CN109171933A - A kind of screw steel plate system for spinous process of axis - Google Patents
A kind of screw steel plate system for spinous process of axis Download PDFInfo
- Publication number
- CN109171933A CN109171933A CN201811184646.4A CN201811184646A CN109171933A CN 109171933 A CN109171933 A CN 109171933A CN 201811184646 A CN201811184646 A CN 201811184646A CN 109171933 A CN109171933 A CN 109171933A
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- Prior art keywords
- screw
- spinous process
- steel plate
- hole
- plate body
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- Pending
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- 238000000034 method Methods 0.000 title claims abstract description 112
- 230000008569 process Effects 0.000 title claims abstract description 109
- 229910000831 Steel Inorganic materials 0.000 title claims abstract description 47
- 239000010959 steel Substances 0.000 title claims abstract description 47
- 210000003484 anatomy Anatomy 0.000 claims abstract description 12
- 238000003780 insertion Methods 0.000 claims abstract description 6
- 230000037431 insertion Effects 0.000 claims abstract description 6
- 239000000758 substrate Substances 0.000 claims description 11
- 230000007704 transition Effects 0.000 claims description 3
- 210000002385 vertebral artery Anatomy 0.000 abstract description 10
- 238000001356 surgical procedure Methods 0.000 abstract description 4
- 210000000278 spinal cord Anatomy 0.000 abstract description 3
- 230000006378 damage Effects 0.000 description 3
- 238000005516 engineering process Methods 0.000 description 3
- 210000003748 coronary sinus Anatomy 0.000 description 2
- 230000006870 function Effects 0.000 description 2
- 230000002980 postoperative effect Effects 0.000 description 2
- 238000011084 recovery Methods 0.000 description 2
- 210000001367 artery Anatomy 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 210000000988 bone and bone Anatomy 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 235000013399 edible fruits Nutrition 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 230000006872 improvement Effects 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 238000011160 research Methods 0.000 description 1
- 238000006467 substitution reaction Methods 0.000 description 1
- 239000013589 supplement Substances 0.000 description 1
- 230000001225 therapeutic effect Effects 0.000 description 1
- 210000003462 vein Anatomy 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/8605—Heads, i.e. proximal ends projecting from bone
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/864—Pins or screws or threaded wires; nuts therefor hollow, e.g. with socket or cannulated
Abstract
The present invention relates to a kind of screw steel plate systems for spinous process of axis, including spinous process screw, isthmus screw and spinous process steel plate, the spinous process steel plate includes the first plate body to match with the anatomical structure of spinous process side and the second plate body for matching with the anatomical structure of vertebral plate, the first through hole for spinous process screw insertion is offered on above-mentioned first plate body, and the second through-hole for the insertion of isthmus screw is offered on the second plate body.Compared with prior art, the corresponding position for the spinous process of axis that the present invention can enable the spinous process steel plate be firmly secured to, while being avoided that spinous process screw is placed in canalis spinalis, a possibility that invading spinal cord is farthest reduced, and be avoided that isthmus screw invades vertebral artery.As it can be seen that the screw steel plate system in the present invention can effectively avoid the infringement to dentata normal function on the basis of strong fix spinous process of axis fracture, to effectively improve the safety and reliability of surgical procedure.
Description
Technical field
The present invention relates to medical instruments field more particularly to a kind of screw steel plate systems for spinous process of axis.
Background technique
Currently, clinically used dentata technique for fixing includes through C1-2Joint screw, axis arch root screw and vertebral plate spiral shell
Nail, the above technology have the risk of damage vertebral artery.Wherein, since screw wears four layers of cortex bone fixation of articulatio atlantoepistrophica, Margerl
Coronary sinus retroperfusion provides strong fixation, but coronary sinus retroperfusion has the risk of very high technical requirements and vertebral artery injuries.
Pedicle screw equally has a higher technical requirements, the angle of pedicle of vertebral arch, diameter, vertebral artery and foramen transversarium position there may be
Variation, good screw screw way must avoid canalis spinalis and foramen transversarium, in some cases, since axis arch root is too small or vertebra is dynamic
The arteries and veins position anatomical factors such as interior, " high position rides " partially, may should not use axis arch root screw fix.Dentata Translaminar screw
It is fixed to be also applied to clinic, but the report that Jea etc. and Wang have axis laminar screw arranging to enter the generation of canalis spinalis complication.
Dentata anatomical structure is unique, and spinous process is maximum in cervical vertebra, the average width of part basal part in research CT measurement spinous process
Degree is (20.7 ± 1.3) mm, this, can be clinically as a kind of new pivot to provide possibility through the fixation of spinous process of axis screw
Vertebra Posterior fixation method supplement uses.Since spinous process screw is located at the rear structure of C2, screw way avoids foramen transversarium completely, so this
Technology is almost without the risk of vertebral artery injuries, however it is exactly screw that spinous process of axis screw, which fixes a clearly disadvantageous place,
Veutro cortex may be broken through and enter canalis spinalis infringement neck marrow, this technical risk of spinous process of axis screw limits this technology in clinic
It is universal.
Summary of the invention
It is a kind of safe and reliable for dentata spine the technical problem to be solved by the present invention is to be provided for the prior art
Prominent screw steel plate system.
The technical scheme of the invention to solve the technical problem is: a kind of screw steel plate system for spinous process of axis
System, which is characterized in that including spinous process screw, isthmus screw and spinous process steel plate, which includes the solution with spinous process side
The second plate body learning the first plate body for matching of structure and matching with the anatomical structure of vertebral plate is cutd open, is opened on above-mentioned first plate body
Equipped with the first through hole being inserted into for spinous process screw, and the second through-hole for the insertion of isthmus screw is offered on the second plate body, use
Under state, from dentata cross section as it can be seen that above-mentioned first through hole is opposite with the spinous process substrate of side where spinous process steel plate, above-mentioned spinous process spiral shell
The central axes of nail and the angle of horizontal direction are 5 °~10 °, and the tip of spinous process screw is pierced by from the spinous process substrate of the other side, on
State the second through-hole and C2/C3The top of zygapophysial joint is opposite, and the central axes of isthmus screw and the angle of vertical direction are 25 °
~30 °.
Vertebral artery, second through-hole and C are invaded to further avoid isthmus screw2/C3The top 5mm of zygapophysial joint
Place is opposite, i.e., the entry point of isthmus screw is in C2/C3The top 5mm of zygapophysial joint, in this way energy during isthmus screw enters
It is farthest avoided to invade vertebral artery.
For improve the present invention in spinous process steel plate applicability, make it is suitable for more with different spinous process of axis forms
Angle formed by body, plane where first plate body and the second plate body place plane is 125 °~135 °.
To reduce the cuing open from range of spinous process steel plate and spinous process side and vertebral plate, enable the first plate body and the second plate body more preferably
Ground is attached respectively on spinous process side and vertebral plate, and first plate body is bonded spinous process side and vertebral plate with the intersection of the second plate body
Intersection and in smooth transition.
To keep spinous process steel plate internal structure firm, so as to more preferably firmly fix the corresponding position of spinous process, the spinous process steel
Plate is integrated.
Screw steel plate system in surgical procedure in the present invention needs to be combined with other surgical instruments, for convenience of using, institute
It states spinous process screw and isthmus screw includes head and the bar portion for connecting with other surgical instruments.
Preferably, the diameter of the bar portion of the spinous process screw and isthmus screw is 3.5mm~4.0mm, further, spine
The length of the bar portion of prominent screw is 22mm~24mm, and the length of the bar portion of the isthmus screw is 16mm~18mm, so as to protect
Depth of needle needed for demonstrate,proving spinous process screw and isthmus screw.
Preferably, the first through hole and the second through-hole are locking made of being overlapped as pressurization hole slot and threaded bore portion
Pressurization hole increases the flexibility fixed in art, promotes treatment effect so as to carry out preferably fixed to knochenbruch face and/or pressurize
Fruit is conducive to post-operative recovery.
Further, it is preferable that formed by plane where the central axis of the threaded bore portion of the first through hole and the first plate body
Angle is 85 °~90 °, and central axis and the plane angulation where the second plate body of the threaded bore portion of second through-hole are
65 °~70 ° so that spinous process screw into nail direction and the angle of horizontal direction be 5 °~10 °, isthmus screw into nail side
It is 25 °~30 ° to the angle with vertical direction.
Compared with the prior art, the advantages of the present invention are as follows: the first plate body and the anatomical structure of spinous process side match,
The anatomical structure of second plate body and vertebral plate matches, and first be inserted into for spinous process screw is offered on above-mentioned first plate body
Through-hole offers the second through-hole for the insertion of isthmus screw on the second plate body, so as to be firmly secured to the spinous process steel plate
The corresponding position of spinous process of axis.Meanwhile under use state, from dentata cross section as it can be seen where above-mentioned first through hole and spinous process steel plate
The spinous process substrate of side is opposite, and the central axes of above-mentioned spinous process screw and the angle of horizontal direction are 5 °~10 °, and the point of spinous process screw
End be pierced by from other side spinous process substrate, thus be avoided that spinous process screw be placed in canalis spinalis, farthest reduce invade spinal cord can
Energy property, while above-mentioned second through-hole and C2/C3The top of zygapophysial joint is opposite, and the central axes of isthmus screw and vertical direction
Angle be 25 °~30 °, thus be avoided that isthmus screw invade vertebral artery.As it can be seen that the screw steel plate system in the present invention is steady
Admittedly the infringement to dentata normal function can be effectively avoided, to effectively improve operation on the basis of fixed spinous process of axis fracture
The safety and reliability of process.
Detailed description of the invention
Fig. 1 is the dentata schematic cross-sectional view in the embodiment of the present invention under screw steel plate system use state;
Fig. 2 is the structural schematic diagram of screw in the embodiment of the present invention.
Specific embodiment
The present invention will be described in further detail below with reference to the embodiments of the drawings.
As illustrated in fig. 1 and 2, a kind of screw steel plate system for spinous process of axis, including spinous process screw 51, isthmus screw 52
And spinous process steel plate 3, the setting position for both the central axes of spinous process screw 51 and isthmus screw 52 being respectively adopted in Fig. 1 to indicate
It sets.Above-mentioned spinous process steel plate 3 includes the first plate body 31 and the second plate body 32, wherein the anatomy knot of the first plate body 31 and spinous process side
Structure matches, and the anatomical structure of the second plate body 32 and vertebral plate matches.For improve the present invention in spinous process steel plate 3 applicability,
Make that it is suitable for more with the individual of different spinous process of axis forms, above-mentioned first plate body, 31 place plane and the second plate body 32
Angle α formed by the plane of place is 125 °~135 °, in addition, to reduce the cuing open from model of spinous process steel plate 3 and spinous process side and vertebral plate
It encloses, the first plate body 31 and the second plate body 32 is preferably attached on spinous process side and vertebral plate respectively, above-mentioned first plate body
31 are bonded the intersection of spinous process side and vertebral plate with the intersection of the second plate body 32 and are in smooth transition.Preferably, the present embodiment
In, spinous process steel plate 3 is integrated, and so as to keep 3 internal structure of spinous process steel plate firm, then more preferably can firmly fix spinous process
Corresponding position.
Further, the first through hole 41 being inserted into for spinous process screw 51, and the second plate body are offered on above-mentioned first plate body 31
The second through-hole 42 being inserted into for isthmus screw 52 is offered on 32.In the present embodiment, above-mentioned first through hole 41 and the second through-hole 42
Be one, each through-hole be as pressurization hole slot and threaded bore portion it is overlapping made of locking compress hole, so as to knochenbruch face into
Row is preferable fixed and/or pressurizes, and increases flexibility fixed in art, promotes therapeutic effect, is conducive to post-operative recovery.Into one
Step, the central axis and 31 place plane angulation γ of the first plate body of the threaded bore portion of above-mentioned first through hole 41 for 85 °~
90 °, the central axis and 32 place plane angulation ε of the second plate body of the threaded bore portion of above-mentioned second through-hole 42 be 65 °~
70 °, so that spinous process screw 51 (is preferably in the present embodiment for 5 °~10 ° into the angle β of nail direction and horizontal direction
5 °), isthmus screw 52 into the angle δ of nail direction and vertical direction be 25 °~30 ° (in the present embodiment be preferably 30 °).
Specifically, in a state of use, from dentata cross section as it can be seen that above-mentioned first through hole 41 and 3 place side of spinous process steel plate
Spinous process substrate it is opposite (i.e. the entry point of spinous process screw 51 is spinous process substrate), the central axes and level side of above-mentioned spinous process screw 51
To angle β be 5 °~10 ° (in the present embodiment be preferably 5 °), and the tip of spinous process screw 51 is worn from the spinous process substrate of the other side
Out, above-mentioned second through-hole 42 and C2/C3(i.e. 52 entry point of isthmus screw is C for the top of zygapophysial joint2/C3Zygapophysial joint
Top) relatively, and the angle δ of the central axes of isthmus screw 52 and vertical direction (is preferably in the present embodiment for 25 °~30 °
30°)。
The first plate body 31 and the anatomical structure of spinous process side match in the present invention in this way, the second plate body 32 and vertebral plate
Anatomical structure matches, and the first through hole 41 being inserted into for spinous process screw 51 is offered on above-mentioned first plate body 31, and second
The second through-hole 42 being inserted into for isthmus screw 52 is offered on plate body 32, so that the spinous process steel plate 3 be enable to be firmly secured to pivot
The corresponding position of vertebra spinous process.Meanwhile under use state, from dentata cross section as it can be seen that above-mentioned first through hole 41 and 3 institute of spinous process steel plate
Spinous process substrate in side is opposite, and the central axes of above-mentioned spinous process screw 51 and the angle β of horizontal direction are 5 °~10 °, and spinous process spiral shell
The tip of nail 51 is pierced by from the spinous process substrate of the other side, to be avoided that spinous process screw 51 is placed in canalis spinalis, is farthest reduced
A possibility that invading spinal cord 1, while above-mentioned second through-hole 42 and C2/C3The top of zygapophysial joint is opposite, and isthmus screw 52
The angle δ of central axes and vertical direction is 25 °~30 °, to be avoided that isthmus screw 52 invades vertebral artery 2.As it can be seen that of the invention
In 3 system of screw steel plate on the basis of firm fixed spinous process of axis fracture, can effectively avoid to dentata normal function
Infringement, to effectively improve the safety and reliability of surgical procedure.Preferably, the second through-hole 42 and C2/C3Zygapophysial joint
Opposite at the 5mm of top, i.e., the entry point of isthmus screw 52 is in C2/C3The top 5mm of zygapophysial joint, in this way in isthmus screw
It can be farthest avoided to invade vertebral artery 2 during 52 entrance.
In the present embodiment, above-mentioned spinous process screw 51 and isthmus screw 52 include the head for connecting with other surgical instruments
Portion 501 and bar portion 502 increase so that screw steel plate system and other surgical instruments in surgical procedure in the present invention be facilitated to be combined
Add operability.Preferably, the diameter of the bar portion 502 of each above-mentioned spinous process screw 51 and isthmus screw 52 be 3.5mm~
4.0mm, further, the length of the bar portion 502 of spinous process screw 51 are 22mm~24mm, the bar portion 502 of above-mentioned isthmus screw 52
Length is 16mm~18mm, thus depth of needle needed for can guarantee spinous process screw 51 and isthmus screw 52.
The above above-mentioned specific embodiment has carried out further in detail the purpose of the present invention, technical scheme and beneficial effects
It describes in detail bright, it should be understood that above are only specific embodiments of the present invention above, is not intended to restrict the invention, it is all
Within the spirit and principles in the present invention, any modification, equivalent substitution, improvement and etc. done should be included in guarantor of the invention
Within the scope of shield.
Claims (10)
1. a kind of screw steel plate system for spinous process of axis, which is characterized in that including spinous process screw (51), isthmus screw (52)
And spinous process steel plate (3), the spinous process steel plate (3) include the first plate body (31) to match with the anatomical structure of spinous process side and
The second plate body (32) to match with the anatomical structure of vertebral plate is offered for spinous process screw (51) on above-mentioned first plate body (31)
The first through hole (41) of insertion, and the second through-hole (42) for isthmus screw (52) insertion is offered on the second plate body (32),
Under use state, from dentata cross section as it can be seen that the spinous process substrate of side where above-mentioned first through hole (41) and spinous process steel plate (3)
Relatively, the central axes of above-mentioned spinous process screw (51) and the angle of horizontal direction are 5 °~10 °, and the tip of spinous process screw (51) from
The spinous process substrate of the other side is pierced by, above-mentioned second through-hole (42) and C2/C3The top of zygapophysial joint is opposite, and isthmus screw
(52) angle of central axes and vertical direction is 25 °~30 °.
2. screw steel plate system as described in claim 1, which is characterized in that second through-hole (42) and C2/C3Joint tip out
It is opposite at the top 5mm of section.
3. screw steel plate system as described in claim 1, which is characterized in that plane and second where first plate body (31)
Angle formed by plane where plate body (32) is 125 °~135 °.
4. screw steel plate system as claimed in claim 3, which is characterized in that first plate body (31) and the second plate body (32)
Intersection fitting spinous process side and vertebral plate intersection and in smooth transition.
5. screw steel plate system as described in claim 3 or 4, which is characterized in that the spinous process steel plate (3) is integrated.
6. screw steel plate system as claimed in any one of claims 1 to 3, which is characterized in that each spinous process screw (51) and
Isthmus screw (52) includes the head (501) and bar portion (502) for connecting with other surgical instruments.
7. screw steel plate system as claimed in claim 6, which is characterized in that each spinous process screw (51) and isthmus screw
(52) diameter of bar portion (502) is 3.5mm~4.0mm.
8. screw steel plate system as claimed in claim 6, which is characterized in that the bar portion (502) of the spinous process screw (51)
Length is 22mm~24mm, and the length of the bar portion (502) of the isthmus screw (52) is 16mm~18mm.
9. screw steel plate system as claimed in any one of claims 1 to 3, which is characterized in that the first through hole (41) and
Two through-holes (42) are locking compress hole made of being overlapped as pressurization hole slot and threaded bore portion.
10. screw steel plate system as claimed in claim 9, which is characterized in that the threaded bore portion of the first through hole (41)
Plane angulation where central axis and the first plate body (31) is 85 °~90 °, the threaded bore portion of second through-hole (42)
Plane angulation where central axis and the second plate body (32) is 65 °~70 °.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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CN201811184646.4A CN109171933A (en) | 2018-10-11 | 2018-10-11 | A kind of screw steel plate system for spinous process of axis |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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CN201811184646.4A CN109171933A (en) | 2018-10-11 | 2018-10-11 | A kind of screw steel plate system for spinous process of axis |
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CN109171933A true CN109171933A (en) | 2019-01-11 |
Family
ID=64947832
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CN201811184646.4A Pending CN109171933A (en) | 2018-10-11 | 2018-10-11 | A kind of screw steel plate system for spinous process of axis |
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Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN102551868A (en) * | 2012-01-10 | 2012-07-11 | 刘观燚 | Posterior cervical spine single open door side block spinous process steel plate |
CN202665673U (en) * | 2012-06-13 | 2013-01-16 | 常州华森医疗器械有限公司 | Laminoplasty steel plate |
CN105596070A (en) * | 2016-01-22 | 2016-05-25 | 赵海生 | Fixing system for cervical posterior open-door expansive laminoplasty |
CN106725788A (en) * | 2016-12-27 | 2017-05-31 | 中国人民解放军第二军医大学第二附属医院 | A kind of wing plate with curved surface internal fixation system for spondylolysis and spondylolithesis of the lumbar spine |
CN209611279U (en) * | 2018-10-11 | 2019-11-12 | 刘观燚 | A kind of screw steel plate system for spinous process of axis |
-
2018
- 2018-10-11 CN CN201811184646.4A patent/CN109171933A/en active Pending
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN102551868A (en) * | 2012-01-10 | 2012-07-11 | 刘观燚 | Posterior cervical spine single open door side block spinous process steel plate |
CN202665673U (en) * | 2012-06-13 | 2013-01-16 | 常州华森医疗器械有限公司 | Laminoplasty steel plate |
CN105596070A (en) * | 2016-01-22 | 2016-05-25 | 赵海生 | Fixing system for cervical posterior open-door expansive laminoplasty |
CN106725788A (en) * | 2016-12-27 | 2017-05-31 | 中国人民解放军第二军医大学第二附属医院 | A kind of wing plate with curved surface internal fixation system for spondylolysis and spondylolithesis of the lumbar spine |
CN209611279U (en) * | 2018-10-11 | 2019-11-12 | 刘观燚 | A kind of screw steel plate system for spinous process of axis |
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