U.S. patent application number 16/910471 was filed with the patent office on 2020-10-15 for spinal implant system and method.
This patent application is currently assigned to WARSAW ORTHOPEDIC INC.. The applicant listed for this patent is WARSAW ORTHOPEDIC INC.. Invention is credited to Neel Anand, Jonathan A. Blackwell, Cristian A. Capote, Anthony J. Melkent.
Application Number | 20200323644 16/910471 |
Document ID | / |
Family ID | 1000004926029 |
Filed Date | 2020-10-15 |
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United States Patent
Application |
20200323644 |
Kind Code |
A1 |
Capote; Cristian A. ; et
al. |
October 15, 2020 |
SPINAL IMPLANT SYSTEM AND METHOD
Abstract
A spinal implant includes an implant body extending between an
anterior surface and a posterior surface. The implant body includes
a first vertebral engaging surface and a second vertebral engaging
surface. The implant body defines a cavity. A plate is connectable
with the implant body via a coupling member adjacent the cavity and
is translatable relative thereto. The coupling member has a portion
including a frangible torque limit. The plate defines at least one
opening oriented to implant a fastener with tissue. Systems, spinal
constructs, surgical instruments and methods are disclosed.
Inventors: |
Capote; Cristian A.;
(Memphis, TN) ; Blackwell; Jonathan A.; (Lakeland,
TN) ; Melkent; Anthony J.; (Memphis, TN) ;
Anand; Neel; (Los Angeles, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
WARSAW ORTHOPEDIC INC. |
Warsaw |
IN |
US |
|
|
Assignee: |
WARSAW ORTHOPEDIC INC.
Warsaw
IN
|
Family ID: |
1000004926029 |
Appl. No.: |
16/910471 |
Filed: |
June 24, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15958253 |
Apr 20, 2018 |
10729556 |
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16910471 |
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15151717 |
May 11, 2016 |
10034771 |
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15958253 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/7059 20130101;
A61F 2002/30553 20130101; A61F 2002/30401 20130101; A61F 2002/30836
20130101; A61F 2002/30507 20130101; A61F 2/4455 20130101; A61F
2/447 20130101; A61F 2002/30578 20130101; A61B 17/8042 20130101;
A61F 2002/30265 20130101; A61F 2/30749 20130101; A61F 2/4611
20130101; A61B 17/808 20130101; A61F 2002/30593 20130101 |
International
Class: |
A61F 2/44 20060101
A61F002/44; A61F 2/30 20060101 A61F002/30; A61F 2/46 20060101
A61F002/46; A61B 17/80 20060101 A61B017/80 |
Claims
1-20. (canceled)
21. A spinal implant comprising: a screw comprising a first mating
element; an implant comprising a cage and a joint positioned in the
cage, the joint comprising a second mating element; and a plate
comprising a body and a tab, the body including an opening, wherein
the second mating element is connected to the first mating element
to allow freedom of movement of the plate relative to the cage, and
wherein the tab is movable relative to the body between a first
orientation in which the tab overlaps the opening and a second
orientation in which the tab is spaced apart from the opening.
22. A spinal implant as recited in claim 21, wherein the freedom of
movement includes translation of the plate relative to the cage in
a plurality of orientations in multiple planes.
23. A spinal implant as recited in claim 21, wherein the joint is a
spheroidal joint.
24. A spinal implant as recited in claim 21, wherein the cage
includes a track, the joint being configured for engagement with
and translation along the track.
25. A spinal implant as recited in claim 21, wherein the joint
includes a spheroidal portion and a post extending from the
spheroidal portion, the post including the second mating
element.
26. A spinal implant as recited in claim 21, wherein the joint
includes a ball and a post extending from the ball, the post
including the second mating element.
27. A spinal implant as recited in claim 21, wherein the mating
elements are threads.
28. A spinal implant as recited in claim 21, wherein the first
mating element is a male thread and the second mating element is a
female thread.
29. A spinal implant as recited in claim 21, wherein the screw is
configured to draw the plate and the cage together into an
assembled orientation.
30. A spinal implant as recited in claim 21, wherein the opening is
a first opening and the body comprise a second opening that is
spaced apart from the first opening, the tab overlapping the second
when the tab is in the first orientation, the tab being spaced
apart from the second opening when the tab is in the second
orientation.
31. A spinal implant as recited in claim 30, wherein the first
opening is oriented to implant a fastener and the second opening is
configured for disposal of the screw.
32. A spinal implant as recited in claim 30, wherein the first
opening has a diameter that is larger than a diameter of the second
opening.
33. A spinal implant as recited in claim 30, wherein the screw has
a first portion that is disposed in the second opening and a second
portion having the first mating element.
34. A spinal implant as recited in claim 33, wherein the first and
second portions are connected at a reduced diameter portion.
35. A spinal implant comprising: a screw comprising a first mating
element; an implant comprising a cage and a joint positioned in the
cage, the joint comprising a second mating element; and a plate
comprising a body and a tab, the body including spaced apart first
and second openings, wherein the second mating element is connected
to the first mating element to allow freedom of movement of the
plate relative to the cage, and wherein the tab is rotatable
relative to the body between a first orientation in which the tab
overlaps the openings and a second orientation in which the tab is
spaced apart from the openings.
36. A spinal implant as recited in claim 35, wherein the freedom of
movement includes translation of the plate relative to the cage in
a plurality of orientations in multiple planes.
37. A spinal implant as recited in claim 35, wherein the joint is a
spheroidal joint.
38. A spinal implant as recited in claim 35, wherein the cage
includes a track, the joint being configured for engagement with
and translation along the track.
39. A spinal implant as recited in claim 35, wherein the joint
includes a ball and a post extending from the ball, the post
including the second mating element.
40. A spinal implant comprising: a screw comprising a male thread;
an implant comprising a cage and a joint positioned in the cage,
the joint comprising a ball and a post extending from the ball, the
post comprising a female thread, the cage including a track, the
ball being configured for engagement with and translation along the
track; and a plate comprising a body and a tab, the body including
spaced apart first and second openings, wherein the female thread
is connected to the male thread to allow freedom of movement of the
plate relative to the cage, and wherein the tab is rotatable
relative to the body between a first orientation in which the tab
overlaps the openings and a second orientation in which the tab is
spaced apart from the openings.
Description
TECHNICAL FIELD
[0001] The present disclosure generally relates to medical devices
for the treatment of musculoskeletal disorders, and more
particularly to a spinal implant system and a method for treating a
spine.
BACKGROUND
[0002] Spinal pathologies and disorders such as degenerative disc
disease, disc herniation, spondylolisthesis, stenosis,
osteoporosis, tumor, scoliosis and other curvature abnormalities,
kyphosis and fracture may result from factors including trauma,
disease and degenerative conditions caused by injury and aging.
Spinal disorders typically result in symptoms including deformity,
pain, nerve damage, and partial or complete loss of mobility.
[0003] Non-surgical treatments, such as medication, rehabilitation
and exercise can be effective, however, may fail to relieve the
symptoms associated with these disorders. Surgical treatment of
these spinal disorders includes fusion, fixation, correction,
discectomy, microdiscectomy, corpectomy, decompression, lam
inectomy, laminotomy, foraminotomy, facetectomy and implantable
prosthetics. As part of these surgical treatments, spinal
constructs, such as, for example, bone fasteners, spinal rods and
interbody devices can be used to provide stability to a treated
region. For example, during surgical treatment, surgical
instruments can be used to deliver components of the spinal
constructs to the surgical site for fixation with bone to
immobilize a joint. Certain spinal surgery approaches utilize a
direct lateral approach to access intervertebral spaces, however,
these techniques present certain challenges due to the location of
musculature and neural structures embedded therein. This disclosure
describes an improvement over these prior technologies.
SUMMARY
[0004] In one embodiment, a spinal implant is provided. The spinal
implant includes an implant body extending between an anterior
surface and a posterior surface. The implant body includes a first
vertebral engaging surface and a second vertebral engaging surface.
The implant body defines a cavity. A plate is connectable with the
implant body via a coupling member adjacent the cavity and is
translatable relative thereto. The coupling member has a portion
including a frangible torque limit. The plate defines at least one
opening oriented to implant a fastener with tissue. In some
embodiments, systems, spinal constructs, surgical instruments and
methods are provided.
[0005] In one embodiment, a spinal implant includes an implant body
extending between an anterior surface and a posterior surface. The
implant body includes a first vertebral engaging surface and a
second vertebral engaging surface. A plate is connectable with the
implant body via a coupling member and defines a single opening
oriented to implant a fastener with tissue.
BRIEF DESCRIPTION OF THE DRAWINGS
[0006] The present disclosure will become more readily apparent
from the specific description accompanied by the following
drawings, in which:
[0007] FIG. 1 is a perspective view of components of one embodiment
of a surgical system in accordance with the principles of the
present disclosure;
[0008] FIG. 2 is a side view of components of one embodiment of a
surgical system in accordance with the principles of the present
disclosure;
[0009] FIG. 3 is a plan view of components of one embodiment of a
surgical system in accordance with the principles of the present
disclosure disposed with vertebrae;
[0010] FIG. 4 is a perspective view of the components and vertebrae
shown in FIG. 3;
[0011] FIG. 5 is a perspective view of components of one embodiment
of a surgical system in accordance with the principles of the
present disclosure disposed with vertebrae;
[0012] FIG. 6 is a perspective view of the components and vertebrae
shown in FIG. 5;
[0013] FIG. 7 is a perspective view of the components and vertebrae
shown in FIG. 5;
[0014] FIG. 8 is a cross section view of the components and
vertebrae shown in FIG. 5;
[0015] FIG. 9 is a perspective view of the components and vertebrae
shown in FIG. 5;
[0016] FIG. 10 is a side view of the components and vertebrae shown
in FIG. 5;
[0017] FIG. 11 is a perspective view of components of one
embodiment of a surgical system in accordance with the principles
of the present disclosure disposed with vertebrae; and
[0018] FIG. 12 is a perspective view of components of one
embodiment of a surgical system in accordance with the principles
of the present disclosure disposed with vertebrae.
DETAILED DESCRIPTION
[0019] The exemplary embodiments of the surgical system and related
methods of use disclosed are discussed in terms of medical devices
for the treatment of musculoskeletal disorders and more
particularly, in terms of a spinal implant system and a method for
treating a spine. In some embodiments, the systems and methods of
the present disclosure are employed with a spinal joint and fusion,
for example, with a cervical, thoracic, lumbar and/or sacral region
of a spine.
[0020] In some embodiments, the present surgical system includes an
interbody implant. In some embodiments, the interbody implant
includes an interbody cage. In some embodiments, the surgical
system includes a plate that is affixed to an interbody implant and
a superior vertebral body and/or an inferior vertebral body
adjacent an interbody space of vertebrae. In some embodiments, the
surgical system includes an interbody implant connected with a
plate, locks and/or insertion mechanisms. In some embodiments, the
surgical system includes one or more radiographic markers
selectively disposed with one or more components of the surgical
system. In some embodiments, the surgical system includes a
hyper-lordotic interbody implant configured to achieve lordosis of
vertebrae in a range of greater than 12 angular degrees.
[0021] In some embodiments, the surgical system includes
instrumentation that is employed with a method to anchor an
interbody implant within an interbody space of vertebrae. In some
embodiments, the method includes the step of disposing a
hyper-lordotic interbody implant configured to achieve lordosis of
vertebrae in a range of greater than 12 angular degrees within an
interbody space, In some embodiments, the present system avoids
migration of the interbody implant within the interbody space. In
some embodiments, the interbody implant includes a plate that is
modularly or removably connected to the interbody implant via a set
screw. In some embodiments, the plate is attached to a lateral or
antero-lateral aspect of a vertebra outside the interbody space
using a bone screw. In some embodiments, the surgical system
includes a plate that is not attached with the interbody
implant.
[0022] In some embodiments, the surgical system includes a plate
that is connected to an interbody implant and the plate includes a
single bone screw engageable with a vertebral body adjacent an
interbody space of vertebrae. In some embodiments, the single bone
screw is configured to anchor the interbody implant and/or plate
with tissue. In some embodiments, the single bone screw includes a
buttress configuration. In some embodiments, the interbody implant
is not attached with the plate.
[0023] In some embodiments, the surgical system includes a plate
that is connected to an interbody implant and the plate includes a
two bone screw assembly engageable with vertebrae adjacent an
interbody space of the vertebrae. In some embodiments, the two bone
screw assembly is configured to anchor the interbody implant and/or
plate with tissue. In some embodiments, the two bone screw assembly
is configured to provide stabilization between vertebra. In some
embodiments, the surgical system includes a plate that is connected
to an interbody implant and the plate includes a four bone screw
assembly engageable with vertebrae adjacent an interbody space of
the vertebrae. In some embodiments, the four bone screw assembly is
configured to anchor the interbody implant and/or plate with
tissue. In some embodiments, the four bone screw assembly is
configured to provide stabilization between vertebra.
[0024] In some embodiments, the surgical system includes a plate
that is connected to an interbody implant via a set screw. In some
embodiments, the set screw includes a break off portion or head
that is removable, separable or frangible at a selected torque
limit. In some embodiments, the surgical system is employed with a
method such that the interbody implant and plate assembly is
positioned with an interbody space and bone screws attach the plate
to tissue. In some embodiments, the method includes the step of
breaking off the set screw head to release the assembly from a
surgical inserter. In some embodiments, the surgical inserter
includes a screw driver.
[0025] In some embodiments, the surgical system is configured to
resist and/or prevent migration of the interbody implant within an
interbody space. In some embodiments, the surgical system includes
a plate that is modularly or removably connected to the interbody
implant by a set screw. In some embodiments, the plate is attached
to a lateral or antero-lateral portion of vertebra outside the
interbody space using a bone screw. In some embodiments, the
interbody implant is a standalone interbody implant.
[0026] In some embodiments, the surgical system includes a plate
that is connected to an interbody implant via a set screw, the
plate including one or more bone screws for fixation with tissue.
In some embodiments, the plate includes an element to resist and/or
prevent backout of the screws from the interbody implant and plate
assembly and/or tissue. In some embodiments, the element includes a
surface that is disposed with the set screw and a bone screw to
resist and/or prevent backout of the set screw and the bone screw.
In some embodiments, the surface includes a cam lock capture member
that is disposed with the set screw and a bone screw to resist
and/or prevent backout of the set screw and the bone screw. In some
embodiments, the surface is movable into alignment with the set
screw and a bone screw to resist and/or prevent backout of the set
screw and the bone screw. In some embodiments, the surface is
rotatable into alignment with the set screw and a bone screw.
[0027] In some embodiments, the surgical system includes an
interbody implant and plate assembly having two bone screws. In
some embodiments, the interbody implant and plate assembly includes
an element to resist and/or prevent backout of the two bone screws
and the set screw from the interbody implant and plate assembly
and/or tissue. In some embodiments, the surgical system includes an
interbody implant and plate assembly having four bone screws. In
some embodiments, the interbody implant and plate assembly includes
an element to resist and/or prevent backout of the four bone screws
and the set screw from the interbody implant and plate assembly
and/or tissue.
[0028] In some embodiments, the surgical system is used with
surgical navigation, such as, for example, fluoroscope or image
guidance. In some embodiments, one or all of the components of the
surgical system are disposable, peel-pack, pre-packed sterile
devices. One or all of the components of the surgical system may be
reusable. The surgical system may be configured as a kit with
multiple sized and configured components.
[0029] In some embodiments, the present disclosure may be employed
to treat spinal disorders such as, for example, degenerative disc
disease, disc herniation, osteoporosis, spondylolisthesis,
stenosis, scoliosis and other curvature abnormalities, kyphosis,
tumor and fractures. In some embodiments, the present disclosure
may be employed with other osteal and bone related applications,
including those associated with diagnostics and therapeutics. In
some embodiments, the disclosed surgical system may be
alternatively employed in a surgical treatment with a patient in a
prone or supine position, and/or employ various surgical approaches
to the spine, including anterior, posterior, posterior mid-line,
direct lateral, postero-lateral, and/or antero lateral approaches,
and in other body regions. The present disclosure may also be
alternatively employed with procedures for treating the lumbar,
cervical, thoracic, sacral and pelvic regions of a spinal column,
The system and methods of the present disclosure may also be used
on animals, bone models and other non-living substrates, such as,
for example, in training, testing and demonstration.
[0030] The present disclosure may be understood more readily by
reference to the following detailed description of the embodiments
taken in connection with the accompanying drawing figures, which
form a part of this disclosure. It is to be understood that this
application is not limited to the specific devices, methods,
conditions or parameters described and/or shown herein, and that
the terminology used herein is for the purpose of describing
particular embodiments by way of example only and is not intended
to be limiting. In some embodiments, as used in the specification
and including the appended claims, the singular forms "a," "an,"
and "the" include the plural, and reference to a particular
numerical value includes at least that particular value, unless the
context clearly dictates otherwise. Ranges may be expressed herein
as from "about" or "approximately" one particular value and/or to
"about" or "approximately" another particular value. When such a
range is expressed, another embodiment includes from the one
particular value and/or to the other particular value. Similarly,
when values are expressed as approximations, by use of the
antecedent "about," it will be understood that the particular value
forms another embodiment. It is also understood that all spatial
references, such as, for example, horizontal, vertical, top, upper,
lower, bottom, left and right, are for illustrative purposes only
and can be varied within the scope of the disclosure. For example,
the references "upper" and "lower" are relative and used only in
the context to the other, and are not necessarily "superior" and
"inferior".
[0031] As used in the specification and including the appended
claims, "treating" or "treatment" of a disease or condition refers
to performing a procedure that may include administering one or
more drugs to a patient (human, normal or otherwise or other
mammal), employing implantable devices, and/or employing
instruments that treat the disease, such as, for example,
microdiscectomy instruments used to remove portions bulging or
herniated discs and/or bone spurs, in an effort to alleviate signs
or symptoms of the disease or condition. Alleviation can occur
prior to signs or symptoms of the disease or condition appearing,
as well as after their appearance. Thus, treating or treatment
includes preventing or prevention of disease or undesirable
condition (e.g., preventing the disease from occurring in a
patient, who may be predisposed to the disease but has not yet been
diagnosed as having it). In addition, treating or treatment does
not require complete alleviation of signs or symptoms, does not
require a cure, and specifically includes procedures that have only
a marginal effect on the patient. Treatment can include inhibiting
the disease, e.g., arresting its development, or relieving the
disease, e.g., causing regression of the disease. For example,
treatment can include reducing acute or chronic inflammation;
alleviating pain and mitigating and inducing re-growth of new
ligament, bone and other tissues; as an adjunct in surgery; and/or
any repair procedure. As used in the specification and including
the appended claims, the term "tissue" includes soft tissue,
ligaments, tendons, cartilage and/or bone unless specifically
referred to otherwise.
[0032] The following discussion includes a description of a
surgical system and related methods of employing the surgical
system in accordance with the principles of the present disclosure.
Alternate embodiments are also disclosed. Reference is made in
detail to the exemplary embodiments of the present disclosure,
which are illustrated in the accompanying figures. Turning to FIG.
1, there are illustrated components of a surgical system, such as,
for example, a spinal implant system 10.
[0033] The components of spinal implant system 10 can be fabricated
from biologically acceptable materials suitable for medical
applications, including metals, synthetic polymers, ceramics and
bone material and/or their composites. For example, the components
of spinal implant system 10, individually or collectively, can be
fabricated from materials such as stainless steel alloys,
commercially pure titanium, titanium alloys, Grade 5 titanium,
super-elastic titanium alloys, cobalt-chrome alloys, superelastic
metallic alloys (e.g., Nitinol, super elasto-plastic metals, such
as GUM METAL.RTM.), ceramics and composites thereof such as calcium
phosphate (e.g., SKELITE.TM.), thermoplastics such as
polyaryletherketone (PAEK) including polyetheretherketone (PEEK),
polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK
composites, PEEK-BaSO.sub.4 polymeric rubbers, polyethylene
terephthalate (PET), fabric, silicone, polyurethane,
silicone-polyurethane copolymers, polymeric rubbers, polyolefin
rubbers, hydrogels, semi-rigid and rigid materials, elastomers,
rubbers, thermoplastic elastomers, thermoset elastomers,
elastomeric composites, rigid polymers including polyphenylene,
polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone
material including autograft, allograft, xenograft or transgenic
cortical and/or corticocancellous bone, and tissue growth or
differentiation factors, partially resorbable materials, such as,
for example, composites of metals and calcium-based ceramics,
composites of PEEK and calcium based ceramics, composites of PEEK
with resorbable polymers, totally resorbable materials, such as,
for example, calcium based ceramics such as calcium phosphate such
as hydroxyapatite (HA), corraline HA, biphasic calcium phosphate,
tricalcium phosphate, or fluorapatite, tri-calcium phosphate (TCP),
HA-TCP, calcium sulfate, or other resorbable polymers such as
polyaetide, polyglycolide, polytyrosine carbonate, polycaroplaetohe
and their combinations, biocompatible ceramics, mineralized
collagen, bioactive glasses, porous metals, bone particles, bone
fibers, morselized bone chips, bone morphogenetic proteins (BMP),
such as BMP-2, BMP-4, BMP-7, rhBMP-2, or rhBMP-7, demineralized
bone matrix (DBM), transforming growth factors (TGF, e.g.,
TGF-.beta.), osteoblast cells, growth and differentiation factor
(GDF), insulin-like growth factor 1, platelet-derived growth
factor, fibroblast growth factor, or any combination thereof.
[0034] Various components of spinal implant system 10 may have
material composites, including the above materials, to achieve
various desired characteristics such as strength, rigidity,
elasticity, compliance, biomechanical performance, durability and
radiolucency or imaging preference. The components of spinal
implant system 10, individually or collectively, may also be
fabricated from a heterogeneous material such as a combination of
two or more of the above-described materials. The components of
spinal implant system 10 may be monolithically formed, integrally
connected or include fastening elements and/or instruments, as
described herein.
[0035] Spinal implant system 10 is employed, for example, with a
fully open surgical procedure, a minimally invasive procedure,
including percutaneous techniques, and mini-open surgical
techniques to deliver and introduce instrumentation and/or an
implant, such as, for example, an interbody implant, at a surgical
site of a patient, which includes, for example, a spine having
vertebrae V, as shown in FIG. 3. In some embodiments, a surgical
pathway P to a surgical site is formed via an oblique lateral
interbody fusion (OLIF) or a direct lateral interbody fusion (DLIF)
procedure. In some embodiments, the implant can include spinal
constructs, such as, for example, bone fasteners, spinal rods,
connectors and/or plates.
[0036] Spinal implant system 10 includes an implant body, such as,
for example, an interbody cage 12. Cage 12 extends between a
posterior surface 14 and an anterior surface 16 and defines an axis
L1. Posterior surface 14 is configured to face a posterior side of
a subject body B and be disposed adjacent a posterior portion of
vertebrae, such as, for example, a posterior portion P1 of one or
more intervertebral spaces of vertebrae V, as shown in FIG. 4.
Anterior surface 16 is configured to face an anterior side of
subject body B and be disposed adjacent an anterior portion of
vertebrae, such as, for example an anterior portion A1 of one or
more intervertebral spaces of vertebrae V.
[0037] In some embodiments, cage 12 includes a convex distal end,
such as, for example, a bullet nose 18 to facilitate insertion by a
surgeon. In some embodiments, cage 12 may include chamfers, such
as, for example, cut outs 20a, 20b disposed on bullet nose 18 such
that cage 12 may be placed in an intervertebral space to avoid
impinging on various structures in or adjacent vertebral tissue,
such as, for example, a spinal foramina.
[0038] In some embodiments, cage 12 includes any number and
configuration of radiopaque markers (such as tantalum pins (not
shown)) for visualizing a position of cage 12 using fluoroscopy
during insertion, manipulation and implantation thereof. In some
embodiments, the markers may be placed obliquely on bullet nose 18,
in sidewalls of cage 12 adjacent surfaces 14, 16 and/or in a
proximal end of cage 12. In some embodiments, the markers may be
placed parallel, oblique to and/or perpendicular to surfaces 14, 16
as required to properly visualize the position of cage 12 relative
to surgical pathway P and/or relative to an oblique axis O, as
shown in FIG. 3, to facilitate placement of cage 12, as described
herein.
[0039] Cage 12 includes a vertebral engaging surface 22 and a
vertebral engaging surface 24. Surface 22 may be substantially
planar and configured to engage endplate tissue of a vertebral
body, such as, for example, an endplate E1 of a vertebral level V1,
as shown in FIG. 4. Surface 24 may be substantially planar and
configured to engage endplate tissue of a vertebral body, such as,
for example, an endplate E2 of a vertebral level V2. In some
embodiments, surface 22 and/or surface 24 may be rough, textured,
porous, semi-porous, dimpled, knurled, toothed, grooved and/or
polished to facilitate engagement with tissue.
[0040] In some embodiments, surface 22 and/or surface 24 may be
partially convex along axis L1 and/or at least partially convex in
a direction substantially perpendicular to an axis L2 (i.e., from
surface 16 to surface 14). In some embodiments, surface 22 and/or
surface 24 may be angled along axis L1 or angled perpendicular to
axis L1 such that anterior surface 16 is taller than posterior
surface 14 such that cage 12 may be capable of creating and/or
augmenting lateral or lordotic curvature in a spine when implanted.
In some embodiments, surface 22 and surface 24 are disposed at a
relative angular orientation to include a hyper-lordotic
configuration to correct lumbar lordosis in situations where a
natural curve of a lumbar region of the back is accentuated. In
some embodiments, surface 22 and surface 24 are disposed at a
relative angular orientation in a range of greater than 12
degrees.
[0041] In some embodiments, vertebral tissue includes
intervertebral tissue, endplate surfaces and/or cortical bone. In
some embodiments, surface 22 and/or surface 24 may be coated with
materials suitable for facilitating or encouraging bony ongrowth or
fusion including but not limited to titanium and HA coatings. In
some embodiments, a titanium coating is applied to surface 22
and/or surface 24 in a porous layer using plasma spray
technology.
[0042] Cage 12 has a substantially rectangular configuration and
includes an inner surface 26 and an outer surface 28. Surface 26
defines an opening 30 configured to receive an agent, which may
include bone graft (not shown) and/or other materials, as described
herein, for employment in a fixation or fusion treatment. In some
embodiments, a plan geometry of cage 12 may have various
configurations, such as, for example, oval, round, cylindrical,
oblong, triangular, rectangular, polygonal having planar or arcuate
side portions, irregular, uniform, non-uniform, consistent,
variable, horseshoe shape, U-shape or kidney bean shape.
[0043] Outer surface 28 includes an oblique surface 44 that defines
a cavity, such as, for example, an elongated opening 45. Elongated
opening 45 defines a track 46. Oblique surface 44 is oriented with
cage 12 and in substantial alignment with surgical pathway P, as
shown in FIGS. 3 and 4. Track 46 is in open communication with
surface 44 to define a track pathway 48 that facilitates
translation and/or rotation of a plate connected with cage 12, as
described herein. In some embodiments, pathway 48 is arcuate in
shape. In some embodiments, track 46 includes a varying radius of
curvature. Track 46 includes a limit, such as, for example, a
lateral axis limit 50 and a limit, such as, for example, an oblique
axis limit 52. Limits 50, 52 provide a range of translation
relative to cage 12 along track 46 and/or pathway 48, as discussed
herein,
[0044] Member 54 is slidably engageable with track 46 for
translation relative to cage 12 along track pathway 48. In some
embodiments, member 54 is movable along track pathway 48 for
translation substantially along axis L2 and/or transverse to axis
L1. In some embodiments, member 54 is movable along track pathway
48 for rotation about axis L2 and/or axis L1. In some embodiments,
track pathway 48 includes an arcuate configuration. In some
embodiments, track pathway 48 extends along an arcuate
configuration that is substantially concentric with track 46 and/or
a lateral surface of cage 12. In some embodiments, track 46,
surface 44 and/or track pathway 48 may be arcuate with a single
radius defining an arcuate configuration. In some embodiments,
track 46, surface 44 and/or track pathway 48 may be arcuate with
multiple radii defining one or more portions of an arcuate
configuration.
[0045] In some embodiments, track 46, surface 44 and/or track
pathway 48 may extend along a pathway having various configurations
corresponding to an overall shape of cage 12, such as, for example,
round, cylindrical, oblong, triangular, rectangular, polygonal
having planar or arcuate side portions, irregular, uniform,
non-uniform, consistent, variable, horseshoe shape, U-shape or
kidney bean shape. In some embodiments, the surfaces of cage 12 may
be rough, textured, porous, semi-porous, dimpled, knurled, toothed,
grooved and/or polished for selective translation of member 54.
[0046] Spinal implant system 10 includes a plate 60, as shown in
FIG. 2. Plate 60 includes a surface 62 and a surface 64, as shown
in FIG. 8. In some embodiments, plate 60 includes a substantially
rectangular configuration. In some embodiments, plate 60 can be
variously configured, such as, for example, tubular, oval, oblong,
triangular, square, polygonal, irregular, uniform, non-uniform,
variable, hollow and/or tapered. In some embodiments, plate 60 may
be attached with cage 12 prior to implantation, in vivo or in situ.
In some embodiments, plate 60 is removably connected with cage
12.
[0047] Plate 60 includes a surface 66 that defines an opening 68.
Opening 68 extends between surfaces 62, 64. Opening 68 is
configured to receive a coupling member, such as, for example, a
set screw 90, as described herein. Opening 68 is configured for
alignment with track pathway 48 and track 46 and facilitates
engagement of set screw 90 with member 54, as described herein.
Plate 60 includes instrument engagement surfaces 70, Surfaces 70
are configured to engage a surgical instrument, such as, for
example, an inserter I to facilitate insertion and disposal of the
components of spinal implant system 10 at a surgical site, as
described herein.
[0048] Plate 60 includes a portion 72 configured to engage a
vertebral level. Plate 60 includes a surface 74 that defines an
opening 76. Opening 76 extends between surfaces 62, 64. Opening 76
is configured to receive a fastener 120, as described herein.
Opening 76 orients fastener 120 for fixation with tissue, such as,
for example, a vertebral level V1, as shown in FIG. 5. In some
embodiments, a surgical instrument or tool, as described herein,
manipulates and/or rotates plate 60 about cage 12, opening 68
and/or tissue such that opening 76 is aligned with selected
vertebral tissue, for example, a superior vertebral body such as
vertebral level V1 or an inferior vertebral body such as vertebral
level V2 for orienting a fastener for fixation of cage 12 and/or
plate 60 with the selected vertebral level. In some embodiments, a
surgical instrument or tool is engageable with portion 72, surface
74 and/or surface 66 to rotate plate 60.
[0049] In some embodiments, plate 60 includes an element, such as,
for example, a capture tab 78. In some embodiments, tab 78 is
configured as a rotating cam lock having a protrusion 102 and a
protrusion 104. Protrusion 102 is configured to extend over and/or
overlap all or a portion of fastener 120 to resist and/or prevent
backout of fastener 120 from plate 60 and/or tissue through opening
76, for example, which can be caused by growth, movement and
adjustments of vertebrae. Protrusion 104 is configured to extend
over and/or overlap all or a portion of set screw 90 to resist
and/or prevent backout of set screw 90 from plate 60 and/or cage 12
through opening 68.
[0050] Tab 78 includes a portion 106 configured to facilitate
movement of protrusions 102, 104 between a non-locking orientation,
as shown in FIG. 9, and a locking orientation, as shown in FIG. 10,
relative to fastener 120 and set screw 90. In some embodiments,
portion 106 includes a surface that defines a cavity 108 having a
hexagonal geometry configured for engagement with a similarly
shaped surgical tool, such as, for example, a portion of inserter
I, as described herein. In some embodiments, cavity 108 includes a
cruciform, phillips, square, hexalobe, polygonal or star cross
sectional configuration for disposal of a correspondingly shaped
portion of a surgical tool. In some embodiments, tab 78 is disposed
within a cavity 110 of plate 60 for rotation relative thereto. In
some embodiments, tab 78 is configured for rotation such that
protrusions 102, 104 move into alignment with fastener 120 and/or
set screw 90 to resist and/or prevent fastener 120 and set screw 90
from disengaging from cage 12 and/or a vertebra.
[0051] In some embodiments, member 54 includes a spheroidal joint,
such as, for example, a ball screw 80 having an elongated post 82,
as shown in FIG. 8. Screw 80 is configured to provide freedom of
movement and/or toggle of plate 60 relative to cage 12. Screw 80 is
configured for engagement with and translation along track 46
and/or track pathway 48. Post 82 includes a surface 84 that defines
a cavity 86. Surface 84 is configured for engagement with set screw
90 to fix plate 60 with cage 12. In some embodiments, set screw 90
is configured to draw plate 60 and cage 12 together into an
assembled orientation during insertion. In some embodiments, screw
80 provides translation of plate 60 relative to cage 12 in a
plurality of orientations in multiple planes.
[0052] In some embodiments, surface 44 and/or member 54 can
comprise a dovetail or t-slot sliding attachment mechanism can be
utilized for connection plate 60 with cage 12. In some embodiments,
plate 60 is freely translatable within the patient body such that
plate 60 is configured for dynamic translation. In some
embodiments, plate 60 is positioned within the patient body and
locked into a fixed position with tissue and/or cage 12. In some
embodiments, plate 60 is configured for selective positioning with
a subject body for adapting to the configuration of the tissue
surfaces of vertebrae, as well as provide range of motion limits
50, 52 for plate 60.
[0053] Screw 90 includes a portion 92 and a portion 94, as shown in
FIG. 8. Portions 92, 94 are connected at a reduced diameter portion
96 that is frangibly connected to portion 94. In some embodiments,
portion 92 is configured for a threaded engagement with surface 84.
In some embodiments, portions 92, 94 are fabricated from a
fracturing and/or frangible material such that manipulation of
portion 94 relative to portion 92 can fracture and separate portion
94 from portion 92 at a predetermined force and/or torque limit, as
described herein. In some embodiments, as force and/or torque is
applied to portion 94 by inserter I and resistance increases, for
example, due to fixation of portion 92 with surface 84 of cavity
86, as described herein, the predetermined torque and force limit
is approached. In some embodiments, portions 92, 94 include offset
hex geometries.
[0054] In some embodiments, portions 92, 94 can fracture and
separate at a predetermined force or torque limit, which may be in
a range of approximately 20 Newton centimeters (N-cm) to 50 N-cm.
In some embodiments, portions 92, 94 may have the same or alternate
cross section configurations, may be fabricated from a homogenous
material or heterogeneously fabricated from different materials,
and/or alternately formed of a material having a greater degree,
characteristic or attribute of plastic deformability, frangible
property and/or break away quality to facilitate fracture and
separation of portions 92, 94.
[0055] Portion 92 includes a shaft 98 having an outer surface 100.
Surface 100 includes a thread form 102 configured for engagement
with surface 84. In some embodiments, thread form 102 is continuous
along surface 100. In some embodiments, thread form 102 may include
a single thread turn or a plurality of discrete threads. In some
embodiments, other penetrating elements may be located on shaft 98,
such as, for example, a nail configuration, barbs, expanding
elements, raised elements, ribs, and/or spikes to facilitate
engagement of shaft 98.
[0056] In some embodiments, portion 94 includes an end having a
hexagonal geometry configured for engagement with a similarly
shaped surgical tool, such as, for example, a portion of inserter
I, as described herein. In some embodiments, end 94 includes a
cruciform, phillips, square, hexalobe, polygonal or star cross
sectional configuration for disposal of a correspondingly shaped
portion of a tool. Set screw 90 is configured to removably couple
plate 60 with cage 12, as described herein.
[0057] Spinal implant system 10 includes one or more fasteners 120
for attaching plate 60 and/or cage 12 to tissue, as described
herein. In some embodiments, fastener 120 may be engaged with
tissue, such as, for example, the bony structures of a vertebral
body in various orientations, such as, for example, series,
parallel, offset, staggered and/or alternate vertebral levels. In
some embodiments, one or more of fasteners 120 may comprise
multi-axial screws, sagittal angulation screws, pedicle screws,
mono-axial screws, uni-planar screws, facet screws, fixed screws,
tissue penetrating screws, conventional screws, expanding screws,
wedges, anchors, buttons, clips, snaps, friction fittings,
compressive fittings, expanding rivets, staples, nails, adhesives,
posts, fixation plates and/or posts.
[0058] Fastener 120 comprises a portion, such as, for example, a
head 122 and a portion, such as, for example, an elongated shaft
124 configured for penetrating tissue. Head 122 includes an
engagement portion configured for engagement with a surgical
instrument, as described herein. Shaft 124 has a cylindrical cross
section configuration and includes an outer surface having an
external thread form. In some embodiments, the external thread form
may include a single thread turn or a plurality of discrete
threads. In some embodiments, other engaging structures may be
located on shaft 124, such as, for example, a nail configuration,
barbs, expanding elements, raised elements and/or spikes to
facilitate engagement of shaft 124 with tissue.
[0059] In some embodiments, all or only a portion of shaft 124 may
have alternate cross section configurations, such as, for example,
oval, oblong, triangular, square, polygonal, irregular, uniform,
non-uniform, offset, staggered, undulating, arcuate, variable
and/or tapered. In some embodiments, the outer surface of shaft 124
may include one or a plurality of openings. In some embodiments,
all or only a portion of the outer surface of shaft 124 may have
alternate surface configurations, such as, for example, smooth
and/or surface configurations to enhance fixation with tissue, such
as, for example, rough, arcuate, undulating, porous, semi-porous,
dimpled, polished and/or textured. In some embodiments, all or only
a portion of shaft 124 may be cannulated.
[0060] In some embodiments, spinal implant system 10 may comprise
various surgical instruments, such as, for example, drivers,
extenders, reducers, spreaders, distracters, blades, forceps,
elevators and drills, which may be alternately sized and
dimensioned, and arranged as a kit. In some embodiments, spinal
implant system 10 may comprise the use of microsurgical and image
guided technologies, such as, for example, surgical navigation
components employing emitters and sensors, which may be employed to
track introduction and/or delivery of the components of spinal
implant system 10 and the surgical instruments described to a
surgical site. See, for example, the surgical navigation components
and their use as described in U.S. Pat. Nos. 6,021,343, 6,725,080,
6,796,988, the entire contents of each of these references being
incorporated by reference herein.
[0061] In assembly, operation and use, as shown in FIGS. 3-10,
spinal implant system 10, similar to the systems and methods
described herein, is employed with a surgical procedure for
treatment of a spinal disorder, such as those described herein,
affecting a section of a spine of a patient. The components of
spinal implant system 10 are employed with a surgical procedure for
treatment of a spinal disorder affecting a section of a spine of a
patient, for example, to treat the affected section of vertebrae V
of a patient utilizing an OLIF or DLIF procedure.
[0062] A retractor (not shown) is disposed in communication with
surgical pathway P for spacing tissue. In some embodiments, spinal
implant system 10 may include retractors such that no further probe
is required. In some embodiments, spinal implant system 10 may
include retractors constrained via a frame or semi-constrained
using an elastic or partial frame. In some embodiments, retractor
blades are inserted simultaneously as part of a unitary retractor
instrument around one or more intervertebral spaces to protect
vessels.
[0063] In some embodiments, an annulotomy and/or discectomy is
performed with a surgical instrument with x-ray confirmation of the
starting point that is central on one or more intervertebral
spaces. In some embodiments, spinal implant system 10 includes a
semi-constrained retractor that facilitates minimal tissue
pressures on surrounding abdominal structures and provides
flexibility such that its blades rotate on a fixed pin allowing
greater degrees of freedom of movement and working angles for a
practitioner.
[0064] A probe is passed into the disc space to secure its
location. In some embodiments, the oblique angle and lordotic angle
of the probe as it enters the disc space is assessed
pre-operatively and measured intra-operative using image guidance
or using a mechanical or digital protractor. Fluoroscopy, image
guidance and/or surgical navigation, as described herein, is used
to confirm proper probe alignment into the disc space. In some
embodiments, a guide wire is placed through a cannula into the disc
space and positioning is confirmed with fluoroscopy. Instruments,
such as, for example, a Cobb, mallet, shaver, serrated curettes,
rasp, a ring curette, a uterine curette and/or combo tools are
utilized to perform a discectomy of the disc space. The instruments
enter the patient body obliquely through the retractor and can be
turned orthogonally to allow the surgeon to work orthogonally
across the disc space. The disc space is distracted until adequate
disc space height is obtained.
[0065] In some embodiments, a discectomy is performed via surgical
pathway P. In some embodiments, trial implants are delivered along
surgical pathway P and used to distract one or more intervertebral
spaces and apply appropriate tension in the intervertebral space
allowing for indirect decompression. In some embodiments, a direct
decompression of the disc space is performed by removing a portion
of a herniated disc. In some embodiments, the size of cage 12 is
selected after trialing and cage 12 is visualized by fluoroscopy
and oriented before malleting into the intervertebral space.
Trialing is utilized to establish a starting point for cage 12
insertion. In some embodiments, an anterior longitudinal ligament
(ALL) release procedure can be performed using an OLIF or a DLIF
approach post-discectomy. For example, loosening the ALL can be
performed by placing holes or partial cuts in the ALL such that the
OLIF surgical pathway is immediately closer to the ALL.
[0066] A pilot hole(s) or the like is made in selected vertebra V1
of vertebrae V adjacent the intervertebral space, via surgical
pathway P, for receiving bone fastener 120. Inserter I is attached
with cage 12 and/or plate 60, as described herein. Inserter I
delivers cage 12 and plate 60 along surgical pathway P adjacent to
a surgical site for implantation adjacent he intervertebral space
between vertebrae V1 and V2, as shown in FIGS. 3 and 4. In some
embodiments, inserter I includes a navigation component to
facilitate placement of cage 12 and plate 60 between vertebrae V1,
V2.
[0067] During insertion, inserter I is attached with plate 60 by
arms 130, 132. Arms 130, 132 are configured to engage surfaces 70
to facilitate manipulation of plate 60 relative to cage 12.
Inserter I is connected with set screw 90 by a driver 134. Portion
94 of set screw 90 is engaged with driver 134. Driver 134 and set
screw 90 are utilized to provisionally fix plate 60 and cage 12
with inserter I. Tightening of set screw 90 causes cage 12, plate
60 and inserter I to be drawn together and held in an assembled
orientation during insertion.
[0068] Cage 12 and plate 60 are inserted through the retractor
adjacent the surgical site. Anterior surface 16 faces an anterior
side of the patient body adjacent anterior portion Al and posterior
surface 14 faces a posterior side of the patient body adjacent
posterior portion P1, as described herein. Surface 22 engages
endplate tissue of endplate E1 and surface 24 engages endplate
tissue of endplate E2. In some embodiments, after implantation of
cage 12 and plate 60, a practitioner can loosen the connection of
inserter I, cage 12 and plate 60. This configuration allows plate
60 to rotate and translate relative to cage 12, which provides cage
12 and plate 60 relative freedom of movement such that the
practitioner can maneuver the spinal construct for final placement
of cage 12 and/or plate 60.
[0069] Inserter I is an adaptable instrument configured to perform
multiple applications during a surgical procedure. In some
embodiments, inserter I can prepare and/or create a cavity in
tissue, such as, for example, bone. In some embodiments, inserter I
guides a surgical instrument, such as, for example, a drill, tap
and/or an awl, as well as guiding fasteners to penetrate tissue. In
some embodiments, inserter I is a guide that holds plate 60 and
cage 12 together. Surgical instruments including an awl, a tap and
screws can be passed through inserter I.
[0070] In some embodiments, inserter I is utilized to apply a force
to plate 60 such that plate 60 is translatable along track 46
and/or track pathway 48, as shown by arrows C in FIG. 4. In some
embodiments, plate 60 is translated along track 46 to position
plate 60 with vertebra V1. Plate 60 is translated between lateral
axis limit 50 and oblique axis limit 52 to facilitate proper
positioning of plate 60 relative to cage 12 and vertebra V1. Plate
60 is rotated into position such that portion 72 is oriented to
engage vertebra V1, as shown in FIG. 5. Translation and rotation of
plate 60 allows selective manipulation of plate 60 to facilitate
plate 60 positioning relative to vertebra V1. In some embodiments,
inserter I or other surgical instrument, as described herein,
engages portion 72 and/or surface 66 to rotate plate 60, in a
clockwise or counter-clockwise direction, about opening 68 such
that opening 76 is selectively aligned with vertebral level V1 for
orienting fastener 120 for fixation of cage 12 and/or plate 60 with
vertebral level V1. In some embodiments, plate 60 can be rotated to
align opening 76 with a superior vertebral body such as vertebral
level V1 or an inferior vertebral body such as vertebral level V2
for orienting fastener 120 to fix cage 12 and/or plate 60 with
tissue.
[0071] Fastener 120 is aligned with opening 76 and tissue, and
inserted along inserter I via a driver 140. Fastener 120 is
disposed with opening 76 such that fastener 120 engages vertebra
V1. Driver 140 is configured to drive, torque, insert or otherwise
fasten fastener 120 with vertebra V1 adjacent an intervertebral
space S. In some embodiments, driver 140 may include surgical
navigation components, as described herein, to establish a pathway
for fastener 120 that is substantially concurrent with and/or
parallel to the surgical approach angle. In some embodiments, plate
60 is fixed with fastener 120 at an oblique angle relative to cage
12. In some embodiments, plate 60 is fixed with fastener 120
laterally with cage 12.
[0072] Driver 134 is disposed with inserter I and rotated to fix
plate 60 with cage 12, as shown in FIGS. 6-8. In some embodiments,
plate 60 is configured for removable fixation with cage 12 such
that plate 60 can be adjusted in situ and/or removed during a
post-operative procedure. Driver 134 is rotated in a clockwise
direction to manipulate set screw 90 such that portion 94 separates
from portion 92 at a predetermined force and/or torque limit, as
described herein. Portion 94 is removed from inserter I.
[0073] Tab 78 is initially disposed in a non-locking orientation,
as shown in FIG. 9. In some embodiments, driver 140 is engaged with
tab 78, as described herein, to actuate rotation of tab 78. Tab 78
is rotated into a locking orientation, as shown in FIG. 10. In the
locking orientation, protrusion 102 extends over and/or overlaps a
portion of fastener 120 to resist and/or prevent backout of
fastener 120 from plate 60 and/or vertebra V1 through opening 76
and protrusion 104 extends over and/or overlaps a portion of set
screw 90 to resist and/or prevent backout of set screw 90 from
plate 60 and/or cage 12 through opening 68.
[0074] Upon completion of a procedure, as described herein, the
surgical instruments, assemblies and non-implanted components of
spinal implant system 10 are removed and the incision(s) are
closed. One or more of the components of spinal implant system 10
can be made of radiolucent materials such as polymers. Radiopaque
markers may be included for identification under x-ray,
fluoroscopy, CT or other imaging techniques. In some embodiments,
the use of surgical navigation, microsurgical and image guided
technologies may be employed to access, view and repair spinal
deterioration or damage, with the aid of spinal implant system 10.
In some embodiments, spinal implant system 10 may include one or a
plurality of plates, connectors and/or bone fasteners for use with
a single vertebral level or a plurality of vertebral levels.
[0075] In some embodiments, spinal implant system 10 includes an
agent, which may be disposed, packed, coated or layered within, on
or about the components and/or surfaces of spinal implant system
10. In some embodiments, the agent may include bone growth
promoting material, such as, for example, bone graft to enhance
fixation of the components and/or surfaces of spinal implant system
10 with vertebrae. In some embodiments, the agent may include one
or a plurality of therapeutic agents and/or pharmacological agents
for release, including sustained release, to treat, for example,
pain, inflammation and degeneration.
[0076] In one embodiment, as shown in FIG. 11, spinal implant
system 10, similar to the systems and methods described herein,
includes cage 12, similar to that described herein and a plate 260,
similar to plate 60 described herein. Plate 260 includes a surface
262 and a surface 264. Plate 260 includes a surface 266 that
defines an opening 268. Opening 268 extends between surfaces 262,
264. Opening 268 is configured to receive set screw 90 for
connecting cage 12 and plate 260, similar to that described herein.
Opening 268 is configured for alignment with track 46 and
facilitates engagement of set screw 90 with member 54, as described
herein. Plate 260 includes instrument engagement surfaces 270.
Surfaces 270 are configured to engage an instrument, such as, for
example, an inserter I, as described herein.
[0077] Plate 260 includes a portion 272 configured to engage a
vertebral level V1 and a portion 280 configured to engage a
vertebral level V2. Portion 272 includes a surface 274 that defines
an opening 276. Opening 276 extends between surfaces 262, 264,
Opening 276 is configured to receive a fastener 120, as described
herein, and to align fastener 120 for fixation with vertebral level
V1. Portion 280 includes a surface 284 that defines an opening 286.
Opening 286 extends between surfaces 262, 264. Opening 286 is
configured to receive a fastener 120, as described herein, and to
align fastener 120 for fixation with vertebral level V2.
[0078] In some embodiments, plate 260 includes a capture tab 278,
similar to tab 78 described herein. Tab 278 is configured as a
rotating cam lock having a protrusion 482, a protrusion 484 and a
protrusion 490. Protrusion 482 extends over and/or overlaps all or
a portion of fastener 120 to resist and/or prevent backout of
fastener 120 from plate 260 and/or vertebra V1 through opening 276.
Protrusion 484 extends over and/or overlaps all or a portion of set
screw 90 to resist and/or prevent backout of set screw 90 from
plate 260 and/or cage 12 through opening 268. Protrusion 490
extends over and/or overlaps all or a portion of fastener 120 to
resist and/or prevent backout of fastener 120 from plate 260 and/or
vertebra V2 through opening 286. Tab 278 includes a portion 486,
similar to portion 106 described herein, configured to facilitate
movement of protrusions 482, 484, 490 between a non-locking
orientation and a locking orientation relative to fasteners 120 and
set screw 90.
[0079] In one embodiment, as shown in FIG. 12, spinal implant
system 10, similar to the systems and methods described herein,
includes cage 12, similar to that described herein and a plate 360,
similar to the plates described herein. Plate 360 includes a
surface 362 and a surface 364. In some embodiments, plate 360
includes a substantially rectangular configuration. In some
embodiments, plate 360 can be variously configured, such as, for
example, tubular, oval, oblong, triangular, square, polygonal,
irregular, uniform, non-uniform, variable, hollow and/or tapered.
In some embodiments, plate 360 may be attached with cage 12 prior
to implantation or in situ. In some embodiments, plate 360 is
removably connected with cage 12.
[0080] Plate 360 includes a surface that defines an opening (not
shown), similar to opening 68, which extends between surfaces 362,
364 and is configured to receive set screw 90 for connecting cage
12 and plate 360, similar to that described herein. Plate 360
includes instrument engagement surfaces 370. Surfaces 370 are
configured to engage an instrument, such as, for example, an
inserter I, as described herein.
[0081] Plate 360 includes a portion 372 configured to engage a
vertebral level V1 and a portion 380 configured to engage a
vertebral level V2. Portion 372 includes an opening 376 and an
opening 390. Openings 376, 390 extend between surfaces 362, 364.
Openings 376, 390 are configured to receive fasteners 120, as
described herein, and to align fasteners 120 for fixation with
vertebral level V1. Portion 380 includes an opening 386 and an
opening 392. Openings 386, 392 extend between surfaces 362, 364.
Openings 386, 392 are configured to receive fasteners 120, as
described herein, and to align fasteners 120 for fixation with
vertebral level V2.
[0082] In some embodiments, plate 360 includes a capture tab 378,
similar to the tabs described herein. Tab 378 is a rotating cam
lock having a protrusion 582, a protrusion 584, a protrusion 590
and a protrusion 592. Protrusions 582, 590 extend over and/or
overlap all or a portion of fasteners 120 to resist and/or prevent
backout of fasteners 120 from plate 360 and/or vertebra V1 through
openings 376, 390. Protrusions 584, 592 extend over and/or overlap
all or a portion of fasteners 120 to resist and/or prevent backout
of fasteners 120 from plate 360 and/or vertebra V2 through openings
386, 392. In some embodiments, tab 378 is configured to extend over
and/or overlap all or a portion of set screw 90 to resist and/or
prevent backout of set screw 90 from plate 260 and/or cage 12. Tab
378 includes a portion 586, similar to portion 106 described
herein, configured to facilitate movement of protrusions 582, 584,
590, 592 between a non-locking orientation and a locking
orientation relative to fasteners 120 and set screw 90.
[0083] It will be understood that various modifications may be made
to the embodiments disclosed herein. Therefore, the above
description should not be construed as limiting, but merely as
exemplification of the various embodiments. Those skilled in the
art will envision other modifications within the scope and spirit
of the claims appended hereto.
* * * * *