RU2817675C1 - Expandable modular intervertebral implant - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: bone fusion device intended for insertion between upper and lower vertebrae, includes at least one folding sliding element containing a support part with proximal and distal ends, and lateral sides. At least one folding sliding element is made with possibility of dynamic change of dimensions of device for bone fusion to increase the volume of the bone fusion device. Bone fusion device is actuated at the proximal end of the support portion by means of a detachable tool to advance the distal end of the support portion to increase the interstitial space between the upper and lower vertebrae, in order to deliver the device to the implantation site. Device is in a compact form of the first form factor, the first surface area of which is in contact with the upper and lower vertebrae, and the first volume is located inside the interstitial space. At least one extending element is rotatable by means of a detachable tool from a folded position outward in a direction from one of the lateral sides of the support portion and an abutment against at least one of the upper vertebra and the lower vertebra and expanding the bone fusion device into a second form factor, having a second surface area in contact with the upper vertebra and lower vertebrae, and a second volume in the interstitial space. Dynamically varying prismatic element for use in an intervertebral implantable device for bone fusion comprises an interlocking modular element, at least one folded structural element and an engaging part. Coupling modular element passes through the distal and proximal ends of the device and has at least one folded structural element connected to it, for each of which geometric shapes and holes are provided. At least one folded structural element is pivotally connected to the interlocking modular element, which enables to use it in the folded position and to be inserted between the upper and lower vertebrae, as well as in the unfolded position for dynamic change of the device form factor. Engaging part is located at the distal end of the device. Coupling modular element is configured to be actuated at the proximal end by means of a detachable tool to advance the engaging portion to increase the interstitial space between the upper and lower vertebrae, thereby allowing the device to be delivered to the implantation site, wherein the device is provided in the form of a compact first form factor, the first surface area of which is in contact with the upper and lower vertebrae, and the first volume is located inside the interstitial space. Device is made with possibility of lateral opening using detachable tool on coupled modular element and folded structural element so as to transform from a compact first form factor into a decomposed second form factor, which implies a decomposed device with an increased second volume, and a larger second surface area compared to the first form factor. Method of implantation of dynamically transforming intervertebral implantable device for bone fusion includes the following stages: separation of the upper and lower vertebrae to move the device in the interstitial space between the upper and lower vertebrae to the implantation site; inserting the device into the interstitial space in a compact configuration of a first form factor; rotating the device around the axis in a first direction so that the folded structure can rotate in a lateral direction; rotation of the folded structure around the axis in the same first direction in order to unfold the folded structure so that it opens laterally outward from the device for transition to the second form factor; as well as fastening of the unfolded structure at the implantation point in the configuration of the second form factor in order to provide a larger surface area and volume within the surrounding interstitial space between the superior and inferior vertebrae. Method of implantation of dynamically transforming intervertebral implantable device for bone fusion includes the following stages: separation of the upper and lower vertebrae to move the device in the interstitial space between the upper and lower vertebrae to the implantation site; inserting the device into the interstitial space in a compact configuration of a first form factor; rotating the device around the axis in a first direction so that the folded structure can rotate in a lateral direction; rotation of the folded structure around the axis in the second direction opposite to the first one in order to unfold the folded structure and thus to provide its lateral opening in the outward direction from the device for transition to the second form factor; as well as fastening of the unfolded structure at the implantation point in the configuration of the second form factor in order to provide a larger surface area and volume within the surrounding interstitial space between the superior and inferior vertebrae.

EFFECT: inventions provide the possibility of increasing the volume of the interbody cage from the first folded or folded position to the second opened or unfolded position in such a way that the perimeters of the contact surfaces between the interbody cage and the vertebrae increased from the folded position to the unfolded position of the cage.

12 cl, 94 dwg

Description

The present invention relates to the field of medicine, in particular to expandable and modular intervertebral implants.

Certain spinal pathologies, such as disc tissue degeneration, facet diseases and vertebral dislocations, lead to impairment of the load-bearing capacity of the spine and load distribution.

Treatment of such pathologies in advanced stages is provided by various stabilization systems with intradiscal implants, such as interbody cages, which are usually combined with extradiscal systems that combine vertebral screws, plates or pins to rigidly connect two adjacent vertebrae. Such intradiscal implants have made it possible to significantly increase the effectiveness of treatment of spinal pathologies by restoring the intervertebral space, which makes it possible to decompress nerve roots and accelerate bone fusion of adjacent vertebrae.

An important category of interbody cages are impact cages. Such cages, which are essentially parallelepiped-shaped, are inserted between the vertebrae by impaction. The disadvantage of these cages is the difficulty of their introduction into the intervertebral space through narrow access paths using various surgical access methods, such as posterior, transforaminal, posterolateral, lateral, anterolateral and anterior access methods, in particular, if necessary, to ensure maximum contact surface interbody cages with adjacent vertebrae in order to optimize the distribution of load between two adjacent vertebrae and reproduce the natural lordosis in the lumbar spine.

To solve these problems, interbody cages with the possibility of expansion at the installation site were developed, which include expanding cages, in which the increase in the volume of the cage is ensured by a rotating element that is directly attached to the vertebrae and allows the space between the vertebrae to be expanded.

In applications US 13/877851, US 12/171,165, US 11/276,345, US11/394,719, US 09/350,984, US 13/941,095, US 13/605,751, US13/667,551, US13/095,634, US 12/9 93,960, US 8,187,332 and US 15/739,696 describe interbody cages that are designed with components that articulate with the vertebrae and provide long-term increases in the height of the interbody cage. Some literature describes cages that include a movable element that rotates along the longitudinal axis of another component. Of these applications, US 12/171, 165 describes a movable element which, when rotated within a fixed element, causes the flexible elements to open outwards from the fixed element, thereby increasing the volume of the cage. US 15/739696 describes a movable element which, when rotated within a fixed element, directly opens outwards from the fixed element. The increased volume of cages in these applications represents an asymmetrical increase in dimensions and does not provide an increase in the perimeter of the contact surface of the cages with adjacent vertebrae.

An object of the present invention is to provide an interbody cage for the spine that allows the volume of the interbody cage to be increased from a first folded or collapsed position to a second unfolded or expanded position such that the perimeters of the contact surfaces between the interbody cage and the vertebrae increase from the collapsed position to the expanded position of the cage. The interbody cage according to the invention is made in the form of a scaffold consisting of at least two folding and unfolding scaffolds: one support part (also called the cage body) on which the rotating mechanisms of the rotating element (also called the expanding element) are located to provide the ability to rotate around an axis on the body of the cage, and such an axis, as a rule, when installing the cage is oriented towards the vertebrae. The expanding element is designed to increase the perimeter of the contact surface of the interbody cage with one vertebra or both vertebrae of the spinal region, or to increase the height of the interbody cage, or to increase the perimeter of the contact surface of the interbody cage and its height. Opening the expanding element allows you to increase the dimensions of the cage, providing a larger area and stability of the contact surface with the vertebrae.

In preferred embodiments of the invention, the expansion element includes plates, rings or hooks that are positioned or folded within the cage body in a first position and then deployed or deployed from the outside of the cage body to spread adjacent vertebrae in a second position, wherein such deployment is accomplished by rotation an expanding element around an axis of rotation within the cage body, on the surface or on the side of the cage body. In other embodiments of the invention, the expansion element may have various shapes, ie, be, for example, L-shaped or T-shaped or consist of a compact block or have a quadrangular semi-open type design.

All embodiments of the invention may include a cage body structure made of thin walls and expansion elements with thin serrated and/or segmented plates, rings and/or hooks so that the implant acts as a shock absorber between two adjacent vertebrae, thereby simulating the natural structure of the cancellous bone. bone, prevent subsidence around the cage and allow bone growth around and through the interbody cage. Various embodiments of the invention can also be provided in the form of modular scaffolds, where the same cage body can be assembled using expansion elements of different sizes and shapes, allowing the interbody cage layout to be adjusted in height, width, length and other characteristics so that to adjust it in size and taking into account the anatomical features of the interbody space and vertebrae in the spine.

The invention can also be used to separate two spinous processes and fix the processes in a separated position.

A first method of deploying an interbody cage is provided, characterized in that after the cage is installed in its final position between adjacent vertebrae, the vertebrae are first separated by rotating the body of the cage (“Rotation”) to create a buffer space between the body of the cage and the upper vertebra and lower vertebra, which allows the expansion element or two opposing elements to open by rotating said expansion elements and then reversing (“Reverse Rotation”) the body of the cage in the opposite direction so that the upper and lower surfaces of the cage and expansion elements are adjacent to and attached to two adjacent vertebrae him. With another method of opening the cylindrical body of the cage, the rotation step is absent, and the opening of the expanding element is performed from the outside. In yet another method, the cage body is first rotated and the expansion elements are deployed, but reverse rotation is not applied because the expansion of the expansion elements has locked the cage body in the rotated position after rotation. In yet another method of deploying a cage, the body of the cage is rotated in the opposite direction to values outside the range of the reverse rotation of the first method, which allows the spinal section to be re-expanded (“Re-reverse rotation”) to deploy another, opposing expansion member by rotating that other opposing expansion element before re-rotating the cage body in the opposite direction (“Re-rotation”) to allow the cage body and both expansion elements to abut and lock into one or both vertebrae of the spinal region.

Embodiments of the invention may relate to any structures for spreading and/or fusing any bones.

The features of the invention will be more clearly presented within the framework of the description of various embodiments and variations thereof, which are given solely as examples and are not intended to be limiting, and within which references are made in particular to the front part or front part of the cage or body, thus indicates that part of the cage that is adjacent to the vertebrae immediately before installation of the specified cage or body in the interbody space, as well as the back or rear part of the cage body, which is the part of the cage that is located opposite the front or front part. The words "rotary" and "rotating" are used in the same sense to describe movement around an axis. The description of these various embodiments refers to the accompanying schematic Figures, where:

Figure 1 shows a rear perspective view of the cage body of the first embodiment.

Figure 2 shows a front perspective view of the cage body of the first embodiment.

Figure 3 shows a front perspective view of the cage body of a variation of the first embodiment.

Figure 4 shows a front perspective view of the cage body of a variation of the first embodiment.

Figure 5 shows a rear perspective view of the cage body of the first embodiment in a first position with the expansion member folded.

Figure 6 also shows a rear perspective view of the cage body as in Figure 5, but in a second position with the expansion member open.

Figure 7 is a top view of the cage arrangement shown in Figure 5 with the expansion member folded.

Figure 8 shows a front view of the same cage as Figures 5 and 7 in the same first position with the expansion member folded.

Figure 9 shows a front view of the same cage as in Figures 5, 7 and 8 with the expansion member partially opened.

Figure 10 is a top view of the cage assembly shown in Figure 6 in a second position with the expansion member fully deployed.

Figure 11 shows a front view of the same cage as Figure 10 in the same second position with the expansion member fully deployed.

Figure 12a shows a rear view of a variation of the cage according to the first embodiment of the invention with the eccentric axis of rotation in the second position with the expansion element fully deployed.

Figure 12b shows a front view of the same cage as Figure 12a in the same second position.

Figure 13 shows a rear perspective view of the cage with the eccentric axis of rotation of the expansion element in the open position.

Figure 14 is a perspective view of the expansion member at the front of the cage shown in Figure 13.

Figure 15 shows a rear perspective view of the cage according to the second embodiment, shown in an inverted embodiment with two expansion elements open.

Figure 16 shows a rear perspective view of a variation of the cage according to the second embodiment with two eccentric axes of rotation and open expansion elements.

Figure 17 shows a top view of the cage shown in Figure 16 with two expansion elements deployed.

Figure 18a shows a rear view of the cage of the second embodiment between two schematic vertebrae with folded expansion elements installed in the same manner as the hooks.

Figure 18b shows a rear view of the same cage as in Figure 18a, between two separated schematic vertebrae with the hooks partially exposed.

Figure 18c shows a rear view of the same cage as in Figures 18a and 18b, between two schematic vertebrae with the hooks fully deployed.

Figure 19 shows a rear perspective view of a cage according to a third embodiment of the invention with the expansion elements folded.

Figure 20 shows a rear perspective view of the same cage of the third embodiment of the invention as in Figure 19, with two sets of plate-mounted expansion members exposed.

Figure 21a shows a rear view of the same cage as Figure 19 with the plates folded.

Figure 21b shows a rear view of the same cage as in Figure 20 with the plates open.

Figure 22a shows a front perspective view of a variation of the cage according to the third embodiment of the invention with the triangular plates opened.

Figure 22b shows another front view of the same cage in the same position as Figure 22a.

Figure 23 shows a top view of the same cage as in Figures 22a and 22b, but with the expansion elements folded.

Figure 24a shows a rear view of the same cage as Figure 23 in the same position with the plates folded.

Figure 24b shows a rear view of the same cage as Figure 24a, but with the plates open.

Figure 25 shows a front perspective view of a second embodiment of a cage according to a third embodiment of the invention with the thin triangular plates exposed.

Figure 26 shows a rear perspective view of the cage body of Figure 25.

Figure 27 shows a rear perspective view of the cage body of Figure 25 with two flaring elements.

Figure 28 shows a side sectional view from the rear of the same cage as in Figure 25, but in the folded plate position.

Figure 29 shows a front perspective view of the cage body of a fourth embodiment of the invention for an oblique approach with the block type expander element exposed.

Figure 30 shows a rear view of the cage from Figure 29 with the expansion member deployed.

Figure 31a shows a top view of a cage according to a fourth embodiment of the invention mounted on a vertebral body, with the expansion elements folded.

Figure 31b shows the same top view of the cage on the vertebral body as Figure 31a, but with the block-type expansion element deployed.

Figure 32 shows a front perspective view of a first embodiment of a cage according to a fourth embodiment of the invention for an oblique approach with an open expansion member consisting of parallel rings.

Figure 33 shows a front view of the cage of Figure 32 with the expansion member deployed.

Figure 34 shows a top view of a second embodiment of the fourth embodiment of the cage for an oblique approach with an expanded element consisting of quadrangular plates exposed.

Figure 35 shows a rear perspective view of the same cage as in Figure 34, in the same second position with the expansion member deployed.

Figure 36a shows a rear perspective view of the cage of the fifth invention in a first position with the plates folded.

Figure 36b shows a front perspective view of the same cage as Figure 36a, in the same position with the plates folded.

Figure 37a shows a front perspective view of the cage from Figure 36a, but in a second position with the plates open.

Figure 37b shows a front perspective view of the cage variant of Figure 37a with the cage body guard rails and tip deployed, in the same position with the plates deployed.

Figure 38 shows a top view of the same cage as Figure 37a in the same position with the plates open.

Figure 39a shows a rear perspective view of one of the two cage extension members of the fifth embodiment.

Figure 39b shows a rear perspective view of the second of the two cage extension members of the fifth embodiment.

Figure 40a shows a side section of the fifth embodiment of the cage with a rear view in the first position with the plates folded.

Figure 40b shows the same side section of the same cage as in Figure 40a, but with the expansion elements partially exposed.

Figure 40c shows the same side section of the same cage as in Figures 40a and 40b, but with the expansion elements fully deployed.

Figure 41 shows a rear perspective view of the first cage variant of the fifth embodiment in a second position with the plates open.

Figure 42 shows a rear view of the cage shown in Figure 41.

Figure 43 shows a rear perspective view of a second variation of the cage of the fifth embodiment in a second position with the plates open.

Figure 44a shows a front perspective view of the cage extension member shown in Figure 43.

Figure 44b shows a rear perspective view of the same expansion element as in Figure 44a.

Figure 45 shows a rear perspective view of the third embodiment of the cage of the fifth embodiment in a first position with the hooks folded.

Figure 46 shows a rear perspective view of the same cage as in Figure 45 with the hooks partially open.

Figure 47 shows a rear perspective view of the same cage as in Figures 45 and 46 with the hooks fully deployed.

Figure 48 shows a side sectional view from the rear of the same cage as in Figure 46 in a slightly rotated position with the hooks partially open.

Figure 49 shows a rear view of the same cage as Figure 47 with the hooks fully deployed.

Figure 50 shows a rear perspective view of the cage of the sixth embodiment in the second position with two sets of rings open.

Figure 51 shows a front perspective view of the cage of the sixth embodiment with one drop-down set of two plates.

Figure 52 shows a top view of the cage from Figure 50.

Figure 53 shows a front perspective view of a cage expansion member of the sixth embodiment with one set of two rings.

Figure 54 shows a front perspective view of a cage variation of the sixth embodiment in a second position with the L-shaped flaring members open.

Figure 55a shows a front view of the same cage of the sixth embodiment between two schematic vertebrae with stacked ring sets.

Figure 55b shows a front view of the same cage as in Figure 55a between two spread out schematic vertebrae with one set of rings partially open.

Figure 55c shows a front view of the same cage as in Figures 55a and 55b, between two schematic vertebrae with one set of rings fully deployed.

Figure 55d shows a front view of the same cage as in Figures 55a-55c, between two spaced schematic vertebrae with one set of rings fully deployed and one set of rings partially deployed.

Figure 55e shows a front view of the same cage as in Figures 55a-55d between two spaced schematic vertebrae with one set of rings fully deployed and one set of rings partially deployed.

Figure 55f shows a front view of the same cage as in Figures 55a-55e between two schematic vertebrae with two sets of rings fully deployed.

Figure 56 shows a front perspective view of yet another variation of the cage of the sixth embodiment with two diagonally mounted L-shaped expansion members.

Figure 57 is a front perspective view of the cage body of the seventh embodiment.

Figure 58a shows a front perspective view of the cage of the seventh embodiment with two diagonally arranged expansion members in a folded position.

Figure 58b shows a front perspective view of the same cage as Figure 58a with the two sets of hooks fully deployed.

Figure 59 shows a top view of the same cage as Figure 58b with the two sets of hooks fully deployed.

Figure 60a shows a side sectional view from the back of the cage shown in Figure 58a in the first position with two sets of hooks folded.

Figure 60b shows the same side section as Figure 60a of the cage shown in Figures 58b and 59, but with the hooks fully extended.

Figure 61 shows a front view of the same cage as in Figures 58b, 59 and 60, with the hooks fully deployed.

Figure 62 shows a front perspective view of the cage of the eighth embodiment with an inclined tip and two sets of folded triangular plates.

Figure 63 shows a rear view of the same cage as in Figure 62, with one set of triangular plates fully deployed and one set of triangular plates partially deployed.

Figure 64 shows a front perspective view of the same cage as in Figures 62 and 63, with two sets of triangular plates fully deployed.

Figure 65 shows a front perspective view of the cage of the ninth embodiment with an insertion system.

Figure 66a shows a front view of the cage of the ninth embodiment with the distal ends of the tool's flaring elements visible.

Figure 66b shows a front view of a smaller cage than that shown in Figure 66a, with the same spacing between the tool flares.

Figure 66c shows a front view of a cage with an even smaller diameter than that shown in Figure 66b, with the same spacing between the flaring elements of the tool.

Figure 67a shows a front perspective view of the cage of the ninth embodiment with one expansion member located along the longitudinal axis of the body in a folded position.

Figure 67b shows another perspective view from the front of the cage shown in Figure 67a, with one extension member in the folded position.

Figure 67c shows a front view of the cage that is shown in Figures 67a and 67b, with one extension member in the folded position.

Figure 68a shows a front perspective view of the same cage as in Figures 67a-67c in a second position with the expansion member deployed.

Figure 68b shows another perspective view from the front of the cage that is shown in Figure 68a, with the expansion member open.

Figure 68c shows a front view of the cage that is shown in Figures 68a and 68b, with the expansion member deployed.

Figure 69a shows a front view of a variation of the cage according to the ninth embodiment with a flaring member that opens through the top or side of the body in a top-opening position.

Figure 69b shows a front view of the same cage as Figure 69a in a position where the expansion member is deployed through the side of the body.

Figure 70 shows a front perspective view of a second embodiment of the ninth embodiment of a cage with a single expansion member with a double set of opposing plates in a folded state.

Figure 71 shows a front perspective view of the expansion member with a double set of opposing cage plates shown in Figure 70.

Figure 72a shows a front view of the cage shown in Figure 70 in the folded position of the expansion member with the double stack of opposing plates.

Figure 72b shows a front view of the cage shown in Figures 70-72a in position with the expansion member with the double stack of opposing plates deployed.

Figure 73 shows a rear perspective view of a third variation of the cage of the ninth embodiment with a single extension member with additional double plates extending beyond the rear of the cage body.

Figure 74 shows a cross-section of a T-shaped expansion member.

Figure 75 shows a front perspective view of a variation of the cage of the sixth embodiment with open rings comprising two gable elements.

Figure 76 shows a front perspective view of a variation of the cage of the sixth embodiment with open rings comprising two gable elements.

Figure 77 shows a front perspective view of a variation of the cage according to the sixth embodiment with the expansion member opened and the sets of threads laid out.

Figure 78 shows a rear perspective view of a variation of the cage of the second embodiment with thin walls and exposed thin hooks.

Figure 79 shows a front perspective view of the same cage as Figure 78.

Figure 80 shows a front perspective view of the cage body of the fourth embodiment with the extended tip in a folded expansion member position.

Figure 81 shows a front perspective view of the same cage as Figure 80 in a second position with the expansion member deployed.

Figure 82 shows a rear perspective view of the same cage as in Figure 81 in the same second position with the expansion member deployed.

Figure 83 is a front perspective view of a cage according to the tenth embodiment with a cylindrical shaped body with a folded extension member.

Figure 84 shows a front perspective view of the same cage as Figure 83, but with the flaring element deployed and equipped with a set of parallel flat-sided hooks.

Figure 85 shows a rear view of the same cage as Figure 84 in the same position with the expansion member deployed.

Figure 86 shows a perspective view of a cylindrical-shaped body of the tenth embodiment with a set of parallel rings.

Figure 87 shows a rear perspective view of a tenth embodiment cage variant of the body shown in Figure 86 with the flat-sided parallel hook flarer exposed.

Figure 88 shows a rear view of the cage shown in Figure 87, with a cylindrical body and an open flat-sided hook flare.

Figure 89 shows a rear perspective view of yet another variation of the tenth embodiment cage with a body that includes a set of parallel rings with an open cylindrical shaped hook flare member.

Figure 90 shows a side section of the cage that is shown in Figure 89, showing a rear view with a cylindrical body and an open flaring member with cylindrical hooks.

Figure 91 shows a view of a vertebral portion with an implant inserted between the spinous processes of an eleventh embodiment of the invention in a folded position.

Figure 92 shows an enlarged view of Figure 91 with the same implant between the spinous processes, but in a second position with the expansion elements exposed.

Figure 93 shows a variation of the eleventh implant with one hook-shaped open expansion element to separate the vertebrae and create space between them, as well as another hook-shaped open expansion element to prevent displacement of the implant.

Figure 94 shows another variation of the eleventh implant with one open hook-shaped expansion element, which is used both to separate the vertebrae and create space between them, and as an element that prevents displacement of the implant.

According to Figures 1-6, the first embodiment of the invention describes an interbody cage 1 for an anterior surgical approach with a body 2 characterized by a substantially flat upper surface 3 that allows abutment of the upper vertebra V1, as well as a substantially flat lower surface 4 , which allows to rest against the lower vertebra V2, the front part 5, which is the part that first enters the intervertebral space between the two vertebrae V1, V2, the back part 6, which is located opposite the front part 5, and the two lateral sides 7a, 7b. According to Figures 1 and 2, the dimensions of the body 2 between the front part 5 and the back part 6 (which are defined as "length") and between the sides 7a, 7b (which are defined as "width W" or "l/l/') are relatively similar. The upper surface 3 and the lower surface 4, having a slightly convex shape, are separated by a distance which is defined as the height of the body 2 (which is also defined as the “thickness” of the body 2 or cage 1). The thickness parameter of body 2 is significantly less than the parameters of the length and width “W” of body 2, and this thickness runs at an angle along the length of body 2, with a thicker rear part 6 and a thinner front part 5. The thickness determines the pillow-shaped shape of body 2 both along the length, and in width W, which may correspond to the anatomical structure of the concave vertebral plates. In various variations of this first embodiment, the body 2 may be angled between the side walls 7a, 7b rather than along its length, or have a substantially parallel top 3 and bottom surface 4. The top surface 3 and bottom surface 4 of the body 2 may be smooth or partially or completely covered with teeth, which prevent the cage 1 from moving in the interbody space or from leaving the interbody space. One side side 7b of the body 2 has a curved surface between the front part 5 and the rear part 6, and the second side side 7a has a serrated shape made of alternating walls 8 and slots 9. This side side 7a is configured to receive an expansion element 10. In the walls 8, in the front part 5 and in the rear part 6 there are round holes 11 for receiving the support part 12 of the expansion element 10 along the axis “a”. The body 2 is provided with a cavity 13 which may contain bone implant material. Figure 3 shows a variation of the body 2 of the cage 1 according to the first embodiment, characterized in that the holes 11 located in the walls 8 of the side 7a, as well as in the front part 5 and rear part 6 of the body 2, are replaced by channels 14, which allow receiving the supporting part 12 of the expanding element 10 and provide the possibility of its rotation around the axis “a” in the lower part of the specified channel 14.

According to Figure 4, the expansion element 10 has a longitudinal structure with a support part 12, which is in the form of a pin with a proximal end 16a and a distal end 16b, on which parallel plates 15 are mounted. The proximal end 16a of the support part 12 may have a socket (as shown in Figure 30 , 35, 48, 49 and 78) or a hexagonal cross-section (as shown in Figures 22a-24b, 59, 62 and 82) for receiving or otherwise engaging the pin tip of the cage insertion tool. The supporting part 12 is designed to feed into the holes 11 or to the bottom of the channels 14 located in the walls 8 of the body 2. The plates 15 have a thickness that is slightly less than the width of the slots 9 located on the side 7a of the body 2, while the said slots 9 are intended for plates 15 of the expanding element 10 in one of the positions of the cage arrangement 1. The upper and lower grooves for adhesion to the bone tissue 23 of the plates 15 are located at an angle to each other, and the plates 15 are larger closer to the supporting part 12, which generally gives the plates 15 trapezoidal shape. In embodiments of the invention, the plates 15 can have any other shape: square, rectangular (as in Figure 21b), triangular (as in Figures 24b and 64), longitudinal (as in Figures 39a and 40c), semi-hook (as in Figures 40b and 40c ), as well as oblong, round, oval, etc.

As shown in Figure 5, in the first position of the cage 1 arrangement, consisting of a body 2 and an expanding element 10, the plates 15 of the expanding element 10 are laid in the slots 9 in the body 2. The supporting part 12 of the expanding element is installed in the round holes 11 in the walls 8 of the body 2 10, and its proximal and distal ends 16a, 16b are approximately flush with the surfaces of the front portion 5 and rear portion 6, respectively, of the body 2.

The distance between the upper and lower bone engagement grooves 23 of the plates 15 is preferably less than the thickness of the body 2 when the expansion member 10 is folded into the body 2 in this specified position. The slots 9 on the side 7a of the body 2 are of sufficient depth to accommodate the entire width of the plates 15 when said plates 15 are in a fully folded position. According to Figures 5, 7 and 8, no part of the plates 15 or other components of the expansion element 10 protrudes from the side 7a of the body 2, while in variations of this embodiment of the invention in the first position with the plates 15 folded, some parts of the expansion element 10 may protrude from side side 7a and/or upper surface 3 or lower surface 4 of body 2.

According to Figures 6, 10 and 11, the expansion member 10 can open outward in the transverse direction and extend beyond the side 7a of the body 2 from a first position to a second position by rotating the support portion 12 approximately 180° about the axis of rotation "a". Figure 9 shows the expansion element 10 partially deployed from the body 2 (after rotating the support portion 12 by approximately 90°), and Figures 6, 10, 11, 12a and 12b show the fully expanded expansion element 10. In this second position of the cage 1 arrangement the width W of the body 2 increases to the width W1 of the entire arrangement of the cage 1. In the second position of the arrangement of the cage 1, the height of the plates 15 of the expansion element 10 is similar to the thickness of the body 2 in a cross section symmetrically opposite to the other side 7b of the body 2, which makes it possible to preferably give a symmetrical arrangement of the cage 1 in the open position. In such an open position, the upper surface 3 and the lower surface 4 of the body 2, as well as two grooves for adhesion to the bone tissue 23, which determine the height of the plates 15 of the expanding element 10, can abut the upper and lower vertebrae V1, V2.

The advantage of the present invention is that the path of installation of the cage 1 into the intervertebral space can be narrower; accordingly, the hole that is cut in the anterior ligament can be smaller in width, which allows maintaining some of the stabilizing properties of this ligament. The same applies to the disc ring, for which, according to the invention, only a reduced opening is required, which allows the preservation of a larger biological ring around the interbody space. In addition, the expansion element 10 opens behind the ring and the preserved portion of the anterior ligament, which form an additional barrier to prevent the cage 1 from being pushed out.

Figures 6, 9 and 11 also show thin anchors 17 placed in the grooves for adhesion to the bone tissue 23 of the plates 15 in order to further fix the plates 15 and cage 1 in the plates of the vertebrae V1, V2. Figures 6, 10 and 13 also show a side hook 18 located adjacent to the side groove of the last plate 15, which is secured laterally in the inner wall of the ring during expansion of the expansion element 10 and thus further prevents displacement of the cage 1.

Preventing the expansion member 10 from opening more than 180° around the axis 12 can be achieved by any limiting means installed in the body 2, such as the limiting pin 19 shown in Figures 5, 9 and 15 and connecting the walls 8 of the body 2 on the lower surface 4. As shown in Figure 8, the opening of the expansion element plates 15 can also be limited at angles greater than 180° by the bottom surface 4 of the body 2 extending to the side 7a of the body 2. Other limiting elements can be provided on the bottom surface 4 body 2, thus limiting the opening of the expanding element. In various variations of the invention, the expanding element 10 can be configured to rotate around its axis by amounts greater than the rotation of its supporting part 12 by 180°, which can give the cage 1 additional flexibility taking into account the anatomical structure of the vertebral plates, while the upper and lower surfaces 3 and 4 of body 2 are rigid planes abutting the vertebrae V1, V2, while the joints of said lower surfaces 3 and 4 of body 2 and the surfaces formed by grooves for adhesion to bone tissue 23 of plates 15 of the expanding element 10 can be located in planes different from the planes of surfaces 3, 4 of body 2, and it is better to take into account the anatomical structure of the vertebrae V1, V2. To increase the flexibility of the cage 1, taking into account this anatomical structure, the body 2 can be made with holes 11 with a diameter that exceeds the diameter of the supporting part 12 of the expanding element 10,

To provide additional space for the expansion element 10 inside the hole 11. The same result can be achieved using channels 14 made in the body 2, the bottom of which exceeds the diameter of the supporting part 12. The combination of the flexibility of the unrestricted expansion element 10 and the mobility that additional space, leads to absolute three-dimensional mobility of the expanding element 10 relative to the body 2.

Cage 1 is inserted into the space between two vertebrae V1, V2 by hammering. After the cage 1 is installed in the desired position between the two vertebrae V1, V2, the expansion element 10 can be opened using the opening method described in Figures 18a - 18c, characterized in that the body 2 is first slightly rotated between the vertebrae V1, V2 with so as to separate said vertebrae and thus provide sufficient buffer space over portions of the upper surface 3 and lower surface 4 of the body 2 to open the expansion element 10 without pressing the plates 15 against the vertebrae V1 or V2 in their radius of rotation. Expansion of the expansion element 10 from the outside of the body 2 to increase the form factor of the body 1 from the first position of the cage 1 to the second position with full deployment of the expansion element 10 can be accomplished using any suitable tool that allows engagement with the proximal end 16a of the support part 12 of the expansion element 10.

Figures 12a, 12b and 13 show a variation of the cage 1 invention according to the first embodiment, characterized in that channels 14, made instead of holes 11, are located in the front part 5 and rear part 6 of the body 2, as well as in the walls 8 of the body 2. The advantage of this variation in the arrangement of the cage 1 is that the expansion element 10 can be inserted into the body 2 of the cage 1 shown in Figure 3, immediately prior to insertion of the cage 1 between the vertebrae V1, V2, thus allowing the surgeon to select the preferred characteristics, shape or size of the expansion element 10, which most closely correspond to the individual anatomical structure of the spine. Because the cage 1 of this variety is modular with a plurality of additional expansion elements 10 configured to fit one individual body 2, many different additional arrangements of the cage 1 can be formed.

In addition, according to Figures 12a, 12b, 13 and 16, the bottom of the channels 14 is located in the front part 5 and rear part 6 of the body 2 and in the walls 8 of the body 2 in an eccentric axis position, which allows the body 2 to receive the support part 12 of the expansion element 10 along the eccentric axis relative to the median horizontal plane “MR” passing through the central axis “a”. In this variation, additional space for folding the plates 15 is provided in the slots 9 between the walls 8 of the body 2, accordingly, the thickness of the body 2 can be used in addition to the depth of the slots 9 in the body 2 to accommodate wider plates 15 of the expansion element 10. According to Figures 12a and 12b , the cage 1 with the eccentric support part 12 with the plates 15 fully open has the same width W1 as the width W1 of the cage 1 with the support part 12 located on the median horizontal plane "MP" with the plates 15 open, shown in Figure 11, while The width W1 of the body 2 with the displaced bottom of the channel 14 is significantly less than the width W of the body 2 of the cage 1 shown in Figures 7-11, which has round holes 11 located on the middle horizontal plane “MR” intersecting the axis “a”. The closer the round holes 11 or the bottom of the channels 14 are located to the upper surface 3 or lower surface 4 of the body 2, the wider the plates 15 of the expanding element 10 can be.

Figure 14 shows the expansion element 10 of the cage 1, the body 2 of which has a large angle between the front part 5 and the rear part 6 and is made with an eccentric displacement of the bottom of the channels 14. The support part 12 of the expansion element 10, made in the eccentrically displaced channel 14, may not correspond the entire length of the body 2 with such a large angle and can protrude from the upper surface 3 or the lower surface 4 of the body 2 before reaching the front part 5 of the body 2 due to its significantly smaller thickness compared to its rear part 6.

According to Figures 14, the length of the support part 12 between its proximal end 16a and the distal end 16b is less than the distance between the first plate 15a and the last plate 15z, and the first two plates 15a and 15b are not attached to the support part 12, instead the first plate 15a is attached to the second plate 15b by means of curved connecting members 20, and the second plate 15b is attached to the third plate 15c also by means of curved connecting members 20, with the third plate 15c directly attached to the support part 12 near the distal end 16b. The first two plates 15a, 15b are rotated by rotating the support part 12 through the third plate 15c. The curved design of the curved connecting elements 20 is achieved by curved slots on the upper surface 3 and the lower surface 4 of the body 2, which saves material on the body 2 compared to straight connecting elements that would have a curved rotation path. An alternative configuration of the expansion elements 10 for cages 1 with large angles involves the location of the bottom of the channels 14 on an oblique axis relative to the central longitudinal axis "a" of the body 2. As shown in Figure 14, the plates 15 have a circular hole 34 to solve the problem of the thickness of the longitudinal structure 22, connecting wall 8 of body 2.

In the second embodiment of the invention, shown in Figures 15-18c, and also in Figures 78 and 79, the cage 1.2 has a body 2.2, in which are located two expansion elements 10.2a and 10.2b, configured to open outward according to the invention, in each case beyond the side 7.2a, 7.2b of the body 2.2. As a result of doubling the width of the hooks 21a, 21b of the expanding element 10.2a, 10.2b, the width W of the body 2.2 of the cage 1.2 according to the second embodiment can be significantly less than the width W of the body 2 of the cage 1 according to the first embodiment, while the fully opened layout of the cage 1.2 has the same the same width W1 as the width W1 of the cage 1 of the first embodiment. Figure 15 shows a cage 1.2 with two expansion elements 10.2a, 10.2b positioned so that their support portion 12.2a, 12.2b fits into the bottom of two channels 14.2a, 14.2b located on the median horizontal plane "MP" of body 2.2 . Both channels 14.2a, 14.2b have access to the upper surface 3.2 of body 2.2. Restriction pads 19 are located on the bottom surface 4.2 of the body 2.2 to prevent rotation of the two expansion members 10.2a, 10.2b by more than 180°.

Figures 16 and 17 show a variation of the cage 1.2 according to the second embodiment of the invention, in which the bottom of the two channels 14.2a, 14.2b is located eccentrically from the median horizontal plane "MP" of the body 2.2, which allows the reception of two expansion elements 10.2a, 10.2b with hooks larger size 21a, 21b and this doubles the advantage described in Figures 12a and 12b for the eccentric single expansion element 10 of the cage 1 of the first embodiment. Unlike the cage 1.2 of the second embodiment shown in Figure 15, two expansion elements 10.2a, 10.2b of this variety fit into respective channels 14.2a, 14.2b each on the opposite surface 3.2, 4.2 of the body 2.2. The longitudinal connecting structure 22 connecting the walls 8.2 from the front portion 5.2 to the rear portion 6.2 of the body 2.2 increases the stability of the structure of the body 2.2, which may help maintain said structure of the body 2.2 during rotation during deployment of the expansion members 10.2a, 10.2b, as shown in Figure 18b. According to Figure 16, the expansion elements 10.2a, 10.2b, instead of the plates 15, are provided with hooks 21a, 21b connected to the support part 12.2a, 12.2b of the expansion elements 10.2a, 10.2b. The first hook 21a is connected not directly to the expansion element 10.2a, but through the second hook 21a by one direct connecting element 20.2a, while the first two hooks 21b are not connected directly to the base 12 with a connecting element 10.2b, but to the third hook 21b through straight connecting elements 20.2b. When they are completely folded inside the body 2.2 in the first position of the cage 1.2, the hooks 21a, 21b encircle the longitudinal connecting structure 22. During their rotational opening, the hooks 21a, 21b bypass the longitudinal connecting structure 22. The hooks 21a, 21b also improve the grip of the expanding elements 10.2a, 10.2b in vertebrae V1, V2.

Figures 18a-18c show a method for opening the expansion elements 10.2a, 10.2b of the cage variant 1.2 according to the second embodiment of the invention. Once inserted into the intervertebral space and reaching its final position between vertebrae V1, V2, the cage 1.2 is positioned such that the upper surface 3.2 and lower surface 4.2 are aligned with the vertebrae V1, V2, as shown in Figure 18a. Next, Figure 18b shows the cage 1.2 while the body 2.2 is sideways rotating. Rotation can be achieved using any suitable tool by engaging the rear portion 6.2 of body 2.2 and rotating 15-25° as shown in Figure 18b. The rotation of the body 2.2 slightly separates the vertebrae V1, V2 and provides a buffer space on the lateral sections of the upper 3.2 and, accordingly, the lower surface 4 of the body 2.2, from which the opening of the hooks 21a, 21b can be performed due to a single lateral rotation of approximately 180° of the two expansion elements 10.2 a, 10.2b.

Such individual rotations may be provided simultaneously or sequentially by any tool that engages the respective proximal ends 16.2a of each of the support portions 12.2a, 12.2b of the expansion members 10.2a, 10.2b. As shown in Figure 18c, after the hooks 21a, 21b are fully deployed, using a tool that ensures that the vertebrae V1, V2 are firmly supported on the upper surface 3 and lower surface 4 of the body 2.2 of the cage 1.2 and engages the bony grooves 23 of the hooks 21a , 21b, reverse rotation of the body is performed 2.2. at 15°-25°.

The third embodiment of the invention is shown in Figures 19-21b and is characterized in that the cage 1.3 is designed to be inserted between two vertebrae V1, V2 through a lateral approach to restore the natural lordosis of the vertebrae due to lateral bending. As shown in Figures 21a and 21b, the cage body 2.3 is trapezoidal in cross-section with one side 7.3a shorter than the other side 7.3b. Protective guides 24 are located on the upper surface 3.3 and lower surface 4.3 of the body 2.3 to protect the vertebrae V1, V2 from the rougher upper surface 3.3 and/or lower surface 4.3 of the body 2.3 when the cage 1.3 is inserted between the vertebrae in the first position with the expansion elements 10.3a folded, 10.3b, while the presence of such protection also facilitates the controlled insertion of the body 2.3 between the vertebrae V1, V2. The protective guides 24, located in the direction shown in Figures 19 and 20, also prevent lateral movement of the cage 1.3 towards the anterior side of the vertebrae or towards the spinal canal.

In the first position of the cage 1.3 arrangement, shown in Figures 19 and 21a, when the plates 15.3a, 15.3b are folded in the body 2.3, such a body has smaller dimensions, both in thickness and in width W, which provides a less wide access path to the spine and facilitates the insertion of the 2.3 body between the vertebrae V1, V2. According to Figure 21b, after opening the two expansion elements 10.3a, 10.3b using the method described in Figures 18a-18c, the dimensions of the cage 1.3 increased and the cage expanded in width by 1/1/1 the width of the plates 15.3b adjacent to both vertebrae V1, V2. The dimensions of the cage 1.3 also increased in height (thickness) due to the opening of the triangular-shaped plates 15.3a beyond the lower surface 4.3 of the body 2.3, while these plates 15.3a abut only the lower vertebra V2 with a corresponding groove for adhesion to the bone tissue 23. Due to increased size of grooves for adhesion to bone tissue 23 plates 15.3a, dimensions of cage 1.3 are also increased on the side 7.3a of cage 1.3, increasing the contact surface of cage 1.3 with the lower vertebra V2 by a width W1 exceeding I/I/7 of the contact surface of the upper surface 3.3 cage 1.3 and plates 15.3b with the upper vertebra V1. As shown in Figure 21b, the bone engagement grooves 23 of the plates 15.3a are positioned perpendicular to the protective guides 24, thereby protecting the cage 1.3 from movement in any direction. Referring to Figures 20 and 21b, the bone engagement slots 23 of the blades 15.3a may also have beveled profiles which improve the engagement of the blades 15.3a, 15.3b in the vertebrae V1, V2 and further prevent the cage 1.3 from moving towards one of the lateral sides of the vertebrae. . According to Figures 20, 22a and 22b, the plates 15.3a have a rotating protective guide 25 installed on the surfaces of one of their side grooves connecting all the plates 15.3a. The advantage of such a rotating protective guide 25 is that it protects the vertebrae in the same way as make protective guides 24 when introducing the cage 1.3 between the vertebrae V1, V2, and also strengthens the structure of the plates 15.3a on the expanding element 10.3a. A further advantage of the invention is that the rotatable protective guides 25 can be positioned on the laid extension members 10.3 in such a way that they do not interfere with such laying, but still protrude above the upper surface 3.3 or lower surface 4.3 of the body 2.3 to provide their protective purpose. In the second position of the opened expansion element 10.3, the rotary protective guide 25 no longer performs this protective function, but continues to serve to strengthen the structure of the expansion element 10.3.

Figures 22a-24b show a first variation of the third embodiment of the cage 1.3 comprising a body 2.3 which, as shown in Figure 24a, is thinner than the thickness of the body 2.3 of the cage 1.3 of the third embodiment shown in Figure 21a on the corresponding sides 7.3a . This has the advantage of further reducing the size of the required access path for the 1.3 cage towards the V1, V2 vertebrae. Considering the reduced space for laying the plates of the second expansion element 10.3b, such a second expansion element 10.3b also has triangular plates 15.3b. Figure 28 (representing another variation of the third embodiment) shows a limited space between two support parts 12.3a, 12.3b with a small buffer space inside the body 2.3 for triangular plates 15.3a, 15.3b, which can rotate around their axes without stopped by another suitable support part 12.3a or 12.3b. The supporting part of each of the triangular plates 15.3a, 15.3b has longitudinal buttresses 26a, 26b: in accordance with Figure 24b, buttresses 26a continue the contact surface of the cage 1.3 with the upper vertebra V1, and buttresses 26b continue the contact surface of the cage 1.3 with the lower vertebra V2. Figures 22a and 22b also show that both sets of plates 15.3a, 15.3b are provided with a rotatable guard rail 25 which duplicates the function of the cage insert guard rails 24 1.3 as shown in Figure 23. Figures 22a and 24b also show recesses 27 , located on the grooves for adhesion to bone tissue 23 of the plates 15.3a, 15.3b, to improve the adhesion characteristics of the beveled grooves for adhesion to bone tissue 23.

Figures 25-28 show a second variation of the third embodiment of the invention, in which the cage 1.3 has a body 2.3 made with thin walls 28, between which there are extensions 10.3a, 10.3b. thin triangular plates 15.3a, 15.3b can be laid and opened. The advantage of this variation of the third embodiment is that it provides a more dense and uniform contact surface of the vertebrae due to the plates 15.3a, 15.3b, as well as the upper surface 3.3 and lower surface 4.3 of the body 2.3. The structure of the body 2.3 in this variation is also strengthened by installing an internal longitudinal connecting structure 22 between the front part 5.3 and the rear part 6.3 of the body 2.3. The connecting structure 22 has a curved cross-section, which allows the plates 15.3a, having a curved slot 29, to open their full width to engage the bone tissue 23 without being obstructed by the longitudinal connecting structure 22. As also shown in Figure 27 , the supporting part 12.3 of the expanding element 10.3 along the entire length can have different dimensions: the diameter of the near end 16.3a and the far end 16.3b of the supporting part 12.2 is less than the diameter in the area between them. Such non-uniform dimensions may be useful for optimizing the placement of the support part 12.3 in smaller or larger channels 14.3 within the body 2.3.

In the fourth embodiment of the invention, which is shown in Figures 29-31b, the cage 1.4 can be used to access vertebrae V1, V2 at an angle. The height of the anterior part 5.4 of the 2.4 body, which will be located closer to the spinal canal, is less than the height of the posterior part 6.4, which corresponds to the natural lordosis of the lumbar spine. The expanding element 10.4 is made in the form of a single block structure, generally having a trapezoidal shape, which fits into the receiving cavity 13 of the body 2.4 of the cage 1.4 and is opened by rotating around the axis of its supporting part 12.4 in the channel 14.4, which is located in the side 7.4a of the body 2.4. A block design may be beneficial for the expansion member 10.4, which is made from a material that promotes bone growth, such as bone blocks, porous alloys, or densified metal or synthetic strands. In variations of this fourth embodiment, the shape of the expansion element 10.4 may also be an open box with five sides, or a cavity structure having only four walls, into which a bone graft, other biomaterial or synthetic material may be packaged, or another geometric shape, such as rectangular, round, oval or triangular. The rotary protective guide 25, which is located on the block of the expansion element 10.4, when such an expansion element is laid in the cavity 13 of the body 2.4, is designed to protect the vertebrae from abrasive surfaces on the block of the expansion element 10.4. Once the expansion element 10.4 is deployed, as shown in Figures 30 and 31b, the surface with the rotating protective guide 25 is moved to a lateral position on the cage 1.4, and two surfaces adjacent to the bone engagement surfaces 23.4 of the expansion element 10.4 can be secured in the vertebrae V1, V2.

Figures 32 and 33 show the first variation of the fourth embodiment of the invention, in which the expansion element 10.4 is made in the form of a sequence of parallel rings 30, attached to the support part 12.4 and connected by a rotating protective guide 25. The contours of the rings 30 generally reflect the contours of the block of the expansion element 10.4, presented in Figures 29-31b. A bone graft or other bone growth material may be placed in a circular cavity formed by a series of 30 rings.

According to Figures 34 and 35, the second version of the cage 1.4 according to the fourth embodiment of the invention is made with an expansion element 10.4, which is equipped with quadrangular plates 15.4 connected to the support part 12.4. Thus, the blades 15.4 form a three-sided rectangle, closed by the supporting part 12.4. In another version, plates 15.5, instead of a rectangular shape, could have the shape of a semicircle, similar to a “rozhon”. The expanding element 10.4 also has two plates 35a of a curved cross-section with a gutter profile, which are mounted with their longitudinal side on the support part 12.4, and one plate 35b, which also has a curved cross-section with a gutter profile, but is attached to the support part 12.4 at an oblique acute angle. The curved plates 35a, 35b may impart certain shock-absorbing properties to the cage assembly 1.4.

As shown in Figures 30, 33, 35, 81 and 82, the planes designated by the upper surface 3.4 and the lower surface 4.4 of the body 2.4, and the extension of these planes on the surfaces and grooves for engaging the bone 23.4 of the expansion element 10.4 are inclined, so that the natural The lordosis between the two vertebrae V1, V2 can be restored despite the inclined position of the cage 1.4 between the vertebrae, as shown in Figures 31a and 31b.

Figures 36a-40c show a cage 1.5 according to a fifth embodiment of the invention, the device of which is intended for posterior or transforaminal access to the spine. The width W of the body 2.5 is smaller than the width W of the bodies 2-2.4 according to the first to fourth embodiments of the invention. According to Figures 36a-38, similar to the cage according to the second embodiment of the invention, two expansion elements 10.5a, 10.5b are arranged to fit into two channels 14.5a, 14.5b located in the body 2.5, rotating from the first position with the plates 15.5a, 15.5b laid down to the second position with the plates open. One of the channels 14.5a is located on the median horizontal plane "MP" of the body 2.5, while the other channel 14.5b is offset from the center of this median horizontal plane "MP" and is located towards the lower surface 4.5 of the body 2.5. As shown in Figures 37b and 39b, one expansion element 10.5a is provided with a plurality of parallel plates 15.5b which are substantially trapezoidal in shape, with a circular opening 34 located on each of the plates 15.5a to accommodate a longitudinal connecting structure 22.5 along the entire length of the body 2.5 to give it greater stability and resistance to torsional forces. As shown in Figure 39a, the other expansion element 10.5b has a shorter support portion 12.5b compared to the support portion 12.5a of the first expansion element 10.5a, and is provided with narrower longitudinal plates 15.5a connected together by a straight connector 20.5, the function of which is to increasing the structural stability of the longitudinal plates 15.5b and to increase the contact surface of the groove for engagement with the bone tissue 23.5 of the plates 15.5b with the upper vertebra V1, especially when the straight connector 20.5 extends beyond the last plate 15.5b, as shown in Figures 38 and 39a. The first expansion element 10.5a is rotatable by approximately 180° and engages and abuts two adjacent vertebrae V1, V2, while the second expansion element 10.5b is configured to rotate approximately 75° and engages and abuts only in the upper vertebra V1. In accordance with the variation shown in Figure 37b, the protective guides 24, located on the upper surface 3.5 and on the lower surface 4.5 of the body 2.5, have guide extensions 24.1 made on the end 5.5 of the body 2.5, which allows to smooth out the deviation of the vertebrae V1, V2 during an impact , especially if the body 2.5 (except for the protective guides 24 and the guide extensions 24.1) is made of an abrasive material.

As shown in Figure 40c, the planes designated by the upper surface 3.5 and the lower surface 4.5 of the body 2.5, and the extension of these planes on the bone-adhesive grooves 23.5 of the plates 15.5a, 15.5b, are inclined, so that the natural lordosis between the two vertebrae V1, V2 can be restored despite the 1.5 angled cage position between the vertebrae. The angles of these two inclined planes for the cage 1.5 according to the fifth embodiment of the invention diverge from the rear part 6.5 of the body 2.5 towards the front part 5.5 of the body 2.5, and vice versa, the angles of the two inclined planes described in Figures 30, 33, 81 and 82 for cage 1.4 according to the fourth embodiment of the invention, diverge from the front part 5.4 of the body 2.4 towards the rear part 6.4 of the body 2.4.

Figures 41 and 42 show a first variation of the cage 1.5 according to the fifth embodiment of the invention, characterized in that one of the expansion elements 10.5b is located in the channel 14.5b, also located offset from the center of the horizontal median plane "MP" of the body 2.5, but in the direction to the upper surface 3.5 of the body 2.5. The rotation angle required to open the expansion element 10.5b according to the present embodiment is approximately 145°. The longitudinal plates 15.5b of this embodiment are also connected at their ends by a straight connector 20.5. The advantage of this first variation of the device (compared to the expansion element 10.5b of the body 1.5) is that a wider perimeter of the contact surface is obtained with the plates 15.5b, which abut the upper vertebra V1. Additionally, the 2.5 body can also be made with more material in its lower half. In still other variations of the cage 1.5 according to a fifth embodiment of the invention, the cage assembly 1.5 may be assembled with two expansion elements 10.5 having the same structure, whether in the form of an expansion element 10.5a or an expansion element 10.5b.

Figures 43, 44a and 44b show a second variation of the cage 1.5 of the fifth embodiment, in which the expansion member 10.5a is configured with the majority of the plates 15.5a attached to the curved connector 31, and only three plates 15.5a are attached directly to the support portion 12.5. This variation has the advantage of strengthening the design of the 10.5 flare member and allowing the 2.5 body to be assembled using more material in its lower portion.

Figures 45-49 show a third variation of the cage 1.5 according to the fifth embodiment of the invention with a body 2.5 made with a wedge-shaped front part 5.5 and a series of rectangular and parallel thin walls 28.5 forming a narrow upper surface 3.5 and a narrow lower surface 4.5 of the body 2.5, and relatively high sides 7.5a, 7.5b. The thin walls 28.5 and the front part 5.5 are all secured to the longitudinal connecting structure 22.5. Several parallel thin hooks 21.5 are installed on the extension element 10.5. They are arranged so as to be able to insert them into the slots 9.5 between the thin walls 28.5 in the first embodiment of the cage 1.5 with the expansion element 10.5 installed. Cage 1.5 in this version is designed to be inserted between two vertebrae V1, V2, with its lateral sides 7.5a, 7.5b interlocking with these two vertebrae. When the cage is in the desired position, it is rotated 90°. As shown in Figure 48, during such rotation, the expansion element 10.5 can be rotated to open the hooks 21.5. When the hooks 21.5 are fully opened, their upper and lower grooves for adhesion to the bone tissue 23.5 rest against the vertebrae V1, V2 and increase the width 1/1/ from the narrow surfaces 3.5, 4.5 of the body 2.5 to the larger width 1/1/1 of the entire body 1.5.

Figures 50-54 show a sixth embodiment of the invention consisting of a cage assembly 1.6 of a body 2.6 configured to receive two expansion members 10.6a, 10.6b, each equipped with one set of two parallel rings 30.6a, 30.6b. As shown in Figures 50 and 52, the supporting portions 12.6a, 12.6b of said expansion members 10.6a, 10.6b are in the form of rods which must pass through two straight channels 14.6a, 14.6b provided in the body 2.6. The lower part of the two straight channels 14.6a, 14.6b is located in the same plane towards the lower surface 4.6 of the body 2.6. The support portion 12.6b of one expansion member 10.6b is shorter than the support portion 12.6a of the other expansion member 10.6a, and its set of plates 15.6b or rings 30.6b opens toward the rear portion 6.6 of the body 2.6.

In accordance with Figures 50-52 and 54, the upper surface 3.6 and the lower surface 4.6 of the body 2.6 of the cage 1.6 have short sections of protective guides 24.6 located along the longitudinal axis of the body 2.6. Also shown in Figure 53 is that the grooves of the rings 30.6a, 30.6b of the expansion element 10.6 are covered with thin guides 17.6a, 17.6b: more specifically, the thin guides 17.6a on one groove of the rings 30.6a, 30.6b are located along the longitudinal axis of the housing 2.6, in while thin guides 17.6b on two bone engaging grooves 23.6 for engaging the bones of each of the rings 30.6a, 30.6b are arranged perpendicular to the longitudinal axis of the body 2.6. Referring to Figure 51, when the cage 1.6 is arranged in its first position with the rings 30.6a, 30.6b retracted, the thin guides 17.6a on the groove of the rings 30.6a, 30.6b are continuous with small portions of the protective guides 24.6. on the upper and lower surfaces 3.6, 4.6 of the body 2.6. This allows the vertebrae V1, V2 to be protected from the impact of the body 2.6 of the cage 1.6 due to “reconstructed” continuous protective guides, consisting of a sequence of thin guides 17.6a and small sections of protective guides 24.6. As shown in Figures 50 and 52, as the expansion members 10.6a, 10.6b rotate and the rings 30.6a or plates 15.6a open, the continuity of the thin guides 17.6a into small portions of the guard rails 24.6 is interrupted, and small portions of the guard rails 24.6 are consequently interrupted. become means of fastening which prevent displacement of the cage 1.6 along both the longitudinal and transverse axes, while the thin guides 17.6a no longer serve any function. However, the thin guides 17.6b on the two slots for engagement with the bone tissue 23.6 of the rings 30.6a, 30.6b or plates 15.6a, 15.6b, which now rest against the vertebrae V1, V2, act as anchors for the cage 1.6, as well as prevent its displacement both along the longitudinal and transverse axis. Thus, the invention makes it possible to move from a first position with the expansion elements 10.6a, 10.6b retracted, which protect the vertebrae V1, V2 during insertion, to an effective means of fastening in a second position of the cage device 1.6 after the expansion elements 10.6a, 10.6b are deployed.

The cage 1.6 according to the sixth embodiment of the invention can reveal both expansion elements 10.6a, 10.6b or only one of them, depending on the anatomy between the two vertebrae V1, V2. In addition, in another embodiment, two cages 1.6 can be inserted between two vertebrae V1, V2 next to each other, with the first cage opening one expansion element 10.6a towards the second cage 1.6, and the second cage opening one expansion element 10.6b towards the first cage. In this position, given the shorter expansion element 10.6b, the corresponding sets of rings 30.6 or plates 15.6 of both opened expansion elements, each of which is opened from one separate cage, are located parallel to each other and provide a continuous transition between the four rings 30.6 or plates 15.6, and They also expand the supporting surface between two 1.6 cages in the form of a bridge, which allows you to share the load of the opened cages with the V1, V2 vertebrae.

In accordance with Figures 55a-55f, since their supporting parts 12.6a, 12.6b are located in the longitudinal direction on the same plane, the expanding elements 10.6a, 10.6b of the cage 1.6 rotate in opposite directions, and their rings 30.6 also open in opposite directions a, 30.6b. As shown in Figures 55a-55c, the first set of rings 30.6a is deployed in accordance with the same process as the cage 1 in the first embodiment of the invention, as described in Figures 18a-18c. Referring to Figure 55d, the body 2.6 of the cage 1.6 is then rotated in the opposite direction to that shown in Figure 55b, and the support portion 12.6b of the second expansion member 10.6b is then rotated in the opposite direction to allow the second set of rings 30.6b to open. This process is illustrated in Figures 55d-55f.

Figure 54 shows a variation of the sixth embodiment of the cage 1.6 with expansion elements 10.6a, 10.6b, each of which is configured to deploy one set of two L-shaped expansion elements 32.6a, 32.6b instead of plates 15, hooks 21 or rings 30. The L-shaped expanding elements 32.6a, 32.6b rest against one vertebra with grooves for adhesion to the bone tissue 23.6 of the L-shaped elements and against the other vertebra with the tips of other legs of the L-shaped elements. Such lugs are connected with a straight connector 20.6, which increases the load sharing surface of the lugs.

In another variation of the sixth embodiment of the invention, shown in Figure 56, the body 2.6 of the cage 1.6 includes two expansion elements 10.6a, 10.6b, the supporting parts 12.6a, 12.6b of which are located diagonally to each other. The first channel 14.6a opens onto the upper surface 3.6, and its bottom part is located near the lower surface 4.6. The second channel 14.6b opens onto the lower surface 4.6, and its bottom part is located near the upper surface 3.6 of the body 2.6. These diagonally arranged expansion elements 10.6a, 10.6b are rotated in one direction to open their L-shaped expansion elements 32.6a, 32.6b, 32.6c in accordance with the process described in Figures 18a-18c. In addition, one expansion element 10.6a is provided with one set of two L-shaped expansion elements 32.6a and one separate L-shaped expansion element 32.6c, while the other expansion element 10.6b is provided with only one set of two L-shaped expansion elements expansion elements 32.6b. This type of cage 1.6 offers many options for the design of expansion elements 10.6 with a variety of selection, number and arrangement of plates 15, hooks 21, rings 30, L-shaped expansion elements 32.6 or elements of any other shape.

Figures 57-61 show a seventh embodiment of the invention comprising a cage 1.7 with a body 2.7 configured to receive two inclined expansion members 10.7a, 10.7b, each of which has a plurality of hooks 21.7a, 21.7b mounted on their support portion. 12.7a, 12.7b. As shown in Figure 57, in this embodiment, fewer thin walls 28.7 are provided on the connecting structure 22.7, allowing space for more collapsible hooks 21.7a, 21.7b to accommodate the longitudinal dimension of the housing 2.7. The thin walls 28.7 are pierced with circular holes 11.7 to receive support portions 12.7a, 12.7b of the expansion elements 10.7a, 10.7b. Over large areas of the cage 1.7, two opposing sets of hooks 21.7a, 21, 7b are directly adjacent to each other. The connecting structure 22.7 connects the thin walls 28.7 to the rear portion 6.7 and to the front portion 5.7 of the body 2.7. As shown in Figures 58a and 60a, the grooves of the two sets of hooks 21.7a, 21.7b in the folded position constitute the majority of the outer surfaces of the cage 1.7.

Figures 60b and 61 show that in the open position of the cage 1.7, unlike all other embodiments of the invention, the volume of the cage 1.7 is determined only by the hooks 21.7a, 21.7b of the open expansion elements 10.7a, 10.7b, and the contact surface between the cage 1.7c vertebrae V1, V2 is determined only by the perimeter of the grooves for adhesion to the bone tissue 23 of hooks 21.7a, 21.7b, and not by any part of the body 2.7. Thus, in the open position, the cage 1.7 according to the seventh embodiment of the invention represents another reflection of the nature of the invention based on scaffold technologies, with the body 2.7 serving as a vector for opening the cage 1.7 as a supporting structure for the expansion elements 10.7a, 10.7b, c as a connector between the front part 5.7 and the rear part 6.7 of the body 2.7 and as a means of fixing the expansion elements 10.7a, 10.7b. Due to this characteristic, an additional feature of this cage 1.7 is that its placement between the two vertebrae V1, V2 does not require reverse rotation of the body 2.7 (as shown in Figure 18c for the first embodiment and in Figure 55e for the sixth embodiment). In fact, the expansion elements 10.7a, 10.7b of the cage 1.7 can be deployed even without any rotation of the body 2.7, since the deployment of the hooks 21, 7a, 21, 7b can itself create a lever effect to retract the vertebrae V1, V2.

The cage 1.7 of this seventh embodiment more than doubles in volume in height and width (but mostly in height) from the folded version of its device, which is shown in Figures 58a and 60a, to the opened version of the device, shown in Figures 58b. , 59, 60b and 61.

Although the cage 1.7 of the seventh embodiment, as shown in Figures 57-61, can be self-locking when deployed, any additional locking means may be installed on the cage 1.7, such as a rack and pinion system or the implementation of a locking pin after deployment, or slight retraction or rotation of a pre-installed pin. With such a locking mechanism, the cage 1.7 can also be deployed when its body 2.7 is positioned at an angle of 90° compared to its position shown in Figures 60b and 61, in which case the hooks 21, 7a, 21, 7b will rest against the V1 vertebrae , V2 with other grooves without using the grooves for adhesion to the bone tissue 23, presented in Figure 61. In this version, the method of placing the cage is also different: the cage is inserted, the body 2.7 is rotated by 90°, and the expanding elements 10.7a, 10.7b are opened outwards according to the method according to the invention.

Figures 62-64 show an eighth embodiment of a cage 1.8 configured with two expansion elements 10.8a, 10.8b, the axes of their respective supporting parts 12.8a, 12.8b located in a plane that is substantially parallel to the upper surface 3.8 of the body 2.8, near such top surface 3.8. The body 2.8 of the cage 1.8 is provided with an elongated tip 5.81, which is inclined and can be used to retract the vertebrae V1, V2 for the purpose of inserting the cage 1.8 between the vertebrae V1, V2 by rotating the body 2.8 in accordance with the method described in Figures 37a and 37b in the US patent 15/739,696. The expansion elements 10.8a, 10.8b include parallel sets of triangular plates 15.8a, 15.8b, which are stacked inside the body 2.8 in the first embodiment of the device shown in Figure 62, both of which are opened beyond the top surface 3.8 of the body 2.8 and the sides 7.8a and 7.8b, as shown in Figures 63 and 64. After inserting the cage 1.8 between the vertebrae V1, V2 in accordance with Figure 37b of US patent 15/739,696 and when it is in its final position, the first extension element 10.8b opens, and its plates 15.8b open beyond the side 7.8b. body 2.8 in the same manner as shown in Figures 55b and 55c in relation to the cage 1.6 according to the sixth embodiment of the invention. As shown in Figures 63 and 64, the plates 15.8b are locked in an open position behind the side 7.8b and behind the top surface 3.8 of the body 2.8. The body 2.8 of the cage 1.8 is then rotated in the opposite direction, as shown in Figure 55d in relation to the cage 1.6, after which the second expansion member 10.8a can be rotated to open the set of parallel plates 15.8a. Figure 63 shows this stage for the cage 1.8 when the first expansion element 10.8b is fully deployed and the second expansion element 10.8a is in the process of deployment.

In this eighth embodiment, unlike what is described in Figure 55d for the cage 1.6, the upper surface 3.8 of the body 2.8 does not engage the upper vertebra V1. As a lever for the abduction of both vertebrae V1, V2, only the open expanding element 10.8b with grooves for adhesion to the bone tissue 23 of the plates 15.8a interact with the upper vertebra V1. This allows the second expansion element 10.8a to be subsequently opened. An advantage of the cage 1.8 of the eighth embodiment, which is shown in Figure 64, is that the cage 1.8 can expand both laterally beyond the two sides 7.8a, 7.8b and vertically beyond the top surface 3.8.

Figures 65-69b show a ninth embodiment of the invention, in which the cage 1.9 includes one body 2.9 and one expansion element 10.9, with the bottom of the channel 14.9 located on the central longitudinal axis "a1" between two side faces 7.9. a, 7.9b bodies 2.9. The 2.9 body has one side 7.9a higher than the other side 7.9b. The expansion element 10.9 includes a support part 12.9, made with plates 15.9.

The cage 1.9 is installed in accordance with the method described in US 9,421,114 using the tool 40 shown in Figure 65. The tool 40 is equipped with a first handle 41a and a second handle 41b. The rod is fixed to the first handle 41a at its proximal end and is configured to engage with the proximal end 16a of the expansion element 10.9 to operate its rotation mechanism according to the corresponding steps of the deployment method of the invention. The first rod attached to the first handle 41a slides inside the second rod attached to the second handle 41b. The second handle 41b can rotate the bodies of the cage 2.9 in accordance with installation methods according to the invention. At its distal end, the tool 40 is equipped with two expansion elements 42a, 42b, which have a groove-shaped cross-section, as shown in Figures 65, 66a-66c. The two expansion elements 42a, 42b of the tool 40 can be slid into two corresponding curved receiving slots 43a, 43b located on the sides 7.9a, 7.9b and/or on the upper surface 3.9 and/or the lower surface 4.9 of the body 2.9. cage 1.9, such curved receiving slots corresponding to the groove-shaped cross-section of the two expansion elements 42a, 42b.

The advantage of these trough-shaped expansion elements 42a, 42b is that the corresponding curved receiving slots 43a, 43b in the body 2.9 do not take up much space, leaving more material for stability of the body 2.9, as well as maximizing the size of the expansion element 10.9 and plates 15.9 , in contrast to how much space is taken up by expansion elements with a different cross-section. In addition, the combination of the curved receiving slots 43a, 43b with the curved expansion elements 42a, 42b eliminates or significantly limits the risk of separation of the two expansion elements 42a, 42b beyond the "D" dimension. Moreover, as shown in Figures 66a-66c, this curved cross-section of the expansion elements 42a, 42b allows the same tool 40 with expansion elements 42a, 42b that are separated by the same dimension "D" to fit curved slots with the same degree of curvature 43a , 43b, located on the bodies 2.9 of cages 1.9 of different sizes, but at the same time performing their function within the framework of the method of installing the cages. The advantage of this approach is that it limits the number of instruments to 40 required to install cages of various sizes. In accordance with Figures 66a-66c, two expansion elements 42a, 42b are located along opposite curves. In various variations of the tool 40, these expansion elements 42a, 42b may have bends facing the same direction or bends with their convex portions facing different axes. The tool 40 with its expansion elements 42a, 42b can also be used with interbody cages that are not the subject of the present invention, such as one-piece interbody cages or other types of expandable cages.

Figures 67a, 67b and 67c show how, in the first embodiment of the cage 1.9 according to the ninth embodiment of the invention, the plates 15.9 are laid in the body 2.9 inside the slots 9.9 made in the thickness of one side side 7.9a. When deployed in the second embodiment of the device, the plates 15.9 increase both the width and height of the cage 1.9 by aligning the top surface 3.9 to the "P" plane, as shown in Figure 68c.

Figures 69a and 69b show a variation of the cage 1.9 of the ninth embodiment, in which the body 2.9 is designed such that the sides 7.9a, 7.9b could become surfaces of the body 2.9 abutting the upper and lower vertebrae V1, V2. Depending on the anatomy of the spinal segment and the space between the two vertebrae V1, V2, the surgeon can choose to open the plates 15.9 through the upper surface 3.9 to create a “P” plane (as shown in Figure 69a) or rotate the cage at an angle of 90° with the opening of the plate 15.9 through side side 7.9a to create the plane "P1" (as shown in Figure 69b), with the side sides 7.9a, 7.9b in this case serving as the upper and lower contact surfaces between the body 2.9 and the vertebrae V1, V2.

Figures 70-72b show another variation of the cage 1.9 according to the ninth embodiment of the invention, in which the body 2.9 is configured to receive one single expansion element 10.9 on its central longitudinal axis "a1", equipped with one double set of symmetrically opposed plates 15.9, 15.91 ( shown in Figure 71). Both sides 7.9a, 7.9b of the body 2.9 are equipped with slots 9.9, alternating with the walls 8.9, for laying the plates 15.9, 15.91 of the expansion element 10.9 in the stacked version of the cage device 1.9, which is shown in Figures 70 and 72a. This feature provides twice the height of the cage 1.9 in the second embodiment of the open plates 15.9, 15.91, as shown in Figure 72b, compared to the increase in height that is provided by the opening of the plates 15.9 within the other variation of the cage 1.9, shown in Figure 68c.

Figure 73 shows another variation of the cage 1.9 of the ninth embodiment, in which the expansion member 10.9 may have a final set of dual plates 15.92, 15.93 that are inserted into the channel 14.9 behind the rear portion 6.9 of the body 2.9. The advantage of this variation is that the same body 2.9 can be used to receive expansion elements 10.9 within its channel 14.9, which can be longer than the body 2.9 itself. Thus, the invention is completely modular in that it allows the height, length, width, angles and overall shape of the cage 1.9 to be varied by installing different types of expansion elements 10.9 on the same body 2.9 to suit the needs of a specific anatomy.

Figures 83-85 show a tenth embodiment of a cage 1.10 configured with a cylindrical shaped body 2.10 configured with a series of parallel disc-shaped thin walls 28.10 and slots 9.10, the thin walls and the front portion 5.101 of the body 2.10 being connected by one or more connecting structures 22.10. The front part 5.10 of the body 2.10 is equipped with a tip 5.101, having two concave bevels, for insertion between the two vertebrae V1, V2. The expansion element 10.10 is provided with hooks 21.10, which have flat sides and are mounted parallel to the support part 12.10 for full expansion after rotation of approximately 72°. The 1.10 cage is inserted between two vertebrae by first inserting the 5.101 tip and then rotating the 2.10 body or 1.10 cage 90° to allow the vertebrae to be pulled back to a size close to the height of the 2.10 body and then pushing the 1.10 cage into its final position between the vertebrae. V1, V2. The body 2.10 of the cage 1.10 can also be provided with threads located along the periphery of the cylindrical thin walls 28.10 of the body 2.10, so that the cage 1.10 can be screwed into position in accordance with the well-known method of installing interbody cages.

Thus, the advantage of the cage 1.10 according to this tenth embodiment of the invention is that it provides the expansion element 10.10 according to the invention on a cylindrical body 2.10, which is provided in an impact-resistant or screw-on design. Another advantage is that after insertion of the cage 1.10 there is no need to retract the vertebrae V1, V2 by rotating the body 2.10 in accordance with the methods of the invention, since the hooks 21.10 are retracted from the slots 9.10 provided in the body 2.10 by simply rotating the expansion element 10.10. Preferably, the opening of the expansion element 10.10 occurs in the position of the cage 1.10 relative to the vertebrae V1, V2, when the support part 12.10 of the expansion element 10.10 and the circular holes 11.10 of the body 2.10 are close to the upper or lower vertebrae V1, V2.

In various variations of this tenth embodiment, shown in Figures 86-89, the thin disc-shaped walls 28.10 of the body 2.10 may be replaced by a series of parallel rings 44 forming a tubular structure of rings 44, as shown in Figure 86. Arrangement of the rings 44 on the body 2.10 and hooks 21.10 on the expansion member 10.10 has the advantage of packing the graft material and allowing it to grow through the rings 44 and hooks 21.10. As shown in Figures 87 and 88, the hooks 21.10 have flat sides, which reduces the lateral protrusion of material not resting on the V1, V2 vertebrae.

In contrast, Figures 89 and 90 describe a variation of the tenth embodiment in which the expansion element 10.10 is provided with a series of cylindrical shaped hooks 21.10. According to Figure 89, the advantage of this variation is that the width "W" of the cage 1.10 with the rounded hooks 21.10 opened is greater than the width "W" of the cage 1.10 of the other variation shown in Figure 88. It is preferable that the expansion element 10.10 of this variation is opened first occurs in the position of the cage 1.10 relative to the vertebrae, when the supporting part 12.10 of the expanding element and the round holes 11.10 of the body 2.10 are close to the upper or lower vertebrae V1, V2. As the expansion member 10.10 gradually opens, the body 2.10 can be rotated to gradually move the support portion 12.10 and channel 14.10 to a more central position in the space between the upper vertebra and the lower vertebra until full deployment is achieved, as shown in Figure 90.

This tenth embodiment again illustrates the characteristics of the invention based on scaffold technologies: first laying and then opening several thin scaffolds to create a strong cage structure 1.10.

Figures 91-94 describe an eleventh embodiment of the invention comprising an interspinous vertebral implant 1.11 configured to be inserted between two adjacent spinous processes V1, V2 to separate them from each other. According to Figure 91, the implant 1.11 of the seventh embodiment described in Figures 58a-61 can be used to separate the vertebrae V1, V2 at the level of the spinous processes from each other. Figure 92 shows the same segment of the spinous processes V1, V2 after deployment of the implant 1.11. In the variation shown in Figure 93, the implant 1.11 is equipped with one expansion element 10.11a, which is provided with one or more hooks 21.11a, designed to increase the space between the vertebrae, while the other expansion element 10.11b is equipped with two hooks 21.11b. to open beyond the spinous process surfaces to prevent forward or backward movement of the implant. In the second variation of the eleventh embodiment of the invention, which is presented in Figure 94, the implant 1.11 is made with one single expansion element 10.11a, having two functional characteristics: one lever 45 designed to increase the distance between the body 2.11 of the implant 1.11, and the lower vertebra V2, and also one or two hooks 21.11 to prevent displacement of the implant 1.11.

All eleven embodiments and variations thereof of cage 1 or body 2 or expansion member 10 individually may be configured to provide a shock-absorbing effect for cage 1 or certain individual components thereof when subjected to the compressive force of vertebrae V1, V2, or others. forces of movement. Soft cages that imitate the cancellous bone structure of the vertebral plates prevent subsidence and promote bone growth. Implants with shock-absorbing properties are also well suited for non-discal implants, such as interspinous implants, as they protect the bony structure of the vertebral processes.

As shown in Figures 78 and 79 for cage 1.2 in the second embodiment, in Figure 27 for cage 1.3 in the third embodiment, in Figures 34, 35 and 80-82 for cage 1.4 in the fourth embodiment, and in Figures 45-49 in In relation to the cage 1.5 of the fifth embodiment, the thin walls 28, 28.2, 28.4, 28.5 located on the body 2.2, 2.3, 2.42.5 are inherently more flexible in structure than the larger walls 8 (for example, shown in Figures 1 and 2) also depending on the choice of material.

Curved thin walls, which are similar in design to the curved plates 35a, 35b shown in Figures 34 and 35 having a grooved cross-section, can also increase cage flexibility. The flexibility of the thin walls 28, 28.2, 28.4, 28.5 can also be increased by providing notches 27 on the grooves of the thin walls 28.2, 28.4, 28.5, on their vertebrae engaging grooves, as shown in Figures 45, 48 and 49, or on the grooves of the thin walls 28.2, 28.4, 28.5 forming the sides 7.2a, 7.2b, 7.5a, 7.5b of the body 2.2, 2.4, 2.5 (for example, as shown in Figures 78, 79, 81 and 82). These recesses 27 can be located perpendicular to the groove or obliquely. They may also have bends.

Another flexibility-enhancing feature is the presence of slots 33 in the thin wall structure 28.2, 28.4, 28.5, as shown in Figures 46, 78, 79, 80 and 81. Thin plates 15.3a, 15.3b, 15.4, 15.5a, 15.5b ( as shown in Figures 27, 38, 81 and 82), curved plates 35a, 35b (as shown in Figures 34 and 35), thin hooks 21.2 (as shown in Figures 78 and 79), and figure 8 hooks 21.5 "(as shown in Figures 46 and 48) also have a flexible or soft structure. The same can be said for the T-shaped components 39 of the expansion elements 10, such as those shown in Figure 74. These thin plates and hooks can be made even more flexible by providing notches 27, curved slots 29, rounded holes 34 or slots 33 on their grooves for engagement with bone tissue 23 (as shown in Figure 24b) or, in the case of cage 1.4, which is shown in Figure 35, along a significant portion of the height of the quadrangular plates 15.4, including making slots through their corners.

In accordance with Figure 75, thicker plates 15.6, such as plates of the expansion element 10.6 according to a variation of the sixth embodiment of the invention, can also be made more flexible and have expanding recesses 27. Thicker rings 30.6 can be equipped with two gable components 36a, 36b, as shown in Figure 76, which allows you to increase the vibration damping coefficient of the rings 30.6. Figure 77 shows a variation of the cage 1.6 according to the sixth embodiment of the invention, in which the expansion element 1.6 is made using thin tightly packed rods 37 mounted on a supporting structure 38 connected to the support part 12.6 and opened by rotating the support part 12.6. These tightly packed rods 37 are like compact strands of brush, providing softness to the expansion element 10.6 while compressing and twisting the cage 1.6.

Figures 80 to 83 show a variation of the fourth embodiment in which the cage 1.4 includes a body 2.4 configured with thin walls 28.4 and an elongated tip 5.81, as well as an expansion member 10.4 that includes thinner plates 15.4. The elongated slanted tip 5.81 performs the same function as the slanted tip 5.81 of the eighth embodiment, which is described in Figures 62 and 64 and allows the insertion of a variation of the cage 1.4 in accordance with the method described in Figures 37a and 37b in the US patent. 15/739,696. The advantage of rotating the body 2.4 in the described method is to create a buffer space in the areas of the upper surface 3.4 and lower surface 4.4 of the body 2.4, which allows the cage 1.4, despite the thinner plates 15.4 protruding from the upper surface 3.4 of the body 2.4 (as shown in Figure 80) , or the thin plates 17 located on the slots to engage the bone tissue 23 of the thinner plates 15.4 (as shown in Figures 81 and 82) pass between the vertebrae without such protruding components interfering with the vertebrae V1, V2 or obstructing the passage of the cage 1.4 between the vertebrae. Another advantage of this embodiment, in addition to the vibration damping characteristics of the cage 1.4, is that the housing 2.4 and the expansion element 10.4 when opened form continuous and elongated surfaces that rest on the upper and lower vertebrae V1, V2, and also that such the elongated surfaces denote planes inclined relative to the longitudinal axis "a1" of the body 2.4, as shown in Figures 81 and 82, to restore the natural lordosis of the spinal segment.

The flexibility of the thin walls 28, 28.2, 28.4, 28.5 of the plates 15.3a, 15.3b, 15.4, hooks 21.2, 21.5 and rings 30 can be made more or less rigid in certain areas of the cage 1 by increasing the number, length, depth, thickness and angle the inclination of notches 27 and/or slots 33 on thin walls, or notches 27, curved slots 29 or rounded holes 34 on their plates 15. These can be useful for creating cages that are more flexible in some parts and more rigid in others, to ensure or, conversely, prevent certain directed micromovements between two adjacent vertebrae V1, V2 within the segment.

All embodiments of the invention are made with the possibility of self-locking in their second version of the device of the disclosed expanding element 10 due to the compression force of the vertebrae V1, V2. The invention can use any suitable technical means for fixing the expansion element 10 in the open position. The Figures show retractable elements 10, the supporting parts 12 of which are located within the perimeter of the surfaces of the bodies 2 of cages and implants 1. In various embodiments of the invention, channels 14 or round holes 11 can be made on the body 2 outside the sides 7 of the body 2.

It goes without saying that each of the characteristics of each embodiment of the invention and any of its variations can be applied to any other embodiment or any of its variations. In various variations of any of the embodiments of the invention, the support part 12 can be located at an angle to the longitudinal axes "a" or "a1" of the cage, which, when deployed, allows the use of different sizes of plates, hooks and rings installed on the inclined support part 12 of the expansion element 10 The bodies 2 of the cages 1 according to the first to eleventh embodiments of the invention and the expanding elements 10 can be made of various materials.

Embodiments of the invention can be applied to any implants that separate and/or fuse vertebrae, including interbody implants, vertebral body replacement implants, interspinous implants, and artificial discs. The invention can also be used to reduce and/or fuse other bones such as the hips, pelvis and any long bones and joints.

Embodiments of the invention can be applied to the human and animal spine.

Claims (28)

1. A bone fusion device for insertion between an upper and lower vertebrae, comprising at least one foldable sliding element comprising a support portion with proximal and distal ends, and sides, with at least one folding sliding element the member is configured to dynamically change the dimensions of the bone fusion device to increase the volume of the bone fusion device, wherein the bone fusion device is actuated at the proximal end of the support portion using a removable tool to advance the distal end of the support portion to increase the interstitial space between the upper and lower vertebrae to thereby deliver the device to the implantation site, wherein the device is in a compact form of a first form factor, the first surface area of which is in contact with the upper and lower vertebrae, and the first volume is located within the interstitial space, wherein at least one the sliding element is configured to be rotated by means of a removable tool from a folded position outwardly in a direction from one of the sides of the support part and abutment into at least one of the upper vertebra and the lower vertebra and expanding the bone fusion device into a second form factor, having a second surface area that is in contact with the upper vertebra and lower vertebrae, and a second volume in the interstitial space. 2. A dynamically changing prismatic element for use in an intervertebral implantable bone fusion device, comprising: an interlocking modular element extending through the distal and proximal ends of the device, having at least one folded structural element connected thereto, each of which is provided with geometric shapes and openings; at least one folded structural element that is hingedly connected to the interlocking modular element, allowing it to be used in a folded position and inserted between the upper and lower vertebrae, as well as in an unfolded position to dynamically change the form factor of the device; an engaging portion located at the distal end of the device; wherein the engaging modular element is configured to be actuated at the proximal end by a removable tool to advance the engaging portion to increase the interstitial space between the upper and lower vertebrae, thereby allowing the device to be delivered to the implantation site, the device being provided in a compact first form - a factor whose first surface area is in contact with the upper and lower vertebrae, and the first volume is within the interstitial space; wherein the device is configured to be laterally deployable using a removable tool on the interlocking modular element and the folded structural element so as to transform from a compact first form factor to an unfolded second form factor, providing an unfolded device with an increased second volume, and a larger second area surfaces compared to the first form factor. 3. The element of claim 2, wherein the engaging modular element is rotatable about a central axis such that rotation of the removable tool at the proximal end causes the engaging modular element to rotate about the pivot point, causing the device to rotate in a first direction about the pivot point. between at least two positions relative to the upper and lower vertebrae, whereby the device is brought to a first position with a separation distance between the upper and lower vertebrae that exceeds the interstitial space defined by the engaging portion, wherein subsequent rotation by means of a removable tool of at least one folded structural element in a second direction opposite to the first direction, allowing, accordingly, to unfold and extend laterally the at least one folded structural element and simultaneous further rotation of the engaged one by the removable tool the modular element in the first direction results in the device being oriented in the second direction and changing the configuration of the device to the second form factor, with the separation distance between the upper and lower vertebrae still exceeding the interstitial space formed by the engaging portion. 4. The element of claim 2, wherein the interlocking modular element and at least one folded structural element are rotatably attached about a central axis to the interlocking modular element such that rotation of the removable tool at the proximal end causes rotation of the interlocking modular element about pivot points within the respective movement, wherein the movement of the interlocking modular element causes the at least one folded structural element to rotate through about 90 degrees between at least two positions relative to the upper and lower vertebra. 5. The member of claim 2, wherein the engaging modular member is rotatable about a central axis such that rotation of the removable tool at the proximal end causes the engaging modular member to rotate about a pivot point, causing the device to rotate in a first direction about the pivot point. rotation between at least two positions relative to the upper and lower vertebrae, whereby the device is brought into a first position with a separation distance between the upper and lower vertebrae that exceeds the interstitial space formed by the engaging part, and subsequent rotation by means of a removable tool, according to at least one folded structure in a first direction or a second direction opposite to the first direction, respectively allowing the at least one folded structure to be folded out and laterally extended, and in that either simultaneous or subsequent rotation is removable tool of the interlocking modular element in the second direction results in the device being oriented in the second direction and changing the configuration of the device to the second form factor. 6. The element according to claim 2, wherein at least one overall dimension of the interstitial space between the upper and lower vertebrae increases when the interlocking modular element is rotated while it is in the first form factor. 7. The element according to claim 2, in which at least one overall dimension of the interstitial space between the upper and lower vertebrae increases when the device configuration is dynamically changed from the first form factor to the second form factor. 8. The member of claim 2, wherein the engaging modular member is rotatable about a central axis such that rotation of the removable tool at the proximal end causes the engaging modular member to rotate about a pivot point, causing the device to rotate in a first direction about the pivot point. rotation between at least two positions relative to the upper and lower vertebrae, and the at least one folded structural member rotates about the pivot point in a second direction opposite to the first direction, thereby allowing the at least one folded structure to be expanded and laterally stretched , a single folded structural element, resulting in a second device orientation and allowing the device to be reconfigured to a second form factor. 9. The element according to claim 2, in which the interlocking modular element includes structural elements with geometric shapes and openings having one of the types of holes, openings, channels, projections and open cavities having a shape that provides a prismatic element of the device or combinations thereof . 10. The element according to claim 2, in which the interlocking modular element includes first surfaces in contact with the upper and lower vertebrae, wherein the device is presented in the form of a first form factor, as well as second surfaces in contact with the upper and lower vertebrae, when the device is presented in the form of a second form factor, with the first surfaces being different in size from the second surfaces. 11. A method for implanting a dynamically transforming intervertebral implantable device for bone fusion, including the following steps: separating the upper and lower vertebrae to move the device in the interstitial space between the upper and lower vertebrae to the implantation site; inserting the device into the interstitial space in a compact first form factor configuration; rotating the device about an axis in a first direction so that the folded structure can be rotated laterally; rotating the folded structure about an axis in the same first direction so as to unfold the folded structure so that it opens laterally outward from the device to transition to a second form factor; and securing the unfolded structure to the implantation site in a second form factor configuration to provide greater surface area and volume within the surrounding interstitial space between the upper and lower vertebrae. 12. A method for implanting a dynamically transforming intervertebral implantable device for bone fusion, including the following steps: separating the upper and lower vertebrae to move the device in the interstitial space between the upper and lower vertebrae to the implantation site; inserting the device into the interstitial space in a compact first form factor configuration; rotating the device about an axis in a first direction so that the folded structure can be rotated laterally; rotating the folded structure about an axis in a second direction opposite to the first in order to unfold the folded structure and thereby cause it to open laterally in a direction outward from the device for transition to the second form factor; and securing the unfolded structure to the implantation site in a second form factor configuration to provide greater surface area and volume within the surrounding interstitial space between the upper and lower vertebrae.