U.S. patent application number 13/200866 was filed with the patent office on 2012-04-12 for upload shank swivel head bone screw spinal implant.
Invention is credited to Roger P. Jackson.
Application Number | 20120089196 13/200866 |
Document ID | / |
Family ID | 38498690 |
Filed Date | 2012-04-12 |
United States Patent
Application |
20120089196 |
Kind Code |
A1 |
Jackson; Roger P. |
April 12, 2012 |
Upload shank swivel head bone screw spinal implant
Abstract
A polyaxial bone screw having a bone implantable shank, a head
and a retaining ring. The retaining ring includes an outer partial
hemispherical surface and an inner bore. The shank mates and
polyaxially rotates with the retaining ring inside the head. The
head includes an internal cavity having a spherical shaped surface
that mates with the ring surface and has a lower restrictive neck
that prevents passage of the ring once the ring is seated in the
cavity.
Inventors: |
Jackson; Roger P.; (Prairie
Village, KS) |
Family ID: |
38498690 |
Appl. No.: |
13/200866 |
Filed: |
October 4, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10818555 |
Apr 5, 2004 |
8052724 |
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13200866 |
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10464633 |
Jun 18, 2003 |
6716214 |
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10818555 |
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10651003 |
Aug 28, 2003 |
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10464633 |
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Current U.S.
Class: |
606/305 ;
29/428 |
Current CPC
Class: |
Y10T 29/49826 20150115;
A61B 17/7032 20130101; A61B 17/7037 20130101 |
Class at
Publication: |
606/305 ;
29/428 |
International
Class: |
A61B 17/86 20060101
A61B017/86; B23P 11/00 20060101 B23P011/00 |
Claims
1. A method of implanting a bone screw in a patient comprising the
steps of: a) providing a bone screw head having a lower aperture, a
cavity, a rod receiving channel wherein the aperture and channel
communicate with opposite sides of the cavity; b) providing an
elongate shank having a lower threaded portion and an upper
portion; c) providing a retainer for mating with the shank that is
sized and shaped to be received in the head; d) after steps a), b)
and c), loading the retainer into the head and thereafter loading
said shank upper portion into said head from below and through the
aperture; e) positioning the shank upper portion to polyaxially
rotate with the retainer and so as to extend above the retainer
after the shank mates with the retainer; and f) placing the rod
into the channel and securing the rod in the channel.
2. The method according to claim 1 including the step of extending
the shank upper portion into the channel so as to engage the rod
when the rod is received in the channel.
3. A method of implanting a bone screw in a patient comprising the
steps of: a) providing: i) a bone screw head having a lower
aperture, an interior cavity, and a rod receiving channel wherein
the cavity communicates with the channel and the aperture; and ii)
an elongate shank having a lower threaded portion and an upper
portion; then b) loading said shank upper portion into said head
cavity from below through said aperture; and c) capturing said
shank inside said head while allowing pivoting of said shank
relative to said head during positioning and locating the shank so
as to receive a downward locking force to fix the position of the
shank relative to the head when fully assembled; d) implanting the
shank into a bone of a patient; e) positioning said head into a
selected angular configuration with respect to the shank; followed
by f) placing said rod into said channel; g) applying a downward
force to the upper portion of the shank; followed by g) installing
a closure in the head that closes the channel and biases against
the rod.
4. The method according to claim 3 including wherein the step of
implanting is performed prior to placement of the shank into the
head.
5. The method according to claim 3 including wherein the step of
implanting is preformed after the placement of the shank into the
head.
6. A method of implanting a polyaxial bone screw in a patient
wherein the bone screw has a shank and a head wherein the head has
a channel adapted to receive a rod comprising the steps of: a)
providing a separate retainer to capture the shank and loading the
retainer into the head; b) uploading said shank into said head so
as to be captured therein by the retainer; c) providing the shank
with an upper engagement end; and d) positioning the shank upper
engagement end above the retainer, such that the shank upper
engagement end receives a downward locking force from above to fix
the shank in position relative to the head when fully
assembled.
7. A method of assembling a bone screw for a patient comprising the
steps of: a) providing a shank with an upper capture portion; b)
providing a bone screw head having a lower aperture, an upper
channel adapted to receive an implant and an internal cavity
communicating with the aperture and the channel; c) providing a
capture structure separate from the shank and the head; d) loading
the capture structure into the cavity; e) loading the shank capture
portion into the cavity; and f) joining the capture structure to
the shank upper capture portion in the cavity such that the shank
thereafter polyaxially rotates together with the capture structure
relative to the head.
8. The method according to claim 7 including the steps of: a)
implanting the shank in a patient's bone; b) thereafter,
polyaxially rotating the shank relative to the head to a selected
angular configuration of the head in comparison to the shank by
rotating the shank in combination with the capture structure
relative to the head; and c) thereafter, locking the selected
angular configuration of the shank relative to the head.
9. The method according to claim 8 wherein the step of implanting
in the bone is performed prior to loading the shank into the
head.
10. The method according to claim 8 wherein the step of implanting
in the bone is performed after loading the shank into the head.
11. A method constructing a polyaxial bone screw including
providing a shank and a head and including the steps of: a)
providing a retaining structure that is non-integral with said
shank and loading the retaining structure separately into said
head; b) uploading of an upper portion of the shank through the
aperture into the head after the retaining structure; c) mating the
retaining structure with and capturing the shank in said head
wherein the retaining structure is secured to the shank and
polyaxially pivots with the shank during positioning; and d)
positioning a surface of said shank upper portion above the
retaining structure so as to directly receive a downward force to
lock the shank with respect to the head when fully assembled.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 10/818,555 filed Apr. 5, 2004, now U.S. Pat.
No. ______, which was a continuation of Ser. No. 10/464,633, filed
Jun. 18, 2003, now U.S. Pat. No. 6,716,214 and a
continuation-in-part of Ser. No. 10/651,003, filed Aug. 28, 2003,
now U.S. Pat. No. ______, all of the disclosures of which are
incorporated by reference herein.
BACKGROUND OF THE INVENTION
[0002] The present invention is directed to a polyaxial bone screw
for use in spinal surgery and the like and especially to such a
screw adapted to receive a rod member and secure the rod member to
a vertebra or the like.
[0003] Many spinal surgery procedures require securing various
implants to bone and especially to vertebrae along the spine. For
example, elongate rods are often required that extend along the
spine to provide support to vertebrae that have been damaged or
weakened due to injury, disease or the like. Such rods must be
supported by certain vertebra and support other vertebra. The most
common mechanism for providing such structure is to implant bone
screws into certain bones which then in turn support the rod or are
supported by the rod. Bone screws of this type may have a fixed
head relative to a shank thereof. In the fixed bone screws, the
head cannot be moved relative to the shank and the rod must be
favorably positioned in order for it to be placed within the head.
This is sometimes very difficult or impossible to do so polyaxial
bone screws are commonly used. The polyaxial bone screws allow
rotation of the head about the shank until a desired rotational
position is achieved for the head relative to the shank after which
the rod can be inserted and the position of the head eventually
locked with respect to movement relative to the shank.
[0004] The present invention is directed to such swivel head type
bone screws and, in particular, to swivel head bone screws having
an open head that allows placement of the rod member within the
head and then subsequent closure by use of a closure top, plug or
the like to capture the rod in the head of the screw.
[0005] Because such implants are for placement within the human
body, it is always desirable for the implant to have as little
effect on the body as possible. Consequently, it is quite desirable
for the implants to have a relatively small profile both in height
and width. It is also desirable that the implants be
lightweight.
[0006] Furthermore, it is desirable that the swivel head implants
be unlikely to unintentionally disassemble within the body. It is
very undesirable for pieces of the implant to be free to move
around within the body after surgery is completed and it also
assures that the implant retains an ability to correct the
structural problem for which it was implanted. Furthermore, if the
implant should slip or become loose for some reason, it is still
desirable for all of the parts to remain together and not
separate.
[0007] Consequently, it is desirable for there to be a lightweight,
low profile polyaxial bone screw which assembles in such a manner
that each subsequent piece locks proceeding pieces within the
overall structure, so that there is less likelihood that the
various pieces of the structure will undesirably disassemble.
SUMMARY OF THE INVENTION
[0008] The present invention is directed to a polyaxial bone screw
that comprises a shank, a head and a retainer ring that operably
cooperate with each other. The bone screw is designed to allow the
shank to be locked or secured in a selected angular configuration
with respect to the head, while the head receives a rod member and
while the shank is implanted in a bone, such as a vertebra or
vertebral body.
[0009] The shank has an implant body which includes an external
helically wound thread that is in turn attached by a neck to a
capture end with a capture or connector type structure. The capture
structure is positioned outside the bone in use and has a radiused
and cylindrically shaped radially outer surface that has at least
one radially outwardly extending non helically wound projection or
spline thereon. The capture structure also has an upper axially
aligned and radiused dome that protrudes above the remainder of the
shank and above the ring during use to manipulate the shank and to
contact the rod. Further, in some embodiments the shank includes
off axis apertures, grooves, side slots or the like for use by an
installation tool with a mating configured head for driving and
rotating the shank into the bone.
[0010] The head has a generally cylindrical shaped profile with an
upwardly open U-shaped channel formed therein so as to effectively
produce a lower base with two upstanding and spaced arms. The inner
surfaces of the arms have a threadform thereon or another suitable
guide and advancement structure such as a helically wound
flangeform for use in closing the upper part of the channel.
Located in the interior of the base and coaxially aligned with the
head is a chamber having an interiorly facing partial spherical
shaped surface. The chamber further opens onto a bottom surface of
the head through a head lower wall bore forming a constricted or
restrictive neck sized and shaped to allow passage of the capture
structure therethrough.
[0011] The retainer ring includes an external partial spherical or
hemispherical surface that is sized and shaped to be seated in and
slidably engage the partial spherical surface within the head, both
having approximately the same radius of generation. The ring also
has an internal, centrally located and axially extending ring bore
sized and shaped to receive the capture structure of the shank
therethrough. Further, the ring has a series of axially extending
channels positioned about and opening into the central bore that
are sized and shaped to allow sliding passage of the shank splines
entirely through the ring so that the shank can be inserted through
the ring while the ring is positioned within the chamber in the
head. The channels are not helically wound about the bore and
preferably extend vertically or parallel to the axis of the ring.
The ring further includes a set of recesses that are
circumferentially spaced from the channels and that open onto the
upper part of the ring and into the bore, but do not pass entirely
through the ring and that can be entered by the splines by drawing
the shank with the splines thereon axially downwardly with respect
to the ring. In this manner, the splines can be passed upwardly or
uploaded through the ring by sliding through the channels in
conjunction with the remainder of the shank capture and after
sliding completely through the bore, the shank is then rotated a
certain number of degrees relative to the head, and then drawn back
downwardly or downloaded so that the splines encounter and engage
the recesses wherein the splines are captured by the ring. The
splines preferably have a wedge-shaped surface thereon which pushes
not only downwardly, but radially outward against the retainer or
capture ring when force is applied to the top of the shank.
[0012] During assembly, the ring is placed through the U-shaped
channel into the chamber having the partial spherical surface and
then rotated so that the ring hemispherical surface mates with and
slidably engages the head partial spherical surface. Subsequently,
the shank capture structure is uploaded into and extended through
the ring central bore, while the splines pass through the channels.
The shank is then rotated relative to the ring and then the shank
is moved in an axially reverse direction opposed to uploading while
the splines are positioned over the recesses so as to be aligned
with the recesses and not aligned with the channels and so that the
splines then enter the recesses. The ring with connected shank
effectively thereafter form a ball and socket joint with the head
and allow free rotation to a selected angular configuration until
later locked in the selected configuration. The shank, head and
ring are then placed in a bone by screwing the shank body into the
bone using the apertures on the top of the shank or alternative
structure such as grooves or faceted surfaces on the outside of the
portion of the shank extending above the ring.
[0013] Thereafter, a rod is placed in the U-shaped channel and
captured therein by closing the channel by use of a closure top or
plug having a threadform or other external guide and advancement
structure that mates with and advances along mating guide and
advancement structure of the arms of the head, when the closure top
is rotated. Preferably, the closure top also includes a break-off
head that provides purchase for a tool for rotation and torquing of
the closure top to a preselected torque and that such torque is
transferred and applied as pressure against the rod received in the
head. Once the preselected torque is achieved, the break-off head
breaks away from the closure top. Under pressure from the closure
top, the rod pushes against the dome of the shank that extends
above the ring and thereby urges the splines downwardly. Because of
the wedge shaped structure of the splines, the splines push both
downwardly and outwardly upon the retainer or capture ring, when
force is applied to the dome, so as to frictionally engage and
positively seat the retaining ring in the cavity and prevent
further rotation in conjunction with the shank dome frictionally
engaging the rod under pressure. In particular, the hemispherical
surface of the ring abuttingly and frictionally mates with the
integral hemispherical interior facing surface of the head, while
the dome frictionally mates with the rod under pressure from the
rod so as to lock the shank and ring in a selected angular
configuration relative to the head. The shank, in this manner, can
be locked in a configuration selected from an infinite number of
angular configurations with respect to the head. Once fully
assembled in this manner, unless a part breaks into pieces, the
shank cannot disengage from the capture ring and the head without
disassembly of the device by reversing the process or breaking the
parts.
OBJECTS AND ADVANTAGES OF THE INVENTION
[0014] Therefore, the objects in the present invention are: to
provide a polyaxial bone screw having a bone implantable shank that
can be locked in a fixed position relative to a head of the bone
screw; to provide such a bone screw having a capture or retaining
ring having a partial external hemispherical surface that seats
within a partial internal spherical shaped chamber surface within
and integrally formed with a head of the bone screw to form a ball
and socket joint and wherein the shank is securable to the
retaining ring; to provide such a bone screw wherein the shank has
at least one spline that extends radially outward from a capture
end thereof and wherein the retaining ring has a central bore that
receives the capture end while a channel opening into the bore
allows the spline to slide through the ring so as to pass above the
ring, at which time the shank can be rotated a select number of
degrees and further wherein the retaining ring has a capture recess
that receives the spline on further downward or reverse movement
along the axis of the shank relative to the retainer ring; to
provide such a bone screw wherein the shank has an upwardly
protruding radiused dome which has a radius that in one embodiment
is substantially less than the radius of the external hemispherical
surface on the retainer ring and that extends upwardly within the
head chamber so as to reduce height of the screw head and further,
is operably positioned so as to engage a rod member received in the
head so as to receive downward pressure from the rod during
assembly; to provide such a bone screw wherein a closure top is
used to close a channel in the bone screw head after receiving the
rod and to apply pressure to the rod member that in turn, exerts
pressure on the dome of the shank so as to urge each spline into an
abutting and tight relationship with the retaining ring and to urge
the retaining ring both downwardly and radially outwardly, so that
the external hemispherical surface on the retaining ring more
completely contacts and frictionally engages the internal spherical
surface within the chamber of the head thereby providing improved
mechanical fixation to prevent further rotation of the shank
relative to the head; to provide such a bone screw which has a
comparatively low profile and which is comparatively light in
weight; to provide such a bone screw that resists disassembly
thereof except by removal of the closure top; to provide such a
bone screw wherein the closure top can be removed by the surgeon
should disassembly be desired at which time the entire structure
can be easily and quickly disassembled and removed from the bone,
if necessary; to provide such a bone screw wherein the shank is
locked in position relative to the head during usage in a locked or
fixed configuration; to provide such a bone screw wherein the shank
cannot disassemble from the head and the retaining ring once the
screw is fully assembled except if the closure top is removed and
the device is disassembled by the surgeon; to provide such a bone
screw which is easy to use and extremely effective for the intended
usage thereof.
[0015] Other objects and advantages of this invention will become
apparent from the following description taken in conjunction with
the accompanying drawings wherein are set forth, by way of
illustration and example, certain embodiments of this
invention.
[0016] The drawings constitute a part of this specification and
include exemplary embodiments of the present invention and
illustrate various objects and features thereof.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] FIG. 1 is an exploded perspective view of three elements of
a polyaxial bone screw in accordance with the present invention,
including a shank, a head, and a retaining ring.
[0018] FIG. 2 is an enlarged top plan view of the retaining
ring.
[0019] FIG. 3 is an enlarged perspective view of the retaining
ring.
[0020] FIG. 4 is an enlarged side elevational view of the retaining
ring.
[0021] FIG. 5 is an enlarged bottom plan view of the retaining
ring.
[0022] FIG. 6 is an enlarged cross-sectional view of the head,
taken along line 6-6 of FIG. 1, illustrating the retaining ring
being inserted into the head.
[0023] FIG. 7 is an enlarged cross-sectional view of the head
similar to FIG. 6, showing the retaining ring seated in the
head.
[0024] FIG. 8 is a cross-sectional view of a vertebra illustrating
the shank implanted therein.
[0025] FIG. 9 is an enlarged and fragmentary perspective view of
the shank, head and retainer ring during assembly and just prior to
the retainer ring being placed over the shank.
[0026] FIG. 10 is an enlarged, fragmentary and perspective
cross-sectional view of the head similar to FIG. 6, illustrating
splines on a capture end of the shank that have been inserted
through channels in the retainer ring and are positioned upwardly
in the head above the retainer ring.
[0027] FIG. 11 is a cross-sectional view of the head, similar to
FIG. 10, showing the upper capture end of the shank with the
splines lowered into receiving recesses in the ring and positioned
therein.
[0028] FIG. 12 is a cross sectional view of the head and a top plan
view of the shank and ring corresponding to the positioning shown
in FIG. 10.
[0029] FIG. 13 is a cross sectional view of the head and a top plan
view of the shank and ring corresponding to the positioning shown
in FIG. 11.
[0030] FIG. 14 is a side elevational view of the head, ring and
shank, illustrating the shank swinging or rotating from one
position shown in solid lines to a second position shown in phantom
lines.
[0031] FIG. 15 is a fragmentary and partially exploded view of a
complete polyaxial bone screw assembly, prior to final assembly and
illustrating a rod received in the head and a closure top with a
break-off head, prior to the closure top being rotatably inserted
into the head.
[0032] FIG. 16 is a fragmentary and enlarged front elevational view
of the bone screw assembly fully assembled and illustrating the
head with the rod received therein and with the closure top fully
inserted and biasing against the rod that in turn biases against
the top of the shank.
[0033] FIG. 17 is an enlarged and fragmentary cross-sectional view
of the bone screw assembly with rod inserted therein, taken along
line 17-17 of FIG. 16.
[0034] FIG. 18 is an enlarged cross-sectional view of the vertebra,
head, rod and closure top, taken along line 18-18 of FIG. 17
showing the shank implanted in the vertebra and with the bone screw
assembly in a completely assembled and operational configuration
with the shank locked in an angled orientation with respect to the
head.
[0035] FIG. 19 is a perspective view of a modified retainer ring of
a first modified embodiment in accordance with the present
invention.
[0036] FIG. 20 is a perspective view of a second modified
embodiment of the present invention illustrating a cannulated shank
having four splines and a hex tool engageable head for manipulating
the shank.
[0037] FIG. 21 is a perspective view of a ring for use in
accordance with the second modified embodiment of the invention and
the shank of FIG. 20.
DETAILED DESCRIPTION OF THE INVENTION
[0038] As required, detailed embodiments of the present invention
are disclosed herein; however, it is to be understood that the
disclosed embodiments are merely exemplary of the invention, which
may be embodied in various forms. Therefore, specific structural
and functional details disclosed herein are not to be interpreted
as limiting, but merely as a basis for the claims and as a
representative basis for teaching one skilled in the art to
variously employ the present invention in virtually any
appropriately detailed structure.
[0039] The reference number 1 generally represents a polyaxial bone
screw apparatus or assembly in accordance with the present
invention operably utilized by implantation into a vertebra 2 and
in conjunction with a longitudinal member or rod 3 so as to
operably secure the rod 3 in a fixed position relative with respect
to the vertebra 2.
[0040] The fully assembled bone screw assembly 1 comprises a shank
6, a head 7, a retainer ring 8 and a closure top 9. The shank 6 is
perhaps best seen in FIGS. 1 and 8. The shank 6 is elongate and has
a lower body 15 ending in a tip 16. The shank body 15 has a
helically wound bone implantable thread 17 extending from near the
tip 16 to near the top 18 of the body 15 and extending radially
outward therefrom. During use, the body 15 utilizing the thread 17
is implanted into the vertebra 2, as is seen in FIG. 18. The shank
6 has an elongated axis of rotation generally identified by the
reference letter A. It is noted that the reference to the words top
and bottom as used herein refers to the alignment shown in the
various drawings, as well as the normal connotations applied to
such devices, and is not intended to restrict positioning of the
assembly 1 in actual use.
[0041] Axially extending outward and upward from the shank body 15
is a neck 20 of reduced radius as compared to the adjacent top 18
of the body 15. Further extending axially and outwardly from the
neck 20 is a capture end or structure 21 operably providing a
connective or capture structure free from the bone or vertebra 2
for joining with the head 7. The capture structure 21 has a
radially outer cylindrical surface 22. The cylindrical surface 22
has at least one non-helically wound and radially outward extending
projection or spline 24 that extends beyond the surface 22. In the
embodiment shown in FIGS. 1 through 18, the capture structure 21
has three such splines 24. The splines 24 are located near an upper
end 25 of the shank 6 and are equally circumferentially centered
and spaced thereabout so as to be centered at approximately 120
degree intervals relative to each other. Each of the splines 24 has
a triangular shaped profile and a front wedge forming face 27 that
slopes downwardly and radially inwardly from near the upper end 25
of the shank 6. Also located on the shank upper end 25 is a
centrally located, axially extending and upwardly directed
projection or dome 29 that is centrally radiused so as to have a
first radius.
[0042] The shank upper end 25 still further includes at least one
tool engagement aperture for engagement by a tool driving head (not
shown) that is sized and shaped to fit into the apertures for both
driving and rotating the shank 6 into the vertebra 2. In the
illustrated embodiment, a pair of apertures 31 located in spaced
relationship to each other, the dome 29 and the shank axis of
rotation A are located on the shank upper end 25. The apertures 31
extend into the shank capture structure 21 parallel to the axis A.
It is foreseen that various numbers of apertures, slots or the like
may be utilized in accordance with the invention for engaging the
driving tool of suitable and similar mating shape, or that the
outer surface of the upper axial projection can be grooved or
formed with a faceted surface that can be driven by a mating tool
that goes over the surface.
[0043] The head 7 has a generally cylindrical shaped profile, as is
seen in FIG. 1, although the head 7 is not a solid cylinder. The
head 7 has a base 33 with a pair of upstanding arms 34 and 35
forming a U-shaped channel 38 between the arms 34 and 35 with a
lower seat 39 having substantially the same radius as the rod 3 for
operably snugly receiving the rod 3. Each of the arms 34 and 35 has
an interior surface 41 that includes a partial helically wound
guide and advancement structure 42. In the illustrated embodiment,
the guide and advancement structure 42 is a partial helically wound
flangeform which will mate under rotation with a similar structure
on the closure top 9, as described below. However, it is foreseen
that the guide and advancement structure 42 could alternatively be
a V-shaped thread, a buttress thread, a reverse angle thread or
other thread like or non-thread like helically wound advancement
structures for operably guiding under rotation and advancing the
closure top between the arms 34 and 35. Tool engaging apertures 44
are formed on the outsides of the arms 34 and 35 for holding the
head 7 during assembly.
[0044] A chamber or cavity 47 is located within the head base 33
that opens upwardly into the U-shaped channel 38. The cavity 47
includes a partial spherical shaped surface 48, at least a portion
of which forms a partial internal hemispherical seat 49 for the
ring 8, as is described further below. A bore 52 further
communicates between the cavity 47 and the bottom exterior of the
base 33 and is coaxial with a rotational axis B of the head 7. The
bore 52 at least partially defines a restrictive neck 54 that has a
radius which is smaller than the radius of the ring 8, as will be
discussed further below, so as to form a restrictive constriction
at the location of the neck 54 relative to the retainer ring 8 to
prevent the ring 8 from passing between the cavity 47 and the lower
exterior of the head 7. A bevel 55 extends between the neck 54 and
the bottom exterior of the base 33. The hemispherical shaped
surface 48 has a second radius associated therewith.
[0045] The retainer ring 8 which is best seen in FIGS. 2 through 5
has an operational central axis which is the same as the elongate
axis A associated with the shank 6, but when the ring 8 is
separated from the shank 2, the axis of rotation is identified as
axis C, such as in FIG. 4. The retainer ring 8 has a central bore
57 that passes entirely through the retainer ring 8 from a top
surface 58 to a bottom surface 59 thereof. The bore 57 is sized and
shaped to fit snugly but slidably over the shank capture structure
cylindrical surface 22 in such a manner as to allow sliding axial
movement therebetween under certain conditions, as described below.
Three axially aligned channels 60 are spaced from the axis C and
extend radially outward from the bore 57 and into the wall of the
retainer ring 8 so as to form three top to bottom grooves or slots
therein. Backs 61 of the channels 60 are the same radial distance
from the axis C as the distance the outermost portion of the
splines 24 extend from the axis A of the shank 6. The channels 60
are also circumferentially angularly spaced equivalent to and have
a width that corresponds with the splines 24. In this manner, the
shank capture structure 21 can be uploaded into the ring 8 by
axially sliding the capture structure 21 through the ring central
bore 57 whenever the splines 24 are aligned with the channels 60 or
are in an aligned configuration, as seen in FIG. 12.
[0046] The retainer ring 8 also has three capture partial slots,
receivers or recesses 62 which extend radially outward from the
upper part the bore 57 and that do not extend the entire length
from top to bottom of the retainer ring 8, but rather only open on
the top surface 59 and extend partly along the height of the ring 8
thereof. The recesses 62 are sized and positioned and shaped to
receive the splines 24 from above when the splines 24 are in a
non-aligned configuration relative to the channels 60. That is,
each of the recesses 62 has a width that approximates the width of
the splines 24 and has a mating wedge engaging surface 64 that is
shaped similar to the spline wedge forming faces 27, so that the
splines 24 can be slidably received into the recesses 62 from above
by axially translating or moving the shank 6 downward relative to
the ring 8 when the splines 24 are positioned above the recesses 62
in a recess aligned configuration.
[0047] In some embodiments, the wedge engaging faces 64 slope
slightly greater than the wedge forming faces 27 on the splines 24
so that there is additional outward wedging that takes place when
the splines 24 are urged downwardly into the recesses 62, as
further discussed below.
[0048] In this manner the shank capture structure 21 can be
uploaded or pushed upwardly through the retainer ring central bore
57 so as to clear the top 58 of the retainer ring 8, rotated
approximately 60 degrees and then downloaded or brought downwardly
so that the splines 24 become located and captured in the recesses
62. Once the splines 24 are seated in the recesses 62 the shank 6
cannot move further axially downward relative to the ring 8.
Preferably, the retainer ring 8 is constructed of a metal or other
material having sufficient resilience and elasticity as to allow
the ring 8 to radially expand slightly outward by downward pressure
of the splines 24 on the recesses 62 under pressure from structure
above, as will be discussed further below. This produces a slight
outward radial expansion in the ring 8 at the location of the
recesses 62.
[0049] The ring 8 has a radially outer partial hemispherical shaped
surface 65 sized and shaped to mate with the partial spherical
shaped surface 48 and having a third radius approximately equal to
the second radius associated with the surface 48. The ring third
radius is substantially larger than the first radius associated
with the dome 29 and also substantially larger than the radius of
the neck 54.
[0050] The longitudinal member or elongate rod 3 can be any of many
different types of implants utilized in reconstructive spinal
surgery and the like, but is normally a cylindrical elongate
structure having a cylindrical surface 66 of uniform diameter. The
rod 3 is preferably sized and shaped to snugly seat near the bottom
of the U-shaped channel 38 and, during normal operation, will be
positioned slightly above the bottom of the channel 38. In
particular, the rod 3 normally engages the shank dome 29, as is
seen in FIG. 16 and urges the dome 29 and, consequently, the shank
6 downwardly when the entire assembly 1 is fully assembled.
[0051] The closure top 9 can be any of the variety of different
types of closure tops for use in conjunction with the present
invention with suitable mating structure on the upstanding arms 34
and 35. The illustrated closure top 9 has a generally cylindrical
shaped base 67 with an upwardly extending break-off head 68. The
base 67 includes a helically wound guide and advancement structure
71 that is sized, shaped and positioned so as to engage the guide
and advancement structure 42 on the arms 34 and 35 to allow the
closure top 9 to be rotated into the head 7 and, in particular, to
close the top of the U-shaped channel 38 to capture the rod 3, see
FIG. 16, preferably without splaying of the arms 34 and 35. The
closure top 9 also operably biases against the rod 3 by advancement
and applying pressure to the rod 7 under torquing, so that the rod
3 is urged downwardly against the shank dome 29. Downward biasing
of the shank dome 29 operably produces a frictional engagement
between the rod 3 and dome 29 and also urges the splines 24
downwardly to both bias downwardly and radially outwardly against
the retainer ring 8, so as to snugly and frictionally seat the
retainer ring external hemispherical surface 65 into and quite
tightly against the partial internal spherical surface 48 of the
head 7 and further so as to lock the shank 6 and retainer ring 8 in
a fixed position relative to the head 7.
[0052] The closure top break-off head 68 is secured to the base 67
at a neck 73 that is sized and shaped so as to break away at a
preselected torque that is designed to properly seat the retainer
ring 8 in the head 7. The break-off head 68 includes an external
faceted surface 75 that is sized and shaped to receive a
conventional socket head of a driving tool (not shown) to rotate
and torque the closure top 9. The break-off head 68 also includes a
central bore 77 and grooves 78 for operably receiving the
manipulating tools.
[0053] The closure top 9 also includes removal structure comprising
a pair of off axis pass through apertures 81 that extend from top
to bottom of the base 67. The apertures 81 are located parallel to
an axis of rotation axis D of the closure top 9, but are radially
spaced away therefrom. The apertures 81 become accessible from the
top of the base 67 after the break-off head 68 breaks away from the
base 67, as is seen in FIG. 18. The apertures 81 are designed to
receive a tool having a face that mates with and is insertable into
the apertures 81 for rotating the closure top base 67 subsequent to
installation so as to provide for removal, if necessary.
[0054] While the embodiment illustrated in FIGS. 1 through 18
includes three splines 3, it is foreseen that a shank 6 with a
single spline would be operable within the scope of the invention.
However, in some embodiments additional splines 3 may provide a
more even distribution of force upon the ring 8 and reduce the
likelihood of failure because of hoop strain or the like. Paired
and opposed splines in certain embodiments may provide a more even
distribution of forces. While any number of splines are foreseen as
possible for use under the present invention, the requirement that
the splines must get smaller as their number gets larger, limits
the maximum number at some point. However, the concept appears
viable until that point is reached. It is also noted that
additional channels and recesses allow the ring to be more elastic
in certain embodiments.
[0055] When the polyaxial bone screw assembly 1 is placed in use in
accordance with the invention the retainer ring 8 is normally first
slid through the head U-shaped channel 38, as is shown in FIG. 6,
and into and seated in the chamber 47, as is seen in FIG. 6.
Thereafter, the retainer ring 8 is rotated 90 degrees so as to be
coaxial with the head 7 and so that the retainer ring outer surface
65 snugly but slidably mates with the head interior spherical
shaped surface 48, as is seen in FIG. 7.
[0056] With reference to FIGS. 9, 10, and 12 the ring 8 in the head
7 is slid over the shank capture structure 21 so that the splines
24 slide upwardly through and above respective channels 60 so that
the splines 24 are then located, at least partially, in the
U-shaped channel 38 and chamber 47 above the retainer ring 8, as is
shown in FIG. 10. The shank 6 is then rotated 60 degrees relative
to the head about the axis A and the translational direction of the
shank 6 is reversed so that it goes downwardly or axially with
respect to the head 7, as is seen in FIGS. 11 and 13 and the
splines 24 enter the recesses 62. At this point there is no
substantial outward or downward pressure on the retainer ring 8 and
so the retainer ring 8 is easily rotatable along with the shank 6
within the chamber 47 and such rotation is of a ball and socket
type limited by engagement of the shank neck 20 with the ring
restrictive neck 54. Rotation is shown in FIG. 14 where it is
illustrated that the shank 6 can be rotated through a substantial
angular rotation relative to head 7, both from side to side and
from front to rear so as to substantially provide a universal or
ball joint wherein the angle of rotation is only restricted by
engagement of the neck 20 with the neck 54 on the head 7.
[0057] The assembly 1 is then normally screwed into a bone, such as
vertebra 2, by rotation of the shank 6 using a suitable driving
tool (not shown) that operably drives and rotates the shank 6 by
engagement thereof at the apertures 31. The relative position of
the shank 6 is shown in FIG. 8 with a phantom vertebra 2. Normally,
the head 7 and ring 8 are assembled on the shank 6 before placing
the shank 6 in the vertebra 2, but in certain circumstances, the
shank 6 can be first implanted with the capture structure 21
extending proud to allow assembly and then the shank 6 can be
further driven into the vertebra 2.
[0058] A rod 3 is eventually positioned within the head U-shaped
channel 38, as is seen in FIG. 15, and the closure top 9 is then
inserted into and advanced between the arms 34 and 35 so as to bias
or push against the rod 3. The break-off head 68 of the closure top
9 is torqued to a preselected torque, for example 90 inch pounds,
to urge the rod 3 downwardly. The shank dome 29, because it is
radiused and sized to extend upwardly into the U-shaped channel 38,
is engaged by the rod 3 and pushed downwardly when the closure top
9 pushes downwardly on the rod 3, as is seen in FIG. 16.
[0059] The downward pressure on the shank 6 in turn urges the
splines 24 downwardly which exerts both a downward and outward
thrust on the retainer ring 8, as is seen in the configuration
shown in FIG. 17. The polyaxial bone screw assembly 1 including rod
3 and shown positioned in a vertebra 2 is illustrated in FIG. 18.
The axis A of the bone screw shank 6 is illustrated as not being
coaxial with the axis B of the head 7 and the shank 6 is locked in
this angular locked configuration. Other angular configurations can
be achieved, as required during installation surgery due to
positioning of the rod 3 or the like.
[0060] If removal of the assembly 1 is necessary, the assembly 1
can be disassembled by using a driving tool mating with the closure
top apertures 81 to rotate the base 67 and reverse the advancement
thereof in the head 7 and then disassembly of the remainder of the
assembly 1 in reverse mode in comparison to the procedure described
above for assembly.
[0061] Illustrated in FIG. 19 is a second embodiment of a retainer
ring 88 in accordance with the present invention. The retainer ring
88 is quite similar to the retainer ring 8 of the previous
embodiment except that it is noncontinuous and has a radially
extending space or gap 90 from top to bottom along one side
thereof. The gap 90 allows for expansion without requiring
stretching of the material of construction of the ring 88, as is
the case with the previous embodiment. The ring 88 includes a
central bore 92, spline channels 93 and spline receivers 94 which
are all similar to the similar structures described for the
previous embodiment. The retainer ring 88 also has a partial
hemispherical shaped surface 95 on the outer side thereof.
[0062] Illustrated in FIGS. 20 and 21 are elements of a third
embodiment of the present invention including a shank 106 and a
capture ring 107 which are used otherwise in the same manner as has
been described in the first embodiment and, in particular, with a
head such as head 7 which is not further described herein. The
shank 106 is similar to the shank 6 in that it has a body 110 with
a helically round thread 111 thereon and a capture structure 114
joined to the body 110 by a neck 115. The principle differences
between the present embodiment and the first embodiment is that the
capture structure 114 includes four splines 120 that are similar in
shape to the splines 24 of the first embodiment, but the splines
120 are centered and located at 90 degrees from one another such
that there is a pairing of opposed splines 120 and the dome of the
prior embodiment is replaced with an axial extension 122. Each of
the splines 120 includes a wedge face 121. The extension 122 has a
faceted surface 123 that extends parallel to the axis of the shank
106 and that is sized and shaped to receive a hex head driving tool
(not shown) for driving the shank 106 into bone. The extension 123
also has a radiused upper surface 124. The shank 106 also has an
axial extending cannulation or bore 125 that extends entirely
through the length of the shank 106.
[0063] The capture ring 107, shown in FIG. 21, is otherwise similar
to the retainer ring 8 except that it includes a set of four
channels 126 and four recesses 127 that are sized shaped and
positioned so as with respect to the channels 126 to allow the
splines 120 to slidingly pass upwardly through and with respect to
the recesses 127 to capture and receive the splines 120, as they
move axially downwardly. The ring 107 has a partial hemispherical
outer surface 129 that mates with the corresponding surface in the
head 7 in the manner described for the first embodiment.
[0064] It is to be understood that while certain forms of the
present invention have been illustrated and described herein, it is
not to be limited to the specific forms or arrangement of parts
described and shown.
* * * * *