U.S. patent application number 13/687220 was filed with the patent office on 2014-05-29 for vertebral fixation system.
This patent application is currently assigned to Zimmer Spine, Inc.. The applicant listed for this patent is ZIMMER SPINE, INC.. Invention is credited to Daniel Carlson, Hugh Hestad.
Application Number | 20140148854 13/687220 |
Document ID | / |
Family ID | 49752954 |
Filed Date | 2014-05-29 |
United States Patent
Application |
20140148854 |
Kind Code |
A1 |
Carlson; Daniel ; et
al. |
May 29, 2014 |
VERTEBRAL FIXATION SYSTEM
Abstract
A vertebral fixing system having a flexible elongated member, a
connecting part, and an anchor, where the anchor may engage a bone
structure (e.g., a vertebra) through an opening of the connecting
part and the flexible elongated member may connect to the
connecting part. In some cases, the vertebral fixing system may
include a tightening part configured to apply a tension to the
elongated member and/or secure the elongated member with respect to
the connecting part. The vertebral fixing system may be configured
to receive a rod and may be capable of connecting thereto. The
connecting part may have a plurality of connecting members, where
at least one of the connecting members includes an opening for
receiving the anchor and at least one of the connecting members
connects to the elongated member.
Inventors: |
Carlson; Daniel; (St. Louis
Park, MN) ; Hestad; Hugh; (Edina, MN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
ZIMMER SPINE, INC. |
Minneapolis |
MN |
US |
|
|
Assignee: |
Zimmer Spine, Inc.
Minneapolis
MN
|
Family ID: |
49752954 |
Appl. No.: |
13/687220 |
Filed: |
November 28, 2012 |
Current U.S.
Class: |
606/254 ;
606/279 |
Current CPC
Class: |
A61B 17/7049 20130101;
A61B 17/7029 20130101; A61B 17/82 20130101; A61B 17/7053
20130101 |
Class at
Publication: |
606/254 ;
606/279 |
International
Class: |
A61B 17/70 20060101
A61B017/70 |
Claims
1. A vertebral fixing system comprising: a flexible elongated
member having a first portion, a second portion, and an
intermediate portion extending between the first portion and the
second portion; a connecting part having an opening, wherein the
flexible elongated member is connected to the connecting part; a
bone anchor configured to be inserted through the opening of the
connecting part to engage a bone.
2. The system of claim 1, further comprising: a tightening part in
adjustable connection with the flexible elongated member, wherein
the tightening part is configured to secure the flexible elongated
member with respect to the connecting part.
3. The system of claim 1, wherein: the connecting part comprises: a
first connecting member having an opening; and a second connecting
member having an opening; and the bone anchor is configured to be
inserted through the opening of the first connecting member and the
opening of the second connecting member to engage a bone.
4. The system of claim 3, wherein the flexible elongated member
engages the first connecting member and/or the second connecting
member.
5. The system of claim 3, wherein the first connecting member is
configured to move with respect to the second connecting
member.
6. A vertebral fixing system, comprising a flexible elongated
member having a first portion, a second portion, and an
intermediate portion extending between the first portion and the
second portion; a connecting part, wherein the flexible elongated
member is connected to the connecting part; a tightening part
engaging the flexible elongated member, wherein the tightening part
is configured to secure the flexible elongated member with respect
to the connecting part; and wherein the first portion of the
flexible elongated member and/or the second portion of the flexible
elongated member is/are configured to be wrapped around a bone and
inserted into the tightening part.
7. The system of claim 6, further comprising: an opening in the
connecting part; and a bone anchor configured to be inserted
through the opening of the connecting part and to engage a
bone.
8. The system of claim 7, wherein: the opening of the connecting
part is a first opening; the connecting part has a second opening;
the bone anchor is configured to be inserted through the first
opening; and the flexible elongated member connects to the
connecting part through the second opening.
9. The system of claim 6, wherein the tightening part engages the
first portion of the flexible elongated member and the second
portion of the flexible elongated member to secure the flexible
elongated member with respect to the connecting part.
10. The system of claim 6, wherein the tightening part includes a
one-way catch mechanism.
11. The system of claim 6, wherein the tightening part includes a
release to allow for adjustment of the flexible elongated member
with respect to the bone.
12. The system of claim 6, wherein the first portion of the
flexible elongated member is mechanically affixed to the connecting
part.
13. The system of claim 12, wherein the second portion of the
flexible elongated member is configured to be wrapped around the
bone and inserted into the tightening part.
14. The system of claim 6, further comprising: a spacer having a
first opening, a second opening, and an extending portion extending
between the first opening of the spacer and the second opening of
the spacer; and wherein the spacer receives the flexible elongated
member in the first opening of the spacer and/or the second opening
of the spacer.
15. The system of claim 14, wherein: the spacer has a lumen; and
the spacer receives the flexible elongated member in the lumen.
16. The system of claim 15, wherein: the spacer has a length
extending substantially from the first opening of the spacer to the
second opening of the spacer; and the lumen has a length
substantially equal to the length of the spacer.
17. The system of claim 16, wherein the flexible elongated member
extends into a first end of the lumen, along the length of the
lumen, and out of a second end of the lumen.
18. The system of claim 14, wherein: the spacer has an intermediate
opening between the first opening of the spacer and the second
opening of the spacer; and the intermediate opening communicates
with the lumen.
19. The system of claim 18, wherein the tightening part engages the
flexible elongated member adjacent the intermediate opening of the
spacer.
20. The system of claim 14, further comprising: a set screw
engaging the spacer; and the set screw engaging the first portion
of the flexible elongated member, the second portion of the
flexible elongated member and/or the intermediate portion of the
flexible elongated member.
21. A method for manipulating spinal anatomy, the method
comprising: connecting a bone anchor inserted through an opening of
a connecting part to a first portion of the spinal anatomy;
extending a flexible elongated member connected to the connecting
part around a second portion of the spinal anatomy; inserting a
first end of the elongated member and/or a second end of the
elongate member into a tightening part; tensioning a portion of the
elongated member extending between the connecting part and the
second portion of the spinal anatomy; and locking the inserted
elongated member in the tightening part to maintain a tension in
the tensioned portion of the elongated member.
Description
TECHNICAL FIELD
[0001] The disclosure is directed to vertebral fixing systems. More
particularly, the disclosure is directed to vertebral fixing
systems suitable for being mounted on a vertebra.
BACKGROUND
[0002] The spine is constituted by superposed vertebrae that are
normally in alignment along a vertical axis going from the lumbar
vertebrae to the cervical vertebrae, each vertebrae presenting a
posterior wall from which there projects a spinous process and two
sides having walls from which there project the ribs and/or
transverse processes. When the spine of an individual presents
abnormal curvature, the vertebrae are inclined relative to one
another and/or relative to the vertebral axis. For example, the
sides of the vertebrae situated on one side may be moved closer
together forming a concave side, whereas the sides of the vertebrae
on the other side may be spaced apart from one another and form a
convex side.
[0003] In order to straighten the spinal column, a spinal
stabilization system may be surgically installed along a vertebral
segment. In order to keep the vertebrae in a desired relative
position, known devices have screws that are inserted in the
vertebrae and/or hooks that are inserted along the inside wall of
the vertebral canal, and rods that are for interconnecting the
screws and/or the hooks.
SUMMARY
[0004] The disclosure is directed to several alternative or
complementary designs, materials, and methods of using medical
device structures and assemblies. Although it is noted that
conventional vertebral fixing systems and similar devices exist,
there exists a need for improvement on those devices.
[0005] Accordingly, one illustrative embodiment of the disclosure
may include a vertebral fixing system having an elongated member
(e.g., a flexible elongated member), a connecting part, and an
anchor, where the anchor may engage a bone structure through an
opening in the connecting part and the elongated member may connect
to the connecting part. The elongated member may be flexible and
may connect to the connecting part in any manner. For example, the
elongated member may be looped through an opening in the connecting
part (e.g., the opening through which the anchor may be inserted
and/or through a different opening), the elongated member may be
mechanically fixed to the connecting part through gluing, applying
pressure, clamping, riveting, sewing, or other mechanical fixation
or fastening techniques, and/or the elongated member may be
connected to the connecting part in any other manner, as
desired.
[0006] In some cases, the connecting part may have a first
connecting member with an opening and a second connecting member
with an opening, where the bone anchor may be inserted through the
opening of the first connecting member and/or the opening of the
second connecting member to engage a bone structure.
Illustratively, the first connecting member and the second
connecting member may be movable with respect to the other of the
first connecting member and the second connecting member.
Alternatively, the first connecting member and the second
connecting member may be unitarily formed and substantially fixed
with respect to the other of the first connecting member and the
second connecting member. Each, or at least one, of the connecting
members may be connected to the elongated member(s).
[0007] In some illustrative instances, the vertebral fixing system
may include a tightening part. The tightening part may be in
adjustable connection with the elongated member and may be
configured to secure the elongated member with respect to the
connecting part. In an illustrative example, the elongated member
connected to the connecting part may be wrapped around a bone
structure or other structure and inserted into the tightening part,
where the tightening part may be used to retain and/or apply a
tension in and/or to the inserted elongated member and/or secure
the elongated member in a position with respect to the connecting
part.
[0008] In some instances, the vertebral fixing system may be used
in a method of manipulating spinal anatomy. For example, the anchor
of the vertebral fixing system may be inserted through an opening
of the connecting part and connected to a first portion of the
spinal anatomy. In the example, the elongated member connected to
the connecting part may be extended around a second portion of the
spinal anatomy and inserted into a tightening member or part. Then,
the elongated member extending between the connecting part and the
second portion of the spinal anatomy may be tensioned and locked
into a position with the tightening member to maintain a tension in
the elongated member.
[0009] The above summary of some example aspects is not intended to
describe each disclosed embodiment or every implementation of the
claimed disclosure.
BRIEF DESCRIPTION OF THE DRAWINGS
[0010] The disclosure may be more completely understood in
consideration of the following detailed description of various
embodiments in connection with the accompanying drawings, in
which:
[0011] FIG. 1 is a schematic perspective view of an illustrative
vertebral fixing system according to an aspect of the
disclosure;
[0012] FIG. 2 is a schematic perspective view of an illustrative
vertebral fixing system according to an aspect of the
disclosure;
[0013] FIG. 3A is a schematic perspective view of an illustrative
vertebral fixing system according to an aspect of the
disclosure;
[0014] FIG. 3B is a schematic perspective partially exploded view
of an illustrative vertebral fixing system according to an aspect
of the disclosure;
[0015] FIG. 4 is a schematic sectional view of a feature of an
illustrative vertebral fixing system according to an aspect of the
disclosure, where the illustrative vertebral fixing system is
engaging a bone structure;
[0016] FIG. 5A is a schematic sectional view of an illustrative
vertebral fixing system according to an aspect of the disclosure,
where the illustrative vertebral fixing system is in an unlocked
position;
[0017] FIG. 5B is a schematic sectional view of the illustrative
vertebral fixing system depicted in FIG. 5A, where the illustrative
vertebral fixing system is in a preliminary locking position;
[0018] FIG. 5C is a schematic sectional view of the illustrative
vertebral fixing system depicted in FIG. 5A, where the illustrative
vertebral fixing system is in a final locking position;
[0019] FIG. 6 is a schematic plan view of an illustrative vertebral
fixing system according to an aspect of the disclosure, where the
illustrative vertebral fixing system is engaging a bone
structure;
[0020] FIG. 7 is a schematic sectional view of the illustrative
vertebral fixing system of FIG. 6;
[0021] FIG. 8 is a schematic perspective view of an illustrative
vertebral fixing system including a spacer according to an aspect
of the disclosure;
[0022] FIG. 9 is a schematic sectional view of an illustrative
vertebral fixing system including a spacer according to an aspect
of the disclosure, where the illustrative vertebral fixing system
is engaging a bone structure;
[0023] FIG. 10 is a schematic sectional view of an illustrative
vertebral fixing system including a spacer according to an aspect
of the disclosure, where the illustrative vertebral fixing system
is engaging a bone structure;
[0024] FIG. 11 is a schematic sectional view of an illustrative
vertebral fixing system including a spacer according to an aspect
of the disclosure, where the illustrative vertebral fixing system
is engaging a bone structure;
[0025] FIG. 12A is a schematic perspective view of an illustrative
vertebral fixing system including an elongated member and a spacer
according to an aspect of the disclosure;
[0026] FIG. 12B is an expanded schematic side view taken of the
illustrative vertebral fixing system including a spacer depicted in
FIG. 12A, where the dotted lines show features interior of the
spacer;
[0027] FIG. 13 is a schematic side view of an illustrative
vertebral fixing system including an elongated member and a spacer
according to an aspect of the disclosure;
[0028] FIG. 14 is a schematic perspective view of an illustrative
vertebral fixing system according to an aspect of the
disclosure;
[0029] FIG. 15 is a schematic perspective view of illustrative
interior features of the illustrative vertebral fixing system
depicted in FIG. 14, where a housing of the illustrative vertebral
fixing system is depicted as being transparent; and
[0030] FIG. 16 is a schematic flow diagram of an illustrative
method for manipulating spinal anatomy using an illustrative
vertebral fixing system according to an aspect of the
disclosure.
[0031] While the disclosure is amenable to various modifications
and alternative forms, specifics thereof have been shown by way of
example in the drawings and will be described in detail. It should
be understood, however, that the intention is not to limit aspects
of the claimed disclosure to the particular embodiments described.
On the contrary, the intention is to cover all modifications,
equivalents, and alternatives falling within the spirit and scope
of the claimed disclosure.
DESCRIPTION
[0032] For the following defined terms, these definitions shall be
applied, unless a different definition is given in the claims or
elsewhere in this specification.
[0033] All numeric values are herein assumed to be modified by the
term "about", whether or not explicitly indicated. The term "about"
generally refers to a range of numbers that one of skill in the art
would consider equivalent to the recited value (i.e., having the
same function or result). In many instances, the term "about" may
be indicative as including numbers that are rounded to the nearest
significant figure.
[0034] The recitation of numerical ranges by endpoints includes all
numbers within that range (e.g., 1 to 5 includes 1, 1.5, 2, 2.75,
3, 3.80, 4, and 5).
[0035] Although some suitable dimensions, ranges and/or values
pertaining to various components, features and/or specifications
are disclosed, one of skill in the art, incited by the present
disclosure, would understand desired dimensions, ranges and/or
values may deviate from those expressly disclosed.
[0036] As used in this specification and the appended claims, the
singular forms "a", "an", and "the" include plural referents unless
the content clearly dictates otherwise. As used in this
specification and the appended claims, the term "or" is generally
employed in its sense including "and/or" unless the content clearly
dictates otherwise.
[0037] As used herein, the proximal end (i.e., trailing end) of an
object is the end that is closest to the individual or instrument
inserting the object during a medical procedure and the distal end
(i.e., leading end) of an object is the end that is farthest from
the individual or instrument inserting the object during a medical
procedure.
[0038] As used herein, any numerical or other order designations of
elements (e.g., first, second, third, a, b, c, etc.) are used for
descriptive purposes to improve the clarity of the description of
the disclosure and differentiate between similar disclosed
features. These numerical indications, unless expressly indicated,
are not used for any limiting purposes.
[0039] The following detailed description should be read with
reference to the drawings in which similar elements in different
drawings are numbered the same. The detailed description and the
drawings, which are not necessarily to scale, depict illustrative
embodiments and are not intended to limit the scope of the claimed
disclosure. The illustrative embodiments depicted are intended only
as exemplary. Selected features of any illustrative embodiment may
be incorporated into an additional embodiment unless clearly stated
to the contrary.
[0040] Turning to the figures, FIGS. 1-15 depict illustrative
vertebral fixing systems 10. Generally, vertebral fixing systems 10
may include an elongated member 12 (e.g., a flexible elongated
member or ligature, as shown in FIGS. 1-15, or an inflexible
elongated member), a connecting part 14, an anchor 16 (e.g., a bone
anchor, a bone screw, or other fastener or anchor), and/or a
tightening part 18. In some instances, illustrative vertebral
fixing systems 10 may be configured to engage a bone (e.g., a
vertebra, a rib, or other bone structure) via the bone anchor 16,
the elongated member 12, and/or any other feature, where the
elongated member 12 may extend from the connecting part 14 and may
be configured to be wrapped around at least a portion of a bone
structure and inserted into the tightening part 18.
[0041] In some illustrative cases, the connecting part 14 may be
configured in the shape of a grommet or washer and may include an
opening(s) 20 through which objects may be received or inserted
(e.g., a first opening 20a and a second opening 20b, as shown in
FIG. 1, or any other number of openings 20). For example, in some
instances the connecting part 14 may be a flat member having an
upper surface, a lower surface opposite the upper surface, and one
or more, or a plurality of openings 20 extending through the
connecting part 14 from the upper surface to the lower surface. The
lower surface of the connecting part 14 may be configured to face
and/or contact a bony structure of a vertebra. The connecting part
14 may devoid of any structure (e.g., an elongate channel) for
coupling the connecting part 14 to a spinal rod and thus not be
configured to be coupled to an elongate spinal rod.
[0042] Illustratively, the opening(s) 20 may be sized and/or
otherwise configured to receive the threaded anchor 16 and/or the
elongated member 12. For example, the opening 20 may be sized such
that the threaded anchor 16 may be inserted through the opening 20
to engage a vertebra and to position the connecting part 14 with
respect to the vertebra (e.g., with the lower surface bearing
against a bony structure of the vertebra). In some instances, the
anchor 16 may be removable from the connecting part 14, or the
anchor 16 may be configured to be retained with the connecting part
14. For example, in some instances the anchor 16 may be
pre-assembled with the connecting part 14 during manufacture, and
provided as an assembly during a surgical procedure. In some such
instances, the anchor 16 may be rotatable relative to the
connecting part 14 but not removable from the connecting part 14.
In the example, once the anchor 16 is inserted through the opening
20 and engaging the vertebra, connecting part 14 may be in a fixed
position relative to the vertebra or the connecting part 14 may be
in an adjustable position with respect to the vertebra.
[0043] The connecting part 14 may be made of any material. For
example, the connecting part 14 may be made of a metal material, a
polymer material, or any other similar or dissimilar material, as
desired. The opening(s) 20 in the material of the connecting part
14 may be formed through any technique. For example, the opening(s)
20 may be punched out, drilled out, or milled out of the material
of the connecting part 14, molded into the material of the
connecting part 14, and/or developed in any other similar or
dissimilar manner.
[0044] In some instances, the elongated member 12 (e.g., a flexible
elongated member) may have a first portion 12a, a second portion
12b, and a third portion 12c (e.g., an intermediate portion)
extending between the first portion 12a of the elongated member 12
and the second portion 12b of the elongated member 12, where the
first portion 12a and the second portion 12b of the elongated
member 12 may be end portions. Illustratively, the first portion
12a, the second portion 12b, and/or the third portion 12c of the
elongated member 12 may be configured to engage the connecting part
14 in any manner. For example, the elongated member 12 may
mechanically engage the connecting part(s) 14 (see FIGS. 2 and 3),
the elongated member 12 may be threaded through the opening 20
(e.g., the second opening 20b, as shown in FIG. 1) of the
connecting part 14, or the elongated member 12 may engage the
connecting part in any other manner, as desired. In some instances,
the second portion 12b may be attached (e.g., stitched, glued,
riveted, etc.) to the first portion 12a, forming a loop portion
with the third portion 12c extending through the opening 20b, with
only the first portion 12a being a free end portion extending from
the connecting part 14. In other instances, the first portion 12a
and the second portion 12b may both be free end portions extending
from the connecting part 14. Example mechanical engagements between
the connecting part 14 and the elongated member 12 include, but are
not limited to, welded engagements, glued engagements, press-fit or
crimped engagements, clamped engagements, riveted engagements,
etc.
[0045] As discussed, the connecting part 14 may include the first
opening 20a and the second opening 20b. In such instances, the
anchor 16, illustratively, may be configured to be inserted through
the first opening 20a to engage a portion of an anatomy (e.g., a
bone) accessible through the first opening 20a. The second opening
20b may facilitate the connection between the connecting part 14
and the elongated member 12, as shown in FIG. 1. For example, the
elongated member 12 may connect to the connecting part 14 via
insertion through the second opening 20b of the connecting part 14
and wrapping the elongated member around the connecting part 14.
The second opening 20b may be arranged laterally from the first
opening 20a, such that the second opening 20b is located within a
portion of the connecting part 14 extending away from the anchor
16.
[0046] In some instances, the connecting part 14 may include a
first connecting member 14a and a second connecting member 14b
having an opening 20, as shown in FIGS. 3A and 3B. When engaged by
an anchor 16 and/or when separate from the anchor 16, the first
connecting member 14a and the second connecting member 14b of the
connecting part 14 may be fixed relative to one another (e.g.,
unitarily formed, as shown in FIG. 3A, or fixed relative to one
another in any other manner). Alternatively, as shown in FIG. 3B,
the first connecting member 14a of the connecting part 14 and/or
the second connecting member 14b of the connecting part 14 may be
configured to be adjusted relative to one another (e.g., pivoted
about an anchor 16 received through the opening 20 of the first
connecting member 14a and/or the opening of the second connecting
member 14b, and/or otherwise movable with respect to the other
connecting member 14a, 14b).
[0047] As illustrated in FIG. 3A, the first connecting member 14a
and the second connecting member 14b may be unitarily configured
and have a single opening 20 configured to receive the anchor 16.
Alternatively, as shown in FIG. 3B, each of the first connecting
member 14a and the second connecting member 14b may be separately
configured and may have separate openings 20 configured to receive
the anchor 16. The openings 20 of the first connecting member 14a
and the second connecting member 14b may be positioned and/or
aligned with respect to one another such that the anchor 16 may be
inserted through the opening 20 of the first connecting member 14a
and the opening 20 of the second connecting member 14b to engage a
bone (e.g., a vertebra, a rid, or other bone structure).
[0048] The elongated member 12 may engage the first connecting
member 14a and/or the second connecting member 14b in any manner.
In some instances, an elongated member 12 may extend from each of
the first connecting member 14a and the second connecting member
14b. For example, each of the first connecting member 14a and the
second connecting member 14b may include a first opening 20a and a
second opening 20b, where an elongated member 12 may be threaded
through each of the second openings 20b of the respective first
connecting member 14a and the second connecting member 14b or a
single elongated member 12 may be threaded through both of the
second openings 20b of the respective first connecting member 14a
and the second connecting member 14b. Alternatively, an elongated
member 12 may mechanically engage each of the first connecting
member 14a and the second connecting member 14b or a single
elongated member 12 may mechanically engage both of the second
openings 20b of the respective first connecting member 14a and the
second connecting member 14b.
[0049] The tightening part 18 or clamping part may be any
configuration capable of engaging the first portion 12a of the
elongated member 12, the second portion 12b of the elongated member
12, and/or the third portion 12c of the elongated member 12 to
secure the elongated member 12 with respect to the connecting part
14, the anchor 16, and/or any other feature, as desired. For
example, the tightening part 18 may have a configuration that
includes a one-way catch mechanism 22 (e.g., a gear, zip-tie head),
a release 24 to allow for adjustment of the elongated member 12
with respect to a bone (e.g., a vertebra) or other piece of human
anatomy, and/or any other engaging and/or tightening features, as
desired. Alternatively, or in addition, in some instances, the
tightening part 18 may be configured to receive and engage a
portion of the elongated member 12 (e.g., the second portion 12b of
the elongated member 12) that has been wrapped and/or extended
around a bone (e.g., a vertebra, a rib, or other bone) to
substantially secure the portion of the elongated member 12 with
respect to the connecting part 14, the anchor 16, the bone, and/or
the other feature.
[0050] The tightening part 18 may be made of any material. For
example, the tightening part 18 may be made of a metal material, a
polymer material, or any other similar or dissimilar material, as
desired.
[0051] Illustratively, the tightening part 18 may be configured to
be in adjustable connection with the flexible elongated member 12.
In some cases, the tightening part 18 may include a one-way catch
mechanism 22. For example, the one-way catch mechanism may include
a pivoted cam-shaped pawl, (as shown in FIG. 4), a zip-tie head,
ratcheting teeth, or other fastener features. The one-way catch
mechanism 22 may be configured to allow the elongated member 12 to
be inserted in a first direction by pulling or moving the elongated
member 12 through the tightening part 18 in the first direction.
Once the elongated member 12 is inserted, the one-way catch
mechanism 22 may be configured to prevent movement of the elongated
member 12 through the tightening part 18 in a second direction,
substantially opposite the first direction.
[0052] In some cases, a cam-shaped pawl portion 40 of the
tightening part 18 may include a toothed catch mechanism 42, as
shown in FIG. 4, where the catch mechanism 42 may engage the
elongated member 12 against a surface of the tightening part 18 to
maintain the elongated member 12 in a position with respect to the
tightening part 18. The catch mechanism 42 may be spring loaded
and/or otherwise biased toward the second direction and may pivot
about a pivot feature 46 (e.g., a pin, a screw, a nail, etc.) of
the catch mechanism 42. In operation, when the elongated member 12
is moved in the first direction through the cam-shaped pawl 40 of
the tightening part 18 or a force in substantially the first
direction is applied to the elongated member 12 inserted into the
cam-shaped pawl 40 and/or when the release 24 (e.g., a pawl) is
pressed against catch mechanism 42, the catch mechanism 42 may
pivot about the first pivot feature 46 to allow the elongated
member 12 to advance in substantially the first direction. When the
elongated member 12 has ceased movement in the first direction
and/or the force in substantially the first direction has been
removed from the elongated member 12, the catch mechanism 42 may
pivot to a resting position such that the catch mechanism 42
engages the elongated member 12 and the side of the tightening part
18 to substantially prevent movement of the elongated member 12 in
substantially the second direction.
[0053] Alternatively, or in addition to including a one-way catch
mechanism 22, the tightening part 18 or clamping part may have a
pivot design, as shown in FIGS. 5A-5C. Illustratively, the
tightening part 18 may include a first longitudinal element 50 and
a second longitudinal element 52 in a spaced apart position, as
shown in FIG. 5A, and configured to pivot about the same axis or
different axes. The first longitudinal element 50 and/or the second
longitudinal element 52 may be configured to include lock recesses
70. In addition, the first longitudinal element 50 and/or the
second longitudinal element 52 may be configured to include a lock
tooth or lock teeth 72. The lock teeth 72 on the first longitudinal
element 50 and/or the second longitudinal element 52 may be
configured to engage the lock recesses(s) 70 of the second
longitudinal element 52 and/or the first longitudinal element 50,
respectively. For example, as shown in FIGS. 5A-5C, the first
longitudinal element 50 may include a first lock recess 70a and a
second lock recess 70b and the second longitudinal element 52 may
include a lock tooth 72, where the lock tooth 72 may engage the
first lock recess 70a when the tightening part 18 is in a
preliminary or provisional locking position, as shown in FIG. 5B,
and the lock tooth 72 may engage the second lock recess 70b when
the tightening part 18 is in a final locking position, as shown in
FIG. 5C.
[0054] In some cases, the tightening part 18 may take on other
configurations and features and/or be combined with other features.
Illustrative tightening parts are disclosed in U.S. Pat. No.
8,172,843, U.S. Pat. No. 7,959,654, and U.S. Pat. No. 7,481,828,
which are all expressly herein incorporated by reference in their
entireties.
[0055] In some instances where the tightening part 18 includes a
pivot design, the flexible elongated member 12 may be received or
engaged in a first opening 54 in the first longitudinal element 50
and a second opening 56 in the second longitudinal element 52
against a portion of a first inside wall 58 of a first recess 62 of
the first longitudinal element 50 and/or a second inside wall 60 of
a second recess 64 of the second longitudinal element 52. In some
cases, a rod 66 may be introduced into the first recess 62 of the
first longitudinal element 50 and/or the second recess 64 of the
second longitudinal element 52 such that the elongated member 12
may be disposed between the first inside wall 58 and the second
inside wall 60 of the first recess 62 and the second recess 64,
respectively, and the rod 66.
[0056] As shown in FIGS. 5A-5C, the third portion 12c of the
elongated member 12 may define a loop 68 that may extend beyond an
outer surface of the first longitudinal element 50 or second
longitudinal element 52 from the first opening 54. In addition, the
first portion 12a of the elongated member 12 and the second portion
12b of the elongated member 12 may extend beyond an outer surface
of the second longitudinal element 52 or the first longitudinal
element 50 from the second opening 56. When the first longitudinal
element 50 and the second longitudinal element 52 are spaced in the
provisional locking position, as shown in FIG. 5B, the elongated
member 12 may be adjusted for final positioning (e.g., the
elongated member 12 may be adjusted and/or tightened for final
positioning with the one-way catch mechanism of tightening part 18
described herein, with the first longitudinal element 50, the
second longitudinal element 52 and the rod 66, and/or with any
other similar or dissimilar tightening mechanism). Provisional
positioning of the elongated member 12 may allow for frictional
movement of the elongated member within the tightening part 18, for
example, to adjust tension in the elongated member 12. Once the
third portion 12c of the elongated member 12 forming the loop 68
has been placed around a bone (e.g., a vertebra, rib, or other bone
structure 19) or other object and the elongated member is in its
final position, a user (e.g., a surgeon) may further engage the
second longitudinal element 52 with the first longitudinal element
50 to place the tightening part 18 in the final locking position.
Final locking of the elongated member 12 within the tightening part
18 may fix the elongated member 12 in relation to the tightening
part 18 or clamping member preventing further movement of the
elongate member 12 through the tightening part 18. This multi-step
locking system of the tightening part 18 may allow the user to
extract traction on the elongated member 12 around the bone or
other object and once the tension in the elongated member 12 is
sufficient for providing appropriate fastening, the user may finish
the tightening process by applying a force to the second
longitudinal element 52 to move the second longitudinal element 52
to the final locking position with respect to the first
longitudinal element 50.
[0057] In some instances, the tightening part 18 may be configured
to receive and/or engage a plurality of elongated members 12. For
example, as shown in FIGS. 6 and 7, the tightening part 18 may be
configured to receive and/or engage two elongated members 12.
Illustratively, the tightening part 18 receiving a plurality of
elongated members 12 may be configured to tighten each elongated
member 12 separately from the others or tighten each elongated
member 12 at the same time, where the tightening of the elongated
members 12 may be performed with a one-way catch mechanism 22, a
set screw 74 and a pressure fit, and/or with any other similar or
dissimilar device. Further, the tightening part 18 receiving the
plurality of elongated members 12 may be configured to lock each of
the plurality of elongated members 12 independently of one another
or substantially simultaneously, where the elongated members 12 may
be locked in place using teeth and teeth recesses to provisionally
lock and finally lock the elongated members 12 in place, using a
tightening set screw 74 for each elongated member 12, as shown in
FIGS. 6 and 7, a single tightening set screw 74 for the elongated
members 12, and/or any other locking or tightening features, as
desired.
[0058] In some instances, the tightening part 18 may be configured
to allow for post-operative and/or percutaneous adjustability of
tension in the elongated member 12 received and/or engaged by the
tightening part 18 and/or of the positioning of the tightening part
18 with respect to the rod 66. Illustratively, such a tightening
part 18, as shown in FIGS. 14 and 15, may include a housing 80, a
worm drive 82 having a screw 84 and a worm gear 86, a rod locking
screw 88, and/or other features, as desired. As shown in FIG. 14,
the housing 80 may have an opening 90, where the worm gear 86 of
the worm drive 82 may extend substantially across the opening 90.
The opening 90 may be any shape and/or size configured to receive
the elongated member 12. In some instances, the housing 80 may
include a cover at least partially enclosing the opening 90, where
the cover may have a slit(s) or slot(s) for receiving the elongated
member 12. Further, the screw 84 of the worm drive 82 and the rod
locking screw 88 may be configured to extend from the same side of
the housing 80, such that a user (e.g., a surgeon) may access the
screw 84 of the worm drive 82 and the rod locking screw 88 at a
substantially same angle or access point with respect to the
housing 80.
[0059] The worm gear 86 may have a geared portion 86a and a
receiving portion 86b, where the geared portion 86a may be
configured to engage the screw 84 and the receiving portion 86b may
be configured to receive the elongated member(s) 12. The receiving
portion 86b may include a slot 92 through which the elongated
member(s) 12 may be received, engaged, and/or wrapped. In some
cases, the slot 92 of the receiving portion 86b of the worm gear 86
may clamp the received elongated member(s) 12 and/or the receiving
portion 86b of the worm gear 86 may otherwise engage the elongated
member(s) 12 to facilitate adjusting a tension in the elongated
member 12 when the worm gear 86 is rotated. Alternatively, or in
addition, the elongated member 12 may be mechanically attached to
the receiving portion 86b of the worm gear 86 and/or the elongated
member 12 may be wrapped around worm drive 82.
[0060] In operation, once the elongated member(s) 12 have been
received by the receiving portion 86b of the worm gear 86, the
screw 84 of the worm drive 82 may be adjusted to adjust a tension
in the received elongated member(s) 12. To adjust the tension in
the received elongated member(s) 12, the screw 84 of the worm drive
82 may be rotated, such as with an elongated driver, which causes
the worm gear 86 to rotate and adjust the tension in the received
elongated member(s) 12.
[0061] The housing of the tightening part 18 may include an opening
(e.g., a hook, U-shaped channel, through hole, or other opening) 94
configured to engage and/or receive the rod 66, as shown in FIGS.
15 and 16. To facilitate securing the housing 80 to the rod 66, the
rod locking screw 88 may be adjusted (e.g., rotated) such that it
engages the rod 66 received in the opening 94. The tightening of
the rod locking screw 88 may apply a force to the rod 66 to secure
the housing 80 at a position with respect to the rod 66.
Alternatively, or in addition, the rod locking screw 88 may be
configured to facilitate securing the housing 80 at a position with
respect to the rod 66 through any connection technique including,
but not limited to, engaging an opening in the rod 66, and/or any
other similar or dissimilar connection technique, as desired.
[0062] In such an embodiment, during a medical procedure the
tightening part 18 may be inserted through an incision of the
patient and be secured to a rod 66 or other construct installed on
the vertebrae. Then the elongated member 12 may be tightened to a
desired amount by rotating the worm gear 86 via the worm drive 82
with a driver instrument during the medical procedure. Thereafter,
the incision may be closed at the conclusion of the medical
procedure. In a subsequent revision medical procedure, a small
access incision may be made in the patient to gain access to the
previously installed tightening part 18, and a driver instrument
may be minimally invasively or percutaneously inserted through the
small access incision to further adjust the tension of the elongate
member 12. For example, the driver instrument may be used to rotate
the worm gear 86 via the worm drive 82 in order to adjust the
amount of tension applied to the elongate member 12 (e.g., apply
less tension or apply more tension). The access incision need only
be large enough to advance the elongate shaft of the driver
instrument to the driver interface of the worm drive 82, and thus
the access incision may not be large enough to pass the tightening
part 18 therethrough.
[0063] In some instances, the vertebral fixing system 10 may
include a spacer 26 (e.g., a bumper). The spacer 26 may be made of
any material. For example, the spacer 26 may be made of a metal
material, a polymer material, or any other similar or dissimilar
material, as desired. In some cases, the spacer 26 may be rigid or
inflexible, while in other instances the spacer 26 may be flexible
or elastically yielding.
[0064] An illustrative spacer 26 may have a first opening 28a at or
near a first end of the spacer 26, a second opening 28b at or near
a second end of the spacer 26, and an extending portion 30
extending between the first end at or near the first opening 28a of
the spacer 26 and the second end at or near the second opening 28b
of the spacer 26. Illustratively, the spacer 26 may be configured
to extend between the bone structure 19 and a tightening part 18
(as shown in FIG. 8, where loop 68 may be configured to be wrapped
around a bone structure 19), two bone structures 19 (as shown in
FIGS. 9 and 10), and/or between other similar or dissimilar
features, as desired.
[0065] In some cases, the extending portion 30 of the spacer 26 may
at least partially define a lumen 32, as shown in FIG. 9.
Alternatively, or in addition, the extending portion 30 may be
substantially flat or collapsible such that the elongated member 12
may pass through the first opening 28a of the spacer 26, travel
along the extending portion 30, and pass through the second opening
28b of the spacer 26, as shown in FIG. 13.
[0066] The spacer 26 may have a length L extending substantially
from the first end of the spacer 26 to the second end of the spacer
26 and the lumen 32 may have a length L' substantially equal to the
length L of the spacer 26, as shown in FIG. 9, or any other length
dimension, as desired. Illustratively, the spacer 26 may receive
the elongated member 12 in the first opening 28a of the spacer 26
and/or in the second opening 28b of the spacer 26, wherein the
received elongated member 12 may extend along the spacer 26 and/or
at least partially extend through the lumen 32. In use, the spacer
26 may be held in compression while the elongated member 12 may be
held in tension.
[0067] As shown in FIG. 10, the spacer 26, in some cases, may
include a third opening 28c (e.g., an intermediate opening of the
spacer 26). The third opening 28c may be positioned, for example,
at a location between the first opening 28a of the spacer 26 and
the second opening 28b of the spacer 26. Alternatively, or in
addition, the third opening 28c may be an intermediate opening
positioned between a first end 26a and a second end 26b of the
spacer 26. In some illustrative cases, where the spacer 26 may
include the lumen 32, the third opening 28c may communicate with
the lumen 32.
[0068] Illustratively, the spacer 26 may receive the elongated
member 12 through the first opening 28a of the spacer 26 and/or the
second opening 28b of the spacer 26, where the elongated member 12
may extend along at least a portion of the spacer 26. For example,
the elongated member 12 (e.g., a first portion 12a, or other
portion, of the elongated member 12) may extend into the first
opening 28a of the spacer 26 and/or the elongated member 12 (e.g.,
a second portion 12b, or other portion, of the elongated member 12)
may extend into the second opening 28b of the spacer 26 and at
least a part of the elongated member 12 (e.g., the first portion
12a, the second portion 12b, and/or the third portion 12c, or other
portion of the elongated member 12) inserted into and/or through
the first opening 28a of the spacer 26 and/or the second opening
28b of the spacer 26 may extend through the third opening 28c of
the spacer 26, as shown in FIG. 10. In the example, the portion(s)
of the elongated member 12 inserted into and/or through the third
opening 28c may be received and/or engaged by the tightening part
18. In some instances, the tightening part 18 may engage the
elongated member 12 at a position adjacent the third opening
28c.
[0069] In FIG. 11, an illustrative vertebral fixing system 10 is
depicted that may include two elongated members 12, a tightening
part 18, and two spacers 26 (e.g., a first spacer 27 and a second
spacer 29). In some instances, a first elongated member 12 may be
wrapped around a bone structure 19, inserted through the first
spacer 27, and inserted into the tightening part 18 to apply and/or
maintain a tension in the first elongated member 12 and maintain
the first spacer 27 in a position with respect to the bone
structure 19. Similarly, a second elongated member 12 may be
wrapped around a bone structure 19, inserted through the second
spacer 29, and inserted into the tightening part 18 to apply and/or
maintain a tension in the second elongated member 12 and maintain
the second spacer 29 in a position with respect to the bone
structure 19. In some cases, the tightening part 18 may abut the
first spacer 27 and/or the second spacer 29, as shown in FIG. 11.
Alternatively, or in addition, the tightening part 18 may receive
and/or engage the first spacer 27 and/or the second spacer 29.
[0070] As an alternative to the tightening part 18 having separate
pathways for each elongated member 12, as shown in FIG. 11, the
tightening part 18 may have a single pathway or interconnected
pathways configured to receive a single elongated member or
multiple elongated members. For example, a single elongated member
12 may be used with two spacers and one tightening member, where
the single elongated member 12 may be wrapped around two bone
structures 19, rods 66, other structures, or combinations thereof,
and passed through a single pathway or interconnected pathways of
the tightening part 18 (e.g., two discrete juxtaposed portions of
12 may pass through a single pathway of the tightening part
18).
[0071] As shown in FIGS. 10 and 11, set screws 74 of tightening
part 18 may engage the elongated members 12. The set screws 74 may
be configured to engage and tighten the elongated member(s) 12
inserted through the spacer 26 and/or tightening part 18. For
example, the set screw(s) 74 may be configured to engage the
elongated member(s) 12 and tighten the elongated member(s) 12 in a
manner that holds the elongated member(s) 12 in a position relative
to the tightening part 18.
[0072] In some illustrative instances, set screw(s) 34 may engage
the spacer 26 (e.g., a bumper and/or a cross-link connector), as
shown in FIGS. 12A and 12B. The set screw(s) 34 may be configured
to engage any portion of the spacer 26 (e.g., at or near the first
end 26a of the spacer 26, the second end 26b of the spacer 26,
and/or another portion of the spacer 26). The set screw(s) 34 may
be configured to extend through a set screw opening 36 extending
partially through the spacer 26 or all of the way through the
spacer 26. The set screw(s) 34 may engage a hole or opening in the
elongated member 12 (e.g., through which a portion of the elongated
member 12 may extend) and/or may trap the elongated member 12
between the set screw(s) 34 and a surface the spacer 26, such that
the set screw 34 may act on the elongated member 12 to maintain the
engaged portion of the elongated member 12 in a desired position
relative to the set screw 34.
[0073] In some cases, the set screw 34 may engage a portion of the
elongated member 12 within the lumen 32 of the spacer and/or may
engage a portion of the elongated member 12 extending exterior the
spacer 26. For example, the elongated member 12 may be extended
through the lumen 32 of the spacer 26, around a bone or rod,
optionally through another spacer 26, and back to the spacer 26
with the set screw(s) 34, where the set screw 34 may engage the
extended and wrapped elongated member 12 to secure the spacer 26
adjacent or to the bone or rod, as desired. The spacer 26 including
the set screw(s) 34 may be used for other purposes and with other
techniques where the set screw(s) 34 may be configured to engage
the elongated member 12. In some cases, the spacer 26 with the set
screw(s) 34 may be utilized as an intermediate component between
the elongated member 12 and the bone structure 19.
[0074] As shown in FIGS. 12A and 12B, the spacer 26 and the
elongated member 12 may be a cross-link connector 31 or transverse
connector extending between two rods 66. Alternatively or in
addition, the cross-link connector 31 may extend between rods 66,
bone structures, anchors, and/or a combination thereof.
Illustratively, one of the rods 66 may be configured to extend
along a spinal column on a first side of the spinal process and a
second rod 66 may be configured to extend along the spinal column
on a second side of the spinal process, where the rods 66 may be
secured with respect to the spinal column via anchors 16 (e.g.,
mono-axial pedicle screws, poly-axial pedicle screws, bone anchors,
or other securing mechanisms). In some instances, the rods 66 may
be located a distance apart and the cross-link connector 31 may be
configured to extend substantially the distance between the two
rods 66 and receive the elongated member 12. For example, the
elongated member 12 may be configured to be wrapped around one of
the rods 66 or otherwise secured to the rod 66, extended through at
least a portion of the cross-link connector 31, wrapped around
another of the rods 66 or otherwise secured to the another of the
rods 66, and tightened and/or secured with respect to the
cross-link connector 31 through tightening of the set screw(s) 34.
Such an arrangement of the cross-link connector 31 may add
stability to the positioning of the rods 66 with respect to one
another and/or have other benefits.
[0075] Illustratively, the vertebral fixing system 10 may used in a
method 100 for manipulating spinal anatomy. For example, the anchor
16 may be inserted through an opening 20 of the connecting part 14
(step 110), such that the elongated member 12 may be connected to
the connecting part 14. In some cases, the anchor 16 may engage or
connect to the connecting part 14 in any other manner, as desired.
After or before (or while) the elongated member 12 is (being)
inserted through the opening 20 of the connecting part 14, the
anchor 16 may be connected (e.g., through a screwing technique or
other connecting technique facilitated by the design and/or
structure of the anchor 16) to a first object (e.g., first portion
of the spinal anatomy, a rod 66, etc.) (step 112) to secure the
connecting part 14 relative to the first object. The elongated
member 12 connected to the connecting part 14 may be extended
around (or otherwise put in communication with) a second object
(e.g., a second portion of the spinal anatomy, a rod 66, etc.)
(step 114). Further, a first portion 12a and/or a second portion
12b of the elongated member 12 may be inserted into or otherwise
engage a tightening part 18 (step 116). For example, once the
elongated member 12 has been extended around the second object, the
first portion 12a and/or the second portion 12b of the elongated
member 12 may be inserted into the tightening part 18. A user may
tension a portion of the elongated member 12 extending between the
connecting part 14 and the second object with the tightening part
18 or any other feature (step 118). The tension may be applied in
any manner. For example, the tensioning (step 118) may be applied
by pulling the elongated member 12 around the spinal anatomy and
through the tightening member 18 with a tensioning device and/or in
any other manner, as desired. Once a desired tension has been
applied to the elongated member 12, the elongated member 12
inserted into the tightening part 18 may be locked or fixed (step
120) within the tightening part 18 to maintain a tension in the
tensioned portion of the elongated member 12.
[0076] Those skilled in the art will recognize that the present
disclosure may be manifested in a variety of forms other than the
specific embodiments described and contemplated herein.
Accordingly, departure in form and detail may be made without
departing from the scope and spirit of the present disclosure as
described in the appended claims.
* * * * *