JP2008539821A - Multi-axis anchor assembly and method for spinal implants - Google Patents

Abstract

Systems and methods are provided comprising plate members (120, 140, 160, 180, 600) engageable with the spinal column using anchor assemblies (20, 320, 420, 520, 620, 720). The anchor assembly comprises a coupling member (30, 130, 330, 430, 530, 630), the coupling member being a post (32, 332, 432, 532, 632) extending through at least one opening in the plate member. 732) and an anchor member (70) pivotally captured within the receiving portion (34, 334, 434, 534, 634) of the coupling member below the lower surface of the plate member. Locking members (90, 590) secure the plate member to the coupling member. A plate member engages a crown (50, 150, 250, 350, 550, 650) in the receiving portion of the coupling member to secure the anchor member in place relative to the coupling member.
[Selection] Figure 1

Description

  The present invention relates to a polyaxial anchor assembly and method for spinal implants.

  In the field of orthopedic surgery, and in particular in the field of spinal surgery, it has long been known to secure elongate members such as plates and rods to bone to hold and support them in a given position. For example, in a procedure for healing a damaged, diseased, malformed, or other abnormal or impaired vertebra, the vertebra is positioned in a corrected position by the surgeon. An elongated plate is placed adjacent to one or more vertebral bodies and bone anchors, such as screws or bolts, are used to secure the plate to the vertebral bodies. The anchor and plate are secured together to minimize or prevent relative motion. In this way, the vertebral body can be held and / or supported in proper alignment for repair.

  Facilitates positioning and attachment of an implant to one or more vertebrae of the spinal column, provides various attachment modes of the implant to one or more vertebrae of the spinal column, and to one or more vertebrae of the spinal column There remains a need for systems, devices, and methods that provide multi-axis functionality to anchor assemblies used in the installation of existing implants.

  The present invention may be used to stabilize bone elements in a desired spatial relationship in correcting bone misalignment disorders, or to provide stabilization along one or more vertebral levels, or the spine Or an orthopedic implant system and method for fusion of another bone. The multi-axis anchor assembly can be engaged to an implant, such as a plate member, rod member, or another connector or implant to secure the implant to the bone structure.

  According to one embodiment, an anchor assembly is provided that includes an anchor member, the anchor member having a head and a lower portion extending from the head for engaging a bone element. The anchor assembly further includes a coupling member that is pivotally coupled to the head of the anchor. The coupling member includes a lower receiving portion that defines an internal receptacle for receiving the head, and a post extending from the lower receiving portion against the head. The post is configured to engage the locking member. The lower receiving portion defines at least one side wall opening that communicates with the exterior of the coupling member. The anchor assembly further comprises a crown positioned about the head of the anchor member within the receptacle of the coupling member. The crown includes a seat that is positioned in contact with the implant member positioned about the post of the coupling member to secure the implant member between the locking member and the seat. At least one sidewall opening.

  According to another aspect, the spinal plate attachment system includes an elongated plate member, the elongated plate member includes at least one opening, the opening extends through the elongated plate, and is positioned on the top surface and an opposing position along the spinal column. It extends between the lower surface of the side. The system also includes an anchor assembly that is engageable with the plate member. The anchor assembly includes a coupling member having a post positionable through at least one opening and a receiving portion comprising a receptacle positionable adjacent the lower surface of the plate member. The anchor assembly includes an anchor member that has a head that is pivotally captured within the receptacle of the receiving portion and a lower portion that extends from the head for engaging the bone structure of the spinal column. A crown is positioned in the receptacle adjacent to the head and includes a seat that extends through the coupling member along the lower surface of the plate member. A locking member is engageable with the post and can be positioned in contact with the upper surface of the plate member to secure the lower surface of the plate member in contact with the crown seat.

  According to a further aspect, the spinal plate mounting system comprises an elongate plate member that extends along the longitudinal axis and that includes at least one opening, the opening extending through the elongate plate and positionable toward the top surface and the spinal column. Between the opposite lower surface. The system further comprises an anchor assembly engageable with the plate member. The anchor assembly includes a coupling member having a post that is positionable through the at least one opening and engageable with the plate member such that the coupling member does not pivot relative to the plate member. The coupling member includes a receiving portion having a receptacle that opens away from the plate member, the receptacle being positionable along the lower surface of the plate member. The anchor assembly further includes an anchor member that includes a head that is pivotally captured within the receptacle of the receiving portion. The anchor member includes a lower portion extending from the head for engaging the spinal bone structure. The anchor member pivots relative to the plate member and the receiving portion when the post is engaged with the plate member within at least one opening of the plate member.

  According to one aspect, an anchor assembly is provided that includes an anchor member, the anchor portion comprising a head and a lower portion extending from the head for engaging a bone element. The anchor assembly further comprises a coupling member pivotally coupled to the anchor head. The coupling member includes a lower receiving portion that defines an internal receptacle for receiving the head, and a post extending from the receiving portion against the head. The post is configured to engage the locking member. The receiving portion defines a number of openings that communicate with the exterior of the coupling member. A crown is positioned around the head of the anchor member within the receptacle of the coupling member. The crown includes a number of axially extending seats that extend through each one of the number of openings. The seat is positioned to contact at least one of an implant member or a locking member positioned around the post of the coupling member.

  According to another aspect, a spinal plate attachment system comprises an implant comprising at least one opening, the opening extending through the implant and having an upper surface and an opposite lower surface that can be positioned along the spinal column. Extending between. The system further comprises an anchor assembly engageable with the implant. The anchor assembly includes a coupling member, the coupling member having a post positionable through the at least one opening and a receiving portion positionable toward the lower surface of the implant. The receiving portion comprises a receptacle and the post defines a passage extending from its proximal end to the receptacle. The anchor assembly further includes an anchor member, the anchor member having a head that is pivotally captured within the receptacle of the receiving portion and a lower portion extending from the head for engaging the spinal bone structure. Prepare. The locking member can contact the top surface of the implant or one of the receiving portions and engage the attachment portion of the post to secure the implant to the spinal column.

  According to another aspect, a spinal plate attachment system includes a plate member that includes at least one opening, the opening penetrating the plate member and having an upper surface and an opposite lower surface positionable toward the spinal column. Extending between. The system further comprises an anchor assembly engageable with the plate member. The anchor assembly includes a coupling member, the coupling member including a post positionable through the at least one opening and a receiving portion positionable along the lower surface of the plate member. The post is threadably engaged with the receiving portion at the proximal end opening of the receiving portion. The receiving portion includes a receptacle, and the anchor member includes a head that is pivotally captured within the receptacle of the receiving portion. The lower portion of the anchor member extends from the head so that it engages the bone structure of the spinal column. The locking member can contact the upper surface of the plate member and engage the post to secure the plate member to the coupling member between the locking member and the receiving portion.

  According to another aspect, a spinal surgery method includes accessing at least one vertebra of a spinal column and engaging an anchor member of an anchor assembly with at least one vertebra, the anchor assembly including a coupling member. The coupling member includes a receiving portion pivotally mounted about the head of the anchor member, and a post extending proximally from the receiving portion and pivotable with the receiving portion relative to the anchor member; The method further includes pivoting the post and receiving portion to a desired position relative to the engaged anchor member, positioning the elongated plate member around the proximal end of the post, and the plate Advancing the member along the post to a position adjacent to the receiving portion; and a crown extending from the head of the anchor member through the coupling member And a step of engaging against.

  According to another aspect, a spinal surgery method includes accessing at least one vertebra of a spinal column through an incision, and engaging an anchor member of an anchor assembly with at least one vertebra through the incision. The anchor assembly includes a coupling member that is pivotally attached to the anchor member with a post extending proximally from the anchor member, the method further comprising a step for the engaged anchor member to direct the post to a desired position. Pivoting the coupling member; positioning the elongated plate member about the proximal end of the post; advancing the plate member along the post to a position adjacent to the anchor member; Engaging the member to the crown, the crown extending from the anchor in the coupling member and external to the coupling member. A number of seat to be positioned, relative to the plate member which is positioned to secure the anchor member to the coupling member.

  These and other aspects are discussed further below.

  For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments presented herein, and specific language will be used to describe the same. However, it will be understood that no limitation of the scope of the invention is thereby intended. Any changes and further modifications in the described processes, systems or devices, and any further applications of the principles of the invention described herein will normally occur to those skilled in the art to which the invention pertains. As contemplated.

  A multi-axis anchor assembly is provided to secure an implant, such as a plate member or connector, to one or more vertebrae of the spinal column. The anchor assembly includes an anchor member that is pivotally engaged within a receiving portion of the coupling member. The coupling member comprises a post extending proximally from the anchor member for receiving the implant therearound. The anchor member pivots uniformly around the longitudinal axis of the assembly. In one embodiment, the coupling member may be engaged so that the coupling member is restrained from pivoting in at least one direction relative to the implant while the anchor member pivots within the coupling member. it can.

  In one form, the coupling member comprises a crown in the receiving portion, the crown extending between the anchor and a member positioned around the post. In one embodiment, the crown firmly engages the anchor member in place relative to the coupling member when the locking member is secured to one of the implant or the crown. In another form, the coupling member comprises at least one window, the crown comprises a seat, and the seat is in contact with a locking member positioned around the lower surface or post of the implant. Extends through the window. The locking member, when finally engaged with the anchor assembly, can be tightly engaged with either the seat or the implant that contacts the crown seat.

  In another form, a multi-axis anchor assembly is provided that includes a coupling member around which the implant is received and an anchor member extending distally of the coupling member. In one application having a plate member, the elongate slot of the plate member is such that the coupling member is non-pivoting transverse to the longitudinal axis of the slot before being rigidly engaged with the locking member. The anchor member pivots in all directions relative to the coupling member. When the locking member is fixed to firmly engage the plate member to the coupling member, the coupling member and the anchor member are fixed relative to each other and to the plate member.

  In another form, a multi-axis anchor assembly is provided that includes a coupling member and an anchor member pivotally mounted within a receiving portion of the coupling member. A post extends proximally from the receiving portion and receives a locking member. The post includes an attachment portion adjacent to the receiving portion, and a locking member is attached to the attachment portion to secure the implant to the coupling member or to engage the crown within the coupling member. An extension portion extends proximally from the attachment portion to facilitate placement of the implant around the post. The extension portion can be removed from the attachment portion to minimize post-operative penetration of the anchor assembly into adjacent tissue.

  Referring now to FIGS. 1-5, a multi-axis anchor assembly 20 is shown having a first orientation aligned along the longitudinal axis 21. The anchor assembly 20 includes a coupling member 30 and an anchor member 70 that is pivotally engaged to the coupling member 30 using a clip 60. Anchor member 70 pivots about longitudinal axis 21 in a desired orientation relative thereto. A crown 50 is received within the coupling member 30 adjacent to the anchor member 70 and includes at least a seat that extends outwardly from the coupling member 30 through the window 48. The crown 50 can be positioned in contact with the lower surface of the plate member positioned around the coupling member 30, and to secure the plate member to the crown 50 as shown in FIG. The locking member 90 (FIG. 10) can be engaged with the coupling member 30. The downward or distal locking force provided by the engagement of the locking member 90 also forces the crown 50 to anchor the anchor member 70 to firmly engage the anchor member 70 in the desired position relative to the coupling member 30. Can be fixed on top.

  Further features of the coupling member 30 will now be discussed with reference to FIGS. The coupling member 30 includes a proximally extending post 32 and a lower receiving portion 34 centered about the longitudinal axis 21. The post 32 has a smaller size compared to the receiving portion 34 so that the post 32 can pass through the opening of the plate member, and at least a portion of the receiving portion 34 passes through the opening of the plate member. It is sized to prevent you from doing it. As shown in FIG. 6, the coupling member 30 includes an upper passage portion 42 extending through the post 32 that communicates with a receptacle 44 defined in the receiving portion 34. The receiving portion 34 includes an inner circumferential groove 46 adjacent to the receptacle 44 for receiving and retaining the clip 60 therein.

  The receiving portion 34 further comprises at least one opening so that the crown 50 communicates with the exterior of the coupling member 30. In the illustrated embodiment, the coupling member 30 defines a window 48 in communication with the receptacle 44 in its opposite side. As discussed further herein, at least a portion of the crown 50 protrudes through the window 48 so as to contact a plate member positioned about the post 32. The crown 50 is sized to protrude outwardly from the post 32 such that a plate member positioned around the post 32 is supported by the crown 50. As further shown in FIG. 3, the post 32 includes opposed flat portions 38 and opposed curved screw portions 40 extending therebetween. As discussed below and shown in FIG. 14, the flat 38 engages the side of an elongated slot or another opening in the plate member. In one embodiment, the post 32 prevents the plate member from twisting or rotating about the post 32 by engaging the side of the elongated slot of the plate member. The threaded portion 40 threadably engages a locking member 90 positioned about the post 32.

  The upper passage portion 42 of the post 32 has an inner surface forming a non-circular cross section configured to be engaged with a tool to facilitate rotation of the coupling member 30 about the longitudinal axis 21. A tool engagement passage 36 that is open to the rear is defined. In addition, the passage portion 42 is sized to allow the passage of drive equipment to engage the anchor member captured within the receiving portion 34 and apply drive force directly to the anchor member through the coupling member 30. can do.

  Referring now to FIG. 7, a cross-sectional view of crown 50 is shown. The crown 50 includes a seat 52 having an arm 53 extending from the lower cup portion 54. As shown in FIG. 1, the seat 52 forms an oval shape having straight wall portions 57 extending between the arms 53. The cup portion 54 has a hemispherical shape protruding from the seat 52, with an opening formed at its lower or distal end 55. Cup portion 54 defines a receptacle 58 having a concavely curved inner surface adapted to receive the head shape of anchor member 70 positioned within coupling member 30. A through hole 56 extends through the seat 52 and communicates with a receptacle 58 in the cup portion 54 to engage the drive device with a tool recess in the head of an anchor member 70 disposed in the receptacle 58. Therefore, it is possible to arrange through the through hole 56.

  FIG. 8 shows another embodiment crown 250 having an upper or proximal seat 252 and a lower or distal cup portion 254. Cup portion 254 defines a receptacle that extends from seat 252 and opens distally on the opposite side of seat 252. The head of anchor member 70 is received within a receptacle defined by cup portion 254. At least a portion of the seat 252 is formed by a pair of outwardly projecting arms 253 that extend proximally and distally along the cup portion 254. A through hole 256 extends through the seat 252 and communicates with the receptacle defined by the cup portion 254.

  FIG. 9 shows another embodiment crown 350 similar to crown 50. The crown 350 includes an upper or proximal seat 352, a lower or distal cup portion 354, and a through hole 356. An arm 353 extends outwardly from the cup portion 354 and includes a flange member 358 extending distally therefrom at the outer end of each arm 353. The distal end of each flange member 358 includes an inwardly facing lip 359. In use, the lip 359 is supported on the window ridge 49 of the coupling member 30 with the anchor member 70 pivotally captured within the receiving portion 34. Flange member 358 and lip 359 maintain a gap between the head of anchor member 70 positioned adjacent crown portion 350, so that when the plate member is secured relative to seat 352, Flange member 358 and lip 359 maintain a gap between the head of anchor member 70 and crown 350 so that anchor member 70 can pivot within coupling member 30. The crown 350 can be used in situations where dynamic stabilization of one or more vertebrae is desired. Dynamic stabilization also removes the ridge 82 from the head 72 of the anchor member 70 (FIG. 11), provides a resilient crown member, or provides separation between the crown member and the anchor member head. It can be brought about by any one or a combination of maintaining.

  FIG. 10 illustrates one embodiment of a locking member 90 that is engageable with the post 32 of the coupling member 30. The locking member 90 includes a body 92 having a side wall 96 that extends around a threaded through bore 94. The through bore 94 extends along a longitudinal axis 95 that is alignable along the longitudinal axis 21 of the anchor assembly 20. A slot 98 extends through the side wall 96 and communicates with the through bore 94 and divides the locking member 90 into a proximal portion 91 and a distal portion 93. As shown in FIG. 14, when the locking member 90 is engaged around the post 32 and the distal portion is in contact with the plate member 120, the locking member 90 is further tightened against the plate member to thereby approximate it. The place portion 91 is deflected toward the distal portion 93. This provides an interference fit or cross-threading between the threaded portion of the post 32 and the threaded portion of the locking member 90 to prevent the locking member 90 from loosening from its original position. Other embodiments include a locking member that does not have a slot 98, a locking member that has a release portion to ensure that proper torque is applied during engagement, or a bayonet-lock. ), Other forms for the locking member 90 are contemplated, including a locking member that provides another engagement relationship with the post 32, such as an interference fit or a fused connection.

  FIG. 11 shows an embodiment of the anchor member 70. Anchor member 70 includes an enlarged head 72 at its proximal end and a distal portion, the distal portion extending distally from head 72 to a tapered distal end 78. 74. Shaft 74 includes a screw profile 76 that extends along and is configured to engage bone tissue. Shaft 74 and thread profile 76 include grooves along all or part of shaft 74, as well as uniform or varying thread pitch, thread height, thread width, and shape along shaft 74. Any suitable form may be included. The screw profile 76 can be configured for insertion into a drilled and tapped hole, can be configured as a tapping screw, or can be configured as a drilling tapping screw. A non-threaded neck 80 can be provided between the head 72 and the shaft 74, but the threaded portion can extend along the neck 80 and / or extend completely along the neck 80. The head 72 further comprises a tool engagement recess 84 that opens at its proximal end, the recess 84 applying a rotational drive force to the anchor member 70 to threadably engage it with bone tissue. Any suitable configuration can be provided for receiving the device.

  As discussed above, the head 72 includes a plurality of ridges 82 extending around and adjacent to its proximal end, although a head 72 without the ridges 82 is also contemplated. For example, when the anchor assembly is engaged with the plate member using the locking member 90, the anchor member having a smooth head that can rotate within the crown 50 can be used to dynamically adjust the spinal segment. Stabilization can be brought about. As discussed further herein, the ridge 82 is crowned to lock the anchor member 70 in place relative to the coupling member 30 when engaged with the plate member using the locking member 90. Engages in or bites into portion 50. Ridge 82 can be formed by a series of flat surfaces that are machined into head 72. Another embodiment contemplates a ridge 82 formed by lap joints, knurls, teeth, or other surface features. Anchor assembly 20 comprising an anchor member with ridge 82 provides a rigid or static connection between the plate member and the spinal segment.

  Any implant can be fully statically engaged to the spinal column using an anchor assembly 20 having an anchor member that is firmly engaged with a respective coupling member secured to the implant. Any implant can be fully dynamically engaged to the spinal column using an anchor assembly 20 having an anchor member that pivots within a respective coupling member secured to the implant. A combination of a rigid anchor assembly 20 and a dynamic anchor assembly 20 can be used to engage the implant with the spinal column.

  Referring to FIG. 12, another embodiment of the anchor member 70 is shown, wherein the shaft 74 extends longitudinally along it and opens into the tool engagement recess 84 at the distal tip 78. A cavity 86 is provided. The lumen 86 can be configured to receive a guide wire or another guide member for guiding and placing the anchor member 70 to a desired position relative to the bone structure. The lumen 86 can also be used to deliver a bone graft or another bone growth promoting and / or therapeutic substance into the bone structure into which the anchor member 70 engages. Yet another embodiment contemplates shaft 74 comprising one or more perforations or openings that communicate with lumen 86 and are disposed between neck 80 and distal tip 78.

  Yet another embodiment contemplates an anchor member 70 comprising a distal portion having another configuration for engaging bone tissue. For example, the distal portion may be a cable, hook, clamp, staple, smooth shaft with wings or pointed wings, expandable anchor, body for placement in the intervertebral disc space, or bone structure Other structures for engaging the can be included.

  Referring to FIG. 13, an elongate plate member 120 is shown engaged with vertebrae 24, 26 on both sides of intervertebral disc space 28 using multi-axis anchor assembly 20 and single-axis anchor 100. It should be understood that the plate member 120 can be engaged to the vertebra using any combination of multi-axis and / or single-axis anchor assemblies. Single axis anchor assembly 100 includes a threaded shaft member 102 and a proximal head member 104 extending therefrom and integrally formed therewith. Proximal head member 104 extends through plate member 120 and includes a lower support member 108 against which the lower surface of plate member 120 is positioned. The locking member 106 is engaged with the head member 104 to clamp or fix the plate member 120 to the lower support member 108.

  The connection between the plate member 120 and the multi-axis anchor assembly 20 is also shown in the cross-sectional view of FIG. The plate member 120 is positioned such that its lower surface is at least partially in contact with the seat 152 of the crown 150. The post 32 of the coupling member 130 extends through the plate member 120 and the locking member 90 is positioned around the post 32. When the locking member is advanced along the post 32 toward the upper surface of the plate member 120, the locking member 90 applies a force against the plate member 120 and locks it with the seat 52 of the crown 50. It is firmly fixed between the member 90. In the illustrated embodiment, the securing force presses the crown 50 downward against the head 72 of the anchor member 70. For embodiments that are intended for secure fixation, the anchor member 70 includes a ridge 82 that digs into the crown 50 and locks the anchor member 70 in place relative to the coupling member 30 and the plate member 120.

  With reference to FIGS. 15-17, further details of one embodiment of the plate member 120 are shown. The plate member 120 includes an elongated body 122 that extends along the longitudinal axis 121. The body 122 includes at least one opening in the form of an elongated slot 124 that is centered and extends along the longitudinal axis 121. The slot 124 opens at the upper surface 125 and the lower surface 127. The side rails 126 extend longitudinally along the opposite side of the slot 124 and the end rails 128 extend between the side rails 126 at the ends of the body 122.

  The side rail 126 includes an inner surface 129 extending along the slot 124 and an outer surface 131. As shown in FIG. 17, the body 122 includes a longitudinal groove 130 in an inner surface 129 extending along the slot 124. The edges of the plate surface and rails 126, 128 transitioning between the plate upper and lower surfaces and between the rail inner surface and the rail outer surface are rounded to eliminate any sharp edges or abrupt transitions between the plate surfaces. Or can be chamfered.

  In FIG. 18, a plate member 120 is shown having a curved profile along its longitudinal axis 121. The upper surface 125 is curved in a concave shape, and the lower surface 127 is curved in a convex shape. The curved configuration can be provided by a pre-curved plate or by bending the plate during surgery to provide the desired fit with the patient's anatomy.

  FIG. 19 shows another embodiment of the plate member 140. Plate member 140 is similar to plate member 120 and includes an elongated body 142 having opposed side rails 146 and opposed end rails 148. The plate member 140 includes an opening in the form of a pair of elongated slots 144, 145 formed along the body 142, with an intermediate rail 150 disposed between the slots 144, 145 and between the side rails 146. Extend to. In the illustrated embodiment, slot 144 is shorter than slot 145. Another embodiment contemplates a plate member having equal length slots and more than two slots. In any plate member embodiment, the slot can include scallops, recesses, or other features to facilitate placing or engaging the anchor there. It is also contemplated that the plate member can comprise two or more slots extending side by side adjacent to each other. Yet another embodiment contemplates that the plate member comprises an opening in the form of a circular hole between the top and bottom surfaces.

  FIG. 20 shows another embodiment of a plate member 160. Plate member 160 includes a body member 162 having side rails 166 and end rails 168. A pair of end slots 165 are provided adjacent to the end rails 168, an intermediate slot 164 is provided between the end slots 165, and the intermediate rails 170 are respectively connected to the intermediate slot 164 and one end slot. 165. In the illustrated embodiment, the intermediate slot 164 is longer than the slot 165.

  FIG. 21 shows a plate member 180 according to another embodiment. Plate member 180 includes a body 182 having an anchor assembly engaging portion 184 and a rod receiving portion 188. Anchor assembly engaging portion 184 includes an opening therethrough in the form of an elongated slot 186 for receiving an anchor assembly, such as anchor assembly 20. The slot 186 allows the position of the plate member 180 to be adjusted by securing the plate member 180 thereto using the anchor assembly 20. Rod receiving portion 188 defines a passage 190 for receiving elongate spinal rod 196 therein. The passage 190 extends laterally with respect to the slot 186. In the illustrated embodiment, the rod receiving portion 188 is a cylindrical member that completely surrounds the passage 190. However, another embodiment includes a passage open along all or part of its side, a rod receiving portion 188 comprising a plurality of components for clamping or gripping the rod within the passage 190, and a rod or Other suitable configurations for receiving and / or engaging another elongate implant member are contemplated.

  22A-22E illustrate one embodiment of a plate holder 200 that can be engaged in a groove 130 to hold a plate member for delivery to a surgical site, for example. An example of a holding device is provided in US patent application Ser. No. 10 / 202,918 filed Jul. 25, 2002, which is incorporated herein by reference in its entirety. The plate holder 200 includes a handle member 202 and a lever member 204 that is pivotally coupled thereto. A shaft member 206 is coupled to the lever member 204 using a first link 208. A mounting shaft 212 extends from the handle member 202 through the shaft member 206 and includes a locking member 210 that extends through the proximal knob portion and the mounting shaft 212 as shown in FIG. 22C. Has a shaft.

  The distal end of the attachment shaft 212 includes an attachment member 214 pivotally attached thereto. The attachment member 214 includes an engagement portion 218 that is sized to fit within the slot 124 of the plate member 120, for example. The engagement portion 218 can also be sized to fit within an opening or slot of any plate member embodiment discussed herein. In the illustrated embodiment, the engagement portion 218 includes an engagement member 220 for engaging the groove 130 of the plate member 120. The engagement member 220 can be in the form of a spherical member or stem that can be recessed into the engagement portion 218 for positioning within the slot 124 and then into the groove 130. To engage and attach plate member 120 to attachment member 214, it can be moved outward. The locking member 210 is then attached by its proximal knob so that the distal end of the locking member 210 within the engagement portion 218 secures the engagement member 220 in engagement with the plate member. It can be rotated within the shaft 212.

  Member 206 can be moved relative to handle member 202 and mounting shaft 212 by moving lever 204 between an open position as shown in FIG. 22A and a closed position as shown in FIG. 22D. The spring mechanism 222 normally biases the lever member 204 and the handle member 202 to the open position. In the open position, the mounting member 214 is oriented such that the plate member extends along an axis 203 (FIG. 22C) that is oriented more along the longitudinal axis 201 of the instrument 200. In the closed position, the link 216 extending between the shaft member 206 and the mounting member 214 moves the mounting member 214 around the distal end of the mounting shaft 212 when the shaft member 206 is moved proximally using the lever 204. Pivot with. In the closed position, the shaft 203, and thus the plate member secured to the mounting member 214, extends at a right angle or substantially transverse to the longitudinal axis 201 of the instrument 200. That is, the instrument 200 allows the plate to be held in a first orientation that is directed along the approach path to the spinal column, and then the plate can be remotely pivoted to align along the spinal column. This facilitates placement of the plate through a narrow incision or tube.

  Device 200 is only one example of a suitable device for holding a plate member and delivering it to the spinal column for engagement with the spinal column using the anchor assemblies discussed herein. Other examples of holding devices include forceps or another gripping device, a device having a fastener for engaging the plate, and a device that provides an interference fit with the plate. The instrument can, for example, engage in a slot or hole in the plate and clamp between the outer surfaces of the plate, or hold the plate between the surface of the slot or hole and the outer surface of the plate. Yet another example contemplates that the plate is grasped by hand and delivered to the surgical site.

  Referring now to FIGS. 23-26, another embodiment of a multi-axis anchor assembly 320 is shown. Anchor assembly 320 includes a coupling member 330 having a post 332 extending along its longitudinal axis 321. The post 332 extends a sufficient length along the longitudinal axis 321 from the receiving portion 334 proximally to facilitate positioning of the implant about the coupling member 330 and to aid in intraoperative assembly. The multi-axis anchor assembly 320 can also include a post 332 having a removable proximal extension to provide a low profile when implanted.

  In the illustrated embodiment, the anchor assembly 320 includes an anchor member 70 that is pivotally captured within the coupling member 330 using the clip 60. The crown 50 can be positioned around the head 72 of the anchor member 70 within the coupling member 330. The seat 52 of the crown 50 is secured to the bottom surface of the implant, such as a plate member received over and in contact with the post 332, using a locking member 90 as discussed above with respect to the anchor assembly 20. It is exposed through the coupling member 330 so that it can be secured to the anchor member 320.

  The coupling member 330 includes a receiving portion 334 below or at the distal end of the post 332. The receiving portion 334 includes a receptacle 344 for receiving the head 72 of the anchor member 70 therein and an inner circumferential groove 346 for receiving the C-shaped clip 60. Clip 60 pivotally supports head 72 within receptacle 344, and cup portion 54 of crown 50 extends at least a portion of seat 52 through counter window 348 as shown in FIG. As such, it is positioned around the head 372 within the receptacle 344.

  The post 332 includes a locking member attachment portion 333 and an extension portion 352 extending proximally from the attachment portion 333. The extension portion 352 provides a proximal extension of the post 332 along the longitudinal axis 321 that positions the implant member over it and receives the implant portion 334 and the implant during surgery. It is easy to guide to a position adjacent to the crown 50. The extension 352 also prevents the implant from slipping off the post 332 when the implant and vertebra are manipulated during surgery and before the locking member 90 engages the post 332. Further, during operation, before the implant is secured to the anchor assembly 320 using the locking member 90, the crown 50 and the locking member 90 may be moved to manipulate the implant into a fixed position relative to the anchor assembly 320. The locking member 90 can be temporarily engaged with the post 332 around the extended portion 352 while ensuring sufficient space.

  A separation region 350 is provided between the attachment portion 333 and the extension portion 352. As shown in FIG. 26, the detachment region 350 can be formed by an inwardly tapered wall in the post 332 that interrupts the thread profile along the post 332 and provides a flat portion. The surface forming 356 (FIG. 25) is also interrupted. Tool engagement passageway 336 includes a tool engagement surface extending through extension portion 352 and attachment portion 333 and defining a non-circular cross section. A gauge portion 356 is provided in the inner wall surface of the post 332 adjacent to the separation region 350. Gauge portion 356 is adjacent to release region 350 such that extension portion 352 is disconnected from attachment portion 333 by a predetermined level of torque applied to extension portion 352 within tool engagement passageway 336 proximal to release region 350. The wall thickness of the post 332 is reduced. The amount of torque required can be changed by changing the wall thickness of the post 332 in the release region 350.

  The extension portion 352 includes a tapered proximal end 358 to further facilitate placement of the plate member thereabout. The extension portion 352 includes an opposing flat portion 356 and a threaded curved portion 354 that extends between the flat portions. Similarly, the attachment portion 333 includes an opposing flat portion 338 that is aligned with the respective flat portion 356 and curved portion 354 of the extension portion 352, and a threaded curved portion 340 extending therebetween. The threaded curved portions 340, 354 receive the locking member 90 in a threaded manner and engage the post 332. The flats 338, 356 are sized to abut a side wall or another opening along the elongated slot of the plate member positioned over it to eliminate lateral movement or drive of the plate member. . The coupling member 330 is further aligned with the plate member opening as the plate member is advanced along the extension 352. In another embodiment, it is contemplated that post 332 is threaded along its entire length. In a further embodiment, all or a portion of the post 332 is provided to have a circular cross section without an opposing flat. In yet another embodiment, post 332 is not threaded along extension 352.

  Referring now to FIGS. 27-29, another embodiment of a multi-axis anchor assembly 420 is shown. Anchor assembly 420 includes a coupling member 430 having a post 432 extending along the longitudinal axis 421 of the anchor assembly 420. Anchor assembly 420 may include any suitable configuration, as discussed above with respect to another embodiment anchor assembly. The extended post 432 is similar to the extended post 332 of the multi-axis anchor assembly 320, but its proximal end is adjacent to or incision or opening provided to access the spinal column. A length along the longitudinal axis 421 so as to be positioned therethrough. The extended post 432 facilitates positioning of the implant about the coupling member 430 and guides the implant through the incision to a position adjacent to the vertebral body with which the anchor member 70 is engaged. Surgical instruments for holding the implant can be eliminated and the congestion in the surgical space formed by the incision can be reduced.

  In the illustrated embodiment, the anchor assembly 420 includes an anchor member 70 that is pivotally captured within the coupling member 430 using the clip 60. The crown 50 can be positioned around the head 72 of the anchor member 70 within the coupling member 430. The seat 52 of the crown 50 is exposed or extends through the coupling member 430 so that the lower surface of the implant can be contacted and secured thereto as discussed above with respect to the anchor assembly 20.

  The coupling member 430 includes a receiving portion 434 below or at the distal end of the post 432. Receiving portion 434 can be configured as discussed above with respect to receiving portions 34 and 334. The post 432 includes a locking member attachment portion 433 and an extension portion 452 extending proximally from the attachment portion 433. A separation region 450 is provided between the attachment portion 433 and the extension portion 452. The extension portion 452 provides a proximal extension of the post 432 that positions the implant member over it and guides the implant to a position adjacent the crown 50 during surgery. Make it easy to do. The extension 452 also prevents the implant from slipping off the post 432 when the implant and vertebrae are manipulated during surgery and before the locking member 90 engages the post 432. Further, during surgery and prior to securing the implant to the anchor assembly using the locking member 90, additional space for manipulating the implant into place relative to the anchor assembly is provided with the crown 50 and the locking member 90. The locking member 90 can be temporarily engaged with the post 432 around the extended portion 452 while being secured between the two.

  Similar to anchor assembly 320, post 432 includes an inner recess for a tool (not shown) that extends through extension portion 452 and attachment portion 433, and a gauge portion that is within its inner wall surface and is adjacent to release region 450. So that the extension portion 452 is disconnected from the attachment portion 433 by a predetermined level of torque applied to the extension portion 452 proximal to the disengagement region 450.

  The extension 452 includes a tapered proximal end 458 to further facilitate placement of the implant thereabout. The extension portion 452 includes an opposing flat portion 456 and a threaded curved portion 454 extending between the flat portions 456. Similarly, the attachment portion 433 includes opposing flats 438 and a threaded curved portion 440 extending therebetween. The threaded curved portions 440, 454 receive and engage the locking member 90 in a threaded manner. The flats 438, 456 are elongated slots in the implant positioned over the flats 438, 456 to eliminate lateral movement or pivoting of the implant and to align the coupling member 430 with respect to the implant. Or it is sized to abut against the side wall along another opening.

  The extension portion 452 can facilitate rotation of the coupling member 430 so that the receiving portion 434 is properly aligned with the implant. Rotation of the coupling member 430 can occur by the tapered proximal end 458 receiving the implant and by self-aligning the receiving portion 434 as the implant is moved distally along the extension 452. is there. Also, the proximal end 458 can be engaged by a tool or manually to rotate the receiving portion 434 into a desired position relative to the implant.

  In any embodiment of the anchor assembly discussed herein, and with particular reference to anchor assemblies 320, 420, to provide mechanical advantages in positioning the implant, such as a plate member adjacent to crown 50, A reduction instrument can be engaged with the posts 332, 432. Such a reduction device can reduce the misalignment between unaligned vertebrae, or simply adjacent the crown 50 prior to final fixation of the plate member with the locking member 90. Can be pushed into place. Yet another embodiment is that reduction of the plate member and / or vertebra can be achieved by screwing the locking member 90 against the top surface of the plate member and pressing the plate member against the crown 50. Contemplate.

  For example, the locking member can be positioned around the posts 332, 432, and the locking member can be positioned such that a portion of the threaded curved portion 354, 454 is exposed proximal to the locking member. 332 and 432 can be temporarily engaged. The reduction device can include a first member that can be threadably engaged with the extension portions 352, 452 and a second member that can be moved relative to the first member using an actuator. The second member can be positioned in contact with the plate member, and the actuator is used to move the first member to the lever to move the plate member along the posts 332, 432 to the crown 50. be able to. The locking member 90 is then moved along the attachment portions 333, 433 to cause the plate member to firmly engage the crown member while the reduction device holds the plate member in the desired position relative to the anchor assembly. Can move forward.

  FIGS. 30-32 illustrate another embodiment of a multi-axis anchor assembly 520 provided for securing an implant to one or more vertebrae of the spinal column. Anchor assembly 520 includes an anchor member 70 that is pivotally coupled within a receiving portion 534 of coupling member 530. The coupling member 530 comprises a post 532 that extends proximally from the receiving portion 534 to receive an implant therearound, such as a plate member 120 as shown. Anchor member 70 pivots relative to plate member 120 when post 532 is positioned through opening 124 in plate member 120. In one form, the coupling member 530 comprises a crown 550 that extends in the receiving portion 534 between the anchor member 70 and the plate member 120 positioned about the post 532. In one embodiment, the crown 550 firmly engages the anchor member 70 in place relative to the coupling member 530 and the plate member 120 when the locking member 590 is secured to the plate member 120.

  The coupling member 530 can include one or more windows for providing a passage for communicating the crown 550 with the exterior of the coupling member 530. In one embodiment, coupling member 530 includes at least one window 548, crown 550 includes a seat 552 formed by at least one extension arm 553, and extension arm 553 is positioned about post 532. Projects through at least one window 548 to contact the plate member 120 when done. When the locking member 590 is positioned in contact with the plate member 120, the locking member 590 tightly engages the plate member 120 with one or more arms 553 of the crown 550. In the illustrated embodiment, the coupling member 530 includes four windows 548 spaced around it, and the crown 550 defines a seat 552 and each one of the four windows 548. There are four arms 553 extending axially therethrough. Another embodiment contemplates a configuration comprising two arms and windows, three arms and windows, or five or more arms and windows. The windows and arms can be evenly spaced from each other or can be spaced at unequal intervals. It is further contemplated that a particular anchor assembly need not be provided with the same number of arms and windows.

  Multi-axis anchor assembly 520 includes a first orientation in which anchor member 70 and post 532 are aligned along longitudinal axis 521. Anchor assembly 520 further includes an anchor member 70 that is pivotally engaged to coupling member 530 using retaining clip 560 within a distally facing opening of receiving portion 534. Anchor member 70 is multi-axial and pivots in a conical shape extending around axis 521 to a myriad of positions about longitudinal axis 521. In one embodiment, the angular range A defined by the cone extends up to 90 ° between the axis 521 and the longitudinal axis 71 of the anchor member 70. In another embodiment, the angular range A extends up to about 45 °. In another embodiment, the angular range A extends up to about 30 °.

  The crown 550 is received in the coupling member 530 adjacent to another member 70 and extends outwardly from the coupling member 530 through the aligned one of the windows 548. Is provided. The locking member 590 can engage the coupling member 530 to secure the plate member 120 to the crown 550, as shown in FIG. The downward or distal locking force provided by the engagement of the locking member 590 can also cause the crown 550 to engage the anchor member 70 to firmly engage the anchor member 70 in a desired position relative to the coupling member 530. Can be fixed on the proximal end.

  The coupling member 530 includes a proximally extending post 532 and a lower receiving portion 534 that is centered about the longitudinal axis 521. The post 532 has a smaller size compared to the receiving portion 534 so that it can pass through the opening of the implant, so that at least a portion of the receiving portion 534 prevents passage through the opening of the implant. To be sized. The coupling member 530 includes an upper passage portion 542 that extends through the post 532 and communicates with a receptacle 544 defined in the receiving portion 534. The receiving portion 534 includes an internal thread profile 546 adjacent to the receptacle 544 for threadingly receiving and engaging the retaining clip 560 therein.

  Retention clip 560 includes an outer threaded engagement portion 564 and a distal retention portion 562. A bore 566 extends through the engagement portion 564 and the retention portion 562 and receives the threaded shaft of the anchor member 70 therethrough. As shown in FIG. 32, the bore 566 has a proximal portion sized to receive the cup portion 554 of the crown 550 therein with the proximal end of the anchor member 70 within the cup portion 554. Prepare. The distal retaining portion 562 includes a radially inwardly extending flange 568 that is the distal end of the anchor member 70 head having its maximum diameter to retain the anchor member 70 within the coupling member 530. Extends around and touches the position. The threaded engagement of the retaining clip 560 and the coupling member 530 provides a secure coupling configuration of the anchor member 70 within the lower receiving portion 534, but without deforming or bending the retaining clip 560. It facilitates assembly and disassembly with the coupling member 530.

  The post 532 can include a circular outer surface having a male thread profile for threadably engaging the locking member 590. The post 532 can also be configured with opposing flats along its outer surface, as discussed above. The upper passage portion 542 of the post 532 defines a proximally open tool engagement passage 536 that can be used to facilitate rotation of the coupling member 530 about the longitudinal axis 521. And an inner surface forming a non-circular cross section. In addition, the passage portion 542 may be configured to allow passage of a drive device to engage the anchor member 70 captured within the receiving portion 534 and apply a driving force directly to the anchor member 70 through the coupling member 530. Can be sized.

  The crown 550 includes a seat 552 disposed proximal to the lower cup portion 554. The seat portion 552 includes a large number of arms 553 extending in the axial direction therefrom, and a recess is formed between the adjacent arms 553. The seat 552 includes an axially extending arm 553 that extends through the window and projects outwardly such that an implant disposed therearound is at least partially supported by the crown 550. As such, the window 548 is sized. As shown in FIG. 31, the seat 552 forms a proximally open cup shape and has a central recessed region 557 and a valley 558 between the arms 553. The cup portion 554 includes a hemispherical body that projects distally from the seat 552, and the hemispherical body has a distally facing opening formed at a distal end thereof. Cup portion 554 defines a receptacle 559 having a concavely curved inner surface adapted to receive the shape of the proximal end of anchor member 70 positioned within coupling member 530. A through hole 556 extends through the seat 552 and communicates with the receptacle 559 to engage the drive device with a tool recess in the proximal end of the anchor member 70 positioned within the cup portion 554. Allows placement through the through hole 556.

  30-32 illustrate one embodiment of a locking member 590 that can engage the post 532 of the coupling member 530. The locking member 590 includes a body 592 having a sidewall 596 that extends around a threaded through bore 594. The through bore 594 can be aligned along the longitudinal axis 521 of the anchor assembly 520. 30 and 32, when the locking member 590 is engaged around the post 532 and contacts the plate member 120, the locking member 590 is further tightened against the plate member 120, Plate member 120 is secured over any one or combination of ends of arms 553 of seat 552. This in turn pushes crown 550 onto the head of anchor member 70. Since the anchor member 70 includes the locking ridge, the anchor member 70 can be firmly coupled to the coupling member 530. As discussed above, multiaxial coupling configurations are also contemplated. Further, the locking member 590 can be configured to prevent it from loosening or coming out along the post 532 as discussed above with respect to the locking member 590. Another embodiment is a locking member having a release portion to ensure that proper torque is applied when engaged, or another engagement with post 532, such as a bayonet lock, an interference fit, or a fusion connection. Alternative configurations for locking member 590 are contemplated, including a locking member that provides the relationship.

  FIGS. 33 and 34 show another embodiment of a multi-axis anchor assembly 620 provided to secure an implant, such as a plate member 600, to one or more vertebrae of the spinal column. In the illustrated embodiment, the plate member 600 includes a slotted connector portion 602 that defines a slot 604. Another embodiment contemplates a slotless opening through the connector portion 602. Plate member 600 further includes a receiving portion 606 that is offset from a connector portion 602 that defines a receiving passage 608. The receiving passage 608 is oriented transversely to the slot 604 and can be positioned along the spinal column when the connector portion 602 is engaged with the vertebrae using an anchor in the slot 604 or It can be aligned to receive another elongated connecting element. A transverse bore 610 is provided through the receiving portion 606 and communicates with the receiving portion 608. A set screw or another engagement member can be positioned in the bore 610 to engage the elongate connection element within the passage 608 to secure the elongate connection element in place relative to the anchor assembly 620. . Anchor assembly 620 can be used with any embodiment of the plate member discussed herein, and plate member 600 can be used with any embodiment of the anchor assembly discussed herein. Should be understood. It is further contemplated that the anchor assembly 620 can be used to secure any type of implant to the spinal bone structure.

  The anchor assembly 620 includes an anchor member 70 and a locking member 590, such as those provided by the anchor assembly 520 discussed above, although another embodiment of the anchor and locking member for use in the anchor assembly 620 is also provided. Intended. Anchor 70 is loaded from the top into receiving portion 634 of coupling member 630 where it is pivotally received. The crown 650 can be disposed within the receiving portion 634 proximal to the head of the anchor 70. The coupling member 630 further includes a post 632 that is removably engaged with the proximal end of the receiving portion 634. In one embodiment, crown 650 in receiving portion 634 extends between anchor member 70 and plate member 600 positioned about post 632. The crown portion 650 can firmly engage the anchor member 70 at a fixed position with respect to the coupling member 630 and the plate member 600 when the locking member 590 is fixed to the plate member 600. Another embodiment contemplates that the angular motion of the anchor member 70 is maintained after the locking member 590 is secured to the plate member 600.

  Once the post 632 is positioned through the opening 604 in the plate member 600, the anchor member 70 can be pivoted relative to the plate member 600. As discussed herein with respect to another embodiment of the anchor assembly, various angular configurations for the anchor member 70 relative to the post 632 are contemplated. Angular movement of the anchor member 70 relative to the post 632 facilitates positioning the anchor member 70 in the desired orientation into the vertebra while allowing the post 632 to be aligned to receive the plate member therearound. To.

  In one form, the post 632 includes a distal engagement portion 660 that extends radially outward about the distal end of the proximal post portion 636. The engaging portion 660 can be threaded outward to threadably engage the internal thread at the proximal end opening of the receiving portion 634. In another form, the engagement portion 660 is threaded inward to engage a male thread on the receiving portion 634. Other coupling configurations are also contemplated, such as, for example, a friction or interference fit, fusion, adhesive, fastener, inset lock, and snap fit. The engagement portion 660 includes at least one window 648, the crown 650 includes a seat 652, and the seat 652 includes at least one window 648 so that it contacts the plate 600 when positioned about the post 632. Formed by at least one axially extending arm 653 projecting therethrough. When the locking member 590 is positioned against the plate member 600, the locking member 590 firmly engages the plate member 600 with one or more arms 653 of the crown 650.

  In the illustrated embodiment, the engagement portion 660 includes four windows 648 spaced around it, the windows also being elongated in the circumferential direction. The crown 650 includes four arms 653 that define a seat 652 that extends axially through each one of the four windows 648. Another embodiment contemplates a configuration having two arms and windows, three arms and windows, or five or more arms and windows. It is further contemplated that a particular anchor assembly need not be provided with the same number of arms and windows. The crown 650 can be engaged with the anchor member 70 and can be configured in any of the various ways discussed above with respect to the crown 550.

  The crown 650 is received within the coupling member 630 adjacent to the anchor member 70 and includes at least one seat 652 that extends outwardly from the engagement portion 660 through one of the windows 648. The locking member 590 can engage the post 632 to secure the plate member 600 to the crown 650, as shown in FIG. The downward or distal locking force provided by engagement of the locking member 590 also forces the crown 650 to anchor the anchor member 70 in a desired position relative to the coupling member 630 and post 632. It can be fixed on the proximal end of the member 70. In one embodiment, the crown 650 includes a lower cup portion 654 that lowers the anchor member 70 within the receiving portion 634 before at least the locking member 590 is engaged with the implant. It has an outer surface profile that is conformal to the inner surface profile of the receiving portion 634 to allow for pivotal movement of the head.

  The engagement member 630 includes a lower receiving portion 634 that is centered about the longitudinal axis 621, the engagement portion 660 being engageable at the proximal end of the receiving portion 634, from the engagement portion 660 to the post portion. 636 extends proximally along axis 621. The post portion 636 has a smaller size compared to the receiving portion 634 so that the post portion 636 can pass through the opening of the plate member, and at least a portion of the engaging portion 660 and the receiving portion 634 is Sized to prevent passage through the opening 604 of the plate member 600. Post 632 includes a circular outer surface having a male thread profile for threadably engaging locking member 590. The post 632 can also be configured with opposing flats along its outer surface, as discussed above.

  Post 632 can also define a proximally open tool engagement passageway that facilitates rotating post portion 636 and engagement portion 660 about longitudinal axis 621. And an inner surface that is configured to engage the tool with a non-circular cross-section. Sizing the passage to engage the anchor member 70 captured within the receiving portion 634 and allow the passage of drive equipment to apply a drive force directly through the post 632 to the anchor member 70. Can do.

  Referring to FIGS. 35 and 36, another embodiment of an anchor assembly 720 similar to the anchor assembly 620 discussed above is shown. Anchor assembly 720 is positioned axially through an anchor member 70 pivotally received within coupling member 630 and an axially extending window of engagement portion 760 positioned adjacent to the head of anchor member 70. An extending crown 650 is provided. Post 732 includes a post portion 736 that is similar to post 632 but has a smooth, unthreaded outer surface that extends along a substantial portion of its length. In one form, the smooth portion 736 has a length sufficient to receive a connector that engages another spinal implant, such as a rod or tether. The distal end of post 732 includes a screw profile 733 for threadably engaging locking member 590.

  As discussed above with respect to anchor assembly 620, locking member 590 brings the distal end of body 592 into contact with the axially extending arm of crown 650 to secure anchor member 70 in place. Engagement can occur along the screw profile 733 to position. A connector or another implant can be engaged with the post 732 proximal to the locking member 590. The connector can be secured in place by engaging post 732 with a set screw, clamp configuration, friction fit, or other suitable coupling configuration. Another embodiment contemplates that a second locking member can be engaged with post 732 proximal to the connector to clamp the connector between the locking members.

  In one technique using the anchor assemblies discussed herein, the plate member is sized to contact adjacent vertebrae and includes at least one opening adjacent to the vertebrae, and thus the anchor assembly. When the anchor member engages the underlying bone structure, the coupling member of the anchor assembly can be placed through the at least one opening. In another embodiment, the anchor assembly can be temporarily captured on the plate member using a locking member prior to engaging the bone structure. The plate member can also be sized and configured to extend over three or more vertebrae for multi-level stabilization, or can be positioned along two or more vertebrae Can be configured to engage a single vertebra with a receiving member for receiving an elongate coupling element.

  The plate member can be pre-bent to have a curvature or bend during surgery, for example, to reproduce or conform to the natural or desired curvature of the spine. It will be appreciated that any curvature suitable for one or more segments of the spine (whether cervical, thoracic, lumbar or sacral) can be incorporated into the plate member. Such curvature can include fully convex, completely concave, completely straight (ie essentially flat), and combinations thereof. It is further contemplated that the plate can be engaged with an anterior bone portion, an oblique bone portion, a lateral bone portion, or a posterior bone portion of one or more vertebrae.

  The illustrated plate member embodiment does not show a retaining member on or engageable with the plate member to prevent or inhibit retraction of the locking member. However, the plate member may comprise one or more retaining elements to prevent any part of the anchor assembly from retracting relative to the plate member. The retaining member is either a set screw, set screw and washer, spring-loaded member, sliding washer, or another similar device that is attached to, captured on, or integrally formed with the plate member It can be one or a combination.

  To facilitate use, a kit can be provided that includes one or more parts of any one or combination of implant assemblies. For example, the kit can include several embodiments of plate members having several different lengths, sizes, slot configurations, and / or curvatures. Lengths or sizes suitable for cervical, thoracic, lumbar and / or sacral implantation may be included. In such a kit, one or more sets of polyaxes having various anchor member sizes and coupling members adapted to attach to one or more of the cervical, thoracic, lumbar and sacral regions And a single axis anchor assembly can be provided. The kit can further include a plurality of multi-axis anchor assemblies, including those configured to provide strong and dynamic stabilization of the spinal column when engaged with the plate member.

  One method of using one or more multi-axis anchor assemblies as discussed herein will now be described. The anchor assembly uses an open surgical procedure in which skin and tissue are retracted, and one or more minimally invasive access access paths formed by a microincision, retractor, sleeve, and expansion sleeve Can be used in minimally invasive surgical procedures in which the anchor assembly and / or plate member is positioned within the patient.

  In one procedure, the surgeon creates an incision in the patient at a location that is relatively close to the vertebra or other bone (s) to which the implant is to be attached. After a suitable access path to the surgical site is obtained, a portion of the lower vertebra (eg, pedicle) to which the instrument is attached is prepared in a standard manner. For example, a drill or drill can be used to prepare the hole, which is then probed for depth and tapped if appropriate for the anchor member. One of the anchor members is then inserted into the hole in the lower vertebra with the coupling member engaged therewith. The previous or separate incision then provides an access path to the portion of the upper vertebra (eg, pedicle) to which the instrument is attached. The point on the upper vertebra where the implant is to be attached is identified and the vertebra is prepared as described above. Another anchor assembly is engaged to the upper vertebra and the at least one anchor assembly is a multi-axis anchor assembly. As discussed above, the at least one multi-axis anchor assembly can be configured to provide robust or dynamic stabilization when engaged with the plate member. The process is repeated between the upper and lower vertebrae for one or more vertebrae as needed.

  The plate member is then inserted into the anchor assembly directly through the incision or through an access tube or retractor. Each post of the at least one multi-axis anchor assembly coupling member is positioned through the opening in the plate member or loaded from the bottom therethrough. The orientation and axial position of the coupling member relative to the anchor member and the plate member can be adjusted. When the plate member and anchor assembly are in a desired position relative to each other and to the spine, the locking member can be advanced to secure the anchor assembly and plate member in the desired position relative to each other. . Prior to final fixation of the plate member to the anchor assembly, the vertebra can be compressed or distracted and maintained in this position with the fixed plate member. It is further contemplated that one or more intervertebral disc spaces or posterior elements between vertebrae can be fused with any one or combination of bone graft, bone material, and plant. In an anchor assembly that uses a coupling member having an extension post, the post extension can be removed after the plate is secured to the anchor assembly.

  It is further understood that the embodiments described above should be made of a material suitable for implantation in a human or other body and can be composed of an inert metal such as titanium or stainless steel. Will be done. Other sturdy materials such as certain ceramics or plastics can be taken into account. Bioabsorbable materials can be used in addition to or as part of the components described above, such as polylactic acid compositions. In one embodiment, a non-metallic plate can be used with the anchor assembly. The engagement of the anchor assembly to the non-rigid plate has at least some flexibility for flexible spinal stabilization and allows at least limited movement at the vertebral level to which the instrument is attached. By providing an anchor assembly configured to dynamically engage the plate member to the spinal column as discussed above, spinal motion is improved.

  Although the invention has been illustrated and described in detail in the drawings and foregoing description, the invention is to be considered as illustrative and not restrictive in character; only the preferred embodiments are illustrated. It should be understood that all changes and modifications within the spirit of the invention are desired to be protected as well as what has been described.

It is a disassembled perspective view of a multi-axis anchor assembly. FIG. 2 is an exploded elevation view of the anchor assembly of FIG. 1. FIG. 2 is an assembly elevation view of the anchor assembly of FIG. 1. FIG. 4 is an assembled elevational view of the anchor assembly of FIG. 1 rotated 90 ° about the longitudinal axis from the orientation of FIG. 3. FIG. 5 is a top view of the anchor assembly of FIG. 4. It is sectional drawing of the coupling member which comprises a part of anchor assembly of FIG. It is sectional drawing of the crown part which comprises a part of anchor assembly of FIG. It is a perspective view of the crown of another embodiment. It is sectional drawing of the crown part of another embodiment. It is sectional drawing of the locking member which can be engaged with the coupling member of the anchor assembly of FIG. FIG. 2 is a cross-sectional view of the anchor member of the first embodiment of the anchor assembly of FIG. 1. FIG. 6 is a cross-sectional view of another embodiment anchor member of the anchor assembly of FIG. 1. FIG. 9 is an elevation view of the plate member secured to the multi-axis anchor assembly of FIG. 1 using the locking member of FIG. 8 with the plate member secured to the single-axis anchor. FIG. 14 is a cross-sectional view through line 14-14 of FIG. It is a top view of the plate member of one embodiment. FIG. 16 is an elevational view of the plate member of FIG. 15. FIG. 17 is a cross-sectional view taken through line 17-17 of FIG. FIG. 16 is an elevational view of the plate member of FIG. 15 having a curved longitudinal profile. It is a top view of the plate member of another embodiment. It is a top view of the plate member of another embodiment. FIG. 6 is a perspective view of another embodiment plate member having a rod receiving portion. It is an elevational view of an apparatus for holding a plate member. FIG. 22B is a top view of the device of FIG. 22A. FIG. 22B is an enlarged view of the distal retention portion of the device of FIG. 22A in a first orientation. FIG. 22B is an elevational view of the device of FIG. 22A with the retaining portion in a second orientation. FIG. 22B is a top view of the device of FIG. 22A with the retaining portion in a second orientation. FIG. 6 is an exploded elevation view of another embodiment of a multi-axis anchor assembly. FIG. 24 is an elevational view of the anchor assembly of FIG. FIG. 25 is an elevational view of the anchor assembly of FIG. 24 rotated 90 ° about the longitudinal axis. It is sectional drawing of the coupling member which comprises the anchor assembly of FIG. FIG. 6 is an exploded elevation view of another embodiment of a multi-axis anchor assembly. FIG. 28 is an elevational view of the anchor assembly of FIG. 27. FIG. 29 is an elevational view of the anchor assembly of FIG. 28 rotated 90 ° about the longitudinal axis. FIG. 7 is a perspective view of another embodiment multi-axis anchor assembly engaged with a plate member. FIG. 31 is an exploded view of the plate member and anchor assembly of FIG. 30. FIG. 32 is a cross-sectional view of the plate member and anchor assembly of FIG. 31. FIG. 6 is an exploded view of another embodiment multi-axis anchor assembly engaged with a plate member. FIG. 34 is a perspective view of the anchor assembly and plate member of FIG. 33. FIG. 6 is an exploded view of another embodiment multi-axis anchor assembly engaged with a plate member. FIG. 36 is a perspective view of the anchor assembly and plate member of FIG. 35.

Claims (75)

An anchor assembly,
An anchor member having a head and a lower portion extending from the head for engaging a bone element;
A coupling member pivotally coupled to the head of the anchor, wherein the coupling member defines an inner receptacle for receiving the head; A post extending in a direction away from the portion, the post configured to engage a locking member, and the lower receiving portion defining at least one side wall opening communicating with the exterior of the coupling member. An engaging member;
A crown positioned about the head of the anchor member within the receptacle of the coupling member, the crown comprising a seat, the seat comprising the implant member and the locking member A crown that communicates with the at least one sidewall opening to be positioned in contact with the implant member positioned about the post of the coupling member for securing between the seat and the seat; An anchor assembly.   The assembly of claim 1, wherein the lower portion of the anchor member comprises a threaded shaft.   The assembly of claim 2, wherein the anchor member comprises an unthreaded neck portion between the head and the threaded shaft.   The clip further comprises a clip positioned about the neck portion and extending between the coupling portion and the head, the clip holding the anchor member in the coupling member to hold the clip in the head The assembly of claim 3, wherein the assembly is sized to prevent passage of water.   The assembly of claim 1, wherein the head comprises a plurality of ridges extending around and directed toward the crown.   The plurality of ridges engage the crown when the implant is secured to the seat using the locking member, and the engagement between the ridge and the crown is The assembly of claim 5, wherein the anchor member is prevented from pivoting relative to the coupling member.   The seat of the crown includes an arm extending therefrom, the at least one sidewall opening of the coupling member includes an opposing window, and the arm is positioned through each one of the opposing windows. Item 4. The assembly according to Item 1.   8. The assembly of claim 7, wherein the crown includes a cup portion extending from the seat, and the cup portion includes a receptacle for receiving the head of the anchor member therein.   The assembly of claim 8, wherein the crown includes a through hole extending through the seat and into the receptacle of the cup portion.   The assembly of claim 1, wherein the post comprises an external thread for threadably receiving the locking member thereabout.   The locking member comprises a body having a wall extending around a central bore, the central bore receives the post when the locking member is engaged therewith, and the wall includes a slot; The assembly of claim 10, wherein the slot extends through the wall and in communication with the bore transversely to the bore.   The assembly of claim 1, wherein the post comprises opposing flat surfaces, the flat surfaces extending along the length of the post and interconnected by opposing curved threaded surfaces.   The assembly of claim 1, wherein the post defines an axial passage in communication with the receptacle. A spinal plate mounting system,
An elongate plate member comprising at least one opening extending through the plate member between an upper surface and a lower surface opposite the upper surface, the lower surface being positionable along the spine;
An anchor assembly engageable with the plate member, the anchor assembly comprising:
A coupling member having a post positionable through the at least one opening and a receiving portion positionable adjacent a lower surface of the plate member and comprising a receptacle;
An anchor member comprising a head pivotally captured within the receptacle of the receiving portion, and a lower portion extending from the head to engage the bone structure of the spinal column;
A crown positioned adjacent to the head in the receptacle, the crown including a seat extending through the coupling member and along the lower surface of the plate member;
A locking member that is engageable with the post and that can be positioned in contact with the upper surface of the plate to fix the lower surface of the plate member in contact with the seat portion of the crown. A spinal plate mounting system comprising:   The system of claim 14, wherein the coupling member comprises at least one window and the seat projects from the at least one window.   15. The system of claim 14, wherein the coupling member comprises an opposing window and the seat comprises an opposing arm that projects through each one of the opposing windows.   The system of claim 14, wherein the lower portion of the anchor member comprises a threaded shaft.   The system of claim 17, wherein the anchor member comprises an unthreaded neck portion between the head and the threaded shaft.   The clip further comprises a clip disposed about the neck portion and extending between the coupling member and the head, the clip holding the anchor member within the receptacle of the coupling member. The system of claim 18, wherein the system is sized to prevent the head from passing.   The system of claim 14, wherein the head comprises a plurality of ridges around which extend adjacent to the crown.   When the plate member is fixed to the seat using the locking member, the plurality of ridges engage the crown, and the engagement between the ridge and the crown is the 21. The system of claim 20, wherein the anchor member is prevented from pivoting relative to an engagement member.   The system of claim 21, wherein the crown includes a cup portion extending from the seat, and the cup portion includes a receptacle for receiving the head of the anchor member therein.   23. The system of claim 22, wherein the crown includes a through hole extending through the seat and into the receptacle of the cup portion.   The system of claim 14, wherein the post comprises an external thread extending along the post for threadingly receiving the locking member about the post.   The locking member comprises a body having a wall portion extending around a central bore for receiving the post, the wall portion comprising a slot, the slot penetrating the wall portion and transverse to the bore. 25. The system of claim 24, wherein the system extends in communication with the bore in a direction.   The system of claim 14, wherein the at least one opening of the plate member comprises an elongated slot.   27. The system of claim 26, wherein the plate member comprises a rod receiving portion, the rod receiving portion defining a passage extending transversely to the elongated slot, the passage receiving a rod passing through the passage. .   The system of claim 14, wherein the plate member comprises a curved profile along the top and bottom surfaces.   The system of claim 14, wherein the plate member comprises a plurality of slots along the plate member. A spinal plate mounting system,
An elongate plate member comprising at least one opening extending along a longitudinal axis and extending between the upper surface and an opposite lower surface through the plate member, the lower surface being positionable toward the spinal column;
An anchor assembly engageable with the plate member, the anchor assembly comprising:
A coupling member comprising a post, wherein the post is positionable through the at least one opening, engageable with the plate member such that the coupling member does not pivot relative to the plate member; A coupling member, wherein the coupling member comprises a receiving portion positionable along the lower surface of the plate member, the receiving portion comprising a receptacle opening away from the plate member;
An anchor member comprising a head pivotally captured within the receptacle of the receiving portion, the anchor member comprising a lower portion extending from the head to engage the bone structure of the spinal column, the post being the A spinal plate system, comprising: an anchor member that pivots relative to the plate member and the receiving portion when engaged with the plate member within at least one opening. The anchor assembly is
A crown disposed within the receptacle of the coupling member adjacent to the head of the anchor member, the crown including a seat extending through the coupling member and along the lower surface of the plate member; ,
A locking member engageable with the post and positionable in contact with the upper surface of the plate member to fix the lower surface of the plate member in contact with the seat portion of the crown portion; 32. The system of claim 30, comprising:   32. The system of claim 31, wherein the coupling member comprises an opposing window that opens into the receptacle, and wherein the seat of the crown extends through the window.   The locking member engages the plate member such that the lower surface of the plate member is firmly engaged with the seat, thereby engaging the crown with the head of the anchor member. 32. The system of claim 31, wherein the anchor member engages non-pivotally within the receiving portion when positioned in contact with a top surface.   The crown portion includes a cup portion extending from the seat portion, the cup portion defines a receptacle for receiving the head portion of the anchor member, and the head portion of the anchor member includes the anchor member. 34. The system of claim 33, comprising a plurality of ridges for engaging the cup portion for non-pivoting fixation within the coupling member.   When the locking member is positioned in contact with the upper surface of the plate member such that the lower surface of the plate member is firmly engaged with the seat portion of the crown portion, the anchor member is 32. The system of claim 31, wherein the system pivots within the coupling member.   32. The system of claim 30, wherein the opening of the plate member includes at least one elongated slot along the longitudinal axis of the plate member.   31. The system of claim 30, wherein the plate member is curved along the longitudinal axis such that the top surface is concave and the bottom surface is convex.   32. The system of claim 30, wherein the plate member comprises a rod receiving portion that defines a passage for receiving an elongated rod.   40. The system of claim 38, wherein the at least one opening is an elongated slot extending transversely to the passage.   32. The system of claim 30, wherein the lower portion of the anchor member comprises a threaded shaft.   41. The system of claim 40, wherein the anchor member comprises a lumen that extends from the head through a distal end of the threaded shaft.   42. The system of claim 41, wherein the head comprises a tool that engages a recess in communication with the lumen.   32. The system of claim 30, wherein the coupling member comprises an internal passage extending axially through the post and in communication with the receptacle.   44. The system of claim 43, wherein at least a portion of the passage is configured to engage a drive tool.   44. The system of claim 43, wherein the head portion of the anchor member comprises a tool engagement recess in communication with the receptacle.   The anchor assembly comprises a crown around the head of the anchor member within the receptacle position, the crown being aligned with the passage of the coupling member and the tool engaging recess of the anchor member 46. The system of claim 45, comprising possible through holes. A spinal surgery method,
Accessing at least one vertebra of the spine;
Engaging an anchor member of an anchor assembly with the at least one vertebra, the anchor assembly comprising a coupling member, the coupling member being pivotally mounted about a head of the anchor member; Engaging with a receiving portion and a post extending proximally from the receiving portion;
Moving the post by pivoting the receiving portion around the head of the anchor member to a desired position;
Positioning an elongated plate member around the proximal end of the post;
Advancing the plate member along the post to a position adjacent to the receiving portion;
Engaging the plate member outside of the coupling member with a crown extending from the head of the anchor member through the coupling member to engage the plate member. Surgery method.   48. The method of claim 47, wherein engaging the plate member engages the crown with the head of the anchor member.   49. The method of claim 48, wherein the step of engaging the plate member with the crown firmly connects the coupling member to the anchor member.   48. The method of claim 47, wherein the coupling member pivots relative to the anchor member when the plate member is engaged with the crown. An anchor assembly,
An anchor member comprising a proximal end and a distal end extending from said proximal end for engaging a bone element;
A coupling member pivotally coupled to the proximal end of the anchor, the coupling member extending along a longitudinal axis and defining an internal receptacle extending about the axis to receive the proximal end; And a post extending from the receiving portion along the axis and away from the proximal end, the coupling member extending in at least one axial direction communicating with the exterior of the coupling member A coupling member defining a window;
A member engageable with the post;
A crown positioned within the receptacle of the coupling member adjacent to the proximal end of the anchor member, wherein the crown is positioned in contact with the member engaged with the post of the coupling member. And a crown with a seat extending axially in communication with the at least one window.   52. The assembly of claim 51, wherein the post comprises an internal passage extending along the longitudinal axis and in communication with the receptacle of the receiving portion.   52. The assembly of claim 51, wherein the anchor member comprises a threaded shaft along the distal portion and an enlarged head at the proximal end.   And further comprising a retaining clip positioned about the neck portion and extending between the coupling member and the head, the retaining clip being on the coupling member around an opening directed distally of the receptacle. A threaded portion for threaded engagement, wherein the retaining clip includes a radially extending flange, the flange extending around the head of the anchor member, and the anchor member within the coupling member 54. The assembly of claim 53, wherein the assembly is sized to prevent the head from passing through the flange for retention.   54. The assembly of claim 53, wherein the head comprises a plurality of ridges extending around and directed toward the crown.   When the member is fixed to the seat, the plurality of ridges engage the crown, and the engagement between the ridge and the crown is relative to the coupling member. 56. The assembly of claim 55, wherein the member prevents pivoting.   52. The assembly of claim 51, wherein the post is smooth along a substantial portion of its length.   58. The post of claim 57, wherein the post comprises a thread profile adjacent its distal end, and the member is a locking member that contacts the seat and is threadably engageable with the thread profile. assembly.   The seat of the crown includes a plurality of axially extending arms, the at least one window of the coupling member includes a plurality of axially extending windows, and the plurality of arms each includes the plurality of arms. 52. The assembly of claim 51, positioned through each one of the windows.   60. The assembly of claim 59, wherein the crown includes a distally open cup portion extending from the seat, and the cup portion includes a receptacle for receiving the proximal end of the anchor member therein.   The multiple arms include at least three arms distributed circumferentially around the crown, and the multiple windows include at least three windows distributed circumferentially around the coupling member. 60. The assembly of claim 59, comprising.   52. The assembly of claim 51, wherein the post comprises a circular cross section and a male thread provided about the post for threadably engaging the member.   The post includes a distal engagement portion that extends radially about the distal end of the threaded post portion, the engagement portion threadably engaged with a proximal end opening of the lower receiving portion. 52. The assembly of claim 51, which is possible.   64. The assembly of claim 63, wherein the at least one window extends through the engagement portion of the post. In spinal implant systems,
An implant comprising at least one opening extending through the implant and extending between an upper surface and a lower surface opposite the upper surface, the lower surface being positionable toward the spine;
An anchor assembly engageable with the implant, the anchor assembly comprising:
A coupling member comprising a post positionable through the at least one opening and a receiving portion positionable along the lower surface of the plate, the receiving portion being in communication with the receptacle and the receptacle A coupling member comprising at least one window that opens proximally;
An anchor member comprising: a head pivotally received within the receptacle of the receiving portion; and a distal portion extending from the head to engage the bone structure of the spine.
A retaining clip engageable with the coupling member in a distally directed opening of the receptacle to pivotally capture the head within the receptacle;
A crown positioned about the head of the anchor within the receptacle, the crown comprising at least one seat extending through the proximally opening window to be positioned in contact with the implant; The crown,
A spinal implant system comprising a locking member engageable with the post in contact with the implant for contacting the implant with the seat and securing the implant to the coupling member.   66. The system of claim 65, wherein the post comprises an internal passage extending along the longitudinal axis and in communication with the receptacle of the receiving portion.   The retaining clip includes a threaded portion that threadably engages the coupling member about the distally directed opening of the receptacle, the retaining clip including a flange extending radially inward; The flange extends around the head of the anchor member and is sized to prevent the head from passing through the flange to retain the anchor member within the coupling member. The system according to 65.   The seat of the crown includes a plurality of axially extending arms, the at least one window of the coupling member includes a plurality of axially extending windows, and the plurality of arms each includes the plurality of arms. 66. The system of claim 65, wherein the system is positioned through each one of the windows.   The plurality of arms comprises at least three arms arranged circumferentially around the crown, and the plurality of windows comprises at least three windows arranged circumferentially around the coupling member. 69. The system of claim 68, comprising. A spinal surgery method,
Engaging the anchor member of the anchor assembly with at least one vertebra, the anchor assembly comprising a coupling member, the coupling member defining a receptacle for receiving the anchor member; and A proximally extending post and a crown within the receptacle and adjacent to a proximal end of the anchor member, wherein the crown extends from the receptacle to a location outside the receptacle. An engaging step comprising:
Pivoting the coupling member relative to the engaged anchor member to direct the post to a desired position;
Advancing a member along the post to a position adjacent to the anchor member;
Engaging the member against the at least one seat of the crown to engage the crown with the proximal end of the anchor in the receptacle. Method.   The proximally extending seat comprises a number of arms extending proximally of the crown, and the coupling member comprises a corresponding number of proximally directed windows, the windows passing through the windows 71. The method of claim 70, wherein the method is in communication with the receptacle for receiving a respective one of the arms.   72. The method of claim 71, wherein the multiple arms include at least three arms and the multiple windows include at least three windows.   71. The method of claim 70, wherein engaging the plate member comprises firmly securing the anchor member within the coupling member.   71. The method of claim 70, wherein the post is threadably engaged to the receiving portion.   The post includes a distal engagement portion projecting radially outward from a proximal post portion, the distal engagement portion receiving a plurality of windows for receiving a plurality of arms extending proximally from the crown 75. The method of claim 74, comprising:

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