US20120197301A1 - System and method for securing a plate to the spinal column - Google Patents
System and method for securing a plate to the spinal column Download PDFInfo
- Publication number
- US20120197301A1 US20120197301A1 US13/441,218 US201213441218A US2012197301A1 US 20120197301 A1 US20120197301 A1 US 20120197301A1 US 201213441218 A US201213441218 A US 201213441218A US 2012197301 A1 US2012197301 A1 US 2012197301A1
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- United States
- Prior art keywords
- plate
- slot
- washer
- bone
- spinal column
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- 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
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
-
- 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
- A61B17/7059—Cortical plates
-
- 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
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
- A61B17/8019—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones where the means are a separate tool rather than being part of the plate
-
- 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
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
- A61B17/8042—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being a cover over the screw head
-
- 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
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
-
- 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
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
-
- 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
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
-
- 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
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S606/00—Surgery
- Y10S606/902—Cortical plate specifically adapted for a particular bone
Definitions
- the present invention relates generally to the field of instrumentation and systems for the spine, and more particularly to instrumentation and systems for use in engaging plates to the spine.
- Bony structures are subject to defects and trauma which require a plate to be secured thereto in order to stabilize the bony segment as it heals or fuses.
- the spine is subject to various pathologies that compromise its load bearing and support capabilities.
- pathologies of the spine include, for example, degenerative diseases, the effects of tumors and, of course, fractures and dislocations attributable to physical trauma.
- Spinal surgeons have addressed these problems using a wide variety of instrumentation in a broad range of surgical techniques.
- the use of elongated rigid plates has been helpful in the stabilization and fixation of the lower spine, most particularly in the thoracic and lumbar spine. These same plating techniques have found some level of acceptance by surgeons specializing in the treatment of the cervical spine.
- the present invention provides a drill guide for forming holes through a plate in a vertebra into which bone engaging fasteners are inserted to engage the plate to the vertebra.
- the drill guide positions the bone engaging fastener away from the ends of a slotted hole through plate.
- the present invention also provides a bone fixation system that includes a plate and a drill guide.
- the plate includes at least one slotted hole extending therethrough.
- the drill guide is positionable on the plate such that a hole drilled through the drill guide spaces the screw from the ends of the slotted hole.
- the present invention further provides methods for securing a plate to upper and lower vertebrae of a spinal column segment.
- the plate is fixed to one of the vertebra.
- a bone engaging fastener engaged to the other vertebra is positioned away from the ends of a slot extending through the plate.
- the fastener can thus accommodate extension and post-operative settling of the spinal column segment surgeon selectively applies either a compression or distraction load to the spinal column segment with the plate secured to the spinal column segment by the bone engaging fastener.
- FIG. 1 is a top perspective view of an anterior plating system according to the present invention.
- FIG. 2 is a top perspective view of the anterior plating system of FIG. 1 with the bone screws locked in place.
- FIG. 3 is a top perspective view of the anterior plating system of FIG. 1 with bone screws translated in a slot of the plate.
- FIGS. 4( a )- 4 ( f ) are top plan views of fixation plates of the present invention provided in different sizes and configurations.
- FIGS. 5( a )- 5 ( f ) are top plan views of washers of the present invention provided in sizes and configurations corresponding to the plates in FIGS. 5( a )- 5 ( f ).
- FIG. 6 is a side elevational view of a bone screw according to one aspect of the present invention.
- FIG. 7 is a side elevational view of a locking fastener according to another aspect of the present invention.
- FIGS. 8( a )- 8 ( k ) are various views and sections of washers according to the present invention.
- FIG. 9 is a top plan view of a first end of the fixation plate of the present invention.
- FIG. 10 is a cross-sectional view taken through line 10 - 10 of FIG. 9 .
- FIG. 11 is an end elevational view of the plate of FIG. 9 .
- FIG. 12 is a top plan view of a second end of the fixation plate of the present invention.
- FIG. 13 is a cross-sectional view taken along line 13 - 13 of FIG. 12 .
- FIG. 14 is an enlarged cross-sectional view taken through line 14 - 14 of FIG. 12 .
- FIG. 15 is a top plan view of an intermediate portion of the fixation plate of the present invention.
- FIG. 16 is a cross-sectional view taken through line 16 - 16 of FIG. 15 .
- FIG. 17 is an enlarged cross-sectional view taken through line 17 - 17 of FIG. 15 .
- FIG. 18 is an enlarged cross-sectional view taken through line 18 - 18 of FIG. 15 .
- FIG. 19 a is a partial sectional view of the anterior plate assembly of the present invention with the screws disposed through the holes at the first end of the plate and engaged in a vertebra.
- FIG. 19 b is a partial sectional view of the anterior plate assembly of the present invention with the screws disposed through the slots of the plate and engaged in a vertebra.
- FIGS. 20( a )- 20 ( f ) illustrate various instruments and steps of a method according to another aspect to the present invention.
- FIGS. 21( a )- 21 ( c ) are various perspective views of a compression tool according to yet another aspect of the present invention.
- FIGS. 22( a )- 22 ( b ) are side elevational views of the arms of an alternate embodiment compression tool.
- FIG. 23 is a side elevational view of a drill guide according to another aspect of the present invention.
- FIG. 24 is a top plan view of the drill guide of FIG. 23 .
- FIG. 25 is a front elevational view of the drill guide of FIG. 23 .
- FIG. 26 is an enlarged front elevational view of a distal portion of the guide members forming a portion of the drill guide of FIG. 23 .
- FIG. 27 is a medial side elevational view of the distal portion of one of the guide members of FIG. 26 looking in the direction of arrows 27 - 27 of FIG. 26 .
- FIG. 28 is a cross-sectional view taken through line 28 - 28 of FIG. 27 .
- FIG. 29 is a top perspective view of the drill guide of FIG. 23 positioned on a plate located on a spinal column segment.
- FIG. 30 is an enlarged bottom perspective view of the plate and drill guide of FIG. 29 .
- FIGS. 1-3 A plating system 30 having application in an anterior approach to the cervical spine is depicted in FIGS. 1-3 .
- the portion of the spine is shown schematically in FIG. 1 to include a first vertebra V 1 , a second vertebra V 2 , and intermediate vertebrae V 3 and V 4 .
- first vertebra V 1 is the inferior or bottom vertebra in the portion of the spinal column and the second vertebra V 2 is the superior or top vertebra of the portion of the spinal column.
- first vertebra V 1 is the superior vertebra and that second vertebrae V 2 is the inferior vertebra.
- the present invention has application with spinal column portions that include vertebrae ranging in number from two to six vertebrae.
- Implant I may be placed into one or more of the disc spaces between adjacent vertebrae as needed.
- Implant I may be a bone graft, fusion device, or any other type of interbody device that is insertable into a disc space and promotes fusion between adjacent vertebrae.
- the plating system 30 includes an elongated plate 31 having a number of openings therethrough and a number of bone engaging fasteners, shown in the form of bone screws 50 , that are insertable through the openings.
- each bone engaging fastener is in the form of a bone screw.
- Plate 31 has a longitudinal axis L extending along the length of the plate at its centerline. Bone engaging fasteners or bone screws 50 are held in plate 31 by way of a retainer assembly 33 positioned along axis L.
- the openings of elongated plate 31 include a pair of holes 34 at first node 36 adjacent a first end of plate 31 . First node 36 is positioned over first vertebra V 1 .
- Plate 31 also includes a pair of slots 35 at a second node 37 adjacent a second end of plate 31 .
- Second node 37 is positioned over second vertebra V 2 .
- several intermediate nodes 38 are provided along the length of the plate 31 between first node 36 and second node 37 .
- Each intermediate node 38 includes a pair of intermediate slots 32 positioned over a corresponding one of the intermediate vertebrae V 3 and V 4 .
- Plating system 30 can be fabricated from any type of biocompatible material.
- holes 34 are paired with one of the holes of the pair on one side of the longitudinal axis L and the other hole of the pair on the opposite side of axis L.
- Slots 32 and 35 are similarly arranged in pairs. It is also preferred that paired holes 34 are identical in shape and size, and are located symmetrically about the axis L. Paired slots 35 are also identical in shape and size, and are located symmetrically about the axis L. The paired slots 32 at intermediate nodes 38 are also identical in shape and size, and are located symmetrically about the axis L.
- Plate 31 includes recesses between each of nodes 36 , 37 , 38 to reduce the outer contouring size of the plate.
- Plate 31 has a length selected by the surgeon with nodes 36 , 37 , and, if needed, nodes 38 to register with the patient vertebrae.
- Plate 31 preferably includes a rounded upper surface 41 that is in contact with the soft tissue surrounding the spine when the plate is engaged to the spine. Rounded surface 41 reduces the amount of trauma that would be experienced by the surrounding soft tissue.
- the bottom surface 42 of plate 31 is preferably configured to contact the vertebral bodies of the spine at each of the instrumented levels. In one embodiment, at least a portion of bottom surface 42 can be textured along the length of the plate to enhance its grip on a vertebral body.
- Holes 34 include a recess 45 adjacent the top surface of plate 31 that allow the head of the bone engaging fastener, such as bone screw 50 , to be countersunk in plate 31 .
- intermediate slots 32 include a recess 46 around each slot 32 adjacent top surface of the plate
- slots 35 include a recess 47 around each slot 35 adjacent the top surface of the plate.
- slots 35 include a ramp 60 that, as described further below, allows a dynamic compression load to be applied to the spinal column portion upon insertion of screw 50 at second end 43 of slot 35 .
- Recesses 46 , 47 also allow the head of screw 50 to be countersunk in plate 31 when inserted through a corresponding one of the slots 32 , 35 .
- a groove 39 extends along axis L of plate 31 and intersects with each of recesses 45 , 46 , 47 along the length of groove 39 .
- the end of plate 31 at second node 37 includes a notch 40 , which is preferably rounded with a radius R 4 centered on axis L ( FIG. 12 .)
- Retainer assembly 33 includes a washer 90 having a length that substantially corresponds to the length of plate 31 .
- Washer 90 defines a plurality of apertures 91 .
- Each aperture 91 is provided at a body portion 93 , 94 , 95 that corresponds to vertebral nodes 36 , 37 , 38 , respectively.
- a connecting portion 98 extends between and connects body portions 93 , 94 , 95 .
- Each of the apertures 91 has a countersink 92 extending therearound adjacent to the top surface of washer 90 .
- countersink 92 is tapered from a first width at the first end of aperture 91 to a second width at the second end of aperture 91 , the first width being greater than the second width.
- Locking fasteners shown in the form of screws 85 , are positionable, each through a corresponding one of the apertures 91 , to engage a fastener bore 70 (see FIGS. 4( a )- 4 ( f )) in plate 31 and couple washer 90 to plate 31 .
- Washer 90 is translatable from an unlocked position ( FIG. 1 ) for bone screw insertion to a locked position ( FIG. 2 ) after screw insertion to contact the head of the bone screws in holes 34 and overlap the heads of bone screws in slots 32 , 35 .
- washer 90 does not contact the heads of bone screws in slots 32 , 35 , thus allowing translation of the bone screws in the slots.
- Back-out of the bone screws in slots 32 , 35 is prevented when the bone screw backs out from its seated position a sufficient amount to contact washer 90 .
- washer 90 resides almost entirely within groove 39 of plate 31 to minimize the overall height of the construct.
- retainer assembly 33 is in an unlocked condition with screws 85 at the second end of apertures 90 .
- body portions 93 , 94 , 95 of washer 90 do not overlap holes 34 and a portion of slots 32 , 35 , and enable insertion of the bone screws 50 therein.
- Narrowed portions 98 of washer 90 allow bone screws 50 to be placed through holes 34 and slots 35 to secure plate 31 to the vertebrae V 1 and V 2 .
- the surgeon can also place bone screws 50 in intermediate slots 32 to secure plate 31 to vertebrae V 3 and V 4 as deemed necessary.
- Plate 31 and bone screws 50 preferably interface in holes 34 such that rigid fixation of plate 31 to the first vertebra V 1 is achieved.
- Slots 35 are positioned over second vertebra V 2 , and include a second end 43 and a first end 44 . As shown in FIG. 1 , screw 50 is initially is inserted at second end 43 of slot 35 , allowing subsequent translation of screw 50 in slot 35 from second end 43 to first end 44 . For the purposes of clarity, only a single screw 50 is shown in slot 35 ; however, it is contemplated that bone screws are inserted in both slots 35 . Bone screws 50 inserted in intermediate slots 32 also translate from the second end 48 to first end 49 ( FIG. 15 ) of slot 32 .
- washer 90 of retainer assembly 33 may be translated to its locked condition shown in FIG. 2 .
- body portions 93 , 94 , 95 of washer 90 retain the heads of the inserted screws 50 in holes 34 and slots 32 , 35 and prevent the screws from backing out of plate 31 .
- locking screw 85 is threaded into a corresponding fastener bore 70 in plate 31 . This downward threading of locking screw 85 causes the tapered countersink 92 of washer 90 to ride along the head of locking screw 85 until locking screw 85 contacts the first end of aperture 91 . This translates washer 90 along axis L to its locked condition, where the washer 90 retains bone screws 50 in plate 31 .
- Bone screws 50 are allowed to translate within slots 35 and intermediate slots 32 from the second end of the slots to the first end of the slots while retainer assembly 33 retains bone screws 50 in plate 31 and prevents screw backout. As shown in FIG. 3 , the screw positioned in slot 35 has translated from second end 43 to first end 44 . The translation of screw 50 is limited by contact of screw 50 with first end 44 . The amount of translation may also be controlled by providing bone screws in intermediate slots 32 . Thus, the amount of translation of the spinal column segment can be limited by the length of slots 32 , 35 .
- FIGS. 4( a )- 4 ( f ) and FIGS. 5( a )- 5 ( f ) several embodiments of elongated plate 31 and washer 90 are depicted.
- the anterior plating system 30 can be readily adapted for fixation to several vertebrae by modifying the length of plate 31 and the number and arrangements of holes 34 , second slots 35 , and intermediate slots 32 .
- Paired slots 32 , 35 and paired holes 34 at each of the vertebrae provide, at a minimum, for at least two bone screws 50 to be engaged into each respective vertebrae. The placement of two or more screws in each vertebral body improves the stability of the construct.
- the present invention contemplates various specific embodiments for a plate 31 that is provided in lengths that range from 19 millimeters (hereinafter “mm”) to 110 mm, and an overall width of about 17.8 mm. However, other dimensions for the length and width of plate 31 are also contemplated herein.
- the plate 31 of FIGS. 1-3 is sized to span four vertebrae and includes a first node 36 , a second node 37 , and two intermediate nodes 38 .
- plate 31 a and washer 90 a are sized span two vertebrae.
- Plate 31 a has holes 34 a at first node 36 a and holes 34 a at second node 37 a .
- Plate 31 a is provided with washer 90 a that resides in groove 39 a and is translatable to retain bone screws in holes 34 a .
- plate 31 a provides rigid fixation at each vertebra.
- a modification of plate 31 a is depicted FIGS. 4( b ) and 5 ( b ).
- the holes at the second vertebral node are replaced with slots 35 b at second node 37 b .
- a washer 90 b resides in groove 39 b and is translatable to retain bone screws in holes 34 b and slots 35 b.
- Plate 31 c and washer 90 c of FIGS. 4( c ) and 5 ( c ) similarly provide for instrumentation at two vertebrae.
- Plate 30 c has a recess portion between nodes 36 c and 37 c .
- Washer 90 c resides in groove 39 c and is translatable to retain lock screws in holes 34 c and slots 35 c .
- the plates of FIGS. 4( a )- 4 ( c ) span two vertebrae, and preferably do not include notch 40 on the second end of that plate as do the plates sized to span three or more vertebrae.
- Plate 31 d and washer 90 d of FIGS. 4( d ) and 5 ( d ) are provided for instrumentation at three vertebrae.
- Plate 31 d has first vertebral node 36 d , second vertebral node 37 d , and intermediate node 38 d .
- Washer 90 d resides in groove 39 d and is translatable to retain bone screws in holes 34 d and slots 32 d , 35 d .
- Plate 31 e and washer 90 e of FIGS. 4( e ) and 5 ( e ) are provided for instrumentation at five vertebrae.
- Plate 31 e has first vertebral node 36 e , second vertebral node 37 e , and three intermediate nodes 38 e .
- Washer 90 e resides in groove 39 e and is translatable to retain bone screws in holes 34 e and slots 32 e , 35 e .
- Plate 31 f and washer 90 f of FIGS. 4( f ) and 5 ( f ) are provided for instrumentation at six vertebrae.
- Plate 31 f has first vertebral node 36 f , second vertebral node 37 f , and four intermediate nodes 38 f .
- Washer 90 f resides in groove 39 f and is translatable to retain bone screws in holes 34 f and slots 32 f , 35 f.
- Bone screw 50 is preferably configured for engagement in the cervical spine, and includes threaded shank 51 that is configured to engage a cancellous bone of the vertebral body.
- the threaded shank may be provided with self-tapping threads, although it is also contemplated that the threads can require prior drilling and tapping of the vertebral body for insertion of screw 50 .
- the threads on shank 51 define a constant outer diameter d 2 along the length of the shank.
- shank 51 has a root diameter that is tapered along a portion of the length of the shank and increases from the tip of shank 51 to a diameter d 1 at an intermediate or cylindrical portion 52 .
- Intermediate portion 52 extends between shank 51 and a head 54 of screw 50 .
- the threads on shank 51 extend into portion 52 by a thread run out 53 .
- cylindrical portion 52 includes a short segment that does not bear any threads. This segment of cylindrical portion 52 interfaces or contacts with a plate thickness at hole 34 or slot 32 , 35 through which bone screw 50 extends. This short segment has an outer diameter d 1 .
- the head 54 of screw 50 includes a tool recess 55 configured to receive a driving tool.
- tool recess 55 is a hex recess, or in the alternative, any type of drive recess as would occur to those skilled in the art.
- Head 54 includes a truncated or flattened top surface 56 having a diameter d 4 .
- a spherical surface 57 extends from cylindrical portion 52 to a shoulder 59 .
- Shoulder portion 59 has a diameter d 5 .
- An inclined surface 58 extends between shoulder 59 and truncated top surface 56 .
- Inclined surface 58 forms an angle A 1 with top surface 56 .
- screw 50 may be provided with shank 51 having a length that varies from about 10 mm to about 24 mm.
- the threads have diameter d 2 of about 4.5 mm.
- the diameter d 2 is about 4.0 mm.
- cylindrical portion 52 has a diameter d 1 of about 4.05 mm.
- Cylindrical portion 52 has an unthreaded segment with a height h 1 that is determined by standard machining practices for thread run-out between a shank and screw head. Height h 1 and diameter d 1 of cylindrical portion 52 are sized to achieve a snug fit between screw 50 and plate 31 in hole 34 or slot 32 , 35 through which screw 50 is placed.
- Head 54 is provided with height h 2 , outer diameter d 5 at shoulder 59 , diameter d 4 at top surface 56 , and inclined surface 54 angle A 1 such that the head 54 is nested within its corresponding slot 32 , 35 or hole 34 and recessed below the top surface of the plate.
- screw 50 Although reference has been made to specific dimensions in this specific embodiment, it should be understood that the present invention also contemplates other dimensions and configurations for screw 50 . It should also be understood that bone screws used to secure plate 31 can each have a different length and diameters associated therewith, and need not correspond exactly to the other bone engaging fasteners used in the construct.
- Locking screw 85 includes a shank 86 having machine threads thereon. In one specific embodiment, locking screw 85 terminates in a sharp point 88 that permits penetration into the vertebral body when locking screw 85 is secured in threaded fastener bore 70 .
- Head 87 includes a lower conical surface 89 configured to mate with aperture 91 of washer 90 . Head 87 further includes a tool recess 87 a for receiving a driving tool therein.
- Washer 90 includes second body portion 95 , first body portion 93 , and if necessary, one or more intermediate body portions 94 .
- a connecting portion 98 extends between and connects each of the body portions 93 , 94 , 95 .
- Washer 90 has a top surface 100 a and a bottom surface 100 b .
- Each body portion 94 , 95 defines an aperture 91 extending between top surface 100 a and bottom surface 100 b .
- Aperture 91 has a tapered countersink portion 92 therearound adjacent top surface 100 b .
- Aperture 91 allows passage of shank 86 of locking screw 85 therethrough, and countersink 92 is preferably configured to mate with conical surface 89 and seat locking screw 85 at various positions along the length of aperture 91 .
- countersink portion 92 is sloped toward bottom surface 100 b from second end 97 to first end 96 .
- the mating conical features between locking screw 85 and aperture 91 provide a self-translating capability for washer 90 relative to plate 31 as locking screw 85 is tightened into fastener bore 70 of plate 31 .
- Body portions 93 , 94 , 95 have a width W 1 that is greater than a width W 2 of connecting portion 98 .
- the width W 1 and length of body portions 93 , 94 , 95 are configured so that the body portions overlap with recess 45 of holes 34 and recesses 46 , 47 of slots 32 , 35 .
- the body portions 93 , 94 , 95 retain the heads of bone screws extending through the holes and slots of plate 31 when washer 90 resides in groove 39 and is in the locked condition of FIG. 2 .
- the width W 2 and the length of the connecting portions 98 are configured to allow insertion of screws in holes 34 and slots 32 , 35 when washer 90 is in the unlocked condition of FIG. 1 .
- FIGS. 8( a ) and 8 ( b ) there is shown second body portion 95 of washer 90 .
- Aperture 91 has countersink portion 92 that is tapered along the length of aperture 91 .
- Aperture 91 has a width W 3 at bottom surface 100 b of washer 90 .
- Countersink portion 92 has a width that varies along the length of aperture 91 and is greater than width W 3 .
- Countersink portion 92 has a radius R 1 at second end 97 and a radius R 2 at first end 96 at top surface 100 a . It is preferred that R 1 is less than R 2 and the width of countersink portion 92 increases from second end 97 towards first end 96 .
- Aperture 91 has a chord length S 1 extending between the center of radius R 1 and the center of radius R 2 .
- Body portion 95 further includes a transition portion 99 that extends between connecting portion 98 and body portion 95 .
- Intermediate body portion 94 of FIGS. 8( c ) and 8 ( d ) is similar in many respects to second body portion 95 of FIGS. 8( a ) and 8 ( b ), and also includes an aperture 91 having a tapered countersink portion 92 .
- intermediate body portion 94 has a connecting portion 98 extending in both directions therefrom.
- a second transition portion 98 a extends between second connecting portion 98 and body portion 94 .
- Body portion 94 has a chord length S 1 between the center of radius R 1 and the center of radius R 2 .
- Tapered countersink 92 of aperture 91 provides a self-translating capability of the washer 90 . This is because the washer 90 is translated relative to plate 31 as the locking screw 85 is threaded into threaded bore 70 .
- the camming conical surface 89 of screw 85 advances downward along the tapered portion of the wall of countersink portion 92 of aperture 91 .
- FIGS. 8( e ) and 8 ( f ) show first body portion 93 .
- First body portion 93 is also similar to second body portion 95 .
- first body portion 93 includes an aperture 91 ′ having a countersink portion 92 ′ that is not tapered along its length to provide a self-translating capability for washer 90 like the countersink portions 92 of body portions 94 and 95 . Rather, after washer 90 is translated relative to plate 31 as described above, locking screw 85 will already be positioned at first end 96 ′, and may thereafter be threaded into bore 70 and seated within countersink portion 92 ′.
- the surgeon may slide the washer by hand or with a tool to its translated position, and lock the washer in its translated position by seating locking screw 85 into countersink 92 ′ at first end 96 ′.
- Countersink 92 ′ has a definite location at second end 96 ′ for seating locking screw 85 , providing a reference for the surgeon to confirm that washer 90 has been translated to its locked position.
- body portion 93 could also be provided with aperture 91 like body portions 94 and 95 as shown in FIGS. 1-3 .
- Washer 90 has an outer surface 104 configured to overlap bone screws 50 in slots 32 , 35 without contacting inclined surface 58 of screws 50 when retainer assembly 33 is in its locked condition.
- Outer surface 104 extends from bottom surface 100 b to a shoulder 103 .
- Shoulder 103 extends between inclined surface 104 and top surface 100 a .
- Inclined surface 104 forms an angle A 2 with respect to bottom surface 100 b .
- Washer 90 defines a thickness t 1 between top surface 100 a and bottom surface 100 b , and a shoulder height of t 2 from bottom surface 100 b .
- Washer 90 has a width W 7 along bottom surface 100 b at aperture 91 .
- Washer 90 has contact surface 106 configured to contact inclined surface 58 of screws 50 when retainer assembly 33 is in its locked condition.
- Contact surface 106 extends from bottom surface 100 b to a shoulder 105 .
- Shoulder 105 extends between contact surface 106 and top surface 100 a .
- Contact surface 106 forms an angle A 3 with respect to bottom surface 100 b that is configured to mate with and provide surface contact with inclined surface 58 of bone screw 50 .
- Washer 90 defines a thickness t 3 between top surface 100 a and bottom surface 100 b , and a shoulder height of t 4 from bottom surface 100 b.
- the body portions have a width W 1 and connecting portion have width W 2 that is based on the spacing between the centerlines of the paired slots and holes of the plates and the overall width of the plate.
- the width W 3 of aperture 91 in the specific embodiment is sized to accommodate the shank 86 of locking screw 85 without head 87 passing therethrough.
- the length of body portions 94 and 95 varies based on the length and spacing between slots 32 , 35 and holes 34 in plate 31 .
- the body portions 94 , 95 have a length sufficient to overlap substantially the entire length of slot 32 , 35 when retainer assembly 33 is in its locked position.
- the tapered countersink portion 92 of aperture 91 has radius R 1 that transitions to radius R 2 along the chord length S 1 . Thickness t 1 is less than thickness t 3 , and shoulder height t 4 is less than shoulder height t 2 .
- Body portion 93 has a width W 8 along bottom surface 100 b that is greater than width W 7 of body portions 94 , 95 . Angle A 2 is preferably less that angle A 1 .
- the dimensions of washer 90 are preferably arranged so that body portions 94 , 95 do not contact the screw heads nested in slots 32 , 35 to facilitate translation of the screws in slots 32 , 35 . Body portion 93 contacts the screw heads nested in holes 34 to further enhance the fixed orientation between screws 50 and plate 31 in holes 34 .
- the present invention also contemplates a retainer assembly in which individual washers are provided at each node for retaining screws in holes 34 and slots 32 , 35 of plate 31 .
- a slot washer 195 and a hole washer 193 are provided.
- Slot washer 195 is similar to body portion 95 of washer 90 and hole washer 193 is similar to body portion 93 of washer 90 , both of which are described above. Elements that are alike bear the same reference number as the corresponding element of body portions 95 , 93 .
- Slot washer 195 and hole washer 193 do not have a connecting portion 98 extending to another washer.
- Slot washer 195 has a body portion 198 with a length S 2 that varies and is sized to correspond to the length of the adjacent slot 32 , 35 when washers 195 are positioned on plate 31 . Slot washer 195 does not have a connecting portion 98 extending to another washer.
- Hole washer 193 has a body portion 199 with a length S 3 that varies and is sized to correspond to the length of the plate adjacent hole 34 when washer is positioned on plate 31 .
- FIG. 8( k ) an alternate embodiment of washers 193 and 195 is provided and designated at 193 ′, 195 ′ respectively.
- Washers 193 ′, 195 ′ are the same as washers 193 , 195 described above, except for aperture 191 .
- Aperture 191 does not have a tapered countersink, but rather has a semi-circular countersink portion 192 only at first end 196 .
- Countersink portion 192 provides a single position for locking screw 85 to lock the washer 193 ′, 195 ′ to plate 31 after the washer 193 ′, 195 ′ has been translated relative to plate 31 by the surgeon.
- Washers 193 ′, 195 ′ have body portion 198 ′, 199 ′ with length S 4 that varies as described above with respect to length S 2 and S 3 .
- first node 36 of plate 31 is depicted. It is preferred that holes 34 are identical and symmetrical about axis L. Hole 34 includes recess 45 adjacent top surface 41 . Holes 34 include a cylindrical bore 77 having generally vertical sidewalls adjacent bottom surface 42 . Cylindrical bore 77 extends between recess 45 and bottom surface 42 of plate 31 , and has a diameter D 1 . Cylindrical bore 77 has axis 72 b that is offset at angle A 5 from an axis 72 a that extends normal to plate 31 as shown in FIG.
- Recess 45 has a partial spherical portion 45 a defined about a central axis 72 b .
- Axis 72 b is offset from axis 72 a by angle A 5 . Offset angle A 5 directs bone screws inserted into holes 34 toward the first end of plate 31 .
- axes 72 a converge below the bottom surface 42 of plate 31 at angle A 4 with respect to an axis 72 c that extends along the centerline of plate 31 perpendicular to axis L.
- Recess 45 intersects groove 39 at intersecting portion 45 c .
- Spherical portion 45 a is configured to mate with spherical surface 57 of bone screw 50 , allowing at least a portion of head 54 to be recessed below top surface 41 of plate 31 .
- recess 45 also includes a flared portion 45 b that extends in a superior direction from axis 72 b .
- recess 45 includes a wall that parallels bore 77 and extends between between spherical portion 45 a and flared portion 45 b to further facilitate insertion and maintenance of a drill guide in recess 45 .
- spherical portion 45 a has a diameter that mates with the diameter of spherical surface 57 of screw 50 , and is slightly larger than diameter d 5 of head 54 of bone screw 50 .
- the cylindrical bore 77 of hole 34 has a diameter D 1 of 4.1 mm, which is slightly larger than the diameter d 1 of intermediate portion 52 of screw 50 . This portion of the screw contacts bore 77 and assumes a fixed orientation with respect to plate 31 .
- offset angle A 5 is about 12.6 degrees and convergence angle A 4 is about 6 degrees relative to axis 72 c .
- Vertebral node 37 includes slots 35 that are preferably identical and symmetrical about axis L.
- Slot 35 includes slotted bore 78 adjacent bottom surface 42 of plate 31 having generally vertical sidewalls extending between second end 43 and first end 44 .
- Slotted bore 78 extends between bottom surface 42 and recess 47 adjacent top surface 42 .
- Bore 78 has a width W 5 and a chord length S 4 , and has a central axis 75 b extending through plate 31 .
- Recess 47 has a spherical portion 47 a about central axis 75 b that extends around slot 35 . As shown in FIG.
- central axis 75 b is offset from axis 75 a that extends normal to plate 31 by angle A 5 . Offset angle A 5 directs bone screws inserted into slot 35 towards the second end of plate 31 .
- slot 35 allows insertion of a bone screw at angles less than A 5 in slot 35
- bone screw 50 may be positioned within slot 35 at any location between ends 43 and 44 .
- retaining assembly 33 provides for insertion of bone screws 50 at second 43 as would be clinically desirable for settling.
- axes 75 b converge below the bottom surface 42 of plate 31 at angle A 4 with respect to axis 72 c.
- Spherical portion 47 a is configured to mate with spherical surface 57 of bone screw 50 , allowing at least a portion of head 54 to be recessed below top surface 41 of plate 31 .
- recess 47 also includes a flared portion 47 b that extends around spherical portion 47 a .
- recess 47 include a wall that parallels bore 78 extending between spherical portion 47 a and flared portion 47 b to further facilitate maintenance and insertion of a drill guide in recess 47 .
- Recess 47 intersects groove 39 at overlap portion 47 c , as shown in FIG. 14 .
- the second end of second node 37 includes notch 40 having radius R 4 centered about axis L. It is also contemplated herein that plate 31 is provided without notch 40 , as shown in FIGS. 4( a )- 4 ( c ).
- slot 35 includes ramp 60 extending between bore 78 and flared portion 47 b at second end 43 .
- Ramp 60 is not configured to allow spherical surface 57 of screw 50 to seat therein, but has an orientation that causes second end 43 of slot 35 and screw 50 to separate as screw 50 is threaded into slot 35 .
- Spherical surface 57 of head 54 provides camming action along the ramp 60 until head 54 seats in recess 47 at a position spaced a distance from second end 43 . This camming action applies a dynamic compression load to the spinal column portion. The amount of compression applied to the spinal column portion is controlled by the length of ramp 60 from second 43 to the position in slot 35 where screw 50 seats in recess 47 . It should be understood that slot 35 may also be provided without ramp 60 .
- spherical portion 47 a has a diameter sized to mate with spherical surface 57 of screw 50 , and is slightly larger than diameter d 5 of head 54 of bone screw 50 .
- Slotted bore 78 has a width W 5 of about 4.1 mm, which is slightly larger than the diameter d 1 of intermediate portion 52 of screw 50 .
- the cylindrical portion 52 of bone screw 50 contacts plate 31 in bore 78 and prevents rotation of screw 50 transverse to axis 72 c .
- the chord length S 4 varies depending upon the length of the slot 35 needed for the particular application of plate 31 and patient anatomy.
- offset angle A 5 is about 12.6 degrees and convergence angle A 4 is about 6 degrees relative to an axis 72 c .
- Vertebral node 38 includes slots 32 that are preferably identical and symmetrical about axis L.
- Slot 32 includes slotted bore 79 adjacent bottom surface 42 of plate 31 having generally vertical sidewalls extending between a second end 48 and a first end 49 .
- Slotted bore 79 extends between bottom surface 42 and recess 46 adjacent top surface 42 .
- Bore 79 has a width W 5 and a chord length S 5 , and has a central axis 76 a extending through plate 31 .
- Recess 46 has a spherical portion 46 a that extends around slot 35 . As shown in FIG.
- central axis 76 a generally extends normal to plate 31 . However, as shown in FIG. 17 , the axes 76 a converge below the bottom surface 42 of plate 31 at angle A 4 with respect to axis 72 c . It should be noted that slot 32 allows insertion of bone screws 50 at various angles with respect to axis 76 a.
- Spherical portion 46 a is configured to mate with spherical surface 57 of bone screw 50 , allowing at least a portion of head 54 to be recessed below top surface 41 of plate 31 .
- recess 46 also includes a flared portion 46 b that extends around spherical portion 46 a .
- a wall paralleling bore 79 extends between spherical portion 46 a and flared portion 46 b to further facilitate insertion and maintenance of a drill guide in recess 46 .
- Screw 50 may be placed within intermediate slot 32 between ends 48 and 49 . However, it is preferred that the screw is inserted initially at second end 48 , thus allowing compression loading of the spinal column segment.
- Recess 46 intersects groove 39 at overlap portion 46 c , as shown in FIG. 17 .
- spherical portion 46 a has a diameter sized to mate with spherical surface 57 of screw 50 , and is slightly larger than diameter d 5 of head 54 of bone screw 50 .
- the slotted bore 79 has a width W 5 of about 4.1 mm, which is slightly larger than the diameter d 1 of intermediate portion 52 of screw 50 .
- Cylindrical portion 52 of bone screw 50 interfaces with plate 31 in bore 79 such that angular adjustment of screw 50 transverse to axis 72 c is prevented.
- the chord length S 5 varies depending upon the length of slot 35 needed for the particular application of plate 31 and patient anatomy.
- convergence angle A 4 is about 6 degrees relative to an axis 72 c .
- Groove 39 has a width W 6 at top surface 41 of plate 31 .
- Groove 39 has bottom surface 73 extending between inclined sidewalls 74 .
- Sidewalls 74 extend between bottom surface 73 of groove 39 and top surface 41 of plate 31 . It is contemplated that the groove 39 has a depth sufficient to accommodate the washer 90 so as to minimize protrusion of washer 90 above top surface 41 of plate 31 .
- the plate is curved in two degrees of freedom.
- the bottom surface 42 of the plate can be curved along a large radius R, centered in a vertebral plane containing central axis L, as shown schematically in FIG. 16 , to accommodate the lordotic curvature of the cervical spine.
- bottom surface 42 forms a medial/lateral curvature C, as shown in FIG. 18 , to correspond to the curvature of the vertebral body.
- plate 31 can also be bent as needed to accommodate the particular spinal anatomy and vertebral pathology.
- FIG. 19 a a partial sectional view of fixation plate assembly 30 at holes 34 is provided with screws 50 engaged to vertebra V 1 and retainer assembly 33 in the locked position.
- a pair of screws 50 are disposed within the respective holes 34 so that the threaded shanks 51 project beyond the lower surface 42 of plate 31 into the vertebral body V 1 .
- the intermediate portion 52 of screw 50 extends through the bore 77 of the hole 34 .
- Spherical surface 57 of head 54 contacts recess 45 of hole 34 when screw 50 is seated therein.
- the intermediate portion 52 provides a snug fit for screw 50 in the bore 77 so that screw 50 is not able to pivot with respect to plate 31 .
- FIG. 19 b a partial sectional view of fixation plate assembly 30 at slots 32 or 35 is provided with screws 50 engaged to vertebra V 1 and retainer assembly 33 in the locked position.
- a pair of screws 50 are disposed within respective slots 32 , 35 so that threaded shanks 51 project beyond lower surface 42 of plate 31 into the corresponding vertebral body V 2 , V 3 , or V 4 .
- Cylindrical portion 52 of screw 50 extends through bores 78 , 79 of slots 35 and 32 , respectively.
- Spherical surface 57 of head 54 contacts recesses 46 , 47 of slots 32 , 35 when screw 50 is seated therein.
- Cylindrical portion 52 provides a snug fit for screw 50 in bores 78 , 79 so that screw 50 is not able to pivot or translate with respect to axis 72 c of plate 31 .
- screws 50 inserted into slots 32 or 35 are able to translate along the length of slots 32 , 35 as described above. It should be understood that the present invention also contemplates various embodiments of plate 31 that use variable angle screws capable of assuming universal angular orientation with respect to plate 31 in slots 32 , 35 and holes 34 .
- retainer assembly 33 is moved to its locked position where it contacts the heads 54 of bone screws 50 in holes 34 .
- Locking screw 85 is threaded into threaded fastener bore 70 of plate 31 to translate washer 90 from its unlocked position to its locked position, as described above, and to draw contact surface 106 into contact with inclined surface 58 of screw 50 as shown in FIG. 19 a .
- Contact surface 106 preferably applies a downward force onto head 54 to firmly seat the screw heads within the plate recesses and further fix screw 50 in hole 34 . In a preferred embodiment, this downward force is exacted by washer 90 as surface 106 contacts inclined surface 58 . As shown in FIG.
- outer surface 104 of washer 90 does not contact the heads of bone screws 50 in slots 32 , 25 .
- Outer surface 104 overlaps the bone screws 50 to retain bone screws in slots 32 , 35 .
- Outer surface 104 will contact the heads of the bone screws if the bone screws backout from slots 32 , 35 . It is preferred that bottom surface 100 b of washer 90 does not contact bottom surface 73 of groove 39 .
- the retainer assembly 33 may be loosely fixed on plate 31 so the surgeon need not fiddle with applying retainer assembly 33 to plate 31 during surgical procedures.
- the locking fasteners 85 are pre-inserted through apertures 91 of washer 90 and partially threaded into fastener bores 70 .
- Washer 90 is initially positioned such that the second end of each aperture 91 is positioned adjacent locking screw 85 .
- locking fasteners 85 are advanced further into bores 70 and along tapered portions 92 of apertures 91 to translate washer 90 to a locked condition and retain bone screws 50 in plate 31 .
- sharp point 88 of locking screw 85 is preferably configured to penetrate the cortical bone.
- sharp point 88 will penetrate the vertebra when plate 31 is initially positioned on the bone.
- locking screw 85 helps locate and temporarily stabilize the plate on the vertebra as the bone screws 50 are engaged to the vertebra. This temporary location feature provided by locking screw 85 can also be used to maintain the position of plate 31 on the vertebra as a drill guide is used to drill and tap the vertebrae to receive bone screws 50 .
- a guide 150 includes a handle 152 , a template 154 , and arm 153 extending therebetween.
- arm 153 extends outward from the spine and is bent so that handle 152 parallels the spine, positioning handle 152 out of the way of the surgeon.
- Template 154 includes a second end 155 that defines a notch 158 .
- Template 154 also includes first end 156 having a projection 156 a extending downward therefrom towards vertebral body V 2 .
- Template 154 further defines a pair of slots 157 between second end 159 and first end 156 .
- the surgeon selects a guide 150 with a template 154 sized to position notch 158 at the desired location on vertebra V 2 and places guide instrument 150 on vertebral body V 2 .
- Notch 158 is located on vertebra V 2 by placing projection 156 a in abutting contact with the endplate of vertebra V 2 in disc space D.
- Slots 157 provide a visual indication to the surgeon of the range of positions available for screw insertion into the vertebral body through slots 35 of plate 31 . If desired, the surgeon can obtain a desired position or location of notch 158 and the desired available range of bone screw positions on vertebra V 2 by selecting a guide having a different sized template 154 .
- Pin 170 is placed into vertebra V 2 guided by notch 158 .
- Pin 170 includes a lower end 171 having a threaded portion (not shown) for attaching pin 170 to vertebra V 2 .
- the attachment portion is preferably threaded to screw into vertebra V 2 , but may also be smooth with a spiked tip for insertion into the vertebra.
- Pin 170 also includes tool engagement portion 172 to facilitate installation of pin 170 to the vertebral body. It is also contemplated that the surgeon can place pin 170 on the vertebral body spaced away from notch 158 if desired and the vertebral anatomy so allows.
- Sleeve 180 has a hollow body 181 extending between a first end 186 adjacent vertebra V 1 and a second end 184 .
- a second end 174 of pin 170 preferably extends from second end 184 of sleeve 180 , allowing access to pin 170 .
- Sleeve 180 includes enlarged portion 184 to facilitate placement and removal of sleeve 180 . It is contemplated that sleeve 180 has hollow interior and an internal configuration that provides secure attachment to pin 170 .
- Body 181 includes cylindrical outer surface 182 with an outer diameter d 6 .
- plate 31 With sleeve 180 in its proper position, plate 31 is positioned with notch 40 in abutting contact with outer surface 182 of sleeve 180 , as shown in FIG. 20( d ).
- the diameter d 6 of sleeve 180 slightly less than the twice the radius of notch 40 so that notch 40 is nested around sleeve 180 .
- Plate 31 is then secured to vertebra V 1 by inserting screws 50 through holes 34 .
- gap 177 is about 2 mm. However, other sizes for gap 177 are contemplated herein based on the desired compression to be applied.
- a compression tool 290 is secured to pin 170 and to slots 32 of plate 31 . It is also contemplated that the compression tool can be secured to plate 31 other than at slots 32 by, for example, engaging the sides of plate 31 .
- Compression tool 290 has a first arm 291 with a first foot 294 connected to pin 170 . Second arm 292 is connected to the second end of slots 32 via extensions 297 extending from second foot 296 . First arm 291 and second arm 292 are manipulated by the surgeon to apply a compression load to the spinal column segment. The amount of applied load is limited by gap 177 between pin 170 and notch 40 . For example, in the specific embodiment where gap 177 is 2 mm, the spinal column portion is compressed 2 mm.
- Bone screws 50 are inserted into slots 35 with compression tool 290 maintaining the compression load. With ramp 60 at second 43 of slot 35 , an additional amount of dynamic compression is achieved with screw insertion in slots 35 , as described above. With screws 50 seated at end 43 of slots 35 , compression tool 290 may be removed without release of the compression load. Additional bone screws may be inserted into intermediate slots 32 . Washer 90 may then be translated as described above to retain bone screws 50 in plate 31 . It should be note that it is contemplated herein that compression tool 290 and pin 170 are preferably only used with plates providing instrumentation at three or more vertebra. However, utilization of a compression tool configured to engage a plate for providing instrumentation at two vertebrae is not precluded.
- Tool 290 has first arm 291 having first foot 294 extending therefrom.
- First foot 294 defines recess 293 for receiving the pin 170 .
- Second arm 292 has second foot 296 extending therefrom.
- Second foot 296 includes extensions 297 extending downward therefrom configured to engage intermediate slots 32 of plate 31 .
- Extensions 297 preferably include recesses 307 that are configured contact the second ends of intermediate slots 32 . It is also contemplated that extensions 297 have a curved bottom surface 308 that corresponds to the medial lateral curvature of the vertebral bodies.
- First arm 291 has a reduced thickness portion 299 extending through a passage 295 formed in second arm 292 , and is pivotally coupled to second arm 292 with pin 299 .
- First arm 291 has curved handle portion 306 having a projection 303 extending therefrom.
- Second arm 292 has a handle 305 .
- a ratchet bar 301 is pivotally coupled to second arm 292 via coupling 302 .
- ratchet bar 301 is spring-biased towards projection 303 .
- Serrations 304 formed on the bottom side of ratchet mechanism 301 provide for selective engagement with projection 303 on first arm 291 .
- the first and second arms are compressed towards one another to apply the compressive load to the vertebral segment.
- Projection 303 engages the serrated bottom of ratchet bar 301 to prevent relaxation of the arms and allows the surgeon to maintain the compression load during insertion of bone screws 50 within slots 35 .
- Ratchet bar 301 may be lifted against its spring bias away from arm 291 to disengage ratchet bar 301 from projection 303 .
- Arms 291 , 292 may then be moved away from one another to release compression tool 290 from pin 170 and plate 31 .
- compression tool 290 has been illustrated and described in detail, the present invention also contemplates other tools capable of being secured between pin 170 and plate 31 to provide a compression load to the spinal column segment.
- a compression tool may include one or more angular modifications to first arm 391 and second arm 392 to facilitate access to plate 31 and pin 170 at the surgical site.
- First arm 391 has a lower portion 391 a forming angle B 1 with first foot 396 .
- First foot 396 has extensions 397 extending therefrom that are similar to extensions 297 of tool 290 .
- First arm has an upper portion 391 c that terminates with curved handle 406 .
- Curved handle 406 has projection 403 extending therefrom to engage a ratchet bar extending from second arm 392 .
- Arm 391 has a vertical extension 391 b extending between lower portion 391 a and upper portion 391 c .
- Angle B 2 is formed between lower portion 391 a and vertical portion 391 b .
- Angle B 1 is formed between vertical portion 391 b and upper portion 391 c .
- Vertical portion 391 b as a region of reduced thickness 399 for connection with second arm 392 .
- Second arm 392 has a lower portion 392 a forming angle B 1 with second foot 394 .
- Second foot 394 has a recess (not shown) for receiving pin 170 and is similar to recess 293 of tool 290 described above.
- Second arm 392 has an upper portion 392 c that terminates with handle 405 .
- Upper portion 392 c has ratchet bar 401 with serrations 404 .
- Ratchet bar 401 is pivotally coupled to arm 392 and spring-biased towards projection 403 .
- Ratchet bar 401 is similar to ratchet bar 301 , but is preferably curved along its length to accommodate the angular offsets in arms 391 , 392 while maintaining engagement between ratchet bar 401 and projection 403 .
- Arm 392 has a vertical extension 392 b extending between lower portion 392 a and upper portion 392 c .
- Angle B 2 is formed between lower portion 392 a and vertical portion 392 b .
- Angle B 1 is formed between vertical portion 392 b and upper portion 392 c .
- Vertical portion 392 b as a slot 395 of receiving reduced thickness portion 399 of vertical portion 391 b , where first and second arms are pivotally coupled via a pin (not shown.)
- angle B 1 is about 120 degrees and angle B 2 is about 150 degrees.
- other angular offsets in first and second arms of compression tools 190 , 290 are also contemplated herein as would occur to those skilled in the art.
- FIGS. 23-30 there will now be described methods and instrumentation for drilling holes into the vertebrae in order to secure the plate to the vertebrae with bone engaging fasteners extending through the plate and into the drilled holes.
- the methods and instrumentation of FIGS. 23-30 have application with the anterior cervical plates described herein, it is also contemplated that the methods and instrumentation have application with plates secured to other areas of the spine, and also with plates secured to other locations on the vertebrae, such as the lateral, posterior, and antero-lateral aspects of the vertebrae.
- the drill guide of the present invention is described with respect to a plate P oriented with slot SL over upper vertebra V 2 as shown in FIGS. 29 and 30 , it is further contemplated the drill guide has application with a plate having one or more slots over one of or both of vertebrae V 1 and V 2 .
- Drill guide 500 having a proximal handle 502 coupled to a distal guiding portion 504 .
- Drill guide 500 has a distal end 503 that is positioned in slots SL of plate P with plate P aligned over a portion of a bony structure, such as vertebrae V 1 , V 2 and V 3 as shown in FIG. 29 .
- Plate P is to be secured to the bone with bone engaging fasteners, such as discussed above with respect to bone screw 50 ; however, any suitable bone engaging fastener is contemplated.
- Drill guide 500 enables the surgeon to attain the desired orientation and positioning to drill, and if desired or necessary, tap holes through slot SL into the bone into which bone engaging fasteners are to be inserted to engage the plate therewith.
- Guiding portion 504 includes a first guide member 506 and a second guide member 508 interconnected by a connecting member 510 at proximal ends 507 , 509 .
- Each guide member 506 , 508 has a distal portion 511 , 513 ( FIG. 26 ) respectively.
- the present invention further contemplates a guiding portion that includes only one guide member.
- First guide member 506 includes a passage 520 extending along central axis C 2
- second guide member 508 includes a passage 522 extending along central axis C 3 . Passages 520 , 522 are configured such that a drill bit may be passed therethrough and guided to its proper position and orientation through plate P and engaged to vertebra V 2 shown in FIG. 29 .
- Central axes C 2 and C 3 are oriented such that holes drilled through guide portions 506 , 508 converge in the vertebral body below plate P at an angle E 1 .
- angle E 1 is 12 degrees to orient each hole and fastener at a 6 degree angle with respect to central axis C 1 ; however, other convergence angles E 1 are also contemplated.
- guide members 506 , 508 could be oriented such that holes drilled through guide members 506 , 508 diverge below plate P.
- Handle 502 extends proximally from connecting member 510 such that its central axis C 1 is centered between guide members 506 , 508 .
- Handle 502 includes a distal portion 512 extending from connecting member 510 that has a central axis C 4 forming angle E 2 with axes C 2 , C 3 of guide members 506 , 508 .
- a central member 514 extends from distal portion 510 and has central axis C 1 forming angle E 3 with axis C 4 .
- a proximal portion 516 having a gripping portion 518 extends from central member 514 and has a central axis C 5 forming angle E 4 with axis C 1 .
- Angles E 2 , E 3 , and E 4 offset handle 502 from the proximal end openings of guide members 506 , 508 to provide the surgeon clear access for inserting the drill therethrough.
- angle E 2 is 102 degrees
- angle E 3 is 58 degrees
- angle E 4 is 122 degrees.
- angle E 2 provides a 12 degree cephalad angle for the drilled hole if the slot is positioned over the upper vertebra V 2 , or a 12 degree caudal angle for the drilled hole if the slot is positioned over a lower vertebra V 1 .
- handle 502 is not offset from the proximal end openings guide members 506 , 508 .
- Passage 520 has an upper portion 520 a sized to allow passage of at least a portion of the drill therethrough. Passage 520 further includes a lower portion 520 b sized to closely fit with the drill bit to help maintain its proper alignment through guide member 506 . It is contemplated that the height H 3 of lower portion 520 b is great enough to receive a length of the drill bit to ensure it is properly oriented with respect to vertebra V 2 before the hole is drilled in vertebra V 2 . Passage 522 similarly includes an upper portion 522 a and lower portion 522 b .
- Rims 520 c , 522 c are formed in each drill guide between the upper and lower portions of passages 520 , 522 , respectively, and can serve as or contact a depth stop on the drill to limit penetration depth of the drill bit into the vertebral body.
- the proximal ends of guide members 506 , 508 could similarly function to contact or act as a depth stop.
- Guide member 506 further includes a main body portion 532 that extends from proximal end 507 to an intermediate portion 528 .
- Intermediate portion 528 extends about lower portion 520 b of passage 520 and has a width in the direction of the slot width that is less than that of main body portion 532 .
- Intermediate portion 528 is sized such that it can be positioned in a recess extending around the plate slot SL without passing through slot SL ( FIG. 30 .)
- a slot engaging portion 530 also extends about lower portion 520 b of passage 520 and further extends from intermediate portion 528 to distal end 534 of guide member 506 .
- Slot engaging portion 530 has a width in the direction of the slot width that is less than that of intermediate portion 528 .
- Slot engaging portion 538 is sized to reside in plate slot SL and in contact with the slot sidewalls with distal end 534 in close proximity to or in contact with the bone underlying plate P.
- Guide member 508 similarly includes a main body portion 538 that extends from proximal end 509 to an intermediate portion 536 .
- Intermediate portion 536 extends about lower portion 522 b of passage 522 and has a width in the direction of the slot width that is less than that of main body portion 538 .
- Intermediate portion 536 is sized such that it can be positioned in a recess extending around the plate slot SL without passing through slot SL ( FIG. 30 .)
- a slot engaging portion 538 also extends about lower portion 522 b of passage 522 and also extends from intermediate portion 536 to the distal end 540 of guide member 508 .
- Slot engaging portion 538 has a width in the direction of the slot width that is less than that of intermediate portion 536 .
- Slot engaging portion 538 is sized to reside in plate slot SL in contact with the slot sidewalls such that distal end 540 is in close proximity or in contact with the bone underlying plate P.
- Guide member 506 includes a medial notch 524 formed therein extending proximally from distal end 534 .
- Guide member 508 similarly includes a medial notch 526 formed therein extending proximally from distal end 540 .
- Medial notches 524 , 526 are oriented toward one another, and are sized to accommodate a fastener retaining member therebetween, such as the washers for the retaining assemblies described above, so that guide members 506 , 508 do not interfere with movement of the washer along plate P. It is also contemplated that guide members 506 , 508 are provided without notches 524 , 526 .
- Guide member 506 includes an offset portion 542 that extends along intermediate portion 528 and slot engaging portion 530 . Offset portion 542 extends along a side of guide member 508 such that it is positionable against either the upper end or the lower end of slot SL when placed therein. In the illustrated embodiment of FIGS. 29-30 , offset portion 542 is positioned in contact with upper end SL 2 of slot SL.
- Offset portion 542 has a contact surface 543 curved in a plane that extends partially about passage 520 as shown in FIG. 28 . As shown in FIG. 27 , contact surface 543 of offset portion 542 is at least partially coplanar with the exterior surface of main body portion 532 such that contact surface 543 forms an extension of this exterior surface. Contact surface 543 defines a curve having an offset center 544 and a radius R 3 measured from offset center 544 . Offset center 544 is located along an axis C 5 that extends in the direction of the longitudinal axis SL 1 of slot SL ( FIG. 30 .) Axis C 5 also extends though the center 546 of passage 520 , intersecting axis C 2 . Offset center 544 is offset from passage center 546 by a distance d 3 . In one specific embodiment, distance d 3 is 0.95 millimeters and R 3 is 2.05 millimeters.
- plate P is placed over vertebrae V 1 , V 2 and V 3 with holes HL aligned over vertebra V 1 and slots SL aligned over vertebra V 2 . Holes are drilled through holes HL and into vertebra V 1 using known drill guiding instruments. Bone engaging fasteners are inserted through holes HL and into the drilled holes to secure plate P to vertebra V 1 . Drill guide 500 is then placed in slots SL as shown in FIGS. 29 and 30 with contact surface 543 against upper end SL 2 of slot SL.
- Offset portion 542 spaces the adjacent edge of the hole drilled in vertebra V 2 from the upper end SL 2 of each slot SL so that a bone engaging fastener inserted therein is spaced a distance d 4 from upper end SL 2 .
- this offset distance d 4 is about 1.50 millimeters, however, offset distances of 1 millimeter more are also contemplated.
- the holes are then drilled through guide members 506 , 508 of drill guide 500 using manual or power drilling tools. Bone engaging fasteners are then inserted through slots SL and into the offset holes drilled in vertebra V 2 , and are thus spaced a distance d 4 from the upper end SL 2 of slot SL.
- the plate P With the opposite end of plate P fixed to vertebra V 1 , and bone engaging fasteners offset in slots SL between its upper and lower ends, the plate P allows post-operative settling of the spinal columns segment and also accommodates extension of the spinal column segment, which is thought to improve the environment for fusion incorporation of an interbody device in disc space D 2 and/or D 1 . Further, the surgeon can either distract or compress the spinal column segment as desired since the bone engaging fasteners have space to move in either direction in slots SL.
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Abstract
The present invention is directed to a drill guide and methods of using a drill guide with a plate having at least one slotted hole extending therethrough. The drill guide positions a bone engaging fastener away from the ends of the slot, allowing compression or distraction of the bony segment to which the plate is attached.
Description
- The present application is a continuation-in-part of U.S. patent application Ser. No. 09/417,402 filed Oct. 13, 1999, pending.
- The present invention relates generally to the field of instrumentation and systems for the spine, and more particularly to instrumentation and systems for use in engaging plates to the spine.
- Bony structures are subject to defects and trauma which require a plate to be secured thereto in order to stabilize the bony segment as it heals or fuses. For example, the spine is subject to various pathologies that compromise its load bearing and support capabilities. Such pathologies of the spine include, for example, degenerative diseases, the effects of tumors and, of course, fractures and dislocations attributable to physical trauma. Spinal surgeons have addressed these problems using a wide variety of instrumentation in a broad range of surgical techniques. The use of elongated rigid plates has been helpful in the stabilization and fixation of the lower spine, most particularly in the thoracic and lumbar spine. These same plating techniques have found some level of acceptance by surgeons specializing in the treatment of the cervical spine.
- Many spinal plating systems have been developed in the last couple of decades to address some of the needs and requirements for spinal and other bony segment fixation systems. However, even with the more refined plating system designs, there still remains a need for a system that effectively addresses the requirements for such a system. For example, there remains a need for systems and methods for inserting bone engaging fasteners which allow compression and extension of the bony segment to which the plate is attached after the fasteners are inserted. The present invention is directed to satisfying these needs, among others.
- The present invention provides a drill guide for forming holes through a plate in a vertebra into which bone engaging fasteners are inserted to engage the plate to the vertebra. The drill guide positions the bone engaging fastener away from the ends of a slotted hole through plate.
- The present invention also provides a bone fixation system that includes a plate and a drill guide. The plate includes at least one slotted hole extending therethrough. The drill guide is positionable on the plate such that a hole drilled through the drill guide spaces the screw from the ends of the slotted hole.
- The present invention further provides methods for securing a plate to upper and lower vertebrae of a spinal column segment. The plate is fixed to one of the vertebra. A bone engaging fastener engaged to the other vertebra is positioned away from the ends of a slot extending through the plate. The fastener can thus accommodate extension and post-operative settling of the spinal column segment surgeon selectively applies either a compression or distraction load to the spinal column segment with the plate secured to the spinal column segment by the bone engaging fastener.
- These and other forms, embodiments, aspects, features, objects of the present invention will be apparent from the following description.
-
FIG. 1 is a top perspective view of an anterior plating system according to the present invention. -
FIG. 2 is a top perspective view of the anterior plating system ofFIG. 1 with the bone screws locked in place. -
FIG. 3 is a top perspective view of the anterior plating system ofFIG. 1 with bone screws translated in a slot of the plate. -
FIGS. 4( a)-4(f) are top plan views of fixation plates of the present invention provided in different sizes and configurations. -
FIGS. 5( a)-5(f) are top plan views of washers of the present invention provided in sizes and configurations corresponding to the plates inFIGS. 5( a)-5(f). -
FIG. 6 is a side elevational view of a bone screw according to one aspect of the present invention. -
FIG. 7 is a side elevational view of a locking fastener according to another aspect of the present invention. -
FIGS. 8( a)-8(k) are various views and sections of washers according to the present invention. -
FIG. 9 is a top plan view of a first end of the fixation plate of the present invention. -
FIG. 10 is a cross-sectional view taken through line 10-10 ofFIG. 9 . -
FIG. 11 is an end elevational view of the plate ofFIG. 9 . -
FIG. 12 is a top plan view of a second end of the fixation plate of the present invention. -
FIG. 13 is a cross-sectional view taken along line 13-13 ofFIG. 12 . -
FIG. 14 is an enlarged cross-sectional view taken through line 14-14 ofFIG. 12 . -
FIG. 15 is a top plan view of an intermediate portion of the fixation plate of the present invention. -
FIG. 16 is a cross-sectional view taken through line 16-16 ofFIG. 15 . -
FIG. 17 is an enlarged cross-sectional view taken through line 17-17 ofFIG. 15 . -
FIG. 18 is an enlarged cross-sectional view taken through line 18-18 ofFIG. 15 . -
FIG. 19 a is a partial sectional view of the anterior plate assembly of the present invention with the screws disposed through the holes at the first end of the plate and engaged in a vertebra. -
FIG. 19 b is a partial sectional view of the anterior plate assembly of the present invention with the screws disposed through the slots of the plate and engaged in a vertebra. -
FIGS. 20( a)-20(f) illustrate various instruments and steps of a method according to another aspect to the present invention. -
FIGS. 21( a)-21(c) are various perspective views of a compression tool according to yet another aspect of the present invention. -
FIGS. 22( a)-22(b) are side elevational views of the arms of an alternate embodiment compression tool. -
FIG. 23 is a side elevational view of a drill guide according to another aspect of the present invention. -
FIG. 24 is a top plan view of the drill guide ofFIG. 23 . -
FIG. 25 is a front elevational view of the drill guide ofFIG. 23 . -
FIG. 26 is an enlarged front elevational view of a distal portion of the guide members forming a portion of the drill guide ofFIG. 23 . -
FIG. 27 is a medial side elevational view of the distal portion of one of the guide members ofFIG. 26 looking in the direction of arrows 27-27 ofFIG. 26 . -
FIG. 28 is a cross-sectional view taken through line 28-28 ofFIG. 27 . -
FIG. 29 is a top perspective view of the drill guide ofFIG. 23 positioned on a plate located on a spinal column segment. -
FIG. 30 is an enlarged bottom perspective view of the plate and drill guide ofFIG. 29 . - For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended. Any alterations and further modifications in the illustrated devices, and any further applications of the principles of the invention as illustrated herein, are contemplated as would normally occur to one skilled in the art to which the invention relates.
- A
plating system 30 having application in an anterior approach to the cervical spine is depicted inFIGS. 1-3 . The portion of the spine is shown schematically inFIG. 1 to include a first vertebra V1, a second vertebra V2, and intermediate vertebrae V3 and V4. Preferably, first vertebra V1 is the inferior or bottom vertebra in the portion of the spinal column and the second vertebra V2 is the superior or top vertebra of the portion of the spinal column. However, it is also contemplated herein that first vertebra V1 is the superior vertebra and that second vertebrae V2 is the inferior vertebra. It should also be understood that, as described below, the present invention has application with spinal column portions that include vertebrae ranging in number from two to six vertebrae. One or more implants I may be placed into one or more of the disc spaces between adjacent vertebrae as needed. Implant I may be a bone graft, fusion device, or any other type of interbody device that is insertable into a disc space and promotes fusion between adjacent vertebrae. - In accordance with the present invention, the
plating system 30 includes anelongated plate 31 having a number of openings therethrough and a number of bone engaging fasteners, shown in the form of bone screws 50, that are insertable through the openings. In a preferred form, each bone engaging fastener is in the form of a bone screw.Plate 31 has a longitudinal axis L extending along the length of the plate at its centerline. Bone engaging fasteners or bone screws 50 are held inplate 31 by way of aretainer assembly 33 positioned along axis L. The openings ofelongated plate 31 include a pair ofholes 34 atfirst node 36 adjacent a first end ofplate 31.First node 36 is positioned over first vertebra V1.Plate 31 also includes a pair ofslots 35 at asecond node 37 adjacent a second end ofplate 31.Second node 37 is positioned over second vertebra V2. In some forms ofplate 31, severalintermediate nodes 38 are provided along the length of theplate 31 betweenfirst node 36 andsecond node 37. Eachintermediate node 38 includes a pair ofintermediate slots 32 positioned over a corresponding one of the intermediate vertebrae V3 and V4.Plating system 30 can be fabricated from any type of biocompatible material. - It is preferred that holes 34 are paired with one of the holes of the pair on one side of the longitudinal axis L and the other hole of the pair on the opposite side of
axis L. Slots holes 34 are identical in shape and size, and are located symmetrically about the axis L. Pairedslots 35 are also identical in shape and size, and are located symmetrically about the axis L. The pairedslots 32 atintermediate nodes 38 are also identical in shape and size, and are located symmetrically about theaxis L. Plate 31 includes recesses between each ofnodes Plate 31 has a length selected by the surgeon withnodes nodes 38 to register with the patient vertebrae. -
Plate 31 preferably includes a roundedupper surface 41 that is in contact with the soft tissue surrounding the spine when the plate is engaged to the spine. Roundedsurface 41 reduces the amount of trauma that would be experienced by the surrounding soft tissue. Thebottom surface 42 ofplate 31 is preferably configured to contact the vertebral bodies of the spine at each of the instrumented levels. In one embodiment, at least a portion ofbottom surface 42 can be textured along the length of the plate to enhance its grip on a vertebral body. -
Holes 34 include arecess 45 adjacent the top surface ofplate 31 that allow the head of the bone engaging fastener, such asbone screw 50, to be countersunk inplate 31. Similarly,intermediate slots 32 include arecess 46 around eachslot 32 adjacent top surface of the plate, andslots 35 include arecess 47 around eachslot 35 adjacent the top surface of the plate. Preferably,slots 35 include aramp 60 that, as described further below, allows a dynamic compression load to be applied to the spinal column portion upon insertion ofscrew 50 atsecond end 43 ofslot 35.Recesses screw 50 to be countersunk inplate 31 when inserted through a corresponding one of theslots groove 39 extends along axis L ofplate 31 and intersects with each ofrecesses groove 39. The end ofplate 31 atsecond node 37 includes anotch 40, which is preferably rounded with a radius R4 centered on axis L (FIG. 12 .) -
Retainer assembly 33 includes awasher 90 having a length that substantially corresponds to the length ofplate 31.Washer 90 defines a plurality ofapertures 91. Eachaperture 91 is provided at abody portion vertebral nodes portion 98 extends between and connectsbody portions apertures 91 has acountersink 92 extending therearound adjacent to the top surface ofwasher 90. As described more fully below, countersink 92 is tapered from a first width at the first end ofaperture 91 to a second width at the second end ofaperture 91, the first width being greater than the second width. Locking fasteners, shown in the form ofscrews 85, are positionable, each through a corresponding one of theapertures 91, to engage a fastener bore 70 (seeFIGS. 4( a)-4(f)) inplate 31 andcouple washer 90 to plate 31. - Consequently,
retainer assembly 33 retainsscrews 50 placed into the vertebral bodies at each of the instrumented levels.Washer 90 is translatable from an unlocked position (FIG. 1 ) for bone screw insertion to a locked position (FIG. 2 ) after screw insertion to contact the head of the bone screws inholes 34 and overlap the heads of bone screws inslots washer 90 does not contact the heads of bone screws inslots slots washer 90. Preferably,washer 90 resides almost entirely withingroove 39 ofplate 31 to minimize the overall height of the construct. - As shown in
FIG. 1 ,retainer assembly 33 is in an unlocked condition withscrews 85 at the second end ofapertures 90. In the unlocked condition,body portions washer 90 do not overlapholes 34 and a portion ofslots Narrowed portions 98 ofwasher 90 allowbone screws 50 to be placed throughholes 34 andslots 35 to secureplate 31 to the vertebrae V1 and V2. If desired, the surgeon can also place bone screws 50 inintermediate slots 32 to secureplate 31 to vertebrae V3 and V4 as deemed necessary.Plate 31 and bone screws 50 preferably interface inholes 34 such that rigid fixation ofplate 31 to the first vertebra V1 is achieved.Slots 35 are positioned over second vertebra V2, and include asecond end 43 and afirst end 44. As shown inFIG. 1 , screw 50 is initially is inserted atsecond end 43 ofslot 35, allowing subsequent translation ofscrew 50 inslot 35 fromsecond end 43 tofirst end 44. For the purposes of clarity, only asingle screw 50 is shown inslot 35; however, it is contemplated that bone screws are inserted in bothslots 35. Bone screws 50 inserted inintermediate slots 32 also translate from thesecond end 48 to first end 49 (FIG. 15 ) ofslot 32. - Once screws 50 are placed through
holes 34 and inslots washer 90 ofretainer assembly 33 may be translated to its locked condition shown inFIG. 2 . In the locked condition,body portions washer 90 retain the heads of the inserted screws 50 inholes 34 andslots plate 31. In order to translate theretainer assembly 33 to its locked condition, lockingscrew 85 is threaded into a corresponding fastener bore 70 inplate 31. This downward threading of lockingscrew 85 causes the taperedcountersink 92 ofwasher 90 to ride along the head of lockingscrew 85 until lockingscrew 85 contacts the first end ofaperture 91. This translateswasher 90 along axis L to its locked condition, where thewasher 90 retains bone screws 50 inplate 31. - Bone screws 50 are allowed to translate within
slots 35 andintermediate slots 32 from the second end of the slots to the first end of the slots whileretainer assembly 33 retains bone screws 50 inplate 31 and prevents screw backout. As shown inFIG. 3 , the screw positioned inslot 35 has translated fromsecond end 43 tofirst end 44. The translation ofscrew 50 is limited by contact ofscrew 50 withfirst end 44. The amount of translation may also be controlled by providing bone screws inintermediate slots 32. Thus, the amount of translation of the spinal column segment can be limited by the length ofslots - Referring now to
FIGS. 4( a)-4(f) andFIGS. 5( a)-5(f), several embodiments ofelongated plate 31 andwasher 90 are depicted. It is understood that theanterior plating system 30 according to the present invention can be readily adapted for fixation to several vertebrae by modifying the length ofplate 31 and the number and arrangements ofholes 34,second slots 35, andintermediate slots 32. Pairedslots holes 34 at each of the vertebrae provide, at a minimum, for at least twobone screws 50 to be engaged into each respective vertebrae. The placement of two or more screws in each vertebral body improves the stability of the construct. It is one object of the present invention not only to provide for multiple screw placements in each vertebral body, but also to provide means for retaining the bone screws inplate 31 to prevent back out or loosening of the screws. The present invention contemplates various specific embodiments for aplate 31 that is provided in lengths that range from 19 millimeters (hereinafter “mm”) to 110 mm, and an overall width of about 17.8 mm. However, other dimensions for the length and width ofplate 31 are also contemplated herein. - The
plate 31 ofFIGS. 1-3 is sized to span four vertebrae and includes afirst node 36, asecond node 37, and twointermediate nodes 38. InFIGS. 4( a) and 5(a),plate 31 a andwasher 90 a are sized span two vertebrae.Plate 31 a hasholes 34 a atfirst node 36 a and holes 34 a atsecond node 37 a.Plate 31 a is provided withwasher 90 a that resides ingroove 39 a and is translatable to retain bone screws inholes 34 a. In this embodiment,plate 31 a provides rigid fixation at each vertebra. A modification ofplate 31 a is depictedFIGS. 4( b) and 5(b). The holes at the second vertebral node are replaced withslots 35 b atsecond node 37 b. Awasher 90 b resides ingroove 39 b and is translatable to retain bone screws inholes 34 b andslots 35 b. -
Plate 31 c andwasher 90 c ofFIGS. 4( c) and 5(c) similarly provide for instrumentation at two vertebrae. Plate 30 c has a recess portion betweennodes Washer 90 c resides ingroove 39 c and is translatable to retain lock screws inholes 34 c andslots 35 c. It should be noted that the plates ofFIGS. 4( a)-4(c) span two vertebrae, and preferably do not includenotch 40 on the second end of that plate as do the plates sized to span three or more vertebrae. -
Plate 31 d andwasher 90 d ofFIGS. 4( d) and 5(d) are provided for instrumentation at three vertebrae.Plate 31 d has firstvertebral node 36 d, secondvertebral node 37 d, andintermediate node 38 d.Washer 90 d resides in groove 39 d and is translatable to retain bone screws inholes 34 d andslots Plate 31 e andwasher 90 e ofFIGS. 4( e) and 5(e) are provided for instrumentation at five vertebrae.Plate 31 e has firstvertebral node 36 e, secondvertebral node 37 e, and threeintermediate nodes 38 e.Washer 90 e resides in groove 39 e and is translatable to retain bone screws inholes 34 e andslots Plate 31 f andwasher 90 f ofFIGS. 4( f) and 5(f) are provided for instrumentation at six vertebrae.Plate 31 f has firstvertebral node 36 f, secondvertebral node 37 f, and fourintermediate nodes 38 f.Washer 90 f resides ingroove 39 f and is translatable to retain bone screws inholes 34 f andslots - Referring now to
FIG. 6 , the details of bone engaging fastener or screw 50 are shown.Bone screw 50 is preferably configured for engagement in the cervical spine, and includes threadedshank 51 that is configured to engage a cancellous bone of the vertebral body. The threaded shank may be provided with self-tapping threads, although it is also contemplated that the threads can require prior drilling and tapping of the vertebral body for insertion ofscrew 50. It is preferred that the threads onshank 51 define a constant outer diameter d2 along the length of the shank. It is also preferred thatshank 51 has a root diameter that is tapered along a portion of the length of the shank and increases from the tip ofshank 51 to a diameter d1 at an intermediate orcylindrical portion 52. -
Intermediate portion 52 extends betweenshank 51 and ahead 54 ofscrew 50. The threads onshank 51 extend intoportion 52 by a thread run out 53. According to standard machining practices,cylindrical portion 52 includes a short segment that does not bear any threads. This segment ofcylindrical portion 52 interfaces or contacts with a plate thickness athole 34 orslot bone screw 50 extends. This short segment has an outer diameter d1. Thehead 54 ofscrew 50 includes atool recess 55 configured to receive a driving tool. In one specific embodiment,tool recess 55 is a hex recess, or in the alternative, any type of drive recess as would occur to those skilled in the art.Head 54 includes a truncated or flattenedtop surface 56 having a diameter d4. Aspherical surface 57 extends fromcylindrical portion 52 to ashoulder 59.Shoulder portion 59 has a diameter d5. Aninclined surface 58 extends betweenshoulder 59 and truncatedtop surface 56.Inclined surface 58 forms an angle A1 withtop surface 56. - It is contemplated that
screw 50 may be provided withshank 51 having a length that varies from about 10 mm to about 24 mm. In one specific embodiment ofscrew 50, the threads have diameter d2 of about 4.5 mm. In another specific embodiment, the diameter d2 is about 4.0 mm. In both specific embodiments,cylindrical portion 52 has a diameter d1 of about 4.05 mm.Cylindrical portion 52 has an unthreaded segment with a height h1 that is determined by standard machining practices for thread run-out between a shank and screw head. Height h1 and diameter d1 ofcylindrical portion 52 are sized to achieve a snug fit betweenscrew 50 andplate 31 inhole 34 orslot Head 54 is provided with height h2, outer diameter d5 atshoulder 59, diameter d4 attop surface 56, andinclined surface 54 angle A1 such that thehead 54 is nested within its correspondingslot hole 34 and recessed below the top surface of the plate. Although reference has been made to specific dimensions in this specific embodiment, it should be understood that the present invention also contemplates other dimensions and configurations forscrew 50. It should also be understood that bone screws used to secureplate 31 can each have a different length and diameters associated therewith, and need not correspond exactly to the other bone engaging fasteners used in the construct. - The details of locking
screw 85 are provided inFIG. 7 . Lockingscrew 85 includes ashank 86 having machine threads thereon. In one specific embodiment, lockingscrew 85 terminates in asharp point 88 that permits penetration into the vertebral body when lockingscrew 85 is secured in threaded fastener bore 70.Head 87 includes a lowerconical surface 89 configured to mate withaperture 91 ofwasher 90.Head 87 further includes atool recess 87 a for receiving a driving tool therein. - Further details and embodiments of
washer 90 ofretainer assembly 33 are provided inFIGS. 8( a)-8(k).Washer 90 includessecond body portion 95,first body portion 93, and if necessary, one or moreintermediate body portions 94. A connectingportion 98 extends between and connects each of thebody portions Washer 90 has atop surface 100 a and abottom surface 100 b. Eachbody portion aperture 91 extending betweentop surface 100 a andbottom surface 100 b.Aperture 91 has a taperedcountersink portion 92 therearound adjacenttop surface 100 b.Aperture 91 allows passage ofshank 86 of lockingscrew 85 therethrough, and countersink 92 is preferably configured to mate withconical surface 89 andseat locking screw 85 at various positions along the length ofaperture 91. Preferably, countersinkportion 92 is sloped towardbottom surface 100 b fromsecond end 97 tofirst end 96. The mating conical features between lockingscrew 85 andaperture 91 provide a self-translating capability forwasher 90 relative to plate 31 as lockingscrew 85 is tightened into fastener bore 70 ofplate 31. -
Body portions portion 98. The width W1 and length ofbody portions recess 45 ofholes 34 and recesses 46, 47 ofslots body portions plate 31 whenwasher 90 resides ingroove 39 and is in the locked condition ofFIG. 2 . The width W2 and the length of the connectingportions 98 are configured to allow insertion of screws inholes 34 andslots washer 90 is in the unlocked condition ofFIG. 1 . - In
FIGS. 8( a) and 8(b) there is shownsecond body portion 95 ofwasher 90.Aperture 91 has countersinkportion 92 that is tapered along the length ofaperture 91.Aperture 91 has a width W3 atbottom surface 100 b ofwasher 90.Countersink portion 92 has a width that varies along the length ofaperture 91 and is greater than width W3.Countersink portion 92 has a radius R1 atsecond end 97 and a radius R2 atfirst end 96 attop surface 100 a. It is preferred that R1 is less than R2 and the width ofcountersink portion 92 increases fromsecond end 97 towardsfirst end 96.Aperture 91 has a chord length S1 extending between the center of radius R1 and the center of radius R2.Body portion 95 further includes atransition portion 99 that extends between connectingportion 98 andbody portion 95. -
Intermediate body portion 94 ofFIGS. 8( c) and 8(d) is similar in many respects tosecond body portion 95 ofFIGS. 8( a) and 8(b), and also includes anaperture 91 having a taperedcountersink portion 92. However,intermediate body portion 94 has a connectingportion 98 extending in both directions therefrom. Asecond transition portion 98 a extends between second connectingportion 98 andbody portion 94.Body portion 94 has a chord length S1 between the center of radius R1 and the center of radius R2. -
Tapered countersink 92 ofaperture 91 provides a self-translating capability of thewasher 90. This is because thewasher 90 is translated relative to plate 31 as the lockingscrew 85 is threaded into threadedbore 70. The cammingconical surface 89 ofscrew 85 advances downward along the tapered portion of the wall ofcountersink portion 92 ofaperture 91. -
FIGS. 8( e) and 8(f) showfirst body portion 93.First body portion 93 is also similar tosecond body portion 95. However, in one embodiment,first body portion 93 includes anaperture 91′ having acountersink portion 92′ that is not tapered along its length to provide a self-translating capability forwasher 90 like thecountersink portions 92 ofbody portions washer 90 is translated relative to plate 31 as described above, lockingscrew 85 will already be positioned atfirst end 96′, and may thereafter be threaded intobore 70 and seated withincountersink portion 92′. Alternatively, the surgeon may slide the washer by hand or with a tool to its translated position, and lock the washer in its translated position by seating lockingscrew 85 intocountersink 92′ atfirst end 96′.Countersink 92′ has a definite location atsecond end 96′ forseating locking screw 85, providing a reference for the surgeon to confirm thatwasher 90 has been translated to its locked position. It should be understood, however, that it is also contemplated herein thatbody portion 93 could also be provided withaperture 91 likebody portions FIGS. 1-3 . - Referring now to
FIG. 8( g), a cross-sectional view ofwasher 90 is provided throughaperture 91 ofbody portion Washer 90 has anouter surface 104 configured to overlap bone screws 50 inslots inclined surface 58 ofscrews 50 whenretainer assembly 33 is in its locked condition.Outer surface 104 extends frombottom surface 100 b to ashoulder 103.Shoulder 103 extends betweeninclined surface 104 andtop surface 100 a.Inclined surface 104 forms an angle A2 with respect tobottom surface 100 b.Washer 90 defines a thickness t1 betweentop surface 100 a andbottom surface 100 b, and a shoulder height of t2 frombottom surface 100 b.Washer 90 has a width W7 alongbottom surface 100 b ataperture 91. - Referring now to
FIG. 8( h), a cross-sectional view ofwasher 90 is provided throughaperture body portion 93.Washer 90 hascontact surface 106 configured to contactinclined surface 58 ofscrews 50 whenretainer assembly 33 is in its locked condition.Contact surface 106 extends frombottom surface 100 b to ashoulder 105.Shoulder 105 extends betweencontact surface 106 andtop surface 100 a.Contact surface 106 forms an angle A3 with respect tobottom surface 100 b that is configured to mate with and provide surface contact withinclined surface 58 ofbone screw 50.Washer 90 defines a thickness t3 betweentop surface 100 a andbottom surface 100 b, and a shoulder height of t4 frombottom surface 100 b. - In one specific embodiment of the
washer 90, the body portions have a width W1 and connecting portion have width W2 that is based on the spacing between the centerlines of the paired slots and holes of the plates and the overall width of the plate. The width W3 ofaperture 91 in the specific embodiment is sized to accommodate theshank 86 of lockingscrew 85 withouthead 87 passing therethrough. The length ofbody portions slots plate 31. Preferably, thebody portions slot retainer assembly 33 is in its locked position. The taperedcountersink portion 92 ofaperture 91 has radius R1 that transitions to radius R2 along the chord length S1. Thickness t1 is less than thickness t3, and shoulder height t4 is less than shoulder height t2.Body portion 93 has a width W8 alongbottom surface 100 b that is greater than width W7 ofbody portions washer 90 are preferably arranged so thatbody portions slots slots Body portion 93 contacts the screw heads nested inholes 34 to further enhance the fixed orientation betweenscrews 50 andplate 31 inholes 34. Although reference has been made to the dimensional attributes of this specific embodiment, it should be understood that the present invention also contemplates other orientations and dimensional relationships forwasher 90. - The present invention also contemplates a retainer assembly in which individual washers are provided at each node for retaining screws in
holes 34 andslots plate 31. Referring now toFIGS. 8( i) and 8(j), aslot washer 195 and ahole washer 193 are provided.Slot washer 195 is similar tobody portion 95 ofwasher 90 andhole washer 193 is similar tobody portion 93 ofwasher 90, both of which are described above. Elements that are alike bear the same reference number as the corresponding element ofbody portions Slot washer 195 andhole washer 193 do not have a connectingportion 98 extending to another washer.Slot washer 195 has abody portion 198 with a length S2 that varies and is sized to correspond to the length of theadjacent slot washers 195 are positioned onplate 31.Slot washer 195 does not have a connectingportion 98 extending to another washer.Hole washer 193 has abody portion 199 with a length S3 that varies and is sized to correspond to the length of the plateadjacent hole 34 when washer is positioned onplate 31. - In
FIG. 8( k) an alternate embodiment ofwashers Washers 193′, 195′ are the same aswashers aperture 191.Aperture 191 does not have a tapered countersink, but rather has asemi-circular countersink portion 192 only atfirst end 196.Countersink portion 192 provides a single position for lockingscrew 85 to lock thewasher 193′, 195′ to plate 31 after thewasher 193′, 195′ has been translated relative to plate 31 by the surgeon.Washers 193′, 195′ havebody portion 198′, 199′ with length S4 that varies as described above with respect to length S2 and S3. - Referring now to
FIGS. 9-18 , further details ofplate 31 will be discussed with reference to illustrations offirst node 36,second node 37, andintermediate node 38. InFIGS. 9-11 ,first node 36 ofplate 31 is depicted. It is preferred that holes 34 are identical and symmetrical aboutaxis L. Hole 34 includesrecess 45 adjacenttop surface 41.Holes 34 include acylindrical bore 77 having generally vertical sidewalls adjacentbottom surface 42. Cylindrical bore 77 extends betweenrecess 45 andbottom surface 42 ofplate 31, and has a diameter D1. Cylindrical bore 77 hasaxis 72 b that is offset at angle A5 from anaxis 72 a that extends normal to plate 31 as shown inFIG. 10 .Recess 45 has a partialspherical portion 45 a defined about acentral axis 72 b.Axis 72 b is offset fromaxis 72 a by angle A5. Offset angle A5 directs bone screws inserted intoholes 34 toward the first end ofplate 31. Furthermore, as shown inFIG. 11 , axes 72 a converge below thebottom surface 42 ofplate 31 at angle A4 with respect to anaxis 72 c that extends along the centerline ofplate 31 perpendicular toaxis L. Recess 45 intersectsgroove 39 at intersectingportion 45 c.Spherical portion 45 a is configured to mate withspherical surface 57 ofbone screw 50, allowing at least a portion ofhead 54 to be recessed belowtop surface 41 ofplate 31. - To facilitate insertion of drill guides, drills and the bone screws 50,
recess 45 also includes a flaredportion 45 b that extends in a superior direction fromaxis 72 b. In one embodiment,recess 45 includes a wall that parallels bore 77 and extends between betweenspherical portion 45 a and flaredportion 45 b to further facilitate insertion and maintenance of a drill guide inrecess 45. - In one specific embodiment,
spherical portion 45 a has a diameter that mates with the diameter ofspherical surface 57 ofscrew 50, and is slightly larger than diameter d5 ofhead 54 ofbone screw 50. The cylindrical bore 77 ofhole 34 has a diameter D1 of 4.1 mm, which is slightly larger than the diameter d1 ofintermediate portion 52 ofscrew 50. This portion of the screw contacts bore 77 and assumes a fixed orientation with respect toplate 31. In this specific embodiment, offset angle A5 is about 12.6 degrees and convergence angle A4 is about 6 degrees relative toaxis 72 c. Although reference has been made to the dimensional attributes of this specific embodiment, it should be understood that the present invention also contemplates other dimensions. - Referring now to
FIGS. 12-14 , secondvertebral node 37 is depicted.Vertebral node 37 includesslots 35 that are preferably identical and symmetrical aboutaxis L. Slot 35 includes slotted bore 78adjacent bottom surface 42 ofplate 31 having generally vertical sidewalls extending betweensecond end 43 andfirst end 44. Slotted bore 78 extends betweenbottom surface 42 andrecess 47 adjacenttop surface 42.Bore 78 has a width W5 and a chord length S4, and has acentral axis 75 b extending throughplate 31.Recess 47 has aspherical portion 47 a aboutcentral axis 75 b that extends aroundslot 35. As shown inFIG. 13 ,central axis 75 b is offset from axis 75 a that extends normal to plate 31 by angle A5. Offset angle A5 directs bone screws inserted intoslot 35 towards the second end ofplate 31. It should be noted thatslot 35 allows insertion of a bone screw at angles less than A5 inslot 35, andbone screw 50 may be positioned withinslot 35 at any location between ends 43 and 44. However, retainingassembly 33 provides for insertion of bone screws 50 at second 43 as would be clinically desirable for settling. Furthermore, as shown inFIG. 14 , axes 75 b converge below thebottom surface 42 ofplate 31 at angle A4 with respect toaxis 72 c. -
Spherical portion 47 a is configured to mate withspherical surface 57 ofbone screw 50, allowing at least a portion ofhead 54 to be recessed belowtop surface 41 ofplate 31. To facilitate insertion of drill guides, drills and the bone screws 50,recess 47 also includes a flaredportion 47 b that extends aroundspherical portion 47 a. In one embodiment, it is contemplated thatrecess 47 include a wall that parallels bore 78 extending betweenspherical portion 47 a and flaredportion 47 b to further facilitate maintenance and insertion of a drill guide inrecess 47.Recess 47 intersectsgroove 39 atoverlap portion 47 c, as shown inFIG. 14 . The second end ofsecond node 37 includesnotch 40 having radius R4 centered about axis L. It is also contemplated herein thatplate 31 is provided withoutnotch 40, as shown inFIGS. 4( a)-4(c). - In a preferred embodiment,
slot 35 includesramp 60 extending betweenbore 78 and flaredportion 47 b atsecond end 43.Ramp 60 is not configured to allowspherical surface 57 ofscrew 50 to seat therein, but has an orientation that causessecond end 43 ofslot 35 and screw 50 to separate asscrew 50 is threaded intoslot 35.Spherical surface 57 ofhead 54 provides camming action along theramp 60 untilhead 54 seats inrecess 47 at a position spaced a distance fromsecond end 43. This camming action applies a dynamic compression load to the spinal column portion. The amount of compression applied to the spinal column portion is controlled by the length oframp 60 from second 43 to the position inslot 35 wherescrew 50 seats inrecess 47. It should be understood thatslot 35 may also be provided withoutramp 60. - In one specific embodiment,
spherical portion 47 a has a diameter sized to mate withspherical surface 57 ofscrew 50, and is slightly larger than diameter d5 ofhead 54 ofbone screw 50. Slotted bore 78 has a width W5 of about 4.1 mm, which is slightly larger than the diameter d1 ofintermediate portion 52 ofscrew 50. Thecylindrical portion 52 ofbone screw 50contacts plate 31 inbore 78 and prevents rotation ofscrew 50 transverse toaxis 72 c. The chord length S4 varies depending upon the length of theslot 35 needed for the particular application ofplate 31 and patient anatomy. In this specific embodiment, offset angle A5 is about 12.6 degrees and convergence angle A4 is about 6 degrees relative to anaxis 72 c. Although reference has been made to the dimensional attributes of this specific embodiment, it should be understood that the present invention also contemplates other dimensions. - Referring now to
FIGS. 15-17 , various views ofintermediate node 38 are depicted.Vertebral node 38 includesslots 32 that are preferably identical and symmetrical aboutaxis L. Slot 32 includes slotted bore 79adjacent bottom surface 42 ofplate 31 having generally vertical sidewalls extending between asecond end 48 and afirst end 49. Slotted bore 79 extends betweenbottom surface 42 andrecess 46 adjacenttop surface 42.Bore 79 has a width W5 and a chord length S5, and has acentral axis 76 a extending throughplate 31.Recess 46 has aspherical portion 46 a that extends aroundslot 35. As shown inFIG. 16 ,central axis 76 a generally extends normal toplate 31. However, as shown inFIG. 17 , theaxes 76 a converge below thebottom surface 42 ofplate 31 at angle A4 with respect toaxis 72 c. It should be noted thatslot 32 allows insertion of bone screws 50 at various angles with respect toaxis 76 a. -
Spherical portion 46 a is configured to mate withspherical surface 57 ofbone screw 50, allowing at least a portion ofhead 54 to be recessed belowtop surface 41 ofplate 31. To facilitate insertion of drill guides, drills and bone screws 50,recess 46 also includes a flaredportion 46 b that extends aroundspherical portion 46 a. In one embodiment, a wall paralleling bore 79 extends betweenspherical portion 46 a and flaredportion 46 b to further facilitate insertion and maintenance of a drill guide inrecess 46.Screw 50 may be placed withinintermediate slot 32 between ends 48 and 49. However, it is preferred that the screw is inserted initially atsecond end 48, thus allowing compression loading of the spinal column segment.Recess 46 intersectsgroove 39 atoverlap portion 46 c, as shown inFIG. 17 . - In one specific embodiment,
spherical portion 46 a has a diameter sized to mate withspherical surface 57 ofscrew 50, and is slightly larger than diameter d5 ofhead 54 ofbone screw 50. The slotted bore 79 has a width W5 of about 4.1 mm, which is slightly larger than the diameter d1 ofintermediate portion 52 ofscrew 50.Cylindrical portion 52 ofbone screw 50 interfaces withplate 31 inbore 79 such that angular adjustment ofscrew 50 transverse toaxis 72 c is prevented. The chord length S5 varies depending upon the length ofslot 35 needed for the particular application ofplate 31 and patient anatomy. In this specific embodiment, convergence angle A4 is about 6 degrees relative to anaxis 72 c. Although reference has been made to the dimensional attributes of this specific embodiment, it should be understood that the present invention also contemplates other dimensions. - Referring now to
FIG. 18 , a cross-sectional view ofplate 31 is provided through line 18-18 ofFIG. 15 .Groove 39 has a width W6 attop surface 41 ofplate 31.Groove 39 hasbottom surface 73 extending betweeninclined sidewalls 74.Sidewalls 74 extend betweenbottom surface 73 ofgroove 39 andtop surface 41 ofplate 31. It is contemplated that thegroove 39 has a depth sufficient to accommodate thewasher 90 so as to minimize protrusion ofwasher 90 abovetop surface 41 ofplate 31. - To accommodate the anterior application of the
fixation plate assembly 30, the plate is curved in two degrees of freedom. Specifically, thebottom surface 42 of the plate can be curved along a large radius R, centered in a vertebral plane containing central axis L, as shown schematically inFIG. 16 , to accommodate the lordotic curvature of the cervical spine. In addition,bottom surface 42 forms a medial/lateral curvature C, as shown inFIG. 18 , to correspond to the curvature of the vertebral body. It is understood thatplate 31 can also be bent as needed to accommodate the particular spinal anatomy and vertebral pathology. - Referring now to
FIG. 19 a, a partial sectional view offixation plate assembly 30 atholes 34 is provided withscrews 50 engaged to vertebra V1 andretainer assembly 33 in the locked position. A pair ofscrews 50 are disposed within therespective holes 34 so that the threadedshanks 51 project beyond thelower surface 42 ofplate 31 into the vertebral body V1. Theintermediate portion 52 ofscrew 50 extends through thebore 77 of thehole 34.Spherical surface 57 ofhead 54contacts recess 45 ofhole 34 whenscrew 50 is seated therein. Theintermediate portion 52 provides a snug fit forscrew 50 in thebore 77 so thatscrew 50 is not able to pivot with respect toplate 31. - Referring to
FIG. 19 b, a partial sectional view offixation plate assembly 30 atslots screws 50 engaged to vertebra V1 andretainer assembly 33 in the locked position. A pair ofscrews 50 are disposed withinrespective slots shanks 51 project beyondlower surface 42 ofplate 31 into the corresponding vertebral body V2, V3, or V4.Cylindrical portion 52 ofscrew 50 extends throughbores slots Spherical surface 57 ofhead 54 contacts recesses 46, 47 ofslots screw 50 is seated therein.Cylindrical portion 52 provides a snug fit forscrew 50 inbores screw 50 is not able to pivot or translate with respect toaxis 72 c ofplate 31. Of course, screws 50 inserted intoslots slots plate 31 that use variable angle screws capable of assuming universal angular orientation with respect toplate 31 inslots - In order to ensure
screws 50 are retained withinplate 31,retainer assembly 33 is moved to its locked position where it contacts theheads 54 of bone screws 50 inholes 34. Lockingscrew 85 is threaded into threaded fastener bore 70 ofplate 31 to translatewasher 90 from its unlocked position to its locked position, as described above, and to drawcontact surface 106 into contact withinclined surface 58 ofscrew 50 as shown inFIG. 19 a.Contact surface 106 preferably applies a downward force ontohead 54 to firmly seat the screw heads within the plate recesses andfurther fix screw 50 inhole 34. In a preferred embodiment, this downward force is exacted bywasher 90 assurface 106 contacts inclinedsurface 58. As shown inFIG. 19 b,outer surface 104 ofwasher 90 does not contact the heads of bone screws 50 inslots 32, 25.Outer surface 104 overlaps the bone screws 50 to retain bone screws inslots Outer surface 104 will contact the heads of the bone screws if the bone screws backout fromslots bottom surface 100 b ofwasher 90 does not contactbottom surface 73 ofgroove 39. - In a further aspect of the invention, the
retainer assembly 33 may be loosely fixed onplate 31 so the surgeon need not fiddle with applyingretainer assembly 33 to plate 31 during surgical procedures. The lockingfasteners 85 are pre-inserted throughapertures 91 ofwasher 90 and partially threaded into fastener bores 70.Washer 90 is initially positioned such that the second end of eachaperture 91 is positioned adjacent lockingscrew 85. After positioningscrews 50 through the holes and slots ofplate 31, lockingfasteners 85 are advanced further intobores 70 and along taperedportions 92 ofapertures 91 to translatewasher 90 to a locked condition and retainbone screws 50 inplate 31. - As previously mentioned,
sharp point 88 of lockingscrew 85 is preferably configured to penetrate the cortical bone. In one embodiment,sharp point 88 will penetrate the vertebra whenplate 31 is initially positioned on the bone. In this instance, lockingscrew 85 helps locate and temporarily stabilize the plate on the vertebra as the bone screws 50 are engaged to the vertebra. This temporary location feature provided by lockingscrew 85 can also be used to maintain the position ofplate 31 on the vertebra as a drill guide is used to drill and tap the vertebrae to receive bone screws 50. - According to another aspect of the invention, there are provided instruments and techniques for securing
plate 31 to vertebrae of a spinal column segment and for applying a compression load to a graft or implant placed in the spinal column segment. Referring toFIGS. 20( a)-20(f), aguide 150 includes ahandle 152, atemplate 154, andarm 153 extending therebetween. Preferably,arm 153 extends outward from the spine and is bent so that handle 152 parallels the spine, positioning handle 152 out of the way of the surgeon.Template 154 includes asecond end 155 that defines anotch 158.Template 154 also includesfirst end 156 having aprojection 156 a extending downward therefrom towards vertebral body V2.Template 154 further defines a pair ofslots 157 between second end 159 andfirst end 156. - The surgeon selects a
guide 150 with atemplate 154 sized to position notch 158 at the desired location on vertebra V2 and places guideinstrument 150 on vertebral body V2.Notch 158 is located on vertebra V2 by placingprojection 156 a in abutting contact with the endplate of vertebra V2 in discspace D. Slots 157 provide a visual indication to the surgeon of the range of positions available for screw insertion into the vertebral body throughslots 35 ofplate 31. If desired, the surgeon can obtain a desired position or location ofnotch 158 and the desired available range of bone screw positions on vertebra V2 by selecting a guide having a differentsized template 154. - Referring now to
FIG. 20( b), after the notch is in the desired position on vertebra V2, acompression pin 170 is placed into vertebra V2 guided bynotch 158.Pin 170 includes alower end 171 having a threaded portion (not shown) for attachingpin 170 to vertebra V2. The attachment portion is preferably threaded to screw into vertebra V2, but may also be smooth with a spiked tip for insertion into the vertebra. Pin 170 also includestool engagement portion 172 to facilitate installation ofpin 170 to the vertebral body. It is also contemplated that the surgeon can place pin 170 on the vertebral body spaced away fromnotch 158 if desired and the vertebral anatomy so allows. - After
pin 170 is engaged to vertebra V2, guide 150 is removed and asleeve 180 is placed overpin 170 as shown inFIG. 20( c).Sleeve 180 has ahollow body 181 extending between afirst end 186 adjacent vertebra V1 and asecond end 184. Asecond end 174 ofpin 170 preferably extends fromsecond end 184 ofsleeve 180, allowing access to pin 170.Sleeve 180 includesenlarged portion 184 to facilitate placement and removal ofsleeve 180. It is contemplated thatsleeve 180 has hollow interior and an internal configuration that provides secure attachment to pin 170.Body 181 includes cylindricalouter surface 182 with an outer diameter d6. - With
sleeve 180 in its proper position,plate 31 is positioned withnotch 40 in abutting contact withouter surface 182 ofsleeve 180, as shown inFIG. 20( d). The diameter d6 ofsleeve 180 slightly less than the twice the radius ofnotch 40 so thatnotch 40 is nested aroundsleeve 180.Plate 31 is then secured to vertebra V1 by insertingscrews 50 throughholes 34. - With
plate 31 secured to the vertebra V1,sleeve 180 is removed frompin 170, as shown inFIG. 20( e), forming agap 177 betweenpin 170 and notch 40. In a preferred embodiment, it is contemplated thatgap 177 is about 2 mm. However, other sizes forgap 177 are contemplated herein based on the desired compression to be applied. - Referring now to
FIG. 20( f), acompression tool 290 is secured to pin 170 and toslots 32 ofplate 31. It is also contemplated that the compression tool can be secured to plate 31 other than atslots 32 by, for example, engaging the sides ofplate 31.Compression tool 290 has afirst arm 291 with afirst foot 294 connected to pin 170.Second arm 292 is connected to the second end ofslots 32 viaextensions 297 extending fromsecond foot 296.First arm 291 andsecond arm 292 are manipulated by the surgeon to apply a compression load to the spinal column segment. The amount of applied load is limited bygap 177 betweenpin 170 and notch 40. For example, in the specific embodiment wheregap 177 is 2 mm, the spinal column portion is compressed 2 mm. - Bone screws 50 are inserted into
slots 35 withcompression tool 290 maintaining the compression load. Withramp 60 at second 43 ofslot 35, an additional amount of dynamic compression is achieved with screw insertion inslots 35, as described above. Withscrews 50 seated atend 43 ofslots 35,compression tool 290 may be removed without release of the compression load. Additional bone screws may be inserted intointermediate slots 32.Washer 90 may then be translated as described above to retainbone screws 50 inplate 31. It should be note that it is contemplated herein thatcompression tool 290 and pin 170 are preferably only used with plates providing instrumentation at three or more vertebra. However, utilization of a compression tool configured to engage a plate for providing instrumentation at two vertebrae is not precluded. - Referring now to
FIGS. 21( a)-21(c), further details ofcompression tool 290 are provided.Tool 290 hasfirst arm 291 havingfirst foot 294 extending therefrom.First foot 294 definesrecess 293 for receiving thepin 170.Second arm 292 hassecond foot 296 extending therefrom.Second foot 296 includesextensions 297 extending downward therefrom configured to engageintermediate slots 32 ofplate 31.Extensions 297 preferably includerecesses 307 that are configured contact the second ends ofintermediate slots 32. It is also contemplated thatextensions 297 have acurved bottom surface 308 that corresponds to the medial lateral curvature of the vertebral bodies. -
First arm 291 has a reducedthickness portion 299 extending through apassage 295 formed insecond arm 292, and is pivotally coupled tosecond arm 292 withpin 299.First arm 291 hascurved handle portion 306 having aprojection 303 extending therefrom.Second arm 292 has ahandle 305. Aratchet bar 301 is pivotally coupled tosecond arm 292 viacoupling 302. Preferably, ratchetbar 301 is spring-biased towardsprojection 303.Serrations 304 formed on the bottom side ofratchet mechanism 301 provide for selective engagement withprojection 303 onfirst arm 291. - The first and second arms are compressed towards one another to apply the compressive load to the vertebral segment.
Projection 303 engages the serrated bottom ofratchet bar 301 to prevent relaxation of the arms and allows the surgeon to maintain the compression load during insertion of bone screws 50 withinslots 35.Ratchet bar 301 may be lifted against its spring bias away fromarm 291 to disengageratchet bar 301 fromprojection 303.Arms compression tool 290 frompin 170 andplate 31. - While
compression tool 290 has been illustrated and described in detail, the present invention also contemplates other tools capable of being secured betweenpin 170 andplate 31 to provide a compression load to the spinal column segment. For example, referring now toFIGS. 22( a) and 22(b), it is contemplated that a compression tool may include one or more angular modifications tofirst arm 391 andsecond arm 392 to facilitate access toplate 31 andpin 170 at the surgical site.First arm 391 has alower portion 391 a forming angle B1 withfirst foot 396.First foot 396 hasextensions 397 extending therefrom that are similar toextensions 297 oftool 290. First arm has anupper portion 391 c that terminates withcurved handle 406.Curved handle 406 hasprojection 403 extending therefrom to engage a ratchet bar extending fromsecond arm 392.Arm 391 has avertical extension 391 b extending betweenlower portion 391 a andupper portion 391 c. Angle B2 is formed betweenlower portion 391 a andvertical portion 391 b. Angle B1 is formed betweenvertical portion 391 b andupper portion 391 c.Vertical portion 391 b as a region of reducedthickness 399 for connection withsecond arm 392. -
Second arm 392 has alower portion 392 a forming angle B1 withsecond foot 394.Second foot 394 has a recess (not shown) for receivingpin 170 and is similar to recess 293 oftool 290 described above.Second arm 392 has anupper portion 392 c that terminates withhandle 405.Upper portion 392 c hasratchet bar 401 withserrations 404.Ratchet bar 401 is pivotally coupled toarm 392 and spring-biased towardsprojection 403.Ratchet bar 401 is similar to ratchetbar 301, but is preferably curved along its length to accommodate the angular offsets inarms ratchet bar 401 andprojection 403.Arm 392 has avertical extension 392 b extending betweenlower portion 392 a andupper portion 392 c. Angle B2 is formed betweenlower portion 392 a andvertical portion 392 b. Angle B1 is formed betweenvertical portion 392 b andupper portion 392 c.Vertical portion 392 b as aslot 395 of receiving reducedthickness portion 399 ofvertical portion 391 b, where first and second arms are pivotally coupled via a pin (not shown.) - In one specific embodiment of
compression tool 290 and 390, angle B1 is about 120 degrees and angle B2 is about 150 degrees. However, other angular offsets in first and second arms ofcompression tools 190, 290 are also contemplated herein as would occur to those skilled in the art. - Referring now to
FIGS. 23-30 , there will now be described methods and instrumentation for drilling holes into the vertebrae in order to secure the plate to the vertebrae with bone engaging fasteners extending through the plate and into the drilled holes. While the methods and instrumentation ofFIGS. 23-30 have application with the anterior cervical plates described herein, it is also contemplated that the methods and instrumentation have application with plates secured to other areas of the spine, and also with plates secured to other locations on the vertebrae, such as the lateral, posterior, and antero-lateral aspects of the vertebrae. Further, while the drill guide of the present invention is described with respect to a plate P oriented with slot SL over upper vertebra V2 as shown inFIGS. 29 and 30 , it is further contemplated the drill guide has application with a plate having one or more slots over one of or both of vertebrae V1 and V2. - In
FIGS. 23-25 , there is adrill guide 500 having aproximal handle 502 coupled to adistal guiding portion 504.Drill guide 500 has adistal end 503 that is positioned in slots SL of plate P with plate P aligned over a portion of a bony structure, such as vertebrae V1, V2 and V3 as shown inFIG. 29 . Plate P is to be secured to the bone with bone engaging fasteners, such as discussed above with respect tobone screw 50; however, any suitable bone engaging fastener is contemplated.Drill guide 500 enables the surgeon to attain the desired orientation and positioning to drill, and if desired or necessary, tap holes through slot SL into the bone into which bone engaging fasteners are to be inserted to engage the plate therewith. - Guiding
portion 504 includes afirst guide member 506 and asecond guide member 508 interconnected by a connectingmember 510 at proximal ends 507, 509. Eachguide member distal portion 511, 513 (FIG. 26 ) respectively. It should be understood that the present invention further contemplates a guiding portion that includes only one guide member.First guide member 506 includes apassage 520 extending along central axis C2, andsecond guide member 508 includes apassage 522 extending along central axis C3.Passages FIG. 29 . Central axes C2 and C3 are oriented such that holes drilled throughguide portions guide members guide members - Handle 502 extends proximally from connecting
member 510 such that its central axis C1 is centered betweenguide members distal portion 512 extending from connectingmember 510 that has a central axis C4 forming angle E2 with axes C2, C3 ofguide members central member 514 extends fromdistal portion 510 and has central axis C1 forming angle E3 with axis C4. Aproximal portion 516 having a grippingportion 518 extends fromcentral member 514 and has a central axis C5 forming angle E4 with axis C1. Angles E2, E3, and E4 offset handle 502 from the proximal end openings ofguide members drill guide 500, angle E2 is 102 degrees, angle E3 is 58 degrees, and angle E4 is 122 degrees. In this embodiment, angle E2 provides a 12 degree cephalad angle for the drilled hole if the slot is positioned over the upper vertebra V2, or a 12 degree caudal angle for the drilled hole if the slot is positioned over a lower vertebra V1. However, it should be understood that other values for angles E2, E3 and E4 are also contemplated. Further embodiments are also contemplated in which handle 502 is not offset from the proximal end openings guidemembers - Referring now to
FIG. 26 , further details regarding thedistal portions guide members Passage 520 has anupper portion 520 a sized to allow passage of at least a portion of the drill therethrough.Passage 520 further includes alower portion 520 b sized to closely fit with the drill bit to help maintain its proper alignment throughguide member 506. It is contemplated that the height H3 oflower portion 520 b is great enough to receive a length of the drill bit to ensure it is properly oriented with respect to vertebra V2 before the hole is drilled in vertebra V2.Passage 522 similarly includes anupper portion 522 a andlower portion 522 b.Rims passages guide members -
Guide member 506 further includes amain body portion 532 that extends fromproximal end 507 to anintermediate portion 528.Intermediate portion 528 extends aboutlower portion 520 b ofpassage 520 and has a width in the direction of the slot width that is less than that ofmain body portion 532.Intermediate portion 528 is sized such that it can be positioned in a recess extending around the plate slot SL without passing through slot SL (FIG. 30 .) Aslot engaging portion 530 also extends aboutlower portion 520 b ofpassage 520 and further extends fromintermediate portion 528 todistal end 534 ofguide member 506.Slot engaging portion 530 has a width in the direction of the slot width that is less than that ofintermediate portion 528.Slot engaging portion 538 is sized to reside in plate slot SL and in contact with the slot sidewalls withdistal end 534 in close proximity to or in contact with the bone underlying plate P. -
Guide member 508 similarly includes amain body portion 538 that extends fromproximal end 509 to anintermediate portion 536.Intermediate portion 536 extends aboutlower portion 522 b ofpassage 522 and has a width in the direction of the slot width that is less than that ofmain body portion 538.Intermediate portion 536 is sized such that it can be positioned in a recess extending around the plate slot SL without passing through slot SL (FIG. 30 .) Aslot engaging portion 538 also extends aboutlower portion 522 b ofpassage 522 and also extends fromintermediate portion 536 to thedistal end 540 ofguide member 508.Slot engaging portion 538 has a width in the direction of the slot width that is less than that ofintermediate portion 536.Slot engaging portion 538 is sized to reside in plate slot SL in contact with the slot sidewalls such thatdistal end 540 is in close proximity or in contact with the bone underlying plate P. -
Guide member 506 includes amedial notch 524 formed therein extending proximally fromdistal end 534.Guide member 508 similarly includes amedial notch 526 formed therein extending proximally fromdistal end 540.Medial notches guide members guide members notches - Referring now to
FIGS. 27-28 ,guide member 506 will be further described, it being understood thatguide member 508 includes identical features.Guide member 506 includes an offsetportion 542 that extends alongintermediate portion 528 andslot engaging portion 530. Offsetportion 542 extends along a side ofguide member 508 such that it is positionable against either the upper end or the lower end of slot SL when placed therein. In the illustrated embodiment ofFIGS. 29-30 , offsetportion 542 is positioned in contact with upper end SL2 of slot SL. - Offset
portion 542 has acontact surface 543 curved in a plane that extends partially aboutpassage 520 as shown inFIG. 28 . As shown inFIG. 27 ,contact surface 543 of offsetportion 542 is at least partially coplanar with the exterior surface ofmain body portion 532 such thatcontact surface 543 forms an extension of this exterior surface.Contact surface 543 defines a curve having an offsetcenter 544 and a radius R3 measured from offsetcenter 544. Offsetcenter 544 is located along an axis C5 that extends in the direction of the longitudinal axis SL1 of slot SL (FIG. 30 .) Axis C5 also extends though thecenter 546 ofpassage 520, intersecting axis C2. Offsetcenter 544 is offset frompassage center 546 by a distance d3. In one specific embodiment, distance d3 is 0.95 millimeters and R3 is 2.05 millimeters. - In an example of one specific application of the drill guide of the present invention, and with reference to
FIGS. 29 and 30 , plate P is placed over vertebrae V1, V2 and V3 with holes HL aligned over vertebra V1 and slots SL aligned over vertebra V2. Holes are drilled through holes HL and into vertebra V1 using known drill guiding instruments. Bone engaging fasteners are inserted through holes HL and into the drilled holes to secure plate P to vertebra V1.Drill guide 500 is then placed in slots SL as shown inFIGS. 29 and 30 withcontact surface 543 against upper end SL2 of slot SL. Offsetportion 542 spaces the adjacent edge of the hole drilled in vertebra V2 from the upper end SL2 of each slot SL so that a bone engaging fastener inserted therein is spaced a distance d4 from upper end SL2. In one specific embodiment, this offset distance d4 is about 1.50 millimeters, however, offset distances of 1 millimeter more are also contemplated. The holes are then drilled throughguide members drill guide 500 using manual or power drilling tools. Bone engaging fasteners are then inserted through slots SL and into the offset holes drilled in vertebra V2, and are thus spaced a distance d4 from the upper end SL2 of slot SL. With the opposite end of plate P fixed to vertebra V1, and bone engaging fasteners offset in slots SL between its upper and lower ends, the plate P allows post-operative settling of the spinal columns segment and also accommodates extension of the spinal column segment, which is thought to improve the environment for fusion incorporation of an interbody device in disc space D2 and/or D1. Further, the surgeon can either distract or compress the spinal column segment as desired since the bone engaging fasteners have space to move in either direction in slots SL. - While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiment has been shown and described and that all changes and modifications the come within the spirit of the invention are desired to be protected.
Claims (10)
1-20. (canceled)
21. A method for securing a plate to a portion of the spinal column, the spinal column portion including an upper vertebra and a lower vertebra, the method comprising:
providing a plate having a central axis extending between the upper and lower vertebra, the plate including at least one slot extending between a top surface and a bottom surface of the plate, the slot extending in the direction of the central axis between a first end and an opposite second;
placing the plate on the spinal column portion with the slot over the upper vertebra;
positioning a drill guide on the plate, the drill guide having an offset portion positionable in the slot against the first end of the slot; and
drilling a hole through the drill guide, wherein the offset portion of the drill guide spaces the adjacent edge of the drilled hole from the first end of the slot.
22. The method of claim 21 , further comprising:
inserting a bone engaging fastener in the drilled hole, wherein the bone engaging fastener is spaced a distance from the first end of the slot; and
applying a compression load to the spinal column portion with a compression tool to position the bone engaging fastener more towards the second end of the slot.
23. The method of claim 21 , further comprising:
inserting a bone engaging fastener into the drilled hole, wherein the bone engaging fastener is spaced a distance from the firstend of the slot; and
allowing movement of the bone engaging fastener towards the first end of the slot in response to extension of the portion of the spinal column.
24. The method of claim 23 , wherein the distance is based on a desired amount of extension of the portion of the spinal column.
25. The method of claim 24 , wherein the distance is 1 millimeter or more.
26. The method of claim 21 , further comprising fixing the plate to the lower vertebrae.
27. A method for securing a plate to a portion of the spinal column, the spinal column portion including an upper vertebra and a lower vertebra, the method comprising:
providing a plate for stabilizing the spine, the plate having a front and back surfaces and a plurality of pairs of fixation openings extending between the front and back surfaces, wherein the back surface is adapted to contact the spine;
placing the plate on the spinal column portion such that a first pair of fixation openings are positioned on opposing sides of a longitudinally oriented center line of the plate, wherein the first pair of fixation openings is configured in the form of an elongated slot oriented in a longitudinal direction of the plate, and includes a bore, a flared portion, and a ramp extending therebetween;
placing at least one washer along the front surface of the fixation openings; and
placing a bone anchoring screw into each fixation opening through the washer to fix the plate to the spine, wherein one of the bone anchoring screws provides a camming action along the ramp, which causes a compression lead to be applied to the spine.
28. The method of claim 27 wherein the at least one washer translates by being slidably movable between a locked position, in which the bone anchoring screws are locked within the fixation openings, and an unlocked position.
29. The method of claim 27 wherein the bone achoring screws are countersunk in the fixation openings when threaded into the spine.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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US13/441,218 US20120197301A1 (en) | 1999-10-13 | 2012-04-06 | System and method for securing a plate to the spinal column |
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Application Number | Priority Date | Filing Date | Title |
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US09/417,402 US6533786B1 (en) | 1999-10-13 | 1999-10-13 | Anterior cervical plating system |
US09/907,022 US6692503B2 (en) | 1999-10-13 | 2001-07-17 | System and method for securing a plate to the spinal column |
US10/643,878 US20040097950A1 (en) | 1999-10-13 | 2003-08-20 | System and method for securing a plate to a spinal column |
US12/494,116 US8167919B2 (en) | 1999-10-13 | 2009-06-29 | System and method for securing a plate to the spinal column |
US13/441,218 US20120197301A1 (en) | 1999-10-13 | 2012-04-06 | System and method for securing a plate to the spinal column |
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US12/494,116 Division US8167919B2 (en) | 1999-10-13 | 2009-06-29 | System and method for securing a plate to the spinal column |
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US20120197301A1 true US20120197301A1 (en) | 2012-08-02 |
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US09/907,022 Expired - Fee Related US6692503B2 (en) | 1999-10-13 | 2001-07-17 | System and method for securing a plate to the spinal column |
US10/643,878 Abandoned US20040097950A1 (en) | 1999-10-13 | 2003-08-20 | System and method for securing a plate to a spinal column |
US12/494,116 Expired - Fee Related US8167919B2 (en) | 1999-10-13 | 2009-06-29 | System and method for securing a plate to the spinal column |
US13/441,218 Abandoned US20120197301A1 (en) | 1999-10-13 | 2012-04-06 | System and method for securing a plate to the spinal column |
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US10/643,878 Abandoned US20040097950A1 (en) | 1999-10-13 | 2003-08-20 | System and method for securing a plate to a spinal column |
US12/494,116 Expired - Fee Related US8167919B2 (en) | 1999-10-13 | 2009-06-29 | System and method for securing a plate to the spinal column |
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WO (1) | WO2003007826A1 (en) |
Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20110319939A1 (en) * | 2010-01-05 | 2011-12-29 | Neuraxis Technologies LLC | Compression-distraction spinal fixation system and kit |
US9186189B2 (en) | 2000-06-26 | 2015-11-17 | Stryker Spine | Bone screw retaining system |
US10869702B2 (en) | 2017-05-12 | 2020-12-22 | Nextremity Solutions, Inc. | Compression force magnifier |
US11202664B2 (en) | 2018-12-17 | 2021-12-21 | Nextremity Solutions, Inc. | Compression force magnifier |
Families Citing this family (208)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7857838B2 (en) | 2003-03-27 | 2010-12-28 | Depuy Products, Inc. | Anatomical distal radius fracture fixation plate |
US20040153073A1 (en) * | 2000-02-01 | 2004-08-05 | Hand Innovations, Inc. | Orthopedic fixation system including plate element with threaded holes having divergent axes |
US6767351B2 (en) * | 2000-02-01 | 2004-07-27 | Hand Innovations, Inc. | Fixation system with multidirectional stabilization pegs |
US20060041260A1 (en) * | 2000-02-01 | 2006-02-23 | Orbay Jorge L | Fixation system with plate having holes with divergent axes and multidirectional fixators for use therethrough |
US7695502B2 (en) | 2000-02-01 | 2010-04-13 | Depuy Products, Inc. | Bone stabilization system including plate having fixed-angle holes together with unidirectional locking screws and surgeon-directed locking screws |
US6706046B2 (en) * | 2000-02-01 | 2004-03-16 | Hand Innovations, Inc. | Intramedullary fixation device for metaphyseal long bone fractures and methods of using the same |
US6893444B2 (en) * | 2000-02-01 | 2005-05-17 | Hand Innovations, Llc | Bone fracture fixation systems with both multidirectional and unidirectional stabilization pegs |
US20050049594A1 (en) * | 2001-04-20 | 2005-03-03 | Wack Michael A. | Dual locking plate and associated method |
JP4180506B2 (en) * | 2001-06-27 | 2008-11-12 | デピュイ・プロダクツ・インコーポレイテッド | Minimally invasive orthopedic device and method |
DE10152094C2 (en) * | 2001-10-23 | 2003-11-27 | Biedermann Motech Gmbh | Bone fixation device |
US7766947B2 (en) | 2001-10-31 | 2010-08-03 | Ortho Development Corporation | Cervical plate for stabilizing the human spine |
US7094242B2 (en) * | 2001-10-31 | 2006-08-22 | K2M, Inc. | Polyaxial drill guide |
US7070599B2 (en) | 2002-07-24 | 2006-07-04 | Paul Kamaljit S | Bone support assembly |
US7008426B2 (en) | 2001-12-14 | 2006-03-07 | Paul Kamaljit S | Bone treatment plate assembly |
US6755833B1 (en) | 2001-12-14 | 2004-06-29 | Kamaljit S. Paul | Bone support assembly |
ATE525030T1 (en) * | 2001-12-20 | 2011-10-15 | Spine Asia Co Ltd A | SYSTEM FOR FIXING THE SPINE |
US6695846B2 (en) * | 2002-03-12 | 2004-02-24 | Spinal Innovations, Llc | Bone plate and screw retaining mechanism |
US20030187443A1 (en) * | 2002-03-27 | 2003-10-02 | Carl Lauryssen | Anterior bone plate system and method of use |
US8105366B2 (en) * | 2002-05-30 | 2012-01-31 | Warsaw Orthopedic, Inc. | Laminoplasty plate with flanges |
US7011665B2 (en) * | 2002-07-22 | 2006-03-14 | Sdgi Holdings, Inc. | Guide assembly for engaging a bone plate to a bony segment |
US7306603B2 (en) | 2002-08-21 | 2007-12-11 | Innovative Spinal Technologies | Device and method for percutaneous placement of lumbar pedicle screws and connecting rods |
US7862597B2 (en) * | 2002-08-22 | 2011-01-04 | Warsaw Orthopedic, Inc. | System for stabilizing a portion of the spine |
US7625378B2 (en) * | 2002-09-30 | 2009-12-01 | Warsaw Orthopedic, Inc. | Devices and methods for securing a bone plate to a bony segment |
US20040111090A1 (en) * | 2002-10-03 | 2004-06-10 | The University Of North Carolina At Chapel Hill | Modification of percutaneous intrafocal plate system |
AU2003275367B2 (en) | 2002-10-28 | 2010-01-21 | Blackstone Medical, Inc. | Bone plate assembly provided with screw locking mechanisms |
AU2003294342A1 (en) * | 2002-11-19 | 2004-06-15 | Acumed Llc | Guide system for bone-repair devices |
JP4028552B2 (en) | 2002-11-19 | 2007-12-26 | アキュームド・エルエルシー | Adjustable bone plate |
US20050187551A1 (en) | 2002-12-02 | 2005-08-25 | Orbay Jorge L. | Bone plate system with bone screws fixed by secondary compression |
US7780664B2 (en) * | 2002-12-10 | 2010-08-24 | Depuy Products, Inc. | Endosteal nail |
US7048739B2 (en) | 2002-12-31 | 2006-05-23 | Depuy Spine, Inc. | Bone plate and resilient screw system allowing bi-directional assembly |
US7914561B2 (en) | 2002-12-31 | 2011-03-29 | Depuy Spine, Inc. | Resilient bone plate and screw system allowing bi-directional assembly |
WO2004071276A2 (en) * | 2003-02-05 | 2004-08-26 | Pioneer Laboratories, Inc. | Bone plate system |
US7608096B2 (en) * | 2003-03-10 | 2009-10-27 | Warsaw Orthopedic, Inc. | Posterior pedicle screw and plate system and methods |
US6960216B2 (en) * | 2003-03-21 | 2005-11-01 | Depuy Acromed, Inc. | Modular drill guide |
US20040193155A1 (en) * | 2003-03-27 | 2004-09-30 | Hand Innovations, Inc. | Fracture fixation plate with particular plate hole and fastener engagement and methods of using the same |
US7935123B2 (en) * | 2003-04-09 | 2011-05-03 | Depuy Acromed, Inc. | Drill guide with alignment feature |
US7909829B2 (en) * | 2003-06-27 | 2011-03-22 | Depuy Spine, Inc. | Tissue retractor and drill guide |
US20040210232A1 (en) * | 2003-04-09 | 2004-10-21 | Tushar Patel | Guide device and plate inserter |
US7776047B2 (en) * | 2003-04-09 | 2010-08-17 | Depuy Spine, Inc. | Guide for spinal tools, implants, and devices |
WO2004093702A2 (en) | 2003-04-18 | 2004-11-04 | Abdou Samy M | Bone fixation system and method of implantation |
US6945973B2 (en) | 2003-05-01 | 2005-09-20 | Nuvasive, Inc. | Slidable bone plate system |
US7909848B2 (en) | 2003-06-27 | 2011-03-22 | Depuy Spine, Inc. | Tissue retractor and guide device |
US7473259B2 (en) * | 2003-06-30 | 2009-01-06 | Depuy Products, Inc. | Implant stabilizing instrument, kit and method |
US7731721B2 (en) | 2003-07-16 | 2010-06-08 | Synthes Usa, Llc | Plating system with multiple function drill guide |
US7625375B2 (en) | 2003-08-06 | 2009-12-01 | Warsaw Orthopedic, Inc. | Systems and techniques for stabilizing the spine and placing stabilization systems |
US7909860B2 (en) | 2003-09-03 | 2011-03-22 | Synthes Usa, Llc | Bone plate with captive clips |
US20050049595A1 (en) * | 2003-09-03 | 2005-03-03 | Suh Sean S. | Track-plate carriage system |
US7857839B2 (en) | 2003-09-03 | 2010-12-28 | Synthes Usa, Llc | Bone plate with captive clips |
US7766914B2 (en) * | 2003-09-10 | 2010-08-03 | Warsaw Orthopedic, Inc. | Adjustable drill guide |
US7306605B2 (en) * | 2003-10-02 | 2007-12-11 | Zimmer Spine, Inc. | Anterior cervical plate |
US7591821B2 (en) | 2003-11-18 | 2009-09-22 | Smith & Nephew, Inc. | Surgical technique and instrumentation for minimal incision hip arthroplasty surgery |
US8657824B2 (en) | 2003-11-18 | 2014-02-25 | Smith & Nephew, Inc. | Universal double offset surgical instrument |
FR2862862B1 (en) * | 2003-12-01 | 2006-01-06 | Jean Michel Cognet | ASSEMBLY FOR COMPRESSORING TWO ELEMENTS DISPOSED OF THE ONE OF THE OTHER ESPECIALLY IN THE FRAMEWORK OF A BONE FRACTURE |
US7635366B2 (en) * | 2003-12-29 | 2009-12-22 | Abdou M Samy | Plating system for bone fixation and method of implantation |
US7488326B2 (en) * | 2004-01-02 | 2009-02-10 | Zimmer Technology, Inc. | Combination targeting guide and driver instrument for use in orthopaedic surgical procedures |
US7740649B2 (en) * | 2004-02-26 | 2010-06-22 | Pioneer Surgical Technology, Inc. | Bone plate system and methods |
US8900277B2 (en) | 2004-02-26 | 2014-12-02 | Pioneer Surgical Technology, Inc. | Bone plate system |
US7175662B2 (en) * | 2004-04-01 | 2007-02-13 | Cervitech, Inc. | Cervical intervertebral prosthesis |
US7488327B2 (en) * | 2004-04-12 | 2009-02-10 | Synthes (U.S.A.) | Free hand drill guide |
US7963981B2 (en) | 2004-04-19 | 2011-06-21 | Globus Medical, Inc. | Bone fixation plate |
US8236034B2 (en) * | 2004-04-19 | 2012-08-07 | Globus Medical, Inc. | Bone fixation plate |
WO2005102193A2 (en) * | 2004-04-19 | 2005-11-03 | Acumed, Llc | Placement of fasteners into bone |
EP1755474B1 (en) * | 2004-06-01 | 2008-12-03 | Synthes GmbH | Osteosynthesis plate |
US20050277937A1 (en) * | 2004-06-10 | 2005-12-15 | Leung Takkwong R | Bone plating system |
KR100858306B1 (en) * | 2004-06-14 | 2008-09-11 | 엠.에스. 아브두 | Orthopedic device |
US8753348B2 (en) * | 2004-07-02 | 2014-06-17 | DePuy Synthes Products, LLC | Compressor-distractor |
US7686814B2 (en) * | 2004-07-06 | 2010-03-30 | Warsaw Orthopedic, Inc. | Systems and methods for compressing and distracting vertebrae of the spinal column |
US7883510B2 (en) * | 2004-08-27 | 2011-02-08 | Depuy Spine, Inc. | Vertebral staples and insertion tools |
US20060064108A1 (en) * | 2004-09-09 | 2006-03-23 | Blaylock Jeffrey C | Tibial sizing apparatus and method |
US20060084976A1 (en) | 2004-09-30 | 2006-04-20 | Depuy Spine, Inc. | Posterior stabilization systems and methods |
US7766940B2 (en) | 2004-12-30 | 2010-08-03 | Depuy Spine, Inc. | Posterior stabilization system |
US7896906B2 (en) | 2004-12-30 | 2011-03-01 | Depuy Spine, Inc. | Artificial facet joint |
US8092496B2 (en) | 2004-09-30 | 2012-01-10 | Depuy Spine, Inc. | Methods and devices for posterior stabilization |
US7621916B2 (en) * | 2004-11-18 | 2009-11-24 | Depuy Spine, Inc. | Cervical bone preparation tool and implant guide systems |
WO2006058221A2 (en) | 2004-11-24 | 2006-06-01 | Abdou Samy M | Devices and methods for inter-vertebral orthopedic device placement |
US7648508B2 (en) * | 2004-11-30 | 2010-01-19 | Stryker Trauma S.A. | Bone plating implants, instruments and methods |
US7166111B2 (en) | 2004-12-08 | 2007-01-23 | Depuy Spine, Inc. | Spinal plate and drill guide |
US7931678B2 (en) * | 2004-12-08 | 2011-04-26 | Depuy Spine, Inc. | Hybrid spinal plates |
US7736380B2 (en) | 2004-12-21 | 2010-06-15 | Rhausler, Inc. | Cervical plate system |
US7322984B2 (en) * | 2005-01-06 | 2008-01-29 | Spinal, Llc | Spinal plate with internal screw locks |
US20060155283A1 (en) * | 2005-01-07 | 2006-07-13 | Depuy Spine Sarl | Occipital plate and guide systems |
US7591840B2 (en) * | 2005-01-21 | 2009-09-22 | Loubert Suddaby | Orthopedic fusion plate having both active and passive subsidence controlling features |
US8109934B2 (en) * | 2005-02-10 | 2012-02-07 | Zimmer Spine, Inc. | All through one drill guide for cervical plating |
US20060184176A1 (en) * | 2005-02-17 | 2006-08-17 | Zimmer Technology, Inc. | Tibial trialing assembly and method of trialing a tibial implant |
US20060195102A1 (en) * | 2005-02-17 | 2006-08-31 | Malandain Hugues F | Apparatus and method for treatment of spinal conditions |
BRPI0607139A2 (en) | 2005-02-18 | 2009-08-11 | M S Abdou | bone fixation set |
US8016887B1 (en) * | 2005-03-24 | 2011-09-13 | Cardinal Spine, Llc | Spinal implant with overlay |
US8070749B2 (en) | 2005-05-12 | 2011-12-06 | Stern Joseph D | Revisable anterior cervical plating system |
WO2006124273A2 (en) * | 2005-05-12 | 2006-11-23 | Stern Joseph D | Revisable anterior cervical plating system |
US8177823B2 (en) | 2005-06-30 | 2012-05-15 | Depuy Spine Sarl | Orthopedic clamping hook assembly |
US7662154B2 (en) * | 2005-09-16 | 2010-02-16 | Blackstone Medical, Inc. | Anterior cervical plating system |
US7905909B2 (en) * | 2005-09-19 | 2011-03-15 | Depuy Products, Inc. | Bone stabilization system including multi-directional threaded fixation element |
US20080243194A1 (en) * | 2005-09-26 | 2008-10-02 | The Regents Of The University Of California | Articulating instrumentation for dynamic spinal stabilization |
US20070093848A1 (en) * | 2005-09-29 | 2007-04-26 | Peter Harris | Cervical drill guide apparatus |
US7887595B1 (en) | 2005-12-05 | 2011-02-15 | Nuvasive, Inc. | Methods and apparatus for spinal fusion |
US9119677B2 (en) | 2005-12-09 | 2015-09-01 | DePuy Synthes Products, Inc. | Spinal plate and drill guide |
US7678114B2 (en) * | 2005-12-20 | 2010-03-16 | Warsaw Orthopedic, Inc. | Vertebral implant inserter and method of use |
US7707465B2 (en) * | 2006-01-26 | 2010-04-27 | International Business Machines Corporation | Routing of shared I/O fabric error messages in a multi-host environment to a master control root node |
US20070198016A1 (en) * | 2006-02-21 | 2007-08-23 | Osteomed, L.P. | Compression stabilizing spacers |
US20070233108A1 (en) * | 2006-03-15 | 2007-10-04 | Stalcup Gregory C | Spine fixation device |
US8771282B2 (en) * | 2006-03-30 | 2014-07-08 | Spinal Elements, Inc. | Drill guide with rotating handle |
US7963980B1 (en) | 2006-04-18 | 2011-06-21 | University Of South Florida | Cervical plate system |
US8114162B1 (en) | 2006-08-09 | 2012-02-14 | Nuvasive, Inc. | Spinal fusion implant and related methods |
USD708747S1 (en) | 2006-09-25 | 2014-07-08 | Nuvasive, Inc. | Spinal fusion implant |
US8282642B2 (en) * | 2006-09-26 | 2012-10-09 | K2M, Inc. | Cervical drill guide apparatus |
US7835727B2 (en) * | 2007-01-22 | 2010-11-16 | Telefonaktiebolaget L M Ericsson (Publ) | Method and system for using user equipment to compose an ad-hoc mosaic |
WO2008094572A2 (en) * | 2007-01-30 | 2008-08-07 | Dong Myung Jeon | Anterior cervical plating system |
US20090216282A1 (en) * | 2007-05-18 | 2009-08-27 | Blake Doris M | Systems and methods for retaining a plate to a substrate with an asynchronous thread form |
US8840650B2 (en) * | 2007-05-18 | 2014-09-23 | Us Spine, Inc. | Cervical plate locking mechanism and associated surgical method |
US9545275B2 (en) | 2007-05-18 | 2017-01-17 | Us Spine, Inc. | Medical device locking mechanisms and related methods and systems |
US8721693B2 (en) * | 2007-05-18 | 2014-05-13 | Us Spine, Inc. | Cervical plate locking mechanism and associated surgical method |
US8361126B2 (en) | 2007-07-03 | 2013-01-29 | Pioneer Surgical Technology, Inc. | Bone plate system |
US8623019B2 (en) | 2007-07-03 | 2014-01-07 | Pioneer Surgical Technology, Inc. | Bone plate system |
WO2009021144A2 (en) * | 2007-08-07 | 2009-02-12 | Transcorp, Inc. | Device for variably adjusting intervertebral distraction and lordosis |
US8709054B2 (en) * | 2007-08-07 | 2014-04-29 | Transcorp, Inc. | Implantable vertebral frame systems and related methods for spinal repair |
WO2009025841A1 (en) | 2007-08-20 | 2009-02-26 | Nuvasive, Inc. | Surgical fixation system and related methods |
US8388663B2 (en) | 2007-09-13 | 2013-03-05 | Stryker Spine | Dynamic cervical plate |
US8430882B2 (en) | 2007-09-13 | 2013-04-30 | Transcorp, Inc. | Transcorporeal spinal decompression and repair systems and related methods |
US8323320B2 (en) | 2007-09-13 | 2012-12-04 | Transcorp, Inc. | Transcorporeal spinal decompression and repair system and related method |
WO2009036360A1 (en) * | 2007-09-13 | 2009-03-19 | Transcorp, Inc. | Device and method for tissue retraction in spinal surgery |
US8163021B2 (en) * | 2007-11-27 | 2012-04-24 | Transcorp, Inc. | Methods and systems for repairing an intervertebral disc using a transcorporal approach |
US8162950B2 (en) * | 2007-12-17 | 2012-04-24 | Stryker Leibinger Gmbh & Co. Kg | Bone plate instrument and method |
US9220546B2 (en) * | 2008-01-11 | 2015-12-29 | Trimed, Inc. | Expansion and compression instrument for fracture fixation |
US8257403B2 (en) * | 2008-02-19 | 2012-09-04 | Orthohelix Surgical Designs, Inc. | Orthopedic plate for use in the midfoot |
WO2009146135A2 (en) * | 2008-04-04 | 2009-12-03 | Skeletal Dynamics Llc | Compression/distraction osteotomy system, plate, method, drill guide and saw guide |
US9044282B2 (en) | 2008-06-24 | 2015-06-02 | Extremity Medical Llc | Intraosseous intramedullary fixation assembly and method of use |
US8343199B2 (en) * | 2008-06-24 | 2013-01-01 | Extremity Medical, Llc | Intramedullary fixation screw, a fixation system, and method of fixation of the subtalar joint |
US9289220B2 (en) | 2008-06-24 | 2016-03-22 | Extremity Medical Llc | Intramedullary fixation assembly and method of use |
US8303589B2 (en) | 2008-06-24 | 2012-11-06 | Extremity Medical Llc | Fixation system, an intramedullary fixation assembly and method of use |
US9017329B2 (en) | 2008-06-24 | 2015-04-28 | Extremity Medical, Llc | Intramedullary fixation assembly and method of use |
US8313487B2 (en) * | 2008-06-24 | 2012-11-20 | Extremity Medical Llc | Fixation system, an intramedullary fixation assembly and method of use |
US8328806B2 (en) * | 2008-06-24 | 2012-12-11 | Extremity Medical, Llc | Fixation system, an intramedullary fixation assembly and method of use |
US8425514B2 (en) * | 2008-06-25 | 2013-04-23 | Westmark Medical, Llc. | Spinal fixation device |
US8663295B2 (en) | 2008-06-27 | 2014-03-04 | Life Spine, Inc. | Posterior spinal prosthesis |
US8167891B2 (en) * | 2008-07-21 | 2012-05-01 | Osteomed Llc | System and method for fracture reduction |
US10251757B2 (en) * | 2008-09-17 | 2019-04-09 | Skeletal Dynamics Llc | Grooved slot allowing adjustment of the position of a bone fixation device for osteosynthesis |
US20100076500A1 (en) * | 2008-09-22 | 2010-03-25 | Bray Robert S | Insertion tool and guide system |
FR2936700B1 (en) | 2008-10-02 | 2012-04-13 | Memometal Technologies | ORTHOPEDIC IMPLANT IN THE FORM OF A PLATE TO BE FIXED BETWEEN TWO BONE PARTS |
US8328856B1 (en) | 2008-10-14 | 2012-12-11 | Nuvasive, Inc. | Surgical fixation system and related methods |
US9089373B2 (en) * | 2009-03-23 | 2015-07-28 | Medical Design Instruments, Llc | Spinous process retractor |
JP5461083B2 (en) * | 2009-07-01 | 2014-04-02 | 京セラメディカル株式会社 | Osteosynthesis surgical instrument |
US8419777B2 (en) | 2009-07-24 | 2013-04-16 | Spinal Usa, Inc. | Bone plate screw-blocking systems and methods |
US9095444B2 (en) | 2009-07-24 | 2015-08-04 | Warsaw Orthopedic, Inc. | Implant with an interference fit fastener |
EP2456377A4 (en) * | 2009-07-24 | 2014-01-08 | Spinal USA LLC | Bone plate system and methods of using the same |
US8535355B2 (en) * | 2009-10-15 | 2013-09-17 | Biomet C.V. | Dorsal midfoot bone plate system and method |
US8551107B2 (en) | 2009-10-15 | 2013-10-08 | Biomet, C.V. | Bending tool and method for reshaping a bone plate |
US9011507B2 (en) | 2009-10-28 | 2015-04-21 | Orthopro Llc | Compression plate kit and methods for repairing bone discontinuities |
US8162996B2 (en) * | 2009-10-28 | 2012-04-24 | Orthopro Llc | Methods for repairing bone discontinuities |
US20110106157A1 (en) * | 2009-10-30 | 2011-05-05 | Warsaw Orthropedic, Inc. | Self-Locking Interference Bone Screw for use with Spinal Implant |
US8470003B2 (en) | 2009-10-30 | 2013-06-25 | DePuy Synthes Products, LLC | Laminoplasty plates and methods of expanding the spinal canal |
US8425520B2 (en) | 2009-10-30 | 2013-04-23 | Depuy Spine, Inc. | Bone plate holder |
US8764806B2 (en) | 2009-12-07 | 2014-07-01 | Samy Abdou | Devices and methods for minimally invasive spinal stabilization and instrumentation |
US8409259B1 (en) | 2010-01-06 | 2013-04-02 | Bernard M. Bedor | Cervical plate system and method |
US8403970B1 (en) * | 2010-01-06 | 2013-03-26 | Bernard M. Bedor | Cervical plate system and method |
US8486116B2 (en) * | 2010-01-08 | 2013-07-16 | Biomet Manufacturing Ring Corporation | Variable angle locking screw |
US8425569B2 (en) | 2010-05-19 | 2013-04-23 | Transcorp, Inc. | Implantable vertebral frame systems and related methods for spinal repair |
KR101173513B1 (en) | 2010-11-12 | 2012-08-14 | 김형중 | Screw assembly for fixing bone plates |
US8728129B2 (en) | 2011-01-07 | 2014-05-20 | Biomet Manufacturing, Llc | Variable angled locking screw |
US20120197410A1 (en) * | 2011-01-31 | 2012-08-02 | Horan Timothy J | System and methods for patellar tendon advancement in quadrupeds |
US8668723B2 (en) | 2011-07-19 | 2014-03-11 | Neurostructures, Inc. | Anterior cervical plate |
US8845728B1 (en) | 2011-09-23 | 2014-09-30 | Samy Abdou | Spinal fixation devices and methods of use |
US9918723B2 (en) * | 2011-09-23 | 2018-03-20 | Depuy Mitek, Llc | Glenoid anchor guide |
US11123117B1 (en) | 2011-11-01 | 2021-09-21 | Nuvasive, Inc. | Surgical fixation system and related methods |
US8986354B2 (en) * | 2012-02-14 | 2015-03-24 | Zavation Llc | Surgical kit for spinal surgery |
US20130226240A1 (en) | 2012-02-22 | 2013-08-29 | Samy Abdou | Spinous process fixation devices and methods of use |
US9050151B2 (en) | 2012-03-06 | 2015-06-09 | Stryker Trauma Sa | Bone plate and aiming block |
AU2013274872A1 (en) | 2012-06-14 | 2014-12-18 | Synthes Gmbh | Implants/procedures related to tibial tuberosity advancement |
CN102727279B (en) * | 2012-07-16 | 2014-02-19 | 徐永清 | Auxiliary device for positioning and drilling of scaphoid fixator |
US8814912B2 (en) | 2012-07-27 | 2014-08-26 | Zimmer Spine, Inc. | Bone stabilization member with bone screw retention mechanism |
US9198767B2 (en) | 2012-08-28 | 2015-12-01 | Samy Abdou | Devices and methods for spinal stabilization and instrumentation |
US10111693B2 (en) * | 2012-10-08 | 2018-10-30 | Kannan P | Orthopedic external compression plate |
US9320617B2 (en) | 2012-10-22 | 2016-04-26 | Cogent Spine, LLC | Devices and methods for spinal stabilization and instrumentation |
US9642652B2 (en) * | 2013-02-13 | 2017-05-09 | Choice Spine, Lp | Variable angle bone plate with semi-constrained articulating screw |
US20140277182A1 (en) * | 2013-03-12 | 2014-09-18 | Warsaw Orthopedic, Inc. | Spinal implant system and method |
US9468479B2 (en) | 2013-09-06 | 2016-10-18 | Cardinal Health 247, Inc. | Bone plate |
US9750512B2 (en) | 2013-10-21 | 2017-09-05 | Zimmer Spine, Inc. | Drill guide for installing a bone plate |
US9629664B2 (en) | 2014-01-20 | 2017-04-25 | Neurostructures, Inc. | Anterior cervical plate |
US9486250B2 (en) | 2014-02-20 | 2016-11-08 | Mastros Innovations, LLC. | Lateral plate |
US10517657B1 (en) * | 2014-04-14 | 2019-12-31 | Avanti Orthopaedics, LLC | Load sharing bone plate |
US11452553B1 (en) | 2014-04-14 | 2022-09-27 | Avanti Orthopaedics, LLC | Load sharing bone plate |
US9987063B2 (en) * | 2014-04-22 | 2018-06-05 | Stryker European Holdings I, Llc | Plates with countersinks |
US10130487B2 (en) * | 2014-08-22 | 2018-11-20 | Globus Medical, Inc. | Vertebral implants and related methods of use |
KR101658117B1 (en) * | 2014-12-05 | 2016-09-22 | (주)시지바이오 | Instrumentation for Anterior Cervical Discectomy Fusion |
US9968393B2 (en) | 2014-12-23 | 2018-05-15 | DePuy Synthes Products, Inc. | Bending pin |
US9615931B2 (en) * | 2015-03-20 | 2017-04-11 | Globus Medical, Inc. | Surgical plate systems |
US10201358B2 (en) | 2015-04-21 | 2019-02-12 | Acumed Llc | Articulating syndesmosis targeting guide device and method |
US10238439B2 (en) * | 2015-04-24 | 2019-03-26 | Meditech Spine, Llc | Anterior spinal bone plate holding system and method |
US10357314B2 (en) | 2015-07-08 | 2019-07-23 | Stryker European Holdings I, Llc | Instrumentation and method for repair of a bone fracture |
US10857003B1 (en) | 2015-10-14 | 2020-12-08 | Samy Abdou | Devices and methods for vertebral stabilization |
US10105169B2 (en) | 2015-11-13 | 2018-10-23 | Leith Medical LLC | Bone fixation systems, apparatuses, and methods with anti-back-out feature |
US10973648B1 (en) | 2016-10-25 | 2021-04-13 | Samy Abdou | Devices and methods for vertebral bone realignment |
US10744000B1 (en) | 2016-10-25 | 2020-08-18 | Samy Abdou | Devices and methods for vertebral bone realignment |
US10980641B2 (en) | 2017-05-04 | 2021-04-20 | Neurostructures, Inc. | Interbody spacer |
US10512547B2 (en) | 2017-05-04 | 2019-12-24 | Neurostructures, Inc. | Interbody spacer |
US11744619B2 (en) * | 2018-04-06 | 2023-09-05 | K2M, Inc. | Faceted bone plate |
US11076892B2 (en) | 2018-08-03 | 2021-08-03 | Neurostructures, Inc. | Anterior cervical plate |
US11179248B2 (en) | 2018-10-02 | 2021-11-23 | Samy Abdou | Devices and methods for spinal implantation |
US11071629B2 (en) | 2018-10-13 | 2021-07-27 | Neurostructures Inc. | Interbody spacer |
US11744626B2 (en) | 2019-10-14 | 2023-09-05 | Leith Medical, LLC | Bone fixation system with fasteners and a removal tool for decoupling of the fasteners |
JP2022552325A (en) | 2019-10-14 | 2022-12-15 | リース メディカル, エルエルシー | Devices for stabilization of fracture sites |
AU2021235647B2 (en) * | 2020-03-10 | 2023-11-23 | Cartiva, Inc. | Polyaxial drill guide |
US11877779B2 (en) | 2020-03-26 | 2024-01-23 | Xtant Medical Holdings, Inc. | Bone plate system |
US11382761B2 (en) | 2020-04-11 | 2022-07-12 | Neurostructures, Inc. | Expandable interbody spacer |
US11304817B2 (en) | 2020-06-05 | 2022-04-19 | Neurostructures, Inc. | Expandable interbody spacer |
US11717419B2 (en) | 2020-12-10 | 2023-08-08 | Neurostructures, Inc. | Expandable interbody spacer |
US20220265328A1 (en) * | 2021-02-10 | 2022-08-25 | DePuy Synthes Products, Inc. | Bone Plates Having Compression Holes, And Related Systems And Methods |
US11871969B2 (en) | 2021-03-03 | 2024-01-16 | Acustitch, Llc | System and method for osseous reconstruction and repair and implant device |
BE1030630B1 (en) * | 2022-06-15 | 2024-01-22 | Life Int | Bone fixation system |
Family Cites Families (111)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1025008A (en) | 1911-08-07 | 1912-04-30 | Lucien Luttrell Miner | Brace for fractured bones. |
US2443363A (en) | 1942-04-13 | 1948-06-15 | Townsend Kenneth | Bone plate |
US2406832A (en) | 1945-03-05 | 1946-09-03 | Mervyn G Hardinge | Fracture plate |
US2486303A (en) | 1948-04-29 | 1949-10-25 | Harry Herschel Leiter | Surgical appliance for bone fractures |
GB780652A (en) | 1954-04-30 | 1957-08-07 | Zimmer Orthopaedic Ltd | Improvements in or relating to apparatus for use in spinal fixation |
CH373516A (en) | 1959-09-01 | 1963-11-30 | Maurice E Dr Med Mueller | Device for the surgical fixation of bone fragments in limbs |
US3386437A (en) | 1966-01-14 | 1968-06-04 | Richard Mfg Company | Compression device for use with a bone fracture plate |
CH462375A (en) | 1966-06-22 | 1968-09-15 | Synthes Ag | Osteosynthetic pressure plate |
USRE28841E (en) | 1966-06-22 | 1976-06-08 | Synthes A.G. | Osteosynthetic pressure plate construction |
FR1505513A (en) | 1966-11-02 | 1967-12-15 | Benoist & Girard Reunis | Osteosynthesis plate |
FR1538053A (en) | 1967-08-18 | 1968-09-07 | Osteosynthesis plate combined with its key | |
US3659595A (en) | 1969-10-22 | 1972-05-02 | Edward J Haboush | Compensating plates for bone fractures |
US3693616A (en) | 1970-06-26 | 1972-09-26 | Robert Roaf | Device for correcting scoliotic curves |
US3741205A (en) | 1971-06-14 | 1973-06-26 | K Markolf | Bone fixation plate |
US3779240A (en) | 1972-03-31 | 1973-12-18 | S Kondo | Compression plate for osteosynthesis |
CH566767A5 (en) | 1973-06-05 | 1975-09-30 | Synthes Ag | Jawbone fracture compression plate - screw holes elongated in directions at right angles to each other |
FR2233973A1 (en) | 1973-06-25 | 1975-01-17 | Chatin Robert | Osteosynthesis plate for femoral fracture surgery - has anchoring holes in ablong flat portion and widened blade |
US3842825A (en) | 1973-11-12 | 1974-10-22 | R Wagner | Hip fixation device |
CH600862A5 (en) | 1976-03-26 | 1978-06-30 | Synthes Ag | |
GB1571713A (en) | 1976-04-21 | 1980-07-16 | Gil J L | Apparatus for use in the treatment of bone fractures |
CH611147A5 (en) | 1977-01-07 | 1979-05-31 | Mueller Kurt | Osteosynthesis compression plate |
CH613858A5 (en) | 1977-04-22 | 1979-10-31 | Straumann Inst Ag | |
DE3060985D1 (en) | 1979-03-23 | 1982-12-02 | Brinckmann Paul | Tensioning device for a compression plate for use in joining bone fragments under pressure |
CH645013A5 (en) | 1980-04-14 | 1984-09-14 | Wenk Wilh Ag | Osteosynthetic COMPRESSION PLATE. |
CH648197A5 (en) | 1980-05-28 | 1985-03-15 | Synthes Ag | IMPLANT AND SCREW FASTENING ON ITS BONE. |
CH645264A5 (en) * | 1980-05-28 | 1984-09-28 | Straumann Inst Ag | FITTING WITH A PLATE AND SCREWS THAT FIX IT TO A BONE. |
CH651192A5 (en) | 1980-11-20 | 1985-09-13 | Synthes Ag | OSTEOSYNTHETIC DEVICE AND CORRESPONDING DRILL GAUGE. |
CH650915A5 (en) | 1981-03-16 | 1985-08-30 | Synthes Ag | DEVICE FOR STABILIZING THE AREA OF A BONE BREAK OR OSTEOTOMY. |
DE3114136C2 (en) | 1981-04-08 | 1986-02-06 | Aesculap-Werke Ag Vormals Jetter & Scheerer, 7200 Tuttlingen | Osteosynthesis plate |
FR2519857A1 (en) | 1982-01-19 | 1983-07-22 | Butel Jean | DEVICE FOR OSTEOSYNTHESIS OF THE FRACTURES OF THE END OF THE FEMUR |
US4570624A (en) | 1983-08-10 | 1986-02-18 | Henry Ford Hospital | Universal guide for inserting parallel pins |
DE8431616U1 (en) | 1984-10-27 | 1984-12-20 | Howmedica International, Inc. Zweigniederlassung Kiel, 2314 Schönkirchen | Plate for osteosynthesis |
DE8513288U1 (en) | 1985-05-06 | 1986-09-04 | Wolter, Dietmar, Prof. Dr., 2000 Hamburg | Osteosynthesis plate |
US5057111A (en) | 1987-11-04 | 1991-10-15 | Park Joon B | Non-stress-shielding bone fracture healing device |
US4911153A (en) | 1988-02-04 | 1990-03-27 | Biomet, Inc. | Orthopedic surgical instrument |
DE3838774A1 (en) | 1988-11-11 | 1990-05-17 | Mecron Med Prod Gmbh | SLIDING PLATE |
IT1232572B (en) | 1989-02-10 | 1992-02-26 | Calderale Pasquale Mario | MEANS OF OSTEOSYNTHESIS FOR THE CONNECTION OF BONE FRACTURE SEGMENTS |
US4907577A (en) | 1989-04-03 | 1990-03-13 | Wu Shing Sheng | Spinal transpedicle drill jig |
US4959065A (en) | 1989-07-14 | 1990-09-25 | Techmedica, Inc. | Bone plate with positioning member |
DE3923995A1 (en) | 1989-07-20 | 1991-01-31 | Lutz Biedermann | BONE STABILIZING ELEMENT |
FR2651992B1 (en) | 1989-09-18 | 1991-12-13 | Sofamor | IMPLANT FOR ANTERIOR DORSO-LUMBAR SPINE OSTEOSYNTHESIS FOR CORRECTION OF CYPHOSIS. |
JPH066810Y2 (en) | 1989-11-29 | 1994-02-23 | 旭光学工業株式会社 | Vertebral body fixation plate |
PL162734B1 (en) | 1990-05-04 | 1994-01-31 | Jerzy Cieplak | Stabilizer for immobilization broken bones |
US5041116A (en) | 1990-05-21 | 1991-08-20 | Wilson James T | Compression hip screw system |
CH681421A5 (en) * | 1990-06-06 | 1993-03-31 | Synthes Ag | |
US5127912A (en) | 1990-10-05 | 1992-07-07 | R. Charles Ray | Sacral implant system |
US5300073A (en) | 1990-10-05 | 1994-04-05 | Salut, Ltd. | Sacral implant system |
US5492442A (en) | 1990-11-27 | 1996-02-20 | National Medical Specialty, Inc. | Bone screw with improved threads |
US5486176A (en) | 1991-03-27 | 1996-01-23 | Smith & Nephew Richards, Inc. | Angled bone fixation apparatus |
US5129899A (en) | 1991-03-27 | 1992-07-14 | Smith & Nephew Richards Inc. | Bone fixation apparatus |
DE9104025U1 (en) * | 1991-04-03 | 1992-07-30 | Waldemar Link Gmbh & Co, 2000 Hamburg, De | |
US5180381A (en) | 1991-09-24 | 1993-01-19 | Aust Gilbert M | Anterior lumbar/cervical bicortical compression plate |
US5261910A (en) | 1992-02-19 | 1993-11-16 | Acromed Corporation | Apparatus for maintaining spinal elements in a desired spatial relationship |
US5397363A (en) | 1992-08-11 | 1995-03-14 | Gelbard; Steven D. | Spinal stabilization implant system |
US5484439A (en) | 1992-09-16 | 1996-01-16 | Alphatec Manufacturing, Inc. | Modular femur fixation device |
US5324290A (en) | 1992-09-24 | 1994-06-28 | Danek Medical, Inc. | Anterior thoracolumbar plate |
ES2124288T3 (en) | 1992-11-25 | 1999-02-01 | Codman & Shurtleff | PLATE SYSTEM FOR OSTEOSYNTHESIS. |
US5423826A (en) | 1993-02-05 | 1995-06-13 | Danek Medical, Inc. | Anterior cervical plate holder/drill guide and method of use |
US5364399A (en) | 1993-02-05 | 1994-11-15 | Danek Medical, Inc. | Anterior cervical plating system |
FR2705885B1 (en) * | 1993-06-01 | 1995-07-28 | Medinov Sa | Installation set for a unicompartmental knee prosthesis. |
US5380328A (en) | 1993-08-09 | 1995-01-10 | Timesh, Inc. | Composite perforated implant structures |
US5558674A (en) | 1993-12-17 | 1996-09-24 | Smith & Nephew Richards, Inc. | Devices and methods for posterior spinal fixation |
US5487743A (en) | 1994-02-15 | 1996-01-30 | Sofamore, S.N.C. | Anterior dorso-lumbar spinal osteosynthesis instrumentation for the correction of kyphosis |
ATE188363T1 (en) | 1994-02-21 | 2000-01-15 | Collux Ab | IMPLANT FOR THE TREATMENT OF FRACTURES OF THE FEMUR |
DE4409833A1 (en) | 1994-03-22 | 1995-10-05 | Biedermann Motech Gmbh | Stabilizing device, in particular for stabilizing the spine |
CA2551185C (en) * | 1994-03-28 | 2007-10-30 | Sdgi Holdings, Inc. | Apparatus and method for anterior spinal stabilization |
DE4414675C1 (en) | 1994-04-27 | 1995-09-28 | Kirsch Axel | Covering device for bone defects and method for their production |
US5545166A (en) | 1994-07-14 | 1996-08-13 | Advanced Spine Fixation Systems, Incorporated | Spinal segmental reduction derotational fixation system |
US5616142A (en) | 1994-07-20 | 1997-04-01 | Yuan; Hansen A. | Vertebral auxiliary fixation device |
WO1996005778A1 (en) | 1994-08-23 | 1996-02-29 | Spinetech, Inc. | Cervical spine stabilization system |
US5681311A (en) | 1994-09-15 | 1997-10-28 | Smith & Nephew, Inc. | Osteosynthesis apparatus |
US5601553A (en) | 1994-10-03 | 1997-02-11 | Synthes (U.S.A.) | Locking plate and bone screw |
US5601550A (en) * | 1994-10-25 | 1997-02-11 | Esser; Rene D. | Pelvic pin guide system for insertion of pins into iliac bone |
US5620443A (en) | 1995-01-25 | 1997-04-15 | Danek Medical, Inc. | Anterior screw-rod connector |
ES2124988T3 (en) | 1995-02-17 | 1999-02-16 | Sulzer Orthopadie Ag | CONNECTION SYSTEM FOR PEDICULAR SCREWS. |
DE19510372C1 (en) * | 1995-03-22 | 1996-07-25 | Aesculap Ag | Drilling gauge for surgical drilling instruments with sleeve |
US5520690A (en) | 1995-04-13 | 1996-05-28 | Errico; Joseph P. | Anterior spinal polyaxial locking screw plate assembly |
US5578034A (en) | 1995-06-07 | 1996-11-26 | Danek Medical, Inc. | Apparatus for preventing screw backout in a bone plate fixation system |
FR2740321B3 (en) | 1995-10-27 | 1997-12-05 | Fuentes Jean Marc | ANTERIOR OSTEOSYNTHESIS DEVICE FOR CERVICAL VERTEBRES |
US5800433A (en) | 1996-05-31 | 1998-09-01 | Acromed Corporation | Spinal column retaining apparatus |
US5797911A (en) | 1996-09-24 | 1998-08-25 | Sdgi Holdings, Inc. | Multi-axial bone screw assembly |
JP4467647B2 (en) | 1997-02-11 | 2010-05-26 | ウォーソー・オーソペディック・インコーポレーテッド | Bone plating system |
ATE309752T1 (en) | 1997-02-11 | 2005-12-15 | Michelson Gary K | SYSTEM FOR ANTERIOR PLATING OF THE CERVICAL SPINE |
US5827286A (en) | 1997-02-14 | 1998-10-27 | Incavo; Stephen J. | Incrementally adjustable tibial osteotomy fixation device and method |
DE19719052C1 (en) * | 1997-05-06 | 1998-08-06 | Thomas Dr Gausepohl | Marrow-chamber-preparation awl for hip-pinning |
US6017345A (en) | 1997-05-09 | 2000-01-25 | Spinal Innovations, L.L.C. | Spinal fixation plate |
ZA983955B (en) | 1997-05-15 | 2001-08-13 | Sdgi Holdings Inc | Anterior cervical plating system. |
DE19720782B4 (en) | 1997-05-17 | 2004-12-09 | Synthes Ag Chur, Chur | Device for connecting a side member to a pedicle screw |
US6248105B1 (en) | 1997-05-17 | 2001-06-19 | Synthes (U.S.A.) | Device for connecting a longitudinal support with a pedicle screw |
US5851207A (en) | 1997-07-01 | 1998-12-22 | Synthes (U.S.A.) | Freely separable surgical drill guide and plate |
US5964761A (en) | 1997-07-15 | 1999-10-12 | Kambin; Parviz | Method and instruments for percutaneous arthroscopic disc removal, bone biopsy and fixation of vertebrae |
FR2766353B1 (en) | 1997-07-28 | 1999-11-26 | Dimso Sa | IMPLANT, ESPECIALLY ANTERIOR CERVICAL PLATE |
US5954722A (en) * | 1997-07-29 | 1999-09-21 | Depuy Acromed, Inc. | Polyaxial locking plate |
US5984925A (en) | 1997-07-30 | 1999-11-16 | Cross Medical Products, Inc. | Longitudinally adjustable bone plates and method for use thereof |
AU753521B2 (en) | 1997-10-24 | 2002-10-17 | Robert S. Bray Jr. | Bone plate and bone screw guide mechanism |
US5957927A (en) | 1998-02-24 | 1999-09-28 | Synthes (Usa) | Bone fixation device introducer |
US5951558A (en) | 1998-04-22 | 1999-09-14 | Fiz; Daniel | Bone fixation device |
FR2778088B1 (en) | 1998-04-30 | 2000-09-08 | Materiel Orthopedique En Abreg | ANTERIOR IMPLANT, PARTICULARLY FOR THE CERVICAL RACHIS |
US6533786B1 (en) | 1999-10-13 | 2003-03-18 | Sdgi Holdings, Inc. | Anterior cervical plating system |
US20040220571A1 (en) | 1998-04-30 | 2004-11-04 | Richard Assaker | Bone plate assembly |
US6258089B1 (en) | 1998-05-19 | 2001-07-10 | Alphatec Manufacturing, Inc. | Anterior cervical plate and fixation system |
US5904683A (en) | 1998-07-10 | 1999-05-18 | Sulzer Spine-Tech Inc. | Anterior cervical vertebral stabilizing device |
US6066142A (en) * | 1998-10-22 | 2000-05-23 | Depuy Orthopaedics, Inc. | Variable position bone drilling alignment guide |
FR2785787B1 (en) * | 1998-11-12 | 2001-04-13 | Materiel Orthopedique En Abreg | OSTEOSYNTHESIS DEVICE OF AN ANTERIORALLY SPACHED SEGMENT |
US6136002A (en) | 1999-02-05 | 2000-10-24 | Industrial Technology Research Institute | Anterior spinal fixation system |
US6129730A (en) | 1999-02-10 | 2000-10-10 | Depuy Acromed, Inc. | Bi-fed offset pitch bone screw |
US6224602B1 (en) | 1999-10-11 | 2001-05-01 | Interpore Cross International | Bone stabilization plate with a secured-locking mechanism for cervical fixation |
US6602256B1 (en) | 1999-10-11 | 2003-08-05 | Cross Medical Products, Inc. | Bone stabilization plate with a secured-locking mechanism for cervical fixation |
US6379364B1 (en) * | 2000-04-28 | 2002-04-30 | Synthes (Usa) | Dual drill guide for a locking bone plate |
US6342057B1 (en) * | 2000-04-28 | 2002-01-29 | Synthes (Usa) | Remotely aligned surgical drill guide |
US6503250B2 (en) * | 2000-11-28 | 2003-01-07 | Kamaljit S. Paul | Bone support assembly |
-
2001
- 2001-07-17 US US09/907,022 patent/US6692503B2/en not_active Expired - Fee Related
-
2002
- 2002-07-16 WO PCT/US2002/022484 patent/WO2003007826A1/en not_active Application Discontinuation
-
2003
- 2003-08-20 US US10/643,878 patent/US20040097950A1/en not_active Abandoned
-
2009
- 2009-06-29 US US12/494,116 patent/US8167919B2/en not_active Expired - Fee Related
-
2012
- 2012-04-06 US US13/441,218 patent/US20120197301A1/en not_active Abandoned
Cited By (6)
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US9186189B2 (en) | 2000-06-26 | 2015-11-17 | Stryker Spine | Bone screw retaining system |
US20110319939A1 (en) * | 2010-01-05 | 2011-12-29 | Neuraxis Technologies LLC | Compression-distraction spinal fixation system and kit |
US8968367B2 (en) * | 2010-01-05 | 2015-03-03 | The Johns Hopkins University | Compression-distraction spinal fixation system and kit |
US10869702B2 (en) | 2017-05-12 | 2020-12-22 | Nextremity Solutions, Inc. | Compression force magnifier |
US11723701B2 (en) | 2017-05-12 | 2023-08-15 | Zimmer, Inc. | Compression force magnifier |
US11202664B2 (en) | 2018-12-17 | 2021-12-21 | Nextremity Solutions, Inc. | Compression force magnifier |
Also Published As
Publication number | Publication date |
---|---|
US20090326590A1 (en) | 2009-12-31 |
US20040097950A1 (en) | 2004-05-20 |
US20010047172A1 (en) | 2001-11-29 |
WO2003007826A1 (en) | 2003-01-30 |
US6692503B2 (en) | 2004-02-17 |
US8167919B2 (en) | 2012-05-01 |
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