WO1994028824A2 - Apparatus and method of inserting spinal implants - Google Patents

Apparatus and method of inserting spinal implants Download PDF

Info

Publication number
WO1994028824A2
WO1994028824A2 PCT/US1994/006345 US9406345W WO9428824A2 WO 1994028824 A2 WO1994028824 A2 WO 1994028824A2 US 9406345 W US9406345 W US 9406345W WO 9428824 A2 WO9428824 A2 WO 9428824A2
Authority
WO
WIPO (PCT)
Prior art keywords
implant
distractor
spinal
diameter
tubular member
Prior art date
Application number
PCT/US1994/006345
Other languages
French (fr)
Other versions
WO1994028824A3 (en
Inventor
Gary Karlin Michelson
Original Assignee
Karlin Technology, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Family has litigation
First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=27394869&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=WO1994028824(A2) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
Priority claimed from US07/205,935 external-priority patent/US5015247A/en
Priority to DK00204831T priority Critical patent/DK1093760T3/en
Priority to CA002164859A priority patent/CA2164859C/en
Priority to EP94920704A priority patent/EP0703757B1/en
Priority to DE69433088T priority patent/DE69433088T2/en
Application filed by Karlin Technology, Inc. filed Critical Karlin Technology, Inc.
Priority to DK94920704T priority patent/DK0703757T3/en
Priority to AT94920704T priority patent/ATE247928T1/en
Priority to KR1019950705673A priority patent/KR100318703B1/en
Publication of WO1994028824A2 publication Critical patent/WO1994028824A2/en
Priority claimed from US08/396,414 external-priority patent/US6080155A/en
Publication of WO1994028824A3 publication Critical patent/WO1994028824A3/en

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • A61F2/446Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or elliptical cross-section substantially parallel to the axis of the spine, e.g. cylinders or frustocones
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4611Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025Joint distractors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875Screwdrivers, spanners or wrenches
    • A61B17/8886Screwdrivers, spanners or wrenches holding the screw head
    • A61B17/8888Screwdrivers, spanners or wrenches holding the screw head at its central region
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025Joint distractors
    • A61B2017/0256Joint distractors for the spine
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92Impactors or extractors, e.g. for removing intramedullary devices
    • A61B2017/922Devices for impaction, impact element
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/036Abutting means, stops, e.g. abutting on tissue or skin abutting on tissue or skin
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30721Accessories
    • A61F2/30744End caps, e.g. for closing an endoprosthetic cavity
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442Intervertebral or spinal discs, e.g. resilient
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657Measuring instruments used for implanting artificial joints
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/28Bones
    • A61F2002/2835Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108Shapes
    • A61F2002/3011Cross-sections or two-dimensional shapes
    • A61F2002/30138Convex polygonal shapes
    • A61F2002/30143Convex polygonal shapes hexagonal
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108Shapes
    • A61F2002/30199Three-dimensional shapes
    • A61F2002/30224Three-dimensional shapes cylindrical
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108Shapes
    • A61F2002/30199Three-dimensional shapes
    • A61F2002/30224Three-dimensional shapes cylindrical
    • A61F2002/30235Three-dimensional shapes cylindrical tubular, e.g. sleeves
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30405Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30426Bayonet coupling
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30593Special structural features of bone or joint prostheses not otherwise provided for hollow
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772Apertures or holes, e.g. of circular cross section
    • A61F2002/30774Apertures or holes, e.g. of circular cross section internally-threaded
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772Apertures or holes, e.g. of circular cross section
    • A61F2002/30784Plurality of holes
    • A61F2002/30785Plurality of holes parallel
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772Apertures or holes, e.g. of circular cross section
    • A61F2002/30784Plurality of holes
    • A61F2002/30787Plurality of holes inclined obliquely with respect to each other
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30795Blind bores, e.g. of circular cross-section
    • A61F2002/30797Blind bores, e.g. of circular cross-section internally-threaded
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30836Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves knurled
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/3085Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with a threaded, e.g. self-tapping, bone-engaging surface, e.g. external surface
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30904Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves serrated profile, i.e. saw-toothed
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2002/448Joints for the spine, e.g. vertebrae, spinal discs comprising multiple adjacent spinal implants within the same intervertebral space or within the same vertebra, e.g. comprising two adjacent spinal implants
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4619Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof for extraction
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4625Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
    • A61F2002/4627Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4629Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof connected to the endoprosthesis or implant via a threaded connection
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4644Preparation of bone graft, bone plugs or bone dowels, e.g. grinding or milling bone material
    • A61F2002/4649Bone graft or bone dowel harvest sites
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4681Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor by applying mechanical shocks, e.g. by hammering
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4687Mechanical guides for implantation instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017Angular shapes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063Three-dimensional shapes
    • A61F2230/0069Three-dimensional shapes cylindrical

Definitions

  • the present invention relates to artificial fusion implants to be placed into the intervertebral space left remaining after the removal of a damaged spinal disc and specifically to the apparatus for and method of, inserting the implants. 2. Description of the Prior Art
  • a fusion (the joining together of two or more bones via a continuous bridge of incorporated bone) may be performed.
  • the interbody fusion wherein the disc is partially excised and bone placed within that space previously occupied by that disc material (between adjacent vertebrae) for the purpose of restoring a more normal spatial relationship, and to provide for stability; short term by mechanical support, and long term by the permanent cross bonding of bone from vertebra to vertebra.
  • the purpose of the present invention is to provide an implant, and the apparatus and method of inserting the implant within the intervertebral space left after the removal of the disc material and permanently eliminate all motion at that location.
  • the device of the present invention is space occupying within the disc interspace, rigid, self-stabilizing to resist dislodgement, stabilizing to the adjacent spinal vertebrae to eliminate local motion, and able to intrinsically participate in a vertebra to vertebra bony fusion so as to assure the permanency of the result.
  • Patent No. 2,372,622 to FASSIO France describing a motion preserving implant comprising complimentary opposed convex and concave surfaces.
  • these devices resemble the present invention only in that they are placed within the intervertebral space following the removal of a damaged disc. In that they seek to preserve spinal motion, they are diametrically different from the present invention which seeks to permanently eliminate all motion at that spinal segment.
  • a second related area of prior art includes those devices utilized to replace essentially wholly removed vertebrae. Such removal is generally necessitated by extensive vertebral fractures, or tumors, and is not associated with the treatment of disc disease. While the present invention is to be placed within the disc space, these other vertebral devices cannot be placed within the disc space as at least one vertebra has already been removed such that there no longer remains a "disc space”. Furthermore, these devices are limited in that they seek to perform as temporary structural members mechanically replacing the removed vertebrae (not a removed disc) , and do not intrinsically participate in supplying osteogenic material to achieve cross vertebrae bony fusion.
  • this second group of devices differs from the present invention in that they are vertebral replacements struts, do not intrinsically participate in the bony fusion, can only be inserted in the limited circumstances where an entire vertebra has been removed from the anterior approach, and are not designed for, or intended to be used for the treatment of disc disease.
  • a third area of prior art related to the present invention includes all devices designed to be applied to one of the surfaces of the spine.
  • Such devices include all types of plates, struts, and rods which are attached by hooks, wires and screws. These devices differ significantly from the present invention in that they are not inserted within the disc space and furthermore do not intrinsically participate in supplying osteogenic material for the fusion.
  • none of these devices are designed to be nor can be used within the disc space. Moreover, these devices do not replace a damaged disc, and do not intrinsically participate in the generation of a bony fusion.
  • Another area of related prior art to be considered is that of devices designed to be placed within the vertebral interspace following the removal of a damaged disc, and seeking to eliminate further motion at that location.
  • the instrumentation of the present invention also makes overpenetration by the drill impossible.
  • overpenetration in the cervical spine would result in the total paralysis or death of the patient.
  • the result In the thoracic spine, the result would be complete paraplegia.
  • the result In the lumbar spine, the result would be paraplegia or a life-threatening perforation of the aorta, vena cava, or iliac vessels.
  • the present invention is atraumatically screwed into place while the BAGBY device, in contradistinction, is pounded into position.
  • BAGBY describes that its implant is significantly larger in size than the hole drilled and must be pounded in. This is extremely dangerous and the pounding occurs directly over the spinal cord which is precariously vulnerable to percussive injury.
  • the BAGBY device must always be pounded directly towards the spinal cord.
  • the BAGBY device is pounded into a smooth hole under great resistance, and lacking any specific design features to secure it, the device is highly susceptible to forceful ejection which would result in great danger to the patient and clinical failure.
  • the present invention in contradistinction, is securely screwed into place, and possesses highly specialized locking threads to make accidental dislodgement impossible. Because of the proximity of the spinal cord, spinal nerves, and blood vessels, any implant dislodgement as might occur with the BAGBY device might have catastrophic consequences.
  • the BAGBY device can only be inserted from the front of the vertebral column, however, in contrast, the present invention can be utilized in the cervical, thoracic, and lumbar spine, and can be inserted from behind (posteriorly) in the lumbar spine. This is of great importance in that the purpose of these devices is in the treatment of disc disease and probably greater than 99 percent of all lumbar operations for the treatment of disc disease are performed from behind where the present invention can easily be utilized, but the BAGBY device, as per BAGBY'S description, cannot.
  • Disc removal The BAGBY invention requires the complete removal of the disc prior to the drilling step, whereas the present invention eliminates the laborious separate process of disc removal and efficiently removes the disc and prepares the vertebral end plates in a single step. 4.
  • Time required The present invention saves time over the BAGBY invention since time is not wasted laboring to remove the disc prior to initiating the fusion. Also, with the present invention the procedure is performed through a system of guarded instrumentation, time is not wasted constantly placing and replacing various soft tissue retractors throughout the procedure.
  • Implant stability - Dislodgement of the implant would be a major source of device failure (an unsuccessful clinical result) , and might result in patient paralysis or even death.
  • the BAGBY device lacks any specific means of achieving stability and since it is pounded in against resistance to achieve vertebral distraction, and is susceptible to forceful dislodgement by the tendency of the two distracted vertebrae, to return to their original positions squeezing out the device.
  • the present invention is screwed into place. As there is no unscrewing force present between the vertebrae, compression alone cannot dislodge the implant.
  • the implant is inherently stable by its design.
  • the threads of the present invention are highly specialized in that they are periodically interrupted so that the tail ends of each of the tabs so formed are blunted and twisted so as to resist accidental unscrewing.
  • the removal of an implant with such "locking threads” requires the use of a special extractor included within the instrumentation.
  • the stability of the present invention is still further enhanced, again in contradistinction to the BAGBY device, by the presence of a "bone ingrowth” surface texturing, which both increases the friction of the fit and allows for the direct growth of the vertebral bone into the casing of the implant itself.
  • the present invention is not only self-stabilizing, it also provides stability to the adjacent vertebrae in at least three ways that the BAGBY device cannot.
  • the BAGBY device is placed transversely across the joint in the center, leaving both vertebrae free to rock back and forth over this round barrel shaped axis, much like a board over a barrel, being used for a seesaw.
  • the BAGBY device may actually behave as a third body allowing the translation of the vertebrae relative to the device and to each other.
  • any device can only provide stability if it remains properly, seated.
  • the present invention is inherently stable, and therefore assures that it will stabilize the adjacent vertebrae, rather than, as with the BAGBY, the instability of the spine to be treated may cause a dislocation of the BAGBY implant, with further loss of spinal stability. 7.
  • the collapse of the interspace While both the present invention and the BAGBY device can be fabricated to withstand the compression forces within the interspace, the interspace may nevertheless collapse under the superincumbent body weight as the implant settles into the vertebral bone. This is related to the load per unit area. Again the present invention is superior to the BAGBY device in at least four ways.
  • the present invention offers considerably greater surface area to distribute the load.
  • the BAGBY device is placed centrally, the present device is placed bilaterally where the bone tends to be more cortical and much stronger out towards the rim.
  • the present invention supports the load achieving an "I" beam effect, whereas the BAGBY implant does not.
  • it is not pressure alone that causes the collapse of the bone adjacent to the implant, but also bony erosion that is caused by the motion under pressure of the implant against the bone.
  • the present invention alone is highly resistant to such motion, again diminishing the likelihood of erosion and interspace collapse.
  • Bone ingrowth surface texturing The present invention has a surface treatment of known and conventional technology to induce the growth of bone from the vertebrae directly into the casing material of the implant itself.
  • the BAGBY device has no similar feature. ⁇ L.A. - we may want to list examples of these bone growth factors ⁇ .
  • Fusion mass The BAGBY invention calls for removing the disc and then drilling a hole between the adjacent vertebrae. The bony debris so generated is then put into the device.
  • the present invention takes a core of pure bone producing marrow from the iliac crest, and then by use of a special press, forcibly injects the implant device with an extremely dense compressed core of that osteogenic material until the material itself virtually extrudes from every cell of the implant. 10.
  • the probability of achieving fusion - The fusion rate within the spine is known to be related directly to the amount of exposed vascular bone bed area, the quality and quantity of the fusion mass available, and the extent of the stabilization obtained with all other factors being half constant.
  • the fusion rate would be superior with the present invention as compared to the BAGBY device, because of optimal implant stability (#5) , optimal spinal stability (#6) , bone ingrowth surface treatment (#8) , superior fusion mass (#9) , and the greater exposed vertebral bony surface area (#7) .
  • the implant of the present invention would utilize bone ingrowth technology, it would do so with conventional technology.
  • Cloward's method of instrumentation was designed for, and limited to, use on the anterior aspect and in the region of the cervical spine only. The hole was midline, which would preclude its use posteriorly where the spinal cord would be in the way.
  • Cloward's method As the bone graft to be inserted in Cloward's method was necessarily larger in diameter than the hole drilled, the graft could not be inserted through the drill guide. This mandated the removal of the drill guide and left the graft insertion phase completely unprotected. Thus Cloward's method and instrumentation was inappropriate for posterior application.
  • Cloward's method inappropriate for posterior application.
  • the drill guide described by Cloward could not be placed posteriorly within the spinal canal, as the foot plate would crush the nerves. Modifying Cloward's drill guide by removing the foot plate completely, would still leave the instrument unworkable as it would then lack stability, and would not be controllable for depth of seating.
  • Wilterberger (Wilterberger, B.R., Abbott, K.H., "Dowel Intervertebral Fusion as Used in Lumbar Disc Surgery," The Journal of Bone and Joint Surgery. Volume 39A, pg. 234-292, 1957) described the unprotected drilling of a hole from the posterior into the lumbar spine between the nerve roots and across the disc space, and then inserting a stack of button-like dowels into that space. While Wilterberger had taken the Cloward concept of circular drilling and dowel fusion and applied it to the lumbar spine from a posterior approach, he had not provided for an improved method, nor had he advanced the instrumentation so as to make that procedure sufficiently safe, and it rapidly fell into disrepute.
  • Crock Crock, H.V. , "Anterior Lumbar Interbody Fusion - Indications for its Use and notes on Surgical Technique," Clinical Orthopedics, Volume 165, pg. 157-163, 1981) described his technique and instrumentation for Anterior Interbody Fusion of the lumbar spine, wherein he drilled two large holes side by side across the disc space from anterior to posterior essentially unprotected and then pounded in two at least partially cylindrical grafts larger than the holes prepared.
  • the present invention comprises a series of artificial implants, the purpose of which is to participate in, and directly cause bone fusion across an intervertebral space following the excision of a damaged disc.
  • implants are structurally load bearing devices, stronger than bone, capable of withstanding the substantial forces generated within the spinal interspace.
  • the devices of the present invention have a plurality of macro sized cells and openings, which can be loaded with fusion promoting materials, such as autogenous bone, for the purpose of materially influencing the adjacent vertebrae to perform a bony bond to the implants and to each other.
  • the implant casing may be surface textured or otherwise treated by any of a number of known technologies to achieve a "bone ingrowth surface" to further enhance the stability of the implant and to expedite the fusion.
  • the devices of the present invention are configured and designed so as to promote their own stability within the vertebral interspace and to resist being dislodged, and furthermore, to stabilize the adjacent spinal segments.
  • the apparatus and method of the present invention for preparing the vertebrae for insertion of the implant allows for the rapid and safe removal of the disc, preparation of the vertebrae, performance of the fusion, and internal stabilization of the spinal segment.
  • the present invention is a method for Interbody
  • two distractors are used to separate two adjacent vertebrae to a preferred distance.
  • a hollow Outer Sleeve having teeth at one end is driven into the adjacent vertebrae on one side to hold the vertebrae in position when the distractor is removed, a diameter reducing hollow Inner Sleeve is introduced into the Outer Sleeve, a drill having a drill stop is passed through the hollow Inner Sleeve to drill a hole to a desired depth, and an implant is inserted in the hole. The method is repeated on the other side of the disc.
  • the present invention provides for a single surgery providing for an integrated discectomy, fusion, and interbody internal spinal fixation.
  • the present invention is safer by providing protection of the surrounding tissues.
  • An Outer Sleeve places all of the delicate soft tissue structures, nerves, blood vessels, and organs outside of the path of the various sharp surgical instruments and the implant. Further, it is an improvement upon hand held retractors in that it occupies the least possible amount of area, avoids the stretching associated with manual retraction, provides for the retraction and shielding of the surrounding tissues in all directions circu ferentially and simultaneously, and it does so exclusively with smooth, curved surfaces.
  • the present invention is safer by providing protection against the danger of instrument or implant overpenetration. 3. The present invention is safer as the surgical site and wound are protected from the debris generated during the procedure. 4. The present invention is safer because the method provides for absolute protection to the soft tissues directly and from indirect injury by overpenetration. It makes safe the use of power instrumentation which is both more effective and efficient.
  • the present invention maintains the vertebrae to be fused rigid throughout the procedure.
  • the present invention holds the vertebrae to be fused aligned throughout the procedure. 7. The present invention holds the vertebrae to be fused distracted throughout the procedure.
  • the present invention assures that all instruments introduced through the Outer Sleeve are coaxial and equally centered through the disc space and parallel the endplates.
  • the present invention facilitates the implant insertion by countering the high compressive forces tending to collapse the interspace, which if left unchecked would resist the introduction and advancement of the implant and make stripping more likely.
  • the present invention extends the range and use of the procedure and similarly the interbody spinal implant itself by making the procedure safe throughout the spine. 11.
  • the present invention increases the ability to use a specifically sized implant.
  • the design and use of a second or Inner Sleeve in the present invention allows for the difference in size between the inside diameter of the Outer Sleeve, and the outside diameter of the drill itself. This difference being necessary to accommodate the sum of the distraction to be produced, and the depth of the circumferential threading present of the implant.
  • a specially designed drill bit with a central shaft recess allows for the safe collection of the drilling products, which can then be removed without disturbing the Outer Sleeve by removing the drill bit and Inner Sleeve as a single unit.
  • a specially designed trephine for removing a core of bone slightly smaller in diameter than the internal diameter of the implant cavity itself, however of a greater length.
  • a specially designed press for forcefully compressing and injecting the long core of autogenous bone into the implant, such that it extrudes through the implant itself.
  • a specially designed driver extractor which attaches to the implant and allows the implant to be either inserted or removed without itself dissociating from the implant, except by the deliberate disengagement of the operator.
  • predistraction increases the working space.
  • the Distractor in the present invention is self-orienting acting as a directional finder.
  • the Distractor in the present invention is self-centralizing between the opposed vertebral surfaces acting as a centering post for the subsequent bone removal.
  • predistraction assures the equal removal of bone from the adjacent vertebral surfaces.
  • predistraction assures the exact congruence between the hole drilled and the device.
  • predistraction assures that the drilling is parallel to the vertebral endplates. 26. In the present invention predistraction allows for the determination of the optimal distraction prior to drilling.
  • predistraction allows for the verification of the correct prosthesis size prior to drilling.
  • predistraction facilitates device insertion by relieving the compressive loads across the interspace which would resist implantation.
  • predistraction decreases the likelihood of stripping the bone during insertion.
  • predistraction provides for the side by side positioning, spacing, and parallelism required prior to the irrevocable event of drilling.
  • predistraction provides for the rigid stabilization of the vertebrae opposed to the disc space throughout the surgical procedure.
  • predistraction provides for an implant easier to insert as the compressive loads of the opposed vertebrae are held in check so that the device itself need not drive the vertebrae apart to be inserted.
  • predistraction allows for the insertion of a more effective implant as more of the implant can be dedicated to its intended purpose and be full diameter, whereas without the benefit of predistraction and the ability to maintain the same, a significant portion of the forward end of the implant would need to be dedicated to the purpose of separating the opposing vertebrae.
  • the present invention allows for the use of an implant with a sharper thread or surface projections as there is no danger to the surrounding tissues. 35.
  • the present invention allows for the implant to be fully preloaded as provided to the surgeon, or for the surgeon to load it with the material of his choice at the time of surgery. 36.
  • the present invention allows for the loading of a spinal implant outside of the spinal canal and prior to implantation.
  • Figure 1 is a side view of the Long Distractor, of the present invention inserted into the intervertebral space.
  • Figure 2 is a side view of a Convertible Distractor assembly in relation to the spine.
  • Figure 3 is a perspective view of a high retention Short Distractor of Figure 2.
  • Figure 3A is a side view of the high retention Short Distractor of Figure 2.
  • Figure 3B is a side view of an alternative Short Distractor with circumferential forward facing ratcheting.
  • Figure 3C is a top view of the alternative Short Distractor of Figure 3B.
  • Figure 3D is a perspective view of an alternative embodiment of a Short Distractor.
  • Figure 3E is a top view of the alternative distractor of Figure 3D.
  • Figure 3F is a side view of a further alternative rectangularized Short Distractor with knurled surfaces.
  • Figure 4 is a perspective view of a spinal segment (two vertebrae and an interposed disc) with a Short Distractor in place, with a portion of the upper vertebrae and disc cut away to show the Short Distractor on one side of the spine and the Long Distractor about to be placed contralaterally.
  • Figure 5 shows a side view of the Outer Sleeve in place over the Long Distractor, and about to receive the Driver Cap in preparation for being seated.
  • Figure 6 shows the Long Distractor, Outer Sleeve, and Driver Cap following the proper seating of the Outer Sleeve into the two adjacent vertebrae.
  • Figure 7A is a side view of the cervical Outer Sleeve being placed over a Long Distractor which is in place within the disc space anteriorly.
  • Figure 7B is a bottom view of the single Outer Sleeve of Figure 7A.
  • Figure 7C is a bottom view of a Dual Outer Sleeve.
  • Figure 7D is an enlarged side view of the proximal portion of Figure 7C.
  • Figure 7E is a bottom view of a Dual Driver Cap for driving two distractors.
  • Figure 7F is a side sectional view showing the Dual Outer Sleeve of Figures 7C and 7D, Distractors and Dual Cap of Figure 7E seated.
  • Figure 8 is a side view of the Outer Sleeve of Figure 7A centered on the Long Distractor and fully seated on the anterior aspect of the cervical spine.
  • Figure 9 is a perspective view of the Distractor
  • Figure 10 is a cutaway partial side view of the Proximal Puller engaging the extraction ring of the Long Distractor over the end of the Outer Sleeve.
  • Figure 10A is a side view of the Puller coupled to the Long Distractor just prior to its extraction.
  • Figure 10B is a posterior view of the proximal Outer Sleeve and a Short Distractor in place in regard to the vertebrae, disc and nerves.
  • Figure 11A is a side sectional view of the Drill and Inner Sleeve within the Outer Sleeve and drilling across the intervertebral space and cutting partially cylindrical arcs from the adjacent vertebrae.
  • Figure 11B is a sectional side view of preparation of the intervertebral space by the alternative "Trephine Method" showing the Distractor, Trephine, Inner Sleeve, and Outer Sleeve in place.
  • Figure 11C is a sectional side view as in Figure
  • Figure 11D is a side view of an instrument for removing arcs of bone from vertebrae following drilling.
  • Figure 12 is a perspective view of the surgical Tap.
  • Figure 13 is a side view of the Outer Sleeve and the surgical Tap fully threaded within the interspace.
  • Figure 14A is a side view of the bone harvesting
  • Figure 14B is a perspective view of the implant Bone Loading Device.
  • Figure 14C is a perspective view of the Corkscrew bone freeing and extracting instrument.
  • Figure 15 is a partial perspective view of the Bone Loading Device in operation.
  • Figure 16 is a perspective view of the Implant Driver about to engage the spinal implant.
  • Figure 17 is a side view of the spinal implant being fully seated within the intervertebral space by means of the Driver apparatus in place within the Outer Sleeve.
  • Figure 18 is a side view of the lumbar spine showing the end result of the device implantation via the posterior route.
  • the method of the present invention involves the following steps.
  • the patient is placed on a spinal surgery frame, which allows for the distraction and alignment of the disc space to be fused.
  • a bilateral posterior exposure of the interspace, with or without partial discectomy is then performed.
  • Utilizing distractors the disc space is distracted, and a hollow Outer Sleeve is fitted over one of the distractors.
  • the end of the Outer Sleeve has teeth for engaging the two adjacent vertebrae.
  • the Outer Sleeve is driven into the vertebrae and the distractor is then removed.
  • a hollow Inner Sleeve is then inserted into the Outer Sleeve and a stopped Drill is utilized to prepare the opposed vertebral surfaces.
  • the Drill and the Inner Sleeve are removed as a single unit. The space is tapped if so required.
  • the prepared spinal implant is then inserted via the Outer Sleeve utilizing a stopped inserter. The instruments are then removed and the procedure repeated on the contralateral side of the spine.
  • Step la Prior to surgery, translucent implant templates appropriately adjusted for scale are superimposed on AP, lateral, and axial images of the interspace to be fused, for the purpose of selecting the optimal implant size and to determine the desired distraction.
  • Step lb The patient is preferably placed onto a spinal surgery frame capable of inducing both distraction and vertebral alignment.
  • Step 2 a standard bilateral (partial) discectomy is performed and any posterior lipping of the vertebral bodies adjacent the interspace is removed. Alternatively, no disc material need be removed.
  • the interspace is exposed by performing bilateral paired semihemilaminotomies and resecting the inner aspects of the facet joints adjacent the spinal canal while preserving the supra and interspinous ligaments.
  • Step 3 Beginning on the first side, the dural sac and traversing nerve root at that level are retracted medially and a Long Distractor then inserted and impacted flush to the posterior vertebral bodies adjacent that interspace. Long Distractors with working ends of increasing diameter are then sequentially inserted until the optimal distraction is obtained.
  • This optimal distraction not only restores the normal height of the interspace, but further achieves a balance wherein the tendency for the space to collapse is resisted, which in urging the vertebral bodies apart is being equally resisted by the powerful soft tissue structures about the spinal segment including the outer casing of the disc (the annulus fibrosus) , various ligaments, capsular structures, as well as the muscles and other soft tissue structures.
  • This balanced distraction not only provides for the spatial restoration of the height of the interspace, but for considerable stability as the space now resists further distraction or collapse.
  • the use of the solid bodied Long Distractors is terminated and a disassemblable Convertible Distractor is placed with tactile and/or radiographic confirmation of ideal distraction.
  • the Convertible Distractor is then disassembled such that the Short Distractor portion is left in place and the ultra-low profile head portion being positioned adjacent to the canal floor and safely away from the neural structures.
  • various embodiments of the Short Distractor are available with varying degrees of resistance to dislodgment.
  • Step 4 attention is then directed to the contralateral side of the spine.
  • Step 4 On the contralateral side of the same interspace the Long Distractor having at its working end the diameter matching the Short Distractor already in place, is then inserted. If however, due to an asymmetrical collapse of the interspace it is then determined that greater distraction is required on the second side to achieve the optimal stability, then the appropriate Short Distractor would be placed on the second side. Then the Short Distractor would be removed from the first side and replaced with a larger Long Distractor so as to bring the interspace into balance.
  • the entire procedure is performed on the one side of the spine utilizing only the Long Distractor prior to repeating the procedure on the contralateral side of the spine. While this method can be performed in accordance with the remaining steps as described in the preferred embodiment, when utilized it is best performed using a Trephine which allows the Long Distractor to remain in place, thereby allowing for interspace distraction otherwise provided in the first method by the Short Distractor.
  • This alternative method then requires the use of a Trephine over the Long Distractor in lieu of a reamer and is therefore called the "Trephine Method", which will be discussed in detail later.
  • Step 5 With the Short Distractor in place on the first side of the spine, and the matching Long Distractor in place on the second side of the spine, and with the dural sac and traversing nerve root safely retracted, the Outer Sleeve is placed over the Long Distractor and firmly impacted to its optimal depth using the Impaction Cap and a mallet. The Long Distractor is then removed. Step 6. An Inner Sleeve is then placed within the Outer Sleeve, and the interspace is then prepared on that side by utilizing a Drill, Endmill, Reamer, or Trephine to drill, ream, or cut out the bone to be removed to either side, as well as any remaining interposed discal material.
  • a Drill, Endmill, Reamer, or Trephine to drill, ream, or cut out the bone to be removed to either side, as well as any remaining interposed discal material.
  • Step 7 a thread forming Tap with penetration limiting means to control the depth of insertion, is then inserted through the Outer Sleeve.
  • Step 8 The prepared implant is then inserted utilizing the specialized Driver unit.
  • the implant may be coated with, made of, and/or loaded with substances consistent with bony fusion.
  • the implant is treated with bone promoting and inducing substances, but is loaded with materials suitable for participating in a fusion. While substances both natural and artificial are covered by the present invention, the preferred embodiment is in regard to the use of the patient's own bone by the following method.
  • a hollow Trephine is utilized to harvest a core of bone from the posterior superior aspect of the iliac crest adjacent the sacroiliac joint. This core of bone is at its outside diameter, slightly smaller than the inside diameter of the spinal implant to be loaded, but longer than the spinal implant.
  • the core of bone is then injected from within the Trephine into the central cavity of the implant causing a superabundance of the bone material within the implant such that the bone material tends to press out through the openings communicating with the outside surface of the implant.
  • Step 9 Using the Driver Extractor instrument, the prepared implant is threaded into the prepared interspace. The instrumentation is removed from that side of the spine and attention is then redirected to the first side of the spine. A small retractor is utilized to move the dural sac and traversing nerve root medially and to protect them and allowing the direct visualization of the retained Short Distractor unit. Without removing the Short Distractor, it is reassembled to its shaft portion, essentially reconstituting itself into a Long Distractor. With the inserted implant now acting as the distractor on the opposite side, the Long Distractor is utilized to guide the Outer Sleeve down where it is impacted as described in Step 5.
  • Steps 6 & 7 are then repeated, completing the procedure at that level.
  • the wound is then irrigated and closed in the routine manner.
  • the Convertible Distractor would then be disassembled, the barrel and head portion removed, and the Short Distractor portion left deeply embedded and with its flanged head flat against the canal floor and deep to the neural structures. It would then be safe to allow the dural sac and nerve root to return to their normal positions, which would be superficial to the flanged portion of the Short Distractor.
  • the dural sac and nerve root would then be retracted medially on this second side, and a Long Distractor with an 18mm diameter barrel portion and a 10mm working portion would then be inserted into the interspace and driven flush to the bone if necessary, such impaction imploding any osteophytes not already removed, and assuring that the shoulder portion of the barrel comes to lie flat against the posterior aspects of the adjacent bodies.
  • the Outer Sleeve would then be placed over the Long Distractor and utilizing the Driver Cap and a mallet, seated to the optimal depth.
  • the Long Distractor is then removed and the Inner Sleeve is inserted into the Outer Sleeve.
  • the Inner Sleeve Since the purpose of the Inner Sleeve is to support the drill and allow for the increased size of the implant over the size of the drill, thus making it possible for the insertion of the implant to occur through the Outer Sleeve, the Inner Sleeve therefore measures 18mm in its outside diameter, and 16.6mm in its inside diameter. This allows it to fit within the Outer Sleeve, the diameter of which is 18.1 mm and to admit the drill bit which is 16.5mm in diameter.
  • the Drill and Inner Sleeve are removed as a single unit with the trapped interposed cartilaginous and bony debris.
  • the depth of drill penetration is preset and limited by the fixed rigid column of the Outer Sleeve.
  • the space will be prepared to a depth of 28mm in anticipation of countersinking a 26mm long implant at least 2mm. If a Tap were to be utilized, it would be inserted at this time and be appropriate to the minor and major diameters of the implant to be inserted and as with the Drill, controlled for its depth of penetration.
  • the spinal implant would then be prepared for implantation by utilizing a Trephine to harvest a core of posterior iliac bone greater than 30mm long and approximately 14.5mm in diameter.
  • this core of bone would be forcefully injected into the internal chamber of the spinal implant which would then be capped. Cap end forward, the fully loaded implant would then be attached to the Insertion Driver, down the Outer Sleeve and screwed into place with the depth of penetration limited by the Insertion instrument. The Insertion Driver is then unscrewed from the implant and removed from the Outer Sleeve. With the dural sac and nerve root retracted and protected, the Outer Sleeve would then be removed. This would complete the fusion procedure on that side, and then as described, the procedure would be repeated on the other (first) side of the same interspace.
  • Trephine Method An alternative and extremely useful method is the "Trephine Method". Its advantages include that it may be used in conjunction with the preferred embodiment substituting the use of a hollow, tubular cutter, called a Trephine for the use of the Drill in Step 5 of the preferred embodiment. Additionally, it may be utilized so as to obviate the need for the placement of the Short Distractor and to allow the procedure to be effectively performed from start to finish on one side prior to initiating the procedure on the opposite side, and while nevertheless maintaining distraction at the site of the bone removal.
  • the dural sac and nerve root are retracted.
  • the Outer Sleeve has an inner diameter only slightly greater than the implant to be inserted. Therefore, at this time, a first Inner Sleeve is inserted into the Outer Sleeve to make up the difference between the outside diameter of the Long Distractor and the inside diameter of the Outer Sleeve. With the Outer Sleeve and first Inner Sleeve thus assembled, they are placed over the Long Distractor and the Outer Sleeve is optimally seated using the Impaction Cap. The Cap and first Inner Sleeve are removed, but the Long Distractor and Outer Sleeve are left in place.
  • a hollow, tubular cutter known as a Trephine is then inserted over the Long Distractor and its barrel portion and within the Outer Sleeve.
  • the Trephine which is stopped out to the appropriate depth, can then be utilized to cut equal arcs of bone from the opposed vertebral endplates.
  • a second Inner Sleeve may be placed within the Outer Sleeve prior to placing the Trephine over the Long Distractor and within that second sleeve. This second Inner Sleeve would be just greater in its internal diameter than the Long Distractor and just smaller in its outside diameter than the inner diameter of the Outer Sleeve.
  • the Trephine, the Long Distractor, and the second Inner Sleeve, if utilized, are all removed. Since the Trephine cuts two arcs of bone but does not ream them out, a shafted instrument with a perpendicular cutting portion at its working end is then inserted parallel to the disc space and then rotated through an arc of motion cutting the bases of the two longitudinally cut arcs, thus freeing them for removal through the Outer Sleeve. The space may then be tapped if required, and the implant is inserted as per the preferred method. As already mentioned, the "Trephine Method" can be used with or without the use of the Short Distractor on the contralateral side.
  • the following method is the preferred embodiment for performing anterior interbody fusion in the thoracic and lumbar spines. It is also appropriate in the cervical spine when the width of the spine anteriorly is sufficient so that it is possible to place two implants side by side and such that each intrudes at least several millimeters into the substance of the opposed vertebrae and for the length of the implants.
  • the interspace to be fused is adequately exposed and the soft tissues and vital structures retracted and protected to either side.
  • Visualization of the broad width of the interspace anteriorly is made possible by the absence of the neurological structures in relation to this aspect of the spine.
  • the center line of the anterior aspect of the interspace is noted and marked.
  • the disc is removed using first a knife and then curettes and rongeurs as needed. Alternatively, the disc may be left intact to be removed during the drilling stage of the procedure. However, as per the preferred embodiment of the procedure, having removed the great mass of the nucleus and the greater portion of the annulus anteriorly. Long Distractors with progressively increasing diameters to their working ends are inserted into the interspace at a point midway between the central marking line and the lateral extent of the anterior aspect of the spine as visualized.
  • the Dual Outer Sleeve with its common Foot Plate and Retention Prongs is then inserted over either a singly placed Long Distractor and then the second Distractor placed, or is placed over both Distractors if already placed.
  • the Dual Outer Sleeve is then seated firmly against the anterior aspect of the spine. Any spurs which would interfere with the flush seating of the Foot Plate to the anterior aspect of the spine should be removed prior to inserting the Long Distractors.
  • an Inner Sleeve and drill bit Once the Outer Sleeve has been optimally seated, one of the Long Distractors is removed and in its place is inserted an Inner Sleeve and drill bit.
  • the drill bit has as its outside diameter the minor diameter of the implant to be inserted.
  • the Inner Sleeve is essentially equal in thickness to the difference between the minor and major diameters of the threaded implant.
  • a Stopped Drill is then utilized to prepare the opposed vertebral surfaces and to remove any remaining disc material interposed. If required, a Stopped Tap may be inserted through the Outer Sleeve and into the interspace to create a thread form. The properly prepared implant is then affixed to the Insertion Driver and passed through the Outer Sleeve down into the interspace and inserted until its depth of penetration is limited by the stop on the Insertion Driver. With the implant itself now in a position to act as a distractor, the Long Distractor is then removed from the contralateral side and the procedure repeated. When both implants are firmly in place, the outer sleeve may then be removed. The amount of countersinking of the implants may then be adjusted under direct vision.
  • the disc (D) between adjacent vertebrae (V) is approached via bilateral paired semihemilaminotomies of the adjacent vertebrae.
  • the supraspinous ligament, the interspinous ligament, the spinous process, portions of the lamina, and most of the facet joints are preserved.
  • these structures may be removed.
  • a bilateral partial nuclear discectomy is then performed through bilateral openings created through the posterior aspect of the annulus fibrosus. While considered less desirable, disc excision can be delayed and performed simultaneously with the vertebral bone resection during the drilling procedure.
  • a dural nerve root retractor is placed such that the dural sac and lower nerve root are retracted medially allowing exposure to one side of a portion of two adjacent vertebral bodies and the interposed disc posteriorly.
  • a Long Distractor 100 is inserted under direct vision into the intervertebral space.
  • the disc penetrating portion 102 is essentially cylindrical with a bullet-shaped front end 103 and a shoulder portion 104 where the penetrating portion 102 extends from barrel 106.
  • the penetrating portion 102 urges the vertebral bodies apart, facilitating the introduction of the instruments.
  • Long Distractors with sequentially increasing diameter penetrating portions 102 are then introduced. As the optimal diameter of penetrating portion 102 is achieved, the vertebral bodies to either side are forced into full congruence and thus become parallel, not only to the penetrating portion 102, but to each other.
  • any remaining excrescences of bone of the posterior vertebral bodies adjacent the posterior disc which have not already been removed are flattened flush to the vertebral body by the forced impaction, such as by hitting with a hammer flat surface 109 of crown 110, driving the shoulder 104 against the lipped portions of vertebrae V.
  • unit 100 Because of the forced opposition of the vertebral endplates to portion 102 with optimal distraction, unit 100 will then come to lie absolutely perpendicular to the plane of the posterior bodies and absolutely parallel to the vertebral endplates, allowing optimal alignment for the procedure to be performed.
  • Penetrating portion 102 is available in various diameters, but all are of a constant length, which is less than the known depth of the interspace. This combined with the circumferential shoulder 104, which is too large to fit within the interspace, protects against the danger of overpenetration. Barrel 106 is of the same diameter as the external diameter of the device to be implanted. A recessed portion 108 below the crown 110 allows for the Long Distractor 100 to be engaged by an extractor unit shown in Figure 9.
  • a Convertible Long Distractor 113 is used on the first side of the spine. As shown in Figures 2, the Convertible Long Distractor 113 has a barrel portion 152 separable from the Short Distractor portion 120. While the initial distraction may be performed with a solid Long Distractor, as the optimal distraction is approached the appropriate Convertible Long Distractor is utilized.
  • the Convertible Long Distractor 113 consists of a Short Distractor portion 120 and a barrel 152 having a rectangular projection 134 at one end.
  • the Short Distractor 120 has an increased diameter head 128, a rectangular slot 118 and an internal threaded opening 114.
  • the barrel 152 is hollow and has an internal shaft 111 terminating in a large diameter hexagonal crown 115 at one end and a reduced diameter portion 112.
  • the crown has a detent portion 117 in its flat surface.
  • the other end of the shaft 111 has a threaded small member 116 that corresponds to threaded opening 114.
  • the shaft 111 is prevented from removal from the barrel 152 by set pin 119 passing through the wall of barrel 152 in a convenient manner.
  • the Short Distractor portion 120 is removably attached to the barrel portion 152 via the mating of female rectangular slot 118 and the male mating member 134. The mating held together by utilizing knob 136 to drive the crown 110 connected to interior shaft 111 having a threaded working end screw 116 that threads into the female aperture 118 of the Short Distractor portion 120.
  • Cap 136 has an open socket 138 for fitting around crown 115 and engages the reduced diameter hexagonal portion 112 so as to permit the rotation of shaft 111 and threaded male member 116.
  • a detent ball 150 in the inside of the socket 138 engages detent 117 in the crown 115, holding them together.
  • the Short Distractor portion 120 of Figures 2, 3, and 3A-3F are designed to provide for high stability when temporarily situated so as to resist inadvertent migration while the surgeon is working on the second side.
  • the embodiment of the Short Distractor 120 shown in Figures 3 and 3A has a pair of sharp pegs 126, to embed into the opposing vertebral bodies and forward facing ratchetings 124, that further resist backward movement.
  • Figures 3B and 3C which show the preferred embodiment, are side and top views of an alternative embodiment of the distractor portion such that the distractor portion to be interposed between the vertebrae is essentially cylindrical, but with circumferential forward facing ratchetings 124.
  • Figures 3D and 3E A further alternative embodiment is shown in Figures 3D and 3E.
  • This is a more rectangularized design, with forward facing ratchetings, without the sharp prongs 126 of Figure 3.
  • Figure 3F is a side view of a further embodiment of the Short Distractor 120 shown with knurling, to increase the interference with the bone surface so as to add stability to the unit and to resist dislodgment.
  • the working ends of both the Long and Short Distractors can have a variety of configurations consistent with their purpose, and that surface irregularities as well as the shape of the ends themselves, with or without prongs 126, may be utilized to make the Short Distractor 120 more resistant to migration.
  • the Convertible Distractor is dissociated, leaving Short Distractor 120 in place with its rounded external end 128, safely on the canal floor and deep to the dural sac and nerve root.
  • the surgeon then moves to the other side of the spine at the same disc (D) level, and retracts the dural sac and nerve root medially, exposing the disc on that side.
  • Long Distractors 100 are then sequentially inserted into the disc space until the diameter of the distractor on the second side is at least as big as that on the first side. If because of some asymmetry of the interspace a larger diameter distractor is required on the second side to achieve the ideal distraction as compared to the first side, then the second side is fitted with a Short Distractor of the larger diameter, and the surgeon would then return back to the first side. In that event, the first side Short Distractor would then be removed and the Long Distractor 100 corresponding to the increased diameter of the already placed Short Distractor 120 would then be inserted.
  • the Long Distractor now serves as both a centering post and an alignment rod for the hollow Outer Sleeve 140 shown in Figure 5 which is fitted over the Long Distractor 100, shown by phantom lines 101 in Figure 5.
  • the Outer Sleeve 140 is metal and has a sharp toothed front end 142 that is capable of penetrating into and holding fast the two adjacent vertebrae (V) . Interrupting the circumferential sharp teeth of 142 are flat, planar areas 152 which serve to resist the further insertion of the sharp teeth into the vertebral bodies.
  • the toothed front end 142 of the Outer Sleeve 140 is a continuation of the tubular shaft 144, which in turn is connected to circumferentially enlarged tubular back end 146 having a knurled outer surface 148 for easier manipulation.
  • An alternative embodiment of an Outer Sleeve incorporates an expansile key hole and slot configuration 154 to either side of shaft 144 along the mid-plane of the interspace and parallel to it such that the end 142 resists the collapse of the vertebrae (V) to either side of the disc (D) , but may nevertheless allow for their further distraction, in the event the only diameter or the root diameter of the implant is larger than the hole drilled.
  • a Driver Cap 160 in the form of an impaction cap has at its far end a flat, closed-back surface 162 and at its other end a broad, circular opening.
  • the Driver Cap 160 fits over both the Outer Sleeve 140 and the Long Distractor 100.
  • interior surface 170 circumferentially engages portion 146 of the Outer Sleeve until the back end 172 engages the internal shoulder 164.
  • mallet blows are applied to surface 162, that force is transmitted via the internal shoulder 164 to the Outer Sleeve 140 via its far end 172, seating teeth 142 into the vertebral bodies adjacent the disc space D and to the depth of the teeth 142 to the flat portions 152.
  • the Distractor Puller 200 of Figure 9 utilized to remove the Long Distractor 100 from the spine leaving the Outer Sleeve 140 in place.
  • the Distractor Puller 200 has front portion 202, a mid portion 204, and a back handle portion 206.
  • a socket 208 is connected to one end of shaft 210 which at its far end is connected to back handle portion 206.
  • the socket 208 has defined within it a cavity 212 that is open at its front end and funnelized on the interior aspect of its sides.
  • the cavity 212 is constructed so that the head of the Distractor Puller 200 and the partially circumferential flange 218 engages the circumferential recess 108 of the Distractor 100.
  • the entrance to cavity 212 is slightly funnelized, and the leading edges of flange 218 slightly rounded to facilitate the engagement of recess 108 and head 110 of Distractor 100, which is further facilitated in that the Driver Cap 160 leaves portion 108 of Distractor 100 precisely flush with the back surface 172 of the Outer Sleeve 140.
  • This provides a large, flat surface 172 to precisely guide surface 230 of socket 208, and open portion 212 around head 110 while flange 218 engages recess 108.
  • the springloaded detent ball 228 engages hemispherical depression 112 in the crown 110, shown in Figure 2.
  • This springloaded detent 228 in engagement with complimentary indent 218 protects against the inadvertent dissociation of the Long Distractor from the Puller 200 after the Distractor has been removed from within the Outer Sleeve 140 and prior to its removal from the wound.
  • the two instruments are easily disassociated by freeing the crown portion 110 from cavity 212 by a manual force applied perpendicular to their relative long axes at this location.
  • a cylindrical and free removable weight 216 is fitted around shaft 210 between the front portion 202 and the rear handle portion 206. Gently, but repeatedly sliding the weight 216 along shaft 210 and driven rearwardly against flat surface 228, transmits a rearward vector to proximal end 202 and thereby to the Long Distractor 100 to which it is engaged.
  • Paired extended handle 224 and 226, allow the surgeon to resist any excessive rearward motion as the instrument is used to liberate the Long Distractor 100.
  • Paired handles 224 and 226 are also useful in that they allow a rotational directing of portion 208, via the shaft 210. This allows the surgeon to control and manipulate rotationally the orientation of the opening of cavity 212 to facilitate its application, to the head 110 of the distractor 100.
  • the Distractor Puller 200 is a significant improvement over the alternatives of striking a remover instrument with an independent hammer over the exposed surgical wound, or manually extracting the distractor by forcefully pulling.
  • the use of a free hammer over the open wound is dangerous because the neural structures can be impacted on the back swing which is made even more likely by the effects of gravity on the mallet head.
  • Manual extraction by pulling is dangerous because of the significant interference fit of portion 102 within the spine such that significant force would be required to remove the Distractor 100, and if force were not coaxial then the Outer Sleeve might be dislodged or misaligned. Further, once the flat portion 102 became free of the interspace, all resistance to withdrawal would be lost and in the face of the considerable force necessary to free it, the Distractor 100 might easily become projectile imparting injury to the patient and/or the surgeon.
  • the toothed end 142 of the Outer Sleeve 140 working in conjunction with the Short Distractor 120 on the contralateral side rigidly maintains the relative position of the adjacent vertebrae V. Further, since the remainder of the procedure on that side of the spine occurs entirely through the protective Outer Sleeve 140, and as the nerves and dural sac are external to that Outer Sleeve and superficial to the toothed end 142 of the Outer Sleeve 140, which is firmly embedded into the adjacent vertebrae V, the Outer Sleeve 140 serves to insure the safety of these delicate neural structures.
  • the Outer Sleeve 140 is of a fixed length and rigid, its flat rearward surface 172 may be used as a stop to the advancement of all instruments placed through the Outer Sleeve 140, thus protecting against accidental overpenetration. Further, the Outer Sleeve 140 assures that the further procedure to be performed will occur coaxial to the disc space D and further, be symmetrical in regard to each of the opposed vertebral surfaces.
  • Figure 10B is a posterior view of the spine at this stage of the procedure, showing a Short Distractor 120 in place on one side of the spine and the bottom portion of Outer Sleeve 140 in place on the opposite side of the spine.
  • an Inner Sleeve 242 is inserted from the rear within the Outer Sleeve 140.
  • This Inner Sleeve has a collar portion 244 of a known thickness which seats against the top edge surface 172 of Outer Sleeve 140.
  • the cylindrical barrel portion of Inner Sleeve 242 comes to approximate the posterior aspect of the vertebral bodies interior the Outer Sleeve when fully seated.
  • a Drill 240, having a known selected length is then introduced through the rearward aperture of the Inner Sleeve 242 and utilized to ream out the arcs of bone which it engages from the opposed vertebral endplates as well as any discal material within its path down to its predetermined and limited depth.
  • the Drill 240 has a narrow engagement portion 246, which allows it to be affixed to a drill mechanism which may be either a manual or a power unit.
  • a circumferential collar 248 of an increased diameter serves to limit the depth of penetration of the drill 240 and may be fixed, or lockably adjustable.
  • Drill 240 is a modification of a large fluted drill design such that the end resembles an end cutting mill which may contain any workable number of cutting surfaces, but preferably four or more, and such cutting surfaces being relatively shallow such that the advancement of the instrument occurs more slowly.
  • the outside diameter of the Drill 240 corresponds to the minor diameter of the threaded spinal implant.
  • the Inner Sleeve 242 has an inner diameter slightly greater than that dimension and its outer diameter is slightly smaller than the inside diameter of the Outer Sleeve 140 which has the same outer diameter as the major diameter of the threaded implant.
  • the drill shaft of drill 240 comprises an upper portion 243, a central recessed portion 256 of a smaller diameter and a lower cutting drill portion 250.
  • the upper portion 243 and lower portion 256 of the drill 240 have the same outside diameter.
  • the Inner Sleeve 242 serves many functions.
  • Outer Sleeve 140 to have an internal diameter large enough to admit the threaded spinal implant, which is indeed considerably larger in diameter than the Drill 240 itself.
  • the Drill 240 would be free to wander within the confines of that greater space and would not reliably make parallel cuts removing equal portions of bone from the adjacent vertebrae V. Further, the bone removal not only needs to be equal, but must be correctly oriented in three dimensions. That is, the path of the
  • Drill 240 must be equally centered within the disc space, parallel the endplates, and parallel to the sagittal axis dissecting the interspace.
  • a further purpose of the Inner Sleeve 242 is that it may be removed simultaneously with the Drill 240, thereby trapping the debris, both cartilaginous and bony generated during the drilling procedure, which are guided rearward by the large flutes 251 of Drill portion 250, where they are collected around recessed portion 256 between the recessed portion 256 and the inner wall of the Inner Sleeve 242 are there contained therein.
  • the Drill 240 in conjunction with the Inner Sleeve 242, all of the debris generated by the reaming procedure is safely removed from the spinal canal and wound area.
  • Drill end 250 has a forward projecting nipple 260, which itself is bullet-shaped in its leading aspect so as to ease its entrance into the disc space and to urge the vertebrae apart.
  • Nipple 260 is distracting, stabilizing as it resists any tendency of the vertebrae to move together, is self-centering to the Drill portion 250 when working in conjunction with Sleeves 140 and 242, and virtually assures the symmetrical resection of bone from the opposed vertebral surfaces.
  • FIG. 11B The alternative "Trephine Method" referred to earlier in this application, is shown in Figure 11B.
  • a Long Distractor 100 is left in place after the Outer Sleeve 140 is seated.
  • the Long Distractor 100 in this case differs from the Long Distractor of the preferred embodiment in that its outside diameter of the barrel 106 is of a smaller diameter than in the prior version. This is made necessary because regardless of the method, the hole to be formed corresponds to the minor diameter of the spinal implant.
  • Trephine 270 a hollow, tubular member with sharp cutting teeth 251 at its proximal end, has a wall thickness and since the outside diameter of that trephine 270 must correspond to the root diameter of the implant, then the wall thickness of the trephine 270 must be allowed for by a corresponding reduction in the diameter of the Long Distractor 100.
  • a further modification of the Long Distractor 100 to the "Trephine Method” would use longitudinal grooves (not shown) along the barrel surface 106 for the purpose of transmitting any debris generated during the cutting procedure, rearward. Since the cutting element is both centered and aligned by the Long Distractor, the use of the Inner Sleeve 242 is not mandatory, but may once again be useful in controlling the path of the debris. To that end, little debris is generated in the "Trephine Method" as the bony arcs are not so much being reamed out and removed as they are simply being cut into the bone where these arcs of bone are left connected at their far ends.
  • the instrument 272 is inserted through Outer Sleeve 140 where the lower surface 273 of handle 274 abuts the top 172 of the Outer Sleeve 140, both stopping downward motion of instrument 272 and precisely placing the perpendicularly cutting arm 278 of instrument 272 so that as handle portion 274 is rotated, the cutting arm 278 is also rotated, cutting the arcs of bone and liberating them from their last attachments. These portions of bone are then removed utilizing this instrument or a long forceps, and then placed within the implants or otherwise used to participate in the fusion.
  • the spinal implant I is essentially self-tapping, if the bone is unusually hard it may be desirable to form the thread pattern within the interspace prior to the insertion of the implant I.
  • Tap 280 has a threadcutting portion 282 connected by a shaft 286 to a handle portion 292, which has been designed to give mechanical advantage to the rotation of the instrument for the purpose of cutting threads.
  • the lower portion of handle 290 has a forward facing flat surface 288 too large to fit through the opening of Outer Sleeve 140 which thus safely limits the depth of penetration of the cutting element 282.
  • This tap 280 is further made safe by blunt end 294 which will engage the uncut portions of the vertebral bone just prior to the engagement of shoulder 288 against surface 172.
  • This feature allows the surgeon to appreciate a less harsh resistance as the blunt nose 294 encounters the remaining unresected bone for the drill hole and prior to the sudden increase in resistance caused by the seating of shoulder 288 against top edge 172, which first resistance serves as a warning to the surgeon to discontinue the tapping procedure.
  • the surgeon has both visual (as shoulder 288 approaches top edge 172) and tactile warnings to avoid stripping the thread form.
  • Tap end 282 is highly specialized for its specific purpose.
  • a truncated bullet-shaped area 298 which ramps up to the constant diameter intermediate the cutting ridges 296. Ramp portion 298 urges the opposed vertebral bodies apart, which motion is resisted by Outer Sleeve 140, thus progressively driving the sharp leading edges of thread forms 296 into the vertebral bodies.
  • the periodic longitudinal grooves 284 interrupting the thread forms which may number 1 to 8, but preferably 4, function to accumulate the bony material which is removed during the thread cutting process. In that regard, in the ideal embodiment, the thread cutting form is designed to compress the bone to be formed rather than to trough through it.
  • the minor diameter corresponds to the minor diameter of the implant I, but the major diameter is slightly less than the major diameter of the implant.
  • Figure 14a shows a trephine 300 with an exceedingly sharp front cutting edge 302 for quickly and cleanly coring into the patient's posterior iliac crest, or any other bony tissue, and for the purpose of producing a core of bone then contained within the hollow 304 of the trephine 300.
  • Trephine 300 has a rear portion 306 with a pair of diametrically opposed slots 310, and disposed clockwise from their longitudinally oriented rearward facing openings so as to engage diametrically and opposing members 312 of Drive unit 308, by which trephine 300 may be attached to either a hand or power drill. It can be appreciated that engagement mechanism 312 is stable during the clockwise cutting procedure, and yet allows for the rapid disconnection of the two components once the cutting is completed.
  • a corkscrew 408 shown in Figure 14C is introduced though the central opening of rear portion 306 and threaded down and through the core of bone within 304 and to the depth of teeth 302.
  • Trephine 300 has a barrel portion 304 continuous with sharp toothed portion 302 having an inner diameter just less than the inner diameter of the spinal implant I to be loaded.
  • the Trephine 300 with its core of harvested bone is then placed as shown in Figure 14B, through opening 340 of Implant Bone Loading device 320, where the barrel portion 304 then passes through and is stopped by circular flange 344.
  • the plunger shaft 326 of instrument 320 is then prepared for attachment by rotating knob 332 counterclockwise such that the plunger 372 is pulled via the long threaded shaft portion 328 back to the base of collar 330 at its proximal end. In this position, knob 332 is considerably extended rearward from collar 330. With plunger shaft 326 in this position, the plunger head 372 is inserted into the central hollow of portion 306 of Trephine 300 as the proximal cylindrical portion of collar 330 then follows it, such that the plunger 372 then occupies the rearward portion of barrel 304 and the proximal cylindrical portion of collar 330 occupies the central hollow of portion 306. A pair of diametrically opposed radially projecting arms 346 on collar 330 are then advanced longitudinally into diametrically opposed paired L slots 340 and then rotated clockwise to complete this assembly.
  • a spinal implant I is engaged through its female rectangular slot 364 by a rectangular protruding bar extending from rearward facing surface of end plug 324, (not shown) and secured there by knob 334 which extends as a rod through a central aperture within end plug 324 to extend at the far end as.a small bolt which threads to a female aperture centered within the female slot 364 of the spinal implant.
  • end 302 of trephine 300 lies coaxial and opposed to the open end of implant I.
  • knob 332 is then rotated clockwise, the plunger 372 proximal the threaded shaft 328 is then forcibly, but controllably driven forward down the barrel 304 ejecting the bone graft directly into the spinal implant I.
  • the bone graft is greater in length than the interior of the spinal implant, with further compression the bone is forced into the radially disposed apertures through the wall of the device communicating from the central cavity to the exterior.
  • End plug 324 is then removed from apparatus 320. Using end plug 324 as a handle, end cap 374 shown in Figure 16 is secured to the open end of the spinal implant I. The implant is then disassociated from end plug 324 by rotating knob 334 counterclockwise.
  • FIG 16 shows an Implant Driver instrument which may be used to either insert or to remove said implant I.
  • Driver 350 has at its far end 362, a rectangular protrusion 398, which protrusion intimately engages the complimentary rectangular slot 364 of implant I.
  • Protruding from slot 398 of end 362 is threaded portion 353, which extends as a rod through hollow shaft 358 and hollow hand barrel 360 to knob 354 where it can be rotationally controlled.
  • Threaded portion 353 screws into a female aperture central slot 364, urging 353 into 364, and binding them together such that instrument 350 can be rotated via paired and diametrically opposed extending arms 366 and in either direction while maintaining contact with the implant.
  • the implant is then introduced through the Outer Sleeve 140 and screwed into the interspace opposed between the two prepared vertebrae V until such time as the leading edge of the Implant Cap 374 reaches the depth of the prepared hole at which time its forward motion is impeded by the bone lying before it which had not been drilled out. This allows for a progressive feel to the surgeon as the implant is screwed home.
  • this terminal resistance to further seating provides significant tactile feedback to the surgeon.
  • visual monitoring of the depth of insertion of the implant is provided to the surgeon by observing the progressive approximation of the forward surface 370, of barrel portion 360, as it approaches the rearward facing surface 172 of Outer Sleeve 140. Nevertheless, a final safety mechanism, when the full depth of insertion has been achieved, surface 370 of instrument 350 will abut surface 172 of the Outer Sleeve 140, prohibiting any further installation of the spinal implant.
  • the Driver 350 is dissociated from the implant by turning knob 354 in a counterclockwise direction.
  • the Driver 350 is then withdrawn from the outer sheath, then the Outer Sleeve 140 is removed. This leaves the implant fully installed and inset to the determined depth as shown in Figure 18.
  • a dural nerve root retractor is used to retract the neural structures medially, bringing into full view the head 128 of the Short Distractor 120, lying flush on the canal floor.
  • extended screw portion 116 is inserted into the female threaded portion 114 of the Short Distractor 120 as the extended rectangular portion 134 of apparatus 152 is engaged to the female rectangular portion 118 of the Short Distractor 120. Then turning rearward facing portions 108 and 110, utilizing the knob 136 of Figure 2, the Long Distractor configuration is restored.
  • the Outer Sleeve 140 is slipped over the reconstituted Long Distractor and seated using the Driver Cap 162. The entire sequence of events as described for the implantation of the spinal implant I as already placed, is then repeated such that both spinal implants come to lie side by side within the interspace. Though not necessary, circlage or other internal fixation of the levels to be fused may additionally be performed, and then the wound is closed in the routine manner.
  • the interspace to be fused is exposed anteriorly.
  • the soft tissues are withdrawn and protected to either side, and if necessary, above and below as well. It is then possible to visualize the entire width of the vertebrae anteriorly adjacent that interspace.
  • the surgeon has already templated the appropriate patient radiographs to determine the requisite distraction and optimal implant size.
  • the surgeon then broadly excises the great bulk of the nuclear disc portion. (Alternatively, the disc can be left to be removed via the drill later.)
  • the surgeon then notes and marks a point midway from side to side anteriorly. He then inserts Long Distractor 100 centering it on a point midway between the point just noted and the lateral extent of the intervertebral space visualized anteriorly.
  • the outer barrel portion 106 of the Distractor 100 utilized will correspond to the outside diameter of the implants to be installed.
  • the Distractor tips 102 inserted are sequentially larger in diameter until the optimal distraction is achieved.
  • This optimal distraction although suggested by the initial templating, may be visually and tactilely confirmed as performed.
  • the vertebral endplates will come into full congruence and parallel to the forward shaft portion 102 of the Distractor 100, causing an alteration in the alignment of the vertebrae and a significant increase in the interference fit and pressurization at the tip, such that the instrument becomes exceedingly stable.
  • a Dual Outer Sleeve 340 consisting of a pair of hollow tubes is then introduced over the side by side Long Distractors protruding anteriorly from the spine.
  • the Dual Outer Sleeve 340 is comprised of two hollow tubular members identical in size displaced from each other ideally the sum of the difference between the minor and major diameters of both implants combined, but not less than that difference for one implant, as it is possible to have the threads of one implant nest interposed to the threads of the other, such that they both occupy a common area between them.
  • the preferred embodiment is slightly greater than two times the difference between the major and minor diameters of the implant (the sum of both) the distance may be considerably greater.
  • tubular portions 348 of instrument 340 are parallel, when the area between them 350, is sufficiently great, these elements may be inclined or declined relative to each other such that they either converge or diverge at their proximal ends.
  • Paired tubular structures 348 may be bridged in part or wholly throughout their length, but are rigidly fixed by Foot Plate 344.
  • a top view shows the Foot Plate to be essentially rectangular, but without sharp corners.
  • Foot Plate 344 is contoured so as to approximate the shape of the vertebrae anteriorly. Extending forward from Foot Plate 344 are multiple sharp prongs 342 sufficiently long to affix them to the vertebrae. The prongs 342 are limited in length so as to not penetrate too far posteriorly and number from 2 to 10, but preferably 6. As the Dual Outer Sleeve 340 is driven forward utilizing Dual Driver Cap 420, of Figure 7E, engaging the rearward end 352, the prongs 342 extending from Foot Plate 344 are embedded into the opposed vertebral bodies until their forward motion is inhibited by the curved Foot Plate 344 becoming congruent to and being stopped by, the anterior aspect of the vertebral bodies. As already taught in Figure 5, the Dual Driver
  • Cap 420 is of the same design as Single Driver Cap 160, in that there is a recess 354 as per 168, allowing the Outer Sleeve to be fully seated without impeding the rearward projection of the Long Distractor unit. However, unlike in Cap 160, area 354 is more relieved as it is unnecessary for the Dual Cap 420 to contact the Long Distractor through portion 110 to inhibit its forward motion, as the Foot Plate 344 functions to that effect. Further, the Dual Cap 420 for the Dual Outer Sleeve 340 is correspondingly dual itself and engages the rearward facing dual tubular portion 352. Once the Dual Outer Sleeve has been fully seated, the vertebrae adjacent the interspace to be fused are rigidly held via Foot Plate 344 and the prongs 342.
  • the cylindrical implant I comprises a hollow tubular member which in the preferred embodiment is made of an ASTM surgically implantable material, preferably Titanium.
  • the cylindrical implant I is closed at one end and open at the other end covered by a cap 394.
  • the cylindrical implant I has a series of macro-sized openings 390 through the side walls of the cylindrical implant I.
  • a series of external threads 392 are formed on the circumference of the cylindrical implant I. Any variety of threads may be used on the implant.
  • the cap 374 has a hexagonal opening 394 for tightening the cap 374.
  • While the present invention has been described in association with the implant of a threaded spinal implant, it is recognized that other forms of implants may be used with the present method.
  • implants made from bone or artificial materials, knurled or irregularly shaped cylinders or spheres, or any other shaped implants that can be introduced through the outer sleeve may be used. Being able to perform the procedure through the outer sleeve permits the procedure to be performed safely and quickly, and more accurately.

Abstract

Apparatus and a method of inserting spinal implants is disclosed in which an intervertebral space is first distracted, a hollow sleeve (140) having teeth (142) at one end is then driven into the vertebrae adjacent that disc space. A drill (240) is then passed through the hollow sleeve (242) removing disc and bone in preparation for receiving the spinal implant (1) which is then inserted through the sleeve (140).

Description

APPARATUS AND METHOD OF INSERTING SPINAL IMPLANTS
RELATED APPLICATIONS
This application is a continuation in part of
United States application serial no. 07/205,935, filed on June 13, 1988, which is a divisional application of United
States Patent Number 5,015,247 issued May 14, 1991, both of which are incorporated into this application by reference.
BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to artificial fusion implants to be placed into the intervertebral space left remaining after the removal of a damaged spinal disc and specifically to the apparatus for and method of, inserting the implants. 2. Description of the Prior Art
For the purpose of achieving long term stability to a segment of injured spine, a fusion (the joining together of two or more bones via a continuous bridge of incorporated bone) may be performed. Well-known to those skilled in such art is the interbody fusion wherein the disc is partially excised and bone placed within that space previously occupied by that disc material (between adjacent vertebrae) for the purpose of restoring a more normal spatial relationship, and to provide for stability; short term by mechanical support, and long term by the permanent cross bonding of bone from vertebra to vertebra. For fusion to occur within the disc space, it is necessary to prepare the vertebrae to be fused by breaking through, or cutting into, the hardened outside plates of bone (the endplates) to allow the interposed bone graft to come into direct contact with the more vascular cancellous (spongy) bone, and to thereby trick the body into attempting to heal this induced, but controlled, "fracturing" by both bone production and the healing of the grafts to both opposed vertebral surfaces such that they become one continuous segment of bone. The purpose of the present invention is to provide an implant, and the apparatus and method of inserting the implant within the intervertebral space left after the removal of the disc material and permanently eliminate all motion at that location. To do so, the device of the present invention is space occupying within the disc interspace, rigid, self-stabilizing to resist dislodgement, stabilizing to the adjacent spinal vertebrae to eliminate local motion, and able to intrinsically participate in a vertebra to vertebra bony fusion so as to assure the permanency of the result.
At present, following the removal of a damaged disc, either bone or nothing is placed into the remaining space. Placing nothing into this space allows the space to collapse which may result in damage to the nerves; or the space may fill with scar tissue and eventually lead to a reherniation. The use of bone to fill the space is less than optimal in that bone obtained from the patient requires additional surgery and is of limited availability in its most useful form, and if obtained elsewhere, lacks living bone cells, carries a significant risk of infection, and is also limited in supply as it is usually obtained from accident victims. Furthermore, regardless of the source of the bone, it is only marginal structurally and lacks a means to either stabilize itself against dislodgement, or to stabilize the adjacent vertebrae.
a. Prior Art Implants
There have been an extensive number of attempts to develop an acceptable disc prosthesis (an artificial disc) . Such devices by design would be used to replace a damaged disc and seek to restore the height of the interspace and to restore the normal motion of that spinal joint. No such device has been found that is medically acceptable. This group of prosthetic or artificial disc replacements, seeking to preserve spinal motion and so are different from the present invention, would include:
U.S. Patent No. 3,867,728 to STUBSTAD describing a flexible disc implant. U.S. Patent No. 4,349,921 to KUNTZ - describing a flexible disc replacement with file-like surface projections to discourage device dislocation.
U.S. Patent No. 4,309,777 to PATIL - describing a motion preserving implant with spiked outer surfaces to resist dislocation and containing a series of springs to urge the vertebrae away from each other.
U.S. Patent No. 3,875,595 to FRONING - describing a motion preserving bladder-like disc replacement with two opposed stud-like projections to resist dislocation.
Patent No. 2,372,622 to FASSIO (France) describing a motion preserving implant comprising complimentary opposed convex and concave surfaces.
In summary, these devices resemble the present invention only in that they are placed within the intervertebral space following the removal of a damaged disc. In that they seek to preserve spinal motion, they are diametrically different from the present invention which seeks to permanently eliminate all motion at that spinal segment.
A second related area of prior art includes those devices utilized to replace essentially wholly removed vertebrae. Such removal is generally necessitated by extensive vertebral fractures, or tumors, and is not associated with the treatment of disc disease. While the present invention is to be placed within the disc space, these other vertebral devices cannot be placed within the disc space as at least one vertebra has already been removed such that there no longer remains a "disc space". Furthermore, these devices are limited in that they seek to perform as temporary structural members mechanically replacing the removed vertebrae (not a removed disc) , and do not intrinsically participate in supplying osteogenic material to achieve cross vertebrae bony fusion. Therefore, unlike the present invention which provides for a source of osteogenesis, use of this group of devices must be accompanied by a further surgery consisting of a bone fusion procedure utilizing conventional technique. This group consisting of vertebral struts rather than disc replacements would include the following: U.S. Patent No. 4,553,273 to WU - describing a turnbuckle-like vertebral strut.
U.S. Patent No. 4,401,112 to REZAIAN - describing a turnbuckle- like vertebral strut with the addition of a long stabilizing staple that spans the missing vertebral body.
U.S. Patent No. 4,554,914 to KAPP - describing a large distractible spike that elongates with a screw mechanism to span the gap left by the removal of an entire vertebra and to serve as an anchor for acrylic cement which is then used to replace the missing bone (vertebrae) .
U.S. Patent No. 4,636,217 to OGILVIE - describing a vertebral strut mechanism that can be implanted after at least one vertebrae has been removed and consists of a mechanism for causing the engagement of screws into the vertebrae above and the vertebrae below the one removed.
In summary, this second group of devices differs from the present invention in that they are vertebral replacements struts, do not intrinsically participate in the bony fusion, can only be inserted in the limited circumstances where an entire vertebra has been removed from the anterior approach, and are not designed for, or intended to be used for the treatment of disc disease.
A third area of prior art related to the present invention includes all devices designed to be applied to one of the surfaces of the spine. Such devices include all types of plates, struts, and rods which are attached by hooks, wires and screws. These devices differ significantly from the present invention in that they are not inserted within the disc space and furthermore do not intrinsically participate in supplying osteogenic material for the fusion.
Therefore, where permanent spinal immobilization is desired, an additional surgery, consisting of a spinal fusion performed by conventional means or the use of supplemental methylmethacrylate cement is required. Such devices applied to the spine, but not within the disc space, would include the following: U.S. Patent No. 4,604,995 to STEPHENS describing a "U" shaped metal rod attached to the posterior elements of the spine with wires to stabilize the spine over a large number of segments.
U.S. Patent No. 2,677,369 to KNOWLES - describing a metal column device to be placed posteriorly along the lumbar spine to be held in position by its shape alone and to block pressure across the posterior portions of the spinal column by locking the spine in full flexion thereby shifting the maximum weight back onto the patient's own disc.
Other devices are simply variations on the use of rods (e.g. Harrington, Luque, Cotrel-Dubosset, Zielke) , wires or cables (Dwyer) , plates and screws (Steffee) , or struts (Dunn, Knowles)
In summary, none of these devices are designed to be nor can be used within the disc space. Moreover, these devices do not replace a damaged disc, and do not intrinsically participate in the generation of a bony fusion.
Another area of related prior art to be considered is that of devices designed to be placed within the vertebral interspace following the removal of a damaged disc, and seeking to eliminate further motion at that location.
Such a device is contained in Patent No. 4,501,269 issued to BAGBY which describes an implantable device and limited instrumentation. The method employed is as follows: a hole is bored transversely across the joint and a hollow metal basket of larger diameter than the hole is then pounded into the hole and then the hollow metal basket is filled with the bone debris generated by the drilling. While the present invention (device, instrumentation, and method) may appear to bear some superficial resemblance to the BAGBY invention, it is minimal, while the differences are many fold and highly significant. These differences include the following: 1. Safety - The present invention provides for a system of completely guarded instrumentation so that all contiguous vital structures (e.g. large blood vessels, neural structures) are absolutely protected. The instrumentation of the present invention also makes overpenetration by the drill impossible. Such overpenetration in the cervical spine, for example, would result in the total paralysis or death of the patient. In the thoracic spine, the result would be complete paraplegia. In the lumbar spine, the result would be paraplegia or a life-threatening perforation of the aorta, vena cava, or iliac vessels.
The present invention is atraumatically screwed into place while the BAGBY device, in contradistinction, is pounded into position. BAGBY describes that its implant is significantly larger in size than the hole drilled and must be pounded in. This is extremely dangerous and the pounding occurs directly over the spinal cord which is precariously vulnerable to percussive injury. Furthermore, while it is possible, for example in the lumbar spine, to insert the present invention away from the spinal cord and nerves, the BAGBY device must always be pounded directly towards the spinal cord. Furthermore, since the BAGBY device is pounded into a smooth hole under great resistance, and lacking any specific design features to secure it, the device is highly susceptible to forceful ejection which would result in great danger to the patient and clinical failure. The present invention, in contradistinction, is securely screwed into place, and possesses highly specialized locking threads to make accidental dislodgement impossible. Because of the proximity of the spinal cord, spinal nerves, and blood vessels, any implant dislodgement as might occur with the BAGBY device might have catastrophic consequences.
2. Broad applicability - The BAGBY device can only be inserted from the front of the vertebral column, however, in contrast, the present invention can be utilized in the cervical, thoracic, and lumbar spine, and can be inserted from behind (posteriorly) in the lumbar spine. This is of great importance in that the purpose of these devices is in the treatment of disc disease and probably greater than 99 percent of all lumbar operations for the treatment of disc disease are performed from behind where the present invention can easily be utilized, but the BAGBY device, as per BAGBY'S description, cannot.
3. Disc removal - The BAGBY invention requires the complete removal of the disc prior to the drilling step, whereas the present invention eliminates the laborious separate process of disc removal and efficiently removes the disc and prepares the vertebral end plates in a single step. 4. Time required - The present invention saves time over the BAGBY invention since time is not wasted laboring to remove the disc prior to initiating the fusion. Also, with the present invention the procedure is performed through a system of guarded instrumentation, time is not wasted constantly placing and replacing various soft tissue retractors throughout the procedure.
5. Implant stability - Dislodgement of the implant would be a major source of device failure (an unsuccessful clinical result) , and might result in patient paralysis or even death. As discussed, the BAGBY device lacks any specific means of achieving stability and since it is pounded in against resistance to achieve vertebral distraction, and is susceptible to forceful dislodgement by the tendency of the two distracted vertebrae, to return to their original positions squeezing out the device. The present invention, however, is screwed into place. As there is no unscrewing force present between the vertebrae, compression alone cannot dislodge the implant. The implant is inherently stable by its design. Furthermore, the threads of the present invention are highly specialized in that they are periodically interrupted so that the tail ends of each of the tabs so formed are blunted and twisted so as to resist accidental unscrewing. The removal of an implant with such "locking threads" requires the use of a special extractor included within the instrumentation. The stability of the present invention is still further enhanced, again in contradistinction to the BAGBY device, by the presence of a "bone ingrowth" surface texturing, which both increases the friction of the fit and allows for the direct growth of the vertebral bone into the casing of the implant itself.
6. Spinal stability - The present invention is not only self-stabilizing, it also provides stability to the adjacent vertebrae in at least three ways that the BAGBY device cannot. First, the BAGBY device is placed transversely across the joint in the center, leaving both vertebrae free to rock back and forth over this round barrel shaped axis, much like a board over a barrel, being used for a seesaw.
Secondly, as the BAGBY device lacks any specific design features to resist sliding, it may actually behave as a third body allowing the translation of the vertebrae relative to the device and to each other.
Thirdly, any device can only provide stability if it remains properly, seated. The present invention is inherently stable, and therefore assures that it will stabilize the adjacent vertebrae, rather than, as with the BAGBY, the instability of the spine to be treated may cause a dislocation of the BAGBY implant, with further loss of spinal stability. 7. The collapse of the interspace - While both the present invention and the BAGBY device can be fabricated to withstand the compression forces within the interspace, the interspace may nevertheless collapse under the superincumbent body weight as the implant settles into the vertebral bone. This is related to the load per unit area. Again the present invention is superior to the BAGBY device in at least four ways.
First, the present invention offers considerably greater surface area to distribute the load. Secondly, while the BAGBY device is placed centrally, the present device is placed bilaterally where the bone tends to be more cortical and much stronger out towards the rim. Thirdly, the present invention supports the load achieving an "I" beam effect, whereas the BAGBY implant does not. Fourthly, it is not pressure alone that causes the collapse of the bone adjacent to the implant, but also bony erosion that is caused by the motion under pressure of the implant against the bone. As discussed in item 6 above, the present invention alone is highly resistant to such motion, again diminishing the likelihood of erosion and interspace collapse.
8. Bone ingrowth surface texturing - The present invention has a surface treatment of known and conventional technology to induce the growth of bone from the vertebrae directly into the casing material of the implant itself. The BAGBY device has no similar feature. {L.A. - we may want to list examples of these bone growth factors}.
9. Fusion mass - The BAGBY invention calls for removing the disc and then drilling a hole between the adjacent vertebrae. The bony debris so generated is then put into the device. The present invention takes a core of pure bone producing marrow from the iliac crest, and then by use of a special press, forcibly injects the implant device with an extremely dense compressed core of that osteogenic material until the material itself virtually extrudes from every cell of the implant. 10. The probability of achieving fusion - The fusion rate within the spine is known to be related directly to the amount of exposed vascular bone bed area, the quality and quantity of the fusion mass available, and the extent of the stabilization obtained with all other factors being half constant. It would then be anticipated, that the fusion rate would be superior with the present invention as compared to the BAGBY device, because of optimal implant stability (#5) , optimal spinal stability (#6) , bone ingrowth surface treatment (#8) , superior fusion mass (#9) , and the greater exposed vertebral bony surface area (#7) .
The last area of prior art possibly related to the present invention and therefore, to be considered related to "bony ingrowth", are patents that either describe methods of producing materials and or materials or devices to achieve the same. Such patents would include: U.S. Patents No. 4,636,526 (DORMAN) , No. 4,634,720 (DORMAN), No. 4,542,539 (ROWE) , No. 4,405,319 (COSENTINO) , No. 4,439,152 (SMALL), No. 4,168,326 (BROEMER) , NO. 4,535,485 (ASHMAN), No. 3,987,499 (SCHARBACH) , No. 3,605,123 (HAHN) , No. 4,655,777 (DUNN), No. 4,645,503 (LIN), No. 4,547,390 (ASHMAN), No. 4,608,052 (VAN KAMPEN) , No. 4,698,375 (DORMAN), No. 4,661,536 (DORMAN), No. 3,952,334 (BOKROS) , No. 3,905,047 (LONG), No. 4,693,721 (DUCHEYNE) , No. 4,070,514 (ENTHERLY) .
However, while the implant of the present invention would utilize bone ingrowth technology, it would do so with conventional technology.
b. Prior Art Instrumentations And Methods
The following is a history of the prior art apparatus and methods of inserting spinal implants:
In 1956, Ralph Cloward developed a method and instruments which he later described for preparing the anterior aspect (front) of the cervical spine, and then fusing it. Cloward surgically removed the disc to be fused across and then placed a rigid drill guide with a large foot plate and prongs down over an aligner rod and embedded said prongs into the adjacent vertebrae to maintain the alignment so as to facilitate the reaming out of the bone adjacent the disc spaces. As the large foot plate sat against the front of the spine, it also served as a fixed reference point to control the depth of drilling. The reaming left two opposed resected arcs, one each, from the opposed vertebral surfaces. The tubular drill guide, which was placed only preliminary to the drilling, was thereafter completely removed. A cylindrical bony dowel, significantly larger in diameter than the hole formed, was then pounded into the hole already drilled. Cloward's method of instrumentation was designed for, and limited to, use on the anterior aspect and in the region of the cervical spine only. The hole was midline, which would preclude its use posteriorly where the spinal cord would be in the way.
As the bone graft to be inserted in Cloward's method was necessarily larger in diameter than the hole drilled, the graft could not be inserted through the drill guide. This mandated the removal of the drill guide and left the graft insertion phase completely unprotected. Thus Cloward's method and instrumentation was inappropriate for posterior application.
In addition, the failure to provide continuous protection to the delicate neural structures from the instruments, as well as the bony and cartilaginous debris generated during the procedure, made Cloward's method inappropriate for posterior application. Also, the drill guide described by Cloward could not be placed posteriorly within the spinal canal, as the foot plate would crush the nerves. Modifying Cloward's drill guide by removing the foot plate completely, would still leave the instrument unworkable as it would then lack stability, and would not be controllable for depth of seating.
Nevertheless, Wilterberger, (Wilterberger, B.R., Abbott, K.H., "Dowel Intervertebral Fusion as Used in Lumbar Disc Surgery," The Journal of Bone and Joint Surgery. Volume 39A, pg. 234-292, 1957) described the unprotected drilling of a hole from the posterior into the lumbar spine between the nerve roots and across the disc space, and then inserting a stack of button-like dowels into that space. While Wilterberger had taken the Cloward concept of circular drilling and dowel fusion and applied it to the lumbar spine from a posterior approach, he had not provided for an improved method, nor had he advanced the instrumentation so as to make that procedure sufficiently safe, and it rapidly fell into disrepute.
Crock (Crock, H.V. , "Anterior Lumbar Interbody Fusion - Indications for its Use and notes on Surgical Technique," Clinical Orthopedics, Volume 165, pg. 157-163, 1981) described his technique and instrumentation for Anterior Interbody Fusion of the lumbar spine, wherein he drilled two large holes side by side across the disc space from anterior to posterior essentially unprotected and then pounded in two at least partially cylindrical grafts larger than the holes prepared.
A review of the prior art is instructive as to a number of significant deficiencies in regard to the method and instrumentation for the performance of Interbody Spinal Fusion utilizing drilling to prepare the endplates.
As the great majority of spinal surgery is performed in the lumbar spine and from posteriorly, a review of the prior art reveals a number of deficiencies in regard to the spine in general, and to the posterior approach to the lumbar spine specifically. These deficiencies include the:
1. Failure to protect the surrounding tissues throughout the procedure, specifically, prior to drilling and until after the insertion of the graft;
2. Failure to contain the debris, bony and cartilaginous, generated during the procedure;
3. Failure to optimize the contact of the cylindrical drill hole and bone graft, the mismatch in their diameters resulting in incongruence of fit;
4. Failure to determine the optimal drill size prior to drilling;
5. Failure to determine the optimal amount of distraction prior to drilling;
6. Inability to optimize the amount of distraction so as to restore the normal spatial relationships between adjacent vertebrae; 7. Inability to create sufficient working space within the spinal canal (between the nerve roots and the dural sac) to make the procedure safe;
8. Absent a foot plate on the drill guide, as necessitated by the close tolerances posteriorly, the inability to reliably insure that the drilling is parallel to the vertebral endplates;
9. The inability to insure equal bone removal from the opposed vertebral surfaces; and
10. The inability to determine within the spinal canal, the proper side by side positioning for dual drill holes.
BRIEF SUMMARY OF THE INVENTION The present invention comprises a series of artificial implants, the purpose of which is to participate in, and directly cause bone fusion across an intervertebral space following the excision of a damaged disc. Such implants are structurally load bearing devices, stronger than bone, capable of withstanding the substantial forces generated within the spinal interspace. The devices of the present invention have a plurality of macro sized cells and openings, which can be loaded with fusion promoting materials, such as autogenous bone, for the purpose of materially influencing the adjacent vertebrae to perform a bony bond to the implants and to each other. The implant casing may be surface textured or otherwise treated by any of a number of known technologies to achieve a "bone ingrowth surface" to further enhance the stability of the implant and to expedite the fusion.
The devices of the present invention are configured and designed so as to promote their own stability within the vertebral interspace and to resist being dislodged, and furthermore, to stabilize the adjacent spinal segments.
The apparatus and method of the present invention for preparing the vertebrae for insertion of the implant allows for the rapid and safe removal of the disc, preparation of the vertebrae, performance of the fusion, and internal stabilization of the spinal segment.
The present invention is a method for Interbody
Spinal Fusion utilizing novel instrumentation, whereby a protective tubular member is placed prior to the drilling part of the procedure and is left in place until the graft is fully seated.
In the preferred embodiment two distractors are used to separate two adjacent vertebrae to a preferred distance. A hollow Outer Sleeve having teeth at one end is driven into the adjacent vertebrae on one side to hold the vertebrae in position when the distractor is removed, a diameter reducing hollow Inner Sleeve is introduced into the Outer Sleeve, a drill having a drill stop is passed through the hollow Inner Sleeve to drill a hole to a desired depth, and an implant is inserted in the hole. The method is repeated on the other side of the disc.
In summary then, the present invention, instrumentation, and method, provides for a single surgery providing for an integrated discectomy, fusion, and interbody internal spinal fixation.
Discussion of the Instrumentation The apparatus and method of the present invention provide the following advantages:
1. The present invention is safer by providing protection of the surrounding tissues. An Outer Sleeve places all of the delicate soft tissue structures, nerves, blood vessels, and organs outside of the path of the various sharp surgical instruments and the implant. Further, it is an improvement upon hand held retractors in that it occupies the least possible amount of area, avoids the stretching associated with manual retraction, provides for the retraction and shielding of the surrounding tissues in all directions circu ferentially and simultaneously, and it does so exclusively with smooth, curved surfaces.
2. The present invention is safer by providing protection against the danger of instrument or implant overpenetration. 3. The present invention is safer as the surgical site and wound are protected from the debris generated during the procedure. 4. The present invention is safer because the method provides for absolute protection to the soft tissues directly and from indirect injury by overpenetration. It makes safe the use of power instrumentation which is both more effective and efficient.
5. The present invention maintains the vertebrae to be fused rigid throughout the procedure.
6. The present invention holds the vertebrae to be fused aligned throughout the procedure. 7. The present invention holds the vertebrae to be fused distracted throughout the procedure.
8. The present invention assures that all instruments introduced through the Outer Sleeve are coaxial and equally centered through the disc space and parallel the endplates.
9. The present invention facilitates the implant insertion by countering the high compressive forces tending to collapse the interspace, which if left unchecked would resist the introduction and advancement of the implant and make stripping more likely.
10. The present invention extends the range and use of the procedure and similarly the interbody spinal implant itself by making the procedure safe throughout the spine. 11. The present invention increases the ability to use a specifically sized implant.
12. In the present invention the end of all the penetrating instrumentation is blunt faced. 13. In the present invention all of the instruments have been stopped at a predetermined depth to avoid overpenetration.
14. The design of the Outer Sleeve in the present invention conforms to the spacial limitations of the specific surgical site.
15. The design and use of a second or Inner Sleeve in the present invention allows for the difference in size between the inside diameter of the Outer Sleeve, and the outside diameter of the drill itself. This difference being necessary to accommodate the sum of the distraction to be produced, and the depth of the circumferential threading present of the implant.
16. In the present invention a specially designed drill bit with a central shaft recess allows for the safe collection of the drilling products, which can then be removed without disturbing the Outer Sleeve by removing the drill bit and Inner Sleeve as a single unit.
17. In the present invention a specially designed trephine for removing a core of bone slightly smaller in diameter than the internal diameter of the implant cavity itself, however of a greater length.
18. In the present invention a specially designed press for forcefully compressing and injecting the long core of autogenous bone into the implant, such that it extrudes through the implant itself.
19. In the present invention a specially designed driver extractor, which attaches to the implant and allows the implant to be either inserted or removed without itself dissociating from the implant, except by the deliberate disengagement of the operator.
20. In the present invention predistraction increases the working space.
21. The Distractor in the present invention is self-orienting acting as a directional finder.
22. The Distractor in the present invention is self-centralizing between the opposed vertebral surfaces acting as a centering post for the subsequent bone removal.
23. In the present invention predistraction assures the equal removal of bone from the adjacent vertebral surfaces.
24. In the present invention predistraction assures the exact congruence between the hole drilled and the device.
25. In the present invention predistraction assures that the drilling is parallel to the vertebral endplates. 26. In the present invention predistraction allows for the determination of the optimal distraction prior to drilling.
27. In the present invention predistraction allows for the verification of the correct prosthesis size prior to drilling.
28. In the present invention predistraction facilitates device insertion by relieving the compressive loads across the interspace which would resist implantation.
29. In the present invention predistraction decreases the likelihood of stripping the bone during insertion. 30. In the present invention predistraction provides for the side by side positioning, spacing, and parallelism required prior to the irrevocable event of drilling.
31. In the present invention predistraction provides for the rigid stabilization of the vertebrae opposed to the disc space throughout the surgical procedure.
32. In the present invention predistraction provides for an implant easier to insert as the compressive loads of the opposed vertebrae are held in check so that the device itself need not drive the vertebrae apart to be inserted.
33. In the present invention predistraction allows for the insertion of a more effective implant as more of the implant can be dedicated to its intended purpose and be full diameter, whereas without the benefit of predistraction and the ability to maintain the same, a significant portion of the forward end of the implant would need to be dedicated to the purpose of separating the opposing vertebrae.
34. The present invention allows for the use of an implant with a sharper thread or surface projections as there is no danger to the surrounding tissues. 35. The present invention allows for the implant to be fully preloaded as provided to the surgeon, or for the surgeon to load it with the material of his choice at the time of surgery. 36. The present invention allows for the loading of a spinal implant outside of the spinal canal and prior to implantation.
OBJECTS OF THE PRESENT INVENTION
It is an object of the present invention to provide an improved method of performing a discectomy, a fusion, and an, internal stabilization of the spine, and specifically, all three of the above simultaneously and as a single procedure.
It is another object of the present invention to provide an improved method of performing a discectomy, a fusion, and an internal stabilization of the spine, which is both quicker and safer than is possible by previous methods.
It is another object of the present invention to provide an improved method of performing a discectomy, a fusion and an internal stabilization of the spine, to provide for improved surgical spinal implants.
It is another object of the present invention to provide an improved method of performing a discectomy, a fusion, and an internal stabilization of the spine, which provides for an improved system of surgical instrumentation to facilitate the performance of the combined discectomy, fusion, and internal spinal stabilization.
It is another object of the present invention to provide an improved method of performing a discectomy, a fusion, and an internal stabilization of the spine procedures.
It is an object of the present invention to provide instrumentation and a method of spinal interbody arthrodesis that is faster, safer, and more efficacious than prior methods, and can effectively be performed in the cervical, thoracic, and lumbar spine anteriorly, as well as in the lower lumbar spine posteriorly.
It is a further object of the present invention to provide a means for inserting a spinal implant between adjacent vertebrae while maintaining their optimal spacing, positioning, and alignment.
These and other objects of the present invention will be apparent from review of the following specification and the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a side view of the Long Distractor, of the present invention inserted into the intervertebral space.
Figure 2 is a side view of a Convertible Distractor assembly in relation to the spine.
Figure 3 is a perspective view of a high retention Short Distractor of Figure 2.
Figure 3A is a side view of the high retention Short Distractor of Figure 2.
Figure 3B is a side view of an alternative Short Distractor with circumferential forward facing ratcheting.
Figure 3C is a top view of the alternative Short Distractor of Figure 3B.
Figure 3D is a perspective view of an alternative embodiment of a Short Distractor. Figure 3E is a top view of the alternative distractor of Figure 3D.
Figure 3F is a side view of a further alternative rectangularized Short Distractor with knurled surfaces.
Figure 4 is a perspective view of a spinal segment (two vertebrae and an interposed disc) with a Short Distractor in place, with a portion of the upper vertebrae and disc cut away to show the Short Distractor on one side of the spine and the Long Distractor about to be placed contralaterally. Figure 5 shows a side view of the Outer Sleeve in place over the Long Distractor, and about to receive the Driver Cap in preparation for being seated.
Figure 6 shows the Long Distractor, Outer Sleeve, and Driver Cap following the proper seating of the Outer Sleeve into the two adjacent vertebrae.
Figure 7A is a side view of the cervical Outer Sleeve being placed over a Long Distractor which is in place within the disc space anteriorly. Figure 7B is a bottom view of the single Outer Sleeve of Figure 7A.
Figure 7C is a bottom view of a Dual Outer Sleeve. Figure 7D is an enlarged side view of the proximal portion of Figure 7C.
Figure 7E is a bottom view of a Dual Driver Cap for driving two distractors.
Figure 7F is a side sectional view showing the Dual Outer Sleeve of Figures 7C and 7D, Distractors and Dual Cap of Figure 7E seated.
Figure 8 is a side view of the Outer Sleeve of Figure 7A centered on the Long Distractor and fully seated on the anterior aspect of the cervical spine. Figure 9 is a perspective view of the Distractor
Puller.
Figure 10 is a cutaway partial side view of the Proximal Puller engaging the extraction ring of the Long Distractor over the end of the Outer Sleeve. Figure 10A is a side view of the Puller coupled to the Long Distractor just prior to its extraction.
Figure 10B is a posterior view of the proximal Outer Sleeve and a Short Distractor in place in regard to the vertebrae, disc and nerves. Figure 11A is a side sectional view of the Drill and Inner Sleeve within the Outer Sleeve and drilling across the intervertebral space and cutting partially cylindrical arcs from the adjacent vertebrae. Figure 11B is a sectional side view of preparation of the intervertebral space by the alternative "Trephine Method" showing the Distractor, Trephine, Inner Sleeve, and Outer Sleeve in place. Figure 11C is a sectional side view as in Figure
11A, but showing the use of an alternative drilling conformation wherein the extended proximal portion is both distracting and self-centering.
Figure 11D is a side view of an instrument for removing arcs of bone from vertebrae following drilling.
Figure 12 is a perspective view of the surgical Tap.
Figure 13 is a side view of the Outer Sleeve and the surgical Tap fully threaded within the interspace. Figure 14A is a side view of the bone harvesting
Trephine and motor adapter.
Figure 14B is a perspective view of the implant Bone Loading Device.
Figure 14C is a perspective view of the Corkscrew bone freeing and extracting instrument.
Figure 15 is a partial perspective view of the Bone Loading Device in operation.
Figure 16 is a perspective view of the Implant Driver about to engage the spinal implant. Figure 17 is a side view of the spinal implant being fully seated within the intervertebral space by means of the Driver apparatus in place within the Outer Sleeve.
Figure 18 is a side view of the lumbar spine showing the end result of the device implantation via the posterior route.
Detailed Description of the Drawings And Detailed Description of Method of Insertion The following discussion will be in regard to application in the lumbar spine via the posterior approach. In its simplest form, the method of the present invention involves the following steps. The patient is placed on a spinal surgery frame, which allows for the distraction and alignment of the disc space to be fused. A bilateral posterior exposure of the interspace, with or without partial discectomy is then performed. Utilizing distractors the disc space is distracted, and a hollow Outer Sleeve is fitted over one of the distractors. The end of the Outer Sleeve has teeth for engaging the two adjacent vertebrae. The Outer Sleeve is driven into the vertebrae and the distractor is then removed. A hollow Inner Sleeve is then inserted into the Outer Sleeve and a stopped Drill is utilized to prepare the opposed vertebral surfaces. The Drill and the Inner Sleeve are removed as a single unit. The space is tapped if so required. The prepared spinal implant is then inserted via the Outer Sleeve utilizing a stopped inserter. The instruments are then removed and the procedure repeated on the contralateral side of the spine. Detailed Description of the Preferred Embodiment
Step la. Prior to surgery, translucent implant templates appropriately adjusted for scale are superimposed on AP, lateral, and axial images of the interspace to be fused, for the purpose of selecting the optimal implant size and to determine the desired distraction.
Step lb. The patient is preferably placed onto a spinal surgery frame capable of inducing both distraction and vertebral alignment. Step 2. In the preferred embodiment, a standard bilateral (partial) discectomy is performed and any posterior lipping of the vertebral bodies adjacent the interspace is removed. Alternatively, no disc material need be removed. In the preferred embodiment, the interspace is exposed by performing bilateral paired semihemilaminotomies and resecting the inner aspects of the facet joints adjacent the spinal canal while preserving the supra and interspinous ligaments.
Step 3. Beginning on the first side, the dural sac and traversing nerve root at that level are retracted medially and a Long Distractor then inserted and impacted flush to the posterior vertebral bodies adjacent that interspace. Long Distractors with working ends of increasing diameter are then sequentially inserted until the optimal distraction is obtained. This optimal distraction not only restores the normal height of the interspace, but further achieves a balance wherein the tendency for the space to collapse is resisted, which in urging the vertebral bodies apart is being equally resisted by the powerful soft tissue structures about the spinal segment including the outer casing of the disc (the annulus fibrosus) , various ligaments, capsular structures, as well as the muscles and other soft tissue structures. This balanced distraction not only provides for the spatial restoration of the height of the interspace, but for considerable stability as the space now resists further distraction or collapse. In the preferred embodiment, as the desired distraction is approached, the use of the solid bodied Long Distractors is terminated and a disassemblable Convertible Distractor is placed with tactile and/or radiographic confirmation of ideal distraction. The Convertible Distractor is then disassembled such that the Short Distractor portion is left in place and the ultra-low profile head portion being positioned adjacent to the canal floor and safely away from the neural structures. To insure that the Short Distractor remains in place until its removal is desired, various embodiments of the Short Distractor are available with varying degrees of resistance to dislodgment. In the preferred embodiment of the procedure, attention is then directed to the contralateral side of the spine. Step 4. On the contralateral side of the same interspace the Long Distractor having at its working end the diameter matching the Short Distractor already in place, is then inserted. If however, due to an asymmetrical collapse of the interspace it is then determined that greater distraction is required on the second side to achieve the optimal stability, then the appropriate Short Distractor would be placed on the second side. Then the Short Distractor would be removed from the first side and replaced with a larger Long Distractor so as to bring the interspace into balance.
In an alternative embodiment, the entire procedure is performed on the one side of the spine utilizing only the Long Distractor prior to repeating the procedure on the contralateral side of the spine. While this method can be performed in accordance with the remaining steps as described in the preferred embodiment, when utilized it is best performed using a Trephine which allows the Long Distractor to remain in place, thereby allowing for interspace distraction otherwise provided in the first method by the Short Distractor. This alternative method then requires the use of a Trephine over the Long Distractor in lieu of a reamer and is therefore called the "Trephine Method", which will be discussed in detail later.
Step 5. With the Short Distractor in place on the first side of the spine, and the matching Long Distractor in place on the second side of the spine, and with the dural sac and traversing nerve root safely retracted, the Outer Sleeve is placed over the Long Distractor and firmly impacted to its optimal depth using the Impaction Cap and a mallet. The Long Distractor is then removed. Step 6. An Inner Sleeve is then placed within the Outer Sleeve, and the interspace is then prepared on that side by utilizing a Drill, Endmill, Reamer, or Trephine to drill, ream, or cut out the bone to be removed to either side, as well as any remaining interposed discal material. In the preferred method, utilizing a specially designed Endmill-Drill, it and the Inner Sleeve are removed as a unit, safely carrying away the bone and disc debris trapped within them from the spinal canal. Step 7. If required, a thread forming Tap with penetration limiting means to control the depth of insertion, is then inserted through the Outer Sleeve.
Step 8. The prepared implant is then inserted utilizing the specialized Driver unit. It should be noted that the implant may be coated with, made of, and/or loaded with substances consistent with bony fusion. However, in the preferred embodiment, the implant is treated with bone promoting and inducing substances, but is loaded with materials suitable for participating in a fusion. While substances both natural and artificial are covered by the present invention, the preferred embodiment is in regard to the use of the patient's own bone by the following method. A hollow Trephine is utilized to harvest a core of bone from the posterior superior aspect of the iliac crest adjacent the sacroiliac joint. This core of bone is at its outside diameter, slightly smaller than the inside diameter of the spinal implant to be loaded, but longer than the spinal implant. Utilizing an instrument designed for that purpose, the core of bone is then injected from within the Trephine into the central cavity of the implant causing a superabundance of the bone material within the implant such that the bone material tends to press out through the openings communicating with the outside surface of the implant.
Step 9. Using the Driver Extractor instrument, the prepared implant is threaded into the prepared interspace. The instrumentation is removed from that side of the spine and attention is then redirected to the first side of the spine. A small retractor is utilized to move the dural sac and traversing nerve root medially and to protect them and allowing the direct visualization of the retained Short Distractor unit. Without removing the Short Distractor, it is reassembled to its shaft portion, essentially reconstituting itself into a Long Distractor. With the inserted implant now acting as the distractor on the opposite side, the Long Distractor is utilized to guide the Outer Sleeve down where it is impacted as described in Step 5.
Steps 6 & 7 are then repeated, completing the procedure at that level. The wound is then irrigated and closed in the routine manner.
Representative Example of The Preferred Method Through preoperative templating of the patient's anterior posterior, lateral, and axially imaged MRI scan in conjunction with translucent overlays of the various sized implants, the correct implant diameter and length are accurately assessed, as well as the correct amount of distraction needed to restore the interspace to its premorbid height. The patient is then properly positioned and a bilateral partial discectomy performed via paired semihemilaminotomies.
For the purpose of this example, it will be assumed that by preoperative assessment it was determined that the correct implant would have an external diameter of 18mm and be 26mm long. Further, the distraction necessary to restore the height of the interspace would be approximately 10mm. The dural sac and traversing nerve root would then be retracted medially and protected, while a Long Distractor having an outside diameter to the barrel portion corresponding to the implant to be inserted, that is 18mm, and having a diameter at the working end of perhaps 8mm, would be inserted. This then being found to be slightly smaller than optimal by direct observation, a Convertible Distractor having in its barrel portion an 18mm outside diameter, but having in its working portion a 10mm diameter would then be inserted. Direct observation and/or x-ray then confirming the ideal distraction, the Convertible Distractor would then be disassembled, the barrel and head portion removed, and the Short Distractor portion left deeply embedded and with its flanged head flat against the canal floor and deep to the neural structures. It would then be safe to allow the dural sac and nerve root to return to their normal positions, which would be superficial to the flanged portion of the Short Distractor.
Attention would then be directed to the contralateral side. The dural sac and nerve root would then be retracted medially on this second side, and a Long Distractor with an 18mm diameter barrel portion and a 10mm working portion would then be inserted into the interspace and driven flush to the bone if necessary, such impaction imploding any osteophytes not already removed, and assuring that the shoulder portion of the barrel comes to lie flat against the posterior aspects of the adjacent bodies. With the dural sac and nerve root still safely retracted, the Outer Sleeve would then be placed over the Long Distractor and utilizing the Driver Cap and a mallet, seated to the optimal depth. In the preferred embodiment, the Long Distractor is then removed and the Inner Sleeve is inserted into the Outer Sleeve. Since the purpose of the Inner Sleeve is to support the drill and allow for the increased size of the implant over the size of the drill, thus making it possible for the insertion of the implant to occur through the Outer Sleeve, the Inner Sleeve therefore measures 18mm in its outside diameter, and 16.6mm in its inside diameter. This allows it to fit within the Outer Sleeve, the diameter of which is 18.1 mm and to admit the drill bit which is 16.5mm in diameter.
Following the drilling procedure, the Drill and Inner Sleeve are removed as a single unit with the trapped interposed cartilaginous and bony debris. The depth of drill penetration is preset and limited by the fixed rigid column of the Outer Sleeve. In this example, the space will be prepared to a depth of 28mm in anticipation of countersinking a 26mm long implant at least 2mm. If a Tap were to be utilized, it would be inserted at this time and be appropriate to the minor and major diameters of the implant to be inserted and as with the Drill, controlled for its depth of penetration. The spinal implant would then be prepared for implantation by utilizing a Trephine to harvest a core of posterior iliac bone greater than 30mm long and approximately 14.5mm in diameter.
Using the Bone Loading Device, this core of bone would be forcefully injected into the internal chamber of the spinal implant which would then be capped. Cap end forward, the fully loaded implant would then be attached to the Insertion Driver, down the Outer Sleeve and screwed into place with the depth of penetration limited by the Insertion instrument. The Insertion Driver is then unscrewed from the implant and removed from the Outer Sleeve. With the dural sac and nerve root retracted and protected, the Outer Sleeve would then be removed. This would complete the fusion procedure on that side, and then as described, the procedure would be repeated on the other (first) side of the same interspace.
Alternative Methods An alternative and extremely useful method is the "Trephine Method". Its advantages include that it may be used in conjunction with the preferred embodiment substituting the use of a hollow, tubular cutter, called a Trephine for the use of the Drill in Step 5 of the preferred embodiment. Additionally, it may be utilized so as to obviate the need for the placement of the Short Distractor and to allow the procedure to be effectively performed from start to finish on one side prior to initiating the procedure on the opposite side, and while nevertheless maintaining distraction at the site of the bone removal.
The following is a description of the "Trephine Method". Having completed the exposure of the interspace on at least one side, the dural sac and nerve root are retracted. A Long Distractor differing from the Long Solid Bodied Distractor of the preferred embodiment only in that the barrel portion is of a precisely lesser diameter than the spinal implant. As in the preferred embodiment, the Outer Sleeve has an inner diameter only slightly greater than the implant to be inserted. Therefore, at this time, a first Inner Sleeve is inserted into the Outer Sleeve to make up the difference between the outside diameter of the Long Distractor and the inside diameter of the Outer Sleeve. With the Outer Sleeve and first Inner Sleeve thus assembled, they are placed over the Long Distractor and the Outer Sleeve is optimally seated using the Impaction Cap. The Cap and first Inner Sleeve are removed, but the Long Distractor and Outer Sleeve are left in place.
With the Long Distractor maintaining optimal distraction and with the Outer Sleeve locking the vertebrae together so as to resist any movement of the vertebrae, a hollow, tubular cutter known as a Trephine is then inserted over the Long Distractor and its barrel portion and within the Outer Sleeve. The Trephine, which is stopped out to the appropriate depth, can then be utilized to cut equal arcs of bone from the opposed vertebral endplates. Alternatively, a second Inner Sleeve may be placed within the Outer Sleeve prior to placing the Trephine over the Long Distractor and within that second sleeve. This second Inner Sleeve would be just greater in its internal diameter than the Long Distractor and just smaller in its outside diameter than the inner diameter of the Outer Sleeve. While it would provide enhanced stability to the Trephine, provision would then need to be made in the way of large flutes passing longitudinally or obliquely along the outer surface of the Distractor to its barrel portion to accommodate the bony and cartilaginous debris generated during the cutting procedure.
Following the use of the Trephine to the appropriate depth by either of these methods, the Trephine, the Long Distractor, and the second Inner Sleeve, if utilized, are all removed. Since the Trephine cuts two arcs of bone but does not ream them out, a shafted instrument with a perpendicular cutting portion at its working end is then inserted parallel to the disc space and then rotated through an arc of motion cutting the bases of the two longitudinally cut arcs, thus freeing them for removal through the Outer Sleeve. The space may then be tapped if required, and the implant is inserted as per the preferred method. As already mentioned, the "Trephine Method" can be used with or without the use of the Short Distractor on the contralateral side.
Applications of Method in Other Areas of the Spine
The following method is the preferred embodiment for performing anterior interbody fusion in the thoracic and lumbar spines. It is also appropriate in the cervical spine when the width of the spine anteriorly is sufficient so that it is possible to place two implants side by side and such that each intrudes at least several millimeters into the substance of the opposed vertebrae and for the length of the implants.
The interspace to be fused is adequately exposed and the soft tissues and vital structures retracted and protected to either side. Visualization of the broad width of the interspace anteriorly is made possible by the absence of the neurological structures in relation to this aspect of the spine. The center line of the anterior aspect of the interspace is noted and marked. The disc is removed using first a knife and then curettes and rongeurs as needed. Alternatively, the disc may be left intact to be removed during the drilling stage of the procedure. However, as per the preferred embodiment of the procedure, having removed the great mass of the nucleus and the greater portion of the annulus anteriorly. Long Distractors with progressively increasing diameters to their working ends are inserted into the interspace at a point midway between the central marking line and the lateral extent of the anterior aspect of the spine as visualized.
The Dual Outer Sleeve with its common Foot Plate and Retention Prongs is then inserted over either a singly placed Long Distractor and then the second Distractor placed, or is placed over both Distractors if already placed. The Dual Outer Sleeve is then seated firmly against the anterior aspect of the spine. Any spurs which would interfere with the flush seating of the Foot Plate to the anterior aspect of the spine should be removed prior to inserting the Long Distractors. Once the Outer Sleeve has been optimally seated, one of the Long Distractors is removed and in its place is inserted an Inner Sleeve and drill bit. The drill bit has as its outside diameter the minor diameter of the implant to be inserted. The Inner Sleeve is essentially equal in thickness to the difference between the minor and major diameters of the threaded implant.
A Stopped Drill is then utilized to prepare the opposed vertebral surfaces and to remove any remaining disc material interposed. If required, a Stopped Tap may be inserted through the Outer Sleeve and into the interspace to create a thread form. The properly prepared implant is then affixed to the Insertion Driver and passed through the Outer Sleeve down into the interspace and inserted until its depth of penetration is limited by the stop on the Insertion Driver. With the implant itself now in a position to act as a distractor, the Long Distractor is then removed from the contralateral side and the procedure repeated. When both implants are firmly in place, the outer sleeve may then be removed. The amount of countersinking of the implants may then be adjusted under direct vision.
Detailed Description of the Preferred Embodiment
Method and Instrumentation In the preferred embodiment, the disc (D) between adjacent vertebrae (V) is approached via bilateral paired semihemilaminotomies of the adjacent vertebrae. In the preferred embodiment the supraspinous ligament, the interspinous ligament, the spinous process, portions of the lamina, and most of the facet joints are preserved. However, while less desirable, these structures may be removed. In the preferred method, a bilateral partial nuclear discectomy is then performed through bilateral openings created through the posterior aspect of the annulus fibrosus. While considered less desirable, disc excision can be delayed and performed simultaneously with the vertebral bone resection during the drilling procedure. Starting on the first side a dural nerve root retractor is placed such that the dural sac and lower nerve root are retracted medially allowing exposure to one side of a portion of two adjacent vertebral bodies and the interposed disc posteriorly.
Referring now to Figure 1, preferably after removing some portion of nuclear disc material, a Long Distractor 100 is inserted under direct vision into the intervertebral space. The disc penetrating portion 102 is essentially cylindrical with a bullet-shaped front end 103 and a shoulder portion 104 where the penetrating portion 102 extends from barrel 106. The penetrating portion 102 urges the vertebral bodies apart, facilitating the introduction of the instruments. Long Distractors with sequentially increasing diameter penetrating portions 102 are then introduced. As the optimal diameter of penetrating portion 102 is achieved, the vertebral bodies to either side are forced into full congruence and thus become parallel, not only to the penetrating portion 102, but to each other. At this time, any remaining excrescences of bone of the posterior vertebral bodies adjacent the posterior disc which have not already been removed are flattened flush to the vertebral body by the forced impaction, such as by hitting with a hammer flat surface 109 of crown 110, driving the shoulder 104 against the lipped portions of vertebrae V. Because of the forced opposition of the vertebral endplates to portion 102 with optimal distraction, unit 100 will then come to lie absolutely perpendicular to the plane of the posterior bodies and absolutely parallel to the vertebral endplates, allowing optimal alignment for the procedure to be performed.
Penetrating portion 102 is available in various diameters, but all are of a constant length, which is less than the known depth of the interspace. This combined with the circumferential shoulder 104, which is too large to fit within the interspace, protects against the danger of overpenetration. Barrel 106 is of the same diameter as the external diameter of the device to be implanted. A recessed portion 108 below the crown 110 allows for the Long Distractor 100 to be engaged by an extractor unit shown in Figure 9.
In the preferred embodiment, a Convertible Long Distractor 113 is used on the first side of the spine. As shown in Figures 2, the Convertible Long Distractor 113 has a barrel portion 152 separable from the Short Distractor portion 120. While the initial distraction may be performed with a solid Long Distractor, as the optimal distraction is approached the appropriate Convertible Long Distractor is utilized. The Convertible Long Distractor 113 consists of a Short Distractor portion 120 and a barrel 152 having a rectangular projection 134 at one end. The Short Distractor 120 has an increased diameter head 128, a rectangular slot 118 and an internal threaded opening 114. The barrel 152 is hollow and has an internal shaft 111 terminating in a large diameter hexagonal crown 115 at one end and a reduced diameter portion 112. The crown has a detent portion 117 in its flat surface. The other end of the shaft 111 has a threaded small member 116 that corresponds to threaded opening 114. The shaft 111 is prevented from removal from the barrel 152 by set pin 119 passing through the wall of barrel 152 in a convenient manner. The Short Distractor portion 120 is removably attached to the barrel portion 152 via the mating of female rectangular slot 118 and the male mating member 134. The mating held together by utilizing knob 136 to drive the crown 110 connected to interior shaft 111 having a threaded working end screw 116 that threads into the female aperture 118 of the Short Distractor portion 120.
Cap 136 has an open socket 138 for fitting around crown 115 and engages the reduced diameter hexagonal portion 112 so as to permit the rotation of shaft 111 and threaded male member 116. A detent ball 150 in the inside of the socket 138 engages detent 117 in the crown 115, holding them together.
The Short Distractor portion 120 of Figures 2, 3, and 3A-3F are designed to provide for high stability when temporarily situated so as to resist inadvertent migration while the surgeon is working on the second side. To that end, the embodiment of the Short Distractor 120 shown in Figures 3 and 3A has a pair of sharp pegs 126, to embed into the opposing vertebral bodies and forward facing ratchetings 124, that further resist backward movement. Figures 3B and 3C, which show the preferred embodiment, are side and top views of an alternative embodiment of the distractor portion such that the distractor portion to be interposed between the vertebrae is essentially cylindrical, but with circumferential forward facing ratchetings 124.
A further alternative embodiment is shown in Figures 3D and 3E. This is a more rectangularized design, with forward facing ratchetings, without the sharp prongs 126 of Figure 3. Figure 3F is a side view of a further embodiment of the Short Distractor 120 shown with knurling, to increase the interference with the bone surface so as to add stability to the unit and to resist dislodgment. To this end, it is apparent that the working ends of both the Long and Short Distractors can have a variety of configurations consistent with their purpose, and that surface irregularities as well as the shape of the ends themselves, with or without prongs 126, may be utilized to make the Short Distractor 120 more resistant to migration.
Once the ideal distraction has been achieved on the first side of the spine, the Convertible Distractor is dissociated, leaving Short Distractor 120 in place with its rounded external end 128, safely on the canal floor and deep to the dural sac and nerve root.
As shown in Figure 4, the surgeon then moves to the other side of the spine at the same disc (D) level, and retracts the dural sac and nerve root medially, exposing the disc on that side. Long Distractors 100 are then sequentially inserted into the disc space until the diameter of the distractor on the second side is at least as big as that on the first side. If because of some asymmetry of the interspace a larger diameter distractor is required on the second side to achieve the ideal distraction as compared to the first side, then the second side is fitted with a Short Distractor of the larger diameter, and the surgeon would then return back to the first side. In that event, the first side Short Distractor would then be removed and the Long Distractor 100 corresponding to the increased diameter of the already placed Short Distractor 120 would then be inserted. In either event, the operation is continued by working on the one side where the Long Distractor is in place. In this regard, it should be noted, that by the use of such a device as the Michelson Spinal Surgery Frame, it may be possible to obtain adequate distraction preoperatively such that the surgeon is either disinclined to use a distractor, or to simply place the correct Long Distractor on the first side and then proceed with the surgical procedure on that side before moving to the opposite side. These variations are within the scope of the present invention. The Long Distractor now serves as both a centering post and an alignment rod for the hollow Outer Sleeve 140 shown in Figure 5 which is fitted over the Long Distractor 100, shown by phantom lines 101 in Figure 5. The Outer Sleeve 140 is metal and has a sharp toothed front end 142 that is capable of penetrating into and holding fast the two adjacent vertebrae (V) . Interrupting the circumferential sharp teeth of 142 are flat, planar areas 152 which serve to resist the further insertion of the sharp teeth into the vertebral bodies. The toothed front end 142 of the Outer Sleeve 140 is a continuation of the tubular shaft 144, which in turn is connected to circumferentially enlarged tubular back end 146 having a knurled outer surface 148 for easier manipulation. An alternative embodiment of an Outer Sleeve incorporates an expansile key hole and slot configuration 154 to either side of shaft 144 along the mid-plane of the interspace and parallel to it such that the end 142 resists the collapse of the vertebrae (V) to either side of the disc (D) , but may nevertheless allow for their further distraction, in the event the only diameter or the root diameter of the implant is larger than the hole drilled.
A Driver Cap 160 in the form of an impaction cap has at its far end a flat, closed-back surface 162 and at its other end a broad, circular opening. The Driver Cap 160 fits over both the Outer Sleeve 140 and the Long Distractor 100. As the Driver Cap 160 is seated, interior surface 170 circumferentially engages portion 146 of the Outer Sleeve until the back end 172 engages the internal shoulder 164. As mallet blows are applied to surface 162, that force is transmitted via the internal shoulder 164 to the Outer Sleeve 140 via its far end 172, seating teeth 142 into the vertebral bodies adjacent the disc space D and to the depth of the teeth 142 to the flat portions 152. As the Outer Sleeve 140 is advanced forward, crown portion 110 of the Long Distractor is allowed to protrude within the Driver Cap 160 unobstructed until it contacts the interior flat surface 168. Once crown 110 comes into contact with the flat interior surface 168, then further taps of the mallet will not advance the Outer Sleeve, any further motion being resisted by the flat shoulder portion 104 of the Long Distractor abutting the hard surfaces of the posterior vertebral bodies. In this way, the Outer Sleeve 140 is safely and assuredly inserted to its optimal depth and rigidly securing the two opposed vertebrae as shown in Figure 6. The Cap 160 is then removed and the Distractor
Puller 200 of Figure 9 utilized to remove the Long Distractor 100 from the spine leaving the Outer Sleeve 140 in place. The Distractor Puller 200 has front portion 202, a mid portion 204, and a back handle portion 206. At the front portion 202 of the Distractor Puller 200, a socket 208 is connected to one end of shaft 210 which at its far end is connected to back handle portion 206. The socket 208 has defined within it a cavity 212 that is open at its front end and funnelized on the interior aspect of its sides. The cavity 212 is constructed so that the head of the Distractor Puller 200 and the partially circumferential flange 218 engages the circumferential recess 108 of the Distractor 100. The entrance to cavity 212 is slightly funnelized, and the leading edges of flange 218 slightly rounded to facilitate the engagement of recess 108 and head 110 of Distractor 100, which is further facilitated in that the Driver Cap 160 leaves portion 108 of Distractor 100 precisely flush with the back surface 172 of the Outer Sleeve 140. This provides a large, flat surface 172 to precisely guide surface 230 of socket 208, and open portion 212 around head 110 while flange 218 engages recess 108. The springloaded detent ball 228 engages hemispherical depression 112 in the crown 110, shown in Figure 2. This springloaded detent 228 in engagement with complimentary indent 218 protects against the inadvertent dissociation of the Long Distractor from the Puller 200 after the Distractor has been removed from within the Outer Sleeve 140 and prior to its removal from the wound. Once out of the body, the two instruments are easily disassociated by freeing the crown portion 110 from cavity 212 by a manual force applied perpendicular to their relative long axes at this location. A cylindrical and free removable weight 216 is fitted around shaft 210 between the front portion 202 and the rear handle portion 206. Gently, but repeatedly sliding the weight 216 along shaft 210 and driven rearwardly against flat surface 228, transmits a rearward vector to proximal end 202 and thereby to the Long Distractor 100 to which it is engaged.
Paired extended handle 224 and 226, allow the surgeon to resist any excessive rearward motion as the instrument is used to liberate the Long Distractor 100. Paired handles 224 and 226 are also useful in that they allow a rotational directing of portion 208, via the shaft 210. This allows the surgeon to control and manipulate rotationally the orientation of the opening of cavity 212 to facilitate its application, to the head 110 of the distractor 100.
The Distractor Puller 200 is a significant improvement over the alternatives of striking a remover instrument with an independent hammer over the exposed surgical wound, or manually extracting the distractor by forcefully pulling. The use of a free hammer over the open wound is dangerous because the neural structures can be impacted on the back swing which is made even more likely by the effects of gravity on the mallet head. Manual extraction by pulling is dangerous because of the significant interference fit of portion 102 within the spine such that significant force would be required to remove the Distractor 100, and if force were not coaxial then the Outer Sleeve might be dislodged or misaligned. Further, once the flat portion 102 became free of the interspace, all resistance to withdrawal would be lost and in the face of the considerable force necessary to free it, the Distractor 100 might easily become projectile imparting injury to the patient and/or the surgeon.
Once the Long Distractor 100 has been fully removed from the Outer Sleeve 140, the toothed end 142 of the Outer Sleeve 140, working in conjunction with the Short Distractor 120 on the contralateral side rigidly maintains the relative position of the adjacent vertebrae V. Further, since the remainder of the procedure on that side of the spine occurs entirely through the protective Outer Sleeve 140, and as the nerves and dural sac are external to that Outer Sleeve and superficial to the toothed end 142 of the Outer Sleeve 140, which is firmly embedded into the adjacent vertebrae V, the Outer Sleeve 140 serves to insure the safety of these delicate neural structures. Further, since the Outer Sleeve 140 is of a fixed length and rigid, its flat rearward surface 172 may be used as a stop to the advancement of all instruments placed through the Outer Sleeve 140, thus protecting against accidental overpenetration. Further, the Outer Sleeve 140 assures that the further procedure to be performed will occur coaxial to the disc space D and further, be symmetrical in regard to each of the opposed vertebral surfaces.
Figure 10B is a posterior view of the spine at this stage of the procedure, showing a Short Distractor 120 in place on one side of the spine and the bottom portion of Outer Sleeve 140 in place on the opposite side of the spine.
Referring to Figure 11A, an Inner Sleeve 242 is inserted from the rear within the Outer Sleeve 140. This Inner Sleeve has a collar portion 244 of a known thickness which seats against the top edge surface 172 of Outer Sleeve 140. The cylindrical barrel portion of Inner Sleeve 242 comes to approximate the posterior aspect of the vertebral bodies interior the Outer Sleeve when fully seated. A Drill 240, having a known selected length is then introduced through the rearward aperture of the Inner Sleeve 242 and utilized to ream out the arcs of bone which it engages from the opposed vertebral endplates as well as any discal material within its path down to its predetermined and limited depth. The Drill 240, has a narrow engagement portion 246, which allows it to be affixed to a drill mechanism which may be either a manual or a power unit. A circumferential collar 248 of an increased diameter serves to limit the depth of penetration of the drill 240 and may be fixed, or lockably adjustable.
Not shown here, but well known to those skilled in the art, are various mechanisms to lockably adjust such instruments as drills. Such mechanisms include, but are not limited to, the use of collets, threaded shafts with lock nuts, and flanges engaging grooves forced therein by either a cap pulled over the flanges or screwed down upon them. In the preferred embodiment, the forward cutting edge 252 of Drill 240 is a modification of a large fluted drill design such that the end resembles an end cutting mill which may contain any workable number of cutting surfaces, but preferably four or more, and such cutting surfaces being relatively shallow such that the advancement of the instrument occurs more slowly. The outside diameter of the Drill 240 corresponds to the minor diameter of the threaded spinal implant. The Inner Sleeve 242 has an inner diameter slightly greater than that dimension and its outer diameter is slightly smaller than the inside diameter of the Outer Sleeve 140 which has the same outer diameter as the major diameter of the threaded implant. The drill shaft of drill 240 comprises an upper portion 243, a central recessed portion 256 of a smaller diameter and a lower cutting drill portion 250. The upper portion 243 and lower portion 256 of the drill 240 have the same outside diameter.
The Inner Sleeve 242 serves many functions.
First, it provides a more intimate drill guide for drill
240 in the event a smaller diameter hole is to be drilled than that of the inside diameter of the Outer Sleeve 140. Second, since it now guides the Drill, it allows for the
Outer Sleeve 140 to have an internal diameter large enough to admit the threaded spinal implant, which is indeed considerably larger in diameter than the Drill 240 itself.
If a larger Outer Sleeve 140 were utilized absent the Inner Sleeve 242, then the Drill 240 would be free to wander within the confines of that greater space and would not reliably make parallel cuts removing equal portions of bone from the adjacent vertebrae V. Further, the bone removal not only needs to be equal, but must be correctly oriented in three dimensions. That is, the path of the
Drill 240 must be equally centered within the disc space, parallel the endplates, and parallel to the sagittal axis dissecting the interspace.
A further purpose of the Inner Sleeve 242 is that it may be removed simultaneously with the Drill 240, thereby trapping the debris, both cartilaginous and bony generated during the drilling procedure, which are guided rearward by the large flutes 251 of Drill portion 250, where they are collected around recessed portion 256 between the recessed portion 256 and the inner wall of the Inner Sleeve 242 are there contained therein. Thus, by removing the Drill 240 in conjunction with the Inner Sleeve 242, all of the debris generated by the reaming procedure is safely removed from the spinal canal and wound area.
Further, if the disc tissue in the area to be reamed has been removed previously, as per the preferred method, then the patient's own bone of good quality and useful within the operation will then be contained between the Inner Sleeve 242 and the shaft portion 256. Once away from the surgical wound, this material may be used to load the spinal implant or placed deep within the interspace to participate in the fusion. The method of actually producing the surgical hole within the spine is variable. As shown in Figure lie, in an alternative embodiment Drill end 250 has a forward projecting nipple 260, which itself is bullet-shaped in its leading aspect so as to ease its entrance into the disc space and to urge the vertebrae apart. Nipple 260 is distracting, stabilizing as it resists any tendency of the vertebrae to move together, is self-centering to the Drill portion 250 when working in conjunction with Sleeves 140 and 242, and virtually assures the symmetrical resection of bone from the opposed vertebral surfaces.
The alternative "Trephine Method" referred to earlier in this application, is shown in Figure 11B. In this alternative, a Long Distractor 100 is left in place after the Outer Sleeve 140 is seated. The Long Distractor 100 in this case differs from the Long Distractor of the preferred embodiment in that its outside diameter of the barrel 106 is of a smaller diameter than in the prior version. This is made necessary because regardless of the method, the hole to be formed corresponds to the minor diameter of the spinal implant. Trephine 270, a hollow, tubular member with sharp cutting teeth 251 at its proximal end, has a wall thickness and since the outside diameter of that trephine 270 must correspond to the root diameter of the implant, then the wall thickness of the trephine 270 must be allowed for by a corresponding reduction in the diameter of the Long Distractor 100.
A further modification of the Long Distractor 100 to the "Trephine Method" would use longitudinal grooves (not shown) along the barrel surface 106 for the purpose of transmitting any debris generated during the cutting procedure, rearward. Since the cutting element is both centered and aligned by the Long Distractor, the use of the Inner Sleeve 242 is not mandatory, but may once again be useful in controlling the path of the debris. To that end, little debris is generated in the "Trephine Method" as the bony arcs are not so much being reamed out and removed as they are simply being cut into the bone where these arcs of bone are left connected at their far ends. Thus, when the Trephining Method has been completed and the Trephine 270 and Inner Sleeve 242 removed, unlike in the preferred embodiment where the hole is drilled out, it remains necessary to remove both the two arcs of bone, and any interposed material. Nevertheless, this is very easily performed by various means, one of which is depicted in Figure 11D. Instrument 272 consisting of a shaft 276 attached off center to the lower surface 273 handle 274. The shaft 274 terminates in a cutting arm 278. The instrument 272 is inserted through Outer Sleeve 140 where the lower surface 273 of handle 274 abuts the top 172 of the Outer Sleeve 140, both stopping downward motion of instrument 272 and precisely placing the perpendicularly cutting arm 278 of instrument 272 so that as handle portion 274 is rotated, the cutting arm 278 is also rotated, cutting the arcs of bone and liberating them from their last attachments. These portions of bone are then removed utilizing this instrument or a long forceps, and then placed within the implants or otherwise used to participate in the fusion.
While in the preferred embodiment of the present invention the spinal implant I, is essentially self-tapping, if the bone is unusually hard it may be desirable to form the thread pattern within the interspace prior to the insertion of the implant I. To that end, as shown in Figure 12, Tap 280 has a threadcutting portion 282 connected by a shaft 286 to a handle portion 292, which has been designed to give mechanical advantage to the rotation of the instrument for the purpose of cutting threads. The lower portion of handle 290 has a forward facing flat surface 288 too large to fit through the opening of Outer Sleeve 140 which thus safely limits the depth of penetration of the cutting element 282. This tap 280 is further made safe by blunt end 294 which will engage the uncut portions of the vertebral bone just prior to the engagement of shoulder 288 against surface 172. This feature allows the surgeon to appreciate a less harsh resistance as the blunt nose 294 encounters the remaining unresected bone for the drill hole and prior to the sudden increase in resistance caused by the seating of shoulder 288 against top edge 172, which first resistance serves as a warning to the surgeon to discontinue the tapping procedure. Thus, the surgeon has both visual (as shoulder 288 approaches top edge 172) and tactile warnings to avoid stripping the thread form. Tap end 282 is highly specialized for its specific purpose. Rearward to the specialized blunt tip 294 is a truncated bullet-shaped area 298 which ramps up to the constant diameter intermediate the cutting ridges 296. Ramp portion 298 urges the opposed vertebral bodies apart, which motion is resisted by Outer Sleeve 140, thus progressively driving the sharp leading edges of thread forms 296 into the vertebral bodies. The periodic longitudinal grooves 284 interrupting the thread forms, which may number 1 to 8, but preferably 4, function to accumulate the bony material which is removed during the thread cutting process. In that regard, in the ideal embodiment, the thread cutting form is designed to compress the bone to be formed rather than to trough through it. Further, while both the major and minor diameters of the Tap 280 may be varied, in the preferred embodiment, the minor diameter corresponds to the minor diameter of the implant I, but the major diameter is slightly less than the major diameter of the implant. With Tap 280 now removed, and Sleeve 140 still in place, the surgical site is now fully prepared to receive the spinal implant I. In the preferred embodiment of the spinal implant, the implant has been enhanced by the use of, application to, and filling with fusion promoting, enhancing, and participating substances and factors. Thus, the implant may be fully prepared for insertion as provided to the operating surgeon. However, at the present time, human bone is most commonly used as the graft material of choice, with the patient's own bone being considered the best source.
Figure 14a shows a trephine 300 with an exceedingly sharp front cutting edge 302 for quickly and cleanly coring into the patient's posterior iliac crest, or any other bony tissue, and for the purpose of producing a core of bone then contained within the hollow 304 of the trephine 300. Trephine 300 has a rear portion 306 with a pair of diametrically opposed slots 310, and disposed clockwise from their longitudinally oriented rearward facing openings so as to engage diametrically and opposing members 312 of Drive unit 308, by which trephine 300 may be attached to either a hand or power drill. It can be appreciated that engagement mechanism 312 is stable during the clockwise cutting procedure, and yet allows for the rapid disconnection of the two components once the cutting is completed.
Because of the high interference between the graft and the inner wall of hollow portion 304, and the relative weakness of the cancellous bone being harvested, it is possible to remove the Trephine 300 while still drilling, and to have it extract the core of bone with it. However, in the highly unlikely event that the core of bone would remain fixed at its base, then with the drive mechanism 308 removed, a corkscrew 408 shown in Figure 14C is introduced though the central opening of rear portion 306 and threaded down and through the core of bone within 304 and to the depth of teeth 302. The tip 318 of the corkscrew 408, which extends substantially on line with the outer envelope of the corkscrew, then cuts radially through the base of the bone core. As the handle portion 314 of the corkscrew 408 abuts the flat, rearward surface of portion 306 and it can no longer advance. As corkscrew 408 is continued to be turned further, it will cause the core of bone to be pulled rearward, as in removing a cork from a wine bottle. Trephine 300 has a barrel portion 304 continuous with sharp toothed portion 302 having an inner diameter just less than the inner diameter of the spinal implant I to be loaded. The Trephine 300 with its core of harvested bone is then placed as shown in Figure 14B, through opening 340 of Implant Bone Loading device 320, where the barrel portion 304 then passes through and is stopped by circular flange 344. The plunger shaft 326 of instrument 320 is then prepared for attachment by rotating knob 332 counterclockwise such that the plunger 372 is pulled via the long threaded shaft portion 328 back to the base of collar 330 at its proximal end. In this position, knob 332 is considerably extended rearward from collar 330. With plunger shaft 326 in this position, the plunger head 372 is inserted into the central hollow of portion 306 of Trephine 300 as the proximal cylindrical portion of collar 330 then follows it, such that the plunger 372 then occupies the rearward portion of barrel 304 and the proximal cylindrical portion of collar 330 occupies the central hollow of portion 306. A pair of diametrically opposed radially projecting arms 346 on collar 330 are then advanced longitudinally into diametrically opposed paired L slots 340 and then rotated clockwise to complete this assembly.
At the other end of instrument 320, a spinal implant I is engaged through its female rectangular slot 364 by a rectangular protruding bar extending from rearward facing surface of end plug 324, (not shown) and secured there by knob 334 which extends as a rod through a central aperture within end plug 324 to extend at the far end as.a small bolt which threads to a female aperture centered within the female slot 364 of the spinal implant. With the spinal implant I secured to end plug 324 and the opposite end of the implant I presenting as a hollow, tubular opening, end plug 324 is advanced into device 320 where it is secured by rotationally engaging diametrically opposed L-shaped slots 321. With device 320 fully assembled, end 302 of trephine 300 lies coaxial and opposed to the open end of implant I. As shown in Figure 15, as knob 332 is then rotated clockwise, the plunger 372 proximal the threaded shaft 328 is then forcibly, but controllably driven forward down the barrel 304 ejecting the bone graft directly into the spinal implant I. As the bone graft is greater in length than the interior of the spinal implant, with further compression the bone is forced into the radially disposed apertures through the wall of the device communicating from the central cavity to the exterior.
End plug 324 is then removed from apparatus 320. Using end plug 324 as a handle, end cap 374 shown in Figure 16 is secured to the open end of the spinal implant I. The implant is then disassociated from end plug 324 by rotating knob 334 counterclockwise.
Figure 16 shows an Implant Driver instrument which may be used to either insert or to remove said implant I. Driver 350 has at its far end 362, a rectangular protrusion 398, which protrusion intimately engages the complimentary rectangular slot 364 of implant I. Protruding from slot 398 of end 362 is threaded portion 353, which extends as a rod through hollow shaft 358 and hollow hand barrel 360 to knob 354 where it can be rotationally controlled. Threaded portion 353 screws into a female aperture central slot 364, urging 353 into 364, and binding them together such that instrument 350 can be rotated via paired and diametrically opposed extending arms 366 and in either direction while maintaining contact with the implant. Affixed to the Driver 350, the implant is then introduced through the Outer Sleeve 140 and screwed into the interspace opposed between the two prepared vertebrae V until such time as the leading edge of the Implant Cap 374 reaches the depth of the prepared hole at which time its forward motion is impeded by the bone lying before it which had not been drilled out. This allows for a progressive feel to the surgeon as the implant is screwed home.
As described previously, with the use of the Tap 280, this terminal resistance to further seating provides significant tactile feedback to the surgeon. Again, as with the Tap 280, visual monitoring of the depth of insertion of the implant is provided to the surgeon by observing the progressive approximation of the forward surface 370, of barrel portion 360, as it approaches the rearward facing surface 172 of Outer Sleeve 140. Nevertheless, a final safety mechanism, when the full depth of insertion has been achieved, surface 370 of instrument 350 will abut surface 172 of the Outer Sleeve 140, prohibiting any further installation of the spinal implant.
Once the implant has been fully installed, the Driver 350 is dissociated from the implant by turning knob 354 in a counterclockwise direction. The Driver 350 is then withdrawn from the outer sheath, then the Outer Sleeve 140 is removed. This leaves the implant fully installed and inset to the determined depth as shown in Figure 18.
Attention is then redirected to the other, or first, side of the spine. A dural nerve root retractor is used to retract the neural structures medially, bringing into full view the head 128 of the Short Distractor 120, lying flush on the canal floor. Utilizing apparatus 152, extended screw portion 116 is inserted into the female threaded portion 114 of the Short Distractor 120 as the extended rectangular portion 134 of apparatus 152 is engaged to the female rectangular portion 118 of the Short Distractor 120. Then turning rearward facing portions 108 and 110, utilizing the knob 136 of Figure 2, the Long Distractor configuration is restored.
With the dural sac and nerve roots still retracted and protected, the Outer Sleeve 140 is slipped over the reconstituted Long Distractor and seated using the Driver Cap 162. The entire sequence of events as described for the implantation of the spinal implant I as already placed, is then repeated such that both spinal implants come to lie side by side within the interspace. Though not necessary, circlage or other internal fixation of the levels to be fused may additionally be performed, and then the wound is closed in the routine manner.
Brief Discussion With Reference To The Drawings of The
.Preferred Method And Instrumentation For Anterior Interbody Fusion Incorporating Intercorporeal Predistraction And Utilizing A Guarded Sleeve System Is Disclosed Because of the absence of the spinal cord and nerve roots, it is generally possible to visualize in one instance the entire width of the disc space from side to side throughout the cervical, thoracic, or lumbar spine. In the preferred embodiment of the anterior interbody fusion, implants are placed side by side from anterior to posterior parallel to the interspace and extending through into the adjacent vertebral bodies. Where the transverse width of the disc space is insufficient to allow for the use of two implants, each of which would be large enough to protrude to the required depth into the adjacent vertebrae, then a singular and significantly larger implant may be placed centrally. With this in mind, and in light of the very detailed description of the technique and instrumentation already provided in regard to the method of posterior lumbar interbody fusion, a brief discussion of anterior spinal interbody fusion with dual implant installation will suffice, and the method for installation of a large, singular midline graft will become obvious.
The interspace to be fused is exposed anteriorly. The soft tissues are withdrawn and protected to either side, and if necessary, above and below as well. It is then possible to visualize the entire width of the vertebrae anteriorly adjacent that interspace. As discussed above, the surgeon has already templated the appropriate patient radiographs to determine the requisite distraction and optimal implant size. In the preferred method, the surgeon then broadly excises the great bulk of the nuclear disc portion. (Alternatively, the disc can be left to be removed via the drill later.) The surgeon then notes and marks a point midway from side to side anteriorly. He then inserts Long Distractor 100 centering it on a point midway between the point just noted and the lateral extent of the intervertebral space visualized anteriorly. The outer barrel portion 106 of the Distractor 100 utilized, will correspond to the outside diameter of the implants to be installed. The Distractor tips 102 inserted are sequentially larger in diameter until the optimal distraction is achieved. This optimal distraction, although suggested by the initial templating, may be visually and tactilely confirmed as performed. When the optimal distraction is achieved, the vertebral endplates will come into full congruence and parallel to the forward shaft portion 102 of the Distractor 100, causing an alteration in the alignment of the vertebrae and a significant increase in the interference fit and pressurization at the tip, such that the instrument becomes exceedingly stable.
There is a sensation imparted to the surgeon of the tissues having moved through their elastic range to the point where the two adjacent vertebrae V begin to feel and move as if a single solid. These changes are easily appreciated visually as the vertebrae realign to become congruent to tip 102, and can also easily be appreciated via lateral Roentgenography. However, should the surgeon fail to appreciate that optimal distraction has been achieved and attempt to further distract the interspace, he would find that extremely difficult to do because of the increased resistance as the tissues are moved beyond their range of elastic deformation. Further, there would be no elasticity left to allow the vertebrae to move further apart and the sensation to the surgeon should he attempt to gently tap the oversized Distractor forward with a mallet, would be one of great brittleness.
Returning now to the procedure, when the correct intercorporeal Distractor 100 producing the ideal interspace distraction having its barrel portion 106 corresponding to the implant to be installed has been inserted, then its exact duplicate is inserted anteriorly equidistant to the other side of the spine. As the barrel portion 106 of Long Distractor 100 is exactly of the same major diameter as the spinal implant I looking coaxially on end, the surgeon can then asses the anticipated side by side relationship of the dual implants when implanted.
As shown in Figures 7C and 7D, a Dual Outer Sleeve 340 consisting of a pair of hollow tubes is then introduced over the side by side Long Distractors protruding anteriorly from the spine. The Dual Outer Sleeve 340 is comprised of two hollow tubular members identical in size displaced from each other ideally the sum of the difference between the minor and major diameters of both implants combined, but not less than that difference for one implant, as it is possible to have the threads of one implant nest interposed to the threads of the other, such that they both occupy a common area between them. However, while the preferred embodiment is slightly greater than two times the difference between the major and minor diameters of the implant (the sum of both) the distance may be considerably greater. Whereas in the preferred embodiment extending tubular portions 348 of instrument 340 are parallel, when the area between them 350, is sufficiently great, these elements may be inclined or declined relative to each other such that they either converge or diverge at their proximal ends. Paired tubular structures 348, may be bridged in part or wholly throughout their length, but are rigidly fixed by Foot Plate 344. In its preferred embodiment, a top view shows the Foot Plate to be essentially rectangular, but without sharp corners.
Other shapes can be utilized. In side view 7D it can be appreciated, that Foot Plate 344 is contoured so as to approximate the shape of the vertebrae anteriorly. Extending forward from Foot Plate 344 are multiple sharp prongs 342 sufficiently long to affix them to the vertebrae. The prongs 342 are limited in length so as to not penetrate too far posteriorly and number from 2 to 10, but preferably 6. As the Dual Outer Sleeve 340 is driven forward utilizing Dual Driver Cap 420, of Figure 7E, engaging the rearward end 352, the prongs 342 extending from Foot Plate 344 are embedded into the opposed vertebral bodies until their forward motion is inhibited by the curved Foot Plate 344 becoming congruent to and being stopped by, the anterior aspect of the vertebral bodies. As already taught in Figure 5, the Dual Driver
Cap 420 is of the same design as Single Driver Cap 160, in that there is a recess 354 as per 168, allowing the Outer Sleeve to be fully seated without impeding the rearward projection of the Long Distractor unit. However, unlike in Cap 160, area 354 is more relieved as it is unnecessary for the Dual Cap 420 to contact the Long Distractor through portion 110 to inhibit its forward motion, as the Foot Plate 344 functions to that effect. Further, the Dual Cap 420 for the Dual Outer Sleeve 340 is correspondingly dual itself and engages the rearward facing dual tubular portion 352. Once the Dual Outer Sleeve has been fully seated, the vertebrae adjacent the interspace to be fused are rigidly held via Foot Plate 344 and the prongs 342. Thus, it is possible to remove either one, or if desired, both of the Long Distractor rods utilizing Long Distractor puller 200, as per the method already described. It is then the surgeon's choice to work on one or both sides of the spine. As per previous discussion, the surgeon may drill the interspace utilizing the Inner Sleeve 242 or leave the Long Distractors in place as per the "Trephine Method".
Tapping, if necessary, and the insertion of the implants then occurs through the protective Outer Sleeve 340. Once the implants have been fully inserted, the Outer Sleeve is removed.
Having utilized the Drill method, or "Trephine
Method", with or without an Inner Sleeve to prepare the fusion site, it is the preferred embodiment to leave the Outer Sleeve 340 in place as it provides for the ideal placement and alignment of the Tap 280 and implant I.
It is anticipated that the surgeon wishing to work deep within the interspace, or preferring the ability to directly visualize the tap being used, or the implant being inserted, may choose to remove the Outer Sleeve after the insertion of the first prosthesis to maintain stability, or prior to that, which while not the preferred embodiments, are nevertheless within the scope of the present invention.
Alternative Methods To The Preferred Embodiment For
Method Of Anterior Interbody Fusion As previously described for the posterior lumbar spine, alternatively, one can employ the "Trephine Method" as has been described in detail. As a further alternative, it should be noted that the key element in the anterior method is the use of the predistraction principle, where such distraction is maintained by the Outer Sleeve with or without the Long Distractor. Therefore, once the preparation of the interspace has been completed, while not the preferred embodiment, it is nevertheless within the scope of this invention that one could remove the Outer Sleeve as there are no neural structures requiring protection, and insert the implants directly rather than through the Outer Sleeve. As yet a further alternative of this method, where the height of the distracted interspace is such that the diameter of the implant required to span that height and to embed with sufficient depth into the opposed vertebral bodies is such that it is not possible to place two such implants side by side, then only a single implant which may be of significantly increased diameter, is used and placed centrally within the interspace rather than to either side. The placement of a singular central graft via the present invention method and instrumentation is in keeping with the methods already described and can be performed using either a drill or the "Trephine Method". Referring to Figures 16-18, a cylindrical embodiment of the spinal implant I of the present invention is shown. In Figure 16 the implant I is shown attached to the insertion device 350. In Figures 17 and 18 the implant I is shown installed in the disc space D, between the adjacent vertebrae.
The cylindrical implant I comprises a hollow tubular member which in the preferred embodiment is made of an ASTM surgically implantable material, preferably Titanium. The cylindrical implant I is closed at one end and open at the other end covered by a cap 394. The cylindrical implant I has a series of macro-sized openings 390 through the side walls of the cylindrical implant I. A series of external threads 392 are formed on the circumference of the cylindrical implant I. Any variety of threads may be used on the implant. The cap 374 has a hexagonal opening 394 for tightening the cap 374.
While the present invention has been described in association with the implant of a threaded spinal implant, it is recognized that other forms of implants may be used with the present method. For example, dowels, made from bone or artificial materials, knurled or irregularly shaped cylinders or spheres, or any other shaped implants that can be introduced through the outer sleeve may be used. Being able to perform the procedure through the outer sleeve permits the procedure to be performed safely and quickly, and more accurately.
SUBSTITUTE SHEET RULi

Claims

What I claim is:
1. Apparatus for use in performing surgery for fusing vertebrae comprising a hollow tubular outer sleeve having a plurality of teeth or pins at one end for engaging two adjacent vertebrae, said teeth being substantially in line with the side surfaces of said outer sleeve, so that said teeth or pins not do substantially increase the diameter of said outer sleeve.
2. The apparatus of claim 1 including penetration preventing means for preventing penetration of said teeth.
3. The apparatus of claim 2 in which said penetration preventing means is lockably adjustable.
4. The apparatus of claim 2 in which said penetration preventing means comprises flat portions between at least some of said teeth.
5. The apparatus of claim 1 including a removable hollow inner tubular sleeve.
6. The apparatus of claim 5 in which said inner sleeve has a collar at one end larger than the inside diameter of said outer sleeve.
7. The apparatus of claim 1 in which said outer sleeve includes means for restricting its removal from the disc space after insertion.
8. The apparatus of claim 7 in which said means for restricting removal comprises ratchetings.
9. The apparatus of claim 1 in which said outer sleeve has an increased outer diameter portion at its upper end.
10. The apparatus of claim 9 including a cap, said cap having an opening in one end having an inside diameter larger than the outside diameter of said increased diameter portion of said outer sleeve.
11. A spinal distractor, said spinal distractor having a front portion the width of a disc space between adjacent vertebra, a barrel extending from said portion, said barrel having a first end and a second end and a diameter larger than the front portion, a shoulder at the juncture of the front portion and said increased diameter portion for preventing said barrel from entering the disc space, said second end terminating in a head.
12. The spinal distractor of claim 11 in which said second end of said barrel has a reduced diameter portion.
13. The spinal distractor of claim 11 in which said barrel is removably attached to said front portion.
14. The spinal distractor of claim 13 in which said front portion includes a second threaded portion for engaging a corresponding threaded portion in the first end of said barrel.
15. The spinal distractor of claim 14 in which said front portion includes an engagement means for engaging a corresponding engaging means on the first end of said barrel.
16. The spinal distractor of claim 15 in which said barrel includes a central opening and a shaft having a first end and a second end having a third threaded portion for engaging the second threaded portion of said front portion.
17. The spinal distractor of claim 16 in which said second
SMSTITUTESHEB IBULE ZS) end of said shaft includes a head having a reduced diameter portion.
18. The spinal distractor of claim 12 including a removably attachable knob having means for releasably engaging said head.
19. The spinal distractor of claim 18 in which said knob engages the reduced diameter portion of said head.
20. Apparatus for use in performing surgery for fusing vertebrae comprising a pair of hollow tubes joined together along their longitudinal axis, and having engagement means at one end for engaging adjacent vertebrae.
21. The apparatus of claim 20 in which said hollow tubes are rigidly fixed by a footplate.
22. The apparatus of claim 21 in which said engagement means are positioned on said footplate.
23. The apparatus of claim 22 in which said engagement means comprises a plurality of prongs.
24. The apparatus of claim 20 in which said engagement means comprises projections.
25. A spinal distractor removing device for removing a distractor in a disc space, consisting of a shaft, a means for attaching to a spinal distractor at one end and an increased diameter portion at the other end and a freely slidable mass affixed to the shaft between the two ends.
26. The device of claim 25 in which said engagement means comprises a slot for engaging a reduced diameter portion of the head of a spinal distractor.
27. A drilling member for use in a spinal surgical procedure comprising a drill bit, said drill bit having a lower portion, a narrowed diameter central portion, and an upper portion, said upper and lower portions being the same diameter.
28. The apparatus of claim 27 including a stop means said stop means comprising an increased diameter collar on the upper portion of said drill bit at a predetermined position for restricting penetration of said drill.
29. The apparatus of claim 28 in which said stop means is lockably adjustable.
30. Apparatus for use in performing spinal surgery comprising a hollow tubular member having drill teeth at one end and a cylindrical projection extending beyond said drill teeth.
31. The apparatus of claim 30 including a stopping means, said stopping means comprising a shoulder at the other end of said tubular member.
32. The apparatus of claim 31 in which said stopping means is lockably adjustable.
33. A combined distractor and drill for use in performing spinal surgery comprising a hollow drill bit having teeth and a nipple extending from one end, said nipple distally formed to be a spinal distractor.
34. Apparatus for use in spinal surgery comprising a handle, a shaft, said shaft connected to said handle at one end and having a cutting blade at an angle to said shaft said shaft connected off centered to the central axis of said handle.
35. An implant loading device for use in spinal surgery comprising a bone harvester having a first hollow tubular member having cutting teeth at one end and an adapter at its other end; a second hollow tubular member having engagement means at one end for engaging an implant holder and an adapter at its other end for receiving a bone harvester, said second hollow tubular member surrounding said first tubular member; and plunger means for fitting within and extending through said first hollow tubular member.
36. The apparatus of claim 35 in which said bone harvester is removably connectable to a drilling attachment for engagement with a drill.
37. The apparatus of claim 35 in which the inside diameter of said bone harvester is approximately the diameter of said implant.
38. An implant removal/insertion device for inserting or removing an implant in the body of a patient, said implant having a generally cylindrical configuration, a thread on its outside perimeter and a central threaded portion; said removal/insertion device comprising a first tubular member having an outside diameter and thread corresponding to the central threaded portion of said implant and an engaging means for engaging a portion of the implant, whereby, said engaging means is fixed to said implant; said engaging means being rotatable in relationship to said first tubular member.
39. The device of claim 38 further including a lockably
' adjustable stopping means.
40. The apparatus of claim 38 in which said implant has a shoulder and said engaging means comprises a corresponding member for fixing to said shoulder.
41. The apparatus of claim 38 in which said engaging means has handle means extending perpendicularly from said engaging means for rotating said engaging means.
42. A method for inserting a spinal implant between two adjacent vertebrae comprising inserting a hollow tubular member having engagement means for engaging two adjacent vertebrae into the vertebrae; passing a drill through said tubular member to drill a hole in the disc and a portion of the two adjacent vertebrae; removing the drill; inserting an implant in the vertebrae through said tubular member; and then removing said tubular member.
43. The method of claim 42 in which said implant is cylindrical.
44. The method of claim 42 in which said step for inserting an implant comprises inserting one or more partially cylindrical implants.
45. The method of claim 42 in which said implant has a diameter corresponding to the diameter of the opening formed by the drill.
46. The method of claim 42 in which said drill has means associated therewith for limiting the depth of the drilling.
47. The method of claim 42 in which said depth limiting means is lockably adjustable.
48. The method of claim 42 in which the tubular member has a removable hollow inner sleeve.
49. The method of claim 42 in which the hollow tubular member has means for limiting its penetration into the vertebrae.
50. The method of claim 49 in which said depth limiting means is lockably adjustable.
51. The method of claim 42 in which said implant is made of bone.
52. The method of claim 42 in which said implant is made of a material that promotes bone ingrowth.
53. The method of claim 42 in which said hole in the disc and a portion of the adjacent vertebrae is tapped with a thread.
54. The method of claim 42 in which the tubular member has a removable hollow inner sleeve.
55. The method of claim 54 in which said hole is drilled through the hollow inner sleeve and said hollow inner sleeve is removed prior to tapping said hole.
56. The method of claim 53 in which said tubular member has a removable inner sleeve.
57. The method of claim 56 in which said hole is drilled through the hollow inner sleeve and said hollow inner sleeve is removed prior to tapping said hole.
58. The method of claim 55 in which the inside diameter of the hollow inner sleeve is the same diameter as the root diameter of the implant.
59. The method of claim 55 in which the inside diameter of the hollow inner sleeve is slightly greater than the root diameter of the implant.
60. A method for inserting a spinal implant between two adjacent vertebra comprising inserting a spinal distractor in the disc space on one or both sides of the spinal column to provide for proper spacing of the disc space between the vertebra, inserting over the spinal distractor a hollow tubular member having engagement means for engaging two adjacent vertebrae into the vertebrae; removing the spinal distractor from the hollow tubular member; passing a drill through the tubular member to drill a hole in the disc and a portion of the two adjacent vertebrae; removing the drill; inserting an implant in the vertebrae through the tubular member; and then removing said tubular member.
61. The method of claim 60 in which said implant is cylindrical.
62. The method of claim 60 in which said step of inserting an implant comprises inserting one or more partially cylindrical implants.
63. The method of claim 60 in which said implant has a diameter corresponding to the diameter of the opening formed by the drill.
64. The method of claim 60 in which said drill has means associated therewith for limiting the depth of the drilling.
65. The method of claim 64 in which said depth limiting means is lockably adjustable.
66. The method of claim 60 in which the tubular member has a removable hollow inner sleeve.
67. The method of claim 60 in which said hollow tubular member has means for limiting the penetration of the engagement means into the vertebrae.
68. The method of claim 67 in which said means for limiting penetration is lockably adjustable.
69. The method of claim 60 in which said implant is made of bone.
70. The method of claim 60 in which said implant is made of a material that promotes bone ingrowth.
71. The method of claim 60 including tapping a thread into said hole in the disc.
72. The method of claim 60 in which the tubular member has a removable hollow inner sleeve.
73. The method of claim 72 in which said hole is drilled through the hollow inner sleeve and said hollow inner sleeve is removed prior to tapping said hole.
74. The method of claim 72 in which the inside diameter of the hollow inner sleeve is the same diameter as the root diameter of the implant.
75. The method of claim 72 in which the inside diameter of the hollow inner sleeve is slightly greater than the root diameter of the implant.
76. The method of claim 60 in which one spinal distractor remains in place in the disc while a first implant is being inserted.
77. The method of claim 76 in which said spinal distractor remaining in place includes a barrel portion that is separable from the front portion of the spinal implant in the disc space.
78. A method for inserting a spinal implant between two adjacent vertebra comprising inserting a spinal distractor in the disc on one side of the spinal column to provide for proper spacing of the disc space between the vertebra, inserting over the spinal distractor a hollow tubular member having engagement means for engaging two adjacent vertebrae into the vertebrae; passing a trephine through the tubular member and over the spinal distractor to drill a hole in the disc and a portion of the two adjacent vertebrae; removing the trephine; inserting an implant in the vertebrae through the tubular member; and removing said tubular member.
79. The method of claim 78 in which said implant is cylindrical.
80. The method of claim 78 in which said step of inserting an implant comprises inserting one or more partially cylindrical implants.
81. The method of claim 78 in which said implant has a corresponding diameter to the diameter of the opening formed by the trephine.
82. The method of claim 78 in which said trephine has means associated therewith for limiting the depth of the drilling.
83. The method of claim 82 in which said depth limiting means is lockably adjustable.
84. The method of claim 78 in which said depth limiting means includes a shoulder within said trephine.
85. The method of claim 78 in which the tubular member has a removable hollow inner sleeve.
86. The method of claim 78 in which said hollow tubular member has means for limiting the penetration of the engagement means into the vertebrae.
87. The method of claim 86 in which said penetration limiting means is lockably adjustable.
88. The method of claim 78 in which said implant is made of bone.
89. The method of claim 78 in which said implant is made of a material that promotes bone ingrowth.
90. The method of claim 78 including tapping a thread into the hole and said cylindrical implant has a thread.
91. The method of claim 78 in which the one spinal distractor remains in place in the disc while the first implant is being inserted.
92. The method of claim 91 in which said spinal distractor remaining in place includes a barrel portion that is separable from the front portion of the spinal implant in the disc space.
93. The method of claim 78 further including the step of freeing and removing any remaining bone cut by the trephine from within the trephine.
94. The method of claim 93 in which the remaining cut bone is removed from the trephine by an apparatus comprising a handle, a shaft, said shaft connected to said handle at one end and having a cutting blade at an angle to said shaft, said shaft connected off centered to the central axis of said handle.
95. A corkscrew comprising a handle, a coil, said coil connected to said handle at one end and having a cutting tip at an angle to said coil at the other end, said cutting tip extending substantially the diameter of said coil and off centered to the central axis of said coil whereby rotation of said corkscrew causes said cutting tip to radially cut a path substantially the diameter of said coil.
96. The corkscrew of claim 95 further comprising a hollow tubular member to partially cover said coil and contain a bone piece cut by said cutting tip.
97. The corkscrew of claim 96 wherein the cutting tip is self aligning.
98. An impaction device for use in spinal surgery comprising: a spinal distractor inserted in the disc space between two vertebrae; a hollow tubular outer sleeve having a toothed front end and a circumferentially enlarged tubular back end, said back end having a raised crown portion; a driver cap having a closed rear surface on one end and a circular front opening at the other end, said driver cap defining a first large recess within said circular opening for engaging the tubular back end of said outer sleeve, and a second small recess for engaging said crown whereby said crown protrudes within the opening of said driver cap unobstructed until it reached the surface of said small recess.
99. The device of claim 98 including penetration preventing means for preventing penetration of said teeth.
100. The device of claim 99 in which said penetration preventing means is lockably adjustable.
101. The device of claim 99 in which said penetration preventing means comprises flat portions between at least some of said teeth.
102. A driver cap having a closed rear surface on one end and a circular front opening at the other end, said driver cap defining a first large recess within said circular opening for engaging the tubular back end of an outer sleeve, and a second smaller recess for engaging a crown.
103. A method for securing a hollow tubular sleeve to two adjacent vertebrae comprising: inserting a spinal distractor in the disc space on one side of the vertebrae, said distractor having a flat shoulder portion abutting the vertebrae; placing said hollow tubular sleeve having on one end engagement means for engaging two adjacent vertebrae and a circumferentially enlarged tubular back end, said back end having a raised crown portion, said sleeve being placed over said distractor, said distractor serving as a centering post and as an alignment rod for said outer sleeve; engaging a driver cap to said tubular back end, said driver cap having a closed rear surface on one end and a circular front opening at the other end, said driver cap defining a first large recess within said circular opening for engaging the tubular back end of said outer sleeve, and a second smaller recess for engaging said crown portion forming an internal shoulder between said first and second recesses; applying an impaction force with an impacting means to said driver cap whereby said force is transmitted via said internal shoulder to said outer sleeve until said crown is seated within said second recess; removing said driver cap from said back end; and removing said distractor with a distractor pulling means leaving said outer sleeve in place.
104. The method of claim 103 in which said outer sleeve includes penetration preventing means for preventing penetration of said teeth.
105. The method of claim 104 in which said penetration preventing means is lockably adjustable.
106. The method of claim 104 in which said penetration preventing means comprises flat portions between at least some of said teeth.
PCT/US1994/006345 1988-06-13 1994-06-09 Apparatus and method of inserting spinal implants WO1994028824A2 (en)

Priority Applications (7)

Application Number Priority Date Filing Date Title
KR1019950705673A KR100318703B1 (en) 1993-06-10 1994-06-09 Spinal column distributor inserting spinal implant
AT94920704T ATE247928T1 (en) 1993-06-10 1994-06-09 DEVICE FOR INSERTING BACK VERTEBRATE IMPLANTS
CA002164859A CA2164859C (en) 1993-06-10 1994-06-09 Apparatus and method of inserting spinal implants
EP94920704A EP0703757B1 (en) 1988-06-13 1994-06-09 Apparatus for inserting spinal implants
DE69433088T DE69433088T2 (en) 1993-06-10 1994-06-09 DEVICE FOR INSERTING SPINE IMPLANTS
DK00204831T DK1093760T3 (en) 1993-06-10 1994-06-09 Spinal implant insertion device
DK94920704T DK0703757T3 (en) 1993-06-10 1994-06-09 Spinal implant insertion device

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US07/205,935 US5015247A (en) 1988-06-13 1988-06-13 Threaded spinal implant
US69867491A 1991-05-10 1991-05-10
US08/074,781 1993-06-10
US08/074,781 US5484437A (en) 1988-06-13 1993-06-10 Apparatus and method of inserting spinal implants
US08/396,414 US6080155A (en) 1988-06-13 1995-02-27 Method of inserting and preloading spinal implants

Publications (2)

Publication Number Publication Date
WO1994028824A2 true WO1994028824A2 (en) 1994-12-22
WO1994028824A3 WO1994028824A3 (en) 1995-03-16

Family

ID=27394869

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1994/006345 WO1994028824A2 (en) 1988-06-13 1994-06-09 Apparatus and method of inserting spinal implants

Country Status (3)

Country Link
US (3) US5484437A (en)
JP (1) JPH078514A (en)
WO (1) WO1994028824A2 (en)

Cited By (67)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2729557A1 (en) * 1995-01-24 1996-07-26 Stryker Corp INTERSOMATIC CAGE TYPE IMPLANT, AND INSTRUMENTATION AND METHOD FOR ITS INSTALLATION
WO1997030666A2 (en) * 1996-02-22 1997-08-28 Sdgi Holdings, Inc. Methods and instruments for interbody fusion
EP0808136A1 (en) * 1995-02-07 1997-11-26 Inc. Matrix Biotechnologies Surgical implantation of cartilage repair unit
US5700291A (en) * 1993-02-10 1997-12-23 Spine-Tech, Inc. Laparoscopic spinal stabilization method
EP0814718A2 (en) * 1995-02-27 1998-01-07 MICHELSON, Gary Karlin Improved methods and instrumentation for the surgical correction of human thoracic and lumbar spinal disease from the lateral aspect of the spine
US5716415A (en) * 1993-10-01 1998-02-10 Acromed Corporation Spinal implant
WO1998035636A1 (en) * 1995-06-07 1998-08-20 Sdgi Holdings, Inc. Anterior spinal instrumentation and method for implantation and revision
AU701744B2 (en) * 1988-06-13 1999-02-04 Warsaw Orthopedic, Inc. Appartus and method of inserting spinal implants
US6086595A (en) * 1997-08-29 2000-07-11 Sulzer Spine-Tech Inc. Apparatus and method for spinal stabilization
US6171339B1 (en) 1998-05-19 2001-01-09 Sulzer Spine-Tech Inc. Multi-lumen spinal implant guide and method
US6245072B1 (en) 1995-03-27 2001-06-12 Sdgi Holdings, Inc. Methods and instruments for interbody fusion
US6500180B1 (en) 1999-10-20 2002-12-31 Sdgi Holdings, Inc. Methods and instrumentation for distraction of a disc space
EP1325719A3 (en) * 1995-03-27 2003-07-16 SDGI Holdings, Inc. Interbody fusion device
EP1525863A3 (en) * 1995-02-17 2007-01-31 Warsaw Orthopedic, Inc. Arcuate ratcheted spinal fusion implant
USD626233S1 (en) 2008-02-28 2010-10-26 Stryker Spine Expandable intervertebral implant
US8002837B2 (en) 2006-05-19 2011-08-23 Pioneer Surgical Technology Spinal stabilization device and methods
US8029512B2 (en) 2004-10-26 2011-10-04 Pioneer Surgical Technology Spinal stabilization device and methods
US8287538B2 (en) 2008-01-14 2012-10-16 Conventus Orthopaedics, Inc. Apparatus and methods for fracture repair
US8906022B2 (en) 2010-03-08 2014-12-09 Conventus Orthopaedics, Inc. Apparatus and methods for securing a bone implant
US8961518B2 (en) 2010-01-20 2015-02-24 Conventus Orthopaedics, Inc. Apparatus and methods for bone access and cavity preparation
US9050148B2 (en) 2004-02-27 2015-06-09 Roger P. Jackson Spinal fixation tool attachment structure
US9050139B2 (en) 2004-02-27 2015-06-09 Roger P. Jackson Orthopedic implant rod reduction tool set and method
WO2015153104A1 (en) * 2014-03-31 2015-10-08 Hamilton Dennison System and method for stabilizing implanted spinal cord stimulators
US9320610B2 (en) 2011-08-16 2016-04-26 Stryker European Holdings I, Llc Expandable implant
US9610071B2 (en) 2003-09-25 2017-04-04 Nuvasive, Inc. Surgical access system and related methods
US9622732B2 (en) 2004-10-08 2017-04-18 Nuvasive, Inc. Surgical access system and related methods
US9629669B2 (en) 2004-11-23 2017-04-25 Roger P. Jackson Spinal fixation tool set and method
US9636146B2 (en) 2012-01-10 2017-05-02 Roger P. Jackson Multi-start closures for open implants
US9655744B1 (en) 2011-10-31 2017-05-23 Nuvasive, Inc. Expandable spinal fusion implants and related methods
US9662143B2 (en) 2004-02-27 2017-05-30 Roger P Jackson Dynamic fixation assemblies with inner core and outer coil-like member
US9662151B2 (en) 2004-02-27 2017-05-30 Roger P Jackson Orthopedic implant rod reduction tool set and method
US9668771B2 (en) 2009-06-15 2017-06-06 Roger P Jackson Soft stabilization assemblies with off-set connector
USRE46431E1 (en) 2003-06-18 2017-06-13 Roger P Jackson Polyaxial bone anchor with helical capture connection, insert and dual locking assembly
US9717534B2 (en) 2009-06-15 2017-08-01 Roger P. Jackson Polyaxial bone anchor with pop-on shank and friction fit retainer with low profile edge lock
US9717533B2 (en) 2013-12-12 2017-08-01 Roger P. Jackson Bone anchor closure pivot-splay control flange form guide and advancement structure
US9730739B2 (en) 2010-01-15 2017-08-15 Conventus Orthopaedics, Inc. Rotary-rigid orthopaedic rod
US9743957B2 (en) 2004-11-10 2017-08-29 Roger P. Jackson Polyaxial bone screw with shank articulation pressure insert and method
US9743853B2 (en) 1999-11-24 2017-08-29 Nuvasive, Inc. Electromyography system
US9750490B2 (en) 2002-06-26 2017-09-05 Nuvasive, Inc. Surgical access system and related methods
US9770265B2 (en) 2012-11-21 2017-09-26 Roger P. Jackson Splay control closure for open bone anchor
US9795371B2 (en) 2003-01-16 2017-10-24 Nuvasive, Inc. Surgical access system and related methods
US9820729B2 (en) 2002-10-08 2017-11-21 Nuvasive, Inc. Surgical access system and related methods
US9907574B2 (en) 2008-08-01 2018-03-06 Roger P. Jackson Polyaxial bone anchors with pop-on shank, friction fit fully restrained retainer, insert and tool receiving features
US9918745B2 (en) 2009-06-15 2018-03-20 Roger P. Jackson Polyaxial bone anchor with pop-on shank and winged insert with friction fit compressive collet
US9918751B2 (en) 2004-02-27 2018-03-20 Roger P. Jackson Tool system for dynamic spinal implants
US9931077B2 (en) 2001-07-11 2018-04-03 Nuvasive, Inc. System and methods for determining nerve proximity, direction and pathology during surgery
US9949840B1 (en) 2011-04-01 2018-04-24 William D. Smith Systems and methods for performing spine surgery
US10022132B2 (en) 2013-12-12 2018-07-17 Conventus Orthopaedics, Inc. Tissue displacement tools and methods
US10039577B2 (en) 2004-11-23 2018-08-07 Roger P Jackson Bone anchor receiver with horizontal radiused tool attachment structures and parallel planar outer surfaces
US10039578B2 (en) 2003-12-16 2018-08-07 DePuy Synthes Products, Inc. Methods and devices for minimally invasive spinal fixation element placement
US10058354B2 (en) 2013-01-28 2018-08-28 Roger P. Jackson Pivotal bone anchor assembly with frictional shank head seating surfaces
US10064658B2 (en) 2014-06-04 2018-09-04 Roger P. Jackson Polyaxial bone anchor with insert guides
US10299839B2 (en) 2003-12-16 2019-05-28 Medos International Sárl Percutaneous access devices and bone anchor assemblies
US10342675B2 (en) 2013-03-11 2019-07-09 Stryker European Holdings I, Llc Expandable implant
US10349983B2 (en) 2003-05-22 2019-07-16 Alphatec Spine, Inc. Pivotal bone anchor assembly with biased bushing for pre-lock friction fit
US10507120B2 (en) 2001-09-25 2019-12-17 Nuvasive, Inc. Systems and methods for performing surgical procedures and assessments
US10653308B2 (en) 2003-10-17 2020-05-19 Nuvasive, Inc. Surgical access system and related methods
USD907771S1 (en) 2017-10-09 2021-01-12 Pioneer Surgical Technology, Inc. Intervertebral implant
US10918426B2 (en) 2017-07-04 2021-02-16 Conventus Orthopaedics, Inc. Apparatus and methods for treatment of a bone
US10959860B2 (en) 2008-12-26 2021-03-30 Pantheon Spinal, Llc Method of retroperitoneal lateral insertion of spinal implants
US11147597B2 (en) 2004-02-27 2021-10-19 Roger P Jackson Dynamic spinal stabilization assemblies, tool set and method
US11147591B2 (en) 2004-11-10 2021-10-19 Roger P Jackson Pivotal bone anchor receiver assembly with threaded closure
US11147682B2 (en) 2017-09-08 2021-10-19 Pioneer Surgical Technology, Inc. Intervertebral implants, instruments, and methods
US11229457B2 (en) 2009-06-15 2022-01-25 Roger P. Jackson Pivotal bone anchor assembly with insert tool deployment
US11234745B2 (en) 2005-07-14 2022-02-01 Roger P. Jackson Polyaxial bone screw assembly with partially spherical screw head and twist in place pressure insert
US11241261B2 (en) 2005-09-30 2022-02-08 Roger P Jackson Apparatus and method for soft spinal stabilization using a tensionable cord and releasable end structure
US11419642B2 (en) 2003-12-16 2022-08-23 Medos International Sarl Percutaneous access devices and bone anchor assemblies

Families Citing this family (871)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5484437A (en) 1988-06-13 1996-01-16 Michelson; Gary K. Apparatus and method of inserting spinal implants
US6923810B1 (en) 1988-06-13 2005-08-02 Gary Karlin Michelson Frusto-conical interbody spinal fusion implants
US7431722B1 (en) * 1995-02-27 2008-10-07 Warsaw Orthopedic, Inc. Apparatus including a guard member having a passage with a non-circular cross section for providing protected access to the spine
US6770074B2 (en) * 1988-06-13 2004-08-03 Gary Karlin Michelson Apparatus for use in inserting spinal implants
US7491205B1 (en) * 1988-06-13 2009-02-17 Warsaw Orthopedic, Inc. Instrumentation for the surgical correction of human thoracic and lumbar spinal disease from the lateral aspect of the spine
US5609635A (en) 1988-06-28 1997-03-11 Michelson; Gary K. Lordotic interbody spinal fusion implants
US5895427A (en) * 1989-07-06 1999-04-20 Sulzer Spine-Tech Inc. Method for spinal fixation
US5913820A (en) * 1992-08-14 1999-06-22 British Telecommunications Public Limited Company Position location system
PT1092395E (en) 1993-06-10 2004-08-31 Karlin Technology Inc PROTECTIVE DEVICE HAVING A FIRST AND SECOND PASSAGE FOR SPECIAL DISORDER SURGERY
AU726979C (en) * 1993-06-10 2001-08-02 Warsaw Orthopedic, Inc. Apparatus and method of inserting spinal implants
US5584831A (en) * 1993-07-09 1996-12-17 September 28, Inc. Spinal fixation device and method
US5658336A (en) * 1994-03-18 1997-08-19 Pisharodi; Madhavan Rotating, locking, middle-expanded intervertebral disk stabilizer
US5885299A (en) 1994-09-15 1999-03-23 Surgical Dynamics, Inc. Apparatus and method for implant insertion
EP0781113B1 (en) * 1994-09-15 2002-03-27 Surgical Dynamics, Inc. Conically-shaped anterior fusion cage
US5674296A (en) 1994-11-14 1997-10-07 Spinal Dynamics Corporation Human spinal disc prosthesis
USD382961S (en) * 1995-02-02 1997-08-26 Tibor Koros Spinal drill surgical instrument
US5632747A (en) * 1995-03-15 1997-05-27 Osteotech, Inc. Bone dowel cutter
ES2287636T3 (en) * 1995-03-27 2007-12-16 Warsaw Orthopedic, Inc. IMPLANT FOR VERTEBRAL FUSION.
US6206922B1 (en) 1995-03-27 2001-03-27 Sdgi Holdings, Inc. Methods and instruments for interbody fusion
US5782830A (en) * 1995-10-16 1998-07-21 Sdgi Holdings, Inc. Implant insertion device
CA2199462C (en) * 1996-03-14 2006-01-03 Charles J. Winslow Method and instrumentation for implant insertion
US20040176763A1 (en) * 1996-03-22 2004-09-09 Foley Kevin T. Methods for percutaneous surgery
JP3819962B2 (en) * 1996-04-01 2006-09-13 ペンタックス株式会社 Interbody fusion implant guide device
WO1997037619A1 (en) * 1996-04-10 1997-10-16 Synthes Ag Chur Intervertebral implant
US5700264A (en) * 1996-07-01 1997-12-23 Zucherman; James F. Apparatus and method for preparing a site for an interbody fusion implant
US6159214A (en) * 1996-07-31 2000-12-12 Michelson; Gary K. Milling instrumentation and method for preparing a space between adjacent vertebral bodies
US5718717A (en) * 1996-08-19 1998-02-17 Bonutti; Peter M. Suture anchor
US5895426A (en) 1996-09-06 1999-04-20 Osteotech, Inc. Fusion implant device and method of use
FR2753368B1 (en) * 1996-09-13 1999-01-08 Chauvin Jean Luc EXPANSIONAL OSTEOSYNTHESIS CAGE
DE29616778U1 (en) * 1996-09-26 1998-01-29 Howmedica Gmbh Vertebral body placeholder
US5782832A (en) * 1996-10-01 1998-07-21 Surgical Dynamics, Inc. Spinal fusion implant and method of insertion thereof
DE69733976T2 (en) 1996-10-22 2006-06-01 Howmedica Osteonics Corp. Surgical drill and retractor
US6063088A (en) * 1997-03-24 2000-05-16 United States Surgical Corporation Method and instrumentation for implant insertion
WO1998017209A2 (en) * 1996-10-23 1998-04-30 Sdgi Holdings, Inc. Spinal spacer
WO1998017188A1 (en) 1996-10-24 1998-04-30 Spinal Concepts, Inc. Method and apparatus for spinal fixation
US6416515B1 (en) 1996-10-24 2002-07-09 Spinal Concepts, Inc. Spinal fixation system
US6190414B1 (en) 1996-10-31 2001-02-20 Surgical Dynamics Inc. Apparatus for fusion of adjacent bone structures
EP0873145A2 (en) 1996-11-15 1998-10-28 Advanced Bio Surfaces, Inc. Biomaterial system for in situ tissue repair
US20020143331A1 (en) * 1998-10-20 2002-10-03 Zucherman James F. Inter-spinous process implant and method with deformable spacer
US6514256B2 (en) 1997-01-02 2003-02-04 St. Francis Medical Technologies, Inc. Spine distraction implant and method
US6902566B2 (en) * 1997-01-02 2005-06-07 St. Francis Medical Technologies, Inc. Spinal implants, insertion instruments, and methods of use
US7306628B2 (en) * 2002-10-29 2007-12-11 St. Francis Medical Technologies Interspinous process apparatus and method with a selectably expandable spacer
US6796983B1 (en) 1997-01-02 2004-09-28 St. Francis Medical Technologies, Inc. Spine distraction implant and method
US5836948A (en) 1997-01-02 1998-11-17 Saint Francis Medical Technologies, Llc Spine distraction implant and method
US6695842B2 (en) * 1997-10-27 2004-02-24 St. Francis Medical Technologies, Inc. Interspinous process distraction system and method with positionable wing and method
US7201751B2 (en) * 1997-01-02 2007-04-10 St. Francis Medical Technologies, Inc. Supplemental spine fixation device
US6712819B2 (en) * 1998-10-20 2004-03-30 St. Francis Medical Technologies, Inc. Mating insertion instruments for spinal implants and methods of use
US20080039859A1 (en) * 1997-01-02 2008-02-14 Zucherman James F Spine distraction implant and method
US6068630A (en) 1997-01-02 2000-05-30 St. Francis Medical Technologies, Inc. Spine distraction implant
US7959652B2 (en) 2005-04-18 2011-06-14 Kyphon Sarl Interspinous process implant having deployable wings and method of implantation
US7101375B2 (en) * 1997-01-02 2006-09-05 St. Francis Medical Technologies, Inc. Spine distraction implant
US6146385A (en) * 1997-02-11 2000-11-14 Smith & Nephew, Inc. Repairing cartilage
US6120506A (en) * 1997-03-06 2000-09-19 Sulzer Spine-Tech Inc. Lordotic spinal implant
US5800549A (en) * 1997-04-30 1998-09-01 Howmedica Inc. Method and apparatus for injecting an elastic spinal implant
US6045579A (en) * 1997-05-01 2000-04-04 Spinal Concepts, Inc. Adjustable height fusion device
US5876457A (en) 1997-05-20 1999-03-02 George J. Picha Spinal implant
US6042582A (en) * 1997-05-20 2000-03-28 Ray; Charles D. Instrumentation and method for facilitating insertion of spinal implant
US6033438A (en) * 1997-06-03 2000-03-07 Sdgi Holdings, Inc. Open intervertebral spacer
US6175758B1 (en) 1997-07-15 2001-01-16 Parviz Kambin Method for percutaneous arthroscopic disc removal, bone biopsy and fixation of the vertebrae
US5928243A (en) * 1997-07-16 1999-07-27 Spinal Concepts, Inc. Pedicle probe and depth gage
US6475230B1 (en) * 1997-08-01 2002-11-05 Peter M. Bonutti Method and apparatus for securing a suture
US6030389A (en) * 1997-08-04 2000-02-29 Spinal Concepts, Inc. System and method for stabilizing the human spine with a bone plate
US6454769B2 (en) * 1997-08-04 2002-09-24 Spinal Concepts, Inc. System and method for stabilizing the human spine with a bone plate
FR2767675B1 (en) * 1997-08-26 1999-12-03 Materiel Orthopedique En Abreg INTERSOMATIC IMPLANT AND ANCILLARY OF PREPARATION SUITABLE FOR ALLOWING ITS POSITION
US6053921A (en) * 1997-08-26 2000-04-25 Spinal Concepts, Inc. Surgical cable system and method
US5964769A (en) 1997-08-26 1999-10-12 Spinal Concepts, Inc. Surgical cable system and method
US6059790A (en) * 1997-08-29 2000-05-09 Sulzer Spine-Tech Inc. Apparatus and method for spinal stabilization
US6004326A (en) * 1997-09-10 1999-12-21 United States Surgical Method and instrumentation for implant insertion
US6226548B1 (en) 1997-09-24 2001-05-01 Surgical Navigation Technologies, Inc. Percutaneous registration apparatus and method for use in computer-assisted surgical navigation
WO1999021501A1 (en) 1997-10-27 1999-05-06 Saint Francis Medical Technologies, Llc Spine distraction implant
DE19750382A1 (en) * 1997-11-13 1999-05-20 Augustin Prof Dr Med Betz Operative correction equipment for displaced vertebrae used in minimally invasive surgery
US5932552A (en) 1997-11-26 1999-08-03 Keraplast Technologies Ltd. Keratin-based hydrogel for biomedical applications and method of production
US6348058B1 (en) * 1997-12-12 2002-02-19 Surgical Navigation Technologies, Inc. Image guided spinal surgery guide, system, and method for use thereof
US6482233B1 (en) 1998-01-29 2002-11-19 Synthes(U.S.A.) Prosthetic interbody spacer
USRE38614E1 (en) 1998-01-30 2004-10-05 Synthes (U.S.A.) Intervertebral allograft spacer
US6986788B2 (en) * 1998-01-30 2006-01-17 Synthes (U.S.A.) Intervertebral allograft spacer
US6045551A (en) 1998-02-06 2000-04-04 Bonutti; Peter M. Bone suture
US5913860A (en) * 1998-02-27 1999-06-22 Synthes (Usa) Surgical nail inserter
US6224631B1 (en) * 1998-03-20 2001-05-01 Sulzer Spine-Tech Inc. Intervertebral implant with reduced contact area and method
US6241729B1 (en) * 1998-04-09 2001-06-05 Sdgi Holdings, Inc. Method and instrumentation for posterior interbody fusion
US6428541B1 (en) 1998-04-09 2002-08-06 Sdgi Holdings, Inc. Method and instrumentation for vertebral interbody fusion
US7776046B2 (en) 1998-04-09 2010-08-17 Warsaw Orthopedic, Inc. Method and instrumentation for vertebral interbody fusion
DE69919857T2 (en) * 1998-04-09 2005-09-01 SDGI Holdings, Inc., Wilmington Vertebral distractor
US6264657B1 (en) * 1998-04-21 2001-07-24 Depuy Acromed, Inc. Method for removing devices from bone
US6241769B1 (en) * 1998-05-06 2001-06-05 Cortek, Inc. Implant for spinal fusion
WO1999060837A2 (en) * 1998-05-27 1999-12-02 Nuvasive, Inc. Bone blocks and methods for inserting
US6224603B1 (en) * 1998-06-09 2001-05-01 Nuvasive, Inc. Transiliac approach to entering a patient's intervertebral space
EP1681021A3 (en) * 1998-06-09 2009-04-15 Warsaw Orthopedic, Inc. Abrading element for preparing a space between adjacent vertebral bodies
WO2000048521A1 (en) * 1998-06-09 2000-08-24 Nuvasive, Inc. Transiliac approach to entering a patient's intervertebral space
US6083228A (en) * 1998-06-09 2000-07-04 Michelson; Gary K. Device and method for preparing a space between adjacent vertebrae to receive an insert
US6086593A (en) * 1998-06-30 2000-07-11 Bonutti; Peter M. Method and apparatus for use in operating on a bone
AU748746B2 (en) 1998-07-22 2002-06-13 Spinal Dynamics Corporation Threaded cylindrical multidiscoid single or multiple array disc prosthesis
WO2000007527A1 (en) 1998-08-03 2000-02-17 Synthes Ag Chur Intervertebral allograft spacer
US20060241763A1 (en) * 1998-08-03 2006-10-26 Synthes (Usa) Multipiece bone implant
US7641670B2 (en) 1998-08-20 2010-01-05 Zimmer Spine, Inc. Cannula for receiving surgical instruments
US6187000B1 (en) * 1998-08-20 2001-02-13 Endius Incorporated Cannula for receiving surgical instruments
US6099531A (en) 1998-08-20 2000-08-08 Bonutti; Peter M. Changing relationship between bones
US7799036B2 (en) * 1998-08-20 2010-09-21 Zimmer Spine, Inc. Method and apparatus for securing vertebrae
WO2000013619A1 (en) * 1998-09-04 2000-03-16 Spinal Dynamics Corporation Peanut spectacle multi discoid thoraco-lumbar disc prosthesis
US7189234B2 (en) 1998-10-20 2007-03-13 St. Francis Medical Technologies, Inc. Interspinous process implant sizer and distractor with a split head and size indicator and method
US7029473B2 (en) * 1998-10-20 2006-04-18 St. Francis Medical Technologies, Inc. Deflectable spacer for use as an interspinous process implant and method
US6652534B2 (en) 1998-10-20 2003-11-25 St. Francis Medical Technologies, Inc. Apparatus and method for determining implant size
US6652527B2 (en) 1998-10-20 2003-11-25 St. Francis Medical Technologies, Inc. Supplemental spine fixation device and method
US6174311B1 (en) * 1998-10-28 2001-01-16 Sdgi Holdings, Inc. Interbody fusion grafts and instrumentation
US6228022B1 (en) * 1998-10-28 2001-05-08 Sdgi Holdings, Inc. Methods and instruments for spinal surgery
DE19851370C2 (en) * 1998-11-07 2000-09-21 Aesculap Ag & Co Kg Endoscopic insertion instruments
US6159244A (en) * 1999-07-30 2000-12-12 Suddaby; Loubert Expandable variable angle intervertebral fusion implant
US6183517B1 (en) 1998-12-16 2001-02-06 Loubert Suddaby Expandable intervertebral fusion implant and applicator
DE69927717T2 (en) * 1998-12-23 2006-07-20 Nuvasive Inc., San Diego DEVICES FOR CANNULATION AND NERVE MONITORING
EP1016377B1 (en) 1998-12-30 2006-04-26 Ethicon Inc. Suture locking device
EP1217961B1 (en) 1999-01-25 2010-04-21 Warsaw Orthopedic, Inc. Instrument for creating an intervertebral space for receiving an implant
US6325827B1 (en) 1999-02-01 2001-12-04 Blacksheep Technologies, Inc. Intervertebral implant
WO2003026514A1 (en) * 1999-02-04 2003-04-03 Sdgi Holdings, Inc, Methods and instrumentation for vertebral interbody fusion
WO2000045709A1 (en) 1999-02-04 2000-08-10 Sdgi Holdings, Inc. Methods and instrumentation for vertebral interbody fusion
US6743234B2 (en) * 1999-02-04 2004-06-01 Sdgi Holdings, Inc. Methods and instrumentation for vertebral interbody fusion
US6648895B2 (en) * 2000-02-04 2003-11-18 Sdgi Holdings, Inc. Methods and instrumentation for vertebral interbody fusion
US6746485B1 (en) 1999-02-18 2004-06-08 St. Francis Medical Technologies, Inc. Hair used as a biologic disk, replacement, and/or structure and method
US6519319B1 (en) 1999-02-19 2003-02-11 Nuvasive, Inc. Image intensifier reticle system
US6241770B1 (en) * 1999-03-05 2001-06-05 Gary K. Michelson Interbody spinal fusion implant having an anatomically conformed trailing end
EP1253854A4 (en) 1999-03-07 2010-01-06 Discure Ltd Method and apparatus for computerized surgery
US6368350B1 (en) 1999-03-11 2002-04-09 Sulzer Spine-Tech Inc. Intervertebral disc prosthesis and method
US6470207B1 (en) * 1999-03-23 2002-10-22 Surgical Navigation Technologies, Inc. Navigational guidance via computer-assisted fluoroscopic imaging
US6113639A (en) * 1999-03-23 2000-09-05 Raymedica, Inc. Trial implant and trial implant kit for evaluating an intradiscal space
US6113602A (en) * 1999-03-26 2000-09-05 Sulzer Spine-Tech Inc. Posterior spinal instrument guide and method
US6267763B1 (en) 1999-03-31 2001-07-31 Surgical Dynamics, Inc. Method and apparatus for spinal implant insertion
DE60024979T2 (en) * 1999-04-07 2006-08-24 Howmedica Osteonics Corp. FUSION CAGE WITH LOW PROFILE AND INTRODUCTION DEVICE
US6110210A (en) * 1999-04-08 2000-08-29 Raymedica, Inc. Prosthetic spinal disc nucleus having selectively coupled bodies
US6442814B1 (en) 1999-04-23 2002-09-03 Spinal Concepts, Inc. Apparatus for manufacturing a bone dowel
US6557226B1 (en) 1999-04-23 2003-05-06 Michael E. Landry Apparatus for manufacturing a bone dowel
CA2363562C (en) * 1999-05-05 2010-08-03 Gary Karlin Michelson Nested interbody spinal fusion implants
US6558423B1 (en) 1999-05-05 2003-05-06 Gary K. Michelson Interbody spinal fusion implants with multi-lock for locking opposed screws
US6520996B1 (en) 1999-06-04 2003-02-18 Depuy Acromed, Incorporated Orthopedic implant
BR9917397A (en) 1999-07-02 2002-03-05 Spine Solutions Inc Intervertebral Implant
US6283966B1 (en) 1999-07-07 2001-09-04 Sulzer Spine-Tech Inc. Spinal surgery tools and positioning method
FR2897259B1 (en) 2006-02-15 2008-05-09 Ldr Medical Soc Par Actions Si INTERSOMATIC TRANSFORAMINAL CAGE WITH INTERBREBAL FUSION GRAFT AND CAGE IMPLANTATION INSTRUMENT
US6447516B1 (en) 1999-08-09 2002-09-10 Peter M. Bonutti Method of securing tissue
US6368343B1 (en) 2000-03-13 2002-04-09 Peter M. Bonutti Method of using ultrasonic vibration to secure body tissue
US6200322B1 (en) * 1999-08-13 2001-03-13 Sdgi Holdings, Inc. Minimal exposure posterior spinal interbody instrumentation and technique
WO2001013807A2 (en) 1999-08-26 2001-03-01 Sdgi Holdings, Inc. Devices and methods for implanting fusion cages
AU7118100A (en) * 1999-09-03 2001-04-10 Daniel J. Cook Temporary spine fixation device and method
US6371984B1 (en) * 1999-09-13 2002-04-16 Keraplast Technologies, Ltd. Implantable prosthetic or tissue expanding device
US6783546B2 (en) 1999-09-13 2004-08-31 Keraplast Technologies, Ltd. Implantable prosthetic or tissue expanding device
MXPA02002672A (en) * 1999-09-14 2003-10-14 Spine Solutions Inc Instrument for inserting intervertebral implants.
US20050273111A1 (en) * 1999-10-08 2005-12-08 Ferree Bret A Methods and apparatus for intervertebral disc removal and endplate preparation
US6436101B1 (en) * 1999-10-13 2002-08-20 James S. Hamada Rasp for use in spine surgery
US6277122B1 (en) * 1999-10-15 2001-08-21 Sdgi Holdings, Inc. Distraction instrument with fins for maintaining insertion location
US6524318B1 (en) 1999-10-18 2003-02-25 Sulzer Spine-Tech Inc. Spinal surgery instruments and methods
US6251111B1 (en) * 1999-10-20 2001-06-26 Sdgi Holdings, Inc. Jack for pulling a vertebral anchor
JP4326134B2 (en) * 1999-10-20 2009-09-02 ウォーソー・オーソペディック・インコーポレーテッド Method and apparatus for performing a surgical procedure
US6520967B1 (en) * 1999-10-20 2003-02-18 Cauthen Research Group, Inc. Spinal implant insertion instrument for spinal interbody prostheses
US11331150B2 (en) 1999-10-28 2022-05-17 Medtronic Navigation, Inc. Method and apparatus for surgical navigation
US8644907B2 (en) 1999-10-28 2014-02-04 Medtronic Navigaton, Inc. Method and apparatus for surgical navigation
US6474341B1 (en) * 1999-10-28 2002-11-05 Surgical Navigation Technologies, Inc. Surgical communication and power system
US6287313B1 (en) 1999-11-23 2001-09-11 Sdgi Holdings, Inc. Screw delivery system and method
US7887551B2 (en) 1999-12-02 2011-02-15 Smith & Nephew, Inc. Soft tissue attachment and repair
US7153312B1 (en) 1999-12-02 2006-12-26 Smith & Nephew Inc. Closure device and method for tissue repair
US7641657B2 (en) * 2003-06-10 2010-01-05 Trans1, Inc. Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae
US6319257B1 (en) 1999-12-20 2001-11-20 Kinamed, Inc. Inserter assembly
US20010032017A1 (en) * 1999-12-30 2001-10-18 Alfaro Arthur A. Intervertebral implants
US6447512B1 (en) 2000-01-06 2002-09-10 Spinal Concepts, Inc. Instrument and method for implanting an interbody fusion device
US6331179B1 (en) 2000-01-06 2001-12-18 Spinal Concepts, Inc. System and method for stabilizing the human spine with a bone plate
US6635073B2 (en) 2000-05-03 2003-10-21 Peter M. Bonutti Method of securing body tissue
EP1645248B8 (en) * 2000-02-04 2010-06-16 Warsaw Orthopedic, Inc. Expandable interbody spinal fusion implant having pivotally attached blocker
US6814756B1 (en) * 2000-02-04 2004-11-09 Gary K. Michelson Expandable threaded arcuate interbody spinal fusion implant with lordotic configuration during insertion
US6558386B1 (en) 2000-02-16 2003-05-06 Trans1 Inc. Axial spinal implant and method and apparatus for implanting an axial spinal implant within the vertebrae of the spine
DK1578315T3 (en) * 2000-02-16 2008-10-06 Trans1 Inc Device for vertebral column distribution and fusion
US7014633B2 (en) 2000-02-16 2006-03-21 Trans1, Inc. Methods of performing procedures in the spine
US6575979B1 (en) * 2000-02-16 2003-06-10 Axiamed, Inc. Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae
US6899716B2 (en) 2000-02-16 2005-05-31 Trans1, Inc. Method and apparatus for spinal augmentation
US6558390B2 (en) * 2000-02-16 2003-05-06 Axiamed, Inc. Methods and apparatus for performing therapeutic procedures in the spine
US6740090B1 (en) * 2000-02-16 2004-05-25 Trans1 Inc. Methods and apparatus for forming shaped axial bores through spinal vertebrae
US7744599B2 (en) * 2000-02-16 2010-06-29 Trans1 Inc. Articulating spinal implant
US20030191474A1 (en) * 2000-02-16 2003-10-09 Cragg Andrew H. Apparatus for performing a discectomy through a trans-sacral axial bore within the vertebrae of the spine
US6582441B1 (en) 2000-02-24 2003-06-24 Advanced Bionics Corporation Surgical insertion tool
WO2001064124A1 (en) * 2000-03-01 2001-09-07 Surgical Navigation Technologies, Inc. Multiple cannula image guided tool for image guided procedures
US6332895B1 (en) 2000-03-08 2001-12-25 Loubert Suddaby Expandable intervertebral fusion implant having improved stability
US7169183B2 (en) * 2000-03-14 2007-01-30 Warsaw Orthopedic, Inc. Vertebral implant for promoting arthrodesis of the spine
US6514260B1 (en) * 2000-03-15 2003-02-04 Sdgi Holdings, Inc. Methods and instruments for laparoscopic spinal surgery
AR027685A1 (en) * 2000-03-22 2003-04-09 Synthes Ag METHOD AND METHOD FOR CARRYING OUT
US6436141B2 (en) 2000-04-07 2002-08-20 Surgical Dynamics, Inc. Apparatus for fusing adjacent bone structures
US6350283B1 (en) * 2000-04-19 2002-02-26 Gary K. Michelson Bone hemi-lumbar interbody spinal implant having an asymmetrical leading end and method of installation thereof
US7462195B1 (en) 2000-04-19 2008-12-09 Warsaw Orthopedic, Inc. Artificial lumbar interbody spinal implant having an asymmetrical leading end
US6312431B1 (en) 2000-04-24 2001-11-06 Wilson T. Asfora Vertebrae linking system
US6375658B1 (en) * 2000-04-28 2002-04-23 Smith & Nephew, Inc. Cartilage grafting
AU2001259593A1 (en) * 2000-05-05 2001-11-20 Osteotech, Inc. Intervertebral distractor and implant insertion instrument
US6478800B1 (en) 2000-05-08 2002-11-12 Depuy Acromed, Inc. Medical installation tool
EP1289415A4 (en) * 2000-05-18 2008-12-03 Nuvasive Inc Tissue discrimination and applications in medical procedures
FR2808995B1 (en) 2000-05-18 2003-02-21 Aesculap Sa INTERSOMATIC CAGE WITH UNIFIED GRAFT
WO2001091686A1 (en) 2000-05-30 2001-12-06 Lin Paul S Implant for placement between cervical vertebrae
US20020111680A1 (en) * 2000-06-13 2002-08-15 Michelson Gary K. Ratcheted bone dowel
AU2001274821A1 (en) * 2000-06-13 2001-12-24 Gary K. Michelson Manufactured major long bone ring implant shaped to conform to a prepared intervertebral implantation space
US7085400B1 (en) * 2000-06-14 2006-08-01 Surgical Navigation Technologies, Inc. System and method for image based sensor calibration
US8057477B2 (en) * 2000-06-24 2011-11-15 Greatbatch Medical S.A. Guided reamer system for reshaping bone
DE10032126B4 (en) * 2000-07-05 2004-12-02 Marquardt Medizintechnik Gmbh Instrument for inserting a connecting rod into and through mutually aligned transverse bores in the heads of two or more pedicle screws screwed into the spine
WO2002003867A2 (en) * 2000-07-06 2002-01-17 Sulzer Spine-Tech Inc. Bone preparation instruments
US6641582B1 (en) * 2000-07-06 2003-11-04 Sulzer Spine-Tech Inc. Bone preparation instruments and methods
DE20012549U1 (en) * 2000-07-20 2000-10-12 Aesculap Ag & Co Kg Insertion tool for an intervertebral implant
US7056321B2 (en) 2000-08-01 2006-06-06 Endius, Incorporated Method of securing vertebrae
US7985247B2 (en) * 2000-08-01 2011-07-26 Zimmer Spine, Inc. Methods and apparatuses for treating the spine through an access device
US6626905B1 (en) 2000-08-02 2003-09-30 Sulzer Spine-Tech Inc. Posterior oblique lumbar arthrodesis
US6821280B1 (en) 2000-08-03 2004-11-23 Charanpreet S. Bagga Distracting and curetting instrument
US7125380B2 (en) * 2000-08-08 2006-10-24 Warsaw Orthopedic, Inc. Clamping apparatus and methods
US7601174B2 (en) * 2000-08-08 2009-10-13 Warsaw Orthopedic, Inc. Wear-resistant endoprosthetic devices
AU2001281166B2 (en) * 2000-08-08 2006-07-20 Warsaw Orthopedic, Inc. Implantable joint prosthesis
EP1307153B1 (en) * 2000-08-08 2009-09-23 Warsaw Orthopedic, Inc. Apparatus for stereotactic implantation
US6709438B2 (en) 2000-08-10 2004-03-23 Robert A Dixon Cam action vertebral spreader
DE60139262D1 (en) * 2000-08-28 2009-08-27 Disc Dynamics Inc SYSTEM FOR RECONSTRUCTING JOINT SURFACES OF MAMMALS
US8628575B2 (en) 2000-08-29 2014-01-14 Nabil L. Muhanna Vertebral body replacement and method of use
US6824565B2 (en) 2000-09-08 2004-11-30 Nabil L. Muhanna System and methods for inserting a vertebral spacer
US6500206B1 (en) * 2000-09-15 2002-12-31 Donald W. Bryan Instruments for inserting spinal vertebral implant
US6443987B1 (en) 2000-09-15 2002-09-03 Donald W. Bryan Spinal vertebral implant
US20030120274A1 (en) * 2000-10-20 2003-06-26 Morris John W. Implant retaining device
US6599291B1 (en) 2000-10-20 2003-07-29 Sdgi Holdings, Inc. Methods and instruments for interbody surgical techniques
EP1330216B1 (en) 2000-10-24 2006-06-21 SDGI Holdings, Inc. Osteogenic packing device and method
WO2002036049A2 (en) 2000-11-03 2002-05-10 Osteotech, Inc. Spinal intervertebral implant and method of making
JP2004522469A (en) 2000-11-13 2004-07-29 ボエム・フランク・エイッチ・ジュニア Lumbar interbody fusion device and method
US6666891B2 (en) 2000-11-13 2003-12-23 Frank H. Boehm, Jr. Device and method for lumbar interbody fusion
DE10060815A1 (en) * 2000-12-07 2002-06-20 Henkel Kgaa Stone composite panels
US6692501B2 (en) * 2000-12-14 2004-02-17 Gary K. Michelson Spinal interspace shaper
US7153304B2 (en) * 2000-12-29 2006-12-26 Zimmer Trabecular Metal Technology, Inc. Instrument system for preparing a disc space between adjacent vertebral bodies to receive a repair device
US6663637B2 (en) 2001-01-02 2003-12-16 Robert A Dixon Vertebral distraction stabilizer
US6814738B2 (en) 2001-01-23 2004-11-09 Depuy Acromed, Inc. Medical impacting device and system
US6986772B2 (en) * 2001-03-01 2006-01-17 Michelson Gary K Dynamic lordotic guard with movable extensions for creating an implantation space posteriorly in the lumbar spine
JP4133331B2 (en) * 2001-02-04 2008-08-13 ウォーソー・オーソペディック・インコーポレーテッド Apparatus and method for inserting and deploying an expandable interbody spinal fusion implant
US20020107519A1 (en) * 2001-02-05 2002-08-08 Dixon Robert A. Dual spreader flange-tube vertebral stabilizer
US6562045B2 (en) 2001-02-13 2003-05-13 Sdgi Holdings, Inc. Machining apparatus
US6929647B2 (en) 2001-02-21 2005-08-16 Howmedica Osteonics Corp. Instrumentation and method for implant insertion
ATE431110T1 (en) * 2001-02-27 2009-05-15 Smith & Nephew Inc SURGICAL NAVIGATION SYSTEM FOR PARTIAL KNEE JOINT RECONSTRUCTION
US20050113846A1 (en) * 2001-02-27 2005-05-26 Carson Christopher P. Surgical navigation systems and processes for unicompartmental knee arthroplasty
US7547307B2 (en) * 2001-02-27 2009-06-16 Smith & Nephew, Inc. Computer assisted knee arthroplasty instrumentation, systems, and processes
US6896680B2 (en) * 2001-03-01 2005-05-24 Gary K. Michelson Arcuate dynamic lordotic guard with movable extensions for creating an implantation space posteriorly in the lumbar spine
AU2002247230B9 (en) 2001-03-01 2007-05-10 Warsaw Orthopedic, Inc. Dynamic lordotic guard with movable extensions for creating an implantation space posteriorly in the lumbar spine and method for use thereof
US6595998B2 (en) * 2001-03-08 2003-07-22 Spinewave, Inc. Tissue distraction device
US20020138147A1 (en) * 2001-03-22 2002-09-26 Surgical Dynamics, Inc. Apparatus for fusing adjacent bone structures
US6540753B2 (en) 2001-03-23 2003-04-01 Howmedica Osteonics Corp. Instrumentation for implant insertion
US6899734B2 (en) 2001-03-23 2005-05-31 Howmedica Osteonics Corp. Modular implant for fusing adjacent bone structure
US7128760B2 (en) 2001-03-27 2006-10-31 Warsaw Orthopedic, Inc. Radially expanding interbody spinal fusion implants, instrumentation, and methods of insertion
US6890355B2 (en) * 2001-04-02 2005-05-10 Gary K. Michelson Artificial contoured spinal fusion implants made of a material other than bone
US6989031B2 (en) * 2001-04-02 2006-01-24 Sdgi Holdings, Inc. Hemi-interbody spinal implant manufactured from a major long bone ring or a bone composite
WO2002080823A1 (en) * 2001-04-04 2002-10-17 Rapp Lawrence G Interbody spinal fusion device
US6582433B2 (en) 2001-04-09 2003-06-24 St. Francis Medical Technologies, Inc. Spine fixation device and method
US20020198533A1 (en) * 2001-04-17 2002-12-26 Fred Geisler Multipositional intervertebral instrument guide
US6632235B2 (en) 2001-04-19 2003-10-14 Synthes (U.S.A.) Inflatable device and method for reducing fractures in bone and in treating the spine
FR2824261B1 (en) 2001-05-04 2004-05-28 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS AND IMPLEMENTATION METHOD AND TOOLS
US8292926B2 (en) 2005-09-30 2012-10-23 Jackson Roger P Dynamic stabilization connecting member with elastic core and outer sleeve
US10258382B2 (en) * 2007-01-18 2019-04-16 Roger P. Jackson Rod-cord dynamic connection assemblies with slidable bone anchor attachment members along the cord
US10729469B2 (en) * 2006-01-09 2020-08-04 Roger P. Jackson Flexible spinal stabilization assembly with spacer having off-axis core member
US20160242816A9 (en) * 2001-05-09 2016-08-25 Roger P. Jackson Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms
US8353932B2 (en) * 2005-09-30 2013-01-15 Jackson Roger P Polyaxial bone anchor assembly with one-piece closure, pressure insert and plastic elongate member
DE10125717A1 (en) * 2001-05-21 2002-12-12 Storz Karl Gmbh & Co Kg Manipulator for handling a pedicle screw
FR2827156B1 (en) * 2001-07-13 2003-11-14 Ldr Medical VERTEBRAL CAGE DEVICE WITH MODULAR FASTENING
US6926728B2 (en) * 2001-07-18 2005-08-09 St. Francis Medical Technologies, Inc. Curved dilator and method
US6682534B2 (en) 2001-08-02 2004-01-27 Depuy Acromed, Inc. Endplate preparation instrument and associated method
US20030055503A1 (en) * 2001-09-19 2003-03-20 O'neil Michael J. Alignment verification device and method of use
US6652533B2 (en) 2001-09-20 2003-11-25 Depuy Acromed, Inc. Medical inserter tool with slaphammer
CA2460028A1 (en) * 2001-10-30 2003-05-08 Osteotech, Inc. Bone implant and insertion tools
US7664544B2 (en) 2002-10-30 2010-02-16 Nuvasive, Inc. System and methods for performing percutaneous pedicle integrity assessments
US6709439B2 (en) 2001-10-30 2004-03-23 Depuy Spine, Inc. Slaphammer tool
US6840941B2 (en) * 2001-10-31 2005-01-11 Depuy Acromed, Inc. Vertebral endplate chisel
US7766947B2 (en) * 2001-10-31 2010-08-03 Ortho Development Corporation Cervical plate for stabilizing the human spine
WO2003037166A2 (en) * 2001-11-01 2003-05-08 Boyd Lawrence M Devices and methods for the restoration of a spinal disc
AU2002350026A1 (en) * 2001-11-01 2003-05-12 Lawrence M. Boyd System and method for the pretreatment of the endplates of an intervertebral disc
IL161728A0 (en) * 2001-11-01 2005-11-20 Res Dev Foundation Ehrlichia disulfide bond formation proteins and uses thereof
DE10154163A1 (en) * 2001-11-03 2003-05-22 Advanced Med Tech Device for straightening and stabilizing the spine
US7025787B2 (en) * 2001-11-26 2006-04-11 Sdgi Holdings, Inc. Implantable joint prosthesis and associated instrumentation
US6719765B2 (en) 2001-12-03 2004-04-13 Bonutti 2003 Trust-A Magnetic suturing system and method
US6855167B2 (en) * 2001-12-05 2005-02-15 Osteotech, Inc. Spinal intervertebral implant, interconnections for such implant and processes for making
US7485134B2 (en) * 2001-12-07 2009-02-03 Simonson Rush E Vertebral implants adapted for posterior insertion
US7311711B2 (en) * 2001-12-21 2007-12-25 Cole J Dean Surgical distractor frame
US8137402B2 (en) * 2002-01-17 2012-03-20 Concept Matrix Llc Vertebral defect device
US7105023B2 (en) * 2002-01-17 2006-09-12 Concept Matrix, L.L.C. Vertebral defect device
US6923830B2 (en) 2002-02-02 2005-08-02 Gary K. Michelson Spinal fusion implant having deployable bone engaging projections
WO2003065929A2 (en) * 2002-02-07 2003-08-14 Ebi, L.P. Anterior spinal implant
EP1474054A1 (en) * 2002-02-11 2004-11-10 Smith & Nephew, Inc. Image-guided fracture reduction
US7527649B1 (en) 2002-02-15 2009-05-05 Nuvasive, Inc. Intervertebral implant and related methods
AR038680A1 (en) 2002-02-19 2005-01-26 Synthes Ag INTERVERTEBRAL IMPLANT
US6947786B2 (en) * 2002-02-28 2005-09-20 Surgical Navigation Technologies, Inc. Method and apparatus for perspective inversion
US20040030387A1 (en) 2002-03-11 2004-02-12 Landry Michael E. Instrumentation and procedure for implanting spinal implant devices
US20090182341A1 (en) * 2002-03-12 2009-07-16 Cervitech, Inc. Instrument set for fitting an intervertebral jont prosthesis
DE50213818D1 (en) * 2002-03-12 2009-10-15 Cervitech Inc Intrumentarium for the insertion of an intervertebral prosthesis
US7527629B2 (en) * 2002-03-12 2009-05-05 Cervitech, Inc. Instrument set for fitting an intervertebral joint prosthesis
US8147421B2 (en) * 2003-01-15 2012-04-03 Nuvasive, Inc. System and methods for determining nerve direction to a surgical instrument
US7935118B2 (en) * 2002-06-21 2011-05-03 Depuy Products, Inc. Prosthesis removal cutting guide, cutting tool and method
US20030236522A1 (en) * 2002-06-21 2003-12-25 Jack Long Prosthesis cavity cutting guide, cutting tool and method
US7004947B2 (en) 2002-06-24 2006-02-28 Endius Incorporated Surgical instrument for moving vertebrae
US6793678B2 (en) 2002-06-27 2004-09-21 Depuy Acromed, Inc. Prosthetic intervertebral motion disc having dampening
US7083625B2 (en) * 2002-06-28 2006-08-01 Sdgi Holdings, Inc. Instruments and techniques for spinal disc space preparation
AU2003253906A1 (en) 2002-07-19 2004-02-09 Osteotech, Inc. Chisels and procedure for insertion of spinal implant in a spinal disc space
WO2004016217A2 (en) 2002-08-15 2004-02-26 David Gerber Controlled artificial intervertebral disc implant
BR0313502A (en) * 2002-08-15 2005-07-12 Justin K Coppes Intervertebral disc
US7044971B2 (en) * 2002-08-30 2006-05-16 Loubert Suddaby Lordotic fusion implant
US8876868B2 (en) 2002-09-06 2014-11-04 Roger P. Jackson Helical guide and advancement flange with radially loaded lip
US6648888B1 (en) 2002-09-06 2003-11-18 Endius Incorporated Surgical instrument for moving a vertebra
ATE405230T1 (en) * 2002-09-13 2008-09-15 Replication Medical Inc TOOLS FOR HANDLING AND RECEIVING AN IMPLANT
JP4429909B2 (en) * 2002-09-19 2010-03-10 ビリアーズ, マラン デ Intervertebral prosthesis
US7074226B2 (en) * 2002-09-19 2006-07-11 Sdgi Holdings, Inc. Oval dilator and retractor set and method
JP2006501947A (en) * 2002-10-08 2006-01-19 エスディージーアイ・ホールディングス・インコーポレーテッド Orthopedic graft insertion devices and techniques
US7063725B2 (en) * 2002-10-21 2006-06-20 Sdgi Holdings, Inc. Systems and techniques for restoring and maintaining intervertebral anatomy
US7125425B2 (en) * 2002-10-21 2006-10-24 Sdgi Holdings, Inc. Systems and techniques for restoring and maintaining intervertebral anatomy
AU2003272308A1 (en) * 2002-10-25 2004-05-25 Endius Incorporated Apparatus and methods for shielding body structures during surgery
US7909853B2 (en) * 2004-09-23 2011-03-22 Kyphon Sarl Interspinous process implant including a binder and method of implantation
US7497859B2 (en) * 2002-10-29 2009-03-03 Kyphon Sarl Tools for implanting an artificial vertebral disk
US6966929B2 (en) * 2002-10-29 2005-11-22 St. Francis Medical Technologies, Inc. Artificial vertebral disk replacement implant with a spacer
US7549999B2 (en) * 2003-05-22 2009-06-23 Kyphon Sarl Interspinous process distraction implant and method of implantation
US7931674B2 (en) 2005-03-21 2011-04-26 Kyphon Sarl Interspinous process implant having deployable wing and method of implantation
US7273496B2 (en) * 2002-10-29 2007-09-25 St. Francis Medical Technologies, Inc. Artificial vertebral disk replacement implant with crossbar spacer and method
US8048117B2 (en) * 2003-05-22 2011-11-01 Kyphon Sarl Interspinous process implant and method of implantation
US7833246B2 (en) 2002-10-29 2010-11-16 Kyphon SÀRL Interspinous process and sacrum implant and method
US8070778B2 (en) 2003-05-22 2011-12-06 Kyphon Sarl Interspinous process implant with slide-in distraction piece and method of implantation
US20060271194A1 (en) * 2005-03-22 2006-11-30 St. Francis Medical Technologies, Inc. Interspinous process implant having deployable wing as an adjunct to spinal fusion and method of implantation
US7588595B2 (en) * 2002-10-29 2009-09-15 Stryker Endoscopy Graft fixation device and method
FR2846550B1 (en) 2002-11-05 2006-01-13 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS
US7204852B2 (en) 2002-12-13 2007-04-17 Spine Solutions, Inc. Intervertebral implant, insertion tool and method of inserting same
WO2004066884A1 (en) 2003-01-31 2004-08-12 Spinalmotion, Inc. Intervertebral prosthesis placement instrument
JP4398975B2 (en) * 2003-01-31 2010-01-13 スパイナルモーション, インコーポレイテッド Spinal cord midline indicator
US7828849B2 (en) * 2003-02-03 2010-11-09 Warsaw Orthopedic, Inc. Expanding interbody implant and articulating inserter and method
US9314235B2 (en) * 2003-02-05 2016-04-19 Smith & Nephew, Inc. Tissue anchor and insertion tool
EP2457541A1 (en) 2003-02-06 2012-05-30 Synthes GmbH Implant between vertebrae
US7335203B2 (en) 2003-02-12 2008-02-26 Kyphon Inc. System and method for immobilizing adjacent spinous processes
CN1774220A (en) 2003-02-14 2006-05-17 德普伊斯派尔公司 In-situ formed intervertebral fusion device and method
US7094257B2 (en) * 2003-02-14 2006-08-22 Zimmer Spine, Inc. Expandable intervertebral implant cage
US7819801B2 (en) 2003-02-27 2010-10-26 Nuvasive, Inc. Surgical access system and related methods
US20040176764A1 (en) * 2003-03-03 2004-09-09 Centerpulse Spine-Tech, Inc. Apparatus and method for spinal distraction using a flip-up portal
US20040186483A1 (en) * 2003-03-22 2004-09-23 Bagby George W. Implant driver apparatus and bone joining device
WO2004084742A1 (en) 2003-03-24 2004-10-07 Theken Surgical Llc Spinal implant adjustment device
US7465304B1 (en) 2003-04-14 2008-12-16 Spine Design, Inc. Anterior cervical facet discectomy surgery kit and method for its use
US7419505B2 (en) * 2003-04-22 2008-09-02 Fleischmann Lewis W Collapsible, rotatable, and tiltable hydraulic spinal disc prosthesis system with selectable modular components
US7491204B2 (en) * 2003-04-28 2009-02-17 Spine Solutions, Inc. Instruments and method for preparing an intervertebral space for receiving an artificial disc implant
US20040225228A1 (en) 2003-05-08 2004-11-11 Ferree Bret A. Neurophysiological apparatus and procedures
US7608104B2 (en) * 2003-05-14 2009-10-27 Archus Orthopedics, Inc. Prostheses, tools and methods for replacement of natural facet joints with artifical facet joint surfaces
US7645232B2 (en) * 2003-05-16 2010-01-12 Zimmer Spine, Inc. Access device for minimally invasive surgery
WO2004103152A2 (en) * 2003-05-16 2004-12-02 Spine Wave, Inc. Tissue distraction device
US7575599B2 (en) * 2004-07-30 2009-08-18 Spinalmotion, Inc. Intervertebral prosthetic disc with metallic core
US20090076614A1 (en) * 2007-09-17 2009-03-19 Spinalmotion, Inc. Intervertebral Prosthetic Disc with Shock Absorption Core
ZA200509644B (en) 2003-05-27 2007-03-28 Spinalmotion Inc Prosthetic disc for intervertebral insertion
US10052211B2 (en) 2003-05-27 2018-08-21 Simplify Medical Pty Ltd. Prosthetic disc for intervertebral insertion
US20050021037A1 (en) * 2003-05-29 2005-01-27 Mccombs Daniel L. Image-guided navigated precision reamers
US8936623B2 (en) 2003-06-18 2015-01-20 Roger P. Jackson Polyaxial bone screw assembly
US6945974B2 (en) 2003-07-07 2005-09-20 Aesculap Inc. Spinal stabilization implant and method of application
US6945975B2 (en) * 2003-07-07 2005-09-20 Aesculap, Inc. Bone fixation assembly and method of securement
US7803162B2 (en) * 2003-07-21 2010-09-28 Spine Solutions, Inc. Instruments and method for inserting an intervertebral implant
US7153325B2 (en) * 2003-08-01 2006-12-26 Ultra-Kinetics, Inc. Prosthetic intervertebral disc and methods for using the same
US7785351B2 (en) 2003-08-05 2010-08-31 Flexuspine, Inc. Artificial functional spinal implant unit system and method for use
EP1675508B1 (en) * 2003-08-05 2016-04-20 NuVasive, Inc. System for performing dynamic pedicle integrity assessments
US20060229729A1 (en) * 2003-08-05 2006-10-12 Gordon Charles R Expandable intervertebral implant for use with instrument
US7753958B2 (en) 2003-08-05 2010-07-13 Gordon Charles R Expandable intervertebral implant
US7909869B2 (en) 2003-08-05 2011-03-22 Flexuspine, Inc. Artificial spinal unit assemblies
US7300441B2 (en) * 2003-08-20 2007-11-27 Sdgi Holdings, Inc. Technique and instrumentation for preparation of vertebral members
US20050090822A1 (en) * 2003-10-24 2005-04-28 Dipoto Gene Methods and apparatus for stabilizing the spine through an access device
US7731737B2 (en) * 2003-10-24 2010-06-08 Zimmer Spine, Inc. Methods and apparatuses for fixation of the spine through an access device
US7655012B2 (en) * 2003-10-02 2010-02-02 Zimmer Spine, Inc. Methods and apparatuses for minimally invasive replacement of intervertebral discs
US20050090899A1 (en) * 2003-10-24 2005-04-28 Dipoto Gene Methods and apparatuses for treating the spine through an access device
US7862570B2 (en) * 2003-10-03 2011-01-04 Smith & Nephew, Inc. Surgical positioners
JP2007508050A (en) * 2003-10-06 2007-04-05 スミス アンド ネフュー インコーポレーテッド Modular guidance portal
US7835778B2 (en) 2003-10-16 2010-11-16 Medtronic Navigation, Inc. Method and apparatus for surgical navigation of a multiple piece construct for implantation
US8313430B1 (en) 2006-01-11 2012-11-20 Nuvasive, Inc. Surgical access system and related methods
US7840253B2 (en) * 2003-10-17 2010-11-23 Medtronic Navigation, Inc. Method and apparatus for surgical navigation
US7764985B2 (en) * 2003-10-20 2010-07-27 Smith & Nephew, Inc. Surgical navigation system component fault interfaces and related processes
US7618442B2 (en) * 2003-10-21 2009-11-17 Theken Spine, Llc Implant assembly and method for use in an internal structure stabilization system
US7967826B2 (en) 2003-10-21 2011-06-28 Theken Spine, Llc Connector transfer tool for internal structure stabilization systems
US20050090829A1 (en) * 2003-10-23 2005-04-28 Osteotech, Inc. Spinal bone chisels
EP1694228B1 (en) * 2003-10-23 2011-08-31 TRANS1, Inc. Spinal mobility preservation apparatus
JP2007516738A (en) * 2003-10-23 2007-06-28 トランスワン インコーポレイティッド Tools and tool kits for minimal intrusion processing on the spine
US7520899B2 (en) * 2003-11-05 2009-04-21 Kyphon Sarl Laterally insertable artificial vertebral disk replacement implant with crossbar spacer
CA2546023C (en) * 2003-11-14 2012-11-06 Smith & Nephew, Inc. Adjustable surgical cutting systems
US7837732B2 (en) * 2003-11-20 2010-11-23 Warsaw Orthopedic, Inc. Intervertebral body fusion cage with keels and implantation methods
US20050149192A1 (en) * 2003-11-20 2005-07-07 St. Francis Medical Technologies, Inc. Intervertebral body fusion cage with keels and implantation method
US7670377B2 (en) * 2003-11-21 2010-03-02 Kyphon Sarl Laterally insertable artifical vertebral disk replacement implant with curved spacer
US20050283237A1 (en) * 2003-11-24 2005-12-22 St. Francis Medical Technologies, Inc. Artificial spinal disk replacement device with staggered vertebral body attachments
US20050113659A1 (en) * 2003-11-26 2005-05-26 Albert Pothier Device for data input for surgical navigation system
US7481839B2 (en) * 2003-12-02 2009-01-27 Kyphon Sarl Bioresorbable interspinous process implant for use with intervertebral disk remediation or replacement implants and procedures
US20050154462A1 (en) * 2003-12-02 2005-07-14 St. Francis Medical Technologies, Inc. Laterally insertable artificial vertebral disk replacement implant with translating pivot point
US20050143826A1 (en) * 2003-12-11 2005-06-30 St. Francis Medical Technologies, Inc. Disk repair structures with anchors
US20050137600A1 (en) * 2003-12-23 2005-06-23 Jacobs Andrew M. Articular cartilage repair implant delivery device and method of use
US8123757B2 (en) * 2003-12-31 2012-02-28 Depuy Spine, Inc. Inserter instrument and implant clip
JP4440939B2 (en) 2004-01-08 2010-03-24 スパイン・ウェイブ・インコーポレーテッド Apparatus and method for injecting flowable material into distracted tissue site
US20050234332A1 (en) * 2004-01-16 2005-10-20 Murphy Stephen B Method of computer-assisted ligament balancing and component placement in total knee arthroplasty
US20050159759A1 (en) * 2004-01-20 2005-07-21 Mark Harbaugh Systems and methods for performing minimally invasive incisions
AU2005206203A1 (en) * 2004-01-22 2005-08-04 Smith & Nephew, Inc. Methods, systems, and apparatuses for providing patient-mounted surgical navigational sensors
US7625379B2 (en) * 2004-01-26 2009-12-01 Warsaw Orthopedic, Inc. Methods and instrumentation for inserting intervertebral grafts and devices
JP2007519496A (en) 2004-01-27 2007-07-19 オステオテック,インコーポレイテッド Stabilized bone graft
BRPI0507468A (en) 2004-02-04 2007-07-10 Ldr Medical intervertebral disc prosthesis
FR2865629B1 (en) 2004-02-04 2007-01-26 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS
US7311712B2 (en) 2004-02-26 2007-12-25 Aesculap Implant Systems, Inc. Polyaxial locking screw plate assembly
US7470279B2 (en) * 2004-02-27 2008-12-30 Jackson Roger P Orthopedic implant rod reduction tool set and method
US20050234467A1 (en) * 2004-03-08 2005-10-20 James Rains Screw guide
US20050216027A1 (en) * 2004-03-24 2005-09-29 Suh Sean S Extraction screwdriver
US7918891B1 (en) 2004-03-29 2011-04-05 Nuvasive Inc. Systems and methods for spinal fusion
US20050234465A1 (en) * 2004-03-31 2005-10-20 Mccombs Daniel L Guided saw with pins
WO2005096982A1 (en) * 2004-03-31 2005-10-20 Smith & Nephew, Inc. Methods and apparatuses for providing a reference array input device
US7909873B2 (en) 2006-12-15 2011-03-22 Soteira, Inc. Delivery apparatus and methods for vertebrostenting
US7963981B2 (en) * 2004-04-19 2011-06-21 Globus Medical, Inc. Bone fixation plate
US8236034B2 (en) 2004-04-19 2012-08-07 Globus Medical, Inc. Bone fixation plate
US8109942B2 (en) * 2004-04-21 2012-02-07 Smith & Nephew, Inc. Computer-aided methods, systems, and apparatuses for shoulder arthroplasty
US20050240197A1 (en) * 2004-04-23 2005-10-27 Kmiec Stanley J Jr Device and method for inserting, positioning and removing an implant
FR2869528B1 (en) 2004-04-28 2007-02-02 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS
US7524324B2 (en) * 2004-04-28 2009-04-28 Kyphon Sarl System and method for an interspinous process implant as a supplement to a spine stabilization implant
US7033363B2 (en) * 2004-05-19 2006-04-25 Sean Powell Snap-lock for drill sleeve
US20050267555A1 (en) 2004-05-28 2005-12-01 Marnfeldt Goran N Engagement tool for implantable medical devices
US20060036258A1 (en) * 2004-06-08 2006-02-16 St. Francis Medical Technologies, Inc. Sizing distractor and method for implanting an interspinous implant between adjacent spinous processes
US7549993B2 (en) * 2004-06-16 2009-06-23 Warsaw Orthopedic, Inc. Constant lift cam spreader
US7935136B2 (en) * 2004-06-17 2011-05-03 Alamin Todd F Facet joint fusion devices and methods
US7837733B2 (en) * 2004-06-29 2010-11-23 Spine Wave, Inc. Percutaneous methods for injecting a curable biomaterial into an intervertebral space
US20060025778A1 (en) * 2004-07-21 2006-02-02 Ferree Bret A Methods and apparatus for artificial disc replacement (ADR) insertion and other surgical procedures
US20060020342A1 (en) * 2004-07-21 2006-01-26 Ferree Bret A Facet-preserving artificial disc replacements
US7625380B2 (en) * 2004-07-21 2009-12-01 Warsaw Orthopedic, Inc. Dual distractor inserter
US7862617B2 (en) * 2004-07-27 2011-01-04 Lamprich Medical, Llc Spinal disc prosthesis apparatus and placement method
US7585326B2 (en) 2004-08-06 2009-09-08 Spinalmotion, Inc. Methods and apparatus for intervertebral disc prosthesis insertion
US20060041313A1 (en) * 2004-08-19 2006-02-23 Sdgi Holdings, Inc. Intervertebral disc system
US7776045B2 (en) * 2004-08-20 2010-08-17 Warsaw Orthopedic, Inc. Instrumentation and methods for vertebral distraction
US7931688B2 (en) 2004-08-25 2011-04-26 Spine Wave, Inc. Expandable interbody fusion device
US20060052812A1 (en) * 2004-09-07 2006-03-09 Michael Winer Tool for preparing a surgical site for an access device
US20060054171A1 (en) * 2004-09-15 2006-03-16 Bruce Dall Method and apparatus of approaching a joint
US8012209B2 (en) 2004-09-23 2011-09-06 Kyphon Sarl Interspinous process implant including a binder, binder aligner and method of implantation
US7651502B2 (en) * 2004-09-24 2010-01-26 Jackson Roger P Spinal fixation tool set and method for rod reduction and fastener insertion
US7481840B2 (en) * 2004-09-29 2009-01-27 Kyphon Sarl Multi-piece artificial spinal disk replacement device with selectably positioning articulating element
US7575600B2 (en) * 2004-09-29 2009-08-18 Kyphon Sarl Artificial vertebral disk replacement implant with translating articulation contact surface and method
US20060069438A1 (en) * 2004-09-29 2006-03-30 Zucherman James F Multi-piece artificial spinal disk replacement device with multi-segmented support plates
US8298235B2 (en) * 2004-09-30 2012-10-30 Depuy Spine, Inc. Instrument and method for the insertion and alignment of an intervertebral implant
US8979857B2 (en) * 2004-10-06 2015-03-17 DePuy Synthes Products, LLC Modular medical tool and connector
WO2006042335A1 (en) * 2004-10-08 2006-04-20 Sdgi Holdings, Inc. Interior connecting interbody cage insertional tools, methods and devices
US20060085077A1 (en) * 2004-10-18 2006-04-20 Ebi, L.P. Intervertebral implant and associated method
US8721722B2 (en) 2004-10-18 2014-05-13 Ebi, Llc Intervertebral implant and associated method
US7935134B2 (en) 2004-10-20 2011-05-03 Exactech, Inc. Systems and methods for stabilization of bone structures
US9119680B2 (en) 2004-10-20 2015-09-01 Vertiflex, Inc. Interspinous spacer
US9023084B2 (en) 2004-10-20 2015-05-05 The Board Of Trustees Of The Leland Stanford Junior University Systems and methods for stabilizing the motion or adjusting the position of the spine
US8012207B2 (en) * 2004-10-20 2011-09-06 Vertiflex, Inc. Systems and methods for posterior dynamic stabilization of the spine
US8167944B2 (en) 2004-10-20 2012-05-01 The Board Of Trustees Of The Leland Stanford Junior University Systems and methods for posterior dynamic stabilization of the spine
US8128662B2 (en) * 2004-10-20 2012-03-06 Vertiflex, Inc. Minimally invasive tooling for delivery of interspinous spacer
US8025680B2 (en) 2004-10-20 2011-09-27 Exactech, Inc. Systems and methods for posterior dynamic stabilization of the spine
US9161783B2 (en) 2004-10-20 2015-10-20 Vertiflex, Inc. Interspinous spacer
US20100036423A1 (en) * 2004-10-20 2010-02-11 Stanley Kyle Hayes Dynamic rod
US8945183B2 (en) * 2004-10-20 2015-02-03 Vertiflex, Inc. Interspinous process spacer instrument system with deployment indicator
US20090030465A1 (en) * 2004-10-20 2009-01-29 Moti Altarac Dynamic rod
US20070239159A1 (en) * 2005-07-22 2007-10-11 Vertiflex, Inc. Systems and methods for stabilization of bone structures
US20090228045A1 (en) * 2004-10-20 2009-09-10 Stanley Kyle Hayes Dynamic rod
US8277488B2 (en) * 2004-10-20 2012-10-02 Vertiflex, Inc. Interspinous spacer
US8123807B2 (en) * 2004-10-20 2012-02-28 Vertiflex, Inc. Systems and methods for posterior dynamic stabilization of the spine
US8425559B2 (en) 2004-10-20 2013-04-23 Vertiflex, Inc. Systems and methods for posterior dynamic stabilization of the spine
WO2009009049A2 (en) 2004-10-20 2009-01-15 Vertiflex, Inc. Interspinous spacer
US7763074B2 (en) 2004-10-20 2010-07-27 The Board Of Trustees Of The Leland Stanford Junior University Systems and methods for posterior dynamic stabilization of the spine
US8123782B2 (en) 2004-10-20 2012-02-28 Vertiflex, Inc. Interspinous spacer
US8162985B2 (en) * 2004-10-20 2012-04-24 The Board Of Trustees Of The Leland Stanford Junior University Systems and methods for posterior dynamic stabilization of the spine
US8317864B2 (en) 2004-10-20 2012-11-27 The Board Of Trustees Of The Leland Stanford Junior University Systems and methods for posterior dynamic stabilization of the spine
US8226690B2 (en) 2005-07-22 2012-07-24 The Board Of Trustees Of The Leland Stanford Junior University Systems and methods for stabilization of bone structures
US8152837B2 (en) 2004-10-20 2012-04-10 The Board Of Trustees Of The Leland Stanford Junior University Systems and methods for posterior dynamic stabilization of the spine
US8409282B2 (en) 2004-10-20 2013-04-02 Vertiflex, Inc. Systems and methods for posterior dynamic stabilization of the spine
US8267969B2 (en) * 2004-10-20 2012-09-18 Exactech, Inc. Screw systems and methods for use in stabilization of bone structures
US8613747B2 (en) * 2004-10-20 2013-12-24 Vertiflex, Inc. Spacer insertion instrument
WO2006047370A2 (en) * 2004-10-22 2006-05-04 Avatar Design And Development, Inc. Vasectomy tool
WO2006047652A2 (en) * 2004-10-26 2006-05-04 Concept Matrix, Llc Working channel for minimally invasive spine surgery
US20060089649A1 (en) * 2004-10-26 2006-04-27 Ullrich Peter F Jr Surgical instruments and method of using same
US9216015B2 (en) 2004-10-28 2015-12-22 Vycor Medical, Inc. Apparatus and methods for performing brain surgery
US8926672B2 (en) 2004-11-10 2015-01-06 Roger P. Jackson Splay control closure for open bone anchor
US20060106381A1 (en) * 2004-11-18 2006-05-18 Ferree Bret A Methods and apparatus for treating spinal stenosis
US8021392B2 (en) * 2004-11-22 2011-09-20 Minsurg International, Inc. Methods and surgical kits for minimally-invasive facet joint fusion
US20060111779A1 (en) * 2004-11-22 2006-05-25 Orthopedic Development Corporation, A Florida Corporation Minimally invasive facet joint fusion
US9216041B2 (en) 2009-06-15 2015-12-22 Roger P. Jackson Spinal connecting members with tensioned cords and rigid sleeves for engaging compression inserts
US7887589B2 (en) * 2004-11-23 2011-02-15 Glenn Bradley J Minimally invasive spinal disc stabilizer and insertion tool
US8444681B2 (en) 2009-06-15 2013-05-21 Roger P. Jackson Polyaxial bone anchor with pop-on shank, friction fit retainer and winged insert
US9168069B2 (en) 2009-06-15 2015-10-27 Roger P. Jackson Polyaxial bone anchor with pop-on shank and winged insert with lower skirt for engaging a friction fit retainer
ATE524121T1 (en) 2004-11-24 2011-09-15 Abdou Samy DEVICES FOR PLACING AN ORTHOPEDIC INTERVERTEBRAL IMPLANT
WO2006060632A1 (en) * 2004-12-02 2006-06-08 Smith & Nephew, Inc. Systems for providing a reference plane for mounting an acetabular cup
CA2588736A1 (en) * 2004-12-02 2006-06-08 Smith & Nephew, Inc. Systems, methods, and apparatus for automatic software flow using instrument detection during computer-aided surgery
WO2009086010A2 (en) 2004-12-06 2009-07-09 Vertiflex, Inc. Spacer insertion instrument
EP1819375A2 (en) 2004-12-08 2007-08-22 Interpore Spine Ltd. Continuous phase composite for musculoskeletal repair
US20070038303A1 (en) * 2006-08-15 2007-02-15 Ebi, L.P. Foot/ankle implant and associated method
US8535357B2 (en) 2004-12-09 2013-09-17 Biomet Sports Medicine, Llc Continuous phase compositions for ACL repair
US7776090B2 (en) 2004-12-13 2010-08-17 Warsaw Orthopedic, Inc. Inter-cervical facet implant and method
US8029540B2 (en) 2005-05-10 2011-10-04 Kyphon Sarl Inter-cervical facet implant with implantation tool
US7763050B2 (en) * 2004-12-13 2010-07-27 Warsaw Orthopedic, Inc. Inter-cervical facet implant with locking screw and method
WO2006066228A2 (en) * 2004-12-16 2006-06-22 Innovative Spinal Technologies Expandable implants for spinal disc replacement
WO2006069089A2 (en) * 2004-12-21 2006-06-29 Packaging Service Corporation Of Kentucky Cervical plate system
FR2879436B1 (en) 2004-12-22 2007-03-09 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS
US20060161051A1 (en) * 2005-01-18 2006-07-20 Lauralan Terrill-Grisoni Method of computer-assisted ligament balancing and component placement in total knee arthroplasty
US20060247778A1 (en) * 2005-01-26 2006-11-02 Ferree Bret A Intradiscal devices including spacers facilitating posterior-lateral and other insertion approaches
US7785253B1 (en) 2005-01-31 2010-08-31 Nuvasive, Inc. Surgical access system and related methods
US8568331B2 (en) * 2005-02-02 2013-10-29 Nuvasive, Inc. System and methods for monitoring during anterior surgery
US8083797B2 (en) 2005-02-04 2011-12-27 Spinalmotion, Inc. Intervertebral prosthetic disc with shock absorption
US7901437B2 (en) 2007-01-26 2011-03-08 Jackson Roger P Dynamic stabilization member with molded connection
JP2008531091A (en) * 2005-02-22 2008-08-14 スミス アンド ネフュー インコーポレーテッド In-line milling system
US7722622B2 (en) * 2005-02-25 2010-05-25 Synthes Usa, Llc Implant insertion apparatus and method of use
US7267690B2 (en) 2005-03-09 2007-09-11 Vertebral Technologies, Inc. Interlocked modular disc nucleus prosthesis
US7749259B2 (en) * 2005-04-08 2010-07-06 Warsaw Orthopedic, Inc. Slotted screw for use with a vertebral member
US20060235416A1 (en) * 2005-04-15 2006-10-19 Sdgi Holdings, Inc. Intervertebral connecting elements
US7674296B2 (en) * 2005-04-21 2010-03-09 Globus Medical, Inc. Expandable vertebral prosthesis
US20060241641A1 (en) * 2005-04-22 2006-10-26 Sdgi Holdings, Inc. Methods and instrumentation for distraction and insertion of implants in a spinal disc space
CN1314369C (en) * 2005-05-31 2007-05-09 中国医学科学院北京协和医院 Skull-maxillofacial planting system and corresponding surgical equipment
US20060287583A1 (en) * 2005-06-17 2006-12-21 Pool Cover Corporation Surgical access instruments for use with delicate tissues
WO2007002251A2 (en) * 2005-06-22 2007-01-04 Vycor Medical, Inc. Surgical access instruments for use with spinal or orthopedic surgery
US20060293709A1 (en) 2005-06-24 2006-12-28 Bojarski Raymond A Tissue repair device
FR2887762B1 (en) 2005-06-29 2007-10-12 Ldr Medical Soc Par Actions Si INTERVERTEBRAL DISC PROSTHESIS INSERTION INSTRUMENTATION BETWEEN VERTEBRATES
US8273088B2 (en) * 2005-07-08 2012-09-25 Depuy Spine, Inc. Bone removal tool
US8623088B1 (en) 2005-07-15 2014-01-07 Nuvasive, Inc. Spinal fusion implant and related methods
US8147521B1 (en) 2005-07-20 2012-04-03 Nuvasive, Inc. Systems and methods for treating spinal deformities
US8740783B2 (en) * 2005-07-20 2014-06-03 Nuvasive, Inc. System and methods for performing neurophysiologic assessments with pressure monitoring
US8523865B2 (en) * 2005-07-22 2013-09-03 Exactech, Inc. Tissue splitter
WO2007016247A2 (en) 2005-07-28 2007-02-08 Nuvasive, Inc. Total disc replacement system and related methods
WO2007016683A2 (en) 2005-07-29 2007-02-08 X-Sten, Corp. Device for resecting spinal tissue
US20070055379A1 (en) * 2005-08-03 2007-03-08 Stone Corbett W Annular access devices
EP1922000A4 (en) * 2005-08-09 2009-10-28 Trans1 Inc Exchange system for axial spinal procedures
US8366773B2 (en) 2005-08-16 2013-02-05 Benvenue Medical, Inc. Apparatus and method for treating bone
AU2006279558B2 (en) * 2005-08-16 2012-05-17 Izi Medical Products, Llc Spinal tissue distraction devices
US8591583B2 (en) 2005-08-16 2013-11-26 Benvenue Medical, Inc. Devices for treating the spine
US20070050028A1 (en) * 2005-08-26 2007-03-01 Conner E S Spinal implants and methods of providing dynamic stability to the spine
US20070244562A1 (en) * 2005-08-26 2007-10-18 Magellan Spine Technologies, Inc. Spinal implants and methods of providing dynamic stability to the spine
US20090171461A1 (en) * 2005-08-26 2009-07-02 Magellan Spine Technologies, Inc. Spinal implants and methods
US7835784B2 (en) * 2005-09-21 2010-11-16 Medtronic Navigation, Inc. Method and apparatus for positioning a reference frame
WO2007038290A2 (en) 2005-09-22 2007-04-05 Nuvasive, Inc. Multi-channel stimulation threshold detection algorithm for use in neurophysiology monitoring
FR2891135B1 (en) 2005-09-23 2008-09-12 Ldr Medical Sarl INTERVERTEBRAL DISC PROSTHESIS
GB2430396A (en) * 2005-09-23 2007-03-28 Thomas Hoogland A surgical drill
US9271843B2 (en) 2005-09-27 2016-03-01 Henry F. Fabian Spine surgery method and implant
US8568317B1 (en) 2005-09-27 2013-10-29 Nuvasive, Inc. System and methods for nerve monitoring
US8236058B2 (en) * 2005-09-27 2012-08-07 Fabian Henry F Spine surgery method and implant
WO2007038429A1 (en) 2005-09-27 2007-04-05 Endius, Inc. Methods and apparatuses for stabilizing the spine through an access device
US20070093899A1 (en) * 2005-09-28 2007-04-26 Christof Dutoit Apparatus and methods for treating bone
US8167915B2 (en) 2005-09-28 2012-05-01 Nuvasive, Inc. Methods and apparatus for treating spinal stenosis
US20080140076A1 (en) * 2005-09-30 2008-06-12 Jackson Roger P Dynamic stabilization connecting member with slitted segment and surrounding external elastomer
US8105368B2 (en) * 2005-09-30 2012-01-31 Jackson Roger P Dynamic stabilization connecting member with slitted core and outer sleeve
US20070106316A1 (en) * 2005-10-10 2007-05-10 University Of South Florida Dural Knife with Foot Plate
WO2007050644A2 (en) * 2005-10-24 2007-05-03 Nexgen Spine, Inc. Intervertebral disc replacement and associated instrumentation
US20070123904A1 (en) * 2005-10-31 2007-05-31 Depuy Spine, Inc. Distraction instrument and method for distracting an intervertebral site
US20070123903A1 (en) * 2005-10-31 2007-05-31 Depuy Spine, Inc. Medical Device installation tool and methods of use
US7867237B2 (en) * 2005-10-31 2011-01-11 Depuy Spine, Inc. Arthroplasty revision device and method
US20070118055A1 (en) * 2005-11-04 2007-05-24 Smith & Nephew, Inc. Systems and methods for facilitating surgical procedures involving custom medical implants
FR2893838B1 (en) 2005-11-30 2008-08-08 Ldr Medical Soc Par Actions Si PROSTHESIS OF INTERVERTEBRAL DISC AND INSTRUMENTATION OF INSERTION OF THE PROSTHESIS BETWEEN VERTEBRATES
US7862592B2 (en) * 2005-12-06 2011-01-04 Nuvasive, Inc. Methods and apparatus for treating spinal stenosis
US20070162040A1 (en) * 2005-12-06 2007-07-12 Zimmer Spine, Inc. Spinal distraction and endplate preparation device and method
US8002802B2 (en) * 2005-12-19 2011-08-23 Samy Abdou Devices and methods for inter-vertebral orthopedic device placement
US7704271B2 (en) * 2005-12-19 2010-04-27 Abdou M Samy Devices and methods for inter-vertebral orthopedic device placement
US7988695B2 (en) * 2005-12-21 2011-08-02 Theken Spine, Llc Articulated delivery instrument
US20070162132A1 (en) 2005-12-23 2007-07-12 Dominique Messerli Flexible elongated chain implant and method of supporting body tissue with same
US7935148B2 (en) * 2006-01-09 2011-05-03 Warsaw Orthopedic, Inc. Adjustable insertion device for a vertebral implant
US20080294198A1 (en) * 2006-01-09 2008-11-27 Jackson Roger P Dynamic spinal stabilization assembly with torsion and shear control
US20070161962A1 (en) * 2006-01-09 2007-07-12 Edie Jason A Device and method for moving fill material to an implant
WO2007130699A2 (en) * 2006-01-13 2007-11-15 Clifford Tribus Spine reduction and stabilization device
US9168102B2 (en) * 2006-01-18 2015-10-27 Medtronic Navigation, Inc. Method and apparatus for providing a container to a sterile environment
US8377072B2 (en) * 2006-02-06 2013-02-19 Depuy Spine, Inc. Medical device installation tool
US20070233089A1 (en) * 2006-02-17 2007-10-04 Endius, Inc. Systems and methods for reducing adjacent level disc disease
EP1988855A2 (en) 2006-02-27 2008-11-12 Synthes GmbH Intervertebral implant with fixation geometry
US8118869B2 (en) 2006-03-08 2012-02-21 Flexuspine, Inc. Dynamic interbody device
US7875034B2 (en) * 2006-03-14 2011-01-25 Warsaw Orthopedic, Inc. Spinal disc space preparation instruments and methods for interbody spinal implants
US8066714B2 (en) * 2006-03-17 2011-11-29 Warsaw Orthopedic Inc. Instrumentation for distraction and insertion of implants in a spinal disc space
US7976549B2 (en) * 2006-03-23 2011-07-12 Theken Spine, Llc Instruments for delivering spinal implants
JP4849933B2 (en) * 2006-03-29 2012-01-11 富士通株式会社 Web load test method and web load test program
EP2007322A4 (en) 2006-04-12 2011-10-26 Spinalmotion Inc Posterior spinal device and method
US7615079B2 (en) * 2006-04-20 2009-11-10 Meditech Advisors, Llc Monorail system
US8112292B2 (en) * 2006-04-21 2012-02-07 Medtronic Navigation, Inc. Method and apparatus for optimizing a therapy
US7942830B2 (en) 2006-05-09 2011-05-17 Vertos Medical, Inc. Ipsilateral approach to minimally invasive ligament decompression procedure
US8092536B2 (en) 2006-05-24 2012-01-10 Disc Dynamics, Inc. Retention structure for in situ formation of an intervertebral prosthesis
US20070288092A1 (en) * 2006-06-01 2007-12-13 Bambakidis Nicholas Expandable intervertebral implant and method
US7833284B2 (en) * 2006-06-28 2010-11-16 The Cleveland Clinic Foundation Anti-adhesion membrane
US20080033251A1 (en) * 2006-06-30 2008-02-07 Ali Araghi Surgical retractor and method of use
US7780676B2 (en) 2006-07-11 2010-08-24 Ebi, Llc Intervertebral implantation apparatus
USD741488S1 (en) 2006-07-17 2015-10-20 Nuvasive, Inc. Spinal fusion implant
US8998990B2 (en) 2006-07-24 2015-04-07 DePuy Synthes Products, LLC Intervertebral implant with keel
WO2008013960A2 (en) * 2006-07-27 2008-01-31 Abdou Samy M Devices and methods for the minimally invasive treatment of spinal stenosis
US20080051901A1 (en) * 2006-07-28 2008-02-28 Spinalmotion, Inc. Spinal Prosthesis with Multiple Pillar Anchors
US20080051900A1 (en) * 2006-07-28 2008-02-28 Spinalmotion, Inc. Spinal Prosthesis with Offset Anchors
BRPI0714955A2 (en) 2006-07-31 2013-07-23 Systhes Gmbh instrument system and method for preparing an intervertebral space to receive an implant, and milling guide for use with an instrument system
US8834526B2 (en) * 2006-08-09 2014-09-16 Rolando Garcia Methods and apparatus for treating spinal stenosis
US8043377B2 (en) * 2006-09-02 2011-10-25 Osprey Biomedical, Inc. Implantable intervertebral fusion device
US8357168B2 (en) * 2006-09-08 2013-01-22 Spine Wave, Inc. Modular injection needle and seal assembly
US8506636B2 (en) * 2006-09-08 2013-08-13 Theken Spine, Llc Offset radius lordosis
US20080077241A1 (en) * 2006-09-22 2008-03-27 Linh Nguyen Removable rasp/trial member insert, kit and method of use
US20080161817A1 (en) * 2006-09-28 2008-07-03 Depuy Spine, Inc. Intervertebral distraction device
US8660635B2 (en) 2006-09-29 2014-02-25 Medtronic, Inc. Method and apparatus for optimizing a computer assisted surgical procedure
US20080161927A1 (en) * 2006-10-18 2008-07-03 Warsaw Orthopedic, Inc. Intervertebral Implant with Porous Portions
US8845726B2 (en) 2006-10-18 2014-09-30 Vertiflex, Inc. Dilator
US8096996B2 (en) * 2007-03-20 2012-01-17 Exactech, Inc. Rod reducer
US20080108990A1 (en) * 2006-11-02 2008-05-08 St. Francis Medical Technologies, Inc. Interspinous process implant having a fixed wing and a deployable wing and method of implantation
US8025664B2 (en) 2006-11-03 2011-09-27 Innovative Spine, Llc System and method for providing surgical access to a spine
US9737414B2 (en) 2006-11-21 2017-08-22 Vertebral Technologies, Inc. Methods and apparatus for minimally invasive modular interbody fusion devices
US7887548B2 (en) * 2006-12-05 2011-02-15 Aesculap Implant Systems, Llc Screw insertion guide tube with window
US8105382B2 (en) 2006-12-07 2012-01-31 Interventional Spine, Inc. Intervertebral implant
US9480485B2 (en) 2006-12-15 2016-11-01 Globus Medical, Inc. Devices and methods for vertebrostenting
US20080161929A1 (en) 2006-12-29 2008-07-03 Mccormack Bruce Cervical distraction device
US8974496B2 (en) * 2007-08-30 2015-03-10 Jeffrey Chun Wang Interspinous implant, tools and methods of implanting
US20080167655A1 (en) * 2007-01-05 2008-07-10 Jeffrey Chun Wang Interspinous implant, tools and methods of implanting
US8475498B2 (en) * 2007-01-18 2013-07-02 Roger P. Jackson Dynamic stabilization connecting member with cord connection
US8366745B2 (en) * 2007-05-01 2013-02-05 Jackson Roger P Dynamic stabilization assembly having pre-compressed spacers with differential displacements
US8597358B2 (en) 2007-01-19 2013-12-03 Flexuspine, Inc. Dynamic interbody devices
US20080183044A1 (en) * 2007-01-26 2008-07-31 Dennis Colleran Flexible surgical retractor and method of use
US8062217B2 (en) * 2007-01-26 2011-11-22 Theken Spine, Llc Surgical retractor with removable blades and method of use
AU2008216371B2 (en) * 2007-02-12 2014-04-10 Warsaw Orthopedic, Inc. Joint revision implant
US8465546B2 (en) 2007-02-16 2013-06-18 Ldr Medical Intervertebral disc prosthesis insertion assemblies
CA2678006C (en) 2007-02-21 2014-10-14 Benvenue Medical, Inc. Devices for treating the spine
US8556976B2 (en) 2007-03-01 2013-10-15 The Center For Orthopedic Research And Education, Inc. Spinal interbody spacer device
US8673005B1 (en) 2007-03-07 2014-03-18 Nuvasive, Inc. System and methods for spinal fusion
AU2008236665B2 (en) * 2007-04-03 2013-08-22 Nuvasive, Inc. Neurophysiologic monitoring system
ITRE20070053A1 (en) * 2007-04-12 2008-10-13 Cgm Spa "BONE SURGICAL INSTRUMENT"
ITRE20070054A1 (en) * 2007-04-12 2008-10-13 Cgm Spa "BONE SURGICAL INSTRUMENT"
US7901439B2 (en) * 2007-04-13 2011-03-08 Horton Kenneth L Allograft spinal facet fusion system
EP2155121B1 (en) 2007-04-16 2015-06-17 Vertiflex, Inc. Interspinous spacer
US8454622B2 (en) * 2007-04-25 2013-06-04 Spinal Elements, Inc. Spinal implant distractor/inserter
US8062304B2 (en) 2007-04-25 2011-11-22 Spinal Elements, Inc. Spinal implant distractor/inserter
US10383660B2 (en) 2007-05-01 2019-08-20 Roger P. Jackson Soft stabilization assemblies with pretensioned cords
US8579910B2 (en) * 2007-05-18 2013-11-12 DePuy Synthes Products, LLC Insertion blade assembly and method of use
EP2155124A4 (en) * 2007-05-22 2013-04-03 Vg Innovations Llc Method and apparatus for spinal facet fusion
US8480715B2 (en) 2007-05-22 2013-07-09 Zimmer Spine, Inc. Spinal implant system and method
WO2008153747A2 (en) * 2007-05-25 2008-12-18 Vertiflex, Inc. Dynamic rod
US7967867B2 (en) 2007-05-31 2011-06-28 Spine Wave, Inc. Expandable interbody fusion device
US8070754B2 (en) * 2007-05-31 2011-12-06 Fabian Henry F Spine surgery method and instrumentation
KR20100021954A (en) * 2007-06-01 2010-02-26 가부시끼가이샤 와까요시 세이사꾸쇼 Medical cutting tool, its guide member, and cut bone sampling tool
JP2008295901A (en) * 2007-06-01 2008-12-11 Wakayoshi Seisakusho Co Ltd Instrument for collecting excised bone
FR2916956B1 (en) 2007-06-08 2012-12-14 Ldr Medical INTERSOMATIC CAGE, INTERVERTEBRAL PROSTHESIS, ANCHORING DEVICE AND IMPLANTATION INSTRUMENTATION
US8900307B2 (en) 2007-06-26 2014-12-02 DePuy Synthes Products, LLC Highly lordosed fusion cage
US10342674B2 (en) 2007-07-02 2019-07-09 Theken Spine, Llc Spinal cage having deployable member
US8292958B1 (en) 2007-07-02 2012-10-23 Theken Spine, Llc Spinal cage having deployable member
US8142508B1 (en) 2007-07-02 2012-03-27 Theken Spine, Llc Spinal cage having deployable member which is removable
US8864829B1 (en) 2007-07-02 2014-10-21 Theken Spine, Llc Spinal cage having deployable member
US8545562B1 (en) 2007-07-02 2013-10-01 Theken Spine, Llc Deployable member for use with an intervertebral cage
US20090012620A1 (en) * 2007-07-06 2009-01-08 Jim Youssef Implantable Cervical Fusion Device
US7867263B2 (en) * 2007-08-07 2011-01-11 Transcorp, Inc. Implantable bone plate system and related method for spinal repair
US8709054B2 (en) 2007-08-07 2014-04-29 Transcorp, Inc. Implantable vertebral frame systems and related methods for spinal repair
WO2009021144A2 (en) * 2007-08-07 2009-02-12 Transcorp, Inc. Device for variably adjusting intervertebral distraction and lordosis
US20090043391A1 (en) 2007-08-09 2009-02-12 Spinalmotion, Inc. Customized Intervertebral Prosthetic Disc with Shock Absorption
US8808380B2 (en) * 2007-08-27 2014-08-19 William Casey Fox Method and apparatus for an osteotomy fixation or arthrodesis cage
US8430882B2 (en) 2007-09-13 2013-04-30 Transcorp, Inc. Transcorporeal spinal decompression and repair systems and related methods
WO2009036360A1 (en) * 2007-09-13 2009-03-19 Transcorp, Inc. Device and method for tissue retraction in spinal surgery
US8323320B2 (en) * 2007-09-13 2012-12-04 Transcorp, Inc. Transcorporeal spinal decompression and repair system and related method
USD671645S1 (en) 2007-09-18 2012-11-27 Nuvasive, Inc. Intervertebral implant
WO2009045912A2 (en) * 2007-09-28 2009-04-09 Transcorp, Inc. Vertebrally-mounted tissue retractor and method for use in spinal surgery
US8162994B2 (en) * 2007-10-22 2012-04-24 Flexuspine, Inc. Posterior stabilization system with isolated, dual dampener systems
US8187330B2 (en) * 2007-10-22 2012-05-29 Flexuspine, Inc. Dampener system for a posterior stabilization system with a variable length elongated member
EP2209444A4 (en) * 2007-10-22 2013-03-27 Spinalmotion Inc Dynamic spacer device and method for spanning a space formed upon removal of an intervertebral disc
US8267965B2 (en) 2007-10-22 2012-09-18 Flexuspine, Inc. Spinal stabilization systems with dynamic interbody devices
US8182514B2 (en) 2007-10-22 2012-05-22 Flexuspine, Inc. Dampener system for a posterior stabilization system with a fixed length elongated member
US8523912B2 (en) 2007-10-22 2013-09-03 Flexuspine, Inc. Posterior stabilization systems with shared, dual dampener systems
US8157844B2 (en) 2007-10-22 2012-04-17 Flexuspine, Inc. Dampener system for a posterior stabilization system with a variable length elongated member
US8267997B2 (en) * 2007-11-12 2012-09-18 Theken Spine, Llc Vertebral interbody compression implant
US20090125032A1 (en) * 2007-11-14 2009-05-14 Gutierrez Robert C Rod removal instrument
US8518115B2 (en) * 2007-11-16 2013-08-27 DePuy Synthes Products, LLC Porous containment device and associated method for stabilization of vertebral compression fractures
EP2217179A1 (en) 2007-11-16 2010-08-18 Synthes GmbH Low profile intervertebral implant
EP2227293B1 (en) * 2007-11-26 2019-08-28 Attractive Surgical, LLC Magnaretractor system
WO2009070607A1 (en) 2007-11-27 2009-06-04 Transcorp, Inc. Methods and systems for repairing an intervertebral disc using a transcorporal approach
WO2009076239A2 (en) * 2007-12-06 2009-06-18 Vertiflex, Inc. Spondylolisthesis reduction system and method
US9101491B2 (en) 2007-12-28 2015-08-11 Nuvasive, Inc. Spinal surgical implant and related methods
US9005288B2 (en) * 2008-01-09 2015-04-14 Providence Medical Techonlogy, Inc. Methods and apparatus for accessing and treating the facet joint
WO2009091922A2 (en) 2008-01-15 2009-07-23 Vertiflex, Inc. Interspinous spacer
EP2471493A1 (en) 2008-01-17 2012-07-04 Synthes GmbH An expandable intervertebral implant and associated method of manufacturing the same
WO2009094477A1 (en) * 2008-01-25 2009-07-30 Spinalmotion, Inc. Compliant implantable prosthetic joint with preloaded spring
US8372081B1 (en) 2008-02-20 2013-02-12 Nuvasive, Inc. Vertebral distraction assembly and related methods
US8343161B2 (en) * 2008-02-21 2013-01-01 Covidien Lp Femoral guide for ACL repair having multiple lumen
US8083796B1 (en) 2008-02-29 2011-12-27 Nuvasive, Inc. Implants and methods for spinal fusion
US8764833B2 (en) * 2008-03-11 2014-07-01 Spinalmotion, Inc. Artificial intervertebral disc with lower height
US8864770B2 (en) * 2008-03-12 2014-10-21 Spinal Elements, Inc. Offset opposing arm spinal implant distractor/inserter
US8202299B2 (en) 2008-03-19 2012-06-19 Collabcom II, LLC Interspinous implant, tools and methods of implanting
US8333804B1 (en) 2008-03-27 2012-12-18 Spinelogik, Inc. Intervertebral fusion device and method of use
US8313528B1 (en) 2008-03-27 2012-11-20 Spinelogik, Inc. Intervertebral fusion device and method of use
CA2720580A1 (en) 2008-04-05 2009-10-08 Synthes Usa, Llc Expandable intervertebral implant
US9034038B2 (en) * 2008-04-11 2015-05-19 Spinalmotion, Inc. Motion limiting insert for an artificial intervertebral disc
US20090270873A1 (en) * 2008-04-24 2009-10-29 Fabian Henry F Spine surgery method and inserter
US20090275993A1 (en) * 2008-04-30 2009-11-05 Phan Christopher U Apparatus and methods for inserting facet screws
WO2009137514A1 (en) 2008-05-05 2009-11-12 Spinalmotion, Inc. Polyaryletherketone artificial intervertebral disc
US8636740B2 (en) * 2008-05-08 2014-01-28 Aesculap Implant Systems, Llc Minimally invasive spinal stabilization system
EP2346416A4 (en) * 2008-05-23 2013-07-03 Spine View Inc Method and devices for treating spinal stenosis
EP3412231A1 (en) 2008-06-06 2018-12-12 Providence Medical Technology, Inc. Facet joint implants and delivery tools
US8267966B2 (en) * 2008-06-06 2012-09-18 Providence Medical Technology, Inc. Facet joint implants and delivery tools
EP2361046B1 (en) 2008-06-06 2019-04-24 Providence Medical Technology, Inc. Cervical distraction/implant delivery device
US9333086B2 (en) 2008-06-06 2016-05-10 Providence Medical Technology, Inc. Spinal facet cage implant
US9381049B2 (en) 2008-06-06 2016-07-05 Providence Medical Technology, Inc. Composite spinal facet implant with textured surfaces
US11224521B2 (en) 2008-06-06 2022-01-18 Providence Medical Technology, Inc. Cervical distraction/implant delivery device
US8361152B2 (en) 2008-06-06 2013-01-29 Providence Medical Technology, Inc. Facet joint implants and delivery tools
WO2009155319A1 (en) 2008-06-17 2009-12-23 Soteira, Inc. Devices and methods for fracture reduction
US9220603B2 (en) * 2008-07-02 2015-12-29 Simplify Medical, Inc. Limited motion prosthetic intervertebral disc
EP2299944A4 (en) * 2008-07-17 2013-07-31 Spinalmotion Inc Artificial intervertebral disc placement system
WO2010009153A1 (en) 2008-07-18 2010-01-21 Spinalmotion, Inc. Posterior prosthetic intervertebral disc
EP2303196B1 (en) * 2008-07-23 2018-10-24 Marc I. Malberg Modular nucleus pulposus prosthesis
US9364338B2 (en) 2008-07-23 2016-06-14 Resspond Spinal Systems Modular nucleus pulposus prosthesis
US8808294B2 (en) 2008-09-09 2014-08-19 William Casey Fox Method and apparatus for a multiple transition temperature implant
US8165658B2 (en) 2008-09-26 2012-04-24 Medtronic, Inc. Method and apparatus for positioning a guide relative to a base
USD621509S1 (en) 2008-10-15 2010-08-10 Nuvasive, Inc. Intervertebral implant
JP5893407B2 (en) 2008-10-21 2016-03-23 ダブリュ・ダブリュ・テクノロジー・アクチェンゲゼルシャフトWw Technology Ag Fusion device and tool set for fusing human or animal joints
US8382767B2 (en) * 2008-10-31 2013-02-26 K2M, Inc. Implant insertion tool
BRPI0921486A2 (en) 2008-11-07 2019-09-10 Synthes Gmbh vertebral intercorporeal unit of spacer and coupled plate
EP2376028B1 (en) * 2008-12-22 2017-02-22 Synthes GmbH Orthopedic implant with flexible keel
US8721723B2 (en) 2009-01-12 2014-05-13 Globus Medical, Inc. Expandable vertebral prosthesis
US8157865B2 (en) * 2009-01-22 2012-04-17 Stephen Hochschuler Apparatus and method for stabilizing adjacent bone portions
USD754346S1 (en) 2009-03-02 2016-04-19 Nuvasive, Inc. Spinal fusion implant
US9387090B2 (en) 2009-03-12 2016-07-12 Nuvasive, Inc. Vertebral body replacement
US9687357B2 (en) 2009-03-12 2017-06-27 Nuvasive, Inc. Vertebral body replacement
EP2408381B1 (en) 2009-03-16 2014-11-12 Synthes GmbH System for stabilizing vertebrae in spine surgery through a lateral access channel
US8535327B2 (en) 2009-03-17 2013-09-17 Benvenue Medical, Inc. Delivery apparatus for use with implantable medical devices
US8906033B2 (en) * 2009-03-30 2014-12-09 DePuy Synthes Products, LLC Cervical motion disc inserter
US9526620B2 (en) 2009-03-30 2016-12-27 DePuy Synthes Products, Inc. Zero profile spinal fusion cage
US8911497B2 (en) * 2009-04-09 2014-12-16 DePuy Synthes Products, LLC Minimally invasive spine augmentation and stabilization system and method
US8641766B2 (en) 2009-04-15 2014-02-04 DePuy Synthes Products, LLC Arcuate fixation member
US9408715B2 (en) 2009-04-15 2016-08-09 DePuy Synthes Products, Inc. Arcuate fixation member
JP5591912B2 (en) * 2009-04-15 2014-09-17 ジンテス ゲゼルシャフト ミット ベシュレンクテル ハフツング Arcuate fixing member
US8287597B1 (en) 2009-04-16 2012-10-16 Nuvasive, Inc. Method and apparatus for performing spine surgery
US9351845B1 (en) 2009-04-16 2016-05-31 Nuvasive, Inc. Method and apparatus for performing spine surgery
GB0907064D0 (en) * 2009-04-24 2009-06-03 Grampian Health Board Tissue anchor insertion system
DE202009006792U1 (en) * 2009-05-12 2010-09-23 Joimax Gmbh Spinal cutter
US8206394B2 (en) * 2009-05-13 2012-06-26 Depuy Spine, Inc. Torque limited instrument for manipulating a spinal rod relative to a bone anchor
US8998959B2 (en) 2009-06-15 2015-04-07 Roger P Jackson Polyaxial bone anchors with pop-on shank, fully constrained friction fit retainer and lock and release insert
DE102009032034A1 (en) 2009-06-26 2010-12-30 Aesculap Ag Surgical bone anchoring device and spine fixation system
ES2563172T3 (en) 2009-07-09 2016-03-11 R Tree Innovations, Llc Flexible intersomatic implant
US9399086B2 (en) 2009-07-24 2016-07-26 Warsaw Orthopedic, Inc Implantable medical devices
WO2011017712A2 (en) * 2009-08-07 2011-02-10 Exatech, Inc. Systems and methods for stabilization of bone structures, including thorocolumbar stabilization systems and methods
US8382840B2 (en) * 2009-09-03 2013-02-26 Zimmer Spine, Inc. Spinal implant delivery methods and devices
ES2659063T3 (en) 2009-09-17 2018-03-13 Ldr Holding Corporation Intervertebral implant incorporating expandable bone fixation members
CA2774471A1 (en) * 2009-10-05 2011-04-14 James L. Surber Polyaxial bone anchor with non-pivotable retainer and pop-on shank, some with friction fit
USD731063S1 (en) 2009-10-13 2015-06-02 Nuvasive, Inc. Spinal fusion implant
US9028553B2 (en) 2009-11-05 2015-05-12 DePuy Synthes Products, Inc. Self-pivoting spinal implant and associated instrumentation
US20110112373A1 (en) * 2009-11-10 2011-05-12 Trans1 Inc. Soft tissue access apparatus and methods for spinal surgery
DE112010004338B4 (en) 2009-11-10 2019-06-27 Nuvasive, Inc. DEVICE FOR IMPLEMENTING SPINE SURGERY
US8764806B2 (en) 2009-12-07 2014-07-01 Samy Abdou Devices and methods for minimally invasive spinal stabilization and instrumentation
US9393129B2 (en) 2009-12-10 2016-07-19 DePuy Synthes Products, Inc. Bellows-like expandable interbody fusion cage
US8740948B2 (en) 2009-12-15 2014-06-03 Vertiflex, Inc. Spinal spacer for cervical and other vertebra, and associated systems and methods
CA3003975A1 (en) 2009-12-31 2011-07-07 Ldr Medical Anchoring device, intervertebral implant and implantation instrument
US8636655B1 (en) 2010-01-19 2014-01-28 Ronald Childs Tissue retraction system and related methods
US8945227B2 (en) * 2010-02-01 2015-02-03 X-Spine Systems, Inc. Spinal implant co-insertion system and method
US9427324B1 (en) 2010-02-22 2016-08-30 Spinelogik, Inc. Intervertebral fusion device and method of use
US9265622B2 (en) * 2010-03-22 2016-02-23 Amendia, Inc. Percutaneous arthrodesis method and system
US8425569B2 (en) 2010-05-19 2013-04-23 Transcorp, Inc. Implantable vertebral frame systems and related methods for spinal repair
US8979860B2 (en) 2010-06-24 2015-03-17 DePuy Synthes Products. LLC Enhanced cage insertion device
US9592063B2 (en) 2010-06-24 2017-03-14 DePuy Synthes Products, Inc. Universal trial for lateral cages
TW201215379A (en) 2010-06-29 2012-04-16 Synthes Gmbh Distractible intervertebral implant
US9044334B2 (en) 2010-07-21 2015-06-02 Nlt Spine Ltd. Spinal surgery implants and delivery system
EP2598061A1 (en) * 2010-07-27 2013-06-05 Richard S. Ginn System for sacro-iliac stabilization
WO2012018792A1 (en) * 2010-08-02 2012-02-09 Synthes Usa, Llc Orthopedic implant system
DE102010035832A1 (en) * 2010-08-30 2012-03-01 Spontech Spine Intelligence Group Ag Instrumentation for inserting an implant into an intervertebral disc space
BR112013005465A2 (en) 2010-09-08 2019-09-24 P Jackson Roger connecting element in a medical implant assembly having at least two bone attachment structures cooperating with a dynamic longitudinal connecting element
US9392953B1 (en) 2010-09-17 2016-07-19 Nuvasive, Inc. Neurophysiologic monitoring
WO2012040206A1 (en) 2010-09-20 2012-03-29 Synthes Usa, Llc Spinal access retractor
US8449463B2 (en) 2010-10-08 2013-05-28 K2M, Inc. Lateral access system and method of use
US9402732B2 (en) 2010-10-11 2016-08-02 DePuy Synthes Products, Inc. Expandable interspinous process spacer implant
US8409257B2 (en) 2010-11-10 2013-04-02 Warsaw Othopedic, Inc. Systems and methods for facet joint stabilization
EP2654626B1 (en) 2010-12-21 2016-02-24 Synthes GmbH Intervertebral implants and systems
JP5797898B2 (en) * 2010-12-28 2015-10-21 タキロン株式会社 Bone tap jig
US9445825B2 (en) 2011-02-10 2016-09-20 Wright Medical Technology, Inc. Expandable surgical device
US8394129B2 (en) 2011-03-10 2013-03-12 Interventional Spine, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
US8518087B2 (en) 2011-03-10 2013-08-27 Interventional Spine, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
US8388687B2 (en) 2011-03-25 2013-03-05 Flexuspine, Inc. Interbody device insertion systems and methods
US9307972B2 (en) 2011-05-10 2016-04-12 Nuvasive, Inc. Method and apparatus for performing spinal fusion surgery
WO2012153319A1 (en) 2011-05-12 2012-11-15 Non-Linear Technologies Ltd. Tissue disruption device and corresponding methods
WO2012178018A2 (en) 2011-06-24 2012-12-27 Benvenue Medical, Inc. Devices and methods for treating bone tissue
BE1020047A3 (en) * 2011-07-05 2013-04-02 Janssens Johan INSTRUMENT TO TAKE A BOTBIOPSY.
US9295501B2 (en) * 2011-08-02 2016-03-29 Blackstone Medical, Inc. Bayonet counter-torque wrench
WO2013028571A1 (en) 2011-08-19 2013-02-28 Lanx, Inc. Surgical retractor system and methods of use
US8845728B1 (en) 2011-09-23 2014-09-30 Samy Abdou Spinal fixation devices and methods of use
USD675320S1 (en) 2011-11-03 2013-01-29 Nuvasive, Inc. Intervertebral implant
USD721808S1 (en) 2011-11-03 2015-01-27 Nuvasive, Inc. Intervertebral implant
US9526627B2 (en) 2011-11-17 2016-12-27 Exactech, Inc. Expandable interbody device system and method
US9788844B2 (en) * 2011-12-16 2017-10-17 Medos International Sarl Methods and systems for attaching tissue to bone
US9463052B2 (en) * 2012-01-12 2016-10-11 Integrity Implants Inc. Access assembly for anterior and lateral spinal procedures
US20130226240A1 (en) 2012-02-22 2013-08-29 Samy Abdou Spinous process fixation devices and methods of use
FR2987256B1 (en) 2012-02-24 2014-08-08 Ldr Medical ANCHORING DEVICE FOR INTERVERTEBRAL IMPLANT, INTERVERTEBRAL IMPLANT AND IMPLANTATION INSTRUMENTATION
US9510953B2 (en) 2012-03-16 2016-12-06 Vertebral Technologies, Inc. Modular segmented disc nucleus implant
RU2014146705A (en) 2012-05-29 2016-07-20 ЭнЭлТи-СПАЙН ЛТД. Laterally variable implant
USD775735S1 (en) * 2012-07-13 2017-01-03 FusioNX, sarl Apparatus for correcting hammer toe
US9011450B2 (en) 2012-08-08 2015-04-21 DePuy Synthes Products, LLC Surgical instrument
US9198767B2 (en) 2012-08-28 2015-12-01 Samy Abdou Devices and methods for spinal stabilization and instrumentation
US9320617B2 (en) 2012-10-22 2016-04-26 Cogent Spine, LLC Devices and methods for spinal stabilization and instrumentation
USD732667S1 (en) 2012-10-23 2015-06-23 Providence Medical Technology, Inc. Cage spinal implant
USD745156S1 (en) 2012-10-23 2015-12-08 Providence Medical Technology, Inc. Spinal implant
US11877860B2 (en) 2012-11-06 2024-01-23 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US11259737B2 (en) 2012-11-06 2022-03-01 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9757067B1 (en) 2012-11-09 2017-09-12 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US8715351B1 (en) 2012-11-29 2014-05-06 Spine Wave, Inc. Expandable interbody fusion device with graft chambers
KR101302453B1 (en) * 2012-12-11 2013-09-02 박경우 Percutaneous extraforaminotomy with foraminal ligament resection and instrument tools being used for the same
US10022245B2 (en) 2012-12-17 2018-07-17 DePuy Synthes Products, Inc. Polyaxial articulating instrument
US9757072B1 (en) 2013-02-11 2017-09-12 Nuvasive, Inc. Waveform marker placement algorithm for use in neurophysiologic monitoring
US8852239B2 (en) 2013-02-15 2014-10-07 Roger P Jackson Sagittal angle screw with integral shank and receiver
US9492288B2 (en) 2013-02-20 2016-11-15 Flexuspine, Inc. Expandable fusion device for positioning between adjacent vertebral bodies
US9717601B2 (en) 2013-02-28 2017-08-01 DePuy Synthes Products, Inc. Expandable intervertebral implant, system, kit and method
US9522070B2 (en) 2013-03-07 2016-12-20 Interventional Spine, Inc. Intervertebral implant
US9277928B2 (en) * 2013-03-11 2016-03-08 Interventional Spine, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
US8900312B2 (en) 2013-03-12 2014-12-02 Spine Wave, Inc. Expandable interbody fusion device with graft chambers
US9339285B2 (en) 2013-03-12 2016-05-17 Levita Magnetics International Corp. Grasper with magnetically-controlled positioning
US8828019B1 (en) 2013-03-13 2014-09-09 Spine Wave, Inc. Inserter for expanding an expandable interbody fusion device
US10085783B2 (en) 2013-03-14 2018-10-02 Izi Medical Products, Llc Devices and methods for treating bone tissue
US9913728B2 (en) 2013-03-14 2018-03-13 Quandary Medical, Llc Spinal implants and implantation system
US10327910B2 (en) 2013-03-14 2019-06-25 X-Spine Systems, Inc. Spinal implant and assembly
US9707099B2 (en) * 2013-03-15 2017-07-18 NuTech Spine, Inc. Anterior lumbar fusion method and device
USD701100S1 (en) * 2013-03-15 2014-03-18 Aesculap Implant Systems, Llc. Ratchet tool
US9675303B2 (en) 2013-03-15 2017-06-13 Vertiflex, Inc. Visualization systems, instruments and methods of using the same in spinal decompression procedures
US10098585B2 (en) 2013-03-15 2018-10-16 Cadwell Laboratories, Inc. Neuromonitoring systems and methods
US9539041B2 (en) 2013-09-12 2017-01-10 DePuy Synthes Products, Inc. Minimally invasive biomaterial injection system
US9526529B2 (en) 2013-09-25 2016-12-27 Blackstone Medical, Inc. Bone screw systems with pressure caps having biasing members
USD745159S1 (en) 2013-10-10 2015-12-08 Nuvasive, Inc. Intervertebral implant
US9480501B2 (en) 2013-10-21 2016-11-01 Blackstone Medical, Inc. Modular pedicle screw
US9566092B2 (en) 2013-10-29 2017-02-14 Roger P. Jackson Cervical bone anchor with collet retainer and outer locking sleeve
US9980758B2 (en) 2013-11-27 2018-05-29 Blackstone Medical, Inc. Minimally invasive counter-torque wrench system
US9451993B2 (en) 2014-01-09 2016-09-27 Roger P. Jackson Bi-radial pop-on cervical bone anchor
WO2015112645A1 (en) 2014-01-21 2015-07-30 Levita Magnetics International Corp. Laparoscopic graspers and systems therefor
USD775341S1 (en) * 2014-01-28 2016-12-27 Neogen Corporation Filtrating spike
US9445921B2 (en) 2014-03-06 2016-09-20 Spine Wave, Inc. Device for expanding and supporting body tissue
US9439783B2 (en) 2014-03-06 2016-09-13 Spine Wave, Inc. Inserter for expanding body tissue
US9216094B2 (en) 2014-03-06 2015-12-22 Spine Wave, Inc. Expandable spinal interbody fusion device and inserter
US11065132B2 (en) 2014-03-06 2021-07-20 Spine Wave, Inc. Method of expanding a space between opposing tissue surfaces
US9265623B2 (en) 2014-03-06 2016-02-23 Spine Wave, Inc. Method of expanding a spinal interbody fusion device
US10398565B2 (en) 2014-04-24 2019-09-03 Choice Spine, Llc Limited profile intervertebral implant with incorporated fastening and locking mechanism
US9517144B2 (en) 2014-04-24 2016-12-13 Exactech, Inc. Limited profile intervertebral implant with incorporated fastening mechanism
AU2015256024B2 (en) 2014-05-07 2020-03-05 Vertiflex, Inc. Spinal nerve decompression systems, dilation systems, and methods of using the same
TW201545703A (en) 2014-05-13 2015-12-16 Vycor Medical Inc Guidance system mounts for surgical introducers
WO2015184018A1 (en) 2014-05-28 2015-12-03 Providence Medical Technology, Inc. Lateral mass fixation system
US9597119B2 (en) 2014-06-04 2017-03-21 Roger P. Jackson Polyaxial bone anchor with polymer sleeve
EP3151788A4 (en) 2014-06-04 2018-01-17 Wenzel Spine, Inc. Bilaterally expanding intervertebral body fusion device
US10022172B2 (en) 2014-06-25 2018-07-17 Spine Wave, Inc. Minimally invasive posterolateral fusion
US9795370B2 (en) 2014-08-13 2017-10-24 Nuvasive, Inc. Minimally disruptive retractor and associated methods for spinal surgery
US10420480B1 (en) 2014-09-16 2019-09-24 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring
US9867718B2 (en) 2014-10-22 2018-01-16 DePuy Synthes Products, Inc. Intervertebral implants, systems, and methods of use
USD858769S1 (en) 2014-11-20 2019-09-03 Nuvasive, Inc. Intervertebral implant
US10034690B2 (en) 2014-12-09 2018-07-31 John A. Heflin Spine alignment system
US11426290B2 (en) 2015-03-06 2022-08-30 DePuy Synthes Products, Inc. Expandable intervertebral implant, system, kit and method
USD778443S1 (en) * 2015-03-31 2017-02-07 James Brannon Bone coring trephine
ES2897754T3 (en) 2015-04-13 2022-03-02 Levita Magnetics Int Corp retraction devices
EP3282954B1 (en) 2015-04-13 2021-07-28 Levita Magnetics International Corp. Grasper with magnetically-controlled positioning
US9775723B2 (en) 2015-06-16 2017-10-03 Spine Wave, Inc. Instrument and system for placing graft, implant and graft material for minimally invasive posterolateral fusion
US9913727B2 (en) 2015-07-02 2018-03-13 Medos International Sarl Expandable implant
US9895169B2 (en) * 2015-08-21 2018-02-20 Globus Medical, Inc. Self in-fusing pedicle screw implant
WO2017053813A1 (en) 2015-09-24 2017-03-30 Integrity Implants, Inc. Access assembly for anterior and lateral spinal procedures
US20180289363A1 (en) * 2015-10-06 2018-10-11 K2M, Inc. Surgical access system, devices thereof, and methods of using the same
CN108289689A (en) 2015-10-13 2018-07-17 普罗维登斯医疗技术公司 Joint of vertebral column implantation material conveying device and system
USD841165S1 (en) 2015-10-13 2019-02-19 Providence Medical Technology, Inc. Cervical cage
US10857003B1 (en) 2015-10-14 2020-12-08 Samy Abdou Devices and methods for vertebral stabilization
EP3195833B1 (en) 2016-01-19 2022-01-12 K2M, Inc. Surgical instrument
US10085830B2 (en) * 2016-05-13 2018-10-02 Medos International Sarl Device, system, and method for delivery of a tissue fixation device
WO2017223472A1 (en) 2016-06-23 2017-12-28 VGI Medical, LLC Method and apparatus for spinal facet fusion
TW201806562A (en) 2016-06-28 2018-03-01 普羅維登斯醫療科技公司 Spinal implant and methods of using the same
JP7023877B2 (en) 2016-06-28 2022-02-22 イーアイティー・エマージング・インプラント・テクノロジーズ・ゲーエムベーハー Expandable and angle-adjustable range-of-motion intervertebral cage
CN109688981A (en) 2016-06-28 2019-04-26 Eit 新兴移植技术股份有限公司 Distensible, adjustable angle intervertebral cage
USD887552S1 (en) 2016-07-01 2020-06-16 Providence Medical Technology, Inc. Cervical cage
US10314718B2 (en) 2016-09-22 2019-06-11 Loubert S. Suddaby Expandable intervertebral fusion implant
US10405842B2 (en) 2016-09-26 2019-09-10 K2M, Inc. Retraction system and method of use
US10973648B1 (en) 2016-10-25 2021-04-13 Samy Abdou Devices and methods for vertebral bone realignment
US10744000B1 (en) 2016-10-25 2020-08-18 Samy Abdou Devices and methods for vertebral bone realignment
US10543016B2 (en) 2016-11-07 2020-01-28 Vycor Medical, Inc. Surgical introducer with guidance system receptacle
US10376258B2 (en) 2016-11-07 2019-08-13 Vycor Medical, Inc. Surgical introducer with guidance system receptacle
US10888433B2 (en) 2016-12-14 2021-01-12 DePuy Synthes Products, Inc. Intervertebral implant inserter and related methods
US11213402B2 (en) 2017-01-11 2022-01-04 Loubert S. Suddaby Endoscopically implantable inflatable interbody fusion device
US9935395B1 (en) 2017-01-23 2018-04-03 Cadwell Laboratories, Inc. Mass connection plate for electrical connectors
US11207192B2 (en) 2017-01-26 2021-12-28 Loubert S. Suddaby Stand-alone expandable interbody spinal fusion device with integrated fixation mechanism
US11701239B2 (en) 2017-01-26 2023-07-18 Loubert S. Suddaby Stand-alone expandable interbody spinal fusion device with integrated fixation mechanism
US10111755B2 (en) 2017-02-24 2018-10-30 Warsaw, Orthopedic, Inc. Expanding interbody implant and articulating inserter and methods of use
CN110650693B (en) * 2017-03-30 2023-04-07 史密夫和内修有限公司 Bone graft grader for surgical repair
US10470894B2 (en) 2017-04-06 2019-11-12 Warsaw Orthopedic, Inc. Expanding interbody implant and articulating inserter and methods of use
US10398563B2 (en) 2017-05-08 2019-09-03 Medos International Sarl Expandable cage
EP3624708A1 (en) 2017-05-19 2020-03-25 Providence Medical Technology, Inc. Spinal fixation access and delivery system
US11344424B2 (en) 2017-06-14 2022-05-31 Medos International Sarl Expandable intervertebral implant and related methods
US10940016B2 (en) 2017-07-05 2021-03-09 Medos International Sarl Expandable intervertebral fusion cage
US10966843B2 (en) 2017-07-18 2021-04-06 DePuy Synthes Products, Inc. Implant inserters and related methods
US11045331B2 (en) 2017-08-14 2021-06-29 DePuy Synthes Products, Inc. Intervertebral implant inserters and related methods
US10470895B2 (en) 2017-08-16 2019-11-12 Loubert S. Suddaby Endoscopically implantable fusion implant for endoscopic spinal surgery
CN107518966B (en) * 2017-08-23 2023-07-28 北京爱康宜诚医疗器材有限公司 Intervertebral disc prosthesis holder
US11219532B2 (en) 2017-09-18 2022-01-11 Loubert S. Suddaby Stand-alone expandable interbody spinal fusion device with locking mechanism
US10596010B2 (en) 2017-09-18 2020-03-24 Loubert S. Suddaby Stand-alone expandable interbody spinal fusion device with locking mechanism
USD870893S1 (en) * 2017-11-22 2019-12-24 Guoxiang He Lumbar vertebra correcting instrument
WO2019136263A1 (en) 2018-01-04 2019-07-11 Providence Medical Technology, Inc. Facet screw and delivery device
US11253182B2 (en) 2018-05-04 2022-02-22 Cadwell Laboratories, Inc. Apparatus and method for polyphasic multi-output constant-current and constant-voltage neurophysiological stimulation
US11443649B2 (en) 2018-06-29 2022-09-13 Cadwell Laboratories, Inc. Neurophysiological monitoring training simulator
US11179248B2 (en) 2018-10-02 2021-11-23 Samy Abdou Devices and methods for spinal implantation
US11083471B2 (en) * 2018-10-22 2021-08-10 Globus Medical, Inc. Systems and methods for transcorporeal microdecompression
US11446156B2 (en) 2018-10-25 2022-09-20 Medos International Sarl Expandable intervertebral implant, inserter instrument, and related methods
JP2022512769A (en) 2018-11-08 2022-02-07 ネオ・メディカル・ソシエテ・アノニム Spine cage hammer
US11219531B2 (en) 2019-04-10 2022-01-11 Wenzel Spine, Inc. Rotatable intervertebral spacing implant
USD933230S1 (en) 2019-04-15 2021-10-12 Providence Medical Technology, Inc. Cervical cage
US11273058B2 (en) 2019-05-07 2022-03-15 Spinal Elements, Inc. Cervical plate and inserter
USD911525S1 (en) 2019-06-21 2021-02-23 Providence Medical Technology, Inc. Spinal cage
US20220354469A1 (en) * 2019-07-02 2022-11-10 University Of Kentucky Research Foundation Bone biopsy system and method
US10898346B1 (en) 2019-07-19 2021-01-26 Loubert S. Suddaby Expandable intervertebral fusion implant
US11026805B2 (en) 2019-07-30 2021-06-08 Loubert S. Suddaby Expandable intervertebral fusion implant
US11883303B2 (en) 2019-12-30 2024-01-30 Vertebration, Inc. Spine surgery method and instrumentation
USD945621S1 (en) 2020-02-27 2022-03-08 Providence Medical Technology, Inc. Spinal cage
US11426286B2 (en) 2020-03-06 2022-08-30 Eit Emerging Implant Technologies Gmbh Expandable intervertebral implant
US11457950B2 (en) * 2020-04-27 2022-10-04 DePuy Synthes Products, Inc. Locking system and method
JP2022052575A (en) 2020-09-23 2022-04-04 国立大学法人東海国立大学機構 End plate perforator
US11850160B2 (en) 2021-03-26 2023-12-26 Medos International Sarl Expandable lordotic intervertebral fusion cage
US11752009B2 (en) 2021-04-06 2023-09-12 Medos International Sarl Expandable intervertebral fusion cage

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2842131A (en) * 1957-05-27 1958-07-08 George W Smith Automatic drill
US4142517A (en) * 1976-07-23 1979-03-06 Contreras Guerrero De Stavropo Apparatus for extracting bone marrow specimens
US4677883A (en) * 1986-06-09 1987-07-07 Lee Wen Hsin Cork screw
US4830000A (en) * 1987-12-31 1989-05-16 Aspen Laboratories, Inc. Surgical drill
US4878915A (en) * 1987-01-22 1989-11-07 Brantigan John W Surgical prosthetic implant facilitating vertebral interbody fusion
US4943291A (en) * 1987-12-18 1990-07-24 Zimmer S.A. Drilling feeler, in particular for positioning and securing a medullary nail
US4961740A (en) * 1988-10-17 1990-10-09 Surgical Dynamics, Inc. V-thread fusion cage and method of fusing a bone joint
US5055104A (en) * 1989-11-06 1991-10-08 Surgical Dynamics, Inc. Surgically implanting threaded fusion cages between adjacent low-back vertebrae by an anterior approach

Family Cites Families (203)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US350420A (en) * 1886-10-05 Staple-driving implement
US31865A (en) * 1861-04-02 Improvement in harrow-frames
US1137585A (en) * 1915-02-05 1915-04-27 Thornton Craig Jr Dental appliance.
US2065659A (en) * 1934-08-04 1936-12-29 Arthur V Cullen Fastening method and means
US2243718A (en) * 1938-11-05 1941-05-27 Moreira Francisco Elias Godoy Surgical drill
US2181746A (en) * 1939-02-04 1939-11-28 John R Siebrandt Combination bone clamp and adjustable drill guide
GB564591A (en) * 1943-01-28 1944-10-04 Courtaulds Ltd Improvements in the manufacture and production of artificial threads, filaments and the like
US2543780A (en) * 1946-12-09 1951-03-06 Herbert E Hipps Bone graft apparatus
US2537070A (en) * 1948-12-27 1951-01-09 Puy Mfg Company Inc De Surgical appliance and method for fixation of bone fragments
US2514665A (en) * 1949-01-11 1950-07-11 Myller Ernest Medical instrument
US2677369A (en) * 1952-03-26 1954-05-04 Fred L Knowles Apparatus for treatment of the spinal column
US2774350A (en) * 1952-09-08 1956-12-18 Jr Carl S Cleveland Spinal clamp or splint
US2789558A (en) * 1953-09-17 1957-04-23 Leslie V Rush Medullary in driver and extractor
US2832343A (en) * 1955-04-12 1958-04-29 Mose Clara Emilie Marie Dilators
US2878809A (en) * 1958-01-23 1959-03-24 Richards Mfg Company Surgical drill attachment
US3128768A (en) * 1961-11-24 1964-04-14 Rosemount Eng Co Ltd Surgical drill
FR1338873A (en) 1962-06-04 1963-10-04 Comite Central De Fabricants D Furnace for the thermal treatment of agglomerated fuels or classified coal
US3298372A (en) * 1963-12-17 1967-01-17 Feinberg Maurice Surgical hydrocephalus shunt sleeve for placement in a vertebra
US3426364A (en) * 1966-08-25 1969-02-11 Colorado State Univ Research F Prosthetic appliance for replacing one or more natural vertebrae
US3486505A (en) * 1967-05-22 1969-12-30 Gordon M Morrison Orthopedic surgical instrument
US3618611A (en) * 1969-03-05 1971-11-09 Julius C Urban Vacuum rotary dissector
US3604487A (en) * 1969-03-10 1971-09-14 Richard S Gilbert Orthopedic screw driving means
US3948262A (en) * 1969-04-01 1976-04-06 Alza Corporation Novel drug delivery device
US3605123A (en) * 1969-04-29 1971-09-20 Melpar Inc Bone implant
CA962806A (en) * 1970-06-04 1975-02-18 Ontario Research Foundation Surgical prosthetic device
US3720959A (en) * 1970-08-26 1973-03-20 G Hahn Mandibular prosthetic apparatus
US3709219A (en) * 1970-11-27 1973-01-09 W Halloran Bone compression device
CA992255A (en) * 1971-01-25 1976-07-06 Cutter Laboratories Prosthesis for spinal repair
US3750652A (en) * 1971-03-05 1973-08-07 J Sherwin Knee retractor
US3867950A (en) * 1971-06-18 1975-02-25 Univ Johns Hopkins Fixed rate rechargeable cardiac pacemaker
US3848601A (en) * 1972-06-14 1974-11-19 G Ma Method for interbody fusion of the spine
US3888260A (en) * 1972-06-28 1975-06-10 Univ Johns Hopkins Rechargeable demand inhibited cardiac pacer and tissue stimulator
DE2311817C2 (en) * 1973-03-09 1984-06-07 Werner Dipl.-Ing. 8000 München Kraus Stimulation current device to promote the healing of bone damage
DE2314573C2 (en) * 1973-03-23 1986-12-18 Werner Dipl.-Ing. 8000 München Kraus Device for promoting healing processes
US4070514A (en) * 1973-06-05 1978-01-24 The United States Of America As Represented By The United States Department Of Energy Method of fabricating graphite for use as a skeletal prosthesis and product thereof
US3905047A (en) * 1973-06-27 1975-09-16 Posta Jr John J Implantable ceramic bone prosthesis
DE2340546A1 (en) * 1973-08-10 1975-02-27 Pfaudler Werke Ag METALLIC IMPLANT AND PROCEDURE FOR ITS MANUFACTURING
US3892232A (en) * 1973-09-24 1975-07-01 Alonzo J Neufeld Method and apparatus for performing percutaneous bone surgery
US3942535A (en) * 1973-09-27 1976-03-09 G. D. Searle & Co. Rechargeable tissue stimulating system
JPS5060085A (en) 1973-09-27 1975-05-23
US4051905A (en) * 1974-03-28 1977-10-04 Gerbruder Heller Drill for percussion drilling machines
US3916907A (en) * 1974-06-21 1975-11-04 Wendell C Peterson Spreader instrument for use in performing a spinal fusion
JPS5223514B2 (en) * 1974-09-25 1977-06-24
US3952334A (en) * 1974-11-29 1976-04-27 General Atomic Company Biocompatible carbon prosthetic devices
FR2295729A1 (en) 1974-12-27 1976-07-23 Mahay Et Cie TOTAL HIP PROSTHESIS
US4086701A (en) * 1975-04-07 1978-05-02 Kyoto Ceramic Kabushiki Kaisha Device for implanting an artificial endosseous element of ceramics and an implant method for use of the same
USD257511S (en) 1975-09-08 1980-11-11 Olin Corporation Drill tool or the like
DE2546824C2 (en) * 1975-10-18 1986-05-07 Ernst Leitz Wetzlar Gmbh, 6330 Wetzlar Coated endoprosthesis and process for their manufacture
USD245259S (en) 1976-01-29 1977-08-02 Zimmer U.S.A. Inc. Tibial prosthesis
GB1574825A (en) * 1976-03-31 1980-09-10 Rubery Owen Fasteners Ltd Screw threaded members and their manufacture
US4027392A (en) * 1976-05-10 1977-06-07 Interface Biomedical Laboratories Corporation Endosteal bionic tooth and implantation method
DE2621383A1 (en) * 1976-05-14 1977-12-01 Gardner Denver Gmbh METHOD OF PLACING IMPLANTS INTO BONE AND APPARATUS
DE2659916A1 (en) * 1976-05-14 1977-11-24 Pfaudler Werke Ag Surgical prosthetic fixing with self cutting screw threads - having abrasive coating to facilitate insertion and improve screw grip
US4082097A (en) * 1976-05-20 1978-04-04 Pacesetter Systems Inc. Multimode recharging system for living tissue stimulators
US4059115A (en) * 1976-06-14 1977-11-22 Georgy Stepanovich Jumashev Surgical instrument for operation of anterior fenestrated spondylodessis in vertebral osteochondrosis
GB1550010A (en) * 1976-12-15 1979-08-08 Ontario Research Foundation Surgical prosthetic device or implant having pure metal porous coating
US4232679A (en) * 1977-01-26 1980-11-11 Pacesetter Systems, Inc. Programmable human tissue stimulator
GB1565178A (en) * 1977-02-24 1980-04-16 Interfix Ltd Bone screw
US4259072A (en) * 1977-04-04 1981-03-31 Kyoto Ceramic Co., Ltd. Ceramic endosseous implant
JPS53144194A (en) * 1977-05-20 1978-12-15 Kureha Chemical Ind Co Ltd Compound implanted material and making method thereof
US4258716A (en) * 1978-02-06 1981-03-31 The University Of Melbourne Microsurgical instruments
US4181457A (en) * 1978-02-10 1980-01-01 Holmes Horace D Tapping tool for making vibration resistant prevailing torque fastener
FR2429009A1 (en) 1978-06-21 1980-01-18 Roux Christiane PROSTHESIS FOR ARTICULATION, PARTICULARLY COXO-FEMORAL, ARTIFICIAL
GB2029702B (en) * 1978-07-20 1982-12-15 Secr Social Service Brit Fracture fixation aooaratus
AT358715B (en) * 1978-09-04 1980-09-25 Plansee Metallwerk BUTCHING AND REJECTING DEVICE FOR BONE MARKING NAIL
US4197850A (en) * 1978-11-03 1980-04-15 Pacesetter Systems, Inc. Implantable human tissue stimulator with memory protect means
USD260525S (en) 1978-12-04 1981-09-01 Lassiter Will M Channel drill and bolt combination
US4341206A (en) * 1978-12-19 1982-07-27 Synthes Ag Device for producing a hole in a bone
FR2460657A1 (en) * 1979-07-12 1981-01-30 Anvar BIODEGRADABLE IMPLANT FOR USE AS A BONE PROSTHESIS PIECE
US4333469A (en) * 1979-07-20 1982-06-08 Telectronics Pty. Ltd. Bone growth stimulator
US4492226A (en) * 1979-10-10 1985-01-08 Vsesojuzny Nauchno-Issledovatelsky I Ispytatelny Institut Meditsinskoi Tekhniki Device for uniting bone fragments
US4450834A (en) * 1979-10-18 1984-05-29 Ace Orthopedic Manufacturing, Inc. External fixation device
CH642250A5 (en) * 1979-12-22 1984-04-13 Straumann Inst Ag BALL JOINT PROSTHESIS WITH A CAP.
US4293962A (en) * 1980-02-14 1981-10-13 Zimmer Usa, Inc. Bone plug inserting system
SU1124960A1 (en) 1980-02-19 1984-11-23 Bokov Nikolaj F Puncture instrument
US4289123A (en) * 1980-03-31 1981-09-15 Dunn Harold K Orthopedic appliance
US4405319A (en) * 1980-04-08 1983-09-20 Renal Systems, Inc. Porous titanium coating for blood access device
CH648197A5 (en) * 1980-05-28 1985-03-15 Synthes Ag IMPLANT AND SCREW FASTENING ON ITS BONE.
GB2076657A (en) 1980-05-31 1981-12-09 Atkins Brian Norman Apparatus for external fixation of part of the human or animal skeletal structure
CA1146301A (en) * 1980-06-13 1983-05-17 J. David Kuntz Intervertebral disc prosthesis
DE3031905A1 (en) 1980-08-23 1982-03-04 L. & C. Steinmüller GmbH, 5270 Gummersbach BURNER SYSTEM
GB2083754B (en) * 1980-09-15 1984-04-26 Rezaian Seyed Mahmoud Spinal fixator
US4309777A (en) * 1980-11-13 1982-01-12 Patil Arun A Artificial intervertebral disc
CH646857A5 (en) 1980-11-18 1984-12-28 Sulzer Ag SPONDYLODESIS STABILIZER.
US4414979A (en) * 1981-02-23 1983-11-15 Telectronics Pty. Ltd. Monitorable bone growth stimulator
JPS57163309A (en) * 1981-04-01 1982-10-07 Olympus Optical Co Ltd Capsule apparatus for medical use
EP0077159A1 (en) 1981-10-14 1983-04-20 Brian Norman Atkins Vertebrae spreader
BR8107560A (en) * 1981-11-19 1983-07-05 Luiz Romariz Duarte ULTRASONIC STIMULATION OF BONE FRACTURE CONSOLIDATION
US4501269A (en) * 1981-12-11 1985-02-26 Washington State University Research Foundation, Inc. Process for fusing bone joints
US4439152A (en) * 1982-03-04 1984-03-27 Small Irwin A Method of jawbone abutment implant for dental prostheses and implant device
US4547390A (en) * 1982-03-12 1985-10-15 Medical Biological Sciences, Inc. Process of making implantable prosthesis material of modified polymeric acrylic (PMMA) beads coated with PHEMA and barium sulfate
US4535485A (en) * 1982-03-12 1985-08-20 Medical Biological Sciences, Inc. Polymeric acrylic prothesis
US4542539A (en) * 1982-03-12 1985-09-24 Artech Corp. Surgical implant having a graded porous coating
US4549547A (en) * 1982-07-27 1985-10-29 Trustees Of The University Of Pennsylvania Implantable bone growth stimulator
GB2126094A (en) 1982-08-26 1984-03-21 Brian Norman Atkins Device for holding the bones of the wrist and forearm after setting or during arthrodesis of the wrist
US4545374A (en) * 1982-09-03 1985-10-08 Jacobson Robert E Method and instruments for performing a percutaneous lumbar diskectomy
US4600000A (en) * 1982-09-16 1986-07-15 Edwards Charles C External fixation system
US4552200A (en) * 1982-09-30 1985-11-12 Southwire Company Control in continuous casting to enhance feeding
US4535374A (en) * 1982-11-04 1985-08-13 Amcodyne Incorporated Whitney-type head loading/unloading apparatus
US4497320A (en) * 1983-02-14 1985-02-05 Rudolph Beaver, Inc. Surgical blade unit
US4997434A (en) 1983-02-16 1991-03-05 Seedhom Bahaa B Prosthetic ligaments and instruments for use in the surgical replacement of ligaments
SU1107854A1 (en) 1983-03-30 1984-08-15 Харьковский Научно-Исследовательский Институт Ортопедии И Травматологии Им.Проф.М.И.Ситенко Spine fixative
US4570623A (en) * 1983-06-02 1986-02-18 Pfizer Hospital Products Group Inc. Arched bridge staple
USD281814S (en) 1983-07-13 1985-12-17 Techmedica, Inc. Osteotomy staple
US4570624A (en) * 1983-08-10 1986-02-18 Henry Ford Hospital Universal guide for inserting parallel pins
IL69888A0 (en) * 1983-10-03 1984-01-31 Avmedica Ltd Unilateral external fixation system for small bones
US4554914A (en) * 1983-10-04 1985-11-26 Kapp John P Prosthetic vertebral body
SU1222254A1 (en) 1983-11-09 1986-04-07 Bogosyan Aleksandr B Needle for intraosseous injection
US4553273A (en) * 1983-11-23 1985-11-19 Henry Ford Hospital Vertebral body prosthesis and spine stabilizing method
US4611581A (en) * 1983-12-16 1986-09-16 Acromed Corporation Apparatus for straightening spinal columns
US4696290A (en) 1983-12-16 1987-09-29 Acromed Corporation Apparatus for straightening spinal columns
US4655777A (en) 1983-12-19 1987-04-07 Southern Research Institute Method of producing biodegradable prosthesis and products therefrom
SU1217374A1 (en) 1984-02-03 1986-03-15 Институт Сейсмологии Endoscopic knife
US4604995A (en) * 1984-03-30 1986-08-12 Stephens David C Spinal stabilizer
US4653486A (en) 1984-04-12 1987-03-31 Coker Tom P Fastener, particularly suited for orthopedic use
DE3414514A1 (en) 1984-04-13 1985-10-24 Biotronik Meß- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin, 1000 Berlin SCREW-IN PAN FOR AN ARTIFICIAL HIP JOINT
US4608052A (en) * 1984-04-25 1986-08-26 Minnesota Mining And Manufacturing Company Implant with attachment surface
US4619264A (en) * 1984-06-14 1986-10-28 Singh Om P Method and apparatus for treatment of fresh fractures, delayed unions and non-unions of living bone
US4736738A (en) 1984-07-09 1988-04-12 Matej Lipovsek Instrument kit and procedure for performing posterior lumbar interbody fusion
EP0176728B1 (en) 1984-09-04 1989-07-26 Humboldt-Universität zu Berlin Intervertebral-disc prosthesis
GB2164277A (en) 1984-09-12 1986-03-19 Univ Manchester A bone drill
US4602638A (en) * 1984-10-03 1986-07-29 Eddie Adams Apparatus and method for invasive electrical stimulation of bone fractures
CA1264674A (en) 1984-10-17 1990-01-23 Paul Ducheyne Porous flexible metal fiber material for surgical implantation
US4665920A (en) 1984-11-28 1987-05-19 Minnesota Mining And Manufacturing Company Skeletal tissue stimulator and a low voltage oscillator circuit for use therein
US4877020A (en) 1984-11-30 1989-10-31 Vich Jose M O Apparatus for bone graft
ES283078Y (en) 1984-11-30 1985-12-16 Otero Vich Jose M. BONE INSERT FOR CERVICAL INTERSOMATIC ARTHRODESIS
DE3445738A1 (en) 1984-12-14 1986-06-19 Draenert Klaus IMPLANT FOR BONE REINFORCEMENT AND ANCHORING OF BONE SCREWS, IMPLANTS OR IMPLANT PARTS
US4721103A (en) 1985-01-31 1988-01-26 Yosef Freedland Orthopedic device
FR2576779B1 (en) 1985-02-07 1988-10-07 Tornier Sa ASSEMBLY DEVICE BETWEEN A BONE IMPLANT AND THE TOOL FOR ITS PLACEMENT
US4634720A (en) * 1985-02-19 1987-01-06 The Dow Chemical Company Process for the preparation of hard tissue prosthetics
US4661536A (en) 1985-02-19 1987-04-28 The Dow Chemical Company Process for the preparation of hard tissue prosthetics
US4636526A (en) 1985-02-19 1987-01-13 The Dow Chemical Company Composites of unsintered calcium phosphates and synthetic biodegradable polymers useful as hard tissue prosthetics
US4698375A (en) 1985-02-19 1987-10-06 The Dow Chemical Company Composites of unsintered calcium phosphates and synthetic biodegradable polymers useful as hard tissue prosthetics
US4592346A (en) * 1985-04-08 1986-06-03 Jurgutis John A Orthopedic staple
US4636217A (en) 1985-04-23 1987-01-13 Regents Of The University Of Minnesota Anterior spinal implant
FR2581336B1 (en) 1985-05-02 1989-05-05 Collomb Jean WRENCH FOR SCREWING A PART WITH A HEAD WITH A SIZE AND A THREADED BORE
US4599086A (en) * 1985-06-07 1986-07-08 Doty James R Spine stabilization device and method
US4743260A (en) 1985-06-10 1988-05-10 Burton Charles V Method for a flexible stabilization system for a vertebral column
US4653509A (en) 1985-07-03 1987-03-31 The United States Of America As Represented By The Secretary Of The Air Force Guided trephine samples for skeletal bone studies
US4645503A (en) 1985-08-27 1987-02-24 Orthomatrix Inc. Moldable bone-implant material
US4743256A (en) * 1985-10-04 1988-05-10 Brantigan John W Surgical prosthetic implant facilitating vertebral interbody fusion and method
US4664567A (en) 1986-02-06 1987-05-12 Bijur Lubricating Corp. Drill bit
US4903882A (en) 1986-03-10 1990-02-27 Long Gregory T Driving tool for an electrical staple
GB8620937D0 (en) 1986-08-29 1986-10-08 Shepperd J A N Spinal implant
US4769881A (en) 1986-09-02 1988-09-13 Pedigo Irby R High precision tens apparatus and method of use
US4713004A (en) 1986-09-04 1987-12-15 Vent Plant Corporation Submergible screw-type dental implant and method of utilization
US4710075A (en) 1986-10-01 1987-12-01 Boehringer Mannheim Corporation Adjustable drill gauge
DE3637314A1 (en) 1986-11-03 1988-05-11 Lutz Biedermann SPACE HOLDER IMPLANT
US4805602A (en) 1986-11-03 1989-02-21 Danninger Medical Technology Transpedicular screw and rod system
US5116304A (en) 1987-01-28 1992-05-26 Cadwell Industries, Inc. Magnetic stimulator with skullcap-shaped coil
CA1283501C (en) 1987-02-12 1991-04-30 Thomas P. Hedman Artificial spinal disc
US4714469A (en) 1987-02-26 1987-12-22 Pfizer Hospital Products Group, Inc. Spinal implant
US4790303A (en) 1987-03-11 1988-12-13 Acromed Corporation Apparatus and method for securing bone graft
DE3711091A1 (en) 1987-04-02 1988-10-13 Kluger Patrick DEVICE FOR SETTING UP A SPINE WITH A DAMAGED SPINE
US4781591A (en) 1987-04-06 1988-11-01 Allen James P Endosteal implant and method for performing implantation thereof
US4863477A (en) 1987-05-12 1989-09-05 Monson Gary L Synthetic intervertebral disc prosthesis
CH672588A5 (en) 1987-07-09 1989-12-15 Sulzer Ag
GB8718627D0 (en) 1987-08-06 1987-09-09 Showell A W Sugicraft Ltd Spinal implants
US4772287A (en) 1987-08-20 1988-09-20 Cedar Surgical, Inc. Prosthetic disc and method of implanting
US4851008A (en) 1988-02-01 1989-07-25 Orthomet, Inc. Bone implant prosthesis with substantially stress-free outer surface
US4865603A (en) 1988-02-04 1989-09-12 Joint Medical Products Corporation Metallic prosthetic devices having micro-textured outer surfaces
DE3809793A1 (en) 1988-03-23 1989-10-05 Link Waldemar Gmbh Co SURGICAL INSTRUMENT SET
US4848327A (en) 1988-05-23 1989-07-18 Perdue Kevin D Apparatus and procedure for blind alignment of fasteners extended through transverse holes in an orthopedic locking nail
US4911718A (en) 1988-06-10 1990-03-27 University Of Medicine & Dentistry Of N.J. Functional and biocompatible intervertebral disc spacer
US5015247A (en) 1988-06-13 1991-05-14 Michelson Gary K Threaded spinal implant
US5484437A (en) 1988-06-13 1996-01-16 Michelson; Gary K. Apparatus and method of inserting spinal implants
IT215084Z2 (en) 1988-08-03 1990-07-30 Torino A VARIABLE EXCURSION CAMBRA
US4960420A (en) 1988-08-23 1990-10-02 Marlowe Goble E Channel ligament clamp and system
DE3829603A1 (en) 1988-09-01 1990-03-15 Kontron Holding Ag ULTRASONIC DOSCOPE DEVICE
DE3841704A1 (en) 1988-12-10 1990-06-21 Imz Fertigung Vertrieb IMPLANTABLE FASTENER FOR EXTRA-ORAL APPLICATIONS
US4968316A (en) 1988-12-12 1990-11-06 Hergenroeder Patrick T Arthroscopic ankle joint distraction method
US4955885A (en) 1988-12-21 1990-09-11 Zimmer, Inc. Surgical slider instrument and method of using instrument
US4969888A (en) 1989-02-09 1990-11-13 Arie Scholten Surgical protocol for fixation of osteoporotic bone using inflatable device
CA1318469C (en) 1989-02-15 1993-06-01 Acromed Corporation Artificial disc
US5015255A (en) 1989-05-10 1991-05-14 Spine-Tech, Inc. Spinal stabilization method
US5030236A (en) 1989-06-19 1991-07-09 Intermedics Orthopedics, Inc. Apparatus for enhancing biointegration of bony and endoprosthesis structures
US5458638A (en) 1989-07-06 1995-10-17 Spine-Tech, Inc. Non-threaded spinal implant
US4936848A (en) 1989-09-22 1990-06-26 Bagby George W Implant for vertebrae
WO1993014908A1 (en) 1989-11-17 1993-08-05 Sheridan Thomas L Continuously engaged tangential driving tool
US5059193A (en) 1989-11-20 1991-10-22 Spine-Tech, Inc. Expandable spinal implant and surgical method
US4987904A (en) 1990-03-22 1991-01-29 Wilson James T Method and apparatus for bone size gauging
US5108422A (en) 1990-10-22 1992-04-28 United States Surgical Corporation Skin fastener
US5171278A (en) 1991-02-22 1992-12-15 Madhavan Pisharodi Middle expandable intervertebral disk implants
US5123926A (en) 1991-02-22 1992-06-23 Madhavan Pisharodi Artificial spinal prosthesis
US5192327A (en) 1991-03-22 1993-03-09 Brantigan John W Surgical prosthetic implant for vertebrae
US5112336A (en) 1991-05-14 1992-05-12 Intermedics Orthopedics, Inc. Drill guide and template for prosthetic devices
US5263953A (en) 1991-12-31 1993-11-23 Spine-Tech, Inc. Apparatus and system for fusing bone joints
US5258031A (en) 1992-01-06 1993-11-02 Danek Medical Intervertebral disk arthroplasty
EP0561068B1 (en) 1992-02-20 1999-03-03 Neomedics, Inc. Implantable bone growth stimulator
US5396880A (en) 1992-04-08 1995-03-14 Danek Medical, Inc. Endoscope for direct visualization of the spine and epidural space
DE59206917D1 (en) 1992-04-21 1996-09-19 Sulzer Medizinaltechnik Ag Artificial intervertebral disc body
US5324295A (en) 1992-04-24 1994-06-28 Shapiro Michael R Drill guide for surgical pins
US5306309A (en) 1992-05-04 1994-04-26 Calcitek, Inc. Spinal disk implant and implantation kit
US5246458A (en) 1992-10-07 1993-09-21 Graham Donald V Artificial disk
US5314427A (en) 1992-10-13 1994-05-24 Marlowe Goble E Channel ligament clamp
US5292252A (en) 1992-12-14 1994-03-08 Impla-Med, Inc. Stimulator healing cap
US5364399A (en) 1993-02-05 1994-11-15 Danek Medical, Inc. Anterior cervical plating system
AU683243B2 (en) 1993-02-10 1997-11-06 Zimmer Spine, Inc. Spinal stabilization surgical tool set
FR2703580B1 (en) 1993-03-03 1997-10-17 Gilles Robert Cervical interbody fusion cage.
US5352229A (en) 1993-05-12 1994-10-04 Marlowe Goble E Arbor press staple and washer and method for its use
US5425772A (en) 1993-09-20 1995-06-20 Brantigan; John W. Prosthetic implant for intervertebral spinal fusion
US5443514A (en) 1993-10-01 1995-08-22 Acromed Corporation Method for using spinal implants
US5397364A (en) 1993-10-12 1995-03-14 Danek Medical, Inc. Anterior interbody fusion device

Patent Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2842131A (en) * 1957-05-27 1958-07-08 George W Smith Automatic drill
US4142517A (en) * 1976-07-23 1979-03-06 Contreras Guerrero De Stavropo Apparatus for extracting bone marrow specimens
US4677883A (en) * 1986-06-09 1987-07-07 Lee Wen Hsin Cork screw
US4878915A (en) * 1987-01-22 1989-11-07 Brantigan John W Surgical prosthetic implant facilitating vertebral interbody fusion
US4943291A (en) * 1987-12-18 1990-07-24 Zimmer S.A. Drilling feeler, in particular for positioning and securing a medullary nail
US4830000A (en) * 1987-12-31 1989-05-16 Aspen Laboratories, Inc. Surgical drill
US4961740A (en) * 1988-10-17 1990-10-09 Surgical Dynamics, Inc. V-thread fusion cage and method of fusing a bone joint
US4961740B1 (en) * 1988-10-17 1997-01-14 Surgical Dynamics Inc V-thread fusion cage and method of fusing a bone joint
US5055104A (en) * 1989-11-06 1991-10-08 Surgical Dynamics, Inc. Surgically implanting threaded fusion cages between adjacent low-back vertebrae by an anterior approach

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of EP0703757A1 *

Cited By (123)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
AU701744B2 (en) * 1988-06-13 1999-02-04 Warsaw Orthopedic, Inc. Appartus and method of inserting spinal implants
EP1618848A1 (en) * 1988-06-13 2006-01-25 Gary Karlin Michelson Apparatus including a guard member having a passage with a non-circular cross section for providing protected access to the spine
US5928242A (en) * 1993-02-10 1999-07-27 Sulzer Spine-Tech Inc. Laparoscopic spinal stabilization method
US7135026B2 (en) 1993-02-10 2006-11-14 Zimmer Spine, Inc. Laparoscopic spinal stabilization surgical method
US6599320B1 (en) 1993-02-10 2003-07-29 Sulzer Spine-Tech Inc. Alignment guide assembly for spinal stabilization
US5700291A (en) * 1993-02-10 1997-12-23 Spine-Tech, Inc. Laparoscopic spinal stabilization method
US7722621B2 (en) 1993-02-10 2010-05-25 Zimmer Spine, Inc. Laparoscopic spinal stabilization surgical method
US5720748A (en) * 1993-02-10 1998-02-24 Spine-Tech, Inc. Spinal stabilization surgical apparatus
US5899908A (en) * 1993-02-10 1999-05-04 Sulzer Spine-Tech Inc. Spinal drill tube guide
USRE42863E1 (en) * 1993-02-10 2011-10-25 Zimmer Spine, Inc. Spinal stabilization surgical method
US5947971A (en) * 1993-02-10 1999-09-07 Sulzer Spine-Tech Inc. Spinal stabilization surgical apparatus
US5716415A (en) * 1993-10-01 1998-02-10 Acromed Corporation Spinal implant
WO1996022747A1 (en) * 1995-01-24 1996-08-01 Stryker Corporation Interbody cavity type implant, and instrumentation and method for positioning same
FR2729557A1 (en) * 1995-01-24 1996-07-26 Stryker Corp INTERSOMATIC CAGE TYPE IMPLANT, AND INSTRUMENTATION AND METHOD FOR ITS INSTALLATION
EP0808136A4 (en) * 1995-02-07 2002-01-30 Biotechnologies Inc Matrix Surgical implantation of cartilage repair unit
EP0808136A1 (en) * 1995-02-07 1997-11-26 Inc. Matrix Biotechnologies Surgical implantation of cartilage repair unit
EP1525863A3 (en) * 1995-02-17 2007-01-31 Warsaw Orthopedic, Inc. Arcuate ratcheted spinal fusion implant
EP0814718A4 (en) * 1995-02-27 2000-02-09 Michelson Gary K Improved methods and instrumentation for the surgical correction of human thoracic and lumbar spinal disease from the lateral aspect of the spine
EP0814718A2 (en) * 1995-02-27 1998-01-07 MICHELSON, Gary Karlin Improved methods and instrumentation for the surgical correction of human thoracic and lumbar spinal disease from the lateral aspect of the spine
EP1488755A1 (en) * 1995-02-27 2004-12-22 MICHELSON, Gary Karlin Translateral spinal distractor
KR100499543B1 (en) * 1995-02-27 2005-11-25 개리 카린 미켈슨 Improved methods and instrumentation for the surgical correction of human thoracic and lumbar spinal disease from the lateral aspect of the spine
EP1325719A3 (en) * 1995-03-27 2003-07-16 SDGI Holdings, Inc. Interbody fusion device
US6245072B1 (en) 1995-03-27 2001-06-12 Sdgi Holdings, Inc. Methods and instruments for interbody fusion
WO1998035636A1 (en) * 1995-06-07 1998-08-20 Sdgi Holdings, Inc. Anterior spinal instrumentation and method for implantation and revision
WO1997030666A2 (en) * 1996-02-22 1997-08-28 Sdgi Holdings, Inc. Methods and instruments for interbody fusion
WO1997030666A3 (en) * 1996-02-22 1997-10-23 Danek Medical Inc Methods and instruments for interbody fusion
US6562041B1 (en) 1997-08-29 2003-05-13 Sulzer Spine-Tech Inc. Apparatus and method for spinal stabilization
US6156040A (en) * 1997-08-29 2000-12-05 Sulzer Spine-Tech Inc. Apparatus and method for spinal stablization
US6086595A (en) * 1997-08-29 2000-07-11 Sulzer Spine-Tech Inc. Apparatus and method for spinal stabilization
US6171339B1 (en) 1998-05-19 2001-01-09 Sulzer Spine-Tech Inc. Multi-lumen spinal implant guide and method
US8100917B2 (en) 1999-10-20 2012-01-24 Warsaw Orthopedic, Inc. Methods and instrumentation for distraction of a disc space
US6500180B1 (en) 1999-10-20 2002-12-31 Sdgi Holdings, Inc. Methods and instrumentation for distraction of a disc space
US7648512B2 (en) 1999-10-20 2010-01-19 Warsaw Orthopedic, Inc. Methods and instrumentation for distraction of a disc space
US6855148B2 (en) 1999-10-20 2005-02-15 Sdgi Holdings, Inc. Methods and instrumentation for distraction of a disc space
US9743853B2 (en) 1999-11-24 2017-08-29 Nuvasive, Inc. Electromyography system
US9931077B2 (en) 2001-07-11 2018-04-03 Nuvasive, Inc. System and methods for determining nerve proximity, direction and pathology during surgery
US10716509B2 (en) 2001-07-11 2020-07-21 Nuvasive, Inc. System and methods for determining nerve proximity, direction and pathology during surgery
US10507120B2 (en) 2001-09-25 2019-12-17 Nuvasive, Inc. Systems and methods for performing surgical procedures and assessments
US9750490B2 (en) 2002-06-26 2017-09-05 Nuvasive, Inc. Surgical access system and related methods
US9833227B2 (en) 2002-06-26 2017-12-05 Nuvasive, Inc. Surgical access system and related methods
US10980524B2 (en) 2002-06-26 2021-04-20 Nuvasive, Inc. Surgical access system and related methods
US10251633B2 (en) 2002-06-26 2019-04-09 Nuvasive, Inc. Surgical access system and related methods
US9826968B2 (en) 2002-06-26 2017-11-28 Nuvasive, Inc. Surgical access system and related methods
US9848861B2 (en) 2002-06-26 2017-12-26 Nuvasive, Inc. Surgical access system and related methods
US10695044B2 (en) 2002-10-08 2020-06-30 Nuvasive, Inc. Surgical access system and related methods
US9820729B2 (en) 2002-10-08 2017-11-21 Nuvasive, Inc. Surgical access system and related methods
US9795371B2 (en) 2003-01-16 2017-10-24 Nuvasive, Inc. Surgical access system and related methods
US10357238B2 (en) 2003-01-16 2019-07-23 Nuvasive, Inc. Surgical access system and related methods
US11219440B2 (en) 2003-01-16 2022-01-11 Nuvasive, Inc. Surgical access system and related methods
US10349983B2 (en) 2003-05-22 2019-07-16 Alphatec Spine, Inc. Pivotal bone anchor assembly with biased bushing for pre-lock friction fit
USRE46431E1 (en) 2003-06-18 2017-06-13 Roger P Jackson Polyaxial bone anchor with helical capture connection, insert and dual locking assembly
US9610071B2 (en) 2003-09-25 2017-04-04 Nuvasive, Inc. Surgical access system and related methods
US9974531B2 (en) 2003-09-25 2018-05-22 Nuvasive, Inc. Surgical access system and related methods
US10357233B2 (en) 2003-09-25 2019-07-23 Nuvasive, Inc. Surgical access system and related methods
US9788822B2 (en) 2003-09-25 2017-10-17 Nuvasive, Inc. Surgical access system and related methods
US11064934B2 (en) 2003-09-25 2021-07-20 Nuvasive, Inc. Surgical access system and related methods
US10653308B2 (en) 2003-10-17 2020-05-19 Nuvasive, Inc. Surgical access system and related methods
US10299839B2 (en) 2003-12-16 2019-05-28 Medos International Sárl Percutaneous access devices and bone anchor assemblies
US11426216B2 (en) 2003-12-16 2022-08-30 DePuy Synthes Products, Inc. Methods and devices for minimally invasive spinal fixation element placement
US10039578B2 (en) 2003-12-16 2018-08-07 DePuy Synthes Products, Inc. Methods and devices for minimally invasive spinal fixation element placement
US11419642B2 (en) 2003-12-16 2022-08-23 Medos International Sarl Percutaneous access devices and bone anchor assemblies
US9636151B2 (en) 2004-02-27 2017-05-02 Roger P Jackson Orthopedic implant rod reduction tool set and method
US9918751B2 (en) 2004-02-27 2018-03-20 Roger P. Jackson Tool system for dynamic spinal implants
US9662151B2 (en) 2004-02-27 2017-05-30 Roger P Jackson Orthopedic implant rod reduction tool set and method
US9662143B2 (en) 2004-02-27 2017-05-30 Roger P Jackson Dynamic fixation assemblies with inner core and outer coil-like member
US11648039B2 (en) 2004-02-27 2023-05-16 Roger P. Jackson Spinal fixation tool attachment structure
US9050148B2 (en) 2004-02-27 2015-06-09 Roger P. Jackson Spinal fixation tool attachment structure
US10485588B2 (en) 2004-02-27 2019-11-26 Nuvasive, Inc. Spinal fixation tool attachment structure
US11147597B2 (en) 2004-02-27 2021-10-19 Roger P Jackson Dynamic spinal stabilization assemblies, tool set and method
US9050139B2 (en) 2004-02-27 2015-06-09 Roger P. Jackson Orthopedic implant rod reduction tool set and method
US11291480B2 (en) 2004-02-27 2022-04-05 Nuvasive, Inc. Spinal fixation tool attachment structure
US9622732B2 (en) 2004-10-08 2017-04-18 Nuvasive, Inc. Surgical access system and related methods
US11723644B2 (en) 2004-10-08 2023-08-15 Nuvasive, Inc. Surgical access system and related methods
US8029512B2 (en) 2004-10-26 2011-10-04 Pioneer Surgical Technology Spinal stabilization device and methods
US9743957B2 (en) 2004-11-10 2017-08-29 Roger P. Jackson Polyaxial bone screw with shank articulation pressure insert and method
US11147591B2 (en) 2004-11-10 2021-10-19 Roger P Jackson Pivotal bone anchor receiver assembly with threaded closure
US9629669B2 (en) 2004-11-23 2017-04-25 Roger P. Jackson Spinal fixation tool set and method
US11389214B2 (en) 2004-11-23 2022-07-19 Roger P. Jackson Spinal fixation tool set and method
US10039577B2 (en) 2004-11-23 2018-08-07 Roger P Jackson Bone anchor receiver with horizontal radiused tool attachment structures and parallel planar outer surfaces
US11234745B2 (en) 2005-07-14 2022-02-01 Roger P. Jackson Polyaxial bone screw assembly with partially spherical screw head and twist in place pressure insert
US11241261B2 (en) 2005-09-30 2022-02-08 Roger P Jackson Apparatus and method for soft spinal stabilization using a tensionable cord and releasable end structure
US8002837B2 (en) 2006-05-19 2011-08-23 Pioneer Surgical Technology Spinal stabilization device and methods
US9517093B2 (en) 2008-01-14 2016-12-13 Conventus Orthopaedics, Inc. Apparatus and methods for fracture repair
US9788870B2 (en) 2008-01-14 2017-10-17 Conventus Orthopaedics, Inc. Apparatus and methods for fracture repair
US8287538B2 (en) 2008-01-14 2012-10-16 Conventus Orthopaedics, Inc. Apparatus and methods for fracture repair
US10603087B2 (en) 2008-01-14 2020-03-31 Conventus Orthopaedics, Inc. Apparatus and methods for fracture repair
US11399878B2 (en) 2008-01-14 2022-08-02 Conventus Orthopaedics, Inc. Apparatus and methods for fracture repair
US8267939B2 (en) 2008-02-28 2012-09-18 Stryker Spine Tool for implanting expandable intervertebral implant
USD626233S1 (en) 2008-02-28 2010-10-26 Stryker Spine Expandable intervertebral implant
US8603170B2 (en) 2008-02-28 2013-12-10 Stryker Spine Expandable intervertebral implant
US9782271B2 (en) 2008-02-28 2017-10-10 Stryker European Holdings I, Llc Expandable intervertebral implant
US9907574B2 (en) 2008-08-01 2018-03-06 Roger P. Jackson Polyaxial bone anchors with pop-on shank, friction fit fully restrained retainer, insert and tool receiving features
US10959860B2 (en) 2008-12-26 2021-03-30 Pantheon Spinal, Llc Method of retroperitoneal lateral insertion of spinal implants
US9717534B2 (en) 2009-06-15 2017-08-01 Roger P. Jackson Polyaxial bone anchor with pop-on shank and friction fit retainer with low profile edge lock
US11229457B2 (en) 2009-06-15 2022-01-25 Roger P. Jackson Pivotal bone anchor assembly with insert tool deployment
US9918745B2 (en) 2009-06-15 2018-03-20 Roger P. Jackson Polyaxial bone anchor with pop-on shank and winged insert with friction fit compressive collet
US9668771B2 (en) 2009-06-15 2017-06-06 Roger P Jackson Soft stabilization assemblies with off-set connector
US9730739B2 (en) 2010-01-15 2017-08-15 Conventus Orthopaedics, Inc. Rotary-rigid orthopaedic rod
US9848889B2 (en) 2010-01-20 2017-12-26 Conventus Orthopaedics, Inc. Apparatus and methods for bone access and cavity preparation
US8961518B2 (en) 2010-01-20 2015-02-24 Conventus Orthopaedics, Inc. Apparatus and methods for bone access and cavity preparation
US8906022B2 (en) 2010-03-08 2014-12-09 Conventus Orthopaedics, Inc. Apparatus and methods for securing a bone implant
US9993277B2 (en) 2010-03-08 2018-06-12 Conventus Orthopaedics, Inc. Apparatus and methods for securing a bone implant
US9949840B1 (en) 2011-04-01 2018-04-24 William D. Smith Systems and methods for performing spine surgery
US10898344B2 (en) 2011-08-16 2021-01-26 Stryker European Operations Holdings Llc Expandable implant
US9320610B2 (en) 2011-08-16 2016-04-26 Stryker European Holdings I, Llc Expandable implant
US9962270B2 (en) 2011-08-16 2018-05-08 Stryker European Holdings I, Llc Expandable implant
US11648131B2 (en) 2011-08-16 2023-05-16 Stryker European Operations Holdings Llc Expandable implant
US9655744B1 (en) 2011-10-31 2017-05-23 Nuvasive, Inc. Expandable spinal fusion implants and related methods
US9636146B2 (en) 2012-01-10 2017-05-02 Roger P. Jackson Multi-start closures for open implants
US9770265B2 (en) 2012-11-21 2017-09-26 Roger P. Jackson Splay control closure for open bone anchor
US10058354B2 (en) 2013-01-28 2018-08-28 Roger P. Jackson Pivotal bone anchor assembly with frictional shank head seating surfaces
US10342675B2 (en) 2013-03-11 2019-07-09 Stryker European Holdings I, Llc Expandable implant
US10022132B2 (en) 2013-12-12 2018-07-17 Conventus Orthopaedics, Inc. Tissue displacement tools and methods
US10076342B2 (en) 2013-12-12 2018-09-18 Conventus Orthopaedics, Inc. Tissue displacement tools and methods
US9717533B2 (en) 2013-12-12 2017-08-01 Roger P. Jackson Bone anchor closure pivot-splay control flange form guide and advancement structure
US9192759B2 (en) 2014-03-31 2015-11-24 Dennison Hamilton System and method for stabilizing implanted spinal cord stimulators
US9186497B2 (en) 2014-03-31 2015-11-17 Dennison Hamilton System and method for stabilizing implanted spinal cord stimulators
WO2015153104A1 (en) * 2014-03-31 2015-10-08 Hamilton Dennison System and method for stabilizing implanted spinal cord stimulators
US10064658B2 (en) 2014-06-04 2018-09-04 Roger P. Jackson Polyaxial bone anchor with insert guides
US10918426B2 (en) 2017-07-04 2021-02-16 Conventus Orthopaedics, Inc. Apparatus and methods for treatment of a bone
US11147682B2 (en) 2017-09-08 2021-10-19 Pioneer Surgical Technology, Inc. Intervertebral implants, instruments, and methods
USD907771S1 (en) 2017-10-09 2021-01-12 Pioneer Surgical Technology, Inc. Intervertebral implant
USD968613S1 (en) 2017-10-09 2022-11-01 Pioneer Surgical Technology, Inc. Intervertebral implant

Also Published As

Publication number Publication date
US5505732A (en) 1996-04-09
US5484437A (en) 1996-01-16
US6096038A (en) 2000-08-01
WO1994028824A3 (en) 1995-03-16
JPH078514A (en) 1995-01-13

Similar Documents

Publication Publication Date Title
US5484437A (en) Apparatus and method of inserting spinal implants
US7326214B2 (en) Bone cutting device having a cutting edge with a non-extending center
EP0703757B1 (en) Apparatus for inserting spinal implants
US7686805B2 (en) Methods for distraction of a disc space
US7569054B2 (en) Tubular member having a passage and opposed bone contacting extensions
AU749542B2 (en) Apparatus and method of inserting spinal implants

Legal Events

Date Code Title Description
WWE Wipo information: entry into national phase

Ref document number: 94193049.1

Country of ref document: CN

AK Designated states

Kind code of ref document: A2

Designated state(s): AU BB BG BR BY CA CN CZ FI HU JP KP KR KZ LK LV MG MN MW NO NZ PL RO RU SD SK UA UZ VN

AL Designated countries for regional patents

Kind code of ref document: A2

Designated state(s): AT BE CH DE DK ES FR GB GR IE IT LU MC NL PT SE BF BJ CF CG CI CM GA GN ML MR NE SN TD TG

121 Ep: the epo has been informed by wipo that ep was designated in this application
DFPE Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101)
WWE Wipo information: entry into national phase

Ref document number: 2164859

Country of ref document: CA

Ref document number: 1994920704

Country of ref document: EP

WWP Wipo information: published in national office

Ref document number: 1994920704

Country of ref document: EP

WWG Wipo information: grant in national office

Ref document number: 1994920704

Country of ref document: EP