_ arid) or anyother configuration. For example., the spacer iliay be conip esL i bi into a comp of c 3nf tguration for Inserdorl between adjacent bones and then, expandable to space the bones apart. The spacer m .
be allowed to flex to provide a resilient cushion between the bonesThe spacer m -y be locked in the expanded coriditjoii to prevent it from returning to the compact L on iir Lion.
The retention member may extend transversely from f he spacer re'a`ti'L"e to a spacer ! ,E3 lon zt .dinal axis to maintain the spacer between adjacent spinous processes.
A single retention member may extend in one or more directions or multiple extensions arlay be provided that extend in multiple dÃaections. Ohio ori3 ore retention members may be fixed relative to the spacer longitudinally and/or radially~. One or more retention members may be adjustable relative to the spacer and/or other Teter tion m ambers longitudinally and or radially to allow the retention mer,. bera to be positioned relative to the spit ious processes. The retentinn aiernbers may be dt plo a :e tliroo i and or fior within the spacer to allow the spacer to be placed and th ctention met bers deployed in a mirii ally invasive MWUICI,.
The retention rrcmhers may incna e ore or more screws, pins, nails b s-,Ins s't iples. hook:, plates, wings, bars, ex-tensi ns, lrlament;s, Wires, loops, ban as, straps, cables, cords, Nsutures, an d.eor otl cr stiitahle r tea itioi, ,-,i'. aocr. The retentl+n metvpers o'ias lse n' a~#e > Firetztlsa metal alloys, pops-.:aers and/or other suitable materials. The retention members rnay grip bone and/or soft tissue, abut gone and/or soft tissue, facilitate tissue ingrowth and. ox ongrow th, and./or otherwise retain the im-plarit.
j$ i ] 1'hc retention i .temb rs ma cooperate ith fa t ner=s enga :able L itp the sp moos p r cess's n or o tis e. Such F` _ ten rs may include one or more pins, nails, rivets, bolts, stapes, hooks, sutures, wises; straps, clamps, spikes, teeth, adhesives, and/or tither suitabk The fasteners may be integrated Into the retention members or they may be modular. The retention members and/or fasteners, may he adj ,:stable, eplÃaceable, and/o temovahk and i ay be ennployed in one direction and1 or on one side of the implant or in m ultiple directions and/or on multiple sides of the implant to allow tailoring of the kind and quality of fixation of adjacent bones. For example, the implant may be placed such that it acts only as a spacer between adjacent bones, as an elastic restraint between adjacent hones, or as a rigid fixation between adj 3.centi bones. The spacer, retention members, aad'aor fasteners may advantageously be trade of different i aterials.
8 cla ma he used t stabilize. the spinal implant wid/or to provide: other benefits.
For t .ample. sires, straps, sands, cables, cords, and/or other elongated members may encircle the p`dicies, laminae, sp n'was processes, transverse pro ss , and/or other spinal ses. t u ctur The cerciage may be relatively inextensible to provide a hard chcL k to s ine flexion or the cerclagc ma e .relatively extensile to pro=wide inc easÃng resistance to flexion. The cerclage may be Ãe.1;tiv ely flexible and drapeable such ; s a woven fabric or it i:aaa.y be relatively rigid s ich as a metal fiend. The cerciage may have shape memory properties that cause it to resume a prior set shape after implantation. The cerelage may be independent of the s i sous process implant or may, engage it. For exa iple, the cerciage may pass through a hollow interior of the spinous process implant and/or engage tie extension.
[T.83] The implant may be supplemented a th bone growth promoting substances to thcilitate fusion of adjacent vertebrae between spinous processes, laminae, transverse processes, facets, and/or other spinal structures. The bone growth promoting substances may be spaced from the its pliant. placed adjacent the implant, sandwiched beLween the Implant dedying bone, placed inside the implant, coated onto the implant, and/or othe wi a ail up placed relative to the implant. If it is coated onto the implant it may cover the entire implant or only selected portions of the implant such as the spacer, retention >
.embers, fasteners, and/or other portions.
[I'ls4] As used herein, bone growth pr motin substances may includebone paste, hom e chips, bone straps, structural bone grafts, platelet derived growth factors, bone i .arrow aspirate, stern Cells, bone growth proteins, bone growth peptides. bone attachment proteins, bone altaclu-nent peptides, ya roxyiapatite. calcium phosphate, stalins, and"
'or other suitt0ble bone prornoill',zig substances.
i. 851 The spinal implant . ;nd any associated cerciage or other components ;..may be made of any suitable hiocompatib.ie r aterial including among others metals, iesorbabie cerar .iits, non-resorbable cera mt.ics, resorbahle polyrrers,and no.-resorbable polymers.
Sortie spc .tic e unples include stainless steel, titanium and its alloys n lading is + l-titanitari alloys, tantalum; hydroxylapatite, Calcium phosphate, bone, zirco ia, alumina, car bons bioglass, polyesters, polMlacti:c acid, po hg hcolic acid, p ' olefris, pol yami:des, pol im des.
pr3l ateti po(?ketones, fluropolymers, and/or other suitable bioco patihle rnaterrials 'and combinations thereof 1 The spinal implant may he used to treat spine disease in a variety of surgical techniques inch ding superspinous ligament sacrificing posterior approac es, superspi ioaps ligament preserving posterior approaches, lateral approaches, and/or other suitable approaches. The s itial implant may be used to treat spine disease by (sing a(acent vertebrae or by preserving T11011"10 11 between act.jaeent vertebrae. It may include only an extension stop such as a spacer, only a flexion stop such as flexible cerelage elements, or l both a flexion and extension Stop, The spÃrous process à à . lant à a be used to reduce loads on the -facet Joints, it irease s Ãtaous process spacing, reduce toads on the disc, increase disc spacing. ant/cÃ- otherwise treat spire disease. Techniques for the spinal implant may iricltude leaving the tissues at the surgical site unmodified or modifying tissues such as trimming, rasping, roughening, and/or otherwise à odÃ~ying tissues at the implant site.
(1 71 F 'or example, FIGS. 1-3) illustrate a spinal 100 including spacer 102 an a plurality of retention members in the fo : of first and second plate extensions 104, 105 and deployable retention members 106, 108, and 110. The spacer 102 has a, generally cyh ndnca body 112 having a proximal end 114, a distal end 11 6., and. a longitudinal specs axis 118 extending therehetwe :n. The distal end 116 tapers toaÃr. edge to facilitate inserting the spacer 102 bet x,een two bones, e.g. ad;a e, t spmous processes The distal end is defined by r superior facet 120, an inferior facet 122,aand lateral facets 124 (orie shown).
X88; '11e ate: extension 104 projects radially outwardly rroiia the spacer 102) adjacent the proximal end and the second plane extension 105 projects radially outwardly 1"rolm the spacer 10.2 opposite the 1-first plate extension 104, The plate extensions 104, 105 may be integral with the spacer 102 as shown in FIGS. 1-3 or modula and separable from the, spacer 102. The plate extensions 104, 1005 provide an. insert on stop by abutting the spinous processes 126, 128.
[ 189] The deployable retention it e ribe=s 106, 108, 1.10 maybe pre-installed within the spacer 102 or inserted into the spacer 102 i.ntrauperatively. Preferably they are pre-installed and retracted within the spacer 102 as Si' o n in FIG. 2i. Each deployable retention member 106,108, 110 is directed ià to a channel 130, 132, 134 that communicates from the interior. of the spacer 1Ã02 out throu'h the 0i tal end 116 to the exterior of the: spacer 102. The eplo able re :r Lion ; iet l ers 106, 1 # N. 10 are joined at their proxiirtai ends 136 so that they Move together. The interior of the spacer includes a cavity 1.37 that houses the deployable retention members 106, 108. 110 in the un-deployed position. The cavity 137 is threaded and receive an actuator screw 138 in axial translating [~:{90] In use, the spinal implant 100 is inserted l etween adjacent spinous processes 126, 128 as shown. The actuator screw 138 is then rotated so that it translates along the spacer axis 118 and pushes the deployab. _ retention members 1,0 6, 108, 110 distally "I
sough the channels 130, 132. 134. The spacer 102 includes a pair of sockets B9 at its proximal end 114 for receiving a tool for applying a counter torque to the spacer 102 while the actuator screw 138 is rotated. The channels 1311. 132, 134 may be curved to cause the deployable retention members 106, 108, 110 to bend a uy from the spacer axis 118 and -rip the spinous processes 126, 12$ and/or surrounding soft tissue. The deployableretention members 106, 108. 110 may also be pro- beiit and then elastically straightened as they are loaded into the win-deployed position of l;10s. 2. Upon being deployed, they may then return to their pie. bent shape. The deployable retention members 106, 108. 110 may advantageously be made of a sitperelastic material such as Nitinol. They may also respond to the patient's body temperature to change shape from the straight c ontigur'ation of .' 1G. 2 to the cur ''ed configuration of FIG. 3. Soft tissue may also grow arouncd, adhere to, scar around, and, or otherwise grip the deployable ,retention members 106, 108, 1.10 over time.
Deployable retention member 110 is split at its distal end to form a loop 140 that opens upon being deployed from the spacer 1,02 to facilÃtatte tissue growth into aid around the loop 1411 for increased retention strength A plurality of holes 1,42 are formed through the plate extensions 104, 105 for receiving fasteners for attaching the plate extensions 104, 105 to the surrounding is bone and/or soft tissue. Such fasteners may i.nclucde any of the fasteners listed ve. A pin 144 is shown, In one of the holes 142 in FIG, 3.
' 9l] l1~ ; . 4 - 5 illustrate a spinal implant 200 similar isi fora and function to that of FIGS.
1-3. The spinal implant 200 includes aspacer 202, deployable retention members :1Ã = w and spacer end pieces 20 . The spacer 202 and end pieces 206 are general ly cylindrical and are aligned til i? a spacer axis 208 ud by a threaded shaft 210 that three Viably engages the end pieces 206. The threaded shaft 2 10 is mounted to the spacer -20-` . or axial rot-a-6 on and includes a drv .r engaging end 212. The deployable retention members 210 are ixed in the spacer 02 and are slidably received in cliennels h 14 in the end pieces 206.
E9 In use, the spinal implant .200 is inserted between adjacent `}'ones such as s pivl.ious processes 220, 22. A driver (not shoni) is engaged with the r.t r engaging end 212 of the threaded shalt 2110 and rotated to move the end pieces ''0i toward the spacer 20Ã2 causing the retention members 204 to extend out of the channels 214 away- from the spacer axis 208 as shown FIG. 5. A tool (not shown) i ay he engaged with one or more sockets 2.124 in one of the end pieces '406 or notches 226 in the spacer 202 to apply a counter torque while the threaded shale 2 10 is rotated.
~ 9 3 ] I' IGS. i - . i li :i:str rte spinall impl ant 300 similar Ãn form find funcÃion to that f : I s' .
1-3. The spinal implant 300 i nclFudes a spaces 302_ a core X3 4, and deployable r. tent on members 306 e\.t ncdn g ions the core 30$. The. deployable Ã=t~.tention Ãn ;i bci s 306 include plurality of wires projecting in a radial array from a cot ll space. axis 308 at each end of the core 304. In the illustrative exa iple, which h . been designed for interspinÃius place i,ent, there. are no wires projecting anteriorly to avoid impingement with the facets and/or other spinal structures. The core 304 and deployable retention members 306 are.
received in passage wky 309 through the spacer 302 parallel to the sparer acs 308.
[ 4] h use, the spacer 302 is positioned between adjacent bones such as spinous processes 310,312. The core 30' and d e p l a y a b l , c retention riei':ithcrs 306 maybe . rt:a 1\ pr -nmerted as show a a in FIG. 7 such that after the spacer 3302 is positioned the core is advanced to deploy the dcp'oyab k retention member 3136. lterrativei'v, the core and deployable retention members 306 may be separate from the spacer _302 and. inserted after the spacer is placed . in either case, a t ithc 314 may o,stiorally be used to hold the z ci ~'<`a le rete lion members 306 an sor core 304 prior to deployment. Asshow :n inIG, 7, the tube 314 may be engaged with the spacer 3102 in alignment with the pas:sagewaiy. 309 and the core 304 and deployable retention members 306 pushed from the tube 314 into the passageway 309 unti the deployable retention members 306 .ep'o from the opposite end of the passageway 309, The tube 314 may be withdrawn to per i.it the remaining deployable retention.
members 306 `to deploy.
[195] ERGS. 8.11 illustrate a spinal implant 400 similar in form and f tnction to that of FIGS. 1-3. The spinal hnplant 400 includes a generally cylindrical hollow spacer 402 hat ira :
a -first end 404, a second end 406, and a spacer axis 408 extending from the first end 404 to the second end 406. Acore 410 is positionahle within the spaacer 402 a; ong th-he spacer a is 408. Optioonally, : plurality of .eployabl . retention members 412 project radially away fron z tie spacer axis 408 a each end of the core $10. The spacer 402 is made of a compressible material such as a su rel_.s is metal orpolymir such. that it can be compressed to. facilitate insertion. For exarirple, as shown in FIG. 9, the prongs 420 of a tool (not shown) may be inserted into the spacer 402 and spread apart to stretch the spacer 402 into a flattened tCi elliptical shape; The spacer 402 may teen be inserted and the prongs removed spacer 402 to recover to its original shape. Depending on the modulus of the 402 and x]G.ah bones, loads exerted or. ~zbY t17~: surrounding 434, it may recover to its t4 full ~~ pre-insertion and distract tl e bones or it ma).- tilt' recover partially. The core 4 0 may then be inserted to niintait? the spacer a ccr 02 at its recovered height. The core 4 10 may be sized to press into the spacer 402 and thereby prevent any compression of the spacer 402 post--insertion or the core may be sized to allow a predetermined amount of compression of the spacer 402 it) provide a resilient spaces (. The optionual deployable retention members. 412 rfiay be omitted arid the s final implant 400 used in the condition shown in FIG, 10. Preferably', the core 410 includes :yep oya b1e retention i? ea?mb ,rs 412 in the form of filaments t. at can be deployed as an array, of loops pr"~~ acting radially o?.atwardt\x i'ro'n the spacer axis 408 at each end of the core 410, The retention members 412 may retain the space 402 in place by physically blocking witl?d.aa. w,al. The retention members 412 r aay` also retain the spacer $02 due to tissue growth around the retaining members 412.
{1:96] G. 1. 1 illustrates one way of arrangin the deployable retention members 412. A
plurality of 422 are mounted of the con. 410 with at last o_, oi'tl e rings 422 being ax tlTi translatable along the core 410, 1l"he rings are conneclea by a plurality of iiamen'.s 424 spiraling around the core 410.
[1r 7] In use, the spacer 402 is inserted between a jacent bones such as adjacent spir.ious processes and the core 410 is inserted into the spacer 402. t e t r ring } 2.
is it:F ve toward another ring 422 causing the filar ents 424 to bend away from the core and form the array of loops as shown in FIG. 8. Alternatively. the retaining members 412 may be {ode d down ra:a!lel tl spacer axis 408 similar to the embodiment of Fski. 718 98] FIG&. 1244 illustrate a spinal implant 500 similar In fonrn and function to that of FIGS. 1-3. The spinal impIant SOO includes a spacer 502 having a generally cylindrical hollow body 504 including a first end 506, a second, end 508, any a spacer axis '+ 10 extending from the first end 506 to the second end 508. The ends of the spacer 502 are tapered to facilitate insertion between adjacent ,ones. A plurality of channels 5121 extend through the body 504 from the first end 506 to the second end 508 generally parallel to the spacer axis 510 Deployable retention members 514 are enMgageahle with channels 512 in axially slidat le .el;tionship. In the illustrative exam p e of FIGS. 12- i4, the channels -512 and deployable retention members g 14 have complimentary rectangular cross sectional shapes, The deployable retention members 514 are curved to extend radially away` trot i the spacer axis 510 and grip the spinous processes.
[T.-99] in. use, the deployable retention members 514 on ~raighte `e and :
'tr~;C t l tallow the spinal implant 500 to be inserted between the spinous `l leis may be accomplished io a variety of ways. As shown in FIG. 13, the deployable retention members iii 7 tlte ` et rs:~ to s tr~~ g.its.>~.They 514 ma -v- be withdrawn partway through the channels 512 1orc i~, May include a siop to 'prevent them from being withdrawn completely. After the s pacer 502 is inserted between the spinous processes, the. deployable retention members 514 niayy be. feed through the channels 512 and allowed. to resume their curved conf gur tion.
Alternatively the deployable retention members 514 may he separated from the spacer 502 completely and not introduced until after the spacer 502 has been inserted. As shown in FIG.
14, the deployable retentioan e Aber: 51.4 may be straightened &ndthe spinal implant 500 inserted through a tribe 520 and into the space between the sp .ous processes. l-IG. A2 illi_astrawh the spinal implant 500 post-insertion with the deployable retention members 514 fully deployed.
100 FIG, 1 illu-st aces a spinal implant 600 sa u ar w that of FIG'S. 1'-14. S
.i al :implaà t 600 has deployable retention member: 602 Ã,_ the form of wires rather than the rectangular ribbon-like dq, vatic retention members 514 of FAGS 2=14, ( 101] FIG. 16 illustrates a spinal implant 700 sÃ,m l to that w ,"FIGS. 12-14. S ..Tai implant, 700 includes a spacer 702 having a passageway 704 through the spacer 702 parallel to a -sparer axis 706. After the spacer 702 is inserted between adjacent spinous processes, <a pre t=Yr} i a ~. :gtea.
eddci~lt~y~able retention. ~a-aer~>:~ea= `~ ~38 in the form of a ~~~arc. < 2s inserted through the passageway 704 rr m a 'first end 'to a second erd of he pass, gewa;' so that it e 3erges from the second end and returns to its preformed shape to extend transverse to the spacer axis 706 beyond the outer surface of the spacer 702. The end of the deployable reternic n member may also extend transverse to spacer axis 706 at the first end of the spacer axis so that the deployable retention member may e vaens: on both sides of a process to capture the process.
Alternatively,, a set screw or other mechanism may be provided to fix the deployable retention member 708 in the passageway 704 after the deployable retention member 708 has been deployed. In the illustrative embodiment the deployable retention member 708 is preformed into a coil.
[f1021 FIGS. 17-19 illustrate a spinal implant 800 similar to the previous embodiments.
The spinal implant 800 includes spacer 802 1{avin and second en ins ls04, 6 and a spacer axis 808 extending therebetween. The spacer 802 may be wedge shaped, cylindrical, elliptical, rectangular; and/or any other suitable shape. I lie shapemaay be.
based on anatomical cox sider'ations. Deployable retention m embers are provided in the form o fa t:=t`r n al portion 810; S.: 2 <:._.: nd ng tron ea3ii h u d 804 8 't? of ht.
pwicer 8 32. I he ter- aiÃaaal portions 810, 81.2 have a compact posit oa: or shape closer to the ' pac4r axis 808 as slt a,siy it FIG, 17 and an expanded position or shape A tier from the spak, axis 808 as shown FIG.
18. FIG. 19 illustrates the compact and expanded positions superimposed for corÃ.parison, in the itlustrative embodiment of FIGS. 17-19 the teri-ninal portions 8 1 a 812 are provided as coils such as a conventional helical spring coil and the .o r acà posit of corresponds to a o.i~
being tightly wound and the expanded position corresponds to the coil being loosely wound.
Ho,vever, the terminal portions 810, 812 may be shaped s a Mange, solid disc, protrusion, 'bar, or the le as a matter of design cho ce. The spinal implant 800 is implanted with at least one of the terminal onions 810, 812 in the co_ mpact position. Once placed, one or b (All terminal portions are allowed to expand. For exar ip le, the coils may unwind due to their own spring tension. A,lternativel , the coils may be activated, such as e-o, by heat, to expand.
The spacer 802 separates adjacent spinous processes and the expanded terminal portions 8 Ã 0, 812 maintain the spacer 802 between the spinous processes..
he separate devices, in the illustrative 1031 While the terminal portions 910, 11.2 ma y embodiment of FIGS, 17-19, the terminal portions 810, 812 are connec.te :
through a passageway 81.4 formed through the spacer 802 along the spacer axis 808. In this ii_i ti` . SÃ? Ãat, the terminal portions 810. 812 ;re the ends o fa continuous coil placed within tl-t passageway 814. Tlhie coil ina ~~. he designed to be in tension such that the ternminal portions tend to seat against the spinous processes to bold the spacer 802 firmly in place.
104_ The ter ai.Ã anon port ons 810, 812 may be formed of any number o f mate:
ials, but suerelastic materials suchs shape memory ;;Metal alloys or polymers are advantageous. In particular, shape me Tory mwerials can be designed having a first small shape to allow less traumatic inipLantation of the device. Once implanted, activation of the shape memo>y, i .ateria.l would cause th fermi ial portions 810, 812 to move from the compact Position to 1]
the expanded position. Moreover, for a continuous coil embodiment. the coil may be configured to retract and thereby seat the teririinal portions against the, spinous process.
1 J5] The spacer 8()2 may he provided with one or more surface grooves 816 to receive, e.g., the prongs of at sargtcal distraction t0<~. so that the spacer may be placed along the prongs after the spinous processes have been distracted.
[ " 11 s] rIGS.'20-22 illustrate an alternative arrangement to that of FIGS.
17-19 in which a, spinal implant 900 includes a spacer 902 and a coil 904 wrapp eel around the outside of the spacer 902. The coil 904 nmy have shape memory properties allowing it to be transformed from a compa.:t position to an expanded or it may always be biased toward the exuanded position. In the case where it is always biased toward the expanded position, the coil 904 miiav be maintained in the compact position by a sleeve 906 or other surrounding structure. The spinal implant 900 is placed between adjacent bones, e.g. pii edit p_i .es 910, 912, in tine compact position (FIG. 21) and allowed, or activated, to s :ms 'on to the expanded position (FIG. 22) to ? i:aintaÃn the ..-weer 902 bet peen the bones.
AI ernat vc ,, the spacer 902 may be removed after the spit al i mplant is implanted or the spacer 902 may be omitted entirely such diatjust the coil 904 serves as both a spacer and retention member.
[j;:11 07] FIt,GS. 23-24 illustrate a spinal implant TOO,) including a spacer 1002 I t\ ing a proxin-sal end 1004. a distal end 1006, and a spacer axis 10Ã 8 extending there.lietv een.
Optionally, the distal end 1006 i,;.`. ' be tapered as s i:own to insertion between adjacent bones. The spinal implant 1000 includes one or more deployable retention members .
mounted for rotation to the spacer 100:2 for rota i o o n between a compact or stowed position (FIG, 23) and an expanded or deployed position FIG. 24). In the illustrative embodiment of FIGS. 2' -24, the deployable retention members are in the form of wires 101L()mounted to IY) brackets 1012 e: tendig ridiall)- aww.a;,` from the spacer axis 1008 The wires 1:310 e te: d between the brackets 101 ' generally parallel to the spacer axis 1008 and then bend transverse to the spacer axis 10108 at the proximal and distal ends 1004, I1}O6. The spacer I002 includes an annular groove 101 4 `adjacent the distal end and file wire 11110 are curved distally to engage the groove 14 in the co pact or stowed position, As shown in FIG, 23, the groove 1014 rimayr receive the wires 1010 so that their curved portions are completely recessed to ease implantation. The proximal ends of the wires 10:10 are positioned behind the proximal end 1004 of the s pae r 1002 in the compact or stowed position to case implantation, Ater the spinal implant 1000 is inserted bet,.w peen adjacent bones, e.g. spinous processes, the wires 10 are rot ated from he st -v4,cd position to the d elo-yed position to maintain the spacer 1.002 between the bones. In the illustrative e embodiment of FIGS. the proxirnaJ ends of the wires can be accused after implantation. to rotate the wires 1010. The wires may maintain their position. due to friction with the brackets, 1012 or an.
locking mechan: ~r a may be provided. For example, deems 1016 may be provided to receive the wires and help maintain them in position e.g. in the deployed position [!j 0 8 1 FIGS. 25-2 .illustrate a spinal inipk t 1100 including a spacer 11:
' ba 11 g. a first end 1104, a second end 1106 and a spacer axis 1108 extending lierel~eà we ei .
One or more deployable retention members in the form of end pieces are mounted to the spacer 1102 for rotation betwveen a stowed, position nearer the space, axis 11 08 and a deployed position further from the spacer axis. For example, the spinal implant may include a pair of outer end pieces 111 tt and a pair of inner end pieces 1112 with one outer and one inner end pied: at each end of the spacer. The outer end pic c; 111 0 are mounted fS r rotation about an axis 1.111 offset frctri the spacer axis 1108 so that à ie ,iii?w' e nearer to or further from m the spacer axis 1108 as they rotate. For example, the outer and pieces I 110 may be mounted on a common shaft 1116 so that they rotate together. The inner end pieces 11. 12 may b sini laxly mounted fo rotation about an offset axis 1118 on, a common shat 1120.
Preferably the inner pieces 1112 are mounted ona shaft 1120 that is o?-set, from both the spacer axis 1108 andthe shaft 1116 that the outer end pieces I l 10 are n ounted on so that the inner and outer end' piece,, I 1 ` 2, 1110 none away from the, spacer axis 108 in differeiit directions. in the example of FIGS. 25-27, the inner end z i;ec, s 1112 have been relieve; e,g, to Jnclu& notches 1122 (FIG. 27); to clear the shaft of the outer end pieces 1 110 so that they may. be rotated to a t. ed position. that is coaxial with the spacer 1102. as shown in FIG, 25.
In use, the spinal implant 1100 is inserted between adjacent bo es, e.g. .pinous processes, in the sto'~ved position of FIG 25. Once the spacer 1.102 is in the desired location one .i or-- of the outer and inner end pieces 1110, 1 112 may be rotated to the deployed position to maintain the spacer 1102, in e osii C)n. Driver engaging sockets 1 124 are provided to f.ic l . ,ate rotating the end pieces. Any number of end pieces may he provided yip to and including an implant 100 in which the entire spacer is made up of a series of end pieces. The end pieces may be selectively rotated to achieve the desired it with the td#acent bones. The end pieces may be mounted to separate sha!-Is or oherL%ise mounted for independent rotation, The end pieces may, be mounted to a shaft so that they slip when, a torque threshold is met.
For exam le, the end pieces may be mounted for predetermined slipping such that if a plurality of end pieces are being rotated together on a common shaft and one abuts a bone, the abutting end piece ,,.,ip on the shatIl and thereby permit the other end pieces to be rotated fully into the deployed position.
[1:'l O ] FIG&. 28-29 illustrate a spinal implant 1.200 similar to that of FIGS, 25-27. The spinal implant 12040 includes a spacer 1202, a proximal end 1 204_ a disc l end I206~ and a spacer axis 1208 extending therebet s-eet. A fixed retention member in the Ã
mn of a paL or bar shaped extension 1210 extends radially away from the sparer axis 1208 adjacent the proximal end 1204.. deployable retention nwmbea in the form of an end piece 1212 is mounted at the distal end I 206. The end. Isere 1212 is tapered as shown try facilitate insertion bettween adjacent bones. The end piece 1212 is mounted to the spacer 1202 for rotation about an end piece rotation axis 1 2- 14 transverse to the spacer axis 1208.
For example, the distal end 1206 of the spacer may include a distal face 1216 transverse to the spacer axis 1208 and a tru n.ion 1218 projecting outwardly normal to the distal face 1 .16.
The end piece 1212 in iudes a complimentary proximal face 1220 with a soci e. -for r : i tr the triir.iion 1218. 1 'he end piece 1212 is rotatable about the natation axis 1214 from a compact or stowed p sition as sl,.own in FIG, 28 in which the end piece 1212 extends generally parallel to the spacer this 1288 to an expanded or deployed position as shown in FIG. 29 in which the end piece 212 extends genera-fly transverse to the spacer a xis 1208, To facilitate rotation. of fe end piece 1.21'2, a shaft 1 224 extends from title end piece 1212 through a pass i c.wa y 1226 in the spacer 12ÃI2 to the proximal end 12114.
The ;b,.alt. P'4 may extent parallel to the rotctio # axis 1214 or it may bend as shown. A bent shaft may include a flexible por ion, a universal joint, a bevel gear, and/o, some.
other arrangement to permit transmitting torque through the bend. A driver engaging socket 1228 is provided at the end of the shaft to engage a tool for ro ati 4 the end piece.
110 FIGS. 10-33 illustrate a spinal implant 1300 similar to that of FIGS. 28-29. The spinal implant 1300 in :hide s a spacer 1302 havÃn a proximal end 13104, a distal end 1X06, 7c wid a spacer axis 1308 extending therebe_iween. A plurality of deployable retention members aro provided at each end its the ,form end pieces 1310, 1.312 mounted for rotation about axes transverse to the spacer a' s 308. As re vealed through the broken away portion of the spaces 1302 in FIG. 30, the end pieces are mounted to gem f 14 that engage additional gears 1316 on a drive shaft 131 . As the drive shaft 1318 is rotated, t ht end pieces 13 0, 1312 rotate away fotn``i the spacer axis 1308 from the stowed position of FIGS, 30-32 to the deployed position of FIG. 33.
[ 111_] FIGS. 34-37 illustrate another spinal implant 1400 including a spacer 11402 having a f first end 1404, a second end 1406, and .a spacer axis 1408 extending th erehetween. The spacer 402 is in the form of a cylinder, rectangle, ",,edge, cone, and/or some other suitable shape and is compressible transverse to the spacer ax's 140:8. In the illustrative example of F16S, 34-357 t ho spacer is hollow and made of an elastic t? at:eriL 1, preferably a superelast c and/or shape memory material. The spinal implant 1400 includes one or mo:r: a ..:s 1410 extending away from the ends 1404, 1406 of the spacer 1402. The arms are also pr i rably made of an ciastÃc material such as a sup :relastic and or shape memory material. 1.11 zi compact or stowed position. ("'G, 34), the spacer 1402 is compressed radially to-ward the spacer axis 1.408 and the arms 1410 extend outwardly generally parallel to the spacer axis 1408. In an expanded or deployed. position ([1G. 3$) the spacer 1402 is expanded away from the spacer axis 1408 and the arms 1410 extend transverse to the spacer axis 140. In use, the s,p nal implant 1400.1s inserted between adjacent bones, e.g. sp no is processes 1420. 1422, in the compact position and >?.+ n allowed or activated to transition to the expwided position (FIG. 37). In the illustrative example of FIGS, 34-37, the arms 1410 have a pre-for med shape i which they arch or curve by ck over the spacer 1402 to grip the spirtou processes.
in the illustrative example, the arms 1410 also have holes 14224 to receWe fasteners similar to the embodiment of FIGS. 1-3. The spacer 1402 may also receive a core (not shown) to maintain a minimum expanded height similar to, the embodiment of IGS. 9-12.
11,21 1 HGS. 8-3 tl.lustrate a :spinal .11 1ant 1:00Ãnckdmg a spiacv:.r ?. 02 l tà ing one or more holes l504 to receive fas>enors similar to the em3 l odiment of FIGS. 1-
3. In the illust ati example of FIGS. 38-396 the spacer 1502 is a hollow cylinder wit the holes 1504 extending trough the wall of the cylinder and being iav od around the wads of the spacer 1502 The spacer 1502 may be secured by placi_n fasts ors through the holes 1504 and into one or more adjacent bones and/or into surrounding soft tissue. The spacer 1502 may be secured at one end, at both ends, to tissue associated A. th one adjacent bone, to tissue associated with multiple ad' ac~n t bones., and1o.i any combination of securing arrangoments.
In the example of FRI. 39, the spacer 1502 is placed between adjacent spinous processes and sutured to the surrounding soft tissue 1,506 at both ends.
113] FIG. 40 illustrates a spinal irnpl a 1 1600 sire far to that of 1'li CS.
i8 .. 39 Nie 'p nal implant, 1600 includes a generallysolid spacer 1602 arid "Includes one or more transverse passageways 1604 for receiving one of more fasteners 1606. Preferably the passageways 16,04 communicate from the end of the spacer to the outer surface of the spacer traniverso. to 'he spacer a-.,.is as shown. "lie spacer 1602 inky be attache to one "ac- t bone, both adjacent bones, 'for one side or from two sides. For example , in a à n lateral procedure a fastener may be placed into only one bone to maintain the spacer 1602 in position.
Alternatively a fastener may be paced into each of the adjacent bones to maintain th,.... ,F
1602 in position and also to hold the a jace.nt bones in position relative to one another. In 2) 7 the example of FIG. 40, scree=s are piaeed f3 .nn each side of the spacer 1602 into adjacent sp:inou processes 161 ), 1612-imp(a t 14] FIG. 41 illustrates a, spinal implant 1700 similar to that of FIG. 40.
Sp',,,-,z 17110 includes a spacer 1702, a retention:Ãnem er in the forin of a flange E
704, xnd holes 1706 through the lunge for receiving fasteners 1708. The poles 1706 T nay be parallel to the spacer axis (as shown) or transverse to the spacer axis.
t 1151 IMIGS.: 43 f. stra c a spinal .mnla t 1800 including a base 1802 having a base axis 1801 and a hook 1 06 having, a portion 1808 extending generally traz-,tsversety away -from the baase axis 1804 and a potion 1810 extending generally parallel to the base axis 1804. The spinal implant 1800 further includes a spacer 1812 engageable with the base 1802. The spacer 1 81 2 May be Cylindrical, rectangul# , conical, and/or any other suitable shape. In the illustrative example of F l S. 42-43, the spacer 1812 is generally conical and threadably engages the base 1802 in axial translating relationship. In use, the hook 1806 is placed around a portion of one or more adjacent bones, e.g. it may be inserted between adjacent spinous processes to catch on one of the slyÃnous pr cesses as shown in FIG, 422, The spacer spaces them apart a desired distance as shown in FIG. 43. The spinal it p ,.Ã.-. 801) allows unilateral and mini Malty Ãnvasive placement like the prevÃous examples and adjustable:
spacing de ermined by the axial position of the conical spacer 14121 .
[ I 1$ F [GS. 44-46 illustrate a spinal implaaÃht 1900 including a spac er 1902 and deployable retention. members 1904. The spacer 1902 includes a split body 1906 having a superior surface 1908 and an inferior surf ac, 1910. The s, pÃer or surface 1908 and inferior surface 1910 are movably connected to a driver 1912. The driver 1912 has a screw 1914 attached to it and extending from the driver 1912 between the superior 1908 and inferior surface 1910 into a threaded bore 1916 iii a wedge 19 8. In operation, turning the driver 11912 causes the screw ,v 1914 to thread, into the bore 1916, which causes the wedge 1918 to move }e ween the superior surface 1908 and the inferior surface 1910, As the wedge 1918 moves further between the surfaces 1908. 1910, the surfaces 1908, 1910 separate to increase the height of the spacer 1902. Combinations of channels 1920 and ribs 1922 provide stabilization for movement of the wedge 1918 relative to the surfaces 1908, 1910. Retention of the spacer 1902 may be accomplished using the coils, flanges, dÃsc.s, wires and/or other protrusions described above, For example, c eployable retention i sembers.
1904 in the of elastic wires that may be folded puallel to the spacer axis 1924 for insertion may provide lateral retention of the spacer 1902.
11 I1 FI &. 47-48 illustrate a spinal implant 2000 including a spacer _2002.
The spacer 2002 is generally shaped as a cylinder or sleeve having a bore 2004. A gap 2006. or sloÃ, extend: ngth of spacer 2002. Bore'-200-4 may be a complete through bore or bore 21004 may allow for a central ',all or plug (not shown ) for stability. Spinal implant 2u00 f irtheÃ
comprises end craps 2010 having a generally conical shape or suede shape. As end caps 2010 are pressed or threaded into bore 2004, the shape of caps 201 0 causes the diameter of s pacer 2Ã1132 toe pr iitl, which is allowed because of gap} 2006, (_Eap 2006 ould be filled th a suitable elastic material. Alternatively to shaped caps 20 101 caps 2010 could be imiade of an expandable m iterial, such as shape niciiiory alloys, spring steel, resins, polymers or the like to achieve the same result. Lateral retention of the spacer may be accompllished Using the coils, fai ges, d scs, wires and/or other t otrzsions described above and below and will not bere-described relative to this embodiment.
118] FIGS. 49-50 illustrate a spinal impiaut 2100 similar to that of Fl &. 47-48. The s i n . t.:.: 1-100 has a spacer 2102 its the four of a coo :.. l he sp cer 2102 is moveable fuou a Compact position (FIG. 49) in the Coil winds around its la multipke tirnes w id is c I oser to a spacer axis 2104 to at expanded position (FIG.
50) by uncoiling the spacer such that it winds around itself f6 w Feu times and is further fro n the spacer axis 21104 e.g. such that it forms a siiiale continuous riiig. The spacer has inner and outer hook shaped edges 2106, 2108 that can engage as shown in FIG. 50 to limit the amount of e < 7,,_.ion of The spacer 2102. The spinal implant 2100 may also include plugs or cores as shown in prior examples to support the spaces 2102 against collapse. Lateral retention of the spacer may be accomplished using the coils, flanges, discs, wires other protrusions described above and below and will not be re-described relative to this embodiment.
119] FIGS. 51-52 ill strate a spinal implant 22,00 similar i at. of FICIS. The spinal ii plant 2200 includes a coiled sheet-like spacer 2-202 having tabs 2204 projecting away from the sheet to c age slots 2206 to limit the amount of expansion of the spacer 2202. The tabs 2204 and/or slots 2206 may be positioned at the inner and Ã
uÃer edges of the coiled spacer 2202 or they may be positioned at. one or more positions intermediate the edges, for example, the spacer may ha,, tabs 2204 at one e ,d and slots placed at multiple locations to allow the spacer to be fixed at different sizes. The spinal implant 2200 may als include plugs or cures as shown in prior examples to support the spacer 2-202 against collapse. Lateral retention of the spacer may be accomplished using the coils, flanges, discs, wires and/or other protrusions described above and below and not be re-described relative to this e bodirrient.
\0 FIGS, '53-54 illustrate a spinal implant 13O{. including a spacer 2302, having as ti,#.L e,, axis 23113, 'ibmied of at) clastic iriatez ai. such as a polyi'.n or resin materÃa.l. For example.
the spacer 2302 may be a hydroge or other composite or polymer material such -,L'; a siliconee material. A bore 2304 extends through the spacer 2302 into a. base 2306. The base 2306 is shown with a, wedge or conical shape to facilitate insertion but which could be any shape including rounded or bluint. Deployable n- -r. oaa members in. the form of elastic arms 2308 are attached o the base 2306. In use, the base 2306 is inserted between adjacent be-nes, e.g.
s a y>zÃs pro esses> parallel to the spacer xis 2303. As the a ni5 2308 pass the spÃiio is process, they fold into a compact or s ?'GTre insertion position in which they are nearer the pacer .xis % '30' and lie along the sides of tbe spacer 2302 generally pa;
talel to the spacer axis à i' 1 ( r. 53). Once the a .ifs ?308 pass the spt:nous process, they retarn to an expanded or deployed retention position in which they project outwardly transverse to the spacer axis 2303 ( s .:54). Preferably, the arms 23) 08 only fold in one 3irec à ?n. to provide iinc, eased retention once inserted, The spinal implant 2300 further includes a plate 10 having a projection 2312, such as a threaded shat, extendable through the bore 2304 and tl.readabl y engaging the base 2306, Threading, for example, the screw into the base 2306 compresses the spacer 2302 causing the diameter of the spacer w.302 to increase, providing distracting .forces on the sptiious process, Lateral stability is provided by the plate 2310 and t ho arms t3-,8 which extend `~away c aa~r which from the -,pacer axis 2303) on either side of the s~'>Ã~ous process.
111 21 .j Alternatively to screw threading into the base 306. a bolt may be attached to the base Otber i etiiriirisiiis cob i l and the plate 2310 and spacer 2302 compressed with a nut 23114.
also be i sed to compress the spacer 2 30w 1rc . bit Ã1 ratchets, press fits, rivets, and/or any other suitable mechanism .1 [T1222) Ã FIGS. 55-57 illustrate as spiral plant. 2400 ncl .ding a base plate 2402 and wedge prate '404. The base plate, 2402 is shown as having a rectanguiar sy ape. but any shape is p zssibke including, circular, elliptical, square, se jai-circ?il ar, triangular, trapezoidal, random or the like. The base plate 2402 has a through hole 2406(scicaare in the example shown) and two attachment tabs 2408. The attachment tabs have bores 2410..
[1'123] The wedge plate 2404 is shown as having a rectangular shape similar to the base plate 2402. but the base plate 2402 z :l wedge plate 2404 do not necessarily have the sme shape, Moreover, the wedge plate 2404 may have numerous possi ale shapes as explained with reference to tine base. plate 24(?2 A wedge p_ot;usio 2414 .: tends from a first side?.tile wedge plate 2404. The wedge protrusion 2414 is shown with a generally triangular shape having a straight side, but other shapes are possible including sides that are rounded, beveled', ,'irvtid, zarched, convex, concave, or the like. The wedge protrusion 241$ has a superior surface 2416 and an inferior surface 241, 8 that generally converge as they rave away fro the wedge plate 2404. The wedge protrusion 2414 has a channel bore 2420 extendin-through a portion of he wedge protrusion 2414. While not necessary and depending on anatomical factors, the channel bore 2420 may be located hall vaybe!w- en the superior surface 2416 and the in erior surface 2418. The gyred e protrusion 2414 and through hole 240:6 are sized such that the base plate 2402 and wedge plate 2404 can abut, although in the typical implanted configuration, the base plate 24 2 and wedge plate 2404 v uld not in fact abut as the bone., e.g. spun us process, would intervene between the base plate 2402 and wedge plate 2404 as shown in FIG, 57, ; 124] As best seen in .FIGS. 56 and 57, the bores 2410 o: attachment the tabs generally a i n with the channel bore 2420 when, the wedge protrus on 2414 resides in the through hole 2406 such that a coimector 7422 ran extend through the bores 2410 and chain .s bore 2420 to omiec t the base plate 2402 and wedge plate 2404 during use. e .
"f) pica i , the connector 2422 comprises a screw and nut, but any conventional connector may be used.
When 'first implanted, the, base plate 24021 and wedge plat 2404 are aligned ahoat a superior ?Fn.>us process 2450 and an infe for SVIMOUs process 245". r3 he co nector 2422- connects the artachme :t tabs 2408 and the wedge protrusion 2414. Ideally.. but not necessarily, the connector 2422 is not tightened and the base plate 2402 and wedge plate 2404 may move rith respect to each other, al-though in the initial condition they can only move closer together. Once the plates are aligned with t'ae proper disÃrF ct oin, the connector 2422.1 may be tightenedd to lock the final implant 24lfl in l>., .. Ideally, but not riecessariiy the salpraspinous l g aanlent remains intact to inhibit the spinal implant 2400 from moving posteriorly out of the irate noun process space. Alternetively, and optionail , base plate 2402 and wedge plate 2404 may comprise suture bores 424 (FIG. 57), A suture 2426 may be connected to the suture bores 2424 and traverse su eriorthe spinous process 245 and the inferior s. inot s process 2452 . Moreover, while only a pair Ãxf b res is shown with a pair of s ores, more may be provided. I Moreover, the sutu,e2426 should be construed nerically to refer to cables, NTres, bands, orother flexible hiocomp table; connectors.
Sall sutures may be tied or locked using a tie, cable lock, or crimp.
125] FIG. 58 illustrates .an alt'ert aative spinal implant 2 500 similar in form and function to that of FIGS, 55-57. The spinal implant 2500 includes a base plate 2502 and wedge plate 2504. The base plate Y5U2 includes an attachmeu t b 2506 and a bore 2508. The wedge plate 2?04 has at least one wedge pron 2510, but two wedge prongs 1-510 are, provided for improved stability. The two wedge. prongs 2510 Toren a prong chamille] 2512 to receive the attachment tab 2506 and provide sofa a Id t.ionai stability ;'he wedge prongs 2510 have c.1 .r >iei bores 2514. V1' ii both the attachment tab 2506 and à 1e wedge prongs 2510 are shown as wedge shaped, both are not necessarily wedge shaped. The bore 2508 and channel bores 2514 align such that a connector 2516 can be fitted between them to Couple t-1 e base plate 2502 and wedge plate 2 504 together. Alternatively the bore 2508 mays be f'ormed' as a channel bore and the h .n,icl bores 2514 may be formed ;is a bore or they :: iay all be channel bores to allow for lateral adjus'mes c:f the plates, 01:261 iG. 59 illustrates an alternative spinal implant 2600 similar to that of FIG. 58 but instead of bores and connectors, protrusions 2o02 areforrned inside the pang channel 2604 w kid oir the attachment tab 2606. The protrusions 2602 may be r bs, pins, shoulders, barbs, flanges, divots, detents, channels, grooves, teeth and/or other sv~:table protrusions. The protrusions 2602 ina ' opera e similar to a ratchet i 3echanism and may be con.figured so that the base plate and wedge plate can move to 'aids each other and distract adiacent bons, e.g.
spinous processes. The Protrusions 2602 such that the plates do not move apart after they are pressed too t~her. The pro nag channel 2.604 may be vswidened, e.g.
by prying it Pen, tc disengage the protrusions 2602 and allow the, plates lobe separated.
[_I[127 E FIGS. 60 6 I illustrate a spinal iniplant 2700. The spinal implant 2 700 includes a spacer having a spacer axis 1-701, a first part 2702, and ar second part 2 1 ,04, the first part 20'2 has a main body '2706 with a first end 2708 and a second end 2710, One or more lateral -wells 2712 extend out from the first Part 2702 transverse to the spacer axis 2701 at t to first end '-'708, The E ails 2712 are adapted to extend along a superior =d inferior spinout a first side. The t .>nd end 2710 is adapted to reside in a space between the superior and inferior spinous process. The second part 2704 includes a r lain body. 2714 and
In the example of FRI. 39, the spacer 1502 is placed between adjacent spinous processes and sutured to the surrounding soft tissue 1,506 at both ends.
113] FIG. 40 illustrates a spinal irnpl a 1 1600 sire far to that of 1'li CS.
i8 .. 39 Nie 'p nal implant, 1600 includes a generallysolid spacer 1602 arid "Includes one or more transverse passageways 1604 for receiving one of more fasteners 1606. Preferably the passageways 16,04 communicate from the end of the spacer to the outer surface of the spacer traniverso. to 'he spacer a-.,.is as shown. "lie spacer 1602 inky be attache to one "ac- t bone, both adjacent bones, 'for one side or from two sides. For example , in a à n lateral procedure a fastener may be placed into only one bone to maintain the spacer 1602 in position.
Alternatively a fastener may be paced into each of the adjacent bones to maintain th,.... ,F
1602 in position and also to hold the a jace.nt bones in position relative to one another. In 2) 7 the example of FIG. 40, scree=s are piaeed f3 .nn each side of the spacer 1602 into adjacent sp:inou processes 161 ), 1612-imp(a t 14] FIG. 41 illustrates a, spinal implant 1700 similar to that of FIG. 40.
Sp',,,-,z 17110 includes a spacer 1702, a retention:Ãnem er in the forin of a flange E
704, xnd holes 1706 through the lunge for receiving fasteners 1708. The poles 1706 T nay be parallel to the spacer axis (as shown) or transverse to the spacer axis.
t 1151 IMIGS.: 43 f. stra c a spinal .mnla t 1800 including a base 1802 having a base axis 1801 and a hook 1 06 having, a portion 1808 extending generally traz-,tsversety away -from the baase axis 1804 and a potion 1810 extending generally parallel to the base axis 1804. The spinal implant 1800 further includes a spacer 1812 engageable with the base 1802. The spacer 1 81 2 May be Cylindrical, rectangul# , conical, and/or any other suitable shape. In the illustrative example of F l S. 42-43, the spacer 1812 is generally conical and threadably engages the base 1802 in axial translating relationship. In use, the hook 1806 is placed around a portion of one or more adjacent bones, e.g. it may be inserted between adjacent spinous processes to catch on one of the slyÃnous pr cesses as shown in FIG, 422, The spacer spaces them apart a desired distance as shown in FIG. 43. The spinal it p ,.Ã.-. 801) allows unilateral and mini Malty Ãnvasive placement like the prevÃous examples and adjustable:
spacing de ermined by the axial position of the conical spacer 14121 .
[ I 1$ F [GS. 44-46 illustrate a spinal implaaÃht 1900 including a spac er 1902 and deployable retention. members 1904. The spacer 1902 includes a split body 1906 having a superior surface 1908 and an inferior surf ac, 1910. The s, pÃer or surface 1908 and inferior surface 1910 are movably connected to a driver 1912. The driver 1912 has a screw 1914 attached to it and extending from the driver 1912 between the superior 1908 and inferior surface 1910 into a threaded bore 1916 iii a wedge 19 8. In operation, turning the driver 11912 causes the screw ,v 1914 to thread, into the bore 1916, which causes the wedge 1918 to move }e ween the superior surface 1908 and the inferior surface 1910, As the wedge 1918 moves further between the surfaces 1908. 1910, the surfaces 1908, 1910 separate to increase the height of the spacer 1902. Combinations of channels 1920 and ribs 1922 provide stabilization for movement of the wedge 1918 relative to the surfaces 1908, 1910. Retention of the spacer 1902 may be accomplished using the coils, flanges, dÃsc.s, wires and/or other protrusions described above, For example, c eployable retention i sembers.
1904 in the of elastic wires that may be folded puallel to the spacer axis 1924 for insertion may provide lateral retention of the spacer 1902.
11 I1 FI &. 47-48 illustrate a spinal implant 2000 including a spacer _2002.
The spacer 2002 is generally shaped as a cylinder or sleeve having a bore 2004. A gap 2006. or sloÃ, extend: ngth of spacer 2002. Bore'-200-4 may be a complete through bore or bore 21004 may allow for a central ',all or plug (not shown ) for stability. Spinal implant 2u00 f irtheÃ
comprises end craps 2010 having a generally conical shape or suede shape. As end caps 2010 are pressed or threaded into bore 2004, the shape of caps 201 0 causes the diameter of s pacer 2Ã1132 toe pr iitl, which is allowed because of gap} 2006, (_Eap 2006 ould be filled th a suitable elastic material. Alternatively to shaped caps 20 101 caps 2010 could be imiade of an expandable m iterial, such as shape niciiiory alloys, spring steel, resins, polymers or the like to achieve the same result. Lateral retention of the spacer may be accompllished Using the coils, fai ges, d scs, wires and/or other t otrzsions described above and below and will not bere-described relative to this embodiment.
118] FIGS. 49-50 illustrate a spinal impiaut 2100 similar to that of Fl &. 47-48. The s i n . t.:.: 1-100 has a spacer 2102 its the four of a coo :.. l he sp cer 2102 is moveable fuou a Compact position (FIG. 49) in the Coil winds around its la multipke tirnes w id is c I oser to a spacer axis 2104 to at expanded position (FIG.
50) by uncoiling the spacer such that it winds around itself f6 w Feu times and is further fro n the spacer axis 21104 e.g. such that it forms a siiiale continuous riiig. The spacer has inner and outer hook shaped edges 2106, 2108 that can engage as shown in FIG. 50 to limit the amount of e < 7,,_.ion of The spacer 2102. The spinal implant 2100 may also include plugs or cores as shown in prior examples to support the spaces 2102 against collapse. Lateral retention of the spacer may be accomplished using the coils, flanges, discs, wires other protrusions described above and below and will not be re-described relative to this embodiment.
119] FIGS. 51-52 ill strate a spinal implant 22,00 similar i at. of FICIS. The spinal ii plant 2200 includes a coiled sheet-like spacer 2-202 having tabs 2204 projecting away from the sheet to c age slots 2206 to limit the amount of expansion of the spacer 2202. The tabs 2204 and/or slots 2206 may be positioned at the inner and Ã
uÃer edges of the coiled spacer 2202 or they may be positioned at. one or more positions intermediate the edges, for example, the spacer may ha,, tabs 2204 at one e ,d and slots placed at multiple locations to allow the spacer to be fixed at different sizes. The spinal implant 2200 may als include plugs or cures as shown in prior examples to support the spacer 2-202 against collapse. Lateral retention of the spacer may be accomplished using the coils, flanges, discs, wires and/or other protrusions described above and below and not be re-described relative to this e bodirrient.
\0 FIGS, '53-54 illustrate a spinal implant 13O{. including a spacer 2302, having as ti,#.L e,, axis 23113, 'ibmied of at) clastic iriatez ai. such as a polyi'.n or resin materÃa.l. For example.
the spacer 2302 may be a hydroge or other composite or polymer material such -,L'; a siliconee material. A bore 2304 extends through the spacer 2302 into a. base 2306. The base 2306 is shown with a, wedge or conical shape to facilitate insertion but which could be any shape including rounded or bluint. Deployable n- -r. oaa members in. the form of elastic arms 2308 are attached o the base 2306. In use, the base 2306 is inserted between adjacent be-nes, e.g.
s a y>zÃs pro esses> parallel to the spacer xis 2303. As the a ni5 2308 pass the spÃiio is process, they fold into a compact or s ?'GTre insertion position in which they are nearer the pacer .xis % '30' and lie along the sides of tbe spacer 2302 generally pa;
talel to the spacer axis à i' 1 ( r. 53). Once the a .ifs ?308 pass the spt:nous process, they retarn to an expanded or deployed retention position in which they project outwardly transverse to the spacer axis 2303 ( s .:54). Preferably, the arms 23) 08 only fold in one 3irec à ?n. to provide iinc, eased retention once inserted, The spinal implant 2300 further includes a plate 10 having a projection 2312, such as a threaded shat, extendable through the bore 2304 and tl.readabl y engaging the base 2306, Threading, for example, the screw into the base 2306 compresses the spacer 2302 causing the diameter of the spacer w.302 to increase, providing distracting .forces on the sptiious process, Lateral stability is provided by the plate 2310 and t ho arms t3-,8 which extend `~away c aa~r which from the -,pacer axis 2303) on either side of the s~'>Ã~ous process.
111 21 .j Alternatively to screw threading into the base 306. a bolt may be attached to the base Otber i etiiriirisiiis cob i l and the plate 2310 and spacer 2302 compressed with a nut 23114.
also be i sed to compress the spacer 2 30w 1rc . bit Ã1 ratchets, press fits, rivets, and/or any other suitable mechanism .1 [T1222) Ã FIGS. 55-57 illustrate as spiral plant. 2400 ncl .ding a base plate 2402 and wedge prate '404. The base plate, 2402 is shown as having a rectanguiar sy ape. but any shape is p zssibke including, circular, elliptical, square, se jai-circ?il ar, triangular, trapezoidal, random or the like. The base plate 2402 has a through hole 2406(scicaare in the example shown) and two attachment tabs 2408. The attachment tabs have bores 2410..
[1'123] The wedge plate 2404 is shown as having a rectangular shape similar to the base plate 2402. but the base plate 2402 z :l wedge plate 2404 do not necessarily have the sme shape, Moreover, the wedge plate 2404 may have numerous possi ale shapes as explained with reference to tine base. plate 24(?2 A wedge p_ot;usio 2414 .: tends from a first side?.tile wedge plate 2404. The wedge protrusion 2414 is shown with a generally triangular shape having a straight side, but other shapes are possible including sides that are rounded, beveled', ,'irvtid, zarched, convex, concave, or the like. The wedge protrusion 241$ has a superior surface 2416 and an inferior surface 241, 8 that generally converge as they rave away fro the wedge plate 2404. The wedge protrusion 2414 has a channel bore 2420 extendin-through a portion of he wedge protrusion 2414. While not necessary and depending on anatomical factors, the channel bore 2420 may be located hall vaybe!w- en the superior surface 2416 and the in erior surface 2418. The gyred e protrusion 2414 and through hole 240:6 are sized such that the base plate 2402 and wedge plate 2404 can abut, although in the typical implanted configuration, the base plate 24 2 and wedge plate 2404 v uld not in fact abut as the bone., e.g. spun us process, would intervene between the base plate 2402 and wedge plate 2404 as shown in FIG, 57, ; 124] As best seen in .FIGS. 56 and 57, the bores 2410 o: attachment the tabs generally a i n with the channel bore 2420 when, the wedge protrus on 2414 resides in the through hole 2406 such that a coimector 7422 ran extend through the bores 2410 and chain .s bore 2420 to omiec t the base plate 2402 and wedge plate 2404 during use. e .
"f) pica i , the connector 2422 comprises a screw and nut, but any conventional connector may be used.
When 'first implanted, the, base plate 24021 and wedge plat 2404 are aligned ahoat a superior ?Fn.>us process 2450 and an infe for SVIMOUs process 245". r3 he co nector 2422- connects the artachme :t tabs 2408 and the wedge protrusion 2414. Ideally.. but not necessarily, the connector 2422 is not tightened and the base plate 2402 and wedge plate 2404 may move rith respect to each other, al-though in the initial condition they can only move closer together. Once the plates are aligned with t'ae proper disÃrF ct oin, the connector 2422.1 may be tightenedd to lock the final implant 24lfl in l>., .. Ideally, but not riecessariiy the salpraspinous l g aanlent remains intact to inhibit the spinal implant 2400 from moving posteriorly out of the irate noun process space. Alternetively, and optionail , base plate 2402 and wedge plate 2404 may comprise suture bores 424 (FIG. 57), A suture 2426 may be connected to the suture bores 2424 and traverse su eriorthe spinous process 245 and the inferior s. inot s process 2452 . Moreover, while only a pair Ãxf b res is shown with a pair of s ores, more may be provided. I Moreover, the sutu,e2426 should be construed nerically to refer to cables, NTres, bands, orother flexible hiocomp table; connectors.
Sall sutures may be tied or locked using a tie, cable lock, or crimp.
125] FIG. 58 illustrates .an alt'ert aative spinal implant 2 500 similar in form and function to that of FIGS, 55-57. The spinal implant 2500 includes a base plate 2502 and wedge plate 2504. The base plate Y5U2 includes an attachmeu t b 2506 and a bore 2508. The wedge plate 2?04 has at least one wedge pron 2510, but two wedge prongs 1-510 are, provided for improved stability. The two wedge. prongs 2510 Toren a prong chamille] 2512 to receive the attachment tab 2506 and provide sofa a Id t.ionai stability ;'he wedge prongs 2510 have c.1 .r >iei bores 2514. V1' ii both the attachment tab 2506 and à 1e wedge prongs 2510 are shown as wedge shaped, both are not necessarily wedge shaped. The bore 2508 and channel bores 2514 align such that a connector 2516 can be fitted between them to Couple t-1 e base plate 2502 and wedge plate 2 504 together. Alternatively the bore 2508 mays be f'ormed' as a channel bore and the h .n,icl bores 2514 may be formed ;is a bore or they :: iay all be channel bores to allow for lateral adjus'mes c:f the plates, 01:261 iG. 59 illustrates an alternative spinal implant 2600 similar to that of FIG. 58 but instead of bores and connectors, protrusions 2o02 areforrned inside the pang channel 2604 w kid oir the attachment tab 2606. The protrusions 2602 may be r bs, pins, shoulders, barbs, flanges, divots, detents, channels, grooves, teeth and/or other sv~:table protrusions. The protrusions 2602 ina ' opera e similar to a ratchet i 3echanism and may be con.figured so that the base plate and wedge plate can move to 'aids each other and distract adiacent bons, e.g.
spinous processes. The Protrusions 2602 such that the plates do not move apart after they are pressed too t~her. The pro nag channel 2.604 may be vswidened, e.g.
by prying it Pen, tc disengage the protrusions 2602 and allow the, plates lobe separated.
[_I[127 E FIGS. 60 6 I illustrate a spinal iniplant 2700. The spinal implant 2 700 includes a spacer having a spacer axis 1-701, a first part 2702, and ar second part 2 1 ,04, the first part 20'2 has a main body '2706 with a first end 2708 and a second end 2710, One or more lateral -wells 2712 extend out from the first Part 2702 transverse to the spacer axis 2701 at t to first end '-'708, The E ails 2712 are adapted to extend along a superior =d inferior spinout a first side. The t .>nd end 2710 is adapted to reside in a space between the superior and inferior spinous process. The second part 2704 includes a r lain body. 2714 and
4 has a first end 2716 and ,, e, o :e clad 1-1111718. One or ore Iat ual walls 2720 extend out from the second part 2704 transverse to the spacer axis 2701 at the first end 2716.
The walls 2720 are adapted to extend along a superior mid info 3.Gi pi ! pr ce 3 T on a second side. The second. end 2718 is adapted to reside. in a space bets. 'een the superior and inferior sp ous process. The lateral wall 2712, 2720 may be shaped to accommodate anatomy. The second ei :?710 o f the first part 2702 and second end 2 718 of second part 270 4 abut or on gage. A
variety of features may be provided. to enhance this engagement, For example, the second ends mav include one or more chan-nels and/or one or more protrusions that t in the chamiels. A set scre,-% or the like may threadably engage a bore extending through the .fist and secoxnd pats tÃ.? .~T aintai:n+ them in o ? i ;n'1m]:e `lt. However, as explained b low, a setscrew and bore are optional. .ntt,ri 1.~i4 channels and protrusions are optional as the ends may .just abut or have slur aces. The ends may b sloped transverse to the spacer a Js 2701. as shown, to facilitate i se_ tion andror to ncrea-e the abuti et t area. Some alternate exam les will be described below relative to FIGS. 6.2-67.
[ 128] Continuing Ew, th FIÃls. 60-6 1, one or more trough char els or bores 27.22 extend through Ãh first and second parts 2702, 2704. A guidewire 2732 extends t1hrÃ3ugh t1 he channels 2722 geTwrally parallel to the spacer axis 2701. The guidewire 2732 may be for ed of wire, braided or twisted cable Ãrnade 01 Ã fetal zc ur polymer strands), suture n ate.-a], a flat metallic or polymer band 1 1>_ braided or s oli a cf1 t3r th , s ~~t f le materials and configurations, Multiple through channels Om .nay allow the guide'ire 27321-to form a loop about the first end 2702 as shown in FIG. 61. The yguidewire 2732 ends may be connected around the second end such as with a tie, crimp, knot, t , lock, cable lock, and/or other suitable connections. When the guidewir'e 2732 iis` not looped, the g ide ire 2732 may be looked against both the first and second ends using a locking device such as a cable lock, crimp, knot, and/or , ?y :hcr suitable locking device. The guiclewire 2732 maintains the first and second parts looked together, 129J F>G& 62-63 illustrate a spinal i plant .2800 similar to that of FIGS. 6 -6 1 except that it includes a protrusion 2804 extending from t1 ho second part 2704 to engage a slot 2802 extending from tlx , part 2 702 to stabilize the first and second parts relative to one another.
13 FIC;. 64 illustrates a spinal implant 2900 similar to that of FIGS. 60-61 except drat the first part 2702 defines slot 2902 and the second pan 21704 tapers to a blade-like nose .904 that engages the slot 2902.
131; FIGS, 65-66 illustrate a spiral implant 3000 similar to that of FIGS. 60-61 ccn. that the first part 2702 defines tapering side cutouts 3002 separated by a central wedge shaped wall 3004 and the second part 2704 tapers to wedge shaped second end 3006. The wedge shaped second end is divided by a groove 3008; When the first and second parts are pressed together, the wall 3004 cngaÃges the groove 3008 and the wedge shaped second end 300 engages the side c :toots 3002. Also, is the embodiment ot'FIGS. 6-5-66 the first . and second parts 270'2,2704 have. one or more bores 301Ø 3012 transverse to the spacer axis 2701 for receiving a fastener to 'ock the parts togeher.
.i 32] FIG. 67 illustrates a spinal implant 3100 similar to that of FIGS. 60-66 and shown in the implanted condition. ` 'he first and second parts 2702, 2704 are secured together with a single guide wire 3 102 secured at each end by a crimp :) 10$. Passageways "106 are provided 7;":,.- `n :1,: x<.i.:a1 , `<_ s 1712, 2 720. Su uures+., wi,;es, c ales, hwands. or oother flcx'h1e hiocompatible material 3 108 may extend through the passageways 3106 and over and/or throiagli.a spi.nous p Bess. The flexible biocompatible material 3 108 may loop under or over a single process (as shown on the superior process 3 11 ), may loo around a single process (as shown or die inferior process 31.12), or may loop around both processes, or a combination thereof The flexible biocompatÃble material 3108 may, be locked using a locking device si filar to those explained above, The flexible hiocompatible m 1terial 3108 and guidew..re 3102 may optionally he the same element.
133] FIG. 68 is a flowchart 'one exemplary methodology for implanting the spinal implants of FIGS. 61-67. First, the patient is prepared for implanting à e spinal implant, step 7202, P;reparin the patient may include, for example. making one or more incisionsprovsiding access to the spinal segment, placing the guidewire, etc.
The surgical site is distracted (or measured as distraction may be caused by the spacer itself) rising conventional distra ction tools, step 320411, Office exposed, the u tern inotis pros space is prepared. to receive the spinal iinpltrnt, step 3206, This typically iii ,ii.tdes preparing th e spinous processes to accept the spinal lrnplaiit, which may i ,c ode removing som.m portion of the spinous process, and removing muscle, tendons, and ligaments that may interfere with implanting the spinal implant and/or may provide force tending to unseat the spinal implant.
)he first part of the spinal is inserted, over or with the guidewire,, to the surgicaal site through à .e incision or the like, step 3208. Once at the site, the first part of the spinal "Unplant is positioned or aligned such that t hl- lateral walls are loosely abuttin a first side of the superior and inferior spinous processes and the second end extends into the inter'spirno is space, step 3210, Generally, this means that ;lie fist part is implanted through the interspinous process space. The 4 :: lei ire, which is attached to the first part of the spinal imp' ant as explained above extends froni the second end of the first part and isaÃtac red to 3.7 the second pan of , , , iaa1 mplant, Thus. the surgeon inserts the second pail long: the guidewire, step 3212. Noe, the first part and second part may be positioned using tools or the surgeon may place the parts using hands and Using the guidew-ire, the protrusions (ii tl iy) of the second part are inserted into the channels of the first part (if atiy) to align the first part and second part of the spinal implant, step 324.
Compressive force is applied to mate the first. part and the second part, step 3216. The compressive force may be applied by crimping t _ Tire. threading a cable lock, a separate clad , or the like.
Once sufficiently compressed, the first part and second part are locked together, step 3218.
Optionally, excess gu de re may be, cut z nd removed or looped around the adjacent superior interior spinous process to provide iecured seating, stop 3220, Once mateed ill the a, and interspin ous space, the distraction of the spinal segment may be released, step 3222, and the patient's surgical site may be closed, step 3224.
[I fl 34 i~IG. 69 illustrates a spinal i liplant 3300. The spinal implant 3300, includes a superior spinous process seat 3302 and a inferior spinous process seat 3-3,11".4. As show?, swats 3302 and 3304 form a and inverted U shape, but other shapes a- p<
,,sihie including a square channel shape for each seat, a C-shape, and nor any other suita ale shape, although it is believed the saddle shape as shorn would work e 1.
[ T i, 3 so,i 3 30 2 includes asur#ace 3306 which contacts the superior s Vinous process and Walls 3308 traversing each side of the superior sp> ious process to capture superior spinous process in seat 3302. Wills 33 )0may be convergent, divergent or relatively parallei. Wall 3308 may be more akin to bumps, ribs, or shoal en's to traVti \ -nil t. 'Hlmor P on of t7e spinuus process or may be longer to tra -e.rse a major portion of the slyinous process. Surface 3306 and =alls 3308 may be discrete or shaped like a s ,1,11le forming a si-nooth surface in process ea rest. Attached to one wall 3308 Ãs a vestÃcal distraction post 3310 ti nding tow s i à i~ ~ i Wile only one vertical distraction post 33 10 is multiple posts are passible. Moreover, if i-nultiple posts are -used, vertical distraction posts 33 10 may reside or, opposite sides of superior spinous process seat 3302. '-pile shown a a straight post, vertical distraction post 3310 may be curved or straight depending on anatomical c s"' e ations or the like.
j à i 36 Similar to seat 3302, seat 3 304 includes a surface 3306 whichoontacts the inferior spinous process and walls 3308 tra Fersing each side of the i .iferi .ar spilao rs process to capture ixal rior sp.inous process in :seat 3304. Attached to one wall 3308, on the side corresponding to vertical distraction oat 33 is an attachment tab 3312. Attachment tab 33114 has a -vertical bore 3314 throug 3wihich vertical distraction post 3310 extends.
Seat '1304 can be n oved closer To 'or further from seat 3302 along vertical distraction post .3310 Attachment tab 3 312 also com :r ses a horizontal bore 331 . Horizontal bore 3316 intersects vertical bore-31314. seating de c 3 18 is insertable ià to lac rizo tal bare 331. As shown horizontal bore 3316 is threaded to accept a set screw or th ; like.
[1,11371 In use, a surgeon wool distract superior and interior spinous processes and implant spinal implant 3300. Seats 3302 and 3 304 vould be set at a desired distraction andk for e a nple, set screw 3)3l 8 would be tliresadz d into horizontal bore 3316 to app l-,.- <;z atÃi g force to seat verLiceal distraction post 33110 in vertiical bore 3314 locking seats 3302 -U-1d3304 at the set distraction distance.
[xi1381 Vertical distraction post 3310 aridIorvertical. 'bore 3.314 may, be arranged with a protrusion 3.:19 or de tent toinhibit the ability of Otaiuia 'ing vertical distraction post 33) 1 from vertical bore 3314.
[11.1 3t ] FIG. 70 illustrates alternative seats 3400 and 3402. Seats 3 00 and 3402 are designed to nest or iiitcrlà 5. K. that regaid. seat 400 has one or more first blades 3404 or r ultÃple surfaces spaced apart so first gaps 406 separate first blades 3404. Seat 3402 wow' similarly have one or Tore second blades 3408 or multiple surfaces. Seat 3402 is shown t itlh a single second glade for convenience. Second plate 3408 is aligned with first gaps 3406 such that seats 400 and 3402 may nest or interlock. Sii i lail~r, s à #
blades 2 4is cr :il l al.-,'.n with second gaps, not shocwn. Either first blades 3404 (as shown) or second blade 3408 may attach to a vertical distraction post 4 10 and second blade 3408 (as shown) or first blades 3404 ma attach to attache. ent tab 3412 N;1401 Although examples of a spin all implant w id its use have been described and .1, ustzated in detail, it is to be understood that the same is : nt, nd d by way of illustration and only and is not to be taken by way of limitation. The invention. has been illustrated in the forme, of a- spinalimplant for use in spacing adjacent spinous processes of the human spine.
However. the spinal implant may be configured for spacing other portions of the spine or other bones. Accor ngiy, variations in and modifications to the sp na3 implant and its usc will be apparent to those of ordinary skill in the art, '[',he various illustrative embed invents c rs retention illustrate altrrnati rt' t onfif urati on s of various component pans such s spa c members, additional fasteners, and the like. In most cases, and as will be readily understood by one skilled in the art, the alternative configuration of a component part iii one mbodiinenl may be substituted for a similar component part in another embodir ent., For example, the differently shaped or ex andable ;:pacers in one example may be substituted for a spacer in another example. Likewise the various mechanisms for dept , g a reteÃ:!o j miler or for providing additional fasteners may be interchanged. Furthermore, throughout Ã
e exemplary embodiments, here Compon .nt part mating relationships are illustrated, the gender of the co mpfone nt parts ma.), be reversed as is known in the tart within the scope of the invention.
The lollo wing claims are intended to cover all such modifications and equiv a eats.
The walls 2720 are adapted to extend along a superior mid info 3.Gi pi ! pr ce 3 T on a second side. The second. end 2718 is adapted to reside. in a space bets. 'een the superior and inferior sp ous process. The lateral wall 2712, 2720 may be shaped to accommodate anatomy. The second ei :?710 o f the first part 2702 and second end 2 718 of second part 270 4 abut or on gage. A
variety of features may be provided. to enhance this engagement, For example, the second ends mav include one or more chan-nels and/or one or more protrusions that t in the chamiels. A set scre,-% or the like may threadably engage a bore extending through the .fist and secoxnd pats tÃ.? .~T aintai:n+ them in o ? i ;n'1m]:e `lt. However, as explained b low, a setscrew and bore are optional. .ntt,ri 1.~i4 channels and protrusions are optional as the ends may .just abut or have slur aces. The ends may b sloped transverse to the spacer a Js 2701. as shown, to facilitate i se_ tion andror to ncrea-e the abuti et t area. Some alternate exam les will be described below relative to FIGS. 6.2-67.
[ 128] Continuing Ew, th FIÃls. 60-6 1, one or more trough char els or bores 27.22 extend through Ãh first and second parts 2702, 2704. A guidewire 2732 extends t1hrÃ3ugh t1 he channels 2722 geTwrally parallel to the spacer axis 2701. The guidewire 2732 may be for ed of wire, braided or twisted cable Ãrnade 01 Ã fetal zc ur polymer strands), suture n ate.-a], a flat metallic or polymer band 1 1>_ braided or s oli a cf1 t3r th , s ~~t f le materials and configurations, Multiple through channels Om .nay allow the guide'ire 27321-to form a loop about the first end 2702 as shown in FIG. 61. The yguidewire 2732 ends may be connected around the second end such as with a tie, crimp, knot, t , lock, cable lock, and/or other suitable connections. When the guidewir'e 2732 iis` not looped, the g ide ire 2732 may be looked against both the first and second ends using a locking device such as a cable lock, crimp, knot, and/or , ?y :hcr suitable locking device. The guiclewire 2732 maintains the first and second parts looked together, 129J F>G& 62-63 illustrate a spinal i plant .2800 similar to that of FIGS. 6 -6 1 except that it includes a protrusion 2804 extending from t1 ho second part 2704 to engage a slot 2802 extending from tlx , part 2 702 to stabilize the first and second parts relative to one another.
13 FIC;. 64 illustrates a spinal implant 2900 similar to that of FIGS. 60-61 except drat the first part 2702 defines slot 2902 and the second pan 21704 tapers to a blade-like nose .904 that engages the slot 2902.
131; FIGS, 65-66 illustrate a spiral implant 3000 similar to that of FIGS. 60-61 ccn. that the first part 2702 defines tapering side cutouts 3002 separated by a central wedge shaped wall 3004 and the second part 2704 tapers to wedge shaped second end 3006. The wedge shaped second end is divided by a groove 3008; When the first and second parts are pressed together, the wall 3004 cngaÃges the groove 3008 and the wedge shaped second end 300 engages the side c :toots 3002. Also, is the embodiment ot'FIGS. 6-5-66 the first . and second parts 270'2,2704 have. one or more bores 301Ø 3012 transverse to the spacer axis 2701 for receiving a fastener to 'ock the parts togeher.
.i 32] FIG. 67 illustrates a spinal implant 3100 similar to that of FIGS. 60-66 and shown in the implanted condition. ` 'he first and second parts 2702, 2704 are secured together with a single guide wire 3 102 secured at each end by a crimp :) 10$. Passageways "106 are provided 7;":,.- `n :1,: x<.i.:a1 , `<_ s 1712, 2 720. Su uures+., wi,;es, c ales, hwands. or oother flcx'h1e hiocompatible material 3 108 may extend through the passageways 3106 and over and/or throiagli.a spi.nous p Bess. The flexible biocompatible material 3 108 may loop under or over a single process (as shown on the superior process 3 11 ), may loo around a single process (as shown or die inferior process 31.12), or may loop around both processes, or a combination thereof The flexible biocompatÃble material 3108 may, be locked using a locking device si filar to those explained above, The flexible hiocompatible m 1terial 3108 and guidew..re 3102 may optionally he the same element.
133] FIG. 68 is a flowchart 'one exemplary methodology for implanting the spinal implants of FIGS. 61-67. First, the patient is prepared for implanting à e spinal implant, step 7202, P;reparin the patient may include, for example. making one or more incisionsprovsiding access to the spinal segment, placing the guidewire, etc.
The surgical site is distracted (or measured as distraction may be caused by the spacer itself) rising conventional distra ction tools, step 320411, Office exposed, the u tern inotis pros space is prepared. to receive the spinal iinpltrnt, step 3206, This typically iii ,ii.tdes preparing th e spinous processes to accept the spinal lrnplaiit, which may i ,c ode removing som.m portion of the spinous process, and removing muscle, tendons, and ligaments that may interfere with implanting the spinal implant and/or may provide force tending to unseat the spinal implant.
)he first part of the spinal is inserted, over or with the guidewire,, to the surgicaal site through à .e incision or the like, step 3208. Once at the site, the first part of the spinal "Unplant is positioned or aligned such that t hl- lateral walls are loosely abuttin a first side of the superior and inferior spinous processes and the second end extends into the inter'spirno is space, step 3210, Generally, this means that ;lie fist part is implanted through the interspinous process space. The 4 :: lei ire, which is attached to the first part of the spinal imp' ant as explained above extends froni the second end of the first part and isaÃtac red to 3.7 the second pan of , , , iaa1 mplant, Thus. the surgeon inserts the second pail long: the guidewire, step 3212. Noe, the first part and second part may be positioned using tools or the surgeon may place the parts using hands and Using the guidew-ire, the protrusions (ii tl iy) of the second part are inserted into the channels of the first part (if atiy) to align the first part and second part of the spinal implant, step 324.
Compressive force is applied to mate the first. part and the second part, step 3216. The compressive force may be applied by crimping t _ Tire. threading a cable lock, a separate clad , or the like.
Once sufficiently compressed, the first part and second part are locked together, step 3218.
Optionally, excess gu de re may be, cut z nd removed or looped around the adjacent superior interior spinous process to provide iecured seating, stop 3220, Once mateed ill the a, and interspin ous space, the distraction of the spinal segment may be released, step 3222, and the patient's surgical site may be closed, step 3224.
[I fl 34 i~IG. 69 illustrates a spinal i liplant 3300. The spinal implant 3300, includes a superior spinous process seat 3302 and a inferior spinous process seat 3-3,11".4. As show?, swats 3302 and 3304 form a and inverted U shape, but other shapes a- p<
,,sihie including a square channel shape for each seat, a C-shape, and nor any other suita ale shape, although it is believed the saddle shape as shorn would work e 1.
[ T i, 3 so,i 3 30 2 includes asur#ace 3306 which contacts the superior s Vinous process and Walls 3308 traversing each side of the superior sp> ious process to capture superior spinous process in seat 3302. Wills 33 )0may be convergent, divergent or relatively parallei. Wall 3308 may be more akin to bumps, ribs, or shoal en's to traVti \ -nil t. 'Hlmor P on of t7e spinuus process or may be longer to tra -e.rse a major portion of the slyinous process. Surface 3306 and =alls 3308 may be discrete or shaped like a s ,1,11le forming a si-nooth surface in process ea rest. Attached to one wall 3308 Ãs a vestÃcal distraction post 3310 ti nding tow s i à i~ ~ i Wile only one vertical distraction post 33 10 is multiple posts are passible. Moreover, if i-nultiple posts are -used, vertical distraction posts 33 10 may reside or, opposite sides of superior spinous process seat 3302. '-pile shown a a straight post, vertical distraction post 3310 may be curved or straight depending on anatomical c s"' e ations or the like.
j à i 36 Similar to seat 3302, seat 3 304 includes a surface 3306 whichoontacts the inferior spinous process and walls 3308 tra Fersing each side of the i .iferi .ar spilao rs process to capture ixal rior sp.inous process in :seat 3304. Attached to one wall 3308, on the side corresponding to vertical distraction oat 33 is an attachment tab 3312. Attachment tab 33114 has a -vertical bore 3314 throug 3wihich vertical distraction post 3310 extends.
Seat '1304 can be n oved closer To 'or further from seat 3302 along vertical distraction post .3310 Attachment tab 3 312 also com :r ses a horizontal bore 331 . Horizontal bore 3316 intersects vertical bore-31314. seating de c 3 18 is insertable ià to lac rizo tal bare 331. As shown horizontal bore 3316 is threaded to accept a set screw or th ; like.
[1,11371 In use, a surgeon wool distract superior and interior spinous processes and implant spinal implant 3300. Seats 3302 and 3 304 vould be set at a desired distraction andk for e a nple, set screw 3)3l 8 would be tliresadz d into horizontal bore 3316 to app l-,.- <;z atÃi g force to seat verLiceal distraction post 33110 in vertiical bore 3314 locking seats 3302 -U-1d3304 at the set distraction distance.
[xi1381 Vertical distraction post 3310 aridIorvertical. 'bore 3.314 may, be arranged with a protrusion 3.:19 or de tent toinhibit the ability of Otaiuia 'ing vertical distraction post 33) 1 from vertical bore 3314.
[11.1 3t ] FIG. 70 illustrates alternative seats 3400 and 3402. Seats 3 00 and 3402 are designed to nest or iiitcrlà 5. K. that regaid. seat 400 has one or more first blades 3404 or r ultÃple surfaces spaced apart so first gaps 406 separate first blades 3404. Seat 3402 wow' similarly have one or Tore second blades 3408 or multiple surfaces. Seat 3402 is shown t itlh a single second glade for convenience. Second plate 3408 is aligned with first gaps 3406 such that seats 400 and 3402 may nest or interlock. Sii i lail~r, s à #
blades 2 4is cr :il l al.-,'.n with second gaps, not shocwn. Either first blades 3404 (as shown) or second blade 3408 may attach to a vertical distraction post 4 10 and second blade 3408 (as shown) or first blades 3404 ma attach to attache. ent tab 3412 N;1401 Although examples of a spin all implant w id its use have been described and .1, ustzated in detail, it is to be understood that the same is : nt, nd d by way of illustration and only and is not to be taken by way of limitation. The invention. has been illustrated in the forme, of a- spinalimplant for use in spacing adjacent spinous processes of the human spine.
However. the spinal implant may be configured for spacing other portions of the spine or other bones. Accor ngiy, variations in and modifications to the sp na3 implant and its usc will be apparent to those of ordinary skill in the art, '[',he various illustrative embed invents c rs retention illustrate altrrnati rt' t onfif urati on s of various component pans such s spa c members, additional fasteners, and the like. In most cases, and as will be readily understood by one skilled in the art, the alternative configuration of a component part iii one mbodiinenl may be substituted for a similar component part in another embodir ent., For example, the differently shaped or ex andable ;:pacers in one example may be substituted for a spacer in another example. Likewise the various mechanisms for dept , g a reteÃ:!o j miler or for providing additional fasteners may be interchanged. Furthermore, throughout Ã
e exemplary embodiments, here Compon .nt part mating relationships are illustrated, the gender of the co mpfone nt parts ma.), be reversed as is known in the tart within the scope of the invention.
The lollo wing claims are intended to cover all such modifications and equiv a eats.
Claims (72)
1. A spinal implant for placement between adjacent processes of the human spine comprising:
a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer having an outer surface spaced from the spacer axis; and at least one deployable retention member moveable from a first position in which the retention member is positioned generally at or inwardly of the outer surface to a second position in which the retention member projects outwardly beyond the outer surface.
a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer having an outer surface spaced from the spacer axis; and at least one deployable retention member moveable from a first position in which the retention member is positioned generally at or inwardly of the outer surface to a second position in which the retention member projects outwardly beyond the outer surface.
2. The spinal implant of claim 1 wherein the retention member comprises a loop.
3. The spinal implant of claim 1 wherein the retention member is contained within the spacer in the first position.
4. The spinal implant of claim 1 wherein the spacer includes an interior cavity receiving the retention member and an actuator mounted to the spacer, the actuator being responsive to rotation to translate relative to the spacer and move the retention member from the first position to the second position.
5. The spinal implant of claim 1 wherein the retention member is biased into a curved shape and wherein the retention member is elastically straightened in the first position and recovers to its curved shape in the second position.
6. The spinal implant of claim 1 wherein the spacer includes a passageway at least partway through the spacer and at least a portion of the retention member moves within the passageway from the first position to the second position.
7. The spinal implant of claim 6 further comprising a fixed extension projecting outwardly beyond the outer surface adjacent the first end, an interior cavity that houses the retention member, and an actuator screw threadably engaged with the spacer, the actuator screw being responsive to rotation to translate relative to the spacer and move the retention member from the first position to the second position, the retention member projecting outwardly beyond the outer surface adjacent the second end.
8. The spinal implant of claim 1 wherein the spacer includes a curved passageway and at least a portion of the retention member moves through the passageway from the first position to the second position causing the portion to curve as it moves to the second position.
9. The spinal implant of claim 1 further comprising at least one end piece spaced further from the spacer in the first position and spaced nearer to the spacer in the second position, the end piece including a passageway receiving at least a portion of the retention member for translation therethrough.
10. The spinal implant of claim 9 further comprising a threaded shaft connecting the spacer to the end piece, the shaft being responsive to rotation to move the spacer and shaft nearer to one another and thereby force the retention member to project out of the end piece and away from the spacer axis.
11. The spinal implant of claim 1 wherein the spacer comprises a passageway extending through it, the spinal implant further comprising a core receivable in the passageway, the retention member being mounted to the core.
12. The spinal implant of claim 11 wherein the retention member is mounted to the core in generally outwardly oriented relationship transverse to the spacer axis, the retention member being elastically moveable to a position generally parallel to the spacer axis for insertion with the core through the passageway.
13. The spinal implant of claim 12 further comprising a tube removably received around the core and retention member temporarily maintaining the retention member generally parallel to the spacer axis.
14. The spinal implant of claim 11 wherein the retention member comprises a plurality of strands moveable from an orientation along the sides of the spacer to a pattern of loops extending outwardly transverse to the spacer axis.
15. The spinal implant of claim 14 wherein the strands comprise first and second strand ends and the first strand ends are mounted for translation nearer to the second strand ends, the strands being responsive to translation of the first strand ends nearer to the second strand ends to project outwardly transverse to the spacer axis and form a pattern of loops.
16. The spinal implant of claim 11 wherein the spacer is deformable from a first dimension transverse to the spacer axis to a second, smaller, dimension transverse to the spacer axis to facilitate insertion between adjacent processes prior to inserting the core.
17. The spinal implant of claim 16 wherein the spacer is responsive to stretching transverse to the spacer axis to deform from the first dimension to the second dimension.
18. The spinal implant of claim 1 wherein the spacer comprises a passageway extending through it generally parallel to the spacer axis and the retention member comprises a strip of material having a nominally curved shape, the retention member being withdrawn into the passageway at at least a first end of the passageway in the first position and the retention member extending from the first end of the passageway in the second position.
19. The spinal implant of claim 1 wherein the spacer comprises a passageway extending through it and the retention member comprises a strip of material having a nominally curved shape, the retention member being movable from the first position to the second position by inserting the retention member through the passageway, the retention member being responsive to exiting the passageway to return to its nominally curved shape.
20. A spinal implant for placement between adjacent processes of the human spine comprising:
a spacer having a first end, a second end, a spacer axis extending therebetween, a passageway through the spacer having a first passageway end and a second passageway end, and an outer surface spaced from the spacer axis; and at least one deployable retention member comprising an elongated member preformed into a nominal shape able to extend outwardly from the passageway transverse to the spacer axis beyond the outer surface, the retention member being receivable through the passageway from the first passageway end to the second passageway end, the retention member being responsive to exiting the second passageway end to recover its nominal shape and extend outwardly beyond the outer surface.
a spacer having a first end, a second end, a spacer axis extending therebetween, a passageway through the spacer having a first passageway end and a second passageway end, and an outer surface spaced from the spacer axis; and at least one deployable retention member comprising an elongated member preformed into a nominal shape able to extend outwardly from the passageway transverse to the spacer axis beyond the outer surface, the retention member being receivable through the passageway from the first passageway end to the second passageway end, the retention member being responsive to exiting the second passageway end to recover its nominal shape and extend outwardly beyond the outer surface.
21. A spinal implant for placement between adjacent processes of the human spine comprising:
a spacer having a first end, a second end, a spacer axis extending therebetween, and an outer surface spaced from the spacer axis; and at least one deployable retention member mounted adjacent the first end and being expandable from a first position in which the retention member is positioned generally at or inwardly of the outer surface to a second position in which the retention member projects radially outwardly beyond the outer surface.
a spacer having a first end, a second end, a spacer axis extending therebetween, and an outer surface spaced from the spacer axis; and at least one deployable retention member mounted adjacent the first end and being expandable from a first position in which the retention member is positioned generally at or inwardly of the outer surface to a second position in which the retention member projects radially outwardly beyond the outer surface.
22. The spinal implant of claim 21 wherein the retention member comprises a coil having a dimension transverse to the spacer axis, the coil being relatively tightly wound in the first position and the coil being relatively loosely wound in the second position, the dimension of the coil transverse to the spacer axis being greater in the second position than in the first position.
23. The spinal implant of claim 21 wherein the retention member comprises an arm mounted for rotation from the first position in which the arm is closer to the spacer axis to the second position in which the arm is further from the spacer axis.
24. The spinal implant of claim 23 wherein the spacer comprises a generally cylindrical body and the retention member comprises an elongated member mounted to the body for rotation about a rotation axis generally parallel to the spacer axis, the retention member having a transverse portion extending transverse to the rotation axis, the retention member being rotatable from a first position in which the transverse portion is nearer the spacer axis and a second position in which the transverse portion is further from the spacer axis.
25. The spinal implant of claim 21 wherein the retention member comprises a first end piece mounted for rotation about a first rotation axis offset from the spacer axis, the first end piece being rotatable about the first rotation axis from a first position nearer the spacer axis to a second position further from the spacer axis.
26. The spinal implant of claim 25 further comprising a second end piece mounted for rotation about a second rotation axis offset from both the spacer axis and the first rotation axis, the second end piece being rotatable about the second rotation axis from a first position nearer the spacer axis to a second position further from the spacer axis.
27. The spinal implant of claim 26 further comprising third and fourth end pieces, the third end piece being mounted for rotation with the first end piece and the fourth end piece being mounted for rotation with the second end piece, the first and second end pieces being mounted adjacent the first end of the spacer and the second and fourth end pieces being mounted adjacent the second end of the spacer.
28. The spinal implant of claim 25 further comprising a shaft and a second end piece, the first and second end pieces being mounted on the shaft for rotation together with the shaft about the rotation axis, at least the first end piece being mounted for slipping relative to the shaft above a predetermined torque level such that the second end piece can continue to rotate with the shaft while the second end piece remains stationary if the first end piece becomes stuck.
29. The spinal implant of claim 21 wherein the retention member comprises a first end piece mounted for rotation about a first rotation axis transverse to the spacer axis.
30. The spinal implant of claim 29 wherein the end piece is elongated and extends generally parallel to the spacer axis in the first position and extends generally transverse to the spacer axis in the second position.
31. The spinal implant of claim 30 wherein the end piece tapers from a first dimension adjacent the spacer to a second, smaller, dimension spaced from the spacer.
32. The spinal implant of claim 30 further comprising a fixed extension adjacent the second end, the fixed extension extending away from the spacer axis beyond the outer surface, and an actuator operably connected to the first end piece and being operable from the second end, the actuator being responsive to actuation to rotate the first end piece about the first rotation axis.
33. The spinal implant of claim 29 further comprising a second end piece mounted for rotation about a second rotation axis transverse to the spacer axis and the first rotation axis.
34. The spinal implant of claim 33 further comprising a shaft mounted to the spacer for relative rotation, the shaft being operably connected to the first and second end pieces, the shaft being responsive to rotation to simultaneously rotate the first end piece about the first rotation axis and the second end piece about the second rotation axis.
35. The spinal implant of claim 33 further comprising a third end piece mounted for rotation about a third rotation axis transverse to the spacer axis and a fourth end piece mounted for rotation about a fourth rotation axis transverse to the spacer axis, the first and second end pieces being mounted adjacent the first end of the spacer and the third and fourth end pieces being mounted adjacent the second end of the spacer, the first and second end pieces being rotatable to project radially outwardly from the spacer axis in different directions relative to one another and the third and fourth end pieces being rotatable to project radially outwardly from the spacer axis in different directions relative to one another.
36. The spinal implant of claim 21 wherein the spacer comprises a tubular member elastically compressible toward the spacer axis and the retention member comprises an integral arm extending away from the spacer transverse to the spacer axis in the second position, the arm being elastically straightenable to assume the first position.
37. A spinal implant for placement between adjacent processes of the human spine comprising a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer comprising a hollow tubular structure having a tube wall with inner and outer surfaces spaced from the spacer axis and being open at the first and second ends, the tube wall having a plurality of holes penetrating the tube wall in a radial array near each of the first and second ends.
38. A spinal implant for placement between adjacent processes of the human spine comprising a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer comprising a monolithic structure having an outer surface spaced from the spacer axis, the spacer having at least one fastener receiving passageway communicating from the first end to the outer surface transverse to the spacer axis to receive a fastener to attach the spacer to a process.
39. A spinal implant for placement between adjacent processes of the human spine comprising a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer comprising a flange extending outwardly transverse to the spacer axis adjacent the first end to extend alongside a process, the flange including a fastener receiving hole extending through the flange to receive a fastener to attach the flange to the process.
40. A spinal implant for placement between adjacent processes of the human spine, the spinal implant comprising:
a base having an elongated portion having a base axis and a transverse portion extending generally transversely away from the base axis; and a spacer engageable with the elongated portion in axial translating relationship along the base axis.
a base having an elongated portion having a base axis and a transverse portion extending generally transversely away from the base axis; and a spacer engageable with the elongated portion in axial translating relationship along the base axis.
41. The spinal implant of claim 40 wherein the spacer tapers from a first smaller diameter nearer the transverse portion to a second larger diameter further from the transverse portion, the spacer being moveable from a first position further from the transverse portion to a second position nearer the transverse portion.
42. A spinal implant for placement between adjacent processes of the human spine comprising;
a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer having an outer surface spaced from the spacer axis; and means for translating the first end nearer to the second end and causing the outer surface to move further away from the spacer axis.
a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer having an outer surface spaced from the spacer axis; and means for translating the first end nearer to the second end and causing the outer surface to move further away from the spacer axis.
43. The spinal implant of claim 42 further comprising at least one deployable retention member moveable from a first position in which the retention member is positioned generally at or inwardly of the outer surface to a second position in which the retention member projects outwardly beyond the outer surface.
44. The spinal implant of claim 42 wherein the spacer comprises a split body and the outer surface comprises a superior surface and an inferior surface, the spinal implant further comprising a wedge member moveable between the superior surface and the inferior surface to move the superior and inferior surfaces further away from the spacer axis.
45. The spinal implant of claim 42 wherein the spacer comprises a resilient material and a passageway extends through the spacer, the spinal implant further comprising a base positioned at the first end of the spacer and a plate extending transverse to the spacer axis beyond the outer surface at the second end, a shaft connecting the base and plate through the passageway in relative translating relationship, the plate and base being movable between a first position in which they are relatively further from one another and a second position in which they are relatively nearer one another, the plate and base compressing the spacer axially and expanding the spacer transverse to the spacer axis when the plate and base are moved to the second position.
46. A spinal implant for placement between adjacent processes of the human spine comprising:
a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer comprising a hollow tubular structure having a tube wall with inner and outer surfaces spaced from the spacer axis, the inner surface defining an axial passageway; and means for expanding the tube wall to move the outer surface further from the spacer axis.
a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer comprising a hollow tubular structure having a tube wall with inner and outer surfaces spaced from the spacer axis, the inner surface defining an axial passageway; and means for expanding the tube wall to move the outer surface further from the spacer axis.
47. The spinal implant of claim 46 wherein the tube wall is discontinuous and defines first and second edges, the spinal implant further comprising at least one tapered insert axial translatable within the axial passageway from a first position in which the outer surface is spaced a first distance from the spacer axis and a second position in which the outer surface is spaced a second, greater, distance from the spacer axis.
48. The spinal implant of claim 46 wherein the tube wall comprises a coiled sheet, the tube wall being moveable between a first position in which the sheet is relatively tightly coiled and a second position in which the sheet is relatively loosely coiled.
49. The spinal implant of claim 48 wherein the coiled sheet comprises first and second coiled sheet ends, each end defining a hook, the hooks engaging when the sheet is uncoiled to limit the expansion of the coiled sheet.
50. The spinal implant of claim 48 wherein the coiled sheet comprises at least one opening through the tube wall and the coiled sheet comprises at least one tab extending away from the coiled sheet transverse to the spacer axis and being engageable with the opening to limit the expansion of the coiled sheet.
51. The spinal implant of wherein the coiled sheet comprises, a plurality of openings through the tube wall, the tab being selectively engageable with each of the plurality of openings to limit the expansion of the coiled sheet to different sizes depending on which of the plurality of openings is engaged.
52. A spinal implant for placement between adjacent processes of the human spine comprising:
a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer comprising a wedge shaped body tapering, from a first dimension transverse to the spacer axis nearer the first end to a second, smaller, dimension transverse to the spacer axis further from the first end;
a first extension projecting outwardly beyond the outer surface adjacent the first end, and a second extension engageable with the spacer in axial translating relationship relative to the first extension, the first and second extensions defining a midpoint between them, the first and second extensions being moveable from a first position in which the extensions are spaced a first axial distance apart and in which the extensions define a first midpoint between them, mid a second position in which the extensions are spaced a second, smaller, axial distance apart and in which the extensions define a second midpoint between them, the dimension of the spacer body perpendicular to the spacer axis at the first being smaller than the dimension of the spacer body perpendicular to the spacer axis at the second midpoint.
a spacer having a first end, a second end, and a spacer axis extending therebetween, the spacer comprising a wedge shaped body tapering, from a first dimension transverse to the spacer axis nearer the first end to a second, smaller, dimension transverse to the spacer axis further from the first end;
a first extension projecting outwardly beyond the outer surface adjacent the first end, and a second extension engageable with the spacer in axial translating relationship relative to the first extension, the first and second extensions defining a midpoint between them, the first and second extensions being moveable from a first position in which the extensions are spaced a first axial distance apart and in which the extensions define a first midpoint between them, mid a second position in which the extensions are spaced a second, smaller, axial distance apart and in which the extensions define a second midpoint between them, the dimension of the spacer body perpendicular to the spacer axis at the first being smaller than the dimension of the spacer body perpendicular to the spacer axis at the second midpoint.
53. The spinal implant of claim 52 wherein the second extension comprises a plate-like body with a through opening able to receive the spacer body.
54. The spinal implant of claim 53 further comprising a locking for locking the relative axial position of the first and second extensions.
55. The spina implant of claim 54 wherein the comprises a ratchet mechanism.
56. The spinal implant of claim 54 wherein the locking mechanism comprises a screw.
57. The spinal implant of claim 52 wherein the first extension is to the spacer body and the second extension further comprises first and second tabs, the spacer body being receivable between the first and second tabs.
58. A spinal implant for placement between en adjacent processes of the human spine comprising:
a first part having a first end, a second end, and at least one first lateral wall coupled to the first end, the at least one first lateral adapted to extend along a side of one of the the second end, adapted to reside in an inter process space between the processes;
a second part having a third end, a fourth end, and at least one second lateral wall coupled to the third end and adapted to extend along a side of one of the processes;
the fourth end adapted to reside in the inter process space proximate the second end;
at least one guidewire channel extending through the, first part and the second part:
and it least one guidewire extending through the at least one guidewire channel to couple the first part and the second part together in an aligned, relationship wherein the spacer at least one of distracts or maintains the distraction between the
a first part having a first end, a second end, and at least one first lateral wall coupled to the first end, the at least one first lateral adapted to extend along a side of one of the the second end, adapted to reside in an inter process space between the processes;
a second part having a third end, a fourth end, and at least one second lateral wall coupled to the third end and adapted to extend along a side of one of the processes;
the fourth end adapted to reside in the inter process space proximate the second end;
at least one guidewire channel extending through the, first part and the second part:
and it least one guidewire extending through the at least one guidewire channel to couple the first part and the second part together in an aligned, relationship wherein the spacer at least one of distracts or maintains the distraction between the
59. The spinal implant of claim 58, wherein the second end comprises at least one mating channel and the fourth end comprises at least one mating protrusion such that the at least one mating: channel and the at least one mating protrusion engage,
60. The spinal implant of claim 58, Wherein the at least one, guidewire channel comprises a plurality of guidewire channels and the guidewire has a first end proximate the at least one second lateral wall, a second end proximate at least one second lateral wall, and a main body in the plurality of guidewire channels such that the guidewire loops around the at least one first lateral wall.
61. The spinal implant of claim 58, further comprising a bore extending through the second end and the fourth end and a connector residing in the bore.
62. The spinal implant of claim 61 wherein, the connector is a set screw threadably connected to the bore.
6.3. The spinal implant of claim 58, wherein the at least one guidewire has a first end terminated adjacent to the at least one first lateral wall and a second end terminated adjacent to the at least one second lateral wall.
64, The spinal implant of claim, 63> wherein. the guide wire, ends are each terminated with )up of terminating devices consisting of a crimp, a tie, set w device selected from the arc, screw, and a cable lock.
65. The spina1 implant of claim 58, further comprising at least one first bore in the at least one first lateral wall and at least one second bore in the at least one second lateral wall, and at least one flexible biocompatible material extending from the at least one first bore to the at least one second bore about at least one of the processes.
66. A method distracting a vertebral segment comprising a superior vertebral body having a superior process and an inferior vertebral body having an inferior process, the method, comprising the steps of;
providing an access to an inter process space;
inserting a first part of an inter process spacer through the access;
inserting a second part of the inter process spacer through the, access using a guidewire extending from the first part through the access to the second part;
compressing the first part and the second part together; and locking the first part and the second part compressed together.
providing an access to an inter process space;
inserting a first part of an inter process spacer through the access;
inserting a second part of the inter process spacer through the, access using a guidewire extending from the first part through the access to the second part;
compressing the first part and the second part together; and locking the first part and the second part compressed together.
67. The method of claim 66, further comprising the step of distracting the superior vertebral body and the inferior vertebral body.
68. The method of claim 67, wherein the step of distracting and the step inserting a first part occur substantially simultaneously.
69. A spinal implant for placement between adjacent processes of the human spine comprising;
a first seat having a, process contacting surface;
a distraction post connected to the first seat;
a second seat having a process contacting surface, the second seat including an attachment tab having a through opening receiving the distraction post in axial translating relationship, the first and second seats being moveable from a first position in which the process contacting surfaces are relatively closer together to a second position in, which the process contacting surfaces are relatively further apart; and a locking mechanism for locking the first and second seat relative to one another.
a first seat having a, process contacting surface;
a distraction post connected to the first seat;
a second seat having a process contacting surface, the second seat including an attachment tab having a through opening receiving the distraction post in axial translating relationship, the first and second seats being moveable from a first position in which the process contacting surfaces are relatively closer together to a second position in, which the process contacting surfaces are relatively further apart; and a locking mechanism for locking the first and second seat relative to one another.
70. The spinal implant of claim 69 wherein the process contacting surface of the first, seat is coplanar with the process contacting surface of the second seat in the first position.
71. The spinal implant of claim 70 wherein one of the first and second seats includes a plurality of process contacting surfaces spaced apart with a gap between them, the process contacting surface of the other of the first and second seats being receivable in the gap so that at least one process contacting surface of the first seat is coplanar with at least one process contacting surface of the second seat.
72. The spinal implant of claim 69 wherein at least one of the first and second seats further comprises walls extending away from the process contacting surface to surround a portion of a process.
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US11/934,604 US8241330B2 (en) | 2007-01-11 | 2007-11-02 | Spinous process implants and associated methods |
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US12/020,282 | 2008-01-25 | ||
US12/020,282 US9055981B2 (en) | 2004-10-25 | 2008-01-25 | Spinal implants and methods |
PCT/US2008/070353 WO2009058439A1 (en) | 2007-11-02 | 2008-07-17 | Spinal implants and methods |
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CA2704192A Abandoned CA2704192A1 (en) | 2007-11-02 | 2008-07-17 | Spinal implants and methods |
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US20080039859A1 (en) | 1997-01-02 | 2008-02-14 | Zucherman James F | Spine distraction implant and method |
US7959652B2 (en) | 2005-04-18 | 2011-06-14 | Kyphon Sarl | Interspinous process implant having deployable wings and method of implantation |
US6068630A (en) | 1997-01-02 | 2000-05-30 | St. Francis Medical Technologies, Inc. | Spine distraction implant |
FR2897259B1 (en) | 2006-02-15 | 2008-05-09 | Ldr Medical Soc Par Actions Si | INTERSOMATIC TRANSFORAMINAL CAGE WITH INTERBREBAL FUSION GRAFT AND CAGE IMPLANTATION INSTRUMENT |
US8147548B2 (en) | 2005-03-21 | 2012-04-03 | Kyphon Sarl | Interspinous process implant having a thread-shaped wing and method of implantation |
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-
2008
- 2008-01-25 US US12/020,282 patent/US9055981B2/en not_active Expired - Fee Related
- 2008-07-17 JP JP2010532090A patent/JP2011502573A/en active Pending
- 2008-07-17 AU AU2008319176A patent/AU2008319176A1/en not_active Abandoned
- 2008-07-17 BR BRPI0818725A patent/BRPI0818725A2/en not_active IP Right Cessation
- 2008-07-17 CN CN200880123856.0A patent/CN101909550B/en not_active Expired - Fee Related
- 2008-07-17 EP EP08845923A patent/EP2214597A4/en not_active Withdrawn
- 2008-07-17 WO PCT/US2008/070353 patent/WO2009058439A1/en active Application Filing
- 2008-07-17 CA CA2704192A patent/CA2704192A1/en not_active Abandoned
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2015
- 2015-06-15 US US14/739,170 patent/US9770271B2/en not_active Expired - Fee Related
-
2017
- 2017-08-30 US US15/690,926 patent/US20170360485A1/en not_active Abandoned
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JP2011502573A (en) | 2011-01-27 |
US20170360485A1 (en) | 2017-12-21 |
US20080177306A1 (en) | 2008-07-24 |
EP2214597A4 (en) | 2012-04-11 |
US9770271B2 (en) | 2017-09-26 |
AU2008319176A1 (en) | 2009-05-07 |
AU2008319176A2 (en) | 2010-07-01 |
US20150351813A1 (en) | 2015-12-10 |
CN101909550A (en) | 2010-12-08 |
WO2009058439A1 (en) | 2009-05-07 |
BRPI0818725A2 (en) | 2018-05-29 |
US9055981B2 (en) | 2015-06-16 |
CN101909550B (en) | 2014-09-24 |
EP2214597A1 (en) | 2010-08-11 |
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