JP2008541862A - Spinal implant device - Google Patents

Abstract

An orthopedic implant that can be used for spinal applications is disclosed. In one embodiment, the plate portion (1, 101) comprises a threaded protrusion (5) that can be fitted with a connector for attachment to an orthopedic rod. The protrusion (5) can be oriented in a multiaxial manner with respect to the plate portion (1, 101). The plate portion can include a dome (8) having an inner surface (26) that can be conical, in which a portion of the protrusion (5) can extend. A pin (27) may be provided to hold the protrusion (5) in place relative to the dome (8). A second plate portion (13, 104) can be provided that can be coupled to bone such as the iliac or sacrum. The second plate portion may be integral with or movable with respect to the first plate portion (1, 101).
[Selection] Figure 1

Description

  The present invention relates to a spinal column implant device.

  The present application is 35 U.S. Pat. S. C. 119 claims the priority of French patent application No. 0405691 (filed May 26, 2004) and French patent application No. 0405692 (filed May 26, 2004).

  Devices and systems for correcting spinal deformities often include one or more rods that extend along a portion of the spine. In the example of the sacral region of the spinal column, such a rod is typically secured to the patient's sacrum with a plate. The plate can be positioned, for example, across the vertebrae S1 and S2, and can support a protrusion to which a device such as a slotted connector is fitted and secured. A rod can be crossed over such a slotted connector, and the rod can be fixed by a wedge stop action. Examples of such plates are described, for example, in WO 02/38061.

  This device is also known to provide a plate that is secured to one of the patient's vertebrae (eg, S1) and the iliac rather than two vertebrae such as S1 and S2. To this end, the plate may include a lateral extension with an orifice for passing a bone anchor screw at one of its ends. This lateral extension is oriented in the direction of the iliac and is therefore located outside the plane of the plate and forms an angle with this plane of the plate, usually on the order of 50 degrees. This allows the iliac bone to be connected to the rod. Sacral plates with iliac extensions are available in various sizes and are used according to patient configuration. In many cases, however, the adaptation of the plate to the exact patient configuration is only a rough one.

  For a better understanding of the principles of the present invention, reference will now be made to the embodiments illustrated in the drawings. It will be understood that although specific language is used in the description, it is not intended to limit the scope of the invention. Any and all modifications and further modifications of the illustrative apparatus, as would normally occur to those skilled in the art, and further applications of the principles of the invention illustrated herein are contemplated.

  Referring initially to FIGS. 1-7 generally, one embodiment of an implant is shown. In this exemplary embodiment, the implant has two parts. The plate 1 can be fixed to the patient's sacrum, for example, the vertebra S1. In this exemplary embodiment, the plate 1 is oblong or elongated and is secured with a bone anchor 2. The bone anchor may be a bone screw. The plate 1 includes an opening 3 and, in a particular embodiment, includes a hole 4 that can be threaded, at least slightly overlapping the opening 3. The anchor 2 passes through the opening 3 of the plate 1 and contacts the bone. In an embodiment having a threaded hole 4, a plug or screw (not shown) can be screwed to secure the head of the screw 2 and prevent it from moving out of position after placement. The upper surface 40 and the lower surface 24 of the plate 1 may be substantially flat.

  The exemplary embodiment of the plate 1 also has a protrusion or shaft 5 and a dome 8. The shaft 5 has a longitudinal axis and in certain embodiments is threaded so that a connector 6 can be fitted around at least a portion of the shaft 5 as described in detail below. In the example shown, the lower part of the protrusion 5 includes a spherical surface 19, traversed by a slot 20 that is substantially perpendicular to the protrusion 5. As can be seen from FIG. 5, the exemplary embodiment of the slot 20 is defined by a V-shaped upper surface 21 whose apex 22 is substantially on the axis of symmetry 23 of the protrusion 5. The upper portion of the shaft 5 includes a notch or low resistance wire 30 and a head portion 44 that allow the shaft 5 to be cut or folded relatively easily. The head portion 44 can be a hexagonal structure as in this exemplary embodiment. Alternatively, round lobes, slots, internal markings or other structures may be included to allow gripping, holding, rotation, and / or other manipulations.

  In this exemplary embodiment, the dome 8 extends above the upper surface 40 of the plate 1 and is curved and, in certain embodiments, can form a portion of a sphere, and certain embodiments. Has an inner surface 26 that is substantially conical. The dome 8 at least partially surrounds an orifice 25 that extends through the plate 1, for example from its upper edge to the lower surface 24 of the plate 1. One or more holes 48 may be disposed through the dome 8, and the holes 48 may extend from the inner surface 26 through the dome 8 to the outer surface 46. As will be described in detail below, the shaft 5 is inserted into the orifice 25 such that its surface 19 is adjacent or in contact with the inner surface 26 of the dome 8. In this exemplary embodiment, a pin 27 is also provided that is inserted into one or more holes 48 of the dome 8 after the shaft 5 is inserted into the orifice 25. The pin 27 can extend through the slot 20 of the shaft 5 and the apex 22 can be located directly above the pin 27. In one particular embodiment, the pin 27 has a diameter that is substantially equal to the width of the slot 20 to prevent the protrusion 5 from rotating significantly about the axis 23. The pin 27 suppresses the protrusion 5 from falling from the orifice 25.

  The protrusions 5 can be fixed, for example, substantially perpendicular to the upper surface of the plate 1, or, as in the example shown, can be pivoted and / or called “multi-axis”, ie apex It may be of a type that can be oriented inside a cone whose angle can be about 30 degrees. The means for ensuring this multi-axis orientation can be of various types, examples of which are illustrated in detail below.

  The exemplary embodiment of plate 1 also includes a longitudinal rod 10 extending therefrom. The rod 10 can be directed towards the lower part of the sacrum. The rod 10 may be substantially cylindrical and may be of any desired length or diameter that is compatible with spinal fixation. In the illustrated embodiment, the rod 10 has a length comparable to or slightly shorter than the length of the plate 1 and has a diameter comparable to or slightly larger than the distance between the surfaces 40 and 24 of the plate 1. Is shown to have.

  A lateral extension plate 13 is connected to the plate 1. In this exemplary embodiment, the plate 13 includes a portion 50 having an orifice 12 sized and structured to accommodate at least a portion of the rod 10 of the plate 1 and an opening 52 intersecting the orifice 12. The opening 52 can be threaded to receive a threaded plug or screw 11. The plate 13 also includes a portion 54 with an opening 14 for receiving the bone screw 15. Portion 54 is for locating adjacent or in contact with the patient's iliac 16 in one particular embodiment. Further, the exemplary embodiment of portion 54 includes two sub-portions 54a and 54b, each located substantially in a plane, which are angled with respect to each other. The plane of the portion 54 a is also angled with respect to the portion 50. Thus, the rod 10 of the plate 1 can be inserted into the orifice 12 of the plate 13 and can be secured with a threaded plug or screw 11 inserted into the opening 52. The openings 14 in the plate 13 allow implantation of screws 15 (FIG. 2) that penetrate the patient's iliac 16 to secure the plate 13 there.

  The exemplary embodiment of the connector 6 includes an upper portion 58 and a lower portion 60 connected by a joint portion 62. A slot 64 separates the upper portion 58 and the lower portion 60 in a normal or unstressed structure. A channel 66 passes through the coupler 6. The channel 66 is sized and structured to accommodate at least a portion of the spinal rod 7. A hole 29 is also provided through the upper portion 58 and the lower portion 60. In certain embodiments, the holes can be coaxial. In one particular embodiment, the contact between the spherical outer surface 46 of the dome 8 and the coupler 6 is a spherical and conical contact. To that end, the hole 29 can have a conical inner surface 28 as shown in FIG. As will be described in detail below, the connector 6 can be secured to the dome 8 carried by the plate 1 with a nut 9, which closes the slot 64 of the connector 6 and allows the rod 6 to be connected with the connector 6. The clamp can be fixed. The nut 9 includes an upper portion 70 and a lower portion 72 separated by a notch or low resistance wire 31.

  To assemble the exemplary embodiment, the protrusion 5 is engaged through the lower surface 24 of the plate 1 and passed through the orifice 25 located at the top of the dome 8. Therefore, the surface 19 of the protrusion 5 contacts the inner surface 26 of the dome 8. The pin 27 can then be fitted. The pin passes through the dome 8 and is located in a slot 20 that crosses the lower portion of the protrusion 5. As can be seen from FIG. 5, the apex 22 of the V-shaped upper surface defining the slot 20 is located above the pin 27, and in this embodiment, the apex 22 allows the vertical clearance of the protrusion 5 inside the dome 8. Is very acceptable. The protrusion 5 can pivot around the pin 27 to an allowable angle by the dome 8 and is allowed by the depth of the slot 20 in the plane defined by the longitudinal axis 23 of the protrusion 5 and the pin 27. You can turn to an angle. The exemplary embodiment of the pin 27 has a diameter substantially equal to the width of the slot 20 and prevents the protrusion 5 from rotating significantly around the axis 23. The structure of the lower part of these protrusions 5 and the inner surface of the dome 8 provides a complete multi-axial orientation of the protrusions 5 (generally within a cone of approximately 30 degrees angle).

  Plate 1 is connected to plate 13 by inserting rod 10 into and / or through orifice 12. Before locking the plug 11, the plate 1 can be rotated relative to the plate 13 as shown by arrow 17 (FIG. 1) and translated longitudinally as shown by arrow 18 (FIG. 1). . This makes it possible to create a specific relationship between plate 1 and plate 13 with respect to angle and distance. The plate 13 is attached to the bone by inserting screws 15 through the openings 14 in the plate 13 and into the bone (in the specific embodiment, the iliac bone). The plate 1 is attached to the bone by inserting a screw 2 through the opening 3 in the plate 1 and into a bone (in a particular embodiment, a sacrum such as S1). In the embodiment having the hole 4, as described above, a plug is disposed in the hole 4 so as to cover at least a part of the screw 2 in order to suppress the retraction of the screw 2.

  The connector 6 is arranged over the shaft 5 so that the shaft 5 at least partially enters the inside of the hole 29. As described above, in some embodiments, the shaft 5 is pivoted to position the connector 6, or once the connector 6 is positioned so that assembly can be completed, or for other purposes of the surgeon. Or it can be moved in other ways. The nut 9 is screwed into the shaft 5 and tightened as desired by the surgeon to tighten the coupler 6 between the nut 9 and the dome 8 of the plate 1. By such tightening, the spinal rod 7 is clamped and fixed by the connecting tool 6, and the connecting tool 6 and the plate 1 are also connected. Depending on the structure provided to the coupling 6, it is possible to automatically return the projection 5 to a substantially vertical orientation relative to the plate 1 after tightening the nut 9 (thus, for example, the projection The multiaxial nature of the part 5 only worked during the implantation of this orthodontic device) or, as shown in one embodiment of FIG. It may be possible to hold.

  After fitting such a device in place, the surgeon typically removes the extra parts of the protrusion 5 and nut 9. For example, in one embodiment, torque may be applied until the notches 30 and / or 31 are broken, or the notches 30 and 31 may serve as markers for cutting each piece. If necessary, it is also possible to arrange such a low resistance wire on the longitudinal rod 10 of the plate 1 so that it is easy to shorten the portion of the rod 10 extending beyond the plate 13. However, care must be taken that these low resistance wires do not significantly impair the mechanical strength of the rod 10 while being stressed after fitting the device.

  The plate 13 may be provided with a plurality of models having various geometries and sizes, such as that shown fitted to the same rod 7 in FIG. 8, and selected from the plurality of models. These examples range from a substantial extension to a substantially circular shape, some of which show an opening 14 that includes the angled portion of the plate 13 described above, but this implant geometry can be It is part of the structure that can be formed to best fit the form and the exact fixation site of the implant. Using such a model, it is possible to achieve a variety of implant geometries using a single plate 1 model.

  In another embodiment shown in FIG. 9, an implant comprising a lateral extension plate 13 substantially as described above, with the spinal rod 7 inserted directly into the orifice 12 of the plate 13, is screwed into the iliac 16. It is fixed with. In this illustrated example, the rod 7 is secured to other parts of the spinal column with a slotted connector 6 attached to a protrusion carried by a bone anchor screw.

  Turning next to FIGS. 10-14, another embodiment of an implant including a plate 101 is shown. The plate 101 may be a sacral plate for implantation across vertebrae such as the patient's S1 and S2. The plate 101 is fixed to such vertebrae with two bone anchor screws (not shown) penetrating orifices 102 and 103 respectively formed at both ends thereof. This embodiment of the plate 101 includes a lateral extension 104 with an opening 105 through which a bone anchor screw (such as screw 15) can be passed, for example, to penetrate the patient's iliac bone. However, the disclosure herein is applicable to any type of sacral plate and is generally applicable to any type of element of a device for correcting spinal deformities having protrusions that can be fitted with connectors. It should be understood that it is possible. This should be particularly applicable when the protrusion is supported by a simple bone anchor screw or hook.

  The extension 104 is disposed laterally and is integral with the rest of the plate 1 and has a longitudinal direction in this exemplary embodiment, and in one particular embodiment the length of the rest of the plate 1. It is substantially perpendicular to the direction. The extension 104 has a first portion 104a and a second portion 104b. In this exemplary embodiment, the first portion 104a and the second portion 104b are each substantially planar, and there is an angle between the plane of the portion 104a and the plane of the portion 104b. Further, in this exemplary embodiment, the portion 104b is a plane that is substantially parallel to the upper surface 130 of the plate 1 and the opening 105 is oblong or oblong.

  Plate 101 includes a plurality of surfaces that are similar or identical to the structures and methods described above for the embodiment of plate 1. The plate 101 includes a protrusion 106 into which the connector 107 is fitted, and the connector 107 itself is fitted into the rod 108 of the correction device whose outline is shown in FIG. The connector 107 is clamped and fixed to the spherical outer surface of the dome 109 formed on the upper surface of the plate 101. This clamping is performed using a nut 110 that is screwed into a screw existing on the protrusion 106. The exemplary embodiments of the protrusion 106, connector 107, dome 109 and nut 110 are basically the same as the protrusion or shaft 5, connector 6, dome 8 and nut 9 described above.

  Similar to the embodiment described above, the protrusion 106 is engaged through the lower surface 116 of the plate 101 and passes through the orifice 117 located at the top of the dome 109. Therefore, the surface 111 of the protrusion 106 contacts the inner surface 118 of the dome 109. The pin 119 can then be fitted so that the pin passes through the dome 109 and is located in the slot 112 across the lower portion of the protrusion 106. As can be seen from FIG. 12, the apex 114 of the V-shaped upper surface 113 defining the slot 112 is located above the pin 119, and in this embodiment the vertical clearance of the protrusion 106 inside the dome 109 is very high. Slightly acceptable. The exemplary embodiment of the pin 119 has a diameter substantially equal to the width of the slot 112 and prevents the protrusion 106 from rotating significantly around the axis 115.

  The extension 104 is attached to the bone by inserting a screw (eg, a bone screw such as the screw 15 described above) through the opening 105 of the extension 104 and into the bone (in the iliac in certain embodiments). The plate 101 is further attached to the bone by inserting a screw (eg, a bone screw such as the screw 2 above) through the openings 102 and 103 of the plate 101 and into the bone (a sacrum such as S1 in certain embodiments). . In embodiments having a hole 132 (similar or identical to hole 104 above), a plug is placed in hole 132 to cover at least a portion of the screw in opening 102, as described above, to prevent screw retraction.

  The connector 107 is placed over the shaft 106 so that the shaft 106 at least partially enters the interior of the hole (eg, the hole 121 in FIG. 14). As described above, in some embodiments, the shaft 106 pivots to position the connector 107, or once the connector 107 has been positioned so that the assembly can be completed, or for other purposes of the surgeon. Or it can be moved in other ways. The nut 110 is screwed into the shaft 106 and tightened as desired by the surgeon to tighten the coupler 107 between the nut 110 and the dome 109 of the plate 101. By such tightening, the spinal rod 108 is clamped and fixed by the connecting device 107, and the connecting device 107 and the plate 101 are also connected. For example, the conical surface 120 of the connector 107 may be pressed against the spherical surface 111 of the shaft 106. Depending on the structure provided to the connector 107, it may be possible to automatically return the protrusion 106 to a substantially vertical orientation with respect to the plate 101 after tightening the nut 110 (e.g. The multi-axial nature of the portion 106 worked only during implantation of this orthodontic device), or the protrusion 106 was held in a non-perpendicular orientation with respect to the plate 101 as shown in one embodiment of FIG. It may be possible. The multi-axial nature of the protrusion 106 is substantially the same as described above for the protrusion 5 in this exemplary embodiment.

  After fitting such a device in place, the surgeon typically removes the excess parts of the protrusion 106 and nut 110 as described above for the protrusion 5 and nut 9. Other operations can be performed by the surgeon as described above.

  Various modifications to the subject matter described above are possible. For example, it should be possible to use means other than bone anchor screws to secure the various parts of the implant to the spinal column or iliac bone. As mentioned above, the application of the present invention is not limited to plates, but instead a spinal column with a protrusion for fitting a connector to be sought for temporary or permanent multi-axis orientation It can be applied to any element of the device for correcting deformation.

  While the invention has been illustrated and described in detail in the drawings and foregoing description, it is to be considered illustrative and features are not to be limited and include all modifications and variations that fall within the spirit of the invention. It will be appreciated that modifications are desired to be protected.

1 is a perspective view of an embodiment of an implant. FIG. FIG. 2 is a plan view of the embodiment of FIG. 1 attached to a patient's sacrum and iliac. FIG. 2 is a perspective view of a portion of the embodiment of FIG. FIG. 2 is a partial cross-sectional perspective view of a portion of the embodiment of FIG. FIG. 2 is a partial cross-sectional side view of a portion of the embodiment of FIG. FIG. 2 is a perspective view of a portion of the embodiment of FIG. 1 with an additional structural embodiment. FIG. 7 is a partial cross-sectional perspective view of the embodiment of FIG. 6. FIG. 2 is a perspective view of a series of additional embodiments of the components of the implant of FIG. FIG. 6 is a perspective view of another embodiment of an implant attached to a patient's iliac and vertebrae. FIG. 6 is a perspective view of another embodiment of an implant. FIG. 11 is a partial cutaway perspective view of a portion of the embodiment of FIG. 10. FIG. 11 is a partial cross-sectional side view of a portion of the embodiment of FIG. FIG. 11 is a perspective view of a portion of the embodiment of FIG. 10 with an additional structural embodiment. FIG. 14 is a partial cross-sectional perspective view of the embodiment of FIG. 13.

Claims (45)

A first plate member, the first plate member having means for securing the second plate member to the sacrum and a longitudinally extending rod, the rod being disposed within the orifice; A first plate member, wherein the second plate member has a threaded shaft coupled to the plate member;
A second plate member, wherein the second plate member is for passing a longitudinal orifice, an internal screw hole communicating with the orifice, and a bone anchor screw so that the plate member can be secured to the iliac bone. An orthopedic implant comprising: a second plate member having a lateral extension with a plurality of openings; and a threaded plug adapted to pass through the internal threaded hole and against the rod within the orifice .   The apparatus of claim 1, wherein the shaft is adapted to be multi-axis oriented. The shaft has a lower portion traversed by a slot, the surface of which is at least partially spherical;
The first plate member includes a dome having a conical inner surface on which the lower portion of the shaft can be supported, and further comprising a pin connected to the dome and across at least a portion of the slot; The apparatus of claim 2.   4. The apparatus of claim 3, wherein the slot is defined by a substantially V-shaped upper surface with the apex facing the lower end of the shaft.   The apparatus of claim 3, wherein the dome has an outer surface that is at least partially spherical. A slotted connector for attachment to a spinal rod, the connector having an orifice for fitting the connector to the shaft;
The apparatus of claim 2, further comprising a nut for threading the shaft to hold the connector to the first plate member and to clamp the connector about a spinal rod. .   The apparatus of claim 6, wherein the orifice of the connector is substantially conical.   The nut has an upper portion and a lower portion separated by a low resistance wire, and the upper portion and the lower portion of the nut are separated from each other by applying a force to the low resistance wire. The device of claim 6, which is capable.   The apparatus of claim 6, further comprising a rod at least partially contained within the orifice of the connector.   The shaft of claim 1, wherein the shaft has a lower portion traversed by a slot that is at least partially spherical in surface, and the first plate member has an opening into which at least a portion of the shaft extends. apparatus.   The apparatus of claim 10, wherein the opening of the first plate member has an inner surface that is at least partially conical. The first plate member includes an opening having a dome at least partially surrounding the opening;
The apparatus of claim 1, wherein the shaft extends at least partially into the opening such that a portion of the shaft is above the dome.   The apparatus of claim 12, wherein the opening of the first plate member has an inner surface that is at least partially conical. The first plate member includes an opening, is coupled to the first plate member, and further includes a pin adjacent to the shaft;
The apparatus of claim 1, wherein the pin substantially prevents the shaft from falling out of the opening.   The first plate member includes a dome that at least partially surrounds the opening, and the shaft extends at least partially into the opening such that a portion of the shaft is above the dome. The apparatus according to claim 14.   The apparatus of claim 15, wherein the opening of the first plate member has an inner surface that is at least partially conical. A first plate portion, at least partially surrounded by a longitudinal axis, at least one hole for securing the first plate portion to the bone, and a dome having an inner surface and an outer surface. A first plate portion having an opening;
A shaft coupled to the first plate portion, the shaft having an upper portion and a lower portion, the lower portion having at least a partially spherical surface defining a slot, the shaft comprising: In the dome opening so that the surface of the lower part is adjacent to the inner surface of the dome and the shaft can be arranged in a multiaxial manner relative to the first plate part. A shaft extending through and a second plate portion coupled to the first plate portion, the longitudinal axis being substantially perpendicular to the axis of the first plate portion; An orthopedic implant comprising a second plate portion having an opening for a bone screw.   The apparatus of claim 17, wherein the second plate portion is integral with the first plate portion.   The apparatus of claim 18, wherein the first plate portion includes a plurality of holes for securing the first plate portion to a bone.   The apparatus of claim 17, wherein the plate portions are adjustable relative to each other.   21. The apparatus of claim 20, wherein the plate portions are adjustable relative to each other for translation and rotation. The first plate portion includes a substantially flat portion and a longitudinal rod coupled to the substantially flat portion;
The second plate portion includes an elongated orifice adapted to receive the longitudinal rod;
18. The longitudinal rod is inserted at least partially into the orifice such that the first plate portion and the second plate portion are adjustable in rotation and translation. The device described.   The second plate portion further includes a threaded plug including a threaded hole intersecting the orifice and adapted to pass through the interior of the threaded hole, the plug passing through the hole and the longitudinal rod 23. The apparatus of claim 22, wherein the first and second plate portions are locked together by pressing against each other.   The apparatus of claim 17, wherein the shaft is threaded and the locking member comprises a nut.   The nut has an upper portion and a lower portion separated by a low resistance wire, and the upper portion and the lower portion of the nut are separated from each other by applying a force to the low resistance wire. 25. The apparatus of claim 24, wherein the apparatus is capable. A slotted connector for attaching to the spinal rod, the connector having an orifice for fitting the connector to the shaft;
18. The lock member of claim 17, further comprising a locking member for connecting the shaft to hold the connector to the first plate member and to clamp the connector about a spinal rod. Equipment.   27. The apparatus of claim 26, further comprising a rod at least partially contained within the orifice of the connector.   The apparatus of claim 17, further comprising a pin coupled to the first plate portion adjacent to the dome and at least partially contained within the slot of the shaft. The shaft has a longitudinal axis;
29. The apparatus of claim 28, wherein the shaft is pivotable about the pin and is substantially in a plane defined by the shaft axis and the pin.   The apparatus of claim 17, wherein the shaft includes a substantially V-shaped inner surface within the slot.   The apparatus of claim 17, wherein the second plate portion comprises two substantially planar portions that are angled relative to each other.   The apparatus of claim 17, wherein the opening in the second plate portion is one of a laterally elongated shape and a circular shape.   One of the plate portions further includes a screw hole that overlaps the opening for the bone screw, and further comprising a set screw adapted to be passed through the screw hole, wherein the set screw is in the opening for the bone screw. The apparatus according to claim 17, wherein the apparatus prevents bone screws from falling off.   18. The method of claim 17, further comprising a plurality of types of the second plate portion, wherein a surgeon can select at least one of the types for use based on a given patient configuration. Equipment.   The apparatus of claim 17, wherein the first plate portion is adapted to be attached to a vertebral body and the second plate portion is adapted to be attached to an iliac bone. A dome portion at least partially surrounding an opening having at least a partial conical surface;
A shaft having an upper portion and a lower portion, the lower portion having at least a partially spherical surface defining a slot, wherein the shaft has the surface of the lower portion of the opening; A shaft extending through the opening of the dome so as to be adjacent to the surface and so that the shaft can be arranged in a polyaxial manner relative to the dome; and the opening connected to the dome. An orthopedic implant comprising a pin extending at least partially across the shaft and at least partially across the slot of the shaft.   37. The apparatus of claim 36, wherein the slot of the shaft has a substantially V-shaped upper surface with a vertex facing the lower end of the shaft.   40. The device of claim 36, wherein the implant is a bone screw.   40. The device of claim 36, wherein the implant is a bone plate.   40. The device of claim 39, wherein the implant is a sacral plate.   38. The device of claim 36, wherein the implant is a hook.   37. The apparatus of claim 36, wherein the shaft is threaded, includes a low resistance wire, and applying a force to the wire results in the shaft breaking.   38. The apparatus of claim 36, wherein the shaft has a head portion with an inscription adapted to receive a tool.   38. The apparatus of claim 36, further comprising a slotted connector connected to the shaft, the connector being adapted to hold an orthopedic rod.   40. The apparatus of claim 36, further comprising an orthopedic rod coupled to the implant.

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