CN102215767A - Load-sharing bone anchor, dynamic vertical rod and assemblies for dynamic stabilization of the spine - Google Patents

Abstract

A versatile dynamic bone anchor and spinal rod for use in a dynamic stabilization system to support the spine while providing for the preservation of spinal motion. The dynamic bone anchor provides load sharing while preserving range of motion. The dynamic bone anchor includes a deflectable post connected by a ball-joint to a threaded anchor. Deflection of the deflectable post is controlled by a compliant member. The dynamic rod is connected to the dynamic bone anchor by a joint which permits relative movement of the deflectable post and rod reducing the stress exerted upon the bone anchors and spinal anatomy.

Description

Be used for dynamic spinal stable load balancing bone anchor, dynamic vertical bar and assembly

Background technology

Back pain be the clinical problem given prominence to and by operation and medicine to its annual cost for the treatment of estimation above 2,000,000,000 dollars.Being used for the treatment of on a large scale, a kind of method of degenerative spinal disease is a spinal fusion.In the past ten years, design develops very rapidly in order to the vertebra that merges spinal column with the implantable medical device for the treatment of.Yet spinal fusion has some shortcomings, comprises having reduced range of movement and quickened near the degenerative of fused vertebrae to change.

Developed and be used for the treatment of alternative device and the Therapeutic Method that the degenerative spinal disease keeps motion simultaneously.These devices and Therapeutic Method provide treatment degenerative spinal disease and don't have had the probability of the shortcoming of spinal fusion.Yet, conventional device and method have some shortcomings, for example: implant procedure complexity, the motility that lack to adapt to various patient's anatomical structures, needs reject organize and bone the structural pressure of anatomy of spine, anchor system are unreliable to have implanted, to have increased, the selectivity of poor durability and correction is few.Therefore, need new and improved device and method are treated the degenerative spinal disease, can keep motion again simultaneously.

Summary of the invention

The present invention includes a kind of can dynamic spine stabilization the spinal implant system and the method for preservation spinal motion simultaneously.The embodiments of the present invention provide a kind of dynamic stabilization system and method for implantation that comprises universal component, adjustable stabilizing component.An aspect of each embodiment of the present invention be can be by selecting to be used to implant the intravital suitable components of patient the two-stage, three grades and/or multistage of stabilizing spine.Another aspect of each embodiment of the present invention is can be by the concrete anatomical structure that provides the system with universal component to be adapted to the patient, and described universal component can customize according to concrete patient's anatomical structure and demand and implant procedure.Another aspect of the present invention is to be convenient to the carrying out of implanting, and makes when implanting the infringement minimum to tissue.

Therefore, the present invention provides new improved system, the apparatus and method that are used to handle the degeneration disorder of the vertebral column by providing and implant the dynamic spinal stabilizing component, and described assembly can keep motion again when supporting spinal column.These and other purpose of the present invention, feature and advantage will become obvious from accompanying drawing and to the detailed description of accompanying drawing.

Description of drawings

Figure 1A and 1B are the perspective views that is installed to the deflection system parts on the anchor system parts according to one embodiment of the present invention.

Fig. 1 C is the perspective view that is installed to the connected system parts on the anchor system parts according to one embodiment of the present invention.

Fig. 1 D is the perspective view that is installed to the another kind of connected system parts on the anchor system parts according to one embodiment of the present invention.

Fig. 1 E is the rearview according to the anchor system that is used for multistage dynamic stability assembly of one embodiment of the present invention, and this assembly has used the anchor part of Figure 1A to 1D.

Fig. 1 F be according to the use of one embodiment of the present invention the rearview of Figure 1A to the multistage dynamic stability assembly of the parts of 1E.

Fig. 2 A is the exploded view according to the deflecting bar of one embodiment of the present invention.

Fig. 2 B is the perspective view that the deflecting bar component groups of Fig. 2 A installs.

Fig. 2 C is the sectional view of the deflecting bar assembly of Fig. 2 A and 2B.

Fig. 2 D is the sectional view of the deflecting bar assembly of Fig. 2 A and 2B.

Fig. 2 E and 2F are the sectional views of the deflecting bar assembly of Fig. 2 A and 2B, show the deflection of post.

Fig. 2 G is the view in transverse section of vertebra, and it shows the implantation of the deflecting bar assembly of Fig. 2 A and 2B.

Fig. 3 A is the exploded view according to the another kind of deflecting bar assembly of one embodiment of the present invention.

Fig. 3 B is the perspective view that the deflecting bar component groups of Fig. 3 A installs.

Fig. 3 C is the sectional view of the deflecting bar assembly of Fig. 3 A and 3B.

Fig. 3 D is the sectional view of the deflecting bar assembly of Fig. 3 A and 3B, shows the deflection of post.

Fig. 3 E is the view in transverse section of vertebra, and it shows the implantation of the deflecting bar assembly of Fig. 3 A and 3B.

Fig. 3 F is the view in transverse section of vertebra, and it shows the implantation of another kind of deflecting bar.

Fig. 3 G be according to the use of one embodiment of the present invention the side view of multistage dynamic stability assembly of deflecting bar assembly of Fig. 3 A-3B.

Fig. 3 H is the side view according to the skew adapter on the deflecting bar assembly that is installed in Fig. 3 A-3B of one embodiment of the present invention.

Fig. 3 I shows according to the base that is suitable for having of one embodiment of the present invention with the internal structure of the structural engagement of the housing of deflecting bar assembly.

Fig. 3 J shows according to the adapter that is suitable for having of one embodiment of the present invention with the internal structure of the structural engagement of the housing of deflecting bar assembly.

Fig. 4 A is the exploded view according to the another kind of deflecting bar assembly of one embodiment of the present invention.

Fig. 4 B is the perspective view that Fig. 4 A deflecting bar component groups installs.

Fig. 4 C is the sectional view of the deflecting bar assembly of Fig. 4 A and 4B.

Fig. 4 D is the sectional view of the deflecting bar assembly of Fig. 4 A and 4B, shows the deflection of post.

Fig. 4 E is the sectional view according to the another kind of deflecting bar assembly of one embodiment of the present invention.

Fig. 4 F is the sectional view according to the another kind of deflecting bar assembly of one embodiment of the present invention.

Fig. 4 G is the sectional view according to the another kind of deflecting bar assembly of one embodiment of the present invention.

Fig. 5 A is a chart, shows the deflection/force-responsive curve of the various deflecting bar embodiments of numerous embodiments according to the present invention.

Fig. 5 B is the sectional view of another kind of deflecting bar.

Fig. 6 A-6H is the sectional view of the other types deflecting bar assembly of the numerous embodiments according to the present invention.

Fig. 7 A-7E is the perspective view of other combinations of the deflecting bar of the numerous embodiments according to the present invention and bone anchor.

Fig. 7 F-7H is the perspective and the sectional view that torque limit disconnects the alternative bone anchor of head that have of one embodiment of the present invention.

Fig. 8 A-8H shows has the alternative deflecting bar that the deflection post is fastened to the different institutions on deflecting bar assembly and/or the bone anchor.

Fig. 9 A-9C shows the another kind of deflecting bar assembly according to one embodiment of the present invention.

Fig. 9 D-9F shows the another kind of deflecting bar assembly according to one embodiment of the present invention.

Fig. 9 G and 9H show the another kind of deflecting bar assembly according to one embodiment of the present invention.

Figure 10 A-10E show according to one embodiment of the present invention be used for the deflecting bar assembly is connected to locking linkwork on the vertical rod.

Figure 11 A-11D show according to one embodiment of the present invention be used for the deflecting bar assembly is connected to locking ball joint mechanisms on the vertical rod.

Figure 11 E-11F show according to one embodiment of the present invention be attached on the deflecting bar assembly, be used for the deflecting bar assembly is connected to locking container mechanism on the vertical rod.

Figure 12 A-12D shows the locking container mechanism that is used for vertical rod is connected to the post that is terminated at ball according to one embodiment of the present invention.

Figure 13 A and 13B show the deflecting bar assembly with pivoting head according to one embodiment of the present invention.

Figure 14 A and 14B show the deflecting bar assembly with pivoting head according to one embodiment of the present invention.

Figure 15 A-15C shows the view of preferred deflection bar, bone anchor and vertical rod.

Figure 16 A-16B shows various perspective views, and it shows the deflecting bar assembly according to the adjustable vertical rod adapter of having of one embodiment of the present invention.

Figure 17 A shows the sectional view according to the another kind of deflecting bar assembly of one embodiment of the present invention.

Figure 17 B shows the telescopic perspective view of the deflecting bar assembly of Figure 17 A.

Figure 17 C-17E shows the various telescopic view of the deflecting bar assembly of the numerous embodiments according to the present invention.

Figure 18 A is the exploded view according to the another kind of deflecting bar assembly of one embodiment of the present invention.

Figure 18 B is the perspective view that the deflecting bar component groups of Figure 18 A installs.

Figure 18 C is the sectional view of the deflecting bar assembly of Figure 18 A and 18B.

Figure 18 D is the sectional view of the deflecting bar assembly of Figure 18 A and 18B, shows the deflection of post.

Figure 18 E is the partial section of the O type ring of Figure 18 A.

Figure 18 F is the partial section of another kind of O type ring.

Figure 18 G is the partial section of another O type ring.

Figure 18 H is the partial section of another kind of O type circle.

Figure 19 A is the exploded view of the another kind of deflecting bar assembly of a kind of preferred implementation according to the present invention.

Figure 19 B is the perspective view that Figure 19 A deflecting bar component groups installs.

Figure 19 C is the sectional view of the deflecting bar assembly of Figure 19 A and 19B.

Figure 19 D is the sectional view of the deflecting bar assembly of Figure 19 A and 19B, shows the deflection of post.

Figure 19 E-19G shows the enlarged drawing of each parts of the deflecting bar assembly of Figure 19 A-19D.

Figure 20 A shows the perspective view according to the implanting instrument that is used for dynamic bone anchor of one embodiment of the present invention.

Figure 20 B and 20C show the thin portion sectional view of the implanting instrument head of Figure 20 A that is associated with dynamic bone anchor.

Figure 20 D is the transverse view of lumbar spine, and its implanting instrument that shows use Figure 20 A of one embodiment of the present invention is implanted to dynamic bone anchor in the pedicle of vertebral arch of lumbar vertebra.

Figure 21 A shows the perspective view that is used for the dynamic vertical bar is fastened to the attaching tool on the dynamic bone anchor according to one embodiment of the present invention.

Figure 21 B shows the detail drawing of head of the attaching tool of Figure 21 A.

Figure 21 C and 21D show the thin portion sectional view of head of the attaching tool of Figure 21 A that is associated with dynamic vertical bar and bone anchor.

Figure 21 E-21H is the side view of lumbar spine, and it shows according to the attaching tool of use Figure 21 A of one embodiment of the present invention the dynamic vertical bar is fastened to step on the dynamic bone anchor assemblies.

Figure 22 A is the side view of lumbar spine, shows the natural motion of spinal column when stretching with bending.

Figure 22 B is the side view of lumbar spine, shows when stretching with bending and is applied to epispinal motion restriction by the rigidity spinal rod system.

Figure 22 C and 22D show the stable motor pattern of implanting embodiment of dynamic spinal of the present invention, and it has utilized dynamic bone anchor and dynamic vertical bar according to embodiment of the present invention.

Figure 22 E is a chart, shows the motion that the dynamic spinal of the dynamic bone anchor that comprises Figure 22 C and 22D is stablized prosthese.

Figure 22 F is the side view of spinal column, and it shows the motion of being stablized the spinal column of prosthese support by the dynamic spinal of Figure 22 E.

The specific embodiment

The present invention includes can dynamic spine stabilization and the universal spinal implant system and the method for preservation spinal motion.Alternative embodiment can be used for spinal fusion.One aspect of the present invention is recovery and/or keeps the spinal column natural motion that comprises moving-mass and range of movement.In addition, another aspect of the present invention provides the load distribution of spinal column and stablizes, and keeps motion simultaneously.

Another aspect of the present invention provides a kind of modular system, can customize it according to needs of patients.Another aspect of each embodiment of the present invention be can be by selecting to be suitable for implanting the intravital suitable components of patient the two-stage, three grades and/or multistage of stabilizing spine.Another aspect of the present invention is to provide higher rigidity and fusion for the one-level or the part of spinal column, allows another adjacent level of spinal column or another part to have lower rigidity and dynamic stability simultaneously.The embodiments of the present invention permission is placed on grades of fusion by the dynamic stability level.This embodiment of the present invention by provide from the rigidity grades of fusion to dynamic stability, keep transition motion and more easily mobile that one-level and make in abutting connection with the vertebral levels of grades of fusion and can be protected.

The embodiments of the present invention provide the assembly of dynamic stabilization system, and this assembly supports spinal column preservation spinal motion again simultaneously.This dynamic stabilization system has anchor system, deflection system, vertical rod system and connected system.Anchor system with structure anchor on the anatomy of spine structure.Deflection system provides dynamic stability, has reduced to be applied to the structural stress of bone anchor and anatomy of spine simultaneously.The vertical rod system is connected the different levels of structural member in the multistage assembly, and it can comprise the combined deflection bar in some embodiment.Connected system comprises coaxial connector and skew adapter, and they can connect deflection system, vertical rod system and anchor system in adjustable mode, to allow with respect to reasonable, efficient the reaching of spinal column anchor system being set easily.Various alternative embodiments can be used for spinal fusion.

The embodiments of the present invention comprise have anchor system, the structural member of deflection system, vertical rod system and connected system.Deflection system provides dynamic stability, has reduced to be applied to the structural stress of bone anchor and anatomy of spine simultaneously.Anchor system anchors to deflection system on the spinal column.Connected system is connected to deflection system in the vertical rod system.The vertical rod system connects dynamic stabilization system parts on the different vertebras so that load distribution and dynamic stability to be provided.

The embodiments of the present invention comprise the deflecting bar assembly, and it provides the load distribution, keep range of movement simultaneously and have reduced to be applied to the bone anchor and the structural stress of anatomy of spine.The deflecting bar assembly comprises the deflection post that is installed in the bone anchor.The deflection of deflection post is controlled by flexible sleeve.The contact surface that deflecting bar is set is so that the deflection of restriction deflection post.Power/the deflection characteristic of deflecting bar assembly can adapt with patient's anatomical structure and functional requirement.

In all drawings and detailed description, identical Reference numeral is used to represent components identical; Therefore, if relevant element is described elsewhere, the Reference numeral that in a width of cloth figure, uses may or may not can in corresponding to the detailed description of this figure by reference.The figure number of the figure that the first bit representation reference item of three figure place Reference numerals occurs first.Similarly, the figure number of the figure that occurs first of the one or two bit representation reference item of four figures Reference numeral.

In whole description, term " vertically " and " level " are used to represent structural member with respect to the general orientation of the spinal column of the human patients of standing.The application's parts when describing spinal implant system have also used term " closely " and " far " in a conventional manner.Therefore, this end of " closely " indication device or parts or side are nearest from the hands of this device of operation, and " far " then this end of indication device or side be from the hands of operating this device farthest.For example, the tip that will enter the nail of skeleton usually is called far-end (it from the surgeon farthest), and the head that will follow closely is called near-end (its most close surgeon).

Dynamic stabilization system

Figure 1A-1F has introduced each parts according to the dynamic stabilization system of one embodiment of the present invention.These parts comprise anchor system parts, deflecting bar, vertical rod and connected system parts, comprise for example coaxial and the skew adapter.Implantable these parts or it is assembled to form the dissection that is fit to the patient and the dynamic stabilization system of functional requirement.

Figure 1A shows bone anchor 102 and is connected to deflecting bar 104 on the vertical rod 106 by ball-and-socket joint 108.Deflecting bar 104 is examples of the parts of deflecting bar component system.Deflecting bar 104 is a kind of controlled flexible parts that have, and it allows load to distribute.Deflecting bar 104 provides rigidity when needed and supports and be applied to epispinal load during being supported on normal spinal motion, because the soft tissue or the degeneration of spinal column or sustain damage, the soft tissue of spinal column no longer can bear these loads.By selecting suitable deflecting bar rigidity so as with the ability that cooperates of load partition characteristic of expectation, improve the distribution of load.For embodiments of the present invention, term " deflecting bar " and " carrier bar " are used interchangeably.Describe deflecting bar, deflecting bar installing rack and alternative deflecting bar in more detail below.

Deflecting bar 104 comprises can be with respect to the deflection post 105 of installing rack 107 deflections.Installing rack 107 is suitable for deflection post 105 is installed on the bone anchor 102.Installing rack 107 is contained in the cavity 132 of bone anchor 102.In the time of in being contained in cavity 132, installing rack 107 is fastened in the restraint location with respect to bone anchor 102.Deflection post 105 still can controllable mode with respect to 102 deflections of bone anchor, thereby provide load to distribute, keep patient's range of movement simultaneously.May command and/or customization deflection post 105 are with respect to the rigidity/pliability of the deflection of installing rack 107/ bone anchor 102, as following described.

Shown in Figure 1A, installing rack 107 is designed to be contained in the cavity 132 of bone anchor 102.Shown in Figure 1A, installing rack 107 comprises collar 140.Screwed hole 142 tilts to extend through collar 140.Screwed hole 142 holds locking trip bolt 144, the housing 130 of its (Figure 1B) zeugopodium anchor 102 when fastening.Locking trip bolt 144 is placed in the screwed hole 142 that passes collar 140.Thereby locking trip bolt 144 is fastening on the throne in the housing 130 of bone anchor 102 with the installing rack 107 of deflecting bar 104.

Shown in Figure 1A, the orientation of deflecting bar 104 is defined as and bone anchor 102 coaxial, conllinear or parallel.This layout makes to implant and becomes simple, has reduced the damage to the implant site surrounding structure, and has reduced system complexity.The coaxial arrangement of deflecting bar 104 and bone anchor 102 can be basically pivots the moment forces that applied by deflection post 105 or the torque force that rotates converts to and tends to the torque force that works perpendicular to main-shaft axis around main-shaft axis from tending to make bone anchor 102.Therefore, deflecting bar can stop reorientating of deflecting bar and/or bone anchor 102 effectively, and need not to use lock screw or horizon bar to stop rotation.More examples of coaxial deflecting bar are provided below.Each deflecting bar as described herein all can be used as the parts of dynamic stabilization system.

Bone anchor 102 is examples of the parts of anchor system.Bone anchor 102 comprises nail 120 and housing 130.Shown in Figure 1A, bone anchor 102 is for having the nail 120 of one or more screw threads 124, and screw thread 124 engages skeleton so that bone anchor 102 is fastened on the skeleton.Anchor system can comprise one or more alternative bone anchors well known in the prior art, for example, hamulus of hamate bone, expansion gear, barbed device, screw device, binding agent and can replace nail 120 or except that nail 120, parts are fastened to other devices on the skeleton.

Shown in Figure 1A, bone anchor 102 is included in the housing 130 of near-end.Housing 130 comprises the cavity 132 that is used to hold deflecting bar 104.Cavity 132 is coaxial with screw thread nail 120.Housing 130 also comprises and is used for deflecting bar 104 is fastened on groove 134 in the housing 130.Shown in Figure 1A, groove 134 is positioned at the near-end of housing 130.Groove 134 is designed to engage by the locking mechanism that is installed in the parts in the cavity 132.For example, groove 134 is designed to engage by the locking trip bolt 144 of deflecting bar 104.When deflecting bar 104 has been arranged in the cavity 132 of bone anchor 102 shown in Figure 1B, tightens locking trip bolt 144 engaging the groove 134 of housing 130, thereby deflecting bar 104 is fastened in the housing 130.Can use alternative mechanism and technology that deflecting bar is fastened on the bone anchor, for example comprise, welding, soldering, bonding and/or mechanical fitting comprise screw thread, snap ring, lock washer, split pin, bayonet type accessory or other mechanical splices.

Bone anchor 102 also comprises the connector 136 that miscellaneous part can be installed.Shown in Figure 1A, connector 136 is the external cylindrical surface of housing 130.Therefore, housing 130 provides two installation sites, i.e. a coaxial installation site and an outside installation site.Therefore, single bone anchor 102 can be used as one, the mounting points of two or more parts.Deflecting bar 104 can coaxially be installed in the cavity 132 of housing, and one or more optional features can externally be installed on the outer surface 136 of housing.For example, the parts of connected system can be installed on the outer surface 136 of housing---and this adapter is called skew head or skew adapter.In some applications, the parts of connected system can replace deflecting bar 104 coaxial being installed in the cavity 132---this adapter can be described as with spindle nose or coaxial connector.

Expectation be have can with the different connector of the certain limit of anchor system and deflection system compatibility.These adapters can have different attributes, comprise, for example, and different degree of freedom, range of movement and side-play amount, these attributes more or less are fit to the concrete relative direction and the position of two bone anchors and/or patient's anatomical structure.Expectation be that each adapter has enough versatilities on the position of certain limit and direction vertical rod is connected on the bone anchor, it is hated again simply to allow the surgeon to regulate with fastening simultaneously.The one group of permission that provides of expectation is assembled the adapter of dynamic stabilization system to regulate concrete dynamic stability assembly to adapt to patient's anatomical structure rather than adjusting patient anatomical structure in the mode that adapts to assembly implantation (for example, by eliminating the tissue/bone arm with containment).In preferred embodiment, comprise that this group adapter of connected system has enough pliabilities, to realize suitable dynamic stability assembly under all situations that allows dynamic stabilization system in the patient colony that is limited, to run into.

In some embodiment of the present invention, the connected system parts, for example the multiaxis adapter can be installed in the cavity 132 of bone anchor 102 so that the bone anchor is fastened on the vertical rod 106.For example, Fig. 1 C shows the same spindle nose 150 into the multiaxis adapter, and it is coaxial to be installed in the cavity 132 of housing 130 of bone anchor 102.With spindle nose 150 is a example with spindle nose or coaxial connector.Bone anchor 102 is with before identical with the described bone anchor of 1B referring to Figure 1A.Comprise the bar 152 that is designed in the cavity 132 that is assemblied in housing 130 with spindle nose 150.Also comprise collar 154 and locking trip bolt 156 with spindle nose 150.Locking trip bolt 156 is configured to engage with the groove 134 of bone anchor 102 in the mode identical with the locking trip bolt 144 of deflecting bar 104.In some cases, the cross section of bar 152 and cavity 132 can be circular (for example, cylindrical), and in this case, bar 152 can rotate cavity 132 in and lock on the throne up to locked trip bolt 156.In alternative embodiment, the cross section of bar 152 can be a polygon, thereby it is assembled in one of them position of possible position of fastening number.

Refer again to Fig. 1 C, be attached to being yoke 164 on the bar 152 of spindle nose 150.Yoke 164 is connected on the ball 165 by hexagonal pin 162.Saddle 163 also is installed on the ball 165, thereby saddle 163 can pivot around two normal axis with respect to yoke 164.Saddle 163 has the hole 168 that vertical rod can pass.A side of 168 is an inserted link 169 in the hole.168 opposite side is a locking trip bolt 167 in the hole.When vertical rod 106 (not shown) are placed in the hole 168 and locking trip bolt 167 when tightening downwards, locking trip bolt 167 forces vertical rod 106 to be pressed on the inserted link 169 downwards.And inserted link 169 is pressed ball 165 downwards by vertical rod 106.Inserted link 169 engage ball 165, ball 165 engages hexagonal pins 162, so that saddle 163 is locked in certain position with respect to yoke 164, and bar (for example, vertical rod 106) is fastened on the saddle 163.Like this, tighten trip bolt 167 vertical rod 106 is fastened to on the spindle nose 150, also lock orientation simultaneously with spindle nose 150.

To have some advantages with respect to standard multiaxis nail with the spindle nose 150 coaxial abilities that are installed on the bone anchor 102, in standard multiaxis nail, the multiaxis adapter is the part of the one of this device, and non-dismountable or replacing.The installation of bone anchor 102 is simpler, and does not have the risk of any damage multiaxis adapter in the installation process.Can process and be designed to be installed on the different bone anchors of certain limit with spindle nose 150 single, thereby the bone anchor that allows to select be fit to patient's anatomical structure.After the bone anchor is installed, need not to change the orientation that screw depth just can adjustment yoke 164 (if in standard multiaxis nail equally rotating screw be impossible).The bone anchor need not to dismantle the bone anchor and the difference of certain limit just can be installed with one in the spindle nose after implanting.Similarly, proofread and correct if desired, need not to dismantle bone anchor 102 just can be to changing different parts coaxial first watch.

As mentioned above, bone anchor 102 has the housing 130 that can receive coaxial mounted parts (for example, same spindle nose) and an outside installing component (for example being offset adapter).Fig. 1 D shows the parts that can be installed in the connected system of bone anchor 102 outsides in conjunction with coaxial mounted parts.Fig. 1 D shows the perspective view of the skew adapter 170 of housing 130 outsides that are installed in bone anchor 102, wherein, and deflecting bar 104 coaxial installations.Adapter 170 also can be described as skew head or skew adapter.

Skew adapter 170 comprises six parts, and both direction degree of freedom and two position freedoms are arranged when vertical rod being connected on the bone anchor.Six parts of skew adapter 170 are dowel pin 172, pivotal pin 174, locking trip bolt 176, inserted link 178, hold-down ring 180 and saddle 182.Saddle 182 has groove 184, and the size of this groove 184 forms holds the bar that can be vertical rod (for example vertical rod 106 of Figure 1A).Locking trip bolt 176 is installed in an end of groove 184, thereby it can be tightened so that bar is fastened in the groove 184.

The size of hold-down ring 180 forms when it unclamps and can slide by easy on and off on the housing 130 of bone anchor 102, and can rotate around housing 130.Yet when locking trip bolt 176 when being tightened on the bar, hold-down ring 180 clamps housings, and prevents to be offset adapter 170 and move in any direction.Saddle 182 is connected on the hold-down ring 180 in the mode that can pivot by pivotal pin 174.Saddle 182 can pivot around pivotal pin 174.Yet when locking trip bolt 176 was tightened on the bar, inserted link 178 clamped hold-down ring 180, thereby prevents that saddle 182 from further moving.Like this, the operation of single trip bolt 176 is used for hold-down ring 180 is locked onto the housing 130 of bone anchor 102, saddle 182 is fastened in the restraint location with respect to hold-down ring 180, and bar is fastened in the groove 184 of skew adapter 170.

Above-mentioned coaxial connector and skew adapter just propose by example.Also can find alternative embodiment in the patent application of quoting below with spindle nose and skew adapter.These can cooperate with parts described herein with spindle nose and skew adapter, with the assembling of the dynamic stabilization system of the functional requirement that allows the suitable concrete patient of assembling and anatomical structure.In addition, also can utilize the screw with integral connectors, for example, multi-axial screws anchors to the parts of dynamic stabilization system in the restraint location with respect to vertebra.

The parts of dynamic stabilization system can be assembled and be implanted in patient's the spinal column, so that multistage dynamic stability assembly is provided, this assembly provides the dynamic stability of spinal column and load to distribute.In some embodiment, first step is that the bone anchor is implanted in the vertebra.In other embodiments, can be under the situation that deflecting bar/link has been installed the implantable bone anchor.

Fig. 1 E shows three adjacent vertebras 191,192 and 193.As initial step, bone anchor 102a, 102b and 102c spinous process 194 right sides between spinous process 194 and transverse process 195 are implanted in vertebra 191,192 and 193.In cavity 132a, 132b, 132c, insert driver and enter into skeleton so that drive the threaded portion of each bone anchor.In preferred program, the direction of bone anchor is arranged so that the threaded portion is implanted in one of them pedicle of vertebral arch 196 of tilting towards vertebral body 197.Implant in vertebra 191,192 and 193 fully the threaded portion of each bone anchor.Driver is chocolate-substituting ground and/or additionally engage the outer surface of housing 130 also, so that the implantable bone anchor.Driver can have torque measurement and/or torque limiting function so that help the accurate implantation of nail, and avoids too much power to be applied on the vertebra.In alternative embodiment, nail can be combined with the torque limiting element, for example, and isolating auxiliary head when the driver torque surpasses the pre-determined torque limit value.Referring to, for example Fig. 7 F-7H and appended literal.

Shown in Fig. 1 E, housing 130a, the 130b of each bone anchor, 130c retaining part or all be exposed on the spine surface, thus can be with one or more being fastened on each bone anchor 102a, 102b and the 102c in connected system parts and the deflection component.Coaxial elements can coaxially be installed among each cavity 132a, 132b and the 132c.Skew head/adapter also can be from the outer surface that is externally mounted to each housing 130a, 130b, 130c.Notice that the bone anchor is also in the implantation of the left side of spinal column.

Install after the bone anchor, just can install and assemble deflection system parts, vertical rod system unit and connected system parts.Fig. 1 F shows a kind of mode of assembling deflection system parts and connected system parts.Shown in Fig. 1 F, be installed among the bone anchor 102c with spindle nose 150.Skew adapter 170 is installed to bone anchor 102b hull outside.Deflecting bar 104a is coaxial to be installed in the housing of bone anchor 102a.Deflecting bar 104b is coaxial to be installed in the housing of bone anchor 102b.Vertical rod 106a at one end is connected on the deflecting bar 104a by ball-and-socket joint 108a.Vertical rod 106a is connected on the bone anchor 102b by embedded adapter 170 at the other end.The second vertical rod 106b at one end is connected on the deflecting bar 104b by ball-and-socket joint 108b.Vertical rod 106b at the other end by being connected on the bone anchor 102c with spindle nose 150.

Therefore, the dynamic stability assembly 190 of Fig. 1 E has vertical rod 106a, the 106b that stablizes each spinal column level (191-192 and 192-193).Each vertical rod 106a, 106b at one end are rigidly secured on the bone anchor (102b, 102c).Each vertical rod 106a, 106b are fastened on deflecting bar 104a, the 104b by ball-and-socket joint 108a, 108b at the other end, thereby allow to distribute and certain motion by the load of dynamic stability assembly.Be offset adapter 170 and allow dynamic stability assemblies 190 to be assembled into different patient's anatomical structures of relative broad range and/or the layout of bone anchor 102a, 102b and 102c with spindle nose 150.Preferably will implant identical or similar dynamic stability assembly in the left side of spinal column.It should be noted that dynamic stability assembly 190 does not need horizon bar or lock screw, thus,, reduced the exposure of tissue and/or skeleton foreign body object with respect to system with this additional firmware.The dynamic stability assembly of Fig. 1 F has less area, thereby reduced the displacement of tissue and/or skeleton potentially, has reduced in the operation process damage to tissue and/or skeleton.In addition, less area can reduce the amount that needs the tissue that exposes in the implantation process.

Concrete dynamic stability assembly shown in Fig. 1 G just proposes by example.An aspect of the preferred embodiment for the present invention provides the parts of certain limit, and combination and structure that these parts can be different are assembled, so that form suitable different patients' the functional requirement and the different assemblies of anatomical structure.Equally, can on different spinal column levels, incorporate deflecting bar with the function needs into according to dissecting with different power deflection characteristics.Can on one or more motion segmentation, provide dynamic stability,, can cooperate the fusion on the adjacent motion segmentation on one or more motion segmentation, to provide dynamic stability in some cases.Concrete dynamic stability assembly can be in conjunction with the combination of bone anchor described herein, vertical rod, deflecting bar, skew adapter and coaxial connector, in related application, and standard spinal stabilization and/or merge parts, for example, screw, bar and multi-axial screws.Especially, following related application disclose with present patent application in the parts described and the combination of components parts and the assembly that use.

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " A Modular In-Line Deflection Rod And Bone Anchor System And Method For Dynamic Stabilization Of The Spine ", 478 (attorney docket: No.SPART-01042US1); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Versatile Polyaxial Connector Assembly And Method For Dynamic Stabilization Of The Spine ", 485 (attorney docket: No.SPART-01043US1); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Versatile Offset Polyaxial Connector And Method For Dynamic Stabilization Of The Spine ", 487 (attorney docket: No.SPART-01043US2); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Load-Sharing Bone Anchor Having A Deflectable Post and Method For Dynamic Stabilization Of The Spine ", 491 (attorney docket: No.SPART-01044US1); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Load-Sharing Component Having A Deflectable Post And Method For Dynamic Stabilization Of The Spine ", 494 (attorney docket: No.SPART-01044US5); With

JIUYUE in 2009 24 days is that submit to, name is called " Load-Sharing Bone Anchor Having A Durable Compliant Member And Method For Dynamic Stabilization Of The Sp

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Load-Sharing Bone Anchor Having A Deflectable Post With A Compliant Ring And Method For Stabilization Of The Spine ", 504 (attorney docket: No.SPART-01044US7); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Load-Sharing Bone Anchor Having A Deflectable Post With A Compliant Ring And Method For Stabilization Of The Spine ", 507 (attorney docket: No.SPART-01044US8); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Load-Sharing Bone Anchor Having A Deflectable Post And Method For Stabilization Of The Spine ", 511 (attorney docket: No.SPART-01044US9); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Load-Sharing Bone Anchor Having A Deflectable Post And Method For Stabilization Of The Spine ", 516 (attorney docket: No.SPART-01044USA); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Dynamic Spinal Rod And Method For Dynamic Stabilization Of The Spin ", 519 (attorney docket: No.SPART-01044USC); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Dynamic Spinal Rod Assembly And Method For Dynamic Stabilization Of The Spine ", 522 (attorney docket: No.SPART-01044USD); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Configurable Dynamic Spinal Rod And Method For Dynamic Stabilization Of The Spine ", 529 (attorney docket: No.SPART-01044USE); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " A Spinal Prosthesis Having A Three Bar Linkage For Motion Preservation And Dynamic Stabilization Of The Spine ", 531 (attorney docket: No.SPART-01044USF); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Surgical Tool And Method For Implantation of A Dynamic Bone Anchor ", 534 (attorney docket: No.SPART-01045US1); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Surgical Tool And Method For Connecting A Dynamic Bone Anchor and Dynamic Vertical Rod ", 547 (attorney docket: No.SPART-01045US2); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Load-Sharing Bone Anchor Having A Deflectable Post And Centering Spring And Method For Dynamic Stabilization Of The Spine ", 551 (attorney docket: No.SPART-01049US1); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Load-Sharing Component Having A Deflectable Post And Centering Spring And Method For Dynamic Stabilization Of The Spine ", 553 (attorney docket: No.SPART-01049US2); With

JIUYUE in 2009 24 days is that submit to, name is called the U.S. Patent application No.12/566 of " Load-Sharing Bone Anchor Having A Deflectable Post And Axial Spring And Method For Dynamic Stabilization Of The Spine ", 559 (attorney docket: No.SPART-01053US1); With

On May 30th, 2008 submitted to, name is called the U.S. Patent application No.12/130 of " A Deflection Rod System For A Dynamic Stabilization And Motion Preservation Spinal Implantation System And Method ", 395 (attorney docket: No.SPART-01037US1); With

On May 30th, 2008 submitted to, name is called the U.S. Patent application No.12/130 of " A Spine Implant With A Deflection Rod System Including A Deflection Limiting Shield Associated With A Bone Screw And Method ", 095 (attorney docket: No.SPART-01037US2).

Deflecting bar/load beam

A feature of embodiment of the present invention is load distribution and the range of movement that is provided by deflecting bar.Deflecting bar provides rigidity and supports and is applied to epispinal load with during supporting normal spinal motion in the place of needs, thereby need not to sacrifice the spinal function that all motions just can recover to improve.Deflecting bar also makes anchor system parts and the power that is applied by the dynamic stability assembly isolate, thus reduce bone anchor and they the stress on the attached skeleton.In addition, place epispinal load with physiology and the patient who cooperates the patient, just can realize better result for the patient by the suitable rigidity of selecting deflecting bar or load beam.

Deflecting bar comprises deflection post, flexible sleeve and installing rack.Deflection post and installing rack are made by one or more metals of bio-compatible usually, for example titanium and rustless steel.Sleeve is by compatible material, and for example compatible polymer is made.Installing rack is fastened to deflecting bar on the anchor in the mode that allows the deflection of deflection post.The deflection post is configured to be connected in the vertical rod system.The deflection post can be by the flexible material of compression sleeve with respect to installing rack deflection.Telescopic distortion makes the deflection post have power/deflection characteristic.The deflection post allows the controlled motion of bone anchor (being implanted in wherein vertebra with it) with respect to vertical rod with respect to the motion of installing rack, thereby supports the vertebra that is attached with the bone anchor, allows the motion of vertebra simultaneously.

By design, material and the size of choose reasonable post, sleeve and installing rack, can make deflecting bar from being configured in the scope that has very much flexible structure of high degree of rigidity.According to concrete patient's psychological need, can in the dynamic stability assembly, select for use to have certain stiffness/flexible deflecting bar.In a preferred embodiment, the rigidity/pliability of deflecting bar is chosen as provide with patient's normal range 50% to 100%, the load that preferably cooperates with 70% to 100% of patient's normal range distributes.

In some cases, some deflecting bar of dynamic stability assembly can have the rigidity different with other deflecting bars or rigidity or pliability.Therefore, according to patient's demand, in identical assembly, first deflecting bar can have first pliability or rigidity or rigidity, and second deflecting bar can have the second different pliabilities or rigidity or rigidity.The specific embodiment of dynamic stability assembly can utilize the deflecting bar with different deflection characteristics to be used for the at different levels of dynamic stability assembly and/or each side.In other words, according to the design and the selection of different-stiffness characteristic, the part of dynamic stability assembly can provide than the more resistance of motion of other parts, is beneficial to the patient if this is configured with.

Fig. 2 A illustrates design and operation according to first embodiment of the deflecting bar of one embodiment of the present invention to 2G.Fig. 2 A shows the exploded view of deflecting bar 200.Deflecting bar 200 comprises keeper 202, deflection post 204, sleeve 206, outer housing 208, collar 210, screw 212 and ball 214.Deflecting bar 200 is connected on the vertical rod 216 at the ball-and-socket joint place, and this ball-and-socket joint comprises ball 214, dimple 218 and blocks a shot 220.Outer housing 208 and collar 210 attached secured to one anotherly (or forming a part), and constitute installing rack 207.The screwed hole 211 oblique collars 210 that pass.Screwed hole 211 is configured to hold screw 212.Sleeve 206 is by allowing deflection post 204 to make with respect to the flexible material of outer housing 208 motions.Therefore, deflection post 204 can be gone up pivot in the center around spherical keeper 202 in any direction shown in arrow 230.The deflection of sleeve 206 controls and restriction deflection post 204.Deflection post 204 also can rotate around the longitudinal axis of this post rotation and bone anchor, shown in arrow 232.

Referring now to Fig. 2 B,, it shows the perspective view of the deflecting bar 200 that assembles fully.When assembling, deflection post 204 is arranged in the sleeve 206; Sleeve 206 is arranged in the outer housing 208.Ball 214 is connected on the near-end of deflection post 204, so that be provided for deflecting bar 200 is connected to the parts of the ball-and-socket joint of vertical rod 216.Ball 214 can form a part with deflection post 204, perhaps can use joint, and for example nipple, welding point, bonded joint securely are attached on the deflection post 204.Keeper 202 is attached on the far-end of deflection post 204, is drawn out sleeve to prevent deflection post 204.

Shown in Fig. 2 A, keeper 202 can be spherical keeper 202.Keeper 202 can form a part with deflection post 204, perhaps can securely be attached on the deflection post 204.Can come attached keeper 202 by laser weld, soldering or other combination technologies.For example, the keeper 202 of sphere, dish type, plate shape or other shapes can be laser-welded on the far-end of deflection post 204.Perhaps, keeper 202 for example can use that screw thread mechanically engages deflection post 204.For example, can use locking ring, profile of tooth lock washer, split pin or other machinerys that deflection post 204 is fastened in the outer housing 208.

The ball 214 of deflecting bar 200 is contained in the dimple of vertical rod 216.Block 220 is fastened to ball 214 in the dimple of vertical rod 216, thereby form ball-and-socket joint 222, this ball-and-socket joint 222 allows vertical rods 216 to rotate 360 degree (shown in arrow 234) and tilt to move (shown in arrow 236) from the plane perpendicular to the axis of deflection post 204 around the axis of deflection post 204.Therefore, allow vertical rod 216 to rotate and/or tilt and/or oscillating motion around the center consistent with the center of the ball 214 of ball-and-socket joint 222.Ball 214 also can be by the deflection of deflection post 204 with respect to outer housing 208 displacements (shown in arrow 230).

Fig. 2 C shows the deflecting bar 200 that assembles the fully sectional view along the represented axis intercepting of the line C-C of Fig. 2 B.Shown in Fig. 2 C, sleeve 206 has occupied the space between deflection post 204 and the outer housing 208, and be deflected post 204 in any direction in towards the deflection of outer housing 208 compression.In some embodiment, sleeve 206 can separate formation with deflecting bar 200.For example, deflection post 204 and sleeve 206 can be press fit in the outer housing 208.Replacedly or additionally, can use the bonding agent of bio-compatible that sleeve 206 is attached on outer housing 208 and/or the deflection post 204.Perhaps, can be by deflection post 204 being placed in the outer housing 208, using liquid polymer (polymeric reagent) to fill the space between deflection post 204 and the outer housing 208 then and allowing polymer cure (polymerization) to form sleeve 206 on the throne.

Fig. 2 C also illustrates the interior details of the ball-and-socket joint 222 of the deflection post 204 that connects vertical rod 216 and deflecting bar 200.Vertical rod 216 comprises the dish type dimple 218 of an end.The near-end of deflection post 204 passes the hole 219 in the dish type dimple 218 of vertical rod 216.204 the diameter diameter less than hole 219 is lived in deflection.In case the near-end of deflection post 204 passes hole 219, for example just using, screw thread, fusion, interference fit and/or laser welding technology are attached to ball 214 on the deflection post 204.The diameter in hole 219 passes hole 219 less than the diameter of ball 214 from behind so that prevent ball 214.In case ball 214 is arranged in the dish type dimple 218 of vertical rod 216, just will block a shot 220 for example be spirally connected, fusion, bonding, interference fit and/or be laser-welded in the dimple 218, thereby ball 214 is fastened in the dish type dimple 218.Fig. 2 C also shows the optional ridge 209 that being used on outer housing 208 inside keeps sleeve 206.

Fig. 2 D shows the deflecting bar 200 that assembles the fully sectional view along the represented axis intercepting of the line D-D of Fig. 2 B.Shown in Fig. 2 D, sleeve 206 has occupied the space between deflection post 204 and the outer housing 208, and be deflected post 204 in any direction in towards the deflection of outer housing 208 compression.Sleeve 206 stop deflection posts 204 from the position of sleeve 206 longitudinal axis conllinear to extrinsic deflection.The size of scalable sleeve 206 and material produce the expectation deflection/load characteristic of deflecting bar.

Fig. 2 E and 2F illustrate the deflection of deflection post 204.Ball-and-socket joint 222 is applied power cause deflection post 204 with respect to comprise outer housing 208 installing rack 207 deflections of (and may be installed on it any bone anchor).During beginning, deflection post 204 pivots around the pivotal point of representing with X 203.In this embodiment, pivotal point 203 is positioned at the center of spherical keeper 202.Yet in other embodiments, pivotal point can be positioned on the different positions.Shown in Fig. 2 E, sleeve 206 materials of the deflection initial compression of deflection post 204 between deflection post 204 and outer housing 208.Make the required power of deflection post 204 deflections depend on the character of the material of the size of deflection post 204, sleeve 206 and outer housing 208 and sleeve 206.

By changing the size of deflection post 204, sleeve 206 and outer housing 208, can change the deflection characteristic of deflecting bar 200.The rigidity of the parts of deflecting bar can be for example increases by the diameter that increases this post and/or by the diameter that reduces outer housing and deflection guide member inner surface.In addition, the increase of column diameter will increase the rigidity of deflecting bar, and the rigidity that reduces to reduce deflecting bar of column diameter.Alternately and/or additionally, change and comprise that the material of deflecting bar parts also can influence the rigidity and the range of movement of deflecting bar.For example, sleeve 206 bigger by rigidity and/or that the bigger material of hardness is made can reduce the deflection of deflection post 204.

Therefore, the rigidity of deflecting bar can change according to patient's needs or customize.The deflection characteristic of deflecting bar can be configured to normal dynamic motion, provide dynamic support for the spinal column in this zone simultaneously near spinal column.Expectedly be, for example, the rigidity of deflecting bar can be manufactured the range of movement that can recover the intact spinal column of nature and range of movement flexible 70%, intact spinal column naturally and flexible 50%, the range of movement and flexible 30% of intact spinal column naturally.In some cases, for providing, the doctor has one group of tackling that possesses the deflecting bar of different power/deflection characteristics, and the doctor can therefrom select to be suitable for most concrete patient's deflecting bar.In other cases, the surgeon can select deflecting bar before being evaluated at operation according to preoperative.

Sleeve 206 is preferably made by the flexible polymer of bio-compatible.Sleeve 206 can be made by for example polycarbonate polyurethane (PCU), for example Bionate

If sleeve comprises Bionate

Polycarbonate polyurethane or other hydrophilic polymers, then sleeve also can be used as the bearing of fluid lubrication, is used for the rotation (referring to the arrow 232 of Fig. 2 B) of deflection post 204 with respect to the longitudinal axis of deflection post 204.In a kind of preferred implementation, sleeve is made by PCU, and thickness is not 2mm when being compressed, and the deflection that can be deflected post is compressed to thickness and is approximately 1mm.

Sleeve also can comprise the polymer areas with different performance.For example, sleeve can comprise the concentric ring of being made by one or more polymer, and each ring has different hardness or rigidity or durometer value.For example, therefrom each outer continuous loop of mind-set can have higher hardness or rigidity or durometer value, thus when post from the resistance to the increase of further deflection is provided during to extrinsic deflection with the position of sleeve longitudinal axis conllinear.Also can be with sleeve design for different power deflection characteristics is provided on different directions.Resistance force diminishes in the time of also the deflection post can being designed to make the deflection increase of post.

Shown in Fig. 2 F, further after the deflection, deflection post 204 enters with the restriction face 228 of outer housing 208 and contacts.The direction of restriction face 228 is defined as, and when deflection post 204 contacted with restriction face 228, this contact was distributed on certain area, thereby reduced the stress on deflection post 204 and the restriction face 228.Just as depicted, to limit face 228 is configured to be deflected into when contacting with restriction face 228 when deflection post 204, restriction face 228 is with respect to deflection post 204 alignment/one-tenth planes, so that provide bigger surface to absorb arbitrary load, reduces stress and limiting surface damage on the deflection post 204 simultaneously.Additional deflection can cause the strain of deflection post 204.Because deflection post 204 rigidity are relatively large, therefore deflection post 204 with the required power of deflection post 204 deflections is enlarged markedly after outer housing 208 contacts.In a kind of preferred implementation, deflection post 204 with before restriction face 228 contacts in any direction upper deflecting 0.5mm to 2mm.More preferably, but deflection post 204 with the about 1mm of deflection before restriction face 228 contacts.

Therefore, when load or power at first were applied on the deflecting bar by spinal column, during the deflection of deflection post 204 impelled sleeve 206 to compress this shown in Fig. 2 E, the deflection of deflecting bar was approximately linearly in response to the increase of load.After the about 1mm of deflection, when deflection post 204 contact restriction faces 228 (shown in Fig. 2 F), the deflecting bar rigidity that becomes is bigger.Afterwards, the identical deflection increment in order to obtain to realize before this point need apply bigger load or power on deflecting bar, and this is because further deflection needs the bending of deflection post 204.Therefore, deflecting bar provides certain range of movement, and in this scope, when deflection increased, the load of being supported increased approximately linearly, and then, along with the increase of deflection, the load of being supported increases quickly in nonlinear mode, so that stability is provided.In other words, when deflection/load increased, the deflecting bar rigidity that becomes was bigger.In being combined with the dynamic stability assembly of deflecting bar, load distribution and deflection by deflection post and nail or whole bone anchor for example between the bone anchor 102 and less degree or be not in vertical rod for example the deflecting bar in the vertical rod 106 (Figure 1B) provide.

Fig. 2 G is a sectional view, and it illustrates the implantation of deflecting bar 200 in vertebra 240.Shown in Fig. 2 G, the direction of bone anchor 102 is defined as it and passes pedicle of vertebral arch 242 in the vertebral body 244.Length that it should be noted that bone anchor 102 is selected according to patient's anatomical structure.Therefore, in less vertebra, use short bone anchor, in bigger vertebra, use long bone anchor.Shown in Fig. 2 G, bone anchor 102 has shallow thread 250 near housing 130.Screw thread 250 is bonded on vertebra 240 lip-deep harder cortical bone 246.Bone anchor 102 has darker screw thread 252 towards the far-end of bone anchor 102.Screw thread 252 is bonded on the softer spongy bone 248 in the vertebral body 244.

Shown in Fig. 2 G, deflecting bar 200 is installed in the bone anchor 102, thereby pivotal point 203 is positioned under the surface of vertebra 240.Deflection post 204 pivots around this pivotal point 203 that is positioned at vertebra 240.This is favourable, because this just is arranged to more close vertebral body 244 with the pivotal point 203 of deflection post 204, thus the natural instantaneous centre that more close spinal column rotates.Pivotal point 203 is arranged to more close vertebral body 244 promotes natural motioies, and reduce non-physiologic power on the bone and the strain in the system.Pivotal point 203 is arranged to more close vertebral body 244 also to be helped to make bone anchor 102 and vertebra 240 and the relative motion that a vertebra is connected between the vertical rod 216 on another vertebra is isolated.Pivotal point 203 is preferably placed on the vertebral surface or thereunder, more preferably, pivotal point 203 is in the spongy bone 248 of vertebra 240.More preferably, pivotal point 203 is in the pedicle of vertebral arch 242 of vertebra 240.In some cases, pivotal point 203 can be positioned at vertebral body 244.

Alternative deflecting bar/load beam

Fig. 3 A-3H illustrates first kind of alternative deflecting bar 300.Fig. 3 A shows the exploded view of alternative deflecting bar 300.Deflecting bar 300 comprises spherical keeper 302, deflection post 304, sleeve 306, outer housing 308, collar 310 and installing rack 314.In this embodiment, keeper 302 is the spherical structures that form a part with deflection post 304.In this embodiment, installing rack 314 is the near-ends that are suitable for being connected to the deflection post 304 on the vertical rod.Just as described earlier, available ball replaces installing rack 314.In this embodiment, installing rack 314 forms a part with deflection post 304 and keeper 302.In alternative embodiment, deflection post 304 can be made separately, and securely is attached on one or more in installing rack 314 and the keeper 302 by laser weld, soldering or other combination technologies.Perhaps, deflection post 304 can be made separately, and uses on one or more in for example the screw thread mechanical engagement installing rack 314 and keeper 302.For example, can use locking ring, profile of tooth lock washer, split pin or other machinerys that deflection post 304 is fastened on one or more in installing rack 314 and the keeper 302.

Sleeve 306 is by allowing deflection post 304 to make with respect to the flexible material of outer housing 308 motions.The deflection of deflection post 304 is controlled and limited to sleeve 306 effectively.Sleeve 306 is preferably made by the flexible biocompatible polymer as for example PCU of example only.The material property of sleeve 306 and the expected force/deflection characteristic that is dimensioned to realization deflection post 304.In a preferred embodiment, sleeve is by PCU (Bionate

80A) make, thickness is not 2mm when it is compressed, and it is thick to be compressed to about 1mm by the deflection of post.Sleeve 306 can also be configured as to change the flexibility of sleeve 306, for example, by groove 307 is set.Sleeve 306 is assemblied in the outer housing 308 around deflection post 304.

Deflecting bar 300 is configured to be installed in the bone anchor 320, and bone anchor 320 comprises the nail 322 that is connected on the housing 330.Housing 330 also has cavity 332, and the orientation of this cavity 332 is defined as being positioned at near-end along the axis of bone anchor 320, and this cavity 332 is configured to hold deflecting bar 300.Housing 330 also has and is suitable for the outer surface 334 that installing component for example is offset adapter.In some embodiment, housing 330 can be cylindrical as previously described.As shown in Figure 3A, the outer surface 334 of housing 330 is provided with keyway/groove 336.Keyway/groove 336 can engage by cooperate the driver that is used for implantable bone anchor 320 with keyway/groove 336.

Referring now to Fig. 3 B,, it shows the perspective view of the deflecting bar 300 that fits together with bone anchor 320.When assembling, deflection post 304 is placed in the sleeve 306 of Fig. 3 A; Sleeve 306 is placed in the outer housing 308 of Fig. 3 A.Then, deflection post 304, sleeve 306 and outer housing 308 are placed in the cavity 332 of bone anchor 320 of Fig. 3 A.Afterwards, screw thread collar 310 is fastened in the screw thread near-end of cavity 332.Screw thread collar 310 has two bases 311, and it is used to hold the pin of pin spanner so that allow screw thread collar 310 to tighten to the screw thread 338 of housing 330.After the installation, screw thread collar 310 is laser-welded on the housing 330, so that further secure component.Screw thread collar 310 is fastened to deflection post 304, sleeve 306 and outer housing 308 in the cavity 332 of bone anchor 320.

Fig. 3 C shows the sectional view of the axis intercepting that the deflecting bar 300 that fits together with bone anchor 320 represents along the line C-C of Fig. 3 B.Shown in Fig. 3 C, sleeve 306 has occupied the space between deflection post 304 and the outer housing 308, and be deflected post 304 in any direction in towards the deflection of outer housing 308 compression.Keeper 302 is assembled in the hemispherical dimple 339 of the bottom of the cavity 332 of housing 330.Outer housing 308 comprises the flange 309 that spherical keeper 302 is fastened in the hemispherical dimple 339, allows spherical keeper 302 to rotate simultaneously.Both are fastened in the housing 330 collar 310 with outer housing 308 and sleeve 306.If sleeve 306 is by Bionate

Polycarbonate polyurethane or other hydrophilic polymers are made, and then sleeve 306 can be used as the bearing of fluid lubrication, and allow post also to rotate around the longitudinal axis of post and bone anchor.Other materials and structure also can allow post to rotate around the longitudinal axis of post and bone anchor.

Fig. 3 D illustrates the deflection of deflection post 304.The power that applies on installing rack 314 can cause the deflection of the deflection post 304 of deflecting bar 300.During beginning, deflection post 304 pivots around the pivotal point of representing with X 303.Deflection post 304 can be gone up in any direction around pivotal point 303 and pivot.Side by side or alternately, deflection post 304 can rotate around the long axis (it is also by pivotal point 303) of deflection post 304.In this embodiment, pivotal point 303 is positioned at the center of spherical keeper 302.Shown in Fig. 3 D, the deflection of deflection post 304 begins the material of compression sleeve 306.Make the required power of deflection post 304 deflections depend on the attribute of the material of the size of deflection post 304, sleeve 306 and outer housing 308 and sleeve 306.

After further deflection, deflection post 304 contacts with the restriction face 313 of collar 310.The direction of restriction face 313 is defined as when deflection post 304 contacts with restriction face 313, and this contact is distributed on certain area, thereby reduces the stress on the deflection post 304.With after restriction face 313 contacts, further deflection needs the distortion (bending) of deflection post 304 at deflection post 304.In preferred embodiment, deflection post 304 is that diameter is the titanium post of 5mm.Deflection post 304 is harder relatively, therefore deflection post 304 with the required power of deflection post 304 deflections is enlarged markedly after collar 310 contacts.In preferred embodiment, deflection post 304 with before restriction face 313 contacts in any direction upper deflecting 0.5mm to 2mm.More preferably, but deflection post 304 with the about 1mm of deflection before restriction face 313 contacts.

In different collars, the internal diameter of collar 310 can be different, thereby in different deflecting bars, the distance between restriction face 313 and the deflection post 304 is also different.This allows to be manufactured on post and contacts the deflecting bar that has greater or lesser range of deflection before with restriction face.Like this, deflecting bar can manufacture and have different range of movement.Therefore in addition, the distance between restriction face 313 and the deflection post 304 need not on all directions all identical, in the range of movement difference of different direction upper deflecting bars.

Referring to Fig. 3 D, when load or power at first were applied on the deflecting bar 300 by spinal column, the compression that causes sleeve 306 in the deflection of deflection post 304 was during this, and the deflection of deflection post 304 is approximately linearly in response to the increase of load.After the deflection of about 1mm, deflection post 304 contact restriction faces 313, it is obviously harder that deflecting bar becomes.Afterwards, the identical deflection increment in order to obtain to realize before this point need apply bigger load or power on deflecting bar, and this is because further deflection needs the bending of deflection post 304.In this embodiment, the amount of deflection that applies of load is a nonlinear function.Deflecting bar provides certain range of movement, and in this scope, when deflection increased, the load of being supported increased approximately linearly, and then, along with the increase of deflection, the load of being supported increases (at post with after restriction face contacts) more apace.Perhaps, if expectation can be designed so that this embodiment that the rate of change for bigger range of movement amount of deflection all is linear function, for example by increasing the distance between restriction face 313 and the deflecting bar 304.

Fig. 3 E is a sectional view, and it illustrates the implantation of deflecting bar 300 in vertebra 240.Shown in Fig. 3 E, the direction of bone anchor 320 is defined as making it to pass pedicle of vertebral arch 242 and enters into vertebral body 244.Length that it should be noted that bone anchor 320 is selected according to patient's anatomical structure.Therefore, in less vertebra, use short bone anchor, in bigger vertebra, use long bone anchor.Shown in Fig. 3 E, the housing 330 of bone anchor 320 is installed in the top on the surface of vertebra 240 fully.The pivotal point 303 of deflecting bar 300 is positioned at housing 330, thus in this embodiment pivotal point 303 arrange near vertebra 240 but in its outside.

In alternative embodiment, shown in Fig. 3 F, deflection post 304 pivots around the pivotal point 353 that is positioned at vertebra 240.This is favourable, because this pivotal point 353 with deflection post 304 is arranged to more close vertebral body 244, thereby the natural instantaneous centre of more close spinal column rotation.Pivotal point 353 is arranged to more close vertebral body 244 impels natural motion, and reduced non-physiologic power on the bone and the strain on the dynamic stability assembly.Especially, pivotal point 353 is arranged to more close vertebral body 244 helps to make bone anchor 320 and vertebra 240 and the relative motion that the one-level of spinal column is connected between the vertical rod of the dynamic stability assembly on the adjacent level is isolated.Pivotal point 353 is preferably placed on the surface of vertebra 240 or thereunder.More preferably, pivotal point 353 is positioned at the pedicle of vertebral arch 242 of vertebra 240.In some cases, pivotal point 353 can be positioned at vertebral body 244.

Fig. 3 G shows the side view of the dynamic stability assembly that uses deflecting bar 300.Shown in Fig. 3 G, deflecting bar 300 is installed in the bone anchor 320.Bone anchor 320 is implanted in the vertebra 370 (referring to for example Fig. 3 E).Multi-axial screws 350 is implanted in second vertebra 372.Vertical rod 370 at one end is fastened on the installing rack 314 of deflecting bar 300.In this embodiment, installing rack 314 passes the hole in the vertical rod 360.The near-end of installing rack 314 has screw thread, thereby vertical rod 360 can utilize screw nut 362 to be fastened on the installing rack 314.In this embodiment, shown in Fig. 3 G, vertical rod 360 is rigidly secured on the deflection post 304.This being rigidly connected provides hard relatively assembly.Yet when expecting bigger range of movement, deflection post 304 can be provided with the pommel, and vertical rod 360 can be connected on the deflection post 304 by the ball-and-socket joint of before describing referring to Figure 1A-1B.

Vertical rod 306 is installed on the cluster head 352 of multi-axial screws 350 at the other end.This screw can be the standard multi-axial screws, for example, and the multi-axial screws of obtainable 5.5mm on the market.Perhaps, this screw also can be the bone anchor with cluster head (for example cluster head of before having described referring to Fig. 1 C).In a preferred embodiment, vertical rod 360 is the diameter that uses in the rigidity spinal column the is implanted titanium bar as 5.5mm.Vertical rod 360 utilize threaded fittings for example trip bolt 354 be fastened on the cluster head 352.Therefore, vertical rod 360 support vertebrae, deflecting bar 300 then provides load to distribute and allows the relative motion of vertebra 370 with respect to vertebra 372.Therefore, the dynamic stability assembly provides the dynamic stability of spinal column.The dynamic stability assembly can utilize the skew adapter on the housing 330 that is installed in bone anchor 320 and expand to two-stage or multistage.Be worth being understood that the skew adapter can comprise the groove ring that help to engage housing 330 (referring to, the open type spanner 380 among Fig. 3 H for example).Therefore, provide a kind of modular system, it can form multistage dynamic stability assembly.

Fig. 3 H illustrates and is used to drive the open type spanner 380 that bone anchor 320 puts in place.The bone anchor 320 of Fig. 3 H has housing 330.Deflecting bar 300 is installed in the housing 330, and fastening on the throne by screw thread collar 310 (Fig. 3 A and 3B).The screw thread that screw thread collar 310 engages in the housing 330.Collar 310 has and can be engaged so that collar 310 is tightened to two holes 311 on the housing 330 by the pin spanner.Collar 310 also can be soldered on the housing 330, so that further fastening deflecting bar 300 and housing 330.In this embodiment, deflecting bar 300 is designed to fit together in advance with bone anchor 320 before implantation.

Shown in Fig. 3 H, the outer surface 334 of housing 330 is provided with the surface texture of a plurality of keyway 336 forms.The direction of keyway 336 is defined as being parallel to the longitudinal axis of bone anchor 320, and outstanding from housing 330 at regular intervals.Open type spanner 380 has the head 382 that is designed in order to the outer surface 334 that engages housing 330.Use this instrument, housing 330 just can be engaged and rotate around the longitudinal axis of bone anchor 320, enters in the bone so that drive the bone anchor.Open type spanner 380 can be provided with torque limit and/or torque measurement parts so that the installation of bone anchor 320.In alternative embodiment, can use base to replace the open type spanner to engage housing 330.

The plane graph of bone anchor 320 and deflecting bar 300 when Fig. 3 I shows from the deflection rod end observation of assembly.Shown in Fig. 3 I, around the outer surface 334 of housing 330, evenly be interval with 16 keyways 336.In the zone of keyway 336, the diameter of collar 310 is equal to or less than the minimum diameter of housing 330, engages by complementary instrument or adapter to allow keyway 336, and can not interfere with collar 310.The keyway that more or smaller amounts can be arranged in other embodiments.

Fig. 3 I shows the sectional view of the box spanner 384 that is suitable for engaging housing 330.Box spanner 384 has the keyway 336 complementary a plurality of keyways 386 with housing 330.Therefore, box spanner 384 can slide on deflecting bar 300 and housing 330, and settles shown in Fig. 3 I.In on the throne, box spanner 384 can be used for roll-shell 330 so that bone anchor 320 is installed in the bone (or remove from bone the bone anchor).The in-profile of box spanner 384 should with exterior contour 334 complementations of housing 330.It is identical with keyway 336 quantity of housing 330 that keyway 386 quantity of box spanner 384 need not, as long as keyway 386 correctly is positioned to engage the some or all of keyways 336 of housing 330.Open type spanner or other drivers can be designed to have identical composition surface, so that engage the some or all of keyways 336 of housing 330.

Similarly, the adapter of zeugopodium anchor housing also can be suitable for engaging the keyway 336 of housing 330 easily.By example, Fig. 3 J shows the adapter that is suitable for engage splines 336 170 of Fig. 1 D.Adapter 170 is installed in the outside of the housing 330 of bone anchor 320.The parts of the adapter 170 shown in Fig. 3 J comprise locking trip bolt 176, clamping ring 180 and saddle 182.Shown in Fig. 3 J, clamping ring 180 has some on internal diameter and keyway 336 complementary keyways 396 housing 330.Therefore, after bone anchor 320 was implanted vertebra, clamping ring 180 can slide on deflecting bar 300 and housing 330, and settles shown in Fig. 3 J.Keyway 396 engages with the keyway 336 of housing 330.Keyway 396 and 336 prevents that clamping ring 180 from freely rotating around housing 330.This is very favorable, because this is by preventing clamping ring 180 stability around housing 330 slips raising dynamic stability assembly under the effect of load.When clamping ring 180 was placed in expected angle with respect to bone anchor 320, trip bolt 176 can tighten on the vertical rod (not shown) so that vertical rod is clamped on the saddle 182, tightens clamping ring 180 against the outer surface 334 of housing 330 simultaneously.Therefore, adapter 180 can be used for vertical rod securely is attached on the housing 330 of bone anchor 320.

Clamping ring 180 (and then adapter 170) can be installed in the optional position of 16 positions of housing 330 (interval 22.5 degree between each position).The littler if desired arrangement size of space can be used more keyway 336.The in-profile of clamping ring 180 should with outer surface 334 complementations of housing 330.It is identical with keyway 336 quantity of housing 330 that the quantity of the keyway 396 of clamping ring 180 need not, as long as keyway 396 correctly is positioned to engage the some or all of keyways 336 of housing 330.The clamping ring of the no any keyway shown in Fig. 1 D still can be used for engaging housing 330.

Other adapters also can be suitable for the keyway 336 of the housing 330 of zeugopodium anchor 320 similarly.Similarly, the outside that other bone anchors discussed here also can housing is provided with keyway, so that install and promote the installation of adapter.In alternative embodiment, also different surface textures can be used on the surface of housing, so that engage by instrument or adapter.For example, housing can be made into and have polygonal inner section shape, and have 8,3,12,16 or more a plurality of side.Instrument that uses with this housing or adapter can have be designed to engage this 8,3,12,16 or more a plurality of lateral complementary in-profile.Perhaps, housing can be provided with a plurality of holes at regular intervals.The instrument or the adapter that use with this housing can be provided with one or more pins, and these pins are designed for the form of pin spanner and engage with hole in a plurality of positions.On the contrary, housing can be provided with one or more protrudent pins, and instrument or adapter then are provided with a plurality of complimentary aperture.Perhaps, in housing and the adapter one or both can be provided with shallow surface texture, for example point, recess, ridge or be designed for the similar structures of the frictional engagement that increases housing and adapter.Under latter event, the structure of housing and adapter does not need essential complimentary to one another, and adapter and housing can freely engage on the angle position arbitrarily each other.

Fig. 4 A-4D illustrates second kind of alternative deflecting bar 400.Fig. 4 A shows the exploded view of alternative deflecting bar 400.Deflecting bar 400 comprises keeper 402, deflection post 404, sleeve 406, outer housing 408, collar 410 and installing rack 414.In this embodiment, keeper 402 is the spherical structures that form a part with deflection post 404.Installing rack 414 is suitable for being connected on the vertical rod.Just as described earlier, available ball replaces installing rack 414.In this embodiment, installing rack 414 forms a part with deflection post 404.In preferred embodiment, installing rack 414, spherical keeper 402 and deflection post 404 are made by the titanium of monolithic.In alternative embodiment, deflection post 404 can be made separately, and securely is attached on one or more in installing rack 414 and the keeper 402 by laser weld, soldering or other combination technologies.Perhaps, deflection post 404 can be made separately, and uses on one or more in for example screw thread, locking ring, profile of tooth lock washer, split pin or other mechanism's mechanical engagement installing racks 414 and the keeper 402.

Sleeve 406 is by allowing deflection post 404 to make with respect to the flexible material of outer housing 408 motions.The deflection of sleeve 406 control deflection posts 404.Sleeve 406 is preferably made by the bio-compatible polymer of flexibility.With the material property of sleeve 406 and deflection post 404 be dimensioned to so that realize the power/deflection characteristic of expectation for deflection post 404.In a preferred embodiment, sleeve is made by PCU, and thickness is not 2mm when it is compressed, and it is thick to be compressed to about 1mm by the deflection of post.Sleeve 406 can also be configured as to change the flexibility of sleeve 406, for example, by groove 407 (not shown) are set.Sleeve 406 is assemblied in the outer housing 408 around deflection post 404.

Deflecting bar 400 is configured to be installed in the bone anchor 420, and bone anchor 420 comprises the nail 422 that is connected on the housing 430.Housing 430 also has short cavity body 432, and its direction is defined as being in near-end and being configured to hold the threaded far-end of outer housing 408 along the axis of bone anchor 420.Outer housing 408 also has the outer surface 434 that is suitable for installing the skew adapter.In some embodiment, outer surface 434 can be the cylindrical for example surface texture of previously described groove that maybe can have.It should be noted that in this embodiment deflecting bar and bone anchor 422 coaxial arrangement.Especially, the post 404 and bone anchor 422 coaxial arrangement of deflecting bar 400.

Referring now to Fig. 4 B,, it shows the perspective view of the deflecting bar 400 that assembles fully.When fitting together, deflection post 404 is placed in the sleeve 406; Sleeve 406 is placed in the outer housing 408.Then, the threaded distal end (referring to Fig. 4 A) with keeper 402 and the outer housing 406 of Fig. 4 A is placed in short cavity body 432 (not shown) of bone anchor 42.Utilize screw thread that outer housing 408 is tightened on the housing 430, and also can be by laser weld so that outer housing 408 further is fastened on the housing 430.Then, screw thread collar 410 is fastened in the screw thread near-end of outer housing 408.Screw thread collar 410 has two bases 411, is used to receive the pin of pin spanner so that allow screw thread collar 410 to tighten to the screw thread 438 (referring to Fig. 4 A) of outer housing 408.After installing, screw thread collar 410 also can be laser-welded on the outer housing 408, so that further secure component.

Fig. 4 C shows the sectional view of the axis intercepting that the deflecting bar 400 that fits together with bone anchor 420 represents along the line C-C of Fig. 4 B.Shown in Fig. 4 C, spherical keeper 402 is assembled in the hemispherical dimple 439 in the housing 430.Outer housing 408 comprises spherical keeper 402 is remained on flange 409 in the hemispherical dimple 439.Collar 410 is fastened on sleeve 406 in the outer housing 408.Collar 410 also provides the restriction face 413 of the deflection that is used to limit deflection post 404.Sleeve 406 has occupied the space between deflection post 404 and the outer housing 408, and is deflected post 404 and compresses towards the deflection of outer housing 408 in any direction.

Fig. 4 D illustrates the deflection of deflection post 404.The power that applies on installing rack 414 can cause deflection post 404 deflections of deflecting bar 400.During beginning, deflection post 404 pivots around the pivotal point of representing with X 403.Deflection post 404 can be gone up in any direction around pivotal point 403 and pivot.In this embodiment, pivotal point 403 is positioned at the center of spherical keeper 402.Pivotal point 403 can be provided with the far-end of more close nail 422, for example by stretching out virtual pivot point.Shown in Fig. 4 D, the deflection of deflection post 404 begins the material of compression sleeve 406.Make the required power of deflection post 404 deflections depend on the character of the material of the size of deflection post 404, sleeve 406 and outer housing 408 and sleeve 406.Further after the deflection, deflection post 404 enters with the restriction face 413 of collar 410 and contacts.

The shape of restriction face 413 and direction be specified to reduce deflection post 404 owing to contact the wearing and tearing that cause or the probability of damage with restriction face 413.For example, the direction of restriction face 413 is defined as when deflection post 404 contacts with restriction face 413, this contact is distributed on certain area, thereby reduces wearing and tearing and stress on the deflection post 404.With after restriction face 413 contacts, further deflection needs deflection post 404 to be out of shape at deflection post 404.Because deflection post 404 rigidity are bigger, thus deflection post 404 with the required power of deflection post 404 deflections will be enlarged markedly after collar 410 contacts.In a preferred embodiment, deflection post 404 with before restriction face 413 contacts in any direction upper deflecting 0.5mm to 2mm.More preferably, but deflection post 404 with the about 1mm of deflection before restriction face 413 contacts.

Shown in Fig. 4 D, when load or power at first were applied on the deflecting bar by spinal column, the compression that causes sleeve 406 in the deflection of deflection post 404 was during this, and the deflection of deflection post is approximately linearly in response to the increase of load.After the deflection of about 1mm, when deflection post 404 contact restriction faces 413, the deflecting bar rigidity that becomes is bigger.Identical amount of deflection in order to obtain to realize before this point need apply bigger load or power on deflecting bar, this is because further deflection needs the bending of deflection post 404.Therefore relation between deflection and the load is non-linear function.Therefore, the deflecting bar of this example provides certain range of movement, in this scope, when deflection increased, the load of being supported increased approximately linearly, then, along with the increase of deflection, the load of being supported increases more apace in nonlinear mode, so that dynamic stability is provided.

Fig. 4 E shows the distortion 400e of deflecting bar 400.All parts are all identical, and different just changes into deflection post 404e in order to hold ball 444.Ball 444 is contained in the dimple 442 that is arranged in vertical rod 450 1 ends.Ball 444 446 is fastened in the dimple 442 by blocking a shot.Ball 444 has formed a part that deflection post 404e is connected to the ball-and-socket joint 440 on the vertical rod 450.Ball-and-socket joint 440 allows bigger range of movement, and reduced the dynamic stability assembly and the distorting stress on the attached skeleton.Yet, utilize ball-and-socket joint to replace the rigidity that has also reduced assembly that is fastenedly connected between vertical rod and the post.Therefore, ball-and-socket joint or the selection that is fastenedly connected need be weighed between rigidity and range of movement.This selection will be made according to patient's anatomical structure and functional requirement.

Can previous described same way as use deflecting bar 400 and bone anchor 420.Can utilize deflecting bar 400 that load distribution and dynamic stability for example are provided.Deflecting bar 400 can utilize the vertical rod at the multi-axial screws on another grade of spinal column to be connected on this another level of spinal column or another deflecting bar and bone anchor.Utilization is installed in the skew adapter on outer housing 408 outer surfaces, and deflecting bar 400 can be connected on two adjacent vertebras, thereby provides structure to be suitable for providing load to distribute and the ability of the multistage dynamic spinal stabilizing component of stability.

Fig. 4 F shows the sectional view of the deflecting bar 460 of another kind of embodiment.Shown in Fig. 4 F, post 464 comprises keeper 462, and it engages so that post 464 is fastened on the nail 461 by sleeve 468.In deflecting bar 460, keeper 462 is tapering parts of ball, rather than spherical.Keeper 462 winds the pivotal point 463 that is indicated by X and pivots.Dotted line 465 shows the diameter of the spherical keeper with identical effective pivotal point.Taper keeper 462 needs less volume, and effective pivotal point of the far-end of more close nail 461 is provided simultaneously.The taper keeper can be contained in the less cavity in the nail 461.This allows nail 461 firmer, allows pivotal point 463 is arranged to the instantaneous center of rotation of more close spinal column simultaneously.The instantaneous center of rotation of pivotal point 463 being arranged to more close spinal column also helps the relative motion isolation that makes between bone anchor and the vertebra.When implanting, pivotal point 463 is preferably placed on the surface of vertebra or thereunder.More preferably, pivotal point 463 is positioned at the pedicle of vertebral arch or the vertebral body of vertebra.This keeper can be replaced by the keeper in other deflecting bars described here.

Fig. 4 G shows the sectional view of the deflecting bar 470 of another kind of embodiment.Shown in Fig. 4 G, post 474 comprises keeper 472, and it engages so that post 474 is fastened on the nail 471 by sleeve 478.In deflecting bar 470, keeper 472 is one section sphere, rather than spherical.Keeper 472 winds the pivotal point 473 that is indicated by X and pivots.Dotted line 475 shows the diameter of the spherical keeper with identical effective pivotal point.The center of spheroid (if complete) is in the outside of keeper 472.Yet post 474 pivots around this virtual pivot point (statement is because its outside at privot mechanism like this) seemingly.The required volume of keeper 472 is less than spherical keeper.Therefore, keeper 472 can be contained in the less cavity in the nail 471.This allows nail 471 firmer, allows pivotal point 473 is arranged to the instantaneous center of rotation of more close spinal column simultaneously.The instantaneous center of rotation of pivotal point 473 being arranged to more close spinal column also helps the relative motion isolation that makes between bone anchor and the vertebra.When implanting, pivotal point 473 is preferably placed on the surface of vertebra or thereunder.More preferably, pivotal point 473 is positioned at the pedicle of vertebral arch or the vertebral body of vertebra.This keeper can be replaced by the keeper in other deflecting bars described here.

Deflecting bar/load beam response curve

As previously mentioned, can customize the deflection response of deflecting bar according to the selection of design, size and material.Expectedly be, for example, the rigidity of deflecting bar can be manufactured the range of movement that can recover the intact spinal column of nature and range of movement flexible 70%, intact spinal column naturally and range of movement flexible 50%, intact spinal column naturally and flexible 30%, be used for providing at the adapter kit that the doctor uses.Fig. 5 A is a chart, shows the deflection/force-responsive of three kinds of different deflecting bar assemblies.

Curve 501 shows than the power of the deflecting bar of the some/deflection response greatly of the deflecting bar rigidity with 70% rigidity.Being used to of being tested produces the deflecting bar 504 of power/deflection curve 501 shown in Fig. 5 A schematically shown in Fig. 5 B.Deflecting bar 504 has its maximum gauge and is approximately the PEEK sleeve 512 of 4mm and the deflection post of being made by Nitinol 510.Sleeve 512 and deflection post 510 press fit in the sleeve 516.Between sleeve 512 and outer housing 516, have gap 508, can compression sleeve 512 when it allows the initial deflection of deflection post 510.The active length of deflecting bar 504 is about 26mm.Deflection post 510 is connected on the vertical rod 520 by ball-and-socket joint 522.The deflection of deflection post 510 is in response to the load that is applied on the vertical rod 522, shown in curve 501.As what can obviously find out from Fig. 5 A, deflection/force curve 501 is non-linear.When the about 1mm of deflection, sleeve 512 contacts with outer housing 516, and further deflection needs the compression of sleeve 512 and the bending of deflection post 510.Therefore, when load increased, deflecting bar 504 responded with bigger rigidity.When deflection increased, the rigidity of deflecting bar also increased, thereby the required power of further per unit deflection of carrying out in response to being applied to the load on spinal column and the deflecting bar also increases.This can find out from power/deflection curve that its slope increase with curve 501 is represented.

Curve 502 shows the power/deflection response of another kind of deflecting bar.The general design of deflecting bar 504 that being used to of being tested produces power/deflection curve 502 shown in Fig. 5 A is identical with the deflecting bar 300 of Fig. 3 A-3C.It is 80 Bionate that this deflecting bar has by hardness

PCU makes, thickness is the sleeve of 2mm.The deflection post is made of titanium, and its diameter changes between 4mm and 5mm.The length of deflection post (comprise and keep ball and ball-and-socket joint) is about 20mm.The deflection post is connected on the vertical rod by ball-and-socket joint.The deflection of deflection post is in response to the load that is applied on the vertical rod, shown in curve 502.As what can obviously find out from curve 502, when load increased, the response of the deflecting bar rigidity that becomes gradually was bigger.Curve 502 obtains when no collar and restriction face.In the deflecting bar of making according to Fig. 3 A-3H and 4A-4D shown design, when the deflection post contact with restriction face and during the deflection that produces about 1mm the rigidity of deflecting bar should increase.This has been shown among the power/deflection curve 502b of prediction, and its unexpected increase with the slope of curve is represented.Therefore, when deflection increased, the rigidity of deflecting bar also increased, thereby the required power of the further per unit deflection of carrying out in response to being applied to the load on spinal column and the deflecting bar also increases fast.

Curve 503 shows the power/deflection response of another kind of deflecting bar.It is identical with the deflecting bar 300 of Fig. 3 A-3C that being used to of being tested produces the design of the deflecting bar of power/deflection curve 502 shown in Fig. 5 A.It is 80 Bionate that the deflecting bar that being used to of being tested produces power/deflection curve 503 shown in Fig. 5 A also has by hardness

PCU makes, thickness is the sleeve of 2mm.The deflection post is made of titanium, and its diameter changes between 4mm and 5mm.The length of deflection post (comprise and keep ball and ball-and-socket joint) is about 20mm.Yet the deflection post is connected between installing rack and the vertical rod by be rigidly connected (rather than ball-and-socket joint).The deflection of deflection post is in response to the load that is applied on the vertical rod, shown in curve 503.As what can obviously find out from curve 503, to compare when being connected by ball-and-socket joint, deflecting bar is with bigger stiffness response.Curve 503 also obtains when no collar and restriction face.In the deflecting bar of making according to Fig. 3 A-3H and 4A-4D shown design, when post contact with restriction face and during the deflection that produces about 1mm the rigidity of deflecting bar should increase.This has been shown among the power/deflection curve 503b of prediction, and its unexpected increase with the slope of curve is represented.Therefore, when deflection increased, the rigidity of deflecting bar also increased, thereby the required power of the further per unit deflection of carrying out in response to being applied to the load on spinal column and the deflecting bar also increases fast.

Shown in Fig. 5 A, when load or power at first were applied on the deflecting bar by spinal column, the deflection of deflecting bar was approximately linearly in response to the increase of load.After deflection post contact restriction face, deflecting bar responds with bigger rigidity.In this zone, the identical amount of deflection in order to obtain to realize before this point need apply bigger load or power on deflecting bar.Therefore, the deflecting bar in this example provides certain range of movement, and in this scope, when deflection increased, the load of being supported increased approximately linearly, and then, along with the increase of deflection, the load of being supported increases more apace in nonlinear mode.Depend on the distance deflection post and the collar restriction face from relatively low stiffness to the transformation in higher stiffness zone.This distance can such customization as discussed previously, thereby after the amount of deflection of expectation, for example after the about 1mm of deflection or after the about 2mm of deflection, changes.

Deflecting bar with anisotropy deflection characteristic

In some embodiment, deflection system of the present invention can be controlled the rigidity of extension, bending, lateral thrust and axial rotation, and in these motions each is independent of other motions carries out rigidity control.Can change the characteristic of deflecting bar, for example, by the diameter of adjusting deflection post and/or the distance between telescopic thickness and/or deflection post and the restriction face.For example, Fig. 6 A-6D shows the cross section of alternative embodiments of Fig. 2 B deflecting bar 200 of D-D along the line intercepting.Can similarly change other deflecting bars described herein, for example the deflecting bar 400 of the deflecting bar 300 of Fig. 3 A-3C and Fig. 4 A-4C.

In Fig. 6 A, with comparing of deflecting bar 200, the outer housing 208a of deflecting bar 200a is thicker equably, and the sleeve 206a of deflecting bar 200a is thinner equably.Therefore, have deflecting bar 204a rigidity on all directions in cross section as shown in Figure 6A bigger/pliability is littler.

Yet deflection characteristic need not isotropism.Inner surface that can be by changing the outer housing in the diverse location around the deflection post and/or telescopic thickness and in deflecting bar, introduce biasing.Shown in Fig. 6 B, the sleeve 206b that outer housing 208b is designed so that deflecting bar 200b is at the thickness of the left and right sides of the deflection post 204b thickness (for this page) greater than top side and bottom side.Therefore, the deflecting bar 200b with cross section shown in Fig. 6 B last and below upwards rigidity is bigger, and pliability is bigger on a left side and right.

Shown in Fig. 6 C, the sleeve 206c that outer housing 208c is designed so that deflecting bar 200c at the thickness of right side, top side and the bottom side of deflection post 204c greater than thickness in the left side.Therefore, the deflecting bar 200c rigidity on left direction with cross section shown in Fig. 6 C is bigger, and pliability is bigger on right side, top side and bottom side direction.

Shown in Fig. 6 D, the sleeve 206d that outer housing 208d is designed so that deflecting bar 200d is at the thickness on the right side of the deflection post 204d thickness greater than left side, top side or bottom side.Therefore, it is bigger in pliability on the right direction than on other any directions to have a deflecting bar 200d in cross section shown in Fig. 6 D.

Also can change the characteristic of deflecting bar by the flexibility of for example regulating sleeve.For example, use has the PCU of different hardness rate or uses different materials.Make entire sleeve by for example compressibility materials with smaller and will make deflecting bar rigidity bigger, for example, the load that needs are bigger produces identical deflection.On the contrary, make entire sleeve by the bigger material of for example compressibility and will make the deflecting bar pliability bigger, for example, the load that needs are less produces identical deflection.Yet deflection characteristic need not isotropism.Can have different flexibilities and will in deflecting bar 200, introduce bias force by making the material in the sleeve zones of different.This can penetrate by for example use more, and injection molding technology is made sleeve and use the PCU with different hardness rate to realize in penetrating injection technique more.For example, Fig. 6 E-6H shows the cross section of alternative embodiments of deflecting bar 200 of Fig. 2 B of D-D along the line intercepting, and wherein, telescopic each zone has different character.

Shown in Fig. 6 E, the sleeve 206e of deflecting bar 200e has the zone that flexible big material 640 forms in the left side of deflection post 204e, and (for this page) has the zone that flexible materials with smaller 680 forms on the right side.Therefore, material 640 can have the hardness number different with material 680.These two kinds of materials can be polymer.Therefore, the deflecting bar 200e rigidity on right direction with cross section shown in Fig. 6 E is bigger, and pliability is bigger on left direction.

Shown in Fig. 6 F, the sleeve 206f of deflecting bar 200f in the top side of deflection post 204f and the bottom side have the zone that flexible big material 640 forms, on a left side and right side (for this page) have the zone that flexible less material 680 forms.Therefore, the deflecting bar 200f rigidity on a left side and right direction with cross section shown in Fig. 6 E is bigger, and pliability is bigger on top side and bottom side direction.

Shown in Fig. 6 G, the sleeve 206g of deflecting bar 200g in the left side of deflection post 204g and the bottom side have the zone that flexible big material 640 forms, in the top side and right side (for this page) have the zone that flexible less material 680 forms.Therefore, the deflecting bar 200g rigidity on top side and right direction with cross section shown in Fig. 6 G is bigger, and pliability is bigger on left side and bottom side direction.

Shown in Fig. 6 H, the sleeve 206h of deflecting bar 200h has the zone that flexible big material 640 forms in left side, top side and the bottom side of deflection post 204h, and (for this page) has the zone that flexible less material 680 forms on the right side.Therefore, the deflecting bar 200h hardness on right direction with cross section shown in Fig. 6 H is bigger, and pliability is bigger in the other direction.

In addition, by changing the shape of collar, also can change the distance between deflection post and the collar restriction face.By making distance shorter, just can reduce owing to contact with restriction face and cause the sharply amount of deflection of generation before the increase of rigidity.Collar can be configured as the gap that can reduce equably between deflection post and the restriction face, maybe it can be configured as the deflection post that makes on some direction and the gap between the restriction face and reduce than many (anisotropy) in the other direction.

Have in the embodiment of anisotropic power-deflection response at deflecting bar, guarantee that it is very important that deflecting bar is implanted in the correct direction.Therefore, deflecting bar is provided with recognizable vision or physical characteristic (for example, arrow, color, impression or other observable labellings), and these characteristics are directed to the surgeon in the correct implantation direction.When correct installation, have the anisotropic power-deflecting bar of deflection response and can be used for the rigidity of control extension separately, bending, lateral thrust and axial rotation.For example, if deflecting bar make progress upward (with respect to the spinal column-cephalad direction after implanting for upward to) pliability is bigger, but then when rachiocamposis is placed the deflection of deflection post get bigger, but deflection gets less when spinal column extension placement.In fact, this layout is restricted bigger to the spinal motion of spinal column under extension state, and restricted less to the spinal motion of spinal column under case of bending.On the contrary, if deflecting bar on the downward direction (with respect to the spinal column-cephalad direction after implanting for upward to) flexibility is bigger, but then when spinal column extension placement the deflection of deflection post get bigger, but deflection gets less when rachiocamposis is placed.In fact, this layout is restricted bigger to the motion of the spinal column of spinal column under case of bending, restricted less to the motion of spinal column under extension state.

Alternative bone anchor

Fig. 7 A illustrates some possible distortion of the bone anchor of anchor system to 7H.The bone anchor respectively have can be compatible mutually with the skew head/adapter of the deflecting bar of deflection system and connector system housing.In some embodiment, the bone anchor before implanting health, is installed earlier by the bone anchor.In other embodiments, can before deflecting bar is installed, the bone anchor be implanted health.

The bone anchor 710 of Fig. 7 A is for having the nail of threaded portion 714, and threaded portion 714 extends on most of zone of housing 712.Deflecting bar 704 is installed in the housing 712.Threaded portion 714 can be according to each factor, and for example the length of nail, nail will be implanted to the type of skeleton wherein and implant the Desired Height that back casing 712 will extend and extend longlyer on housing 712 or shorter on the skeleton surface.Bone anchor 710 can be used for reducing the natural instantaneous center of rotation of the more close spinal column of the degree of depth of the pivotal point of deflecting bar 704.It should be noted that equally the distal threads degree of depth 716 can be greater than the proximal threads degree of depth 718.The distal threads degree of depth 716 is suitable for engaging softish spongy bone, and the proximal threads degree of depth 718 is suitable for being bonded on the harder cortical bone on the vertebral surface.

The bone anchor 720 of Fig. 7 B is a nail, and wherein, the length of part 724 that only is screw is than the weak point in the nail 710 of Fig. 7 A.Deflecting bar 704 is installed in the housing 722.Different length only for the part of screw can be used for different patients or different vertebras, this is because need the variation of size of the skeleton of implantable bone anchor may be quite big.For example, when dynamic stabilization system will be implanted in the less vertebra, the short bone nail was expected.The doctor can be scanned by Noninvasive by measuring the nail length of determining to be suitable for concrete patient in operation, and for example X-ray nuclear magnetic resonance, NMR and CT scan are determined measured value.Yet, it should be noted that housing 722 is preferably identical with the size and dimension of the housing of other bone anchors, thus with identical deflecting bar and adapter can be compatible.

The bone anchor 730 of Fig. 7 C is a nail, wherein, only is that the diameter and the length of the part 734 of screw is distinguished little and short than the diameter and the length of the nail 710 of Fig. 7 A.Deflecting bar 704 is installed in the housing 732.Different-diameter only for the part of screw can be used for different patients or different vertebras, this is because need the variation of size of the skeleton of implantable bone anchor may be quite big.For example, when dynamic stabilization system will be implanted in the less vertebra, the less nail of diameter may be expected.The doctor can be scanned by Noninvasive by measuring the nail length of determining to be applicable to concrete patient in operation, and for example X-ray nuclear magnetic resonance, NMR and CT scan are determined measured value.Yet, it should be noted that housing 732 is preferably identical with the size and dimension of other bone anchor housings, thus with identical deflecting bar and adapter can be compatible.

The bone anchor 740 of Fig. 7 D is a nail, and wherein, housing 742 has flange 744, and this flange 744 converts threaded portion 746 at housing 742 position extends out from housing 742.Deflecting bar 704 is installed in the housing 742.Flange 744 can be used for keeping being installed in the skew head on the housing 742, and this maintenance can make the skew head still can freely rotate around housing 742 during installation.Flange 744 also can be used for widening when the bone anchor is run into vertebral anatomy and the contact area between the bone anchor 740.This can be used as the stop member that prevents excessive insertion.This also can provide wide base portion, so that overcome lateral movement and torque and stablize housing.It should be noted that housing 742 is preferably identical with the size and dimension of the housing of other bone anchors, thus with identical deflecting bar and adapter can be compatible.

The bone anchor 750 of Fig. 7 E illustrates the hamulus of hamate bone device 751 with housing 752.Deflecting bar 704 is installed in the housing 752.Hamulus of hamate bone device 751 comprises bar 754, and housing 752 is connected to bar 754 rigidly.Be hamulus of hamate bone 756 on each end of bar 754, it has and is used for hamulus of hamate bone 756 is fastened to trip bolt 757 on the bar 754.Each hamulus of hamate bone 756 has a plurality of cusps 758 that are used for hamulus of hamate bone 756 engaged and be fastened on the vertebra.In use, hamulus of hamate bone 756 is promoted toward each other, engage and/or penetrate the skeleton surface up to cusp.Tighten trip bolt 757 so as with hamulus of hamate bone 756 with respect to bar 754 fastening putting in place, thereby with respect to skeleton rugged housing 752.Hamulus of hamate bone and bar different can be arranged to be made into and be suitable for housing 753 is attached on the vertebra of dissimilar, size and position.It should be noted that housing 752 is preferably identical with the size and dimension of the housing of other bone anchors, thus with identical deflecting bar and adapter can be compatible.

In some embodiment, the bone anchor can be provided with torque limit and/or disconnect head, and it engages with driver to drive the bone anchor and enters into vertebra.The torque that torque limit and/or disconnection head are designed for applying in driver prevents from further to drive the bone anchor when surpassing the pre-determined torque limit value and enters into vertebra.In preferred embodiment, the torque limit value is chosen as make drives the bone anchor and enter into the required torque of vertebra and be lower than this torque limit value.In preferred embodiment, when the bone anchor was implanted in the vertebra fully, the bone anchor further rotated required torque far above the torque limit value.Therefore, when the bone anchor was implanted in the vertebra fully, the driver torque surpassed the torque limit value, and torque limit and/or disconnect head and prevent that the bone anchor further is driven in the skeleton.In some cases, may before being installed fully, the bone anchor reach the torque limit value.In this case, removable bone anchor is also installed new bone anchor-can enlarge bone anchor and will be installed in cavity in wherein the skeleton, so that the implantation of the second bone anchor reduces the required torque of implantable bone anchor thus.

The bone anchor 760 of Fig. 7 F-7H is for having the nail of the head 770 that extends beyond housing 772.Housing 772 is preferably identical with the size and dimension of the housing of other bone anchors, thus with identical deflecting bar and adapter can be compatible.Head 770 is the torque limit head, when it is designed for torque on being applied to head 770 and surpasses the pre-determined torque limit value with 760 disconnections of bone anchor.Head 770 can be that hexagonal head (as shown in) maybe can be other designs that are suitable for being mounted tool drives, described erecting tools is spanner or other drivers for example, and described design comprises for example slot type, Philips formula (Phillips), square, Allan formula (Allen) and Tang Shi (Tone) head.Between installation period, driver (for example hexagon base) engages head 770 is also rotated bone anchor 760 so that driving threaded portion 764 enters into vertebra.In preferred embodiment, the torque limit value is chosen as make drives threaded portion 764 and enter into the required torque of vertebra and be lower than the torque limit value.In preferred embodiment, when threaded portion 764 was implanted in the vertebra fully, bone anchor 760 further rotated required torque far above the torque limit value.Therefore, when threaded portion 764 was implanted in the vertebra fully, the driver torque surpassed the torque limit value, thereby head 770 disconnects with bone anchor 760, shown in Fig. 7 G.

Shown in Fig. 7 G, when surpassing the torque limit value, head 770 disconnects from bone anchor 760.Afterwards, head 770 can remove from the cavity 766 of bone anchor 760.If desired or expectation, cavity 766 can comprise and is designed for engagement with driver to allow to remove the internal structure 768 of bone anchor 760.Alternately or additionally, if desired or expectation, the outer surface 763 of housing 762 for example can be provided with the structure of indentation or keyway (not shown, but can referring to for example Fig. 7 A), and this structure allows driver to engage the outer surface 763 of housing 762 so that remove bone anchor 760.Shown in Fig. 7 G, head 770 comprises the axle 772 in the cavity 766 that extends to housing 762.When head 770 had been removed, cavity 766 opened wide, so that receive previous described deflection system parts or connected system parts (not shown).

Fig. 7 H shows the amplification sectional view up to head 770 of bone anchor 760.Shown in Fig. 7 H, head 770 is connected on the bone anchor 760 by axle 772.Axle 772 has cervical region 774, and the diameter of this cervical region 774 is less than the diameter of the remainder of axle 772.Therefore, cervical region 774 bears than the higher stress of axle 772 remainders.The diameter of selection cervical region 774 and material are so that the controlling torque limit value.For concrete material, the diameter that reduces cervical region had reduced before cervical region fractures the maximum torque that can be transmitted by head.When surpassing the torque limit value, axle 772 fractures at cervical region 774 places.Cervical region 774 is positioned so that when cervical region 774 fractures, axle 772 still keep attached any part all to be positioned to can not hindering deflection system parts or the installation of connected system parts in cavity 766 with bone anchor 760.Shown in Fig. 7 H, for example, cervical region 744 can be placed in the recess 767 in cavity 766 far-ends.When cervical region 774 fractureed, cavity 766 was vacated and is used to install miscellaneous part.In some cases, head 770 and axle 772 can form a part with bone anchor 760.In other embodiments, head 770 and axle 772 can separate formation with bone anchor 760, and after securely be connected on the bone anchor 760 by bonding, welding or mechanical splice.

Alternative deflecting bar/load beam

A feature of embodiment of the present invention is to provide load to distribute by deflecting bar.Deflecting bar provides rigidity and supports and is applied to epispinal load with during being supported on normal spinal motion in the place of needs, thereby need not to sacrifice the spinal function that all motions just can recover to improve.Deflecting bar also makes the power that anchor system parts and dynamic stability assembly apply isolate, and reduces the stress on the skeleton that bone anchor and they are attached thereon thus.In concrete embodiment, the direction of deflecting bar of the present invention is specified to and is attached on it with them or to be combined in the longitudinal axis of bone anchor wherein coaxial.In addition, the proper stiffness by selecting to have deflecting bar or load beam, just can be the patient and realizes better result in epispinal load with the physiological structure that cooperates the patient and patient.

Fig. 8 A-8H shows alternative deflecting bar, and it has the deflection post is fastened to different institutions on deflecting bar and/or the bone anchor.The mechanism of Fig. 8 A-8H can be suitable for being used in other deflecting bars described here.For example, Fig. 8 A-8C illustrates a kind of alternative embodiment of deflecting bar/load beam.The Design and Features of the deflecting bar 800 of Fig. 8 A-8C is similar to the deflecting bar 300 of Fig. 3 A-3E.Yet, deflecting bar 800 utilized with deflecting bar 300 in different mechanism of the mechanism that uses spherical keeper is fastened on the housing of bone anchor.

Fig. 8 A shows the exploded view of alternative deflecting bar 800.Deflecting bar 800 comprises spherical keeper 802, post 804, sleeve 806, stop pin 808, collar 810 and installing rack 814.In this embodiment, spherical keeper 802 forms a part with post 804.Spherical keeper 802 is separated by one or more grooves 803 along the longitudinal axis of post 804.Groove 803 allows spherical keeper 802 distortion to have the diameter that reduces.Axle 805 near-ends from installing rack 814 pass post 804, and are communicated with one or more grooves 803.Stop pin 808 can insert and pass axle 805 to occupy the space in one or more grooves 803.After stop pin 808 fastening putting in place, spherical keeper 802 is locked under its normal diameter, and cannot be compressed into littler diameter.

Sleeve 806 is installed in the cavity 832 of the housing 830 of post 804.Sleeve 806 is by allowing post 804 to make with respect to the flexible material of housing 830 motions.Deflecting bar 800 is configured to be installed in the bone anchor 820, and it comprises the nail 822 that is connected on the housing 830.Housing 830 also has the cavity 832 at near-end, and this cavity 832 is defined as direction along the axis of bone anchor 820 and is configured for holding deflecting bar 800.Housing 830 also has and is suitable for the outer surface 834 that installing component for example is offset adapter.Shown in Fig. 8 A, the outer surface 834 of housing 830 is provided with groove 836.Groove 836 can engage with driver and be used for implantable bone anchor 820.

Referring now to Fig. 8 B,, it shows the perspective view of the deflecting bar 800 that fits together with bone anchor 820.When fitting together, deflection post 804 is placed in the sleeve 806 of Fig. 8 A.Then, post 804 and sleeve 806 are placed in the cavity 832 of bone anchor 820 (referring to Fig. 8 A).Afterwards, stop pin 808 is inserted in axle 805 (not shown) so that spherical keeper 802 is fastened on the bone anchor 820.After the installation, stop pin 808 also can be laser-welded on the installing rack 814, so that further secure component.Then, screw thread collar 810 is fastened in the screw thread near-end of cavity 832.Screw thread collar 810 has two bases 811, and the pin that is used to hold pin formula spanner is screwed to the screw thread 838 of housing 830 to allow screw thread collar 810.After the installation, screw thread collar 810 is laser-welded on the housing 830, so that further secure component.Screw thread collar 810 is fastened to sleeve 806 in the cavity 832 of bone anchor 820.

Fig. 8 C shows the sectional view of the axis intercepting that the deflecting bar 800 that fits together with bone anchor 820 represents along the line C-C of Fig. 8 B.Shown in Fig. 8 C, sleeve 806 occupies the space between post 804 and the housing 830.Sleeve 806 is gone up towards the deflection of housing 830 by post 804 and compress in any direction.Spherical keeper 802 is assembled in the dimple 839 of the cavity 832 (not shown) bottom of housing 830.Being shaped as of dimple 839 is mainly spheric block (the sphere block that comprises more than half ball).Therefore, narrower to the ingate 840 of dimple 839 than the major diameter of dimple 839.The diameter of spherical keeper 802 is identical with the major diameter of dimple 839; Yet when not having stop pin 808, spherical keeper 802 can fully be compressed to pass hole 840.Therefore yet when spherical keeper has been pushed in the dimple 839 and stop pin 808 when being installed in axle 805 and the groove 803, spherical keeper 802 can not be compressed again, and is locked in the dimple 839, still allows spherical keeper 802 to rotate simultaneously.Collar 810 is fastened to sleeve 806 in the housing 830.The deflecting bar 800 of Fig. 8 A-8C does not comprise the outer housing between sleeve 806 and the housing 830.By cutting down the thickness of outer housing, just can improve this device size/intensity property.

Shown in Fig. 8 D, alternative deflecting bar 850 can be utilized as a part rather than the spheric keeper 852 of spheroid.In other respects, deflecting bar 850 is similar to the deflecting bar 800 of Fig. 8 A-8C.Yet for by collar 810 deflection of post 804 being limited to situation in the certain angle, as concerning situation herein, it is complete spheroid that keeper 852 need not.In the range of deflection that allows, spherical stagewise keeper 852 keeps fully contacting with the wall of dimple 854, so that keeper 852 is fastened in the dimple 854.In this embodiment, the bottom 851 of keeper 852 is the spheroid of its diameter less than top, but has identical center of rotation.Similarly, can form ball section (maximum gauge that it comprises the center thereby the comprises spheroid) dimple 854 of shape and reduce the size of dimple 852 by clipping the spherical block of main body.The littler following dimple 853 identical with the lower sphere diameter is used for it being positioned between moving period at keeper.Therefore, the material that forms dimple 854 required removals is less, has therefore improved the intensity of bone anchor 850.Also can use the keeper and the dimple of other shapes, need only the desired motion scope that they can be fastened to post 804 on the bone anchor 820 and allow post 804.

Fig. 8 E and 8F show the exploded view and the sectional view of alternative deflecting bar 860, and this deflecting bar 860 has used the keeper of split ring 862 forms.Open type ball collar 862 is assemblied in the dimple 864 of bone anchor 861.Dimple 864 be shaped as the spherical block of main body (the sphere block that has comprised more than half ball).Therefore, the ingate 865 of dimple 864 is narrower than the major diameter of dimple 864.The diameter of split ring 862 is identical with the major diameter of dimple 64, yet opening ring type keeper 862 can fully be compressed to pass hole 865.After opening ring type keeper 862 has been advanced in the dimple 864, post 866 is pushed in the centre bore of opening ring type keeper 862.Under post 866 was locked in situation in the centre bore of opening ring type keeper 862, opening ring type keeper 862 can not be compressed again, therefore is locked in the dimple 864, still allows keeper 862 to rotate simultaneously.Can post 866 be fastened on the opening ring type keeper 862 by inner opening ring 868.Also can use other accessories, for example screw thread, wire clamp and or fin post 866 is fastened on the opening ring type keeper 862.Perhaps, can use combination technology for example Laser Welding fetch post 866 be fastened on the opening ring type keeper 862.

Deflecting bar 860 can be provided with the collar of the collar 810 that is similar to Fig. 8 A-8C.Yet Fig. 8 E and 8F show alternative embodiment, and wherein, post 866 comprises flange 870.Flange 870 is configured as the top surface that when post 866 pivots, keeps very close to the housing 871 of bone anchor 861.Flange 870 remains on sleeve 806 in the housing 871, and need not collar.The inner surface of housing 871 is configured as the restriction face 872 of the deflection that restriction post 866 is provided.By the thickness of reduction outer housing, and omit independent collar, can improve this device size/intensity property.

Ball can be locked in the ball-and-socket joint formula dimple in every way.With ball be locked in some suitable method and apparatus in the ball and socket joint component be disclosed in authorize people such as O ' Connell, name is called in the United States Patent (USP) 4,666,330 of " Ball Joint Assembly ".Fig. 8 G and 8H show the exploded view and the sectional view of alternative deflecting bar 880, and this deflecting bar 880 uses spherical keeper 882.Spherical keeper 882 is assemblied in the dimple 884 of bone anchor 881.Dimple 884 is a hemispherical.The diameter of the ingate 885 of dimple 884 is identical with spherical keeper 882.Yet ingate 885 comprises the groove 883 that holds split ring 888.The diameter of split ring 888 is greater than hole 885, but split ring 888 is during installation by mild compression.After passing hole 885, split ring 888 outwards extends to occupy groove 883.In the time of in being placed in groove 883, split ring 888 has reduced the effective diameter in hole 885, and prevents removing of spherical keeper 882.Then, sleeve 806 is inserted in the housing 891 of bone anchor 881.Collar 890 is fastened to sleeve 806 in the housing 891 of bone anchor 881.By cutting down the thickness of outer housing, can improve this device size/intensity property.

As mentioned above, in some embodiments, deflecting bar comprises deflection post, outer sleeve and comprises the installing rack that is placed in sleeve outer housing on every side.The deflection post allows bone anchor (and the bone anchor is implanted to vertebra wherein) with respect to the controlled motion of vertical rod with respect to the motion of installing rack, props up the support bone anchor thus and is attached to vertebra on it, allows the motion of vertebra simultaneously.Yet shown in Fig. 9 A-9H, deflection post (or be used for other junction points of the vertical rod) can be realized by the some alternative design of using deflecting bar/load beam with respect to the controlled motion of bone anchor.Generally speaking, each mechanism comprises the connector that the deflection with the deflection post is associated with the compression of compliant member.The compression of compliant member has the deflecting bar of formation like this and uses required or desired power/deflection characteristic.

Fig. 9 A-9C shows the view according to the alternative deflecting bar 900 of embodiment of the present invention.Fig. 9 A shows the exploded view of deflecting bar 900.Fig. 9 B and 9C show the sectional view of deflecting bar 900, and Fig. 9 C shows the deflection of the deflecting bar 900 under the stress state.At first referring to Fig. 9 A, deflecting bar 900 is assembled in the cavity 924 of housing 922 of bone anchor 920.At first flexible sleeve 906 is placed in the cavity 924.Sleeve 906 is for annular and have central opening 907.Then retaining ring 908 is inserted in the cavity 924.The lower surface of retaining ring 908 is suitable for connecting flexible sleeve 906 and secures it to the position.The upper surface of retaining ring 908 has the dimple 909 of the bottom that is suitable for holding ball 902.Deflection post 904 is attached to the top of ball 902.Control stick 905 extends from the bottom of ball 902.Control stick 905 is configured as assembling by retaining ring 908 and arrive in the central opening 907 of sleeve 906.In control stick 905 is placed in sleeve 906 and under ball 902 and the situation that retaining ring 908 contacts, screw thread collar 910 is screwed in the upper end of cavity 924.The lower surface 911 of collar 910 is configured as the first half that forms the dimple that ball 902 can rotate therein.Collar 910 has base or other structures that is used for pin formula spanner, is used for allowing collar is fastened to bone anchor 920.Collar 910 also can in conjunction with or be welded in place.

Fig. 9 B shows the sectional view of the deflecting bar 900 when assembling fully.Shown in Fig. 9 B, control stick 905 is surrounded by sleeve 906.Ball 902 is fastened in the dimple that is formed by retaining ring 908 and collar 910.Post 904 can be gone up in any direction and pivot, and rotates around its long axis.Yet shown in Fig. 9 C, when post 904 pivoted, control stick 905 also can pivot (in the opposite direction), thus the material of compression sleeve 906.The compression of 905 pairs of sleeves 906 of control stick makes deflection post 904 produce customizable as previously mentioned controllable force/load response.The restriction face 912 of collar 910 is designed to contact with deflection post 910 after predetermined deflection.The further deflection of the near-end of deflection post 904 needs the bending of deflection post 904 after deflection post 904 contacts with restriction face 912.Therefore, in case produce contact between deflection post 904 and the restriction face 912, the rigidity of deflection post 904 will sharply increase usually.

Fig. 9 D-9F shows the view according to the alternative deflecting bar 930 of embodiment of the present invention.Fig. 9 D shows the exploded view of deflecting bar 930.Fig. 9 E and 9F show the sectional view of deflecting bar 930, and Fig. 9 F shows the deflection of the deflecting bar 930 under the stress state.At first referring to Fig. 9 D, deflecting bar 930 is assembled in the cavity 954 of housing 952 of bone anchor 950.At first flexible disk 936 is placed in the cavity 954.Under the situation that flexible disk 936 is in place, then deflection post 934 is inserted in the cavity 954.Deflection post 934 has console panel 935 at far-end.Console panel 935 and flexible disk 936 close fits.Afterwards, collar 940 is installed in the end of cavity 954.The lower surface 941 of collar 940 is configured as the top that forms the dimple that console panel 935 can pivot therein and rotate.The edge of console panel 935 and the wall of cavity 954 are made into fillet, make console panel 935 on the scope of expectation, to pivot.Collar 940 also can in conjunction with or be welded in place.

Fig. 9 E shows the sectional view of the deflecting bar 930 when assembling fully.Shown in Fig. 9 E, console panel 935 is sat and is put on the top of flexible disk 936.Console panel 935 is fastened in the dimple that the wall by collar 940 and cavity 954 forms.Deflection post 934 can be gone up in any direction and pivot, and rotates around its long axis.Yet shown in Fig. 9 F, when deflection post 934 pivoted, console panel 935 also pivoted, thus the material of compression sleeve 936.The compression of 935 pairs of sleeves 936 of console panel makes deflection post 934 produce the controllable force/load response of foregoing customizable.The restriction face 942 of collar 940 is designed to contact with deflection post 930 after predetermined deflection.The further deflection of the near-end of deflection post 934 needs the bending of deflection post 934 after deflection post 934 contacts with restriction face 942.Therefore, in case produce contact between deflection post 934 and the restriction face 942, the rigidity of deflecting bar 930 will sharply increase usually.

Fig. 9 G and 9H show the view according to the alternative deflecting bar 960 of embodiment of the present invention.Fig. 9 G shows the exploded view of deflecting bar 960.Fig. 9 H shows the sectional view of deflecting bar 960.At first referring to Fig. 9 G, deflection post 964 has the cavity 965 of the part of hold bone anchor 980.Deflection post 964 also has vertical rod can be fastened to screw thread installing rack 963 on it.At first flexible sleeve 966 is placed in the cavity 965.Flexible sleeve 966 has central opening 967.Then retaining ring 968 is placed in the cavity 965.Retaining ring 968 has central opening 969.Bone anchor 980 comprises nail 981, ball 983 and control stick 985.Control stick 985 passes the central opening 969 of retaining ring 968 and enters the central opening 967 of flexible sleeve 966.At last, screw thread collar 970 is screwed in the opening 965.Screw thread collar 970 makes up to form the dimple that its shape is suitable for holding ball 983 with retaining ring 968.Ball 983 is fastened between retaining ring 968 and the collar 970, but can rotate and pivot with respect to deflection post 964.Collar 970 also can in conjunction with or be welded in place.

Fig. 9 H shows the sectional view of the deflecting bar 960 when assembling fully.Shown in Fig. 9 G, flexible sleeve dish 966 is sat and is put around control stick 985.Deflection post 964 can be gone up in any direction and pivot, and rotates around its long axis.Yet, when deflection post 964 pivots, the material of control stick 985 compression sleeves 966.The compression of 985 pairs of sleeves 966 of control stick makes deflection post 964 produce customizable as previously mentioned controllable force/load response.The restriction face 972 of collar 970 is designed to contact with bone anchor 980 after predetermined deflection.The further deflection of deflection post 964 needs the bending of deflection post 964 or bone anchor 980 after bone anchor 980 contacts with restriction face 972.Therefore, in case produce contact between bone anchor 980 and the restriction face 972, the rigidity of deflecting bar 960 will sharply increase usually.

Be used for vertical rod is installed to alternative mechanism on the deflecting bar

In order to use deflecting bar of the present invention to construct the dynamic stability assembly, with deflecting bar and vertical rod coupling connection.Deflecting bar can be coupled on the vertical rod in mode fastening, that pivot or flexibility, and this depends on the requirement of dynamic stability assembly.It is the ball-and-socket joint 222 shown in Fig. 2 A-2C and Fig. 2 E-2G for example that deflecting bar is coupled to a kind of mechanism on the vertical rod.Shown in Fig. 2 B, vertical rod 216 is coupled on the deflection post 204 around the long axis rotation of deflection post 204 and the mode that pivots with respect to deflection post 204 to allow vertical rod 216 by ball-and-socket joint 222.These two kinds of degree of freedom all exist during implanting and in the dynamic stability assembly of finishing.By comparison diagram 2C, 2E and 2F, as can be seen, when 204 deflections of deflection post, the angle between vertical rod 216 and the deflection post 204 also changes thereupon.This variation of angle is regulated by the rotation of ball 214 in ball-and-socket joint 222.

Second kind of mechanism that deflecting bar is coupled on the vertical rod is the screw thread installing rack 314 of the deflecting bar 300 shown in Fig. 3 A-3H.Shown in Fig. 3 G, vertical rod 360 is fastened on the screw thread installing rack 314 by nut 362.Vertical rod 360 can rotate around installing rack 314 before nut 362 is tightened, but afterwards, vertical rod 360 is rigidly secured on the deflecting bar 304.After finishing the dynamic stability assembly, vertical rod still can rotate around the long axis of bone anchor 320, because deflection post 304 can rotate with respect to the long axis of bone anchor 320.Yet the angle between vertical rod 360 and the deflection post 304 is fastening.Therefore, any variation of angle must be regulated by the distortion (bending) of vertical rod 360 and deflection post 304 between vertical rod 360 that causes owing to spinal movement and the deflection post 304.Not crooked vertical rod is compared with the dynamic stability assembly that the deflection post comes adjusting angle to change with using ball-and-socket joint for example, and vertical rod 360 and deflection post 340 relative rigidityes are bigger, and therefore, this dynamic stability assembly rigidity is bigger.

Therefore, vertical rod is coupled to mechanism on the deflecting bar and influences the degree easily that dynamic stabilization system can assemble and the rigidity of dynamic stability assembly.Figure 10 A-12X shows the deflection post that is used for deflecting bar and is coupled on the vertical rod with the alternative mechanism in the certain limit that forms the dynamic stability assembly.

Figure 10 A-10E shows being used in one embodiment of the present invention deflecting bar is connected to radial type coupling 1000 on the vertical rod.Radial type coupling 1000 is designed to be installed on the screw thread near-end of deflection post of deflecting bar.Radial type coupling 1000 can be with for example deflecting bar 300 uses of Fig. 3 A-3H of any deflecting bar with suitable near-end installing rack.

Figure 10 A shows the exploded view of radial type coupling 1000.Radial type coupling 1000 comprises clevis (U 1010, Horse hoof pin 1012, lockplate 1020 and vertical rod 1030.Radial type coupling 1000 is held in place by nut 1002.Vertical rod 1030 is configured to be held by clevis (U 1010.One end of vertical rod 1030 comprises the dish 1032 with centre bore 1034.The periphery of dish 1032 is provided with latch-up structure, and for example tooth 1036.Dish 1032 is contained between the arm 1013,1014 of clevis (U 1010.Afterwards, will sell 1012 insertions and pass hole 1016, two arms 1013,1014 are run through in this hole.Pin 1012 also passes the centre bore 1034 of the dish 1032 of vertical rod 1030.Use mechanical fitting and/or be fastened on the clevis (U 1010 by selling 1012 in conjunction with for example screw thread and/or laser weld.Under the situation that pin 1012 is in place, vertical rod 1030 is fastened on the clevis (U 1010, but it still can pivot around the axis of Horse hoof pin 1012.

Clevis (U 1010 also has installing plate 1017, and installing plate 1017 has the hole of passing wherein 101, and this hole 1018 is used to hold the deflection post of deflecting bar.Hole 1018 can be circular or can polygon (as shown in).When hole 1018 was polygon (non-circular), it can engage with similar polygon post with respect to the mode that post rotates to prevent installing plate 1017.This is very favorable, because this rotation can cause nut 1002 to unclamp.In addition, the deflection post of deflecting bar of the present invention can rotate with respect to the bone anchor usually, thereby the rotation of installing plate 1017 is redundant, so this is a kind of unessential degree of freedom.In the embodiment that the post that radial type coupling 1000 is connected thereto can not rotate, may need to provide a kind of installing rack, can rotate around post by this installing rack installing plate 1017, yet, in this case, must be carefully to guarantee that nut 1002 or employed other these class securing members put in place installing plate is fastening when allowing this rotation.

Figure 10 B shows the radial type coupling 1000 that is ready to be installed on the deflecting bar 1001.Deflecting bar 1001 has installing rack 1005 in the end of deflection post 1004, and this installing rack 1005 is used to hold the installing plate 1016 of radial type coupling 1000.Installing rack 1005 has antelabium 1006, polygon portion 1007 and threaded portion 1008.Antelabium 1006 is provided for catching the mechanical stop of installing plate 1017.1007 close fits of polygon portion are in polygonal hole 1018, to eliminate the rotation of installing plate 1017 with respect to deflection post 1004.During use, hole 1018 is placed on the installing rack 1005, up to installing plate 1017 contact antelabium 1006, and polygon portion 1007 is contained in the hole 1018.

After settling installing plate 1017, the orientation of vertical rod 1030 is determined on desired orientation and angle with respect to deflection post 1004.Usually, by free end 1031 being fastened on other devices on another vertebra of spinal column, for example nail, multi-axial screws or deflecting bar are determined the orientation of vertical rod 1030.After vertical rod 1030 correct arrangements, just lockplate 1020 can be installed.Lockplate 1020 comprises the installing plate 1022 with hole 1024, and this hole 1024 is suitable for being contained on the installing rack 1005 of deflection post 1004.Lock arm 1026 is outstanding from installing plate 1022.Lock arm 1026 is suitable for being assemblied between the arm 1013,1014 of clevis (U 1010, and engages vertical rod 1030 so that with fastening vertical rod 1030 of desired angle and deflection post 1004.Lock arm 1026 is provided with latch-up structure, for example is used to engage the tooth 1028 of periphery of the dish 1032 of vertical rod 1030.In this embodiment, the tooth of lock arm 1,026 1028 engages the tooth 1036 of vertical rods 1030, so that vertical rod 1030 is locked in tightening angle place with respect to deflection post 1004.Clevis (U 1010 and lockplate 1020 are fastening on the throne by nut 1002, and this nut 1002 engages so that vertical rod 1030 is fastened on the deflection post 1004 with the threaded portion 1008 of installing rack 1005.Figure 10 C shows by radial type coupling 1000 and is fastened to vertical rod 1030 on the deflection post 1004, and wherein, vertical rod 1030 is with respect to 1004 one-tenth tightening angles of deflection post.

In the another kind of Installation Modes shown in Figure 10 D, can omit lockplate 1020.In this case, nut 1002 is used for clevis (U 1010 is fastened to the installing rack 1005 of deflection post 1004.Under the situation that does not have lockplate 1020, even after vertical rod 1030 has been installed and has been fastened on the deflection post 1004, vertical rod 1030 also can freely pivot (referring to arrow 1038) around pivotal pin 1012.Therefore, when finally implanting, vertical rod 1030 has additional freely-movable degree.As mentioned above, compare with the embodiment that angle between vertical rod and the deflection post remains unchanged, the rigidity of the dynamic stability assembly that finally obtains here will reduce, and it is bigger that range of movement will become.

Referring to Figure 10 E, radial type coupling 1000 also can be used for vertical rod 1030 is fastened on the standard bone anchor 1050 with binding thread post 1052.Radial type coupling 1000 can use with lockplate 1020, or uses under the situation that does not have lockplate 1020, and this depends on whether expect to make vertical rod 1030 to pivot with respect to bone anchor 1050 after installing.When being used in combination with the standard bone anchor, the radial type coupling plays the effect of cluster head, and this is because it allows to regulate during installation direction and the angle of vertical rod 1030 with respect to bone anchor 1050, thereby is convenient to the implantation of spinal column implant assembly.

Figure 11 A-11D shows being used in one embodiment of the present invention deflecting bar is connected to alternative ball-and-socket joint 1100 on the vertical rod.Ball-and-socket joint 1100 is designed to be installed on the screw thread near-end of deflection post of deflecting bar.Yet ball-and-socket joint 1100 can use with any deflecting bar with suitable near-end installing rack, for example the deflecting bar 300 of Fig. 3 A-3H.

Figure 11 A shows the exploded view of ball-and-socket joint 1100.Ball-and-socket joint 1100 comprises open type spherical bearing 1110, lock washer 1120 and vertical rod 1130.Ball-and-socket joint 1100 is held in place by nut 1102.Vertical rod 1130 is configured to hold open type spherical bearing 1110.One end of vertical rod 1130 comprises the dish 1132 with dimple 1134.Dimple 1134 is configured as the shape of the segment of a sphere, and its inside diameter is greater than the diameter on the surface of dish 1132.The diameter of open type spherical bearing 1110 is identical with the maximum gauge of dimple 1134.Yet, the gap 1114 that open type spherical bearing 1110 has centre bore 1112 and allows open type spherical bearing 1110 to be compressed and to be inserted in the dimple 1134.In the time of in open type spherical bearing 1110 correctly is placed in dimple 1134, allow its expansion to put in place.When open type spherical bearing 1110 was ready for installation, the expansion of bearing 1110 was fastened on it in dimple 1134.

Figure 11 B shows and is ready for the branch mouth formula spherical bearing 1110 that is placed in the dimple 1134 on the deflecting bar 1101, that be installed in vertical rod 1130.Open type spherical bearing 1110 is all given prominence at dish 1132 either side, so that provide enough spaces for coiling 1132 motion.Centre bore 1112 can be that circular (as shown in) maybe can be polygon.When hole 1112 was polygon (non-circular), it can engage with the polygon post of similar shape with respect to the mode that deflection post 1104 rotates to prevent bearing 1110.This is very favorable, because this rotation can cause nut 1102 to unclamp.In addition, the deflection post 1104 of deflecting bar of the present invention can rotate with respect to the bone anchor usually, and the rotation of spherical bearing 1110 is redundant like this, so this is a kind of unessential degree of freedom.

Shown in Figure 11 B, deflecting bar 1101 has installing rack 1105 in the end of deflection post 1104, and this installing rack 1105 is used to hold the installing plate 1116 of ball-and-socket joint 1100.Installing rack 1105 has antelabium 1106, cylindrical portion 1107 and threaded portion 1108.Antelabium 1106 is provided for catching the mechanical stop of bearing 1110.Cylindrical portion 1107 close fits to eliminate the compression of open type spherical bearing 1110, prevent that thus open type spherical bearing 1110 from moving apart dimple 1134 in hole 1112.During use, hole 1112 is placed on the installing rack 1105, up to open type spherical bearing 1110 contact antelabium 1106, and cylindrical portion 1107 is contained in the hole 1112.

After settling bearing 1110, the orientation of vertical rod 1130 is specified to respect to deflection post 1104 is on the direction and angle of expectation.Usually, by free end 1131 being fastened on other devices on other vertebras of spinal column, for example on nail, multi-axial screws or the deflecting bar, determine the orientation of vertical rod 1130.After vertical rod 1130 correct arrangements, just lock washer 1120 can be installed.Lock washer 1120 comprises the hole 1124 that has on the installing rack 1105 that is suitable for being contained in deflection post 1104.Hole 1124 is less than the shoulder 1109 of installing rack 1105.Lock washer 1120 has lower lip 1122, and it is designed in one direction by on bearing 1110.In other directions, can compress in lock washer that lock washer 1120 is subjected to stopping of shoulder 1109 before 1110.Bearing 1110 and lock washer 1120 are fastening on the throne by nut 1102, and this nut 1102 engages so that vertical rod 1130 is fastened on the deflection post 1104 with the threaded portion 1108 of installing rack 1105.

Figure 11 C shows by ball-and-socket joint 1100 and is fastened to vertical rod 1130 on the deflection post 1104, and wherein, vertical rod 1130 is with respect to 1104 one-tenth tightening angles of deflection post.Shown in Figure 11 C, open type spherical bearing 1110 engages at the antelabium 1106 of a side by installing rack 1105.At opposite side, open type spherical bearing 1110 is engaged by the antelabium 1124 of the shoulder that extends beyond installing rack 1,105 1109 of lock washer 1120.When nut 1102 was tightened, open type spherical bearing 1110 was compressed between packing ring 1120 and antelabium 1106.Open type spherical bearing 1110 is designed to make compression in response to by nut 1102, and its high shrinkage and diameter increase.For example, open type spherical bearing 1110 can be provided with the inner structure of alleviating.When the diameter of open type spherical bearing 1110 increased, it fully engaged to eliminate the further motion of bearing 1110 with respect to bar 1130 with the surface of dimple 1134.Like this,, just vertical rod 1130 is fastened on the deflection post 1104 by fastening nut 1102, and the angle between fastening vertical rod 1130 and the deflection post 1104.

In the another kind of Installation Modes shown in Figure 11 D, can omit lock washer 1120.In this case, nut 1102 is used for open type spherical bearing 1110 is fastened to the installing rack 1105 of deflection post 1104.Under the situation that does not have lock washer 1120, nut 1102 can't compress open type spherical bearing 1110, and this is because nut 1102 does not extend beyond the shoulder 1109 of installing rack 1105.Therefore, open type spherical bearing 1110 is not compressed, and thereby still can rotate in the dimple 1134 of vertical rod 1130.Like this, under this pattern, even vertical rod 1130 is installed and is fastened on the deflection post 1104, vertical rod 1130 also can freely pivot (referring to arrow 1138) around bearing 1110.Therefore, when finally implanting, vertical rod 1130 has additional freely-movable degree.As mentioned above, compare with the embodiment that angle between vertical rod and the deflection post remains unchanged, the rigidity of the dynamic stability assembly that finally obtains here will reduce, and it is bigger that range of movement becomes.Similarly, also can use ball-and-socket joint 1100 (with arbitrary pattern) that vertical rod 1130 is fastened on traditional bone anchor with binding thread post (referring to, the bone anchor 1050 of Figure 10 E for example).

In alternative embodiment, shown in Figure 11 E and 11F, the base that is used for the open type spherical bearing be installed in deflecting bar from one's body.Vertical rod can slide in the open type spherical bearing, and can be locked on the correct position and angle by two trip bolts.Figure 11 E shows the exploded view of these parts, and they comprise base 1150, bearing 1160 and screw 1170 and 1172.Base 1150 comprises the following accessory 1152 (for example, screwed hole) that is used for base 1150 is attached to deflecting bar 1101.Base 1150 also can be attached on the deflecting bar 1101 by for example laser weld, perhaps, in some cases, can become a part with the deflection cylindricality of deflecting bar 1101.Base 1150 has the inside dimple 1154 that its diameter equals spherical bearing 1160 diameters.Base 1150 also has the upper screwed hole 1156 that is used to hold trip bolt 1170.

Spherical bearing 1160 has spherical portion 1162, sleeve 1164, central passage 1166 and screwed hole 1168.Spherical portion 1162 is provided with opening or allows other structural alleviation parts in its dimple 1154 that is pressed into base 1150 (when not having vertical rod).Sleeve 1164 extends from a side of spherical portion 1162.Central passage 1166 extends through sleeve 1164 and spherical portion 1162, and its size forms and makes vertical rod slidably pass.Screwed hole 1168 intersects with passage 1166, thereby when inserting, locking trip bolt 1172 can be fastened on vertical rod 1189 in the passage 1166.

Shown in Figure 11 F, before implanting the patient, spherical bearing 1160 is pressed in the base 1150, and base 1150 is fastened on the deflecting bar 1101.Afterwards, vertical rod 1180 can be inserted the central passage 1166 (shown in Figure 11 E) of passing spherical bearing 1160.When vertical rod 1180 is positioned at the position of expectation, can tighten trip bolt 1172 so that vertical rod 1180 is fastened in the passage 1166.At this moment, vertical rod 1180 is secured on the deflecting bar 1101.Spherical bearing 1160 is fastened in the dimple 1154 of base 1150, and this is because when vertical rod was positioned at correct position, spherical portion 1162 can not fully be compressed again so that it breaks away from dimple 1154.Yet spherical portion 1162 still can be rotated in dimple 1154, so the angle between deflecting bar 1101 and the vertical rod 1180 can change.

In some embodiment, the orientation of vertical rod 1180 can be specified to desired angle, can tighten screw 1170 then.The spherical portion 1162 of screw 1170 engage bearings 1160, and promote its wall against base 1154, thus bearing 1160 is locked in the fastening position.As previously mentioned, locking vertical rod 1180 has increased the rigidity of system with respect to the angle of deflecting bar 1101.Yet less if desired rigidity and bigger range of movement can be removed screw 1170, and bearing 1160 can freely be rotated in dimple 1154 after final assembling.

Figure 12 A-12D shows according to being used in one embodiment of the present invention deflecting bar is connected to another kind of ball joint mechanisms on the vertical rod.In the embodiment shown in Figure 12 A-12D, vertical rod is provided with locking ball container 1200, and this locking ball container 1200 can be fastened on the deflecting bar 1201 with deflection post 1204, and deflection post 1204 is terminated in the ball 1206.Locking ball container 1200 can two kinds of patterns be fastened on the ball 1206.In a kind of pattern, will lock ball container 1200 and be fastened on the ball 1206, so that it can't break away from ball 1206, but still can rotate and pivot with respect to ball 1206.In another kind of pattern, will lock ball container 1200 and be fastened to ball 1206, so that it can't break away from ball 1206, and also can't rotate and pivot with respect to ball 1206.

Figure 12 A shows the exploded view of container 1200.Container 1200 comprises anchor clamps 1210 and packing ring 1220, and is attached on the vertical rod 1230.Container 1200 is placed in an end of vertical rod 1230, and comprises dimple 1234.Dimple 1224 is configured as the part as ball, and the diameter of this ball is identical with the diameter of ball 1206.The diameter of the inlet of dimple 1234 is equal to or greater than the diameter of ball 1206, and therefore ball 1206 can be inserted in the dimple 1234 in the process that vertical rod 1230 is connected to deflecting bar 1204.Anchor clamps 1210 have the dimple 1216 that also is configured as the part of figure ball, and the diameter of this ball is identical with the diameter of ball 1206.Dimple 1216 can be removed to allow to insert ball 1206 from dimple 1234.Dimple 1216 can be towards dimple 1234 motions so that be fastened on ball 1206 in the dimple 1234.

Anchor clamps 1210 are held in place by screw 1202.During assembling, screw 1202 passes the hole 1212 in the anchor clamps 1210.Hole 1212 is greater than screw 1202.Anchor clamps 1210 are assemblied in the groove 1236 in the container 1200.Groove 1236 comprises the ramp 1238 in the ramp 1214 of joining jig 1210.When making the bottom of anchor clamps 1210 more close grooves 1236, ramp 1238 impels anchor clamps 1210 to clamp with engaging of ramp 1214.Screw 1202 passes the screwed hole 1235 in the vertical rod 1230, thereby tightening of screw 1202 spurs the bottom of anchor clamps 1210 towards groove 1236.In some pattern, packing ring 1220 between the bottom of anchor clamps 1210 and groove 1236, thereby the anchor clamps 1210 and the bottom interval of groove 1236 are opened, and the clamping action of restriction anchor clamps 1210.

Shown in Figure 12 B, deflection post 1204 has ball 1206 in the end of deflection post 1204, and container 1200 can be installed on this ball 1206.Ball 1206 can form a part with deflection post 1204, or can make separately and after securely attached.Figure 12 B shows the container 1200 of ball 1206 tops that are positioned at deflection post 1204.Be removed or loosely when being attached to vertical rod 1230 at anchor clamps 1210, ball 1206 slides in the dimple 1234.After being arranged to ball 1206 in the dimple 1234, the orientation of vertical rod 1230 is defined as being on the direction and angle of expectation with respect to deflection post 1204.Usually, by free end 1231 being fastened on other devices on other vertebras of spinal column, for example on nail, multi-axial screws or the deflecting bar, determine the orientation of vertical rod 1230.After vertical rod 1230 correct arrangements, can tighten screw 1202.When screw 1202 was tightened, ramp 1238 advanced so that push dimple 1216 to dimple 1234 on ramp 1214.If be provided with packing ring 1220, then dimple 1216 to dimple 1234 near being subjected to the restriction of packing ring 1220, thereby ramp 1210 can not lock onto on the ball 1206.If there is not packing ring 1220, then force anchor clamps 1210 to contact with ball 1206 by tightening screw 1202.

Figure 12 C shows the sectional view that is fastened to the vertical rod 1230 on the deflection post 1204 by container 1200.Shown in Figure 12 C, ball 1206 falls between the dimple 1234 of the dimple 1216 of anchor clamps 1210 and vertical rod 1230. Dimple 1216 and 1234 combinations are to form the dimple that falls into system ball 1206.When screw 1202 is tightened, further push dimple 1216 to dimple 1234 by the interaction of ramp 1214 and 1238.Yet when being provided with packing ring 1220, before any clamp pressure was applied on the ball 1206, dimple 1216 just stopped to the close of dimple 1234.Therefore, after tightening screw 1202, vertical rod 1230 still can rotate and pivot with respect to ball 1206.Like this, when finally implanting, vertical rod 1230 has additional freely-movable degree.As mentioned above, compare with the embodiment that angle between vertical rod and the deflection post remains unchanged, the rigidity of the dynamic stability assembly that finally obtains here will reduce, and it is bigger that range of movement but becomes.

In the another kind of Installation Modes shown in Figure 12 D, packing ring 1220 (not shown) can omit.When omitting packing ring 1220, the bottom of anchor clamps 1210 removable more close grooves 1236.When screw 1202 is tightened, further push dimple 1216 to dimple 1234 by the interaction of ramp 1214 and 1238.If there are not packing ring 1220 (not shown), then dimple 1216 can not stop to the close of dimple 1234, is applied on the ball 1206 up to clamping pressure.As a result, vertical rod 1230 is fastened on the ball 1206, and can not rotate with respect to ball 1206.As mentioned above, compare with the embodiment that angle between vertical rod and the deflection post can change, the rigidity of the dynamic stability assembly that finally obtains here will increase, and it is littler that range of movement will become.Similarly, also can use container (with arbitrary pattern) that vertical rod 1230 is fastened on the traditional bone anchor (for example bone anchor 1050 of Figure 10 E) with binding thread post.

Figure 13 A and 13B show being used in one embodiment of the present invention deflecting bar are connected to another kind of mechanism on the vertical rod.Figure 13 A and 13B show according to the deflecting bar with pivoting head in one embodiment of the present invention.In the embodiment of Figure 13 A-13B, deflecting bar has the integral connectors 1300 that can be fastened on the vertical rod.Adapter 1300 can two kinds of patterns be fastened on the vertical rod.In a kind of pattern, adapter 1300 is fastened on the vertical rod so that it can't break away from adapter 1300, but it still can be pivoted with respect to deflecting bar.In another kind of pattern, adapter 1300 is fastened on the vertical rod so that it can't break away from adapter 1300, and also can't pivots with respect to deflecting bar.

Figure 13 A shows the exploded view of adapter 1300.Adapter 1300 comprises saddle 1310, inserted link 1320, hold-down screw 1330, pivotal pin 1332, and is attached on the deflection post 1340 of deflecting bar 1302.Deflection post 1340 has dish type installing rack 1342 at near-end.Installing rack 1342 has centre bore 1344, and the size of this centre bore 1344 forms and is used to hold pivotal pin 1332.Saddle 1310 is roughly tubulose, and it has the boring 1316 of the long axis that runs through saddle 1310.One end of saddle 1310 is used to hold the clevis (U 1312 of dish type installing rack 1342 for its size forms.Clevis (U 1312 has and runs through clevis (U 1312 and its size forms the hole 1314 that is used to hold pivotal pin 1332.In order to assemble adapter 1300, dish type installing rack 1342 is inserted in the clevis (U 1312, and pivotal pin 1332 is passed hole 1314 and hole 1344.Afterwards, use machinery and/or combination technology for example laser weld pivotal pin 1332 is fastened to the one or both sides of clevis (U 1312.Like this, saddle 1310 just can freely pivot with respect to the axis of deflection post 1340 around pivotal pin 1332.

Boring now 1316 is communicated with dish type installing rack 1342.Inserted link 1320 can be incorporated into now in the boring 1316.Inserted link 1320 has surface texture, and for example rib 1326, and it is designed for engaging the surface texture of dish type installing rack 1342.The end relative with clevis (U 1312 of saddle 1310 has the groove 1318 that runs through it.The size of groove 1318 forms and is used to hold vertical rod.At closing end, groove 1318 intersects with the position of inserted link 1320.At the opening of groove 1318,1316 carry out screw thread processing so that hold hold-down screw 1330 to holing.When the vertical rod (not shown) was inserted in the groove 1318, tightening of hold-down screw 1330 forced vertical rod to move downward towards inserted link 1320 in groove 1318, and this makes inserted link 1320 be pushed downward to dish type installing rack 1342 again and contacts.

Figure 13 B shows the adapter 1300 that fits together with deflecting bar 1302 and bone anchor 1304.After the assembling, adapter 1300 can pivot around the axis of pivotal pin 1332, shown in arrow 1306.Adapter 1300 also can rotate around the long axis of bone anchor 1304, shown in arrow 1308.Because deflection post 1340 can rotate around its long axis in deflecting bar 1302, it is possible therefore rotating 1308.

Figure 14 A and 14B show according to being used in one embodiment of the present invention deflecting bar are connected to another kind of mechanism on the vertical rod.Figure 14 A and 14B show according to the deflecting bar with pivoting head in one embodiment of the present invention.In the embodiment of Figure 14 A and 14B, deflecting bar has the integral connectors 1400 that can be fastened on the vertical rod.Adapter 1400 can two kinds of patterns be fastened on the vertical rod.In a kind of pattern, adapter 1400 is fastened on the vertical rod so that it can't break away from adapter 1400, but it still can be pivoted with respect to deflecting bar.In another kind of pattern, adapter 1400 is fastened on the vertical rod so that it can't break away from adapter 1400, and also can't pivots with respect to deflecting bar.

Figure 14 A shows the exploded view of adapter 1400.Adapter 1400 comprises saddle 1410, inserted link 1420, hold-down screw 1430, pivotal pin 1432,1434, and is attached on the deflection post 1440 of deflecting bar 1402 (referring to Figure 14 B).Deflection post 1440 has clevis (U 1442 at near-end.Clevis (U 1442 has the hole 1444 of two arms that run through clevis (U 1442, and it is configured for holding pivotal pin 1432,1434.Saddle 1410 is roughly tubulose, and it has the boring 1416 that runs through saddle 1410 long axis.Clevis (U 1442 has and runs through clevis (U 1412 and its size forms the hole 1414 that is used to hold pivotal pin 1432,1434.In order to assemble adapter 1400, saddle 1410 is inserted in the clevis (U 1442, pivotal pin 1432,1434 is passed hole 1444 and enters into hole 1414.Afterwards, use machinery and/or combination technology for example laser weld pivotal pin 1432,1434 is fastened to the one or both sides of clevis (U 1442.Like this, saddle 1410 just can freely pivot with respect to the axis of deflection post 1440 around pivotal pin 1432,1434.

Boring now 1416 is communicated with the ridged surface 1446 of clevis (U 1442.Inserted link 1420 can be incorporated into now in the boring 1416.Inserted link 1420 has surface texture, and for example rib 1426, and it is designed for engaging the ridged surface 1446 of clevis (U 1442.The near-end of saddle 1410 has the groove 1418 that runs through it.The size of groove 1418 forms and is used to hold the vertical rod (not shown).At closing end, groove 1418 intersects with the position of inserted link 1420.At the opening of groove 1418,1416 carry out screw thread processing so that hold hold-down screw 1430 to holing.Therefore when the vertical rod (not shown) was inserted in the groove 1418, tightening of hold-down screw 1430 forced vertical rod to move downward towards inserted link 1420 in groove 1318, thereby inserted link 1420 is pushed down with the ridged surface 1446 of clevis (U 1442 again and contacts.Contact locking saddle 1410 between inserted link 1420 and the clevis (U 1442, thereby it can not be pivoted with respect to inserted link again.Yet, in alternative structure, omitted inserted link 1420, can use hold-down screw 1430 that the vertical rod (not shown) is locked onto on the saddle 1410, still allow saddle 1410 to pivot simultaneously with respect to clevis (U 1442.

Figure 14 B shows the adapter 1400 that fits together with deflecting bar 1402 and bone anchor 1404.After the assembling, adapter 1400 can pivot around the axis of pivotal pin 1432, shown in arrow 1406.Adapter 1400 also can rotate around the long axis of bone anchor 1404, shown in arrow 1408.Because deflection post 1440 can rotate around its long axis in deflecting bar 1402, it is possible therefore rotating 1408.The vertical rod (not shown) can be inserted in the groove 1418.Tightening of hold-down screw 1430 can be fastened to vertical rod on the saddle 1410.If be provided with inserted link 1420, then hold-down screw 1430 tighten the relative position that also locks saddle 1410 and clevis (U 1442, thereby prevent from after implantation, to pivot.If there is not inserted link 1420, then not tightening of hold-down screw 1430 can lock onto saddle 1410 on the clevis (U 1442, so saddle 1410 still can pivot after implantation.As mentioned above, compare with the blocked embodiment of angle between vertical rod and the deflection post wherein, allow in the embodiment of the pivot between vertical rod and the deflection mast after implantation, the rigidity of the dynamic stability assembly that finally obtains will reduce, and it is bigger that range of movement will become.

Figure 15 A shows the preferred implementation of deflecting bar 300 and the bone anchor 320 of Fig. 3 A.Shown in Figure 15 A, the installing rack 314 of deflecting bar 300 comprises the fastening polygon portion 1502 that is installed on the vertical rod parts that is used for.Polygon portion 1502 can be hexagon, octagon etc.Polygon portion 1502 be configured as with vertical rod parts (not shown) in the form fit of container, thereby when both are installed together, will not have rotation.Shown in Figure 15 A, the near-end of installing rack 314 is processed with screw thread 1504, so that hold the vertical rod parts is fastened to securing member on the installing rack 314.Deflecting bar 300 also can be previously described such.

Figure 15 A also shows the preferred implementation that is used for the vertical rod 1510 of deflecting bar 300 uses.Shown in Figure 15 A, vertical rod 1510 comprises bar 1511, and it is preferably the titanium bar of diameter 5.5mm.Vertical rod 1510 at one end has its size and forms the dimple 1512 that is used to hold ball 1520.Ball 1520 is preferably cobalt chromium ball.Ball 1520 has the polygonal hole 1522 that is designed for polygon portion 1502 fluid-tight engagement of installing rack 314.Insert ball 1520 in the dimple 1512 and fastened putting in place by screw thread block 1530.Dimple 1512 is carried out screw thread processing so that hold block 1530.Ball 1520 is placed in the dimple 1512, and will block a shot then 1530 is screwed in the threaded portion of dimple 1512.Block 1530 preferably is made of titanium, and can be fastened on the vertical rod 1510 by laser weld or other modes after assembling.The parts of vertical rod 1510---titanium bar 1511, titanium block 1530 and cobalt chromium ball 1520 fitted together before using.

Figure 15 B and 15C show the sectional view of assembling back vertical rod 1510.Figure 15 B shows the ball 1520 in the dimple 1512 that is placed in bar 1511.Shown in Figure 15 B, block 1530 and dimple 1512 trap the puck 1530, thereby make it can not break away from vertical rod 1510.Yet, ball 1530 can be around the hole 1522 axis rotate 360 degree, shown in arrow 1550.This just allows vertical rod 1510 to rotate 360 degree around the long axis that ball 1530 will be installed to bone anchor on it or deflecting bar.Ball 1530 also can be from the inclined position shown in Figure 15 B, shown in the arrow among Figure 15 C 1552.In preferred embodiment, ball 1,530 15 degree that can tilt in any direction, thereby allow vertical rod 1510 from will be installed to bone anchor on it or deflecting bar 15 degree that tilt perpendicular to ball 1530.It should be noted that installing rack 314 and with vertical rod 1510 be fastened to nut on the installing rack 314 be designed to not can be in rotating or tilting the interfering movement scope.

Vertical rod 1510 can use with standard bone anchor, deflecting bar and bone anchor (for example the bone anchor 320 of Figure 15 A and deflecting bar 300) or multi-axial screws.Similarly, the deflecting bar 300 of Figure 15 A and the assembly of bone anchor 320 can use with vertical rod 1510, but also can be used in combination with the vertical rod that does not have ball-and-socket joint.

Figure 16 A and 16B show the another kind of embodiment of deflecting bar 1600, and it comprises and is used for deflecting bar is connected to installing rack 1670 on the vertical rod.Shown in Figure 16 A, installing rack 1670 comprises circular slab 1674, and the plate face of this circular slab 1674 is parallel to the longitudinal axis of deflection post 1604.Threaded 1672 stretches out from the center of circular slab 1674.Threaded 1672 is perpendicular to the longitudinal axis of deflecting bar 1604.Centering on the plate face of pin 1672 of circular slab 1674 a plurality of radially keyways 1676 are arranged.

Installing rack 1670 is designed to and cooperates at the vertical rod 1680 shown in Figure 16 A equally.Vertical rod 1680 at one end has circular slab 1684, and the plate face of this circular slab 1684 is parallel to the longitudinal axis of vertical rod 1680.The center of circular slab 1684 is run through in hole 1682, and the size in this hole 1682 forms and is used to hold threaded 1672.Hole 1682 is perpendicular to the longitudinal axis of vertical rod 1680.Centering on the plate face in hole 1682 of circular slab 1684 a plurality of radially keyways 1686 are arranged.The radially keyway 1686 of vertical rod 1680 is designed to cooperate with the keyway 1676 of installing rack 1670 and engage.

Shown in Figure 16 B, the hole 1682 of vertical rod 1680 is contained on the threaded 1672 of installing rack 1670.Scalable vertical rod 1680 is with respect to the angle of deflection post 1604, shown in arrow 1692.The ability (shown in arrow 1694) that the adjusting of the relative angle of deflection post 1604 and vertical rod 1680 and deflection post 1604 rotate around its long axis with respect to bone anchor 1620 is combined two degree of freedom is provided, and thereby provides vertical rod 1680 and the aligned enough Installation Flexibility of bone anchor that are implanted in another vertebra.Shown in Figure 16 B, nut 1690 engage threads pins 1672 are so that be fastened to plate 1674 on the plate 1684.The keyway 1676 of plate 1674 is arranged to the keyway 1686 in the face of plate 1684.When nut 1690 was tightened, keyway 1686 engage splines 1676 were rotated around pin 1672 to prevent vertical rod 1680.Like this, when nut 1690 was tightened, the angle between deflection post 1604 and the vertical rod 1680 was fixed.The vertical rod installing mechanism of Figure 16 A and 16B also can be conveniently used in the described here arbitrary deflecting bar system.

Another kind of alternative deflecting bar/load beam

Figure 17 A shows alternative deflecting bar 1700.Figure 17 A shows deflection post 304, also shows the position after 304 deflections of (with the dotted line form) deflection post.The parts major part that deflecting bar 1700 has is identical with the deflecting bar 300 of Fig. 3 A-3E.The applicant finds, in case deflection post 304 deflections of the deflecting bar 300 of Fig. 3 A-3E, the sleeve 300 of Fig. 3 A-3E has the tendency of longitudinal dilatation and becomes by sunken between deflecting bar 300 and collar 310 in being subjected to deflection post 304 compression processes.Therefore, deflecting bar 1700 has the sleeve 1706 of remodeling and the collar 1710 of remodeling.[267] shown in Figure 17 A, sleeve 1706 is provided with release portion 1720 at upper surface.Release portion 1720 provides the space that is used for the longitudinal dilatation of sleeve 1706 at sleeve 1706 in by post 304 radial compression processes.Like this, when 304 deflections of deflection post (shown in dotted line), sleeve 1706 just can not become sunken being formed between the contact surface 1713 of deflection post 304 and collar 1710.This design has reduced the wearing and tearing on the sleeve 1706, and guarantees that deflection post 304 can freely move on the range of deflection of its design.

Shown in Figure 17 A, collar 1710 also can be provided with release portion 1712 so that further help prevent sleeve 1706 to be fallen between collar 1710 and deflection post 304.In addition, sleeve 1706 can be provided with down release portion 1722, is fallen between deflection post 304 and outer housing 308 in this zone of keeper 302 so that prevent sleeve 1706.

Figure 17 B shows the perspective view of sleeve 1706.Sleeve 1706 is by allowing deflection post 304 to make with respect to the flexible material of outer housing 308 (Figure 17 A) motion.Sleeve 1706 is controlled the deflection of deflection post 304 effectively.Sleeve 1706 is preferably made by the flexible biocompatible polymer as for example PCU of example only.Select the material property and the size of sleeve 1706, so that realize the expected force/deflection characteristic of deflection post 304 (Figure 17 A).A kind of preferred embodiment in, sleeve is made by PCU, thickness is not 2mm when it is compressed, and it is thick to be compressed to about 1mm by the deflection of post.

As can be seen from Figure 17B, release portion 1720 forms the taper recess sleeve 1706 on the proximal end face of the centre bore 1707 that holds deflection post 304 (not shown).The material of the proximal end face of sleeve 1706 is removed (comparing with the sleeve 306 of Fig. 3 A-3E),, thereby sleeve 1706 can not be fallen between deflection post 304 and collar 1710 (Figure 17 A) for the expansion of sleeve 1706 provides the space.Also sleeve 1706 can be configured as the flexibility that changes sleeve 1706, for example, by additional release portion or cavitation area (referring to the groove among Fig. 3 A 307) are set in the body of sleeve 1706.

Figure 17 C shows the perspective view of alternative sleeve 1706c, and it also has release portion 1720c in the proximal end face of the centre bore 1707c that holds deflection post 304.Release portion 1720c is a curved surface shaped, and this curved surface extends to the flat site 1705c of sleeve 1706c from the periphery of centre bore 1707c, and during assembling, this flat site 1705c engages with collar 1710.In this embodiment, the neighboring of sleeve 1706c is provided with a plurality of scallop 1704c.The degree of depth that these scallop are located at sleeve 1706c near-end (in Figure 17 C for top) is bigger, and successively decreases in the direction towards the far-end (being the bottom in Figure 17 C) of sleeve 1706c.Scallop 1704c is used to make the flexibility/pliability of sleeve 1706 bigger.In sleeve 1706c, scallop makes the near-end of sleeve 1706c bigger than the distal flexible of sleeve 1706c.When the geometry of deflecting bar 1700 caused compression on the sleeve 1706c near-end greater than the compression of sleeve 1706c far-end, this was very favorable.Therefore, the flexible increase of sleeve 1706c near-end is used for balance and is applied to power on the deflection post by the near-end of sleeve 1706c and remote area, thereby allows to distribute more equably in sleeve 1706c load and " merit ".Scallop 1704c also is used to reduce the volume of the material of sleeve 1706c near-end.(Figure 17 a), sleeve 1706c may expand in the hole of being reserved by scallop 1704c, will be fallen into probability between deflection post 304 and collar 1710 thereby further reduced sleeve 1706c in the deflection of deflection post 304.

Figure 17 D shows the perspective view of the alternative sleeve 1706d of another kind.Sleeve 1706d has release portion 1720d in the proximal end face around centre bore 1707d.Release portion 1720d takes the form of the taper recess on the proximal end face of sleeve 1706d.Sleeve 1706d also has a plurality of hole 1704d, and the proximal end face of described a plurality of hole 1704d along the axis that is parallel to centre bore 1707d axis from sleeve 1706d is penetrated into the body of sleeve 1706d.Shown in Figure 17 D, the cross section of hole 1704d is circular.Hole 1704d also can be the cylindrical hole that for example runs through entire sleeve 1706d.Perhaps, hole 1704d can be the cylindrical hole that passes part rather than entire sleeve 1706d.Perhaps, hole 1704d can be the taper hole, and wherein, the size in hole reduces when sleeve 1706d is passed in the hole.The effect in hole is similar to the scallop 1704c of Figure 17 C.For example, hole 1704d is used to increase the flexibility in material/zone of sleeve 1706d, and provides the space for being deflected the sleeve that post 304 pushes wherein, avoids thus being sandwiched in (referring to Figure 17 A) between deflection post 304 and the collar 1710.

Figure 17 E shows the sectional view of another alternative sleeve 1706e.Shown in Figure 17 E, sleeve 1706e is included in intrinsic a plurality of hole 1704e of sleeve 1706e.These holes 1706e goes out towards the outward flange spiral extension of sleeve 1706e from the position near centre bore 1707e.As shown in, hole 1704e is bigger in the outer peripheral position with more materials towards sleeve 1706e.Just as discussed previously, hole 1704e can have different cross sections at the differing heights place of sleeve 1706e.For example, the area that hole 1704e locates at sleeve 1706e near-end (collar 1710 of the most close Figure 17 A) can increase sleeve 1706e has the position of maximum deflection amount at deflection post 304 pliability thus greater than the area of locating at sleeve far-end (keeper 302 of the most close Figure 17 A).The effect of hole 1704e is similar to the scallop 1704c of Figure 17 C.For example, hole 1704e is used to increase the flexibility in material/zone of sleeve 1706e, and provides the space for being deflected the sleeve 1706e that post 304 pushes wherein, avoids thus being sandwiched in (referring to Figure 17 A) between deflection post 304 and the collar 1710.

Sleeve 1706,1706c, 1706d and 1706e show the various alternative structure of the function of the motion that is designed for realizing controlling the deflection post.This sleeve can be attached in any deflecting bar described herein system.Can utilize the different designs and the combination in the release portion that is different from schematic structure and hole to come the pliability of regulating sleeve, and prevent that sleeve is sandwiched between the miscellaneous part of deflection post and deflecting bar system.

Figure 18 A-18D shows another kind of alternative deflecting bar 1800.Figure 18 A shows the exploded view of alternative deflecting bar 1800.Figure 18 B shows the deflecting bar that fits together with the bone anchor.Figure 18 C-18D shows the sectional view of deflecting bar 1800, and shows the deflection of deflecting bar.Shown in Figure 18 A, deflecting bar 1800 comprises four parts: spherical keeper 1802, deflection post 1804, O-shape ring 1806, block 1810.

Deflection post 1804 at one end has keeper 1802.Keeper 1802 is the spherical structure that forms a part with deflection post 1804.The other end at deflection post 1804 is an installing rack 1814.In this embodiment, installing rack 1814 is suitable for being connected on the vertical rod.Can use ball to replace installing rack 1814, just as described earlier.In this embodiment, installing rack 1814 also forms a part with deflection post 1804 and keeper 1802.In other embodiments, deflection post 1804 can be made separately, and securely is attached on one or more in installing rack 1814 and the keeper 1802 by laser weld, soldering or other combination technologies.Perhaps, deflection post 1804 can be made separately, and uses screw thread for example mechanically to engage on one or more in installing rack 1814 and the keeper 1802.For example, can use locking ring, profile of tooth lock washer, split pin or other machinerys that deflection post 1804 is fastened on one or more in installing rack 1814 and the keeper 1802.

Shown in Figure 18 A, installing rack 1814 can be provided with hexagon extension 1815, and it can use when vertical rod being fastened on the installing rack 1814.When on the threaded portion of installing rack 1814, screwing on nut, can control extension 1815 by spanner, rotate to prevent installing rack 1814.Extension 1815 can form a part with installing rack 1814.Groove 1816 between installing rack 1814 and the extension 1815 has reduced the cross section of material, thereby extension 1815 disconnects from installing rack 1814 when reaching the torque of expectation.Like this, just vertical rod can be fastened on the installing rack 1814, remove extension 1815 afterwards.

Deflecting bar 1800 is configured to be installed in the bone anchor 1820, and bone anchor 1820 comprises the nail 1822 that is connected on the housing 1830.Housing 1830 has the cavity 1832 on near-end, and the orientation of this cavity 1832 is defined as along the axis of bone anchor 1820 and is configured for holding deflecting bar 1800.Housing 1830 also has and is suitable for the outer surface 1834 that installing component for example is offset adapter.In some embodiment, housing 1830 can be previously described cylindrical.Shown in Figure 18 A, the outer surface 1834 of housing 1830 is provided with keyway/groove 1836.Keyway/groove 1836 can with and the driver that cooperates of keyway/groove 1836 engage so that implantable bone anchor 1820.

In this embodiment, block 1810 is designed for carrying out multiple function, comprises fastening O-shape ring 1806 and keeper 1802 is fastened in the cavity 1832 of bone anchor 1820.Block 1810 has reduced the complexity of deflecting bar 1800 by integrated collar and telescopic function, and has strengthened the intensity of deflecting bar 1800, or allows to reduce size under identical intensity.Block 1810 comprises the cylindrical jacket portion 1808 that is connected in the collar portion 1809.Block 1810 is designed for cooperating with the hole 1832 of housing 1830.It is a part that sheath portion 1808 and collar portion 1809 are preferably formed, yet they also can be made separately, and after tighten together.Sheath portion 1808 is being processed with screw thread near collar portion 1809 places, so that engage with screwed hole 1832.The block 1810 also chocolate-substituting ground or additionally be attached on the housing 1830, for example pass through laser weld.

O-shape ring 1806 is made by flexible material.O-shape ring 1806 is assemblied in the groove 1805 of outer housing 1808 of block 1810 (referring to Figure 18 C).The cross section of O-shape ring 1806 is circular, but also can take different shapes to change the characteristic of O-shape ring 1806, comprises for example flexible (referring to Fig. 8 E-8G).O-shape ring 1806 has centre bore 1807, and deflection post 1804 can be placed and pass this centre bore 1807.O-shape ring 1806 allows deflection post 1804 with respect to outer housing 1808 motions.The deflection of deflection post 1804 is controlled and limited to O-shape ring 1806 effectively.O-shape ring 1806 is preferably made by the flexible biocompatible polymer as for example PCU of example.Select the material property and the size of O-shape ring 1806, so that realize being used for the expected force/deflection characteristic of deflection post 1804.O-shape ring 1806 can be made by having expectation flexible implantable polymeric flexible and patience.For example, O-shape ring 1806 can be made by polycarbonate polyurethane.A kind of preferred embodiment in, O-shape ring 1806 can be by Bionate

Make.If O-shape ring 1806 comprises Bionate

Polycarbonate polyurethane or other hydrophilic polymers, then O-shape ring 1806 also can be used as the bearing of fluid lubrication.

Referring now to Figure 18 B,, it shows the perspective view of the deflecting bar 1800 that fits together with bone anchor 1820.When assembling, deflection post 1804 is placed in the block 1810, block 1810 is placed in the housing 1830 of bone anchor 1820.At first O-shape ring 1806 (these are not shown) are arranged in the outer housing 1808 of block 1810.Then, deflection post 1804 is settled by O-shape ring 1806 and block 1810.Afterwards, with deflection post 1804, O-shape ring 1806 with block a shot and 1810 be placed in the cavity 1832 of housing 1830.Then, block 1810 is fastened on the screw thread near-end of cavity 1832.Block 1810 has two bases 1811, and described base is used to hold the pin of pin formula spanner so that allow block 1810 to be screwed to housing 1830.Replacedly additionally, block 1810 can be laser-welded on the housing 1830, with secure component after installing.Block 1810 is fastened to deflection post 1804 and O-shape ring 1806 cavity 1832 interior (referring to Figure 18 C) of bone anchor 1820.

Shown in Figure 18 B, deflection post 1804 extends housing 1830 and block 1810, thereby makes installing rack 1814 to be connected on the vertical rod.Deflection post 1804 and block a shot and have the gap between 1810, the scope upper deflecting that it is being scheduled to before allowing deflection post 1804 to contact in its deflection because with block 1810 to be restricted.

Figure 18 C shows the sectional view of the line intercepting that the deflecting bar 1800 that fits together with bone anchor 1820 represents along the line C-C of Figure 18 B.Keeper 1802 is assembled in the hemispherical dimple 1839 in cavity 1832 bottoms of housing 1830.The base of block 1810 comprises the flange 1815 that spherical keeper 1802 is fastened in the hemispherical dimple 1839, allows spherical keeper 1802 to rotate simultaneously.Thus, collar 1809 all is fastened on keeper 1802 and O-shape ring 1806 in the housing 1830.If O-shape ring 1806 comprises Bionate

Polycarbonate polyurethane or other hydrophilic polymers, then O-shape ring 1806 can be used as the bearing of fluid lubrication, and allows deflection post 1804 also to rotate around the longitudinal axis of deflection post 1804 and bone anchor 1820.Other materials and structure also can allow the deflection post to rotate around the longitudinal axis of deflection post and bone anchor.

Shown in Figure 18 C, O-shape ring 1806 occupy deflection post 1804 and 1810 the outer housing 1808 of blocking a shot between the space.O-shape ring 1806 is fastened in the groove 1805 of block 1810.O-shape ring 1806 can be deflected post 1804 and go up in any direction towards the deflection of outer housing 1808 and compress.The cross section of O-shape ring 1806 is circular, and this structure has avoided O-shape ring 1806 to be sandwiched between deflection post 1804 and the outer housing 1808.The circular cross-section of O-shape ring 1806 has reduced the contact area between deflection post 1804 and the O-shape ring 1806, thereby has reduced wearing and tearing.O-shape ring 1806 spaces that can be a bit larger tham between deflection post and groove 1805 bottoms.This just provides prestrain, and it has reduced the delay of the deflection characteristic of deflection post 1800.If O-shape ring is wearing and tearing to some extent in use, this prestrain is also useful to reducing loose generation.

Figure 18 D illustrates the deflection of deflection post 1804.The power that applies on installing rack 1814 can cause deflection post 1804 deflections of deflecting bar 1800.During beginning, deflection post 1804 pivots around the pivotal point of representing with X 1803.Deflection post 1804 can be gone up in any direction around pivotal point 1803 and pivot.Side by side or alternately, deflection post 1804 can rotate around the long axis (it is also by pivotal point 1803) of deflection post 1804.In this embodiment, pivotal point 1803 is positioned at the center of spherical keeper 1802.Shown in Figure 18 D, the material of the deflection of deflection post 1804 compression O-shape ring 1806.O-shape ring 1806 is compressed in the groove 1805.The width of groove 1805 can be a bit larger tham and hold O-shape and encircle 1806 necessary width, but so that makes O-shape ring 1806 axial expansion when being subjected to radial compression.Redundant space in the groove 1805 has reduced that O-shape ring 1806 will be sandwiched in deflection post 1804 and the probability between 1810 inside of blocking a shot.Make the required power of deflection post 1804 deflections depend on deflection post 1804, O-shape ring 1806, groove 1805 and the attribute of the material of the size of 1810 the outer housing 1808 of blocking a shot and O-shape ring 1806.O-shape ring applies the center setback force on deflection post 1804, thus with deflection post 1804 towards pushing back with bone anchor 1820 co-axial positions.

Further after the deflection, deflection post 1804 enters with the restriction face 1813 of collar 1809 and contacts.The side of restriction face 1813 is defined as making that this contact is distributed on certain area, thereby reduces the stress on the deflection post 1804 when deflection post 1804 contacts with restriction face 1813.Deflection post 1804 and restriction face 1813 enter contact after, further deflection needs the distortion (bending) of deflection post 1804.A kind of preferred embodiment in, deflection post 1804 is that diameter is the titanium post of 5mm.Therefore deflection post 1804 rigidity are relatively large, 1810 the required power of deflection post 1804 deflections obviously increased after contacting at deflection post 1804 with blocking a shot.A kind of preferred embodiment in, deflection post 1804 with before restriction face 1813 contacts in any direction upper deflecting 0.5mm to 2mm.More preferably, but deflection post 1804 with the about 1mm of deflection before restriction face 1813 contacts.

In different blocks, block 1810 internal diameter can be different, thereby the distance between restriction face 1813 and the deflection post 1804 is also different in different deflecting bars.This just allows to be manufactured on deflection post 1804 and contacts the deflecting bar that has greater or lesser range of deflection before with restriction face 1813.Like this, just can make deflecting bar with different motion scope.In addition, the distance between restriction face 1813 and the deflection post 1804 need be all not identical on all directions, thereby deflecting bar range of movement in different directions is also different.

Referring to Figure 18 D, when load or power at first were applied on the deflecting bar 1800 by spinal column, the deflection of deflection post approximately caused O-shape to encircle the increase of load in 1806 compression processes in response to the deflection at deflection post 1804 linearly.After the about 1mm of deflection, deflection post 1804 contact restriction faces 1813, the deflecting bar rigidity that obviously becomes is bigger.Need apply bigger load or power on deflecting bar, could obtain the identical deflection increment of realization before this point, this is because further deflection needs the bending of deflection post 1804.In this embodiment, the amount of deflection that is produced by the load that is applied is a nonlinear function.Deflecting bar provides certain range of movement, and in this scope, when deflection increased, the load of being supported increased approximately linearly, and then, along with the increase of deflection, the load of being supported increases (at the deflection post with after restriction face contacts) more apace.Perhaps, if expectation can be designed to make that with this embodiment the rate of change of amount of deflection can all be linear function by for example increasing the distance between restriction face 1813 and the deflection post 1804 in bigger range of movement.

Figure 18 E shows the partial section of O-shape ring 1806.Shown in Figure 18 E, the cross section of O-shape ring 1806 is circular.Circular cross-section helps to reduce the contact area (referring to Figure 18 A-18B) with deflection post 1804.The minimizing of contact can make wearing and tearing also reduce.Yet O-shape ring also can have different shapes.Shown in Figure 18 F, O-shape ring 1856 can have the smooth outward flange 1852 of the groove 1805 that is used for joint cap 1810, still has the curved surface shaped inward flange 1854 that is used to engage deflection post 1804 simultaneously.When every other factor is all identical, the flexibility of the O-shape of this design ring 1856 will be encircled 1806 little than O-shape.Therefore, for identical amount of deflection, O-shape ring 1806 will apply bigger restoring force on deflection post 1804.

Shown in Figure 18 G, also can be by the flexibility that (one or more) hole 1862 changes O-shape ring 1866 is set in O-shape ring 1866.Gas or other fluids can be contained in the hole, and air pressure or hydraulic power/deflection characteristic are provided thus.Just as discussed previously, can O-shape ring be designed to show anisotropic power deflection characteristic by for example making shape or material have anisotropic variation.

Figure 18 H shows another kind of alternative O-shape ring 1876.O-shape ring 1876 has the smooth outward flange 1872 that is used for engaged groove 1805.O-shape ring 1876 has the curved surface shaped inward flange 1874 that is used to engage deflection post 1804.O-shape ring 1876 also has the release portion 1877,1878 of inclination on each side of inward flange 1874, it is used to reduce the contact area between O-shape ring 1876 and the deflection post 1804.

Figure 19 A-19D shows the preferred implementation of the bone anchor that is used for dynamic spine stabilization, and it has the embedded deflecting bar assembly 1900 that is implanted in the bone anchor 1920.Figure 19 A-19D also shows the preferred implementation that is used for the dynamic vertical bar 1950 of deflecting bar assembly 1900 uses.Figure 19 A shows the deflecting bar assembly 1900 that places bone anchor 1920 and the exploded view of dynamic vertical bar 1950.Figure 19 B shows the deflecting bar that fits together with bone anchor and dynamic vertical bar.Figure 19 C-19D shows the sectional view of deflecting bar assembly 1900, and shows the deflection of deflecting bar.Figure 19 E and 19F show the enlarged drawing of the parts of deflecting bar assembly 1900.

Referring now to Figure 19 A,, in this embodiment, deflecting bar assembly 1900 comprises four parts: spherical keeper 1902, deflection post 1904, O-shape ring 1906, block 1910.Keeper 1902 and deflection post 1904 have formed ball rod 1960 shown in Figure 19 B, that will discuss here.Deflecting bar assembly 1900 is configured to be installed in the bone anchor 1920, and bone anchor 1920 comprises the nail 1922 that is connected on the housing 1930.Housing 1930 also has the cavity 1932 on near-end, and the orientation of this cavity 1932 is defined as along the axis of bone anchor 1920 and is configured for holding deflecting bar assembly 1900.In this embodiment, with respect to the bone anchor 1820 of Figure 18 A, housing 1930 is by truncate.Housing 1930 and bone anchor 1920 preferably become a part by titanium or titanium alloys.

Deflection post 1904 at one end has keeper 1902.Keeper 1902 is the spherical junctions member that forms a part with deflecting bar 1904.The other end at deflection post 1904 is an installing rack 1914.Shown in Figure 19 A, installing rack 1914 is the low-profile installing racks that are configured to be assemblied in the ball-and-socket joint 1940 of vertical rod parts.Installing rack 1914 is configured to be fastened on the vertical rod parts of spinal column, and comprises that the vertical rod parts can be fastened to the thread cylinder on it.Can use the ball of one to replace installing rack 1914, just as described earlier.Installing rack 1914 comprises plug-in type hexagon extension 1912, and it can use tool engagement so that keep installing rack 1914 in being attached to the process of vertical rod.Near-end at plug-in type hexagon extension is the structure that is used for instrument that hexagon extension 1912 is fastened on, and described instrument is joint 1918 in this embodiment.A kind of preferred embodiment in, installing rack 1914, deflection post 1904, keeper 1902, hexagon extension 1912 and joint 1918 are made a part by the cochrome material, thereby the wearing character of improvement is provided.Perhaps, titanium or titanium alloy can use separately or use with the cochrome coating.The assembly of installing rack 1914, deflection post 1904 and keeper 1902 can be called ball rod 1960.

Figure 19 G shows the enlarged perspective of ball rod 1960.Referring to Figure 19 G, ball rod 1960 forms a part by four major parts, begins them from far-end and is: spherical keeper 1902, deflection post 1904, installing rack 1914 and hexagon extension 1912.Should be noted that hexagon extension 1912 also is included in the joint 1918 on the most proximal end.Hexagon extension 1915 is the breakaway-element parts, and joint 1918 allows hexagon extension 1912 to come fastening by instrument when disconnecting.Hexagon extension 1912 is a groove 1916 with the position that installing rack 1914 joins.Groove 1916 has reduced the diameter of ball rod 1960, thus in the attach procedure of vertical rod when reaching the level of torque of expectation hexagon extension 1912 disconnect from installing rack 1914.Disconnecting torque is determined by the diameter and the material behavior of surplus material.A kind of preferred embodiment in, disconnect torque value and be approximately 30 Foot-Pounds.Like this, hexagon extension 1912 breaks and is removed at implantation process.If desired installing rack 1914 is removed from vertical rod, then must control other zones of ball rod 1960.Therefore, the position of deflection post 1904 next-door neighbour's installing racks 1914 is provided with par 1917.Par 1917 allow ball rods 1960 hexagon extension 1912 removed the back by tool engagement so that remove vertical rod.

Refer again to Figure 19 A, in this embodiment, block 1910 is designed for carrying out multiple function, comprises fastening O-shape ring 1906 and keeper 1902 is fastened in the cavity 1932 of bone anchor 1920.Block 1910 is also greater than the block 1810 of Figure 18 A.In the embodiment of Figure 19 A, block 1910 comprises the outer surface 1934 with keyway/groove 1936 of discussing below, and it is suitable for installing component and for example is offset adapter.In some embodiment, housing 1930 can be cylindrical, as what describe earlier.Shown in Figure 19 A, the outer surface 1934 of housing 1930 is provided with keyway/groove 1936.Keyway/groove 1936 can be by cooperating with keyway/groove 1936 so that the driver of implantable bone anchor 1920 engages.Block 1910 has reduced the complexity of deflecting bar assembly 1900 by integrated collar and telescopic function, and has strengthened the intensity of deflecting bar assembly 1900, or allows to reduce size under identical intensity.Block 1910 preferably becomes a part by titanium or titanium alloys.

Shown in Figure 19 A, block 1910 comprises the cylindrical jacket portion 1908 that is connected in the collar portion 1909.Block 1910 is designed for cooperating with the cavity 1932 of housing 1930.Sheath portion 1908 is being processed with screw thread near on the position of collar portion 1909, so that engage with the screwed hole 1932 of housing 1930.The far-end of sheath portion 1908 comprises and is used for ball 1902 is fastened on flange 1911 in the housing 1930.Figure 19 E shows partial cross section's detail drawing of block 1910.Shown in Figure 19 E, have curved surface at the flange 1911 of cylindrical jacket portion 1908 far-ends, its diameter is identical with the radius of curvature of ball 1902.The curved surface of flange 1911 combines with dimple 1932 in the housing 1930 and has formed spherical receptacle, and this spherical receptacle falls in the mode that allows ball 1902 and pivot and rotate and makes ball 1902.It in the centre-drilling hole of block 1910 circumferential grooves 1905 that is designed for keeping O-shape ring 1906.Groove 1905 cuts out in the inside of collar portion 1909.Far-end in collar portion 1909 is a restriction face 1913.Groove 1905 is configured as is used to support O-shape ring 1906, reduces and reduces the creep in time of O-shape ring the wearing and tearing of O-shape ring 1906.In this embodiment, groove 1905 has the square-section.

Refer again to Figure 19 A, O-shape ring 1906 is assemblied in and is in deflection post 1904 in the outer housing 1908 of block 1910 and blocks a shot between 1910.A kind of preferred embodiment in, O-shape ring 1906 is the ring of square sectional with fillet.O-shape ring 1906 has circular centre bore 1907.Hole 1907 is slightly smaller than the diameter of deflection post 1904, so that some prestrains are provided on assembly.Figure 19 F shows partial cross section's detail drawing of O-shape ring 1906.Figure 19 E shows the O-shape ring 1906 in the tram of the circumferential grooves 1905 of block 1910.It should be noted that the internal drilling diameter of the external diameter of O-shape ring 1906 greater than outer housing 1908/ block 1910.Therefore, O-shape ring 1906 is compressed in assembling process and expands in groove 1905, thereby is kept by groove 1905.It should be noted that the diameter of the internal diameter in hole 1907 equally, thereby O-shape ring 1906 is projected into around the boring of deflection post 1904 (referring to Figure 19 C and 19D) from groove 1905 less than the boring of outer housing 1908.O-shape ring 1906 is formed by the flexible member of the deflection compression that is deflected post 1904.A kind of preferred embodiment in, O-shape ring 1906 is by polycarbonate polyurethane (Bionate

55D or 80A) make.But also can use the polymer of other biological compatibility with suitable flexibility and durability.This material further is disclosed in the U.S. Patent No. 5 of authorizing on July 28th, 1992,133, on July 20th, 742 and 1993 authorized, name is called the U.S. Patent No. 5 of " Crack-Resistant Polycarbonate Urethane Polymer Prosthesis and the Like ", in 229,431.O-shape among Figure 19 F ring 1906 has flattened side and the preferable shape of the rounded corners of transition between flattened side.Flattened side allows O-shape ring more securely to be assemblied in the groove 1905, applies thereon load thereby distribute more equably by ball rod 1960, so that reduce wearing and tearing, creep and the distortion of O-shape ring.One of them reason with these advantages is, flattened side make with block 1910 in the contact surface of groove 1905 bigger, and also bigger with the contact surface of ball rod 1960.

Figure 19 A also shows the preferred implementation that is used for the dynamic vertical bar 1950 of deflecting bar assembly 1900 uses.Dynamic vertical bar 1950 comprises ball 1944 and seat ring 1946.Ball 1944 is made by cochrome, to realize better polishing machine.Ball 1944 also can be made by titanium with cochrome coating or titanium alloy.Ball 1944 has and is designed for the centre bore 1945 that is fastened on the installing rack 1914.Centre bore 1945 is processed with screw thread so that ball 1944 is securable on the screw thread of installing rack 1914.Centre bore 1945 also has the cellular type hexagon base 1947 that can cooperate with spanner, can ball 1944 be screwed on the end of thread of installing rack 1914 by this base.Ball 1944 is contained in the spherical receptacle 1942 in vertical rod 1950 ends.Ball 1944 is fastened in the spherical receptacle 1942 by seat ring 1946.Seat ring 1946 is fastened on the vertical rod 1950 by for example screw thread and/or laser weld.When fastening, ball 1944 can rotate in spherical receptacle 1942 and pivot.Advantageously, do not extend beyond the nut of ball 1944, thereby reduced the profile of the connection between installing rack 1914 and the vertical rod 1950.In other words, ball 1944 is as the nut of himself, so that ball 1944 is fastened on the installing rack 1914.Ball-and-socket joint 1940 allows bigger range of movement, and reduce the dynamic stability assembly and the distorting stress on the attached skeleton.

Referring now to Figure 19 B,, it shows the perspective view of the deflecting bar assembly 1900 that fits together with the bone anchor 1920 with nail 1922.When fitting together, deflection post 1904 is placed in the block 1910, and block 1910 is placed in the housing 1930 of bone anchor 1920.O-shape ring 1906 (cannot see among this figure) at first are placed in the outer housing 1908 of block 1910.Be compressed and expand in the process of O-shape ring 1906 in being introduced in block 1910 in the groove 1905 in the block 1906 (referring to Figure 19 C and 19D).Use axle to prevent to damage O-shape ring 1906 during insertion.Then, deflection post 1904 settled pass O-shape ring 1906 and block 1910, wherein, make installing rack 1914 from blocking a shot 1910 proximal extension.Then, with deflection post 1904, O-shape ring 1906 with block a shot and 1910 be placed in the cavity 1932 of housing 1930.To block a shot subsequently and 1910 be fastened on the screw thread near-end of cavity 1932.Alternately or additionally, after the installation, block 1910 can be laser-welded on the housing 1930, so that secure component.Block 1910 is fastened to deflection post 1904 and O-shape ring 1906 cavity 1932 interior (referring to Figure 19 C and 19D) of bone anchor 1920.Deflection post 1904 stretches out from housing 1930 and block 1910, thereby installing rack 1914 can be used for being connected on the vertical rod 1950.

Before implanting, deflecting bar assembly 1900 and bone anchor 1920 are assembled, before attached dynamic vertical bar or other rods, it is implanted in the skeleton then.Can use specific purpose tool to come joint cap 1910 (referring to Figure 20 A-20D) during implantation.Block 1910 has by the spanner joint to allow to block a shot 1910 surface textures 1936 that are screwed on the housing 1930.For example, block 1910 can be hexagon or octagonal, or can have keyway and/or groove and/or other registration structure on surface 1934.

Figure 19 B also shows the perspective view of the dynamic vertical bar 1950 that is fastened on the deflecting bar assembly 1900.By ball 1944 is placed in the dimple 1942 of bar 1950, assemble dynamic vertical bar 1950.Then, by screw thread and/or laser weld seat ring 1946 is fastened in the dimple 1942.After the assembling, ball 1944 can freely pivot with respect to the spherical receptacle of dynamic vertical bar 1950 and rotate.Can centre bore 1945 be set at the arbitrary end of dimple 1942, be used for the attached of deflection post 1904.For dynamic deflecting bar assembly 1950 is attached on the deflection post 1904, ball 1944 is screwed on the screw thread of installing rack 1914, and is screwed to position (referring to Figure 21 A-21D) with specific purpose tool.So that when locking onto ball 1944 on the installing rack 1914, hexagon extension 1912 disconnects, and removes hexagon extension 1912 afterwards when applying enough torques.

Figure 19 C shows the sectional view of the axis intercepting that the deflecting bar assembly 1900 that fits together with bone anchor 1920 represents along the line C-C of Figure 19 B.Keeper 1902 is assembled in the hemispherical dimple 1939 in the bottom of the cavity 1932 of housing 1930.The base of block 1910 comprises the curved surface flange 1911 that spherical keeper 1902 is fastened in the hemispherical dimple 1939, allows spherical keeper 1902 to rotate simultaneously.Shown in Figure 19 C, O-shape ring 1906 occupied deflection post 1904 and 1910 the outer housing 1908 of blocking a shot between the space.O-shape ring 1906 is fastened in the groove 1905 of block 1910.Block 1910 all is fastened on keeper 1902 and O-shape ring 1906 in the housing 1930 thus.O-shape ring 1906 can be deflected post 1904 and go up in any direction towards the deflection of outer housing 1908 and compress.Deflection post 1904 is blocked a shot can pivot in any direction around spherical keeper 1902 before 1910 in contact and is reached 1mm (being approximately 3 degree in preferred embodiment).The approximate altitude on skeleton surface when dotted line 1937 shows bone anchor 1920 implantation with nail 1922.A kind of preferred embodiment in, the expression distance H of installing rack 1914 (and then dynamic vertical bar 1950) in the skeleton surface is 16mm.Be illustrated in equally among Figure 19 C is dynamic vertical bar 1950.By ball 1944 being fastened on the installing rack 1914 and the dynamic vertical bar is fastened on the deflection post 1904.

Figure 19 D shows the deflection of deflection post 1904.On installing rack 1914, apply deflection post 1904 deflections that power causes deflecting bar assembly 1900 by vertical rod 1950 and ball-and-socket joint 1940.During beginning, deflection post 1904 pivots around the pivotal point of representing with X 1903.Deflection post 1904 can be gone up in any direction around pivotal point 1903 and pivot.Side by side or alternately, deflection post 1904 can rotate around the long axis (it is also by pivotal point 1903) of deflection post 1904.In this embodiment, pivotal point 1903 is positioned at the center of spherical keeper 1902.Shown in Figure 19 D, the material of the deflection of deflection post 1904 compression O-shape ring 1906.O-shape ring 1906 is compressed in the groove 1905.The width of groove 1905 can be a bit larger tham and hold O-shape and encircle 1906 necessary width, so that make the O-shape ring 1906 can axial expansion by radial compression the time.Redundant space in the groove 1905 has reduced that O-shape ring 1906 will be sandwiched in deflection post 1904 and the probability between 1910 inside of blocking a shot.Make the required power of deflection post 1904 deflections depend on deflection post 1904, O-shape ring 1906, groove 1905 and the attribute of the material of the size of 1910 the outer housing 1908 of blocking a shot and O-shape ring 1906.O-shape ring 1906 has applied the center setback force on deflection post 1904, thus with deflection post 1904 towards pushing back with bone anchor 1920 co-axial positions.It should be noted that the existence owing to ball-and-socket joint 1940, vertical rod 1950 also can pivot with respect to deflection post 1904, and rotates with respect to deflection post 1904, and can not compress O-shape ring 1906.

Further after the deflection, deflection post 1904 enters with the restriction face 1913 of the collar portion 1909 of block 1910 and contacts.The orientation of restriction face 1913 is defined as when deflection post 1904 contacts with restriction face 1913, and this contact is distributed on certain area, to reduce the stress on the deflection post 1904.With after restriction face 1913 contacts, further deflection needs the distortion (bending) of deflection post 1904 at deflection post 1904.A kind of preferred embodiment in, deflection post 1904 is that diameter is the titanium post of 5mm.Therefore deflection post 1904 relative rigidityes are bigger, 1910 the required power of deflection post 1904 deflections obviously increased after contacting at deflection post 1904 with blocking a shot.A kind of preferred embodiment in, deflection post 1904 with before restriction face 1913 contacts in any direction upper deflecting 0.5mm to 2mm.More preferably, but deflection post 1904 with the about 1mm of deflection before restriction face 1913 contacts.

Implant and assembling tool

Figure 20 A-20D shows each step that the dynamic stability assembly was implanted and be connected to the embodiment that utilizes dynamic bone anchor described herein and dynamic vertical bar with 21A-21F.Preferably implant and assemble, therefore provide instrument to be convenient to install and assemble by intubate in the mode of invasive minimum.These instruments also can be used for opening procedure.A kind of proper method for lumbar spine invasive minimum is (paraspinal intermuscular) method between the flesh of the other position of spinal column.This method is disclosed in for example " The Paraspinal Sacraspinalis-Spliting Approach to the Lumber Spine " (The Journal of Bone ﹠amp of people such as Leon L.Wiltse; Joint Surgery, Vol.50-A, No.5, July nineteen sixty-eight) in.Usually, the patient is positioned to prostrate.Cut in vertebra back that will be stable.Open the backing strip film, separate the muscle of the other position of spinal column, with pleurapophysis and little joint (the facet joint) that exposes vertebra.When the selected assembly of needs, will be placed in the vertebra according to dynamic bone anchor and traditional pedicle screw (pedicle screw) of embodiment of the present invention.Screw placement is become to be lateral to little joint, and tilt towards vertebral body.Then, will be inserted in according to the dynamic bar of embodiment of the present invention near according near the tram dynamic bone anchor, screw and the traditional pedicle screw of embodiment of the present invention.Afterwards, will be fastened to according to the ball of the dynamic bar of embodiment of the present invention on the deflection post according to the dynamic bone anchor of embodiment of the present invention, be connected on the conventional screw with the interpediculate distance of expectation the other end subsequently dynamic bar.Can use implanting instrument described below (Figure 20 A-20D) and fastening means (Figure 21 A-21F) to be convenient to the implantation of dynamic bone anchor and being connected of dynamic bar.

Figure 20 A shows the perspective view of employed implanting instrument 2050 when implanting dynamic bone anchor 2000.Dynamically bone anchor 2000 can be the assembly of the deflecting bar assembly 1900 shown in Figure 19 B and bone anchor 1920 for example.Implanting instrument 2050 comprises the interior axle 2060 that is contained in the tubular sleeve 2070.Interior axle 2060 freely rotates in sleeve 2070.Also can make the sleeve 2070 near-end slip of axle 2060 inwardly by pulling on handle part 2074.Disc spring 2072 is connected between sleeve 2070 and the interior axle 2060, so that sleeve 2070 is remained in its position far away with respect to axle 2060.The length of implanting instrument 2050 and diameter are chosen as permission pass intubate with the surgical technic of minimally-invasive and use, thereby reduced, shortened patient's restore cycle, improved surgical effect near the disorganization implantation position.

Refer again to Figure 20 A, axle 2060 has rapid release installing rack 2062 at near-end, axle 2060 in the handle (not shown) can be attached to and be used to rotate on this rapid release installing rack 2062.The suitable handle that is used to be attached on the axle 2060 comprises ratchet handle, torque sensing handle and torque limit handle.In alternative embodiment, handle can permanently be connected to axle 2062 near-end or integrally formed with described near-end.Interior axle has head 2064 at far-end.Head 2064 is used to engage the also device of fastening dynamic bone anchor 2000 during being included in implantation, and is as mentioned below.

Shown in Figure 20 A, head 2064 can be contained on the near-end of dynamic bone anchor 2000 equally, and wherein, ball rod 2006 is contained in the axle 2060 (referring to dotted line).During use, dynamic bone anchor 2000 is inserted in the head 2064 of axle 2060, block 2010 is engaged by head 2064, and ball rod 2006 is fastened in the head 2064.Like this, dynamic bone anchor 2000 is fastened on the implanting instrument 2050.Dynamically bone anchor 2000 will can not be released, unless and up to surgeon's past pulling back on handle part 2074.Like this, just dynamic bone anchor 2000 and implanting instrument implantation position in the spinal column be can be inserted into as a unit by intubate, thereby the arrangement and the implantation of dynamic bone anchor 2000 are convenient to.

Figure 20 B shows the detailed sectional view of head 2064 when dynamically bone anchor 2000 engages of the implanting instrument 2050 of Figure 20 A.Shown in Figure 20 B, head 2064 comprises the base 2065 that is used to hold and engage the block 2010 of dynamic bone anchor 2000.Base 2065 is designed for 2010 cooperating with blocking a shot, so that the thread handle 2020 of dynamic bone anchor 2000 is rotated.Therefore, the inside of base 2065 can be hexagon, octagonal or be provided with groove/keyway etc. that this depends on the concrete structure of block 2010.Base 2065 should be able to apply enough big torque on block 2010, so that dynamic bone anchor 2000 is implanted in the pedicle of vertebral arch.

Refer again to Figure 20 B, head 2064 also comprises the boring 2065 of the ball rod 2006 that is used to hold dynamic bone anchor.Shown in Figure 20 B, ball rod 2006 is included in the joint 2018 of near-end.Ball 2052 is placed in the boring 2067, and this boring is passed from the outside of axle 2060 and intersected with boring 2065 near joint 2018.Ball 2052 is held in place by sleeve 2070, and in this position, ball 2052 is projected in the boring 2065, thereby joint 2052 is fallen in boring 2065.A kind of preferred embodiment in, three this balls are arranged, yet, in this sectional view, only show one.Therefore, by the interaction of joint 2018 and (one or more) ball 2052, block 2010 is contained in the base 2065, and dynamically bone anchor 2000 locks onto on the implanting instrument 2050.

Figure 20 C shows the detailed sectional view of head 2064 of the implanting instrument 2050 of Figure 20 A that is configured to discharge dynamic bone anchor 2000.Implant after the dynamic bone anchor 2000, must remove implanting instrument 2050.First step is with respect to axle 2060 sliding sleeve 2070 closely, as shown by arrow A.This is (shown in Figure 20 A) that realizes toward pulling back on handle part 2074 by the power that overcomes spring 2072.When sleeve 2060 was furthered, (one or more) ball 2052 entered having than in large diameter that part of of sleeve 2060.(one or more) ball 2052 can move apart by ramp 2065 time and the engaging of ball rod 2006, thus releasing-joint 2018.At this moment, axle 2060 and sleeve 2070 can be pulled away from dynamic bone anchor 2000 together.

Figure 20 D shows the transverse view of lumbar spine, and it illustrates the implanting instrument 2050 that uses Figure 20 A dynamic bone anchor 2000 is implanted in the pedicle of vertebral arch 2082 according to the lumbar vertebra 2084 of embodiment of the present invention.Shown in Figure 20 D, implanting instrument 2050 can and be implanted dynamic bone anchor with the program of minimally-invasive by intubate 2080 uses.Intubate 2080 is introduced in patient's bodies, so as at the rear portion near pedicle of vertebral arch.The pedicle of vertebral arch 2082 of exposing vertebra 2084 in a conventional manner.Then, pass pedicle of vertebral arch 2082 and in the vertebral body 2083 of vertebra, bore a hole 2086.Next, select to have the dynamic bone anchor 2000 of appropriate length, diameter, and select power/deflection characteristic of being used to implant.The block 2010 of selected dynamic bone anchor 2000 is inserted in the head 2064 of implanting instrument 2050, and it is fastening on the throne.

Referring now to the left side of Figure 20 D,, dynamic bone anchor 2000 and implanting instrument 2050 are inserted into implantation position as an assembly by intubate 2080.Afterwards, the handle 2088 that rotates on the rapid release spare that is attached on axle 2060 near-ends is implanted dynamic bone anchor.Drive dynamic bone anchor 2000 and enter into hole 2086, be in up to housing on the surface of vertebra 2084 (referring to arrow 2090).The torque that drives dynamic bone anchor 2000 is the block 2010 that is offered dynamic bone anchor 2000 by handle 2088 by axle 2060.

Referring now to the right side of Figure 20 D,, when dynamic bone anchor 2000 is settled in pedicle of vertebral arch 2082 when putting in place, the power that the doctor overcomes spring 2072 on handle part 2074 toward pulling back.Sleeve 2070 closely moves with respect to axle 2060.Axle 2060 is released in controlling on the dynamic bone anchor 2000, and therefore axle 2060 and sleeve 2070 all move apart intubate 2080 and leave patient's (referring to arrow 2092).Now, dynamically bone anchor 2000 has correctly been implanted and has been ready for and has been attached to rods and/or other spinal stabilization component parts.

Figure 21 A-21D shows the view that is used for dynamic vertical bar 2100 is fastened to the attaching tool on the dynamic bone anchor 2000 according to embodiment of the present invention.Figure 21 A shows the perspective view that is used for dynamic vertical bar 2100 is attached to the attaching tool 2150 on the dynamic bone anchor 2000 (shown in Figure 21 C) according to embodiment of the present invention.Dynamic vertical bar 2100 can be the dynamic vertical bar 1950 of for example Figure 19 B.Dynamically bone anchor 2000 can be the assembly of the deflecting bar assembly 1900 shown in Figure 19 B and bone anchor 1920 for example.

At first referring to Figure 21 A, attaching tool 2150 comprises the interior axle 2160 that is contained in the tubular sleeve 2170.The length of attaching tool 2150 and diameter are chosen as permission use by intubate, reduce thus, shorten patient's restore cycle, strengthen surgical effect near the disorganization implantation position with the surgical technic of minimally-invasive.Interior axle 2160 freely rotates in sleeve 2170 and slides.In axle 2160 have attached handle 2162 at near-end.In alternative embodiment, axle 2160 can have handle can be attached to accessory on it, for example, and ratchet handle, torque sensing handle and torque limit handle.Interior axle has head 2164 at far-end, and it is used to engage the also hexagon extension (referring to Figure 21 B) of fastening dynamic vertical bar 2100.

Refer again to Figure 21 A, sleeve 2170 is included in the butterfly handle part 2174 on its near-end.Sleeve 2170 is used to engage and the device of the cellular type hexagon base of the ball of fastening dynamic vertical bar 2100 when being connected to dynamic bone anchor having on its far-end, and is as described below.A kind of preferred embodiment in, head 2164 comprises the plug-in type hexagon accessory 2172 with centre bore 2173.Figure 21 B shows the enlarged drawing of the head of seeing from attaching tool 2,150 2164.Figure 21 B shows the plug-in type hexagon accessory 2172 with centre bore 2173.By centre bore 2173, can see the cellular type hexagon base 2165 of head 2164.Be projected in the cellular type hexagon base 2165 is two spring leafs 2167.

Figure 21 C and 21D show the detailed sectional view of attaching tool 2150 far-ends that are associated with dynamic vertical bar 2100 and dynamic bone anchor 2000.At first referring to Figure 21 C, it shows and the dynamic vertical bar 2100 and the dynamic detailed sectional view of the far-end of the attaching tool 2150 of 2000 that engage, Figure 21 A of bone anchor.Shown in Figure 21 C, the plug-in type hexagon accessory 2172 of the head 2164 of outer sleeve 2170 is assembled in the cellular type hexagon base of ball 2144.Simultaneously, the hexagon extension 2115 of ball rod 2006 is contained in the cellular type hexagon base 2165 of interior axle 2160.After engaging like this, with respect to butterfly grip part 2174 (referring to Figure 21 A) swing handle 2162, just can be with respect to ball 2144 roating sphere head rods 2006.Attaching tool 2150 is designed to apply enough big torque with respect to ball 2144 on ball rod 2006, so that ball rod 2006 is fastened on the ball 2144, and the hexagon extension 2115 of disconnection ball rod 2006.A kind of preferred embodiment in, attaching tool 2150 should be able to provide the torque greater than 30 Foot-Pounds.

Figure 21 D shows after the hexagon extension 2115 of ball rod 2006 disconnects, the detailed sectional view of the far-end of the attaching tool 2150 of Figure 21 A.Shown in Figure 21 D, after ball 2144 had been tightened on the ball rod 2006, the fin 2167 on the centre bore 2173 engaged the either side of the joint 2118 of hexagon extension 2115, so that hexagon extension 2115 is fastened in the cellular type hexagon base 2165.Like this, when hexagon extension 2115 disconnects, can use fastening means 2150 that it is removed in patient's body as shown in the figure.

Figure 21 E-21H is the side view of lumbar spine, and it illustrates the attaching tool that uses Figure 21 A according to embodiment of the present invention dynamic vertical bar 2100 is attached to step on the dynamic bone anchor 2000.Shown in Figure 21 E, after dynamically bone anchor 2000 and multi-axial screws 2140 have been implanted, dynamic vertical bar 2100 is implanted.Dynamic vertical bar 2100 is forwardly implanted on the direction-preferably in the mode of minimally-invasive, near dynamic vertical bar 2100 has been positioned at dynamic bone anchor 2000 and multi-axial screws 2140.Then, the hexagon extension 2115 of dynamic bone anchor 2000 is presented ball 2144 by dynamic vertical bar 2100.

Next, shown in Figure 21 F, fastening means 2150 is inserted through intubate 2080 so that engage ball 2144 and hexagon extension 2155.Then, with respect to 2115 roating spheres 2144 of hexagon extension, be fastened to fully on the ball rod 2006 up to it.When ball 2144 is fastened on the ball rod 2006 fully, further applies torque and fracture up to hexagon extension 2115 (not shown).A kind of preferred embodiment in, this needs the torque of 30 inchpounds, and is enough to ball 2144 is locked onto on the ball rod 2006.Next, shown in Figure 21 G, fastening means 2150 can be removed from intubate 2080.Just as discussed previously, hexagon extension 2115 (not shown) are remained in the attaching tool 2150, remove in patient's body with convenient.Shown in Figure 21 H, afterwards conventional tool 2184 is inserted through intubate 2180, with operation multi-axial screws 2140, thus the other end of fastening dynamic vertical bar 2100.

The normal anatomical motion that keeps spinal column

Figure 22 A is the side view of lumbar spine, shows the natural motion of spinal column when stretching with bending.Show last vertebra 2200 (for example L4) with respect to following vertebra 2210 (for example L5).The basic load supporting structure is vertebral body 2202 and 2102.It between the vertebral body intervertebral disc 2220.The back of vertebral body is pedicle of vertebral arch 2204,2214, little joint 2206,2216 and spinous process 2208,2218.Be ligament between the spinous process, be called ligamenta intervertebralia 2222 again.In the lumbar spine of health, significantly stretch in the lumbar region and bending be possible-overall crooked general 35 spend on whole lumbar region.When rachiocamposis and stretching, extension, vertebra relative to each other moves, and the alignment that keeps vertebral body simultaneously is to support the weight of upper body.

Between stretching, extension and bending, epipyramis 2200 can be with respect to the angle or the scopes of about 15 degree of following vertebra 2210 motions.In healthy spine, the natural center of rotation 2224 of this rotation is positioned at intervertebral disc 2220.Rotation around natural center of rotation 2224 causes the prolongation of ligamenta intervertebralia 2222 and the slight separation in little joint 2206,2216.Yet this rotational motion can not take place separately.Healthy spine has represented a kind of coupled phenomenon that is called, wherein, around or along an axis or planar rotation or translation with around or to move along second axis or planar another kind be consistent related.Dotted line 2200a shows the position of the epipyramis in the bending.Just as can be seen, when crooked, epipyramis 2200 not only rotates around natural center of rotation 2224, and it also does anterior and translation dorsad simultaneously.Therefore, normal crooked also can owing to upwards and the aggregate motion of translation forward cause increasing between the pedicle of vertebral arch 2204,2214 up to the about distance of 8mm.Be caught and can realize this stretching and separating of little joint by ligamenta intervertebralia.Similarly, the rotation to axial of the lateral thrust of spinal column and vertebra coupling.

Along with the growth at age, the vertebral body of spinal column and intervertebral disc can be degenerated.This spinal degeneration has reduced the load bearing ability of spinal column, produces pain, reduces range of movement, and can cause compensatory bone growth.This bone growth can cause range of movement further to reduce and spinal stenosis, wherein, blood vessel and nerve that the skeleton compression is passed through along spinal column, thus inflammation and more pain produced.A large amount of spinal prostheses has been proposed, to be used to keep or recover the load bearing ability of spinal column, reduce unstability, behind disc removal, help eliminate pain, jack-up on vertebra merges or degenerative disc down, and/or when not merging the support degenerative disc.The basic purpose of this prosthese is load distribution and stabilizing spine, so that the problems referred to above are remedied and reduced pain.Unfortunately, spinal column is a kind of very complicated structure, therefore be difficult to be provided for load distributes and stable, can not change the prosthese of spinal column natural motion simultaneously, thereby cause additional artificial consequence, unstability, further degenerate to cause spinal column.

Figure 22 B is the side view of lumbar spine, shows when stretching with bending and is applied to epispinal motion restriction by the rigidity spinal rod system.Figure 22 B shows pedicle screw 2230 that is implanted in the epipyramis 2200 and the pedicle screw 2232 that is implanted in down in the vertebra 2210.These pedicle screws connect by rigid vertical bar 2234.Vertical rod 2234 and screw form theoretic rigid system.Vertical rod thereby a part of load is delivered to down vertebra 2210 from epipyramis 2200 has reduced the load on vertebral body 2202,2212 and the intervertebral disc 2220 thus.

Yet rigid prosthesis shortcoming is that relatively rotating of vertebra is limited shown in Figure 22 B, and interpedicular distance is fixed.During rachiocamposis, some rotation is to realize by being connected between the bending of vertical rod 2234 and vertical rod 2234 and pedicle screw 2230 and 2232.Yet because interpedicular distance remains substantially stationary, so ligamenta intervertebralia 2222 can not prolong, and center of rotation 2236 must move to the rear part edge of intervertebral disc or even farther to the rear portion from natural center of rotation is obvious.Dotted line 2200b shows the relative motion of epipyramis 2200.In addition, the separation in not only little joint is stoped, and in fact also these little joints can be shifted onto together around the bending of new center of rotation, thereby has increased the load in little joint 2206,2216.Prosthese has also been interfered the normal coupling of spinal column by the translation that the rotation with in the natural torsion of eliminating and/or limit epipyramis is associated.In addition, the bending of vertical rod has applied very big strain on interface between pedicle screw and the pedicle screw 2230,2232 and skeleton, and this can cause equipment failure, screw to be deviate from or damage pedicle of vertebral arch.In addition, the motion in the segmentation of restriction spinal column is considered to and can produces additional stress in adjacent segmentation, therefore can quicken the sectional degeneration of those spinal columns (adjacent level disease).

In order to overcome the problem that the rigidity spinal prostheses produces, dynamic spinal is stablized anatomical motion and the moving-mass that prosthese is attempted preservation spinal.Ideal prosthese should be able to keep the stability of internode, and the suitable exercise on the permission spinal column segment, the lateral thrusts of the flexion/extension of for example about 15 degree, about 2 axial rotation of spending, about 6 degree and the relative translation of vertebra, approximately L-R deflection, approximately rising (separation) and/or the approximately back of the body of the 2mm-abdomen transfer of 2mm of 2mm.Ideal prosthese also should allow the complex combination of these motions, and the coupling that allows the spinal column on the anatomy to show.This prosthese should be able to keep these required motions of normal spinal function, the load distribution is provided simultaneously and unusual load can not occur and distribute, and provide spinal column sectional stability, comprises the motion that restriction exceeds anatomy desired limits value.

Figure 22 C and 22D show the motor pattern of stablizing prosthese according to the dynamic spinal of dynamic bone anchor of embodiment of the present invention utilization and dynamic vertical bar.Figure 22 D and 22D show the motor pattern with dynamic vertical bar 2250 bonded dynamic bone anchors 2240.Dynamically bone anchor 2240 comprises ball rod 2242, and this ball rod 2242 pivots with respect to threaded anchoring piece 2246 around the ball 2244 of far-end.Ball rod 2242 is connected on the ball 2254 of dynamic vertical bar 2250 at its near-end.Deflecting bar 2242 is subjected to the control of the compression of flexible ring 2245 with respect to the deflection of the threaded anchoring piece 2246 of dynamic bone anchor 2240, and is subjected to the restriction of the hard contact surface on block 2248 near-ends.These three kinds of connectors---vertical rod 2250, ball rod 2242 and threaded anchoring piece 2246---and two ball-and- socket joints 2244,2254 are connected in series, and therefore, the motion of these connectors is capable of being combined so that the motor pattern of complicated scope to be provided.

Figure 22 C shows the motor pattern of ball rod 2242 with respect to dynamic vertical bar 2250, supposes that the inside of dynamic bone anchor 2240 does not have motion.Shown in Figure 22 C, the ball 2254 of ball rod 2242 moving attitude vertical rods 2250 pivots and rotates.Ball rod 2242 (and threaded anchoring piece 2246) can be from 15 degree that pivot in any direction perpendicular to dynamic vertical bar 2250, and shown in arrow 2260, its total range of movement is 30 degree.Ball rod 2242 (and threaded anchoring piece 2246) also can rotate 360 degree with respect to dynamic vertical bar 2250, shown in arrow 2262.

Figure 22 D shows the motor pattern of threaded anchoring piece 2246 with respect to ball rod 2242, and it is based on the internal motion in the dynamic bone anchor 2240.Shown in Figure 22 D, threaded anchoring piece 2240 pivots and rotation around the ball 2244 of ball rod 2242.Threaded anchoring piece 2240 can be from 3 degree that pivot in any direction perpendicular to ball rod 2242, and shown in arrow 2264, total range of movement is 6 degree.The dynamic vertical bar also can rotate 360 degree with respect to ball rod 2242, shown in arrow 2266.

Ball rod 2242 makes up with respect to the motion of ball rod 2242 with respect to the motion and the threaded anchoring piece 2246 of dynamic vertical bar 2250, to produce than using the resulting more complicated motion of each parts separately.This compound motion is more near the natural motion of spinal column.Figure 22 E and 22F show the compound motion that the dynamic spinal that is combined with dynamic bone anchor 2240 and dynamic vertical bar 2250 is stablized prosthese.Figure 22 E simplicity of illustration the dynamic spinal motion of stablizing prosthese, it shows the motion of dynamic bone anchor 2240 with respect to bone fixation anchor 2241.Figure 22 F is the side view of spinal column, and it shows the motion of being stablized the spinal column segment of prosthese support by the dynamic spinal of Figure 22 E.

Shown in Figure 22 E and 22F, the dynamic spinal prosthese that is combined with dynamic bone anchor 2240 and dynamic vertical bar 2250 not only allows to rotatablely move (arrow 2270), also allows the coupling translation (arrow 2272) of dynamic bone anchor 2240 with respect to bone anchor 2241.In addition, center of rotation 2274 is remained on the anatomy desired locations (referring to Figure 22 F) that is in the intervertebral disc.The maintenance of nature center of rotation helps prevent the inhomogeneous loading of vertebral body 2202,2212.Be coupled and regulate pivoting action and translation (referring to Figure 22 D) flexibly by the flexible member that compresses dynamic bone anchor.In addition, this prosthese also limits available motion by for example ball rod 2242 and the contact of blocking a shot between 2248, thereby the stability of each section is provided.Therefore, dynamically the motion of the threaded anchoring piece 2246 of bone anchor 2240 very near the natural motion of the vertebra shown in Figure 22 A.Therefore, but the dynamic spinal that is combined with dynamic vertical bar 2250 and dynamic bone anchor 2240 is stablized the prosthese stabilizing spine, and provide load to distribute, the center of rotation that to implant vertebra simultaneously remains on the natural center of rotation (referring to Figure 22 A) of close spinal column in the intervertebral disc 2220, thereby keeps the natural motion scope.By allowing the translation of vertebra 2200 with respect to vertebra 2210, the motion of this prosthese also separates for retention in visible little joint when crooked in the natural spinal column.By allowing more natural motion, reduced the pathological changes point on parts and the skeleton interface, thereby improved durability, safety and efficient.

Ball rod 2242 with respect to the rotation of dynamic vertical bar 2250 and threaded anchoring piece 2246 with respect to the rotation (referring to Figure 22 C, 22D) of ball rod 2242 also allow the rigidity pedicle screw system the motion that can not realize.For example, relatively rotating of the lateral thrust of spinal column and vertebra is coupled.In the rigidity spinal column implantation piece of Figure 22 B, this rotation can't be provided, this rotation can be decomposed into the stress on parts and the parts/skeleton interface.Yet, in the dynamic spinal prosthese that combines dynamic vertical bar 2250 and dynamic bone anchor 2240, rotation around ball 2244 and ball 2254 is provided, thereby allow has changed the distance of intervertebral, and changed very coupling axial rotation near the vertebra of spinal column natural motion from a side to opposite side.The dynamic stability assembly that combines embodiment of the present invention also can support the complex combination of natural motion, and the coupling rotation and the translation of spinal column, for example, and by the lateral thrust of reversing, the lateral thrust of passing through bending.Like this, just can stablize and the anatomy of preservation spinal on proper exercise.

The big nearness of the motion of dynamic spinal prosthese and the natural motion of spinal column causes the stress on implant/skeleton interface to reduce, and by using the nature center of rotation to allow the homogeneous state of stress on vertebral body and intervertebral disc to distribute.System compares with the conventional rigid vertical rod, this prosthese has the rigidity that reduces, and the range of movement that has increased supports and implants section and reduce stress on the adjacent segment simultaneously.Yet having the dynamic spinal that is embedded in the flexible member in the dynamic bone anchor, to stablize prosthese more firm than rods system.Also can be according to load and the next flexible degree of regulating dynamic bone anchor of anatomical structure at individuality.The load distribution line on the anatomy consequently, the proper exercise on the anatomy stable and keeping, and the fastness of spinal degeneration prosthesis.

Deflecting bar/load beam material

The deflection post provides load distribution and dynamic stability performance with respect to the motion of bone anchor for the dynamic stability assembly.As mentioned above, the deflection of deflection post makes telescopic material production distortion.The size of telescopic material behavior and each parts of deflecting bar assembly influences the power-deflection curve of deflecting bar jointly.Size and material can be chosen as and realize power-deflection feature of expecting.

By changing the size of deflection post, sleeve and outer housing, can change the deflection characteristic of deflecting bar assembly.The rigidity of the parts of deflecting bar assembly can for example increase by the diameter of increase deflection post and/or by the diameter that reduces outer cover inner surface.In addition, the diameter that reduces the deflection post will reduce the rigidity of deflecting bar assembly, and the diameter that reduces the diameter of deflection post and/or increase outer cover inner surface will reduce the rigidity of deflecting bar.Alternately and/or additionally, the material that changes the parts of deflecting bar assembly also can influence the rigidity and the range of movement of deflecting bar.For example, material sleeve bigger with rigidity and/or that hardness is bigger will reduce the deflection of deflection post.

Deflection post, bone anchor and vertical rod are preferably made by the implantable metal of bio-compatible.The deflection post can be made by for example titanium, titanium alloy, cochrome, shape memory metal (for example Nitinol (NiTi)) or rustless steel.In preferred embodiment, the deflection post is made by cochrome.In preferred embodiment, bone anchor and vertical rod are made by titanium alloy; Yet other materials for example rustless steel also can use, to replace titanium part or replenishing as titanium part.In addition, the ball of dynamic vertical bar is preferably made by cochrome, to realize good wearing character.

The material of sleeve/flexible member/O-shape ring is bio-compatible and the implantable polymer with deformation characteristic of expectation.Bush material also should be able to keep the deformation characteristic expected.Like this, bush material preferably all is competent, antioxidative and dimensionally stable under the findable various conditions in human body.Sleeve can be for example by for example Bionate

Polycarbonate polyurethane (PCU) make.If sleeve comprises Bionate

When polycarbonate polyurethane or other hydrophilic polymers, then sleeve also can be used as the bearing of fluid lubrication, to be used for the rotation of deflection post with respect to the longitudinal axis of deflection post.

Be used for telescopic suitable material and comprise polyurethane, comprise polycarbonate polyurethane (PCU).The trade mark that suitable PCU can produce from Polymer Technology Group-DSM PTG company limited (Berkeley in California) is BIONATE

Product in obtain.BIONATE

PCU has good bio-compatibility, and is used as long-term implant through the FDA approval.BIONATE

PCU has good oxidation stability, bio-compatibility, mechanical strength and abrasion resistance, and suitable physical property, comprises load bearing, dimensional stability and anti-environmental stress breaking property.BIONATE PCU also has five hardness leveles, 80A, 90A, 55D, 65D and 75D, and different hardness leveles makes the parts that are combined with these hardness materials have different deflection characteristics.A kind of preferred embodiment in, sleeve is the BIONATE of 80A by hardness level

PCU makes, and its thickness is not 2mm when being compressed, and the deflection that can be deflected post is compressed to thickness and is approximately 1mm.

Can make sleeve by extruding, injection moulding, pressing mold and/or machining technique, such just as will be understood by the skilled person in the art.In some embodiment, sleeve can be made separately.For example, sleeve can be made by cutting of the polymer of bio-compatible or machined, for example fits together with deflection post and sleeve by being press fit in the outer housing afterwards.Alternately or additionally, can use the bonding agent of bio-compatible that sleeve is bonded on outer housing and/or the deflection post.In alternative embodiment, can be by being arranged to the deflection post in the outer housing, using fluid polymer (polymeric reagent) to fill the space between deflection post and the outer housing then and allow polymer cure, thus sleeve is formed on the throne.

Can make the PCU sleeve/flexible member/O-shape ring of single-piece, for example, spray press moulding mode, can utilize these density gradients to control the power of deflecting bar/deflection response curve by the repeatedly injection moulding or the plug-in type that can produce density gradient.Hole, gap or other architectural features also can be set change telescopic flexibility, thus the power/deflection response curve of change deflecting bar.Can carry out the patterning design to density gradient, so that the response curve of control deflecting bar.Density gradient need not symmetry.Can utilize the direction difference of density gradient to form to have different power in different directions/the deflecting bar assembly of deflection response.

Sleeve also can comprise having polymer areas of different nature.For example, sleeve can comprise the concentric ring of being made by one or more polymer, and wherein each ring all has different hardness or rigidity or durometer value.For example, begin each outside continuous loop from the center and can have higher hardness or rigidity or durometer value, thus when the deflection post from the position of longitudinal axis conllinear during to extrinsic deflection, sleeve provides the resistance of increase to the further deflection of deflection post.Sleeve also can be designed to the power deflection characteristic that provides different on different directions.Resistance reduced when the deflection that also the deflection post can be designed so that proper deflection post increased.

Also can use other polymer or thermoplastic to make sleeve, include but not limited to polyether-ether-ketone (PEEK), polyphenylsulphine (Radel

) or polyetherimide resin (Ultem

).In some embodiment, other polymer are also applicable, and for example, the PEEK of other grades for example is filled with 30% glass or is filled with 30% carbon, as long as this material is enough clean, the implantable device that can be used for the approval of FDA or other mechanism body gets final product.The known PEEK that is filled with glass is very desirable for the improvement of intensity, rigidity or stability, the then known compressive strength and the rigidity that can improve PEEK of the PEEK that is filled with carbon, and reduce its elongation.

Other suitable bio-compatible thermoplastic materials plastics or thermoplastic condensed polymer's material can be fit to, comprise having good Memorability, but flexibility and/or deflection are arranged, have very low hygroscopicity and the good ruggedness and/or the material of wearability, can use and do not depart from the scope of the present invention.This comprises PEKK (PEKK), polyether-ketone (PEK), polyetherketoneetherketoneketone (PEKEKK) and polyether ether ketone ketone (PEEKK) and general PAEK.In addition, also can use other polyketone and other thermoplastics.

The PCU material that is suitable for implanting has been disclosed in the U.S. Patent No. 5 that name is called " Crack-Resistant Polycarbonate Urethane Polymer Prostheses ", 133,742 and name be called the U.S. Patent No. 5 of " Crack-Resistant Polycarbonate Urethane Polymer Prostheses And The Like ", in 299,431.Other polymer that can be used in the sleeve are disclosed in the following document, comprising: on January 10th, 2002, name is called open WO 02/02158 A1 of PCT of " Bio-Compatible Polymeric Materials "; On January 3rd, 2002, name is called open WO 02/00275 A1 of PCT of " Bio-Compatible Polymeric Materials "; With submitted on January 3rd, 2002, name is called open WO 02/00270 A1 of PCT of " Bio-Compatible Polymeric Materials ".

Thereby telescopic material can be chosen as and form deflecting bar assembly with the rigidity/deflection characteristic that satisfies needs of patients.By selecting suitable bush material, just the deflection characteristic of deflecting bar assembly can be configured to the natural dynamic motion of remembeing near concrete patient, provide dynamic support for the spinal column in this zone simultaneously.Can be contemplated that, for example, the rigidity of deflecting bar assembly can be manufactured 70% the range of movement that can recover the intact spinal column of nature and pliability, 50% range of movement of intact spinal column and pliability and 30% range of movement and pliability of intact spinal column naturally naturally.

The above description of preferred implementation of the present invention is provided for explanation and describes.It is not to be intended to be exhaustive or to limit the invention to disclosed exact form.Many embodiments are selected and describe so that explain principle of the present invention and practical application thereof best, make others skilled in the art can understand the embodiments of the present invention thus and the various modifications of the application-specific that is suitable for expecting.Scope of the present invention should be limited by claim and equivalent technical solutions thereof.

Claims (20)

1. pedicle screw that is used for spinal stabilization, described pedicle screw have longitudinal axis and are suitable for engaging the thread spindle of skeleton, it is characterized in that described pedicle screw comprises:

Be fixed to the housing of an end of described thread spindle, described housing has the boring with described longitudinal axis alignment therein;

Post, described post has from the described boring of described housing near-end that extends and the far-end that terminates at the spherical keeper, described spherical keeper falls in the spherical receptacle of described boring, thereby described post is secured on the described housing and can pivots with respect to described longitudinal axis; With

Flexible member, described flexible member are placed in and are in the described boring between described post and the described housing, so that described post is held in and described longitudinal axis alignment flexibly.

2. pedicle screw as claimed in claim 1 is characterized in that:

Described boring has circumferential grooves therein; And

Described flexible member remains in the described circumferential grooves.

3. pedicle screw as claimed in claim 1 is characterized in that described housing has restriction face, described restriction face be arranged in the deflection post from the location deflection scheduled volume of the longitudinal axis alignment of nail after contact with described post.

4. pedicle screw as claimed in claim 3 is characterized in that, the sleeve of described flexible member for being made by polymer.

5. pedicle screw as claimed in claim 1 is characterized in that, described flexible member is an annular shape.

6. as claim 1 or 2 or 3 or 4 or 5 described pedicle screws, it is characterized in that described spherical keeper and described cylindricality become a part.

7. as claim 1 or 2 or 3 or 4 or 5 described pedicle screws, it is characterized in that described housing comprises:

Base portion, described base portion and described thread spindle form a part; Described base portion comprises the part of described spherical receptacle; The tubulose block, described tubulose block has boring therein, and described boring is alignd with the part of described longitudinal axis and described spherical receptacle; And

Wherein, described tubulose block is fixed on described base portion, thereby described spherical keeper is fallen in the described spherical receptacle of described housing.

8. as claim 1 or 2 or 3 or 4 or 5 described pedicle screws, it is characterized in that described housing comprises:

Base portion, described base portion and described thread spindle form a part; Described base portion comprises the part of described spherical receptacle; The tubulose block, described tubulose block has boring therein, and described boring is alignd with the part of described longitudinal axis and described spherical receptacle; And

Wherein, described tubulose block comprises the screw thread fixed part, and described screw thread fixed part is fastened on described tubulose block on the described base portion and with described spherical keeper and falls in described spherical receptacle.

9. as claim 1 or 2 or 3 or 4 or 5 or 6 or 7 described pedicle screws, it is characterized in that described post comprises the screw thread installing rack on its near-end, described screw thread installing rack is used for described post is fastened to the rods that is approximately perpendicular to described longitudinal axis.

10. as claim 1 or 2 or 3 or 4 or 5 or 6 or 7 described pedicle screws, its with the near-end that is fastened on described post on, the rods that is approximately perpendicular to described longitudinal axis is used in combination.

11. as claim 1 or 2 or 3 or 4 or 5 or 6 or 7 described pedicle screws, further comprise the ball on the near-end that is installed in described post, described ball is contained in the spherical receptacle of rods, to form the joint that allows described rods to pivot with respect to described post.

12. a rods that is suitable for across the spinal column segment joint is characterized in that described rods comprises:

Elongate bars with first end, second end and longitudinal rod axis;

Ball-and-socket joint on described first end of described bar;

Described ball-and-socket joint comprises the boring of the post that is suitable for the hold bone anchor;

Thus, described rods is adapted to fasten on the described post, and wherein said rods becomes the angle of approximate vertical each other with described bone anchor, allows described post to change with respect to the angle of described longitudinal rod axis simultaneously, and does not apply the moment of flexure theory on described elongate bars.

13. rods as claimed in claim 12, wherein:

Described elongate bars has housing on described first end of described elongate bars, described ball-and-socket joint is formed in the described housing;

Described housing has dimple, and spherical installing rack is fastened in the described dimple with respect to the mode that described housing pivots to allow described spherical installing rack; And

Described spherical installing rack is adapted to fasten on the post of bone anchor.

14. rods as claimed in claim 13 is characterized in that, described ball-and-socket joint comprises fixture, and described fixture is fastened on described spherical installing rack in the described dimple, allows described spherical installing rack to pivot with respect to described housing simultaneously.

15. rods as claimed in claim 12 is characterized in that, described spherical installing rack comprises threaded bore, and described threaded bore is suitable for described spherical installing rack is fastened on the threaded post of bone anchor.

16. rods as claimed in claim 12, it is characterized in that, described spherical installing rack comprises the tool engagement structure, and described tool engagement structure allows described spherical installing rack joining tool and rotated by described instrument, so that described spherical installing rack is fastened on the threaded post of bone anchor.

17. rods as claimed in claim 12 is characterized in that, described spherical installing rack comprises cochrome.

18. rods as claimed in claim 12, it is used in combination with nail, wherein:

Described nail comprises the thread spindle that is suitable for engage vertebrae and is suitable for installing the post of described spherical installing rack; With

Described nail be configured to make described post can in response to be applied to by described rods on the described post load and with respect to described thread spindle deflection.

19. rods as claimed in claim 12, it is used in combination with nail, wherein:

Described nail comprises thread spindle that is suitable for engage vertebrae and the post that can be installed on the described spherical installing rack;

Described nail is configured to make described post to change angle with respect to described thread spindle in response to being applied to the load on the described post by described rods; And

Described rods is configured to make described rods fully to pivot with respect to described post, to compensate the angle variation of described post with respect to the thread spindle of described nail.

20. rods as claimed in claim 12, it is used in combination with nail, wherein:

Described nail comprises thread spindle that is suitable for engage vertebrae and the post that can be installed on the described spherical installing rack;

Described nail is configured to make described post to change angle with respect to described thread spindle in response to being applied to the load on the described post by described rods; And

Described rods is constructed so that described post can pivot with respect to described longitudinal rod axis, and does not apply the moment of flexure theory on described longitudinal rod.

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