US20140343610A1 - Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms - Google Patents
Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms Download PDFInfo
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- US20140343610A1 US20140343610A1 US14/450,421 US201414450421A US2014343610A1 US 20140343610 A1 US20140343610 A1 US 20140343610A1 US 201414450421 A US201414450421 A US 201414450421A US 2014343610 A1 US2014343610 A1 US 2014343610A1
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- core
- bone anchor
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- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
- A61B17/7008—Longitudinal elements, e.g. rods with a cross-section which varies along its length with parts of, or attached to, the longitudinal elements, bearing against an outside of the screw or hook heads, e.g. nuts on threaded rods
-
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
- A61B17/7022—Tethers, i.e. longitudinal elements capable of transmitting tension only, e.g. straps, sutures or cables
-
- A—HUMAN NECESSITIES
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- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/701—Longitudinal elements with a non-circular, e.g. rectangular, cross-section
-
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
- A61B17/702—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other having a core or insert, and a sleeve, whereby a screw or hook can move along the core or in the sleeve
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
- A61B17/7026—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form
- A61B17/7029—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form the entire longitudinal element being flexible
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- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
- A61B17/7031—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other made wholly or partly of flexible material
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- A—HUMAN NECESSITIES
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- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
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- A—HUMAN NECESSITIES
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- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B2017/00831—Material properties
- A61B2017/00862—Material properties elastic or resilient
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00933—Material properties bone or bone-like
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00955—Material properties thermoplastic
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T29/00—Metal working
- Y10T29/49—Method of mechanical manufacture
- Y10T29/49826—Assembling or joining
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Abstract
A dynamic stabilization assembly includes a core, typically in the form of a tensioned cord, at least one pair of bone anchors, a spacer surrounding the core located between the bone anchors, at least one elastic bumper and at least one fixing or blocking member. The core is slidable with respect to at least one of the bone anchors, the spacer and the bumper. The bumper is compressed. Bone screws of the assembly include closure structures that lock against the bone screw independent of any fixing or sliding of the core with respect to the bone screw.
Description
- This application is a division of U.S. patent application Ser. No. 12/661,042, filed Mar. 10, 2010, which claims the benefit of U.S. Provisional Application Ser. No. 61/210,058 filed Mar. 13, 2009 and are both incorporated by reference herein. This application is also a Continuation-in-part of U.S. patent application Ser. No. 12/584,980 filed Sep. 15, 2009 that claims the benefit of U.S. Provisional Application Ser. No. 61/192,312 filed Sep. 17, 2008, both of which are incorporated by reference herein. This application is also a Continuation-in-part of U.S. patent application Ser. No. 12/148,465 filed Apr. 18, 2008 that claims the benefit of U.S. Provisional Application Ser. No. 60/927,111 filed May 1, 2007, both of which are incorporated by reference herein. This application is also a Continuation-in-part of U.S. patent application Ser. No. 12/229,207 filed Aug. 20, 2008, now U.S. Pat. No. 8,353,932, issued Jan. 15, 2013 that claims the benefit of U.S. Provisional Application Ser. No. 60/994,083 filed Sep. 17, 2007 and that is a continuation-in-part of U.S. patent application Ser. No. 11/894,001 filed Aug. 17, 2007, now U.S. Pat. No. 8,292,926, issued Oct. 23, 2012 that claims the benefit of U.S. Provisional Application Ser. No. 60/851,353 filed Oct. 12, 2006, all of which are incorporated by reference herein. This application is also a Continuation-in-part of U.S. patent application Ser. No. 11/328,481 filed Jan. 9, 2006, now U.S. Pat. No. 7,862,587, issued Jan. 4, 2011, incorporated by reference herein.
- The present invention relates to apparatuses and methods for use in performing spinal surgery and, in particular, to bone attachment structures for dynamic spinal support and alignment, preferably using minimally or less invasive techniques.
- Historically, it has been common to fuse adjacent vertebrae that are placed in fixed relation by the installation therealong of bone screws or other bone anchors and cooperating longitudinal connecting members or other elongate members. Fusion results in the permanent immobilization of one or more of the intervertebral joints. Because the anchoring of bone screws, hooks and other types of anchors directly to a vertebra can result in significant forces being placed on the vertebra, and such forces may ultimately result in the loosening of the bone screw or other anchor from the vertebra, fusion allows for the growth and development of a bone counterpart to the longitudinal connecting member that can maintain the spine in the desired position even if the implants ultimately fail or are removed. Because fusion has been a desired component of spinal stabilization procedures, longitudinal connecting members have been designed that are of a material, size and shape to largely resist flexion, extension, torsion, distraction and compression, and thus substantially immobilize the portion of the spine that is to be fused. Thus, longitudinal connecting members are typically uniform along an entire length thereof, and usually made from a single or integral piece of material having a uniform diameter or width of a size to provide substantially rigid support in all planes.
- An alternative to fusion, which immobilizes at least a portion of the spine, and the use of more rigid longitudinal connecting members or other rigid structure has been a “soft” or “dynamic” stabilization approach in which a flexible loop-, S-, C- or U-shaped member or a coil-like and/or a spring-like member is utilized as an elastic longitudinal connecting member fixed between a pair of pedicle screws in an attempt to create, as much as possible, a normal loading pattern between the vertebrae in flexion, extension, distraction, compression, side bending and torsion. Another type of soft or dynamic system known in the art includes bone anchors connected by cords or strands. Such a cord or strand may be threaded through cannulated spacers that are disposed between adjacent bone anchors when such a cord or strand is implanted, tensioned and attached to the bone anchors. The spacers typically span the distance between bone anchors, providing limits on the bending movement of the cord or strand and thus strengthening and supporting the overall system. The cords or strands utilized in such systems typically are stretched or pulled to maximum tension, followed by fixing the cords to adjoining bone screws. A variety of specialized tools for holding and stretching the cords are required for such an operation. Although easily bendable, the cords or strands utilized in such systems do not allow for elastic distraction of the system once implanted because the cord or strand must be stretched or pulled to maximum tension in order to provide a stable, supportive system.
- A dynamic stabilization assembly according to the invention for attachment to at least two bone anchors includes an elongate inner core, preferably a tensioned cord, with at least one spacer, typically in the form of an elastic spacer, surrounding the core, the core and spacer disposed between the at least two bone anchors. An elastic bumper and a fixing structure or blocker are disposed on an opposite side of one of the bone anchors, the bumper in compression by cooperation between one of the bone anchors and the blocker.
- In a method of one aspect of the invention, a cord and surrounding spacer are inserted between first and second implanted bone anchors with the spacer being in contact with both of the bone anchors. The cord is fixed to the first bone anchor. A bumper and a fixing structure or blocker are threaded along the cord until the bumper abuts the second bone anchor and the blocker abuts the bumper. The cord is tensioned and the blocker is crimped or otherwise fixed to the cord, such as by a set screw, resulting in a tensioned cord with both the bumper and the spacer being in compression. The cord remains in sliding engagement with the second bone anchor, advantageously allowing for some elastic distraction of the system with elongation between the screw heads once implanted, as well as compression and bending in response to spinal flexion and extension. In other embodiments according the invention, the core cord member may be replaced by relatively hard stiff rods or bars or relatively soft, deformable or non elastic rods or bars, or other longitudinal connecting members of different shapes and materials, including PEEK and other polymers and metal cables. Assemblies of the invention may include mono- and polyaxial open and closed screws that may be used with a first locking fastener or closure top that fixes against the core member (cord, cable, rod or bar), or alternatively with a second locking limited travel closure top that is fixed to the bone screw and captures the core (cord, cable, rod or bar) in the screw, but allows such core member to be in sliding engagement with the bone screw. In the case of a polyaxial screw, the polyaxial mechanism is configured to be locked by this second closure top while allowing the core to travel through the screw head.
- Objects and advantages of the invention include providing lightweight, reduced volume, low profile stabilization assemblies, including at least two bone anchors and a longitudinal connecting member therebetween that comprises a core and spacer and an end bumper-blocker combination. Furthermore, it is an object of the invention to provide apparatus and methods that are easy to use and especially adapted for the intended use thereof and wherein the apparatus are comparatively inexpensive to make and suitable for use.
- Other objects and advantages of this invention will become apparent from the following description taken in conjunction with the accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention.
- The drawings constitute a part of this specification and include exemplary embodiments of the present invention and illustrate various objects and features thereof.
-
FIG. 1 is an enlarged and partial perspective view of a dynamic stabilization connector of the invention having an inner cord, an outer spacer, an elastic bumper and a fixing structure or blocker, shown as a crimping structure, the connector shown with a pair of open monoaxial bone screws, one with a cord travel or sliding closure top and one with a cord compressing and locking closure top. -
FIG. 2 is a partial and reduced and exploded front elevational view of the connector and bone screws ofFIG. 1 , shown without the closure tops. -
FIG. 3 is a partial front elevational view, similar toFIG. 2 showing a stage of assembly of the connector and bone screws ofFIG. 1 , showing use of a driving tool for fixing one of the first closure tops against the cord. -
FIG. 4 is a partial top plan view with portions broken away to show the detail thereof, showing use of a crimping tool in a further stage of assembly of the connector and bone screws ofFIG. 1 . -
FIG. 5 is an enlarged and partial cross-sectional view taken along the line 5-5 ofFIG. 1 . -
FIG. 6 is an exploded perspective view of an alternative bone screw for use with the invention ofFIG. 1 , shown with a cord and a cord sliding limited travel closure top. -
FIG. 7 is a partial perspective view of an alternative bar for use with the bone screw and closure top ofFIG. 6 . -
FIG. 8 is an enlarged and partial cross-sectional view of the bone screw ofFIG. 6 taken along the line 8-8 ofFIG. 6 and showing a portion of the cord in phantom. -
FIG. 9 is an enlarged and partial cross-sectional view taken along the line 9-9 ofFIG. 8 and also showing the mated closure top in cross section and a portion of the cord in phantom. -
FIG. 10 is an exploded perspective view of the bone screw ofFIG. 6 shown with a second locking closure top and a deformable rod. -
FIG. 11 is a partial cross-sectional view taken along the line 11-11 ofFIG. 10 and showing the second locking closure top in an early stage of assembly. -
FIG. 12 is a partial cross-sectional view, similar toFIG. 11 , showing the second closure top fully assembled within the bone screw and engaged with and compressing a deformable rod. -
FIG. 13 is an enlarged and partial cross-sectional view of the bone screw ofFIG. 10 taken along the line 11-11, with a portion of the deformable rod being shown in phantom. -
FIG. 14 is an enlarged and partial cross-sectional view, taken along the line 14-14 ofFIG. 13 , also showing the mated closure top and a portion of the deformable rod in cross-section. -
FIG. 15 is a perspective view of another alternative embodiment of a dynamic stabilization connector of the invention having an inner rod, an elastic bumper and a blocking structure, the connector shown with a pair of open polyaxial bone screws. -
FIG. 16 is an enlarged and partial side elevational view of one of the bone screws of the embodiment ofFIG. 15 with portions broken away to show the detail thereof. - As required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present invention in virtually any appropriately detailed structure. It is also noted that any reference to the words top, bottom, up and down, and the like, in this application refers to the alignment shown in the various drawings, as well as the normal connotations applied to such devices, and is not intended to restrict positioning of the connecting member assemblies of the application and cooperating bone anchors in actual use.
- With reference to
FIGS. 1-5 , the reference numeral 1 generally designates a non-fusion longitudinal dynamic stabilization connector assembly of the invention. The illustrated assembly 1 includes the following components: an elongate bendable and flexible core in the form of acord 4; at least one cannulatedspacer 6; anelastic bumper 8; and a fixing structure or blocking member, such as a crimpingstructure 10. The assembly 1 is shown with a pair of open monoaxial bone screws, generally 12, the assembly 1 extending substantially linearly along a central axis A inFIG. 3 , for example. For purposes of this application, the identical bone screws 12 are identified as 12A and 12B as the onebone screw 12A cooperates with a first locking and cord pressing closure top 14 and theother bone screw 12B cooperates with a second locking limited travel closure top 15 that allows for slip or slide of thecord 4 within thebone screw 12B. The closure tops 14 and 15 are substantially similar to one another with the exception that the top 15 is sized and shaped to bottom out on alower seating surface 17 of a run-out of an inner guide andadvancement structure 18 of thebone screw 12 that mates with the outer guide and advancement structure of the closure top 14 or theclosure top 15. The closure top 14 further includes an end orbottom portion 19 that extends beyond the run-outseating surface 17 and abuts against and fixes the cord to the bone screw. The guide and advancement run-outseating surface 17 is best shown and described with respect to analternative bone screw FIGS. 6-14 . Also, as will be described in more detail below, thebone screw 12A cooperates with the closure top 14 to fix a portion of thecord 4 to thebone screw 12A while thebone screw 12B engages and fixes the closure top 15 to thescrew 12B to capture a portion of thecord 4 within thebone screw 12B, but allow for sliding movement of thecord 4 with respect to thebone screw 12B. The elongateinner cord core 4 is slidingly received within thespacer 6 and thebumper 8, and initially within the blocker or crimpingstructure 10, as will be described in greater detail below. Thecord 4 is eventually tensioned and fixed in such tensioned state by the crimpingstructure 10 and thebone screw 12A. In other embodiments according to the invention, thestructure 10 may include a threaded aperture (not shown) and further include a cooperating set screw in addition to or in lieu of crimping. In such embodiments, the set screw rotatably mates with thestructure 10 at the threaded aperture and is rotated until a bottom surface of the screw presses against and, in some embodiments, penetrates the cord, fixing the cord within thestructure 10. As will be described in greater detail below, when fully assembled and all the components are fixed in position as shown inFIGS. 1 and 5 , for example, thecord 4 is in tension, thespacer 6 may be in compression or in a neutral state, and thebumper 8 is in compression. - It is noted that in other embodiments according to the invention, both the bone screws 12A and 12B may be mated with a locking limited
travel closure top 15 and at least one additional blocker or crimping structure is included generally opposite the crimpingstructure 10 in the overall assembly to result in a cord that is tensioned along the assembly but in sliding cooperation with two or more bone anchors of such assembly. It is also noted thatadditional spacers 6 and bone screws 12 cooperating with closure tops 15 may be utilized according to the invention, providing longer assemblies of the invention with one of thespacers 6 placed between each bone screw and thebumper 8 and the crimpingstructure 10 placed at one or both ends of such assembly next to abone screw 12 cooperating with a closure top 15 or two such closure tops 15. Also, as described in greater detail below, bone screws, spacers, bumpers and crimping structures or other blockers of the invention may be sized, shaped and used with hard or deformable rods and bars, alternatively to thecord 4. - Although the
screws 12 are illustrated, it is noted that the assembly 1 may cooperate with a variety of bone screws and other bone anchors, including closed bone screws, hinged bone screws, polyaxial bone screws, with or without compression inserts, and bone hooks that may in turn cooperate with a variety of closure structures having threads, flanges, or other structure for fixing the closure structure to the bone anchor, and may include other features, for example, external or internal drives, break-off tops and inner set screws. A closed bone anchor with or without a set screw may also be used in the invention to capture thecord 4 in sliding, but not fixed engagement. The bone anchors, closure structures and the connecting member 1 are then operably incorporated in an overall spinal implant system for correcting degenerative conditions, deformities, injuries, or defects to the spinal column of a patient. - The connecting member assembly 1 is elongate, with the
inner core 4 being any flexible elongate material including, but not limited to cords, threads, strings, bands, cables or fibers that may be single or multiple strands, including twisted, braided or plaited materials. The illustratedcord 4 has a substantiallyuniform body 20 of substantially circular cross-section, afirst end 22 and an opposedsecond end 24, thecord 4 being cut to length as required by the surgeon. Initially, thecord 4 is typically of a length longer than shown in the drawings to allow for gripping of thecord 4 during assembly with the other components of the assembly 1 and also for tensioning and attachment to the bone screws 12A and 12B as will be described in greater detail below. Thecord 4 may be made from a variety of materials, including polyester or other plastic fibers, strands or threads, such as polyethylene-terephthalate. Thecord 4 may be placed under axial tension prior to final installation between the bone screws 12A and 12B, for example by being tensioned along the axis A for a selected time to lengthen and otherwise deform thecord 4 during a primary creep stage. After thecord 4 reaches a secondary or steady-state creep, further tension is placed on thecord 4 in preparation for fixing between thebone screw 12A and the crimpingstructure 10 as will be described in greater detail below. It is noted that thecord 4 typically does not illustrate elastic properties, such as any significant additional lengthening with axial traction, after the assembly 1 is operatively assembled within a human body, but theelastic bumper 8 will allow for relative movement between the fully stretchedcord 4 and thebone screw 12B in response to spinal flexion, extension and any movement that may draw thebone screw 12B away from thebone screw 12A. - With particular reference to
FIGS. 1 , 2 and 5, thespacer 6 is sized and shaped to be slidingly received over thecord 4 and may be made from a variety of elastic and more rigid materials, including, but not limited to natural or synthetic elastomers such as polyisoprene (natural rubber), and synthetic polymers, copolymers, and thermoplastic elastomers, for example, polyurethane elastomers such as polycarbonate-urethane elastomers. In order to have low or no wear debris, thespacer 6 inner and side surfaces may be coated with an ultra thin, ultra hard, ultra slick and ultra smooth coating, such as may be obtained from ion bonding techniques and/or other gas or chemical treatments. The illustratedspacer 6 has an external substantially cylindricalouter surface 28 and an internal substantiallycylindrical surface 30. Thesurface 30 is sized and shaped to closely cooperate and fit about thecord 4 and yet allow some sliding movement of thecord 4 with respect to thespacer 6 along the axis A. Thespacer 6 includes opposed substantially planar and annular end surfaces 32 and 34 that are sized and shaped to abut against planar surfaces of the bone screws 12A and 12B, respectively. When initially assembled with the other components of the connecting member assembly 1, thesurfaces spacer 6 may be of smaller or larger outer circular cross section, or of a square, rectangular or other inner or outer cross-section including other curved or polygonal shapes. Thespacer 6 may further include one or more compression grooves that allow for some additional compression of thespacer 6 when pressed upon in an axial direction between the bone anchors 12A and 12B. Typically, such a compression groove is substantially uniform and circular in cross-section, being formed in theexternal surface 28 and extending radially toward theinternal surface 30. The spacer can have an off-axial lumen. - Also with particular reference to
FIGS. 1 , 2 and 5, theelastic bumper 8 is annular and includes an outercylindrical surface 40, an innercylindrical surface 42, anend surface 44 and anopposed end surface 46. The illustratedbumper 8 further includes acompression groove 48 that allows for some additional compression of thebumper 8 when pressed upon in an axial direction A between thebone anchor 12B and the crimpingring 10. Thecompression groove 48 is substantially uniform and circular in cross-section, being formed in theexternal surface 40 and extending radially toward theinternal surface 42. Bumpers of the invention may include one, none or a plurality of compression grooves. The innercylindrical surface 42 forms a bore sized and shaped for closely receiving thecord 4 therethrough as shown, for example, inFIG. 5 . The end surfaces 44 and 46 are substantially parallel to one another, but can also be non-parallel. - The
bumper 8 may be made from a variety of elastic materials, including, but not limited to natural or synthetic elastomers such as polyisoprene (natural rubber), and synthetic polymers, copolymers, and thermoplastic elastomers, for example, polyurethane elastomers such as polycarbonate-urethane elastomers. Thebumper 8 is typically shorter in length and more elastic than thespacer 6, but may be equal to or longer than the spacer and of the same, greater or lesser durometer than thespacer 6. In order to have low or no wear debris, thebumper 8 inner and side surfaces may also be coated with an ultra thin, ultra hard, ultra slick and ultra smooth coating, such as may be obtained from ion bonding techniques and/or other gas or chemical treatments. - The fixing structure or blocker, illustrated as the crimping structure or
ring 10 is substantially cylindrical and includes anouter surface 50 and aninner surface 52 forming a substantially cylindrical through bore that opens at planar end surfaces 54 and 56 and operatively extends along the axis A. The crimpingring 10 is sized and shaped to receive theelongate cord 4 through theinner surface 52. The crimpingring 10 further includes a pair of opposed crimp orcompression grooves 58 that are pressable and deformable inwardly toward the axis A upon tensioning of thecord 4 and pre-compression of thebumper 8 during assembly of the assembly 1. The crimpingring 10 is preferably made from a stiff, but deformable material, including metals and metal alloys. It is foreseen that in lieu of or addition to the crimping surface, the blocker could include a threaded aperture and a mating locking set screw for engaging and pressing into thecord 4. - The bone screws generally 12, and in particular the illustrated
screws cord receiving portion 62 integral with a threaded bone attachment portion orshank 64. Theportion 62 further includes a substantiallyU-shaped channel 66 for closely receiving thecord 4 therethrough, thechannel 66 further having an upper closure top receiving portion with the helically wound guide andadvancement structure 18 thereon for receiving and mating with the closure top 14 or theclosure top 15. The upper, receivingportion 62 further includes opposed, substantially parallel side surfaces 70 that abut against side surfaces of thespacer 6 or thebumper 8. However, it is foreseen that according to the invention, other embodiments of the invention may include side surfaces 70 that angle away or towards one another for lordosing or kyphosing controlling embodiments as previously described in applicant's application U.S. Ser. No. 11/328,481, incorporated by reference herein. - To provide a biologically active interface with the bone, the threaded
shanks 64 of the bone screws 12A and 12B may be coated, perforated, made porous or otherwise treated. The treatment may include, but is not limited to a plasma spray coating or other type of coating of a metal or, for example, a calcium phosphate; or a roughening, perforation or indentation in the shank surface, such as by sputtering, sand blasting or acid etching, that allows for bony ingrowth or ongrowth. Certain metal coatings act as a scaffold for bone ingrowth. Bio-ceramic calcium phosphate coatings include, but are not limited to: alpha-tri-calcium phosphate and beta-tri-calcium phosphate (Ca3(PO4)2, tetra-calcium phosphate (Ca4P2O9), amorphous calcium phosphate and hydroxyapatite (Ca10(PO4)6(OH)2). Coating with hydroxyapatite, for example, is desirable as hydroxyapatite is chemically similar to bone with respect to mineral content and has been identified as being bioactive and thus not only supportive of bone ingrowth, but actively taking part in bone bonding. - With particular reference to
FIGS. 1 , 2 and 5, theclosure structures receiver 62 of the open bone screws 12. The illustratedclosure structures receiver 62 and are substantially cylindrical, including an outer helically wound guide and advancement structure in the form of a flange form that operably joins with the guide andadvancement structure 18. A drivingtool 72 illustrated inFIG. 3 is sized and shaped for engagement with aninternal drive feature 74 and is used for both rotatable engagement and, if needed, disengagement of theclosure 14 and/orclosure 15 from one of thereceivers 62. Theinternal drive feature 74 may take a variety of forms and may include, but is not limited to, a hex shape (as shown), TORX or other features or apertures, such as slotted, tri-wing, spanner, two or more apertures of various shapes, and the like. As stated above, theclosure 14 and theclosure 15 are substantially identical with the exception of a height or depth dimension in the form of the portion orknob 19 that extends operatively perpendicular to the axis A. Theclosure structure 14 that includes theportion 19 is sized and shaped to be long enough to compress against thecord 4 and frictionally fix thecord 4 in thereceiver 62 when fully seated and mated with the guide andadvancement structure 18. (See, e.g.,FIG. 14 that shows asimilar closure 114 that abuts against a run-outseat 117′ and has an extendedportion 119 for pressing down on a core, such as a cord or rod or bar). The illustrated closure top 14 may further include points or projections for piercing into thecord 4 to provide enhanced contact and fixing of thecord 4 to thereceiver 62. Theclosure 15 is sized and shaped to be long enough to fully seat within thereceiver 62 and mate with the guide andadvancement structure 18 run-outseating surface 17 in order to fix theclosure 15 in the bone screw and capture thecord 4 within thereceiver 62. However, theclosure 15 is too short to fix thecord 4 against thereceiver 62. Rather, when theclosure 15 is fully seated and mated in thereceiver 62, thecord 4 remains in slidable relationship with thebone screw 12B and is not fixed against a surface of thereceiver 62. (See, e.g.,FIG. 9 that shows asimilar closure 115 that abuts against a run-outseat 117 and is spaced from or in sliding engagement with a core, such as a cord or cable or rod or bar). - In use, the two
bone screws bone screw shank 64 and provides a guide for the placement and angle of theshank 64 with respect to the cooperating vertebra. A further tap hole may be made and theshank 64 is then driven into the vertebra by rotation of a driving tool (not shown) that engages a driving feature on or near thetop portion 62 of thescrew 12. It is foreseen that thescrews - With particular reference to
FIGS. 2-4 , the dynamic connector assembly 1 is assembled by inserting thecord 4 into the through bore formed by theinternal surface 30 of thespacer 6. Also as indicated inFIGS. 2 and 3 , thecord 4 is first received into theU-shaped opening 66 of theopen bone screw 12A and theU-shaped opening 66 of thebone screw 12B, with thespacer 6 being disposed between facingsurfaces 70 ofbone screws closure top 14 is rotated and driven into thereceiver 62 of thebone screw 12A until the closure top 14 frictionally engages thecord 4 and fixes thecord 4 to thescrew 12A. Before or after theclosure top 14 is tightened, theclosure top 15 may be inserted and rotated into thereceiver 62 of thebone screw 12B until the top 15 is fully seated and engaged with such receiver run-out surface 17, capturing but not fixing thecord 4 to thebone screw 12B. Thebumper 8 is threaded along thecord 4 with the cord sliding through the through-bore formed by theinner surface 42 until thebumper face 44 abuts against thesurface 70 of thebone screw 12B located opposite thespacer 6. The crimpingstructure 10 is threaded along thecord 4 with the cord sliding through the through-bore formed by theinner surface 52 until thecrimper face 54 abuts against thebumper face 46. - The
cord 4 is tensioned and thebumper 8 is compressed against thebone screw 12B by axial movement of the crimpingstructure 10 against thebumper 8, squeezing thebumper 8 between thebone screw 12B and the crimpingstructure 10. Thespacer 6 also may be compressed at this time. With particular reference toFIG. 4 , a crimpingtool 80 is used to frictionally attach the tensionedcord 4 to the crimpingstructure 10, thereby holding thecord 4 in tension between thebone screw 12A and the crimpingstructure 10 and also compressing thebumper 8 against thebone screw 12B. - The resulting connecting member assembly 1 is loaded with the
cord 4 in tension and thebumper 8 and optionally thespacer 6 in compression. The assembly 1 is thus substantially dynamically loaded and oriented relative to the cooperating vertebra, providing relief (e.g., shock absorption) and protected movement in response to spinal flexion and extension, and further responding to distractive or tensioning forces as well as to compressive forces. - If removal of the dynamic connector assembly 1 from the bone screws 12A and/or 12B is necessary, or if it is desired to release the assembly 1 at a particular location, disassembly is accomplished by using the
driving tool 72 with a driving formation cooperating with the closure tops 14 and 15 to rotate and remove the closure top from thebone screw 12A and/or 12B. Disassembly is then accomplished in reverse order to the procedure described previously herein for assembly. - With reference to
FIGS. 6-9 , abone screw 112 is illustrated that is identical to thebone screw 12 of the assembly 1 with the exception that theU-shaped channel 66 formed by inner surfaces of thescrew 12 has been replaced with a substantiallyrectangular channel 166 formed by opposedplanar surfaces 167 and a bottomplanar surface 168. Thebone screw 112 has areceiver 162 and ashank 164, thereceiver 162 having a discontinuous guide andadvancement structure 118 that is formed in the opposed surfaces 167. Thebone screw 112 may be utilized in anassembly 101 substantially similar to the assembly 1 that includes acord 104 identical or substantially similar to thecord 4 and further includes thespacer 6,elastic bumper 8, crimpingstructure 10 of the assembly 1 previously described herein. Because of the squared off shape of thechannel 166, thebone screw 112 may also be readily used with other longitudinal connecting members, such as thebar 105 shown inFIG. 7 and therod 106 shown inFIG. 10 . Thebar 105 and therod 106 may be made of a variety of materials ranging from deformable plastics to hard metals, depending upon the desired application. Thus, bars and rods of the invention may be made of materials including, but not limited to metal, metal alloys or other suitable materials, plastic polymers such as polyetheretherketone (PEEK), ultra-high-molecular weight-polyethylene (UHMWP), polyurethanes and composites, including composites containing carbon fiber, natural or synthetic elastomers such as polyisoprene (natural rubber), and synthetic polymers, copolymers, and thermoplastic elastomers, for example, polyurethane elastomers such as polycarbonate-urethane elastomers. Whether the longitudinal connecting member of the invention is a cord, rod or bar; hard-surfaced or soft and deformable; or elastic or non-elastic, the combination of a limited travel closure top that allows the connecting member some movement within the bone screw further cooperating with a bumper and a connector holding structure such as the crimpingstructure 10, advantageously allows for limited movement of the connector with respect to the bone screw, creating a dynamic connection between spinal assembly and cooperating vertebrae. - With particular reference to
FIGS. 8 and 9 , thebone screw 112 guide andadvancement structure 118 that receives and mates with thelimited travel closure 115 includes a run-out aperture or groove partially defined by a bottom orlower seating surface 117 sized and shaped for frictional engagement with a portion of theclosure 115. As shown inFIG. 9 , theclosure 115 minor diameter is slightly bigger than the run-out groove so theclosure 115 abuts against thesurface 117 when driven downward into the receiver. Theseating surface 117 terminates at the opposedplanar surfaces 167. - The
bone screw receiver 162 further includes opposed, substantially parallel outer side surfaces 170. It is foreseen that according to the invention, other embodiments of the invention may include side surfaces that angle away or towards one another for lordosing or kyphosing controlling embodiments as previously described in applicant's application U.S. Ser. No. 11/328,481, the disclosure of which is incorporated by reference herein. It is also noted that thebone screw 112 is identical or substantially similar to the bone screws described in described in detail in Applicant's U.S. patent application Ser. No. 12/584,980, the disclosure of which is incorporated by reference herein. - Specifically, the
closure top 115 is substantially cylindrical and includes atop surface 180, abottom surface 182, adrive feature 184 formed in thetop surface 180 and an outer guide andadvancement structure 186 sized and shaped to mate with the guide andadvancement structure 118 of thebone screw 112. Acylindrical surface 188 represents the minor diameter of a major portion of theclosure 115. The illustratedclosure top 115 is rotatable between the spaced arms forming thereceiver 162 of thescrew 112. The illustrated helically wound guide andadvancement structure 186 is in the form of a flange form that operably joins with respective guide andadvancement structure 118. A driving tool or tools (not shown) sized and shaped for engagement with theinternal drive feature 184 is used for both rotatable engagement and, if needed, disengagement of theclosure 115 from thescrew 112. Theinternal drive feature 184 may take a variety of forms and may include, but is not limited to, a hex shape, TORX or other features or apertures, such as slotted, tri-wing, spanner, two or more apertures of various shapes, and the like. - With particular reference to
FIG. 9 , theclosure top 115 is sized and shaped to cooperate with the run-out surface 117 to lock theclosure 115 on thebone screw 112 independent of any pressure being placed by theclosure 115 on thecord 104. Due to the size of thesurface 188, thebottom surface 182 near thesurface 188 forms a radially extending shelf or abutment seat. When theclosure 115 is tightened by rotation into thescrew 112, the bottom 182 abuts against thesurface 117, allowing the closure to be tightened in thescrew receiver 162 independent of whateversize cord 104 or other core, such as thebar 105 might be. Stated in another way, theclosure 115 is prohibited from entering the space between theplanar surfaces 167 that support thecord 104 or other core therebetween. Thus, it is not possible for theclosure 115 to press upon thecord 104, allowing such cord to slide between theclosure top 115 and thesurfaces - With reference to
FIGS. 10-14 , abone screw 112′ is illustrated that is identical to thebone screw 112, having areceiver 162′, ashank 164′, arectangular channel 166′ formed by opposedplanar surfaces 167′ and abottom surface 168′, the same or substantially similar to thereceiver 162,shank 164,channel 166, opposedplanar surfaces 167 andbottom surface 168 previously described herein with respect to thebone screw 112. Further, thebone screw 112′ includes alower seat 117′ of a guide andadvancement structure 118′ andside surfaces 170′, the same or similar to thelower seat 117, guide andadvancement structure 118 andside surfaces 170 of thebone screw 112. Thebone screw 112 is shown with the plastic,deformable rod 106 and a locking closure top 114 having alower extension portion 119 that is the same or similar to theclosure top 14 having theextended bottom portion 19 previously described herein with respect to the assembly 1. - The
closure top 114 is substantially cylindrical and includes atop surface 180′, abottom surface 182′, adrive feature 184′ formed in thetop surface 180′ and an outer guide andadvancement structure 186′ sized and shaped to mate with the guide andadvancement structure 118′ of thebone screw 112′. Acylindrical surface 188′ represents the minor diameter of a major portion of theclosure 114. The illustratedclosure top 114 is rotatable between the spaced arms forming thereceiver 162′ of thescrew 112′. The illustrated helically wound guide andadvancement structure 186′ is in the form of a flange form that operably joins with respective guide andadvancement structure 118′. A driving tool or tools (not shown) sized and shaped for engagement with theinternal drive feature 184′ is used for both rotatable engagement and, if needed, disengagement of theclosure 115 from thescrew 112. Theinternal drive feature 184 may take a variety of forms and may include, but is not limited to, a hex shape, TORX or other features or apertures, such as slotted, tri-wing, spanner, two or more apertures of various shapes, and the like. - With particular reference to
FIG. 14 , theclosure top 114 is sized and shaped to cooperate with the run-out surface of the guide andadvancement structure 118′ to lock theclosure 114 on thebone screw 112′ independent of any pressure being placed by theclosure 114 on thedeformable rod 106. In the illustrated embodiment, theclosure 114 includes a secondcylindrical surface 190 located adjacent to and below thesurface 188′ that defines the minor diameter of most of theclosure 114. The secondcylindrical surface 190 has a second diameter smaller than the minor diameter of thesurface 188′. Theouter surface 190 partially defines theextended portion 119. Thesurface 190 is located near thebottom surface 182′ of theclosure 114 that contacts and presses against thedeformable rod 106 or other longitudinal connecting member core located within thebone screw receiver 162′ during operation. As shown inFIGS. 12 and 14 , theportion 119 presses against and partially deforms therod 106. A radially extending shelf orabutment seat 192 is formed between thecylindrical surface 188′ and thecylindrical surface 190. When theclosure 114 is tightened by rotation into thescrew 112′, theseat 192 abuts against thesurface 117′, allowing the closure to be tightened in thescrew receiver 162′ independent of therod 106. Therod 106 is pressed upon and held in place by thebottom surface 182′ of the screw, with some deformation of therod 106 being acceptable and even desirable. In the illustrated embodiment, some of the rod material is allowed to flow up into aninner bore 195 of theclosure 114. However, because of the cooperation between theseat 192 and thescrew surface 117′, therod 106 is protected against over-deformation or crushing that might lead to instability and failure. Furthermore, if therod 106 exhibits creep or other deformation during operation, loosening or lessening of the contact engagement between the closurebottom surface 182′ and therod 106 will not result in loosening of theclosure 114 from thescrew 112′. - With reference to
FIGS. 15 and 16 , anassembly 201′ according to the invention is illustrated that provides for dynamic stabilization similar to the assembly 1 utilizing polyaxial bone screws. The illustratedassembly 201 includes a solid, hard-surfacedrod 204, aspacer 206, anelastic bumper 208, a crimpingstructure 210 and a pair ofpolyaxial bone screws 212A and 212B. The bone screws 212A and 212B are identical or substantially similar to those described in Applicant's U.S. patent application Ser. No. 12/229,207, filed Aug. 20, 2008 entitled “Polyaxial Bone Anchor Assembly With One-Piece Closure, Pressure Insert and Plastic Elongate Member,” (hereafter, the '207 application), the disclosure of which is incorporated by reference herein. Aclosure top 214 fixes therod 204 in the bone screw 212A and aclosure top 215 captures therod 204 in thebone screw 212B, but abottom surface 282 thereof does not fix therod 204 with respect to thebone screw 212B as illustrated inFIG. 16 . (See, e.g., FIGS. 15-18 of the '207 application for illustrations of fixing of a rigid or deformable rod with a bone screw the same or similar to the screw 212A). Eachscrew 212A and 212B further includes areceiver 203 for slidingly pivotally receiving a bone screw shank upper portion, and alower pressure insert 205 having surfaces for engaging the shank upper portion and surfaces for closely receiving therod 204. With reference toFIG. 16 , theclosure top 215lower surface 282 engages upper arm surfaces 283 of thepressure insert 205 to capture therod 204 and lock the polyaxial mechanism of thebone screw 212B. Thus, the capturedrod 204 is in sliding engagement with thescrew 212B. Thespacer 206,elastic bumper 208 and the crimpingstructure 210 are the same or similar in form and function to thespacer 6,bumper 8 and crimpingstructure 10 previously described herein with respect to the assembly 1, with the crimpingstructure 210 directly engaging therod 204. In alternative embodiments, a cord or deformable rod may be utilized in lieu of the illustratedrigid rod 204. Thepressure insert 205 may also be configured to receive a square or rectangular bar. - It is to be understood that while certain forms of the present invention have been illustrated and described herein, it is not to be limited to the specific forms or arrangement of parts described and shown.
Claims (15)
1.-11. (canceled)
12. In a medical implant assembly comprising at least a first bone anchor having a receiver portion for receiving a core there-through and a second polyaxial bone anchor and a longitudinal connecting member, the second polyaxial bone anchor including a receiver portion pivotally receiving a bone anchor shank upper portion, a lower pressure insert received in the receiver and having a lower surface for engaging the shank upper portion and a pair of upwardly-extending arms for receiving the core therebetween, the connecting member including the core and a spacer, the spacer surrounding the core and located between the first and second bone anchors, the core extending through the receiver portions of the first and second bone anchors, the improvement comprising:
a) a closure structure in fixed locking engagement with the second polyaxial bone anchor, the closure structure capturing the core within the second polyaxial bone anchor, the closure structure having at least a bottom surface for engaging an upper surface of each of the lower pressure insert arms so as to capture the core in slidable engagement with the second polyaxial bone anchor when the closure structure is locked to the second polyaxial bone anchor;
b) at least one compressible elastic bumper having a through bore, the core disposed in the through bore and slidable with respect to the bumper, the bumper disposed adjacent the second polyaxial bone anchor and opposite the spacer; and
c) a fixing member, the elastic bumper disposed between the second polyaxial bone anchor and the fixing member, the fixing member frictionally engaged with the core and in compressible engagement with the elastic bumper.
13. The improvement of claim 12 , wherein the core is a tensioned cord.
14. The improvement of claim 12 , wherein the fixing member is a closed ring surrounding the core and pressing there against.
15. The improvement of claim 12 , wherein the fixing member abuts directly against the elastic bumper.
16. The improvement of claim 12 , wherein the spacer is compressible.
17. In a medical implant assembly having at least first and second polyaxial bone anchor screws and a longitudinal connecting member, each of the polyaxial bone anchor screws including a receiver pivotally receiving an upper portion of a bone anchor screw shank, a lower pressure insert received in the receiver and having a lower surface for engaging the shank upper portion and upwardly-extending arms for receiving a core member, the connecting member having a spacer, the spacer surrounding the core and located between the first and second bone anchor screws, the core extending through the receiver of at least one of the first and second bone anchor screws, the improvement comprising:
a) a first closure structure in fixed locking engagement with the first bone anchor screw, the first closure structure capturing the core within the first bone anchor screw receiver, the first closure structure having at least a bottom surface for engaging an upper surface of at least one of the lower pressure insert arms so as to capture the core in slidable engagement with the first bone anchor screw receiver when the first closure structure is locked to the first bone anchor screw;
b) at least one compressible elastic bumper having a through bore, the core disposed in the through bore and slidable with respect to the bumper, the bumper disposed adjacent the first bone anchor screw and opposite the spacer; and
c) a fixing member, the elastic bumper disposed between the first bone anchor screw and the fixing member, the fixing member frictionally engaged with the core and in compressible engagement with the elastic bumper.
18. The improvement of claim 17 , wherein the core is selected from the group consisting of a metal rod, a PEEK rod, a tensioned cord, a flexible member, an elastic member and a non-metallic member.
19. The improvement of claim 17 , wherein the fixing member is a closed ring surrounding the core and pressing thereagainst.
20. The improvement of claim 17 , wherein the fixing member abuts directly against the elastic bumper.
21. The improvement of claim 17 , wherein the spacer is compressible.
22. The improvement of claim 17 , wherein at least one of the bone anchor screws has an inner guide and advancement structure with a run-out seat that engages a portion of the first or second closure top mechanism to fix the closure top to the bone anchor screw independent of fixing the core to the bone anchor screw.
23. A medical implant assembly for implanting in a patient comprising:
a) first and second bone anchors adapted to be attached to respective first and second spinal vertebrae;
b) an elongate cord disposed between the first and second bone anchors;
c) each bone anchor having respective first and second receivers, each receiver having two spaced apart arms, forming a channel therebetween, the second receiver channel is threaded down to an abutment surface and having a lower channel surface, the channel extending along a first axis adapted to receive the cord; and
d) a closure having a bottom surface, the closure being advanceable into the second receiver channel until being stopped by the abutment surface creating a gap between the bottom surface of the closure and the lower channel surface so as to capture the cord therein with the gaps being wider than the cord to allow free movement of the cord between the surface and preventing downward pressure on the cord and further advancement of the closure into the channel, the gap being sufficient to allow the cord to slip within and through the second receiver.
24. The assembly of claim 23 , wherein the second bone anchor further comprises a lower pressure insert received in the second receiver and the insert having upwardly-extending arms for receiving a cord and the closure bottom surface engaging an upper surface of each of the lower pressure insert arms so as to capture the cord in slidable engagement with the second bone anchor.
25. In a medical implant assembly having at least one polyaxial bone screw attached to a longitudinal connecting member, the bone screw having a receiver with a channel, a portion of the longitudinal connecting member is sized and shaped to be received in the receiver channel; the assembly further comprising:
a) a compression insert directly engaging the longitudinal connecting member and providing a locking force for an upwardly extending shank of the polyaxial bone screw, the insert having a base, a pair of opposed arms, and the opposed arms defining a through channel with a lower connecting member seating surface; wherein c) the compression insert is top-loadable in the receiver in a first orientation, wherein, when in the first orientation, the compression insert through channel is substantially perpendicular to the receiver channel, and then rotated to a second orientation, such that the compression insert through channel is substantially parallel to the receiver channel.
Priority Applications (1)
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US14/450,421 US20140343610A1 (en) | 2006-01-09 | 2014-08-04 | Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms |
Applications Claiming Priority (12)
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US11/328,481 US7862587B2 (en) | 2004-02-27 | 2006-01-09 | Dynamic stabilization assemblies, tool set and method |
US85135306P | 2006-10-12 | 2006-10-12 | |
US92711107P | 2007-05-01 | 2007-05-01 | |
US11/894,001 US8292926B2 (en) | 2005-09-30 | 2007-08-17 | Dynamic stabilization connecting member with elastic core and outer sleeve |
US99408307P | 2007-09-17 | 2007-09-17 | |
US12/148,465 US10258382B2 (en) | 2007-01-18 | 2008-04-18 | Rod-cord dynamic connection assemblies with slidable bone anchor attachment members along the cord |
US12/229,207 US8353932B2 (en) | 2005-09-30 | 2008-08-20 | Polyaxial bone anchor assembly with one-piece closure, pressure insert and plastic elongate member |
US19231208P | 2008-09-17 | 2008-09-17 | |
US21005809P | 2009-03-13 | 2009-03-13 | |
US12/584,980 US10729469B2 (en) | 2006-01-09 | 2009-09-15 | Flexible spinal stabilization assembly with spacer having off-axis core member |
US12/661,042 US20160242816A9 (en) | 2001-05-09 | 2010-03-10 | Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms |
US14/450,421 US20140343610A1 (en) | 2006-01-09 | 2014-08-04 | Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms |
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US20140343610A1 true US20140343610A1 (en) | 2014-11-20 |
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US14/450,421 Abandoned US20140343610A1 (en) | 2006-01-09 | 2014-08-04 | Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms |
US15/389,296 Abandoned US20170100165A1 (en) | 2005-09-30 | 2016-12-22 | Dynamic Spinal Stabilization Assembly with Elastic Bumpers and Locking Limited Travel Closure Mechanisms |
US16/380,509 Active 2027-05-25 US11707298B2 (en) | 2005-09-30 | 2019-04-10 | Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms |
US18/332,665 Active US11925390B2 (en) | 2005-09-30 | 2023-06-09 | Bone anchor assemblies with interchangeable and different locking threaded closures |
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US12/661,042 Abandoned US20160242816A9 (en) | 2001-05-09 | 2010-03-10 | Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms |
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US15/389,296 Abandoned US20170100165A1 (en) | 2005-09-30 | 2016-12-22 | Dynamic Spinal Stabilization Assembly with Elastic Bumpers and Locking Limited Travel Closure Mechanisms |
US16/380,509 Active 2027-05-25 US11707298B2 (en) | 2005-09-30 | 2019-04-10 | Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms |
US18/332,665 Active US11925390B2 (en) | 2005-09-30 | 2023-06-09 | Bone anchor assemblies with interchangeable and different locking threaded closures |
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Cited By (12)
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US9750540B2 (en) | 2007-01-26 | 2017-09-05 | Roger P. Jackson | Dynamic stabilization member with molded connection |
US9931139B2 (en) | 2007-01-18 | 2018-04-03 | Roger P. Jackson | Dynamic stabilization connecting member with pre-tensioned solid core |
US10130393B2 (en) | 2007-01-18 | 2018-11-20 | Roger P. Jackson | Dynamic stabilization members with elastic and inelastic sections |
US10258382B2 (en) | 2007-01-18 | 2019-04-16 | Roger P. Jackson | Rod-cord dynamic connection assemblies with slidable bone anchor attachment members along the cord |
US10383660B2 (en) | 2007-05-01 | 2019-08-20 | Roger P. Jackson | Soft stabilization assemblies with pretensioned cords |
US10470801B2 (en) | 2007-01-18 | 2019-11-12 | Roger P. Jackson | Dynamic spinal stabilization with rod-cord longitudinal connecting members |
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US9956002B2 (en) | 2007-01-26 | 2018-05-01 | Roger P. Jackson | Dynamic stabilization member with molded connection |
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Also Published As
Publication number | Publication date |
---|---|
US20230320758A1 (en) | 2023-10-12 |
US11925390B2 (en) | 2024-03-12 |
WO2010104583A1 (en) | 2010-09-16 |
US11707298B2 (en) | 2023-07-25 |
US20170100165A1 (en) | 2017-04-13 |
US20190231395A1 (en) | 2019-08-01 |
US20160242816A9 (en) | 2016-08-25 |
US20100174319A1 (en) | 2010-07-08 |
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