Apparatus, systems, and methods for the fixation or fusion of bone

Description

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.

FIELD

This application relates generally to the fixation or fusion of bone.

BACKGROUND

Many types of hardware are available both for the fixation of bones that are fractured and for the fixation of bones that are to fused (arthrodesed).

For example, the human hip girdle (see FIGS. 9 and 10) is made up of three large bones joined by three relatively immobile joints. One of the bones is called the sacrum and it lies at the bottom of the lumbar spine, where it connects with the L5 vertebra. The other two bones are commonly called “hip bones” and are technically referred to as the right ilium and the left ilium. The sacrum connects with both hip bones at the sacroiliac joint (in shorthand, the SI-Joint).

The SI-Joint functions in the transmission of forces from the spine to the lower extremities, and vice-versa. The SI-Joint has been described as a pain generator for up to 22% of lower back pain.

To relieve pain generated from the SI Joint, sacroiliac joint fusion is typically indicated as surgical treatment, e.g., for degenerative sacroiliitis, inflammatory sacroiliitis, iatrogenic instability of the sacroiliac joint, osteitis condensans ilii, or traumatic fracture dislocation of the pelvis. Currently, screw and screw with plates are used for sacro-iliac fusion. At the same time the cartilage has to be removed from the “synovial joint” portion of the SI joint. This requires a large incision to approach the damaged, subluxed, dislocated, fractured, or degenerative joint.

The spine (see FIG. 37) is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain.

The spine is made up of small bones, called vertebrae. The vertebrae protect and support the spinal cord. They also bear the majority of the weight put upon the spine.

Between each vertebra is a soft, gel-like “cushion,” called an intervertebral disc. These flat, round cushions act like shock absorbers by helping absorb pressure and keep the bones from rubbing against each other. The intervertebral disc also binds adjacent vertebrae together. The intervertebral discs are a type of joint in the spine. Intervertebral disc joints can bend and rotate a bit but do not slide as do most body joints.

Each vertebra has two other sets of joints, called facet joints (see FIG. 38). The facet joints are located at the back of the spine (posterior). There is one facet joint on each lateral side (right and left). One pair of facet joints faces upward (called the superior articular facet) and the other pair of facet joints faces downward (called the inferior articular facet). The inferior and superior facet joints mate, allowing motion (articulation), and link vertebrae together. Facet joints are positioned at each level to provide the needed limits to motion, especially to rotation and to prevent forward slipping (spondylolisthesis) of that vertebra over the one below.

In this way, the spine accommodates the rhythmic motions required by humans to walk, run, swim, and perform other regular movements. The intervertebral discs and facet joints stabilize the segments of the spine while preserving the flexibility needed to turn, look around, and get around.

Degenerative changes in the spine can adversely affect the ability of each spinal segment to bear weight, accommodate movement, and provide support. When one segment deteriorates to the point of instability, it can lead to localized pain and difficulties. Segmental instability allows too much movement between two vertebrae. The excess movement of the vertebrae can cause pinching or irritation of nerve roots. It can also cause too much pressure on the facet joints, leading to inflammation. It can cause muscle spasms as the paraspinal muscles try to stop the spinal segment from moving too much. The instability eventually results in faster degeneration in this area of the spine.

Degenerative changes in the spine can also lead to spondylolysis and spondylolisthesis. Spondylolisthesis is the term used to describe when one vertebra slips forward on the one below it. This usually occurs because there is a spondylolysis (defect) in the vertebra on top. For example, a fracture or a degenerative defect in the interarticular parts of lumbar vertebra L1 may cause a forward displacement of the lumbar vertebra L5 relative to the sacral vertebra S1 (called L5-S1 spondylolisthesis). When a spondylolisthesis occurs, the facet joint can no longer hold the vertebra back. The intervertebral disc may slowly stretch under the increased stress and allow other upper vertebra to slide forward.

An untreated persistent, episodic, severely disabling back pain problem can easily ruin the active life of a patient. In many instances, pain medication, splints, or other normally-indicated treatments can be used to relieve intractable pain in a joint. However, in for severe and persistent problems that cannot be managed by these treatment options, degenerative changes in the spine may require a bone fusion surgery to stop both the associated disc and facet joint problems.

A fusion is an operation where two bones, usually separated by a joint, are allowed to grow together into one bone. The medical term for this type of fusion procedure is arthrodesis.

Lumbar fusion procedures have been used in the treatment of pain and the effects of degenerative changes in the lower back. A lumbar fusion is a fusion in the S1-L5-L4 region in the spine.

One conventional way of achieving a lumbar fusion is a procedure called anterior lumbar interbody fusion (ALIF). In this procedure, the surgeon works on the spine from the front (anterior) and removes a spinal disc in the lower (lumbar) spine. The surgeon inserts a bone graft into the space between the two vertebrae where the disc was removed (the interbody space). The goal of the procedure is to stimulate the vertebrae to grow together into one solid bone (known as fusion). Fusion creates a rigid and immovable column of bone in the problem section of the spine. This type of procedure is used to try and reduce back pain and other symptoms.

Facet joint fixation procedures have also been used for the treatment of pain and the effects of degenerative changes in the lower back. These procedures take into account that the facet joint is the only true articulation in the lumbosacral spine. In one conventional procedure for achieving facet joint fixation, the surgeon works on the spine from the back (posterior). The surgeon passes screws from the spinous process through the lamina and across the mid-point of one or more facet joints.

Conventional treatment of spondylolisthesis may include a laminectomy to provide decompression and create more room for the exiting nerve roots. This can be combined with fusion using, e.g., an autologous fibular graft, which may be performed either with or without fixation screws to hold the bone together. In some cases the vertebrae are moved back to the normal position prior to performing the fusion, and in others the vertebrae are fused where they are after the slip, due to the increased risk of injury to the nerve with moving the vertebra back to the normal position.

Currently, these procedures entail invasive open surgical techniques (anterior and/or posterior). Further, ALIF entails the surgical removal of the disc. Like all invasive open surgical procedures, such operations on the spine risk infections and require hospitalization. Invasive open surgical techniques involving the spine continue to be a challenging and difficult area.

SUMMARY OF THE DISCLOSURE

Embodiments of the invention provide bone fixation/fusion systems, devices, and related methods for stabilizing adjacent bone segments in a minimally invasive manner. The adjacent bone segments can comprise parts of the same bone that have been fractured, or two or more individual bones separated by a space or joint. As used herein, “bone segments” or “adjacent bone regions” refer to either situation, i.e., a fracture line in a single bone (which the devices serve to fixate), or a space or joint between different bone segments (which the devices serve to arthrodese or fuse). The devices can therefore serve to perform a fixation function between two or more individual bones, or a fusion function between two or more parts of the same bone, or both functions.

One aspect of the invention provides assemblies and associated methods for the fixation or fusion of bone structures comprising first and second bone segments separated by a fracture line or joint. The assemblies and associated methods comprise an anchor body sized and configured to be introduced into the first and second bone segments. The anchor body has a distal end located in an interior region of the second bone segment; a proximal end located outside an exterior region of the first bone segment; and an intermediate region spanning the fracture line or joint between the first and second bone segments. The assemblies and associated methods also include a distal anchor secured to the interior region of the second bone segment and affixed to the distal end of the anchor body to anchor the distal end in the second bone segment. The assemblies and associated methods further include a proximal anchor secured to the exterior region of the first bone segment and affixed to the proximal end of the anchor body, which, in concert with the distal anchor, places the anchor body in compression to compress and fixate the bone segments relative to the fracture line or joint. The assemblies and associated methods also include an elongated implant structure carried by the intermediate region of the anchor body and spanning the fracture line or joint between the bone segments. The elongated implant structure includes an exterior surface region treated to provide bony in-growth or through-growth along the implant structure, to accelerate the fixation or fusion of the first and second bone segments held in compression and fixated by the anchor body.

The bone fixation/fusion systems, devices, and related methods are well suited for stabilizing adjacent bone segments in the SI-Joint.

Accordingly, another aspect of the invention provides a method for the fusion of the sacral-iliac joint between an iliac and a sacrum. The method comprises creating an insertion path through the ilium, through the sacral-iliac joint, and into the sacrum. The method includes providing an anchor body sized and configured to be introduced through the insertion path laterally into the ilium and sacrum. The anchor body has a distal end sized and configured to be located in an interior region of the sacrum; a proximal end sized and configured to be located outside an exterior region of the iliac; and an intermediate region sized and configured to span the sacral-iliac joint. The method includes providing an elongated implant structure sized and configured to be passed over the anchor body to span the sacral-iliac joint between the iliac and sacrum. The elongated implant structure includes an exterior surface region treated to provide bony in-growth or through-growth along the implant structure. The method includes introducing the anchor body through the insertion path from the ilium, through the sacral-iliac joint, and into the sacrum. The method includes anchoring the distal end of the anchor body in the interior region of the sacrum. The method includes passing the elongated implant structure over the anchor body to span the sacral-iliac joint between the ilium and sacrum, and anchoring the proximal end of the anchor body to an exterior region of the ilium, which, in concert with the anchored distal end, places the anchor body in compression to compress and fixate the sacral-iliac joint. The bony in-growth or through-growth region of the implant structure accelerates the fixation or fusion of the sacral-iliac joint held in compression and fixated by the anchor body.

Embodiments of the invention provide apparatus, systems, and methods for the fusion and/or stabilization of the lumbar spine. The apparatus, systems, and methods include one or more elongated, stem-like implant structures sized and configured for the fusion or stabilization of adjacent bone structures in the lumbar region of the spine, either across the intervertebral disc or across one or more facet joints. Each implant structure includes a region formed along at least a portion of its length to promote bony in-growth onto or into surface of the structure and/or bony growth entirely through all or a portion of the structure. The bony in-growth or through-growth region along the surface of the implant structure accelerates bony in-growth or through-growth onto, into, or through the implant structure 20. The implant structure therefore provides extra-articular/intra osseous fixation, when bone grows in and around the bony in-growth or through-growth region. Bony in-growth or through-growth onto, into, or through the implant structure helps speed up the fusion and/or stabilization process of the adjacent bone regions fixated by the implant structure.

The assemblies of one or more implant structures make possible the achievement of diverse interventions involving the fusion and/or stabilization of lumbar and sacral vertebra in a non-invasive manner, with minimal incision, and without the necessitating the removing the intervertebral disc. The representative lumbar spine interventions, which can be performed on adults or children, include, but are not limited to, lumbar interbody fusion; translaminar lumbar fusion; lumbar facet fusion; trans-iliac lumbar fusion; and the stabilization of a spondylolisthesis.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side section view of a compression stem assembly assembled in adjacent bone regions, which are shown in FIG. 1 in a diagrammatically fashion for the purpose of illustration, without anatomic detail, which is later shown, e.g., in FIG. 16.

FIG. 2 is an exploded perspective view of the components of the compression stem assembly shown in FIG. 1 prior to assembly.

FIGS. 3 to 7 are alternative embodiments of an implant structure which forms a part of the compression stem assembly shown in FIGS. 1 and 2, illustrating different cross-sectional geometries and configurations for the implant structure 20.

FIGS. 8A to 8L are side section views of the introduction and assembly of the compression stem assembly shown in FIGS. 1 and 2, which is shown in FIGS. 8A to 8L in a diagrammatically fashion for the purpose of illustration, without anatomic detail, as later shown, e.g., in FIG. 16.

FIGS. 9 and 10 are, respectively, anterior and posterior anatomic views of the human hip girdle comprising the sacrum and the hip bones (the right ilium, and the left ilium), the sacrum being connected with both hip bones at the sacroiliac joint (in shorthand, the SI-Joint).

FIGS. 11 to 13A and 13B are anatomic views showing, respectively, in exploded perspective, assembled perspective, assembled anterior view, and assembled axial section view, the implantation of three implant structures, without association of a compression stem assembly, for the fixation of the SI-Joint using a lateral approach laterally through the ilium, the SI-Joint, and into the sacrum S1.

FIGS. 14 to 16A and 16B are anatomic views showing, respectively, in exploded perspective, assembled perspective, assembled anterior view, and assembled axial section view, the implantation of three implant structures, in association with a compression stem assembly, for the fixation of the SI-Joint using a lateral approach laterally through the ilium, the SI-Joint, and into the sacrum S1.

FIGS. 17 to 19A and 19B are anatomic views showing, respectively, in exploded perspective, assembled perspective, assembled lateral view, and assembled axial section view, the implantation of three implant structures, without association of a compression stem assembly, for the fixation of the SI-Joint using a postero-lateral approach entering from the posterior iliac spine of the ilium, angling through the SI-Joint, and terminating in the sacral alae.

FIGS. 20 to 22A and 22B are anatomic views showing, respectively, in exploded perspective, assembled perspective, assembled lateral view, and assembled axial section view, the implantation of three implant structures, in association with a compression stem assembly, for the fixation of the SI-Joint using a postero-lateral approach entering from the posterior iliac spine of the ilium, angling through the SI-Joint, and terminating in the sacral alae.

FIGS. 23 and 24A and 24B are anatomic views showing, respectively, in exploded perspective, assembled anterior view, and assembled axial section view, the implantation of a screw-like structure for the fixation of the SI-Joint using a lateral approach laterally through the ilium, the SI-Joint, and into the sacrum S1.

FIGS. 25 and 26A and 26B are anatomic views showing, respectively, in exploded perspective, assembled lateral view, and assembled axial section view, the implantation of a screw-like structure for the fixation of the SI-Joint using a postero-lateral approach entering from the posterior iliac spine of the ilium, angling through the SI-Joint, and terminating in the sacral alae.

FIGS. 27 and 28A and 28B are anatomic views showing, respectively, in exploded perspective, assembled anterior view, and assembled axial section view, the implantation of a fusion cage structure for the fixation of the SI-Joint using a lateral approach laterally through the ilium, the SI-Joint, and into the sacrum S1.

FIGS. 29 and 30A and 30B are anatomic views showing, respectively, in exploded perspective, assembled lateral view, and assembled axial section view, the implantation of a fusion cage structure for the fixation of the SI-Joint using a postero-lateral approach entering from the posterior iliac spine of the ilium, angling through the SI-Joint, and terminating in the sacral alae.

FIG. 31 is an exploded perspective view of the components of an alternative embodiment of a compression stem assembly prior to assembly.

FIGS. 32 and 33 are perspective views of the alternative embodiment of a compression stem assembly shown in FIG. 31 after assembly, showing rotation of an anchor plate associated with the assembly from an aligned position (FIG. 32) to a bone-gripping position (shown in FIG. 33), to anchor the assembly in bone.

FIG. 34 is a side section view of the compression stem assembly shown in FIG. 31 assembled in adjacent bone regions, which are shown in FIG. 34 in a diagrammatically fashion for the purpose of illustration, without anatomic detail.

FIGS. 35A and 35B are side section views of an alternative embodiment of a compression stem assembly prior to assembly (FIG. 35A) and after assembly (FIG. 35B) in adjacent bone regions, which are shown in FIGS. 35A and 35B in a diagrammatically fashion for the purpose of illustration, without anatomic detail.

FIGS. 36A and 36B are side section views of a radially compressible implant prior to assembly (FIG. 36A) and after assembly (FIG. 36B) in adjacent bone regions, which are shown in FIGS. 36A and 36B in a diagrammatically fashion for the purpose of illustration, without anatomic detail.

FIG. 37 is an anatomic anterior and lateral view of a human spine.

FIG. 38 is an anatomic posterior perspective view of the lumbar region of a human spine, showing lumbar vertebrae L2 to L5 and the sacral vertebrae.

FIG. 39 is an anatomic anterior perspective view of the lumbar region of a human spine, showing lumbar vertebrae L2 to L5 and the sacral vertebrae.

FIG. 40 is a perspective view of a representative embodiment of an elongated, stem-like, cannulated implant structure well suited for the fusion or stabilization of adjacent bone structures in the lumbar region of the spine, either across the intervertebral disc or across one or more facet joints.

FIGS. 41 to 44 are perspective views of other representative embodiments of implant structures well suited for the fusion or stabilization of adjacent bone structures in the lumbar region of the spine, either across the intervertebral disc or across one or more facet joints.

FIG. 45 is an anatomic anterior perspective view showing, in an exploded view prior to implantation, a representative configuration of an assembly of one or more implant structures as shown in FIG. 40, sized and configured to achieve anterior lumbar interbody fusion, in a non-invasive manner and without removal of the intervertebral disc.

FIG. 46 is an anatomic anterior perspective view showing the assembly shown in FIG. 45 after implantation.

FIG. 47 is an anatomic right lateral perspective view showing the assembly shown in FIG. 45 after implantation.

FIG. 48 is an anatomic superior left lateral perspective view showing the assembly shown in FIG. 45 after implantation.

FIGS. 49A to 49G are diagrammatic views showing, for purposes of illustration, a representative lateral (or posterolateral) procedure for implanting the assembly of implant structures shown in FIGS. 46 to 48.

FIG. 50 is an anatomic anterior perspective view showing, in an exploded view prior to implantation, assemblies comprising one or more implant structures like that shown in FIG. 40 inserted from left and/or right anterolateral regions of a given lumbar vertebra, in an angled path through the intervertebral disc and into an opposite anterolateral interior region of the next inferior lumbar vertebra, FIG. 50 showing in particular two implant structures entering on the right anterolateral side of L4, through the intervertebral disc and into the left anterolateral region of L5, and one implant structure entering on the left anterolateral side of L4, through the intervertebral disc and into the right anterolateral region of L5, the left and right implant structures crossing each other in transit through the intervertebral disc.

FIG. 51 is an anatomic anterior perspective view showing, in an exploded view prior to implantation, assemblies comprising one or more implant structures like that shown in FIG. 40 inserted from left and/or right anterolateral regions of a given lumbar vertebra, in an angled path through the intervertebral disc and into an opposite anterolateral interior region of the next inferior lumbar vertebra, FIG. 50 showing in particular one implant structure entering on the right anterolateral side of L4, through the intervertebral disc and into the left anterolateral region of L5, and one implant structure entering on the left anterolateral side of L4, through the intervertebral disc and into the right anterolateral region of L5, the left and right implant structures crossing each other in transit through the intervertebral disc.

FIG. 52 is an anatomic posterior perspective view, exploded prior to implantation, of a representative configuration of an assembly of one or more implant structures like that shown in FIG. 40, sized and configured to achieve translaminar lumbar fusion in a non-invasive manner and without removal of the intervertebral disc.

FIG. 53 is an anatomic inferior transverse plane view showing the assembly shown in FIG. 52 after implantation.

FIG. 54 is an anatomic posterior perspective view, exploded prior to implantation, of a representative configuration of an assembly of one or more implant structures like that shown in FIG. 40, sized and configured to achieve lumbar facet fusion, in a non-invasive manner and without removal of the intervertebral disc.

FIG. 55 is an anatomic inferior transverse plane view showing the assembly shown in FIG. 54 after implantation.

FIG. 56 is an anatomic lateral view showing the assembly shown in FIG. 54 after implantation.

FIG. 57A is an anatomic anterior perspective view showing, in an exploded view prior to implantation, a representative configuration of an assembly of one or more implant structures like that shown in FIG. 40, sized and configured to achieve fusion between lumbar vertebra L5 and sacral vertebra S1, in a non-invasive manner and without removal of the intervertebral disc, using an anterior approach.

FIG. 57B is an anatomic anterior perspective view showing the assembly shown in FIG. 57A after implantation.

FIG. 58A is an anatomic posterior view showing, in an exploded view prior to implantation, another representative configuration of an assembly of one or more implant structures sized and configured to achieve fusion between lumbar vertebra L5 and sacral vertebra S1, in a non-invasive manner and without removal of the intervertebral disc, using a postero-lateral approach entering from the posterior iliac spine of the ilium, angling through the SI-Joint, and terminating in the lumbar vertebra L5.

FIG. 58B is an anatomic posterior view showing the assembly shown in FIG. 58A after implantation.

FIG. 58C is an anatomic superior view showing the assembly shown in FIG. 58B.

FIG. 59 is an anatomic lateral view showing a spondylolisthesis at the L5/S1 articulation, in which the lumbar vertebra L5 is displaced forward (anterior) of the sacral vertebra S1.

FIG. 60A is an anatomic anterior perspective view showing, in an exploded view prior to implantation, a representative configuration of an assembly of one or more implant structures like that shown in FIG. 40, sized and configured to stabilize a spondylolisthesis at the L5/S1 articulation.

FIG. 60B is an anatomic anterior perspective view showing the assembly shown in FIG. 60A after implantation.

FIG. 60C is an anatomic lateral view showing the assembly shown in FIG. 60B.

DETAILED DESCRIPTION

Although the disclosure hereof is detailed and exact to enable those skilled in the art to practice the invention, the physical embodiments herein disclosed merely exemplify the invention that may be embodied in other specific structure. While the preferred embodiment has been described, the details may be changed without departing from the invention, which is defined by the claims.

Part I

The following describes embodiments of the invention for use in the fixation or fusion of the SI-joint and other bone segments or joints.

I. The Compression Stem Assembly

FIGS. 1 and 2 show in assembled and exploded views, respectively, a representative configuration of a compression stem assembly 10 sized and configured for the fixation of bone fractures (i.e., fixation of parts of the same bone) or for the fixation of bones which are to be fused (arthrodesed) (i.e. fixation of two or more individual bones that are adjacent and/or jointed). For the sake of shorthand, the assembly 10 will sometimes be called a bone fixation/fusion compression assembly, to indicate that it can perform a fixation function between two or more individual bones), or a fusion function between two or more parts of the same bone, or both functions. As used herein, “bone segments” or “adjacent bone regions” refer to either situation, i.e., a fracture line in a single bone or a space or joint between different bone segments. In FIG. 1, the bone segment or adjacent bone regions are shown diagrammatically without anatomic detail for the purpose of illustration. Later, e.g., in FIGS. 13 to 16 and FIGS. 20 to 22, the bone segments or adjacent bone regions are shown in a specific anatomic setting, comprising the joint between the sacrum and the ilium of the pelvis, also anatomically called the sacroiliac joint (SI-Joint).

As shown in FIGS. 1 and 2, the compression stem assembly 10 comprises an anchor body 12, which (as shown in FIG. 1) is sized and configured to be placed in compression within bone segments or adjacent bone regions. In a representative embodiment, the anchor body 12 takes the form of a cylindrical anchor pin or rod. Still, the anchor body 12 can possess other geometries.

The anchor body 12 is anchored at a distal end to a distal anchor screw 14 coupled to an interior bone region in one side of the space or joint. The anchor body 12 is secured at a proximal end, on the opposite side of the space or joint, to an exterior bone region by an anchor nut 16 and anchor washer 18. The distal anchor screw 14 and anchor nut 16 hold the anchor body 12 in compression and, in doing so, the anchor body 12 compresses and fixates the bone segments or adjacent bone regions.

The anchor body 12 carries within the bone regions or segments an elongated, stem-like, cannulated implant structure 20. The implant structure 20 includes an interior bore 22 that accommodates its placement by sliding over the anchor body 12. As FIG. 2 shows, the implant structure 20 includes a region 24 formed along at least a portion of its length to promote bony in-growth onto or into surface of the structure and/or bony growth entirely through all or a portion of the structure. The bony-in-growth or through-growth region 24 along the surface of the implant structure 20 accelerates bony in-growth or through-growth onto, into, or through the implant structure 20. Bony in-growth or through-growth onto, into, or through the implant structure 20 helps speed up the fusion process or fracture healing time of the bone segments or adjacent bone regions held in compression and fixated by the anchor body 12.

A. The Anchor Body, Nut, and Washer

The anchor body 12, nut 16, and washer 18 can be formed—e.g., by machining, molding, or extrusion—from a material usable in the prosthetic arts that is capable of being placed into and holding compressive forces and that is not subject to significant bio-absorption or resorption by surrounding bone or tissue over time. The anchor body 12, nut 16, and washer 18 are intended to remain in place for a time sufficient to stabilize the fracture or fusion site. Examples of such materials include, but are not limited to, titanium, titanium alloys, tantalum, chrome cobalt, surgical steel, or any other total joint replacement metal and/or ceramic, sintered glass, artificial bone, any uncemented metal or ceramic surface, or a combination thereof.

In length (see FIG. 1), the anchor body 12 is sized to span a distance through one adjacent bone segment or region, through the intervening space or joint, and at least partially into the other adjacent bone segment or region. The anchor body 12 is sized on length and diameter according to the local anatomy. The morphology of the local structures can be generally understood by medical professionals using textbooks of human skeletal anatomy along with their knowledge of the site and its disease or injury. The physician is also able to ascertain the dimensions of the anchor body 12 based upon prior analysis of the morphology of the targeted bone region using, for example, plain film x-ray, fluoroscopic x-ray, or MRI or CT scanning. A representative diameter for the anchor body 12 can range between 3.2 mm to 3.5 mm.

As best shown in FIG. 2, at least the proximal and distal regions of the anchor body 12 include external helical ridges or screw threads 26 and 28 formed around the cylindrical body of the anchor body 12. Alternatively, the anchor body 12, if desired, can be threaded substantially along its entire length. Desirably, the direction of the screw threads 26 and 28 is the same at both proximal and distal regions of the anchor body 12, e.g., they desirably comprise right-hand threads.

The proximal region of the anchor body 12 carrying the threads 26 is sized to extend, in use, a distance outside the one adjacent bone segment or region. In this way, the proximal region is, in use, exposed so that the proximal anchor nut 16 and washer 18 can be attached. The anchor nut 16 includes complementary internal screw threads that are sized and configured to mate with the external screw threads 26 on the proximal region of the anchor body 12. Representative diameters for an anchor nut 16 and anchor washer 18 for a 3.2 mm anchor body 12 are, respectively, 3.2 mm and 8 mm.

The distal region of the anchor body 12 carrying the threads 28 is sized to extend at least partially into the other adjacent bone segment or region, where it is to be coupled to the anchor screw 14, as will next be described.

B. The Anchor Screw

Like the anchor body 12, nut and washer 18, the anchor screw 14 can likewise be formed—e.g., by machining, or molding—from a durable material usable in the prosthetic arts that is capable of being screwed into bone and that is not subject to significant bio-absorption or resorption by surrounding bone or tissue over time. The anchor screw 14, like the other components of the compression assembly 10, is intended to remain in place for a time sufficient to stabilize the fracture or fusion site. Examples of such materials include, but are not limited to, titanium, titanium alloys, tantalum, chrome cobalt, surgical steel, or any other total joint replacement metal and/or ceramic, or a combination thereof.

The anchor screw 14 is sized to span a distance within the other adjacent bone segment or region at the terminus of the threaded distal region 28 of the anchor body 12. As best shown in FIG. 2, the anchor screw 14 includes external helical ridges or screw threads 30 formed around the cylindrical body of the anchor screw 14. The external screw threads 30 are sized and configured to gain purchase in bone when rotated, so that the anchor screw 14 can be advanced and seated by rotation into bone in the bone segment or region. The anchor screw 14, seated within the bone, resists axial migration and separation. A representative range of lengths for the anchor screw 14 can be between 5 mm to 20 mm, again depending upon the demands of the local anatomy. A representative diameter for the anchor screw 14 is about 7 mm.

The anchor screw 14 also includes internal helical ridges or screw threads 32 formed within a bore in the anchor screw 14. The internal screw threads 32 are sized and configured to mate with the complementary external screw threads 28 on the distal region of the anchor body 12. When threaded and mated to the internal screw threads 32 of the anchor screw 14, the anchor screw 14 anchors the distal region of the anchor body 12 to bone to resists axial migration of the anchor body 12. As before described, the anchor screw 14 (on the distal end) and the anchor nut 16 and anchor washer 18 (on the proximal end) hold the anchor body 12 in compression, thereby compressing and fixating the bone segments or adjacent bone regions.

Alternatively, in place of the anchor screw 14, an internally threaded component free external screw threads can be is sized and configured to be securely affixed within the broached bore in the most distal bone segment where the broached bore terminates, e.g., by making an interference fit and/or otherwise being secured by the use of adhesives. Like the anchor screw 14, the interference fit and/or adhesives anchor the overall implant structure. Adhesives may also be used in combination with the anchor screw 14.

C. The Implant Structure

The implant structure 20 can be formed—e.g., by machining, molding, or extrusion—from a durable material usable in the prosthetic arts that is not subject to significant bio-absorption or resorption by surrounding bone or tissue over time. The implant structure 20, like the other components of the compression assembly 10, is intended to remain in place for a time sufficient to stabilize the fracture or fusion site. Such materials include, but are not limited to, titanium, titanium alloys, tantalum, tivanium (aluminum, vanadium, and titanium), chrome cobalt, surgical steel, or any other total joint replacement metal and/or ceramic, sintered glass, artificial bone, any uncemented metal or ceramic surface, or a combination thereof. Alternatively, the implant structure 20 may be formed from a suitable durable biologic material or a combination of metal and biologic material, such as a biocompatible bone-filling material. The implant structure 20 may be molded from a flowable biologic material, e.g., acrylic bone cement, that is cured, e.g., by UV light, to a non-flowable or solid material.

The implant structure 20 is sized according to the local anatomy. The morphology of the local structures can be generally understood by medical professionals using textbooks of human skeletal anatomy along with their knowledge of the site and its disease or injury. The physician is also able to ascertain the dimensions of the implant structure 20 based upon prior analysis of the morphology of the targeted bone region using, for example, plain film x-ray, fluoroscopic x-ray, or MRI or CT scanning.

As FIGS. 3 to 7 show, the implant structure 20 can take various shapes and have various cross-sectional geometries. The implant structure 20 can have, e.g., a generally curvilinear (i.e., round or oval) cross-section—as FIG. 3 shows for purposes of illustration—or a generally rectilinear cross section (i.e., square or rectangular or triangular—as FIG. 4 shows for purposes of illustration—or combinations thereof. In FIG. 2, the implant structure 20 is shown to be triangular in cross section, which effectively resists rotation and micromotion once implanted.

As FIGS. 5 and 6 show, the implant structure 20, whether curvilinear (FIG. 5) or rectilinear (FIG. 6) can include a tapered region 34 at least along a portion of its axial length, meaning that the width or diameter of the implant structure 20 incrementally increases along its axial length. Desirably, the tapered region 34 corresponds with, in use, the proximal region of the implant structure 20 (i.e., the last part of the implant structure 20 to enter bone). The amount of the incremental increase in width or diameter can vary. As an example, for an implant structure 20 having a normal diameter of 7 mm, the magnitude of the incremental increase at its maximum can range between about 0.25 mm to 1.25 mm. The tapered region 34 further enhances the creation and maintenance of compression between the bone segments or regions.

To further enhance the creation and maintenance of compression between the bone segments or regions (see FIG. 7), the implant structure 20, whether curvilinear or rectilinear or tapered, can include projecting bone-gripping surfaces 36 in the form of “teeth” or wings or the like. The teeth or wings 36 can project, e.g., 2 to 4 mm from the surface of the implant structure 20 and face in the direction of the compression forces at proximal and distal ends of the implant structure 20, taking purchase into the bone segments as they are compressed together by the compression assembly.

The bony in-growth or through-growth region 24 may extend along the entire outer surface of the implant structure 20, as shown in FIG. 1 or 2, or the bony in-growth or through-growth region 24 may cover just a specified distance on either side of the bone segments or fracture line. The bony in-growth region 24 or through-growth can comprise, e.g., through holes, and/or various surface patterns, and/or various surface textures, and/or pores, or combinations thereof. The configuration of the bony in-growth or through-growth region 24 can, of course, vary. By way of examples, the bony in-growth or through-growth region 24 can comprise an open mesh configuration; or beaded configuration; or a trabecular configuration; or include holes or fenestrations. Any configuration conducive to bony in-growth and/or bony through-growth will suffice.

The bony in-growth or through-growth region 24 can be coated or wrapped or surfaced treated to provide the bony in-growth or through-growth region, or it can be formed from a material that itself inherently possesses a structure conducive to bony in-growth or through-growth, such as a porous mesh, hydroxyapetite, or other porous surface. The bony in-growth or through-growth region can include holes that allow bone to grow throughout the region.

In a preferred embodiment, the bony in-growth region or through-growth region 24 comprises a porous plasma spray coating on the implant structure 20. This creates a biomechanically rigorous fixation/fusion system, designed to support reliable fixation/fusion and acute weight bearing capacity.

The bony in-growth or through-growth region 24 may further be covered with various other coatings such as antimicrobial, antithrombotic, and osteoinductive agents, or a combination thereof. The entire implant structure 20 may be impregnated with such agents, if desired.

D. Implantation of the Compression Stem Assembly

FIGS. 8A to 8L diagrammatically, show for purposes of illustration, a representative procedure for implanting a compression stem assembly 10. More detailed, anatomically-focused descriptions of particular implantation techniques of the compression stem assembly 10 in the SI-Joint will be described later.

The physician identifies the bone segments or adjacent bone regions that are to be fixated or fused (arthrodesed) (see FIG. 8A). Aided by conventional visualization techniques, e.g., using X-ray image intensifiers such as a C-arms or fluoroscopes to produce a live image feed which is displayed on a TV screen, a guide pin 38 is introduced by conventional means (see FIG. 8B) through the one adjacent bone segment or region, through the intervening space or joint, and partially into the other adjacent bone segment or region.

A cannulated drill bit 40 is passed over the guide pin 38 (see FIG. 8C), to form a pilot insertion path or bore 42 through the one adjacent bone segment or region, through the intervening space or joint, and partially into the other adjacent bone segment or region. A single drill bit or multiple drill bits 40 can be employed to drill through bone fragments or bone surfaces to create a pilot bore 42 of the desired size and configuration. A region of bone distal to the pilot bore 42 is left undrilled and native for seating of the anchor screw 14. When the pilot bore 42 is completed, the cannulated drill bit 40 is removed.

A broach 44 having the external geometry and dimensions matching the external geometry and dimensions of the implant structure 20 (which, in the illustrated embodiment, is triangular) (see FIG. 8D) is tapped over the guide pin 38 through the pilot bore 42. The shaped broach 44 cuts along the edges of the pilot bore 42 to form the desired profile (which, in the illustrated embodiment, is triangular) to accommodate the implant structure 20 through the one adjacent bone segment or region, through the intervening space or joint, and partially into the other adjacent bone segment or region.

The broach 44 is withdrawn (see FIG. 8E), and the anchor screw 14 (its internal screw threads 32 mated to the distal end of a cannulated threaded screw driver 46) is passed over the guide pin 38 to the terminus of the broached bore 48 in the distal bone segment. The anchor screw 14 is threaded by operation of the screw driver 46 (see FIG. 8F) into the undrilled and native bone beyond the terminus of the broached bore 48. For example, the anchor screw 14 can be advanced and buried in bone at least 5 mm beyond the terminus of the broached bore 48.

The threaded screw driver 46 is unthreaded by reverse rotation from the anchor screw 14, and the guide pin 38 is removed (see FIG. 8G). The anchor body 12 is inserted, and its threaded distal end 28 is threaded into and mated with the internal screw threads 32 of the anchor screw 14 (see FIG. 8H).

As shown in FIG. 8H, due to its purposeful size and configuration, when its threaded distal end 28 is suitably threaded to the anchor screw 14, the threaded proximal end 26 of the anchor body 12 projects an exposed distance outside the proximal end of the broached bore 48.

The implant structure 20 is passed over the anchor body 12 by sliding it over the anchor body 12. As FIG. 8I shows, the length of the implant structure 20 selected is less than the distance between the anchor screw 14 and the threaded proximal end 26, such that, when initially inserted and before compression is applied to the anchor body 26, the distal end of the implant structure 20 is spaced from the proximal end of the anchor screw 14 (see FIG. 8I). The distance can range, e.g., between about 4 mm to about 10 mm.

The anchor washer 18 is passed by sliding over the exposed threaded proximal end 26 of the anchor body 12 into abutment against an exterior bone surface (see FIG. 8J). The anchor nut 16 is threaded onto and mated to the threaded proximal end 26 of the anchor body 12 (see FIG. 8K). The anchor nut 16 is tightened against the anchor washer 18 using a hand (or powered) chuck 50 (see FIG. 8L), until a desired amount of compression is applied to the bone regions by the assembly 10. The compression will reduce the distance between the bone segments (as FIGS. 8K and 8L show), as the distal end 28 of the anchor body 12, affixed to the anchor screw 14 in the more distal bone segment, draws the more distal bone segment toward the more proximal bone segment, while eventually placing the implant structure 20 itself into compression within the broached bore 48 as the implant structure 20 comes into abutment against both the anchor washer 18 and the anchor screw 14, assuring intimate contact between the bony in-growth region 24 and bone within the broached bore 48.

The intimate contact created by the compression between the bony in-growth or through-growth region 24 along the surface of the implant structure 20 accelerates bony in-growth or through-growth onto, into, or through the implant structure 20, to accelerate the fusion process or fracture healing time.

As will be described in greater detail later, more than one compression stem assembly 10 can be implanted in a given bone segment. For example, as will be described later (see, e.g., FIG. 20), three such compression stem assemblies can be implanted to fuse a SI-Joint.

E. Alternative Embodiments

1. Distal Anchor Plate

An alternative embodiment for the compression stem assembly 10 is shown in FIGS. 31 to 33. In use, the compression stem assembly 10 is sized and configured to be implanted in adjoining bone segments, which are separated by a space or joint, for the purpose of bone fixation or joint fusion, as already described.

In this embodiment (see FIG. 31), the anchor body 12, nut 16, and washer 18 are sized and configured as previously described. Likewise, the implant structure 20 is sized and configured with a generally rectilinear cross section, as also earlier described and shown in FIG. 4.

In this embodiment, instead of a threaded anchor screw 14, the distal end of the assembly 10 is anchored into bone by a generally rectilinear anchor plate 58. The anchor plate 58 is formed—e.g., by machining, or molding—from a hard, durable material usable in the prosthetic arts that is capable of cutting into and gaining purchase in bone, and that is not subject to significant bio-absorption or resorption by surrounding bone or tissue over time.

As best shown in FIGS. 31 and 32, the rectilinear anchor plate 58 is sized and configured to match the rectilinear cross section of the implant structure itself. In the illustrated arrangement, the implant structure 20 is generally triangular in cross section, and so, too, is the anchor plate 58. As such, the anchor plate 58 includes apexes 64. The sides of the anchor plate 58 between the apexes are sharpened to comprise bone cutting edges 72.

The anchor plate 58 also includes a bore 60 in its geometric center (see FIG. 31). Internal helical ridges or screw threads 62 are formed within the bore 68. The internal screw threads 62 are sized and configured to mate with the complementary external screw threads 28 on the distal region of the anchor body 12. The distal region of the anchor body 12 can thereby be threaded to the anchor plate 58 (as shown in FIG. 32). When threaded to the anchor body 12, the anchor plate 58 rotates in common with the anchor body 12 (as shown in FIG. 33).

Prior to introduction of the implant structure 20 into the broached bore 48 formed in the manner previously described (and as shown in FIGS. 8A to 8D), the anchor body 12 is passed through the bore 22 of the implant structure 20, and the anchor plate 58 is threaded to the distal threaded region 26 of the anchor body 12, which is sized to project beyond the distal end of the implant structure 20. Further, as FIG. 32 shows, the anchor plate 58 is additionally rotationally oriented in a position aligned with the distal end of the implant structure 20. In the aligned position (FIG. 32), the apexes 64 of the anchor plate 58 overlay and register with the apexes 66 of the distal end of the implant structure 20. The implant structure 20, anchor body 12, and anchor plate 58 are introduced as a unit through the broached bore 48 in the orientation shown in FIG. 32. In the aligned position, the anchor plate 58 offers no resistance to passage of the implant structure 20 through the broached bore 48.

Upon contacting the terminus of the broached bore, the proximal end of the anchor body 58 is rotated 60.degree. degrees (as shown in FIG. 33). The rotation moves the anchor plate 58 into an extended, bone-gripping position no longer aligned with the distal end of the implant structure 20 (as is shown in FIG. 33). In the extended, bone-gripping position, the apexes 64 of the triangular anchor plate 58 project radially outward from the triangular sides 68 of the implant structure 20. The anchor plate 58 presents at the distal end of the implant structure 20 an enlarged lateral surface area, larger than the cross sectional area of the implant structure itself.

During rotation of the anchor plate 58 toward the bone-gripping position, the cutting edges 72 of the anchor plate 58 advance into bone and cut bone, seating the anchor plate 58 into bone in the bone segment or region (see FIG. 34). In the bone-gripping position, the anchor plate 58 anchors the distal end of the anchor body 12 into bone. The anchor plate 58 resists axial migration and separation, in much the same fashion as the anchor screw 14.

The sides 68 of the implant structure 20 at the distal end of the structure 20 preferably include cut-outs 70 (see FIGS. 31 and 32). The cut-outs 70 are sized and configured so that, when the anchor plate 58 is rotated into its bone-gripping position, the body of the anchor plate 58 adjoining the apexes detents and comes to rest within the cut outs 70, as FIG. 33 shows. Nested within the cut-outs 70, further tightening of the anchor nut 16 and washer 18 at the proximal end of the anchor body 12, as previously described, locks the anchor plate 58 in the bone-gripping, anchored position. By tightening the anchor nut, the more distal end of the anchor body 12, anchored by the plate 58 in the second bone segment, draws the second bone segment toward the first bone segment, reducing the space or joint between them, while eventually compressing the implant structure 20 between the distal anchor plate 58 and the proximal nut/washer (as FIG. 34 shows), thereby comprising a compression stem assembly 10.

2. Two Piece Compressible Implant Structure

An alternative embodiment of a compressible implant structure is shown in FIGS. 35A and 35B. In use, the implant structure is sized and configured to be implanted in adjoining bone segments, which are separated by a space or joint, for the purpose of bone fixation or joint fusion, as already described.

In this embodiment (see FIG. 35A), the implant structure can possess a circular or curvilinear cross section, as previously described. Unlike previous implant structures, the implant structure 20 shown in FIG. 35A comprises two mating implant components 74 and 78.

As before described, each implant component 74 and can be formed—e.g., by machining, molding, or extrusion—from a durable material usable in the prosthetic arts that is not subject to significant bio-absorption or resorption by surrounding bone or tissue over time.

Each implant component 74 and 78 includes exterior bony in-growth or through-growth regions, as previously described.

Prior to introduction of the implant structure, a broached bore is formed through the bone segments in the manner previously described, and is shown in FIGS. 8A to 8D. The implant component 74 is sized and configured to be securely affixed within the broached bore in the most distal bone segment where the broached bore terminates, e.g., by making an interference fit and/or otherwise being secured by the use of adhesives. The implant component 74 is intended to anchor the overall implant structure.

The implant component 74 further includes a post 76 that extends through the broached bore into the most proximal bone segment, where the broached bore originates. The post 76 includes internal threads 80.

The second implant component 78 is sized and configured to be introduced into the broached bore of the most proximal bone segment. The second implant component includes an interior bore, so that the implant component 78 is installed by sliding it over the post 76 of the first implant component 74, as FIG. 35B shows.

An anchor screw 16 (desirably with a washer 18) includes external screw threads, which are sized and configured to mate with the complementary internal screw threads 80 within the post 76. Tightening the anchor screw 16 draws the first and second implant components 74 and 78 together, reducing the space or joint between the first and second bone segments and putting the resulting implant structure into compression, as FIG. 35B shows.

3. Radial Compression

(Split Implant Structure)

An alternative embodiment of an implant structure 82 is shown in FIGS. 36A and 36B. In use, the implant structure 82 is sized and configured to be implanted in adjoining bone segments, which are separated by a space or joint, for the purpose of bone fixation or joint fusion, as already described. The implant structure 82 is sized and configured to be placed into radial compression.

The implant structure 82 includes a body that can possess a circular or curvilinear cross section, as previously described. As before described, the implant structure 82 can be formed—e.g., by machining, molding, or extrusion—from a durable material usable in the prosthetic arts that is not subject to significant bio-absorption or resorption by surrounding bone or tissue over time.

The implant structure 82 includes one or more exterior bony in-growth or through-growth regions, as previously described.

Unlike previously described implant structures, the proximal end of the implant structure 82 includes an axial region of weakness comprising a split 84. Further included is a self-tapping screw 16. The screw 16 includes a tapered threaded body. The tapered body forms a wedge of increasing diameter in the direction toward the head of the screw 16. The screw 16 is self-tapping, being sized and configured to be progressively advanced when rotated into the split 84, while creating its own thread, as FIG. 36B shows.

Prior to introduction of the implant structure 84, a broached bore is formed through the bone segments in the manner previously described, and as shown in FIGS. 8A to 8D. The implant structure 84 is introduced into the broached bore, as FIG. 36A shows. The implant structure is desirably sized and configured to be securely affixed within the broached bore in the most distal bone segment where the broached bore terminates, e.g., by making an interference fit and/or otherwise being secured by the use of adhesives. The interference fit and/or adhesives anchor the overall implant structure 84.

After introduction of the implant structure 84 into the broached bore, the self-tapping screw 16 (desirably with a washer 18) is progressively advanced by rotation into the split 84. The wedge-shape of the threaded body of the screw 16 progressively urges the body of the implant structure 84 to expand axially outward along the split 84, as FIG. 36B shows. The expansion of the diameter of the body of the implant structure 82 about the split 84 presses the proximal end of the implant structure 82 into intimate contact against adjacent bone. The radial expansion of the body of the implant structure 82 about the split 84 radially compresses the proximal end of the implant structure 82 against bone. The radial compression assures intimate contact between the bony in-growth region and bone within the broached bore, as well as resists both rotational and axial migration of the implant structure 82 within the bone segments.

F. Implant Structures without Compression

It should be appreciated that an elongated, stem-like, implant structure 20 having a bony in-growth and/or through-growth region, like that shown in FIG. 2, can be sized and configured for the fixation of bone fractures (i.e., fixation of parts of the same bone) or for the fixation of bones which are to be fused (arthrodesed) throughout the body without association with a compression stem assembly 10 as just described, or without other means for achieving compression of the implant structure as just described. The configuration and use of representative elongated, stem-like, implant structures 20 having bony in-growth and/or through-growth regions 24 for the fixation of bone fractures (i.e., fixation of parts of the same bone) or for the fixation of bones which are to be fused, without association with a compression stem assembly 10, are described, e.g., in U.S. patent application Ser. No. 11/136,141, filed on May 24, 2005, titled “SYSTEMS AND METHODS FOR THE FIXATION OR FUSION OF BONE,” now U.S. Pat. No. 7,922,765 B2, which is incorporated herein by reference.

II. Arthrodesis of the Sacroiliac Joint Using the Implant Structures

Elongated, stem-like implant structures 20 like that shown in FIG. 2 (and the alternative embodiments) make possible the fixation of the SI-Joint (shown in anterior and posterior views, respectively, in FIGS. 9 and 10) in a minimally invasive manner, with or without association with a compression stem assembly 10. These implant structures 20 can be effectively implanted through the use of two alternative surgical approaches; namely, (i) a Lateral Approach, or (ii) a Postero-Lateral Approach. Either procedure is desirably aided by conventional lateral and/or anterior-posterior (A-P) visualization techniques, e.g., using X-ray image intensifiers such as a C-arms or fluoroscopes to produce a live image feed which is displayed on a TV screen.

A. The Lateral Approach

1. Without Association of a Compression Stem Assembly

In one embodiment of a lateral approach (see FIGS. 11, 12, and 13A/B), one or more implant structures 20 are introduced (without use of a compression stem assembly 10) laterally through the ilium, the SI-Joint, and into the sacrum S1. This path and resulting placement of the implant structures 20 are best shown in FIGS. 12 and 13A/B. In the illustrated embodiment, three implant structures 20 are placed in this manner. Also in the illustrated embodiment, the implant structures 20 are triangular in cross section, but it should be appreciated that implant structures 20 of other cross sections as previously described can be used.

Before undertaking a lateral implantation procedure, the physician identifies the SI-Joint segments that are to be fixated or fused (arthrodesed) using, e.g., the Faber Test, or CT-guided injection, or X-ray/MRI of SI Joint.

Aided by lateral and anterior-posterior (A-P) c-arms, and with the patient lying in a prone position (on their stomach), the physician aligns the greater sciatic notches (using lateral visualization) to provide a true lateral position. A 3 cm incision is made starting aligned with the posterior cortex of the sacral canal, followed by blood-tissue separation to the ilium. From the lateral view, the guide pin 38 (with sleeve) (e.g., a Steinmann Pin) is started resting on the ilium at a position inferior to the sacrum S1 end plate and just anterior to the sacral canal. In A-P and lateral views, the guide pin 38 should be parallel to the S1 end plate at a shallow angle anterior (e.g., 15.degree. to 20.degree. off horizontal, as FIG. 13A shows). In a lateral view, the guide pin 38 should be posterior to the sacrum anterior wall. In the A-P view, the guide pin 38 should be superior to the S1 inferior foramen and lateral of mid-line. This corresponds generally to the sequence shown diagrammatically in FIGS. 8A and 8B. A soft tissue protector (not shown) is desirably slipped over the guide pin 38 and firmly against the ilium before removing the guide pin 38 sleeve.

Over the guide pin 38 (and through the soft tissue protector), the pilot bore 42 is drilled in the manner previously described, as is diagrammatically shown in FIG. 8C. The pilot bore 42 extends through the ilium, through the SI-Joint, and into the S1. The drill bit 40 is removed.

The shaped broach 44 is tapped into the pilot bore 42 over the guide pin 38 (and through the soft tissue protector) to create a broached bore 48 with the desired profile for the implant structure 20, which, in the illustrated embodiment, is triangular. This generally corresponds to the sequence shown diagrammatically in FIG. 8D. The triangular profile of the broached bore 48 is also shown in FIG. 11.

As shown in FIGS. 11 and 12, a triangular implant structure 20 can be now tapped (in this embodiment, without an associated compression sleeve assembly) through the soft tissue protector over the guide pin 38 through the ilium, across the SI-Joint, and into the S1, until the proximal end of the implant structure 20 is flush against the lateral wall of the ilium (see also FIGS. 13A and 13B). The guide pin 38 and soft tissue protector are withdrawn, leaving the implant structure 20 residing in the broached passageway, flush with the lateral wall of the ilium (see FIGS. 13A and 13B). In the illustrated embodiment, two additional implant structures 20 are implanted in this manner, as FIG. 12 best shows.

The implant structures 20 are sized according to the local anatomy. For the SI-Joint, representative implant structures 20 can range in size, depending upon the local anatomy, from about 35 mm to about 55 mm in length, and about 7 mm diameter. The morphology of the local structures can be generally understood by medical professionals using textbooks of human skeletal anatomy along with their knowledge of the site and its disease or injury. The physician is also able to ascertain the dimensions of the implant structure 20 based upon prior analysis of the morphology of the targeted bone using, for example, plain film x-ray, fluoroscopic x-ray, or MRI or CT scanning.

2. With Association of a Compression Stem Assembly

As shown in FIGS. 14 to 16A/B, the lateral approach also lends itself to the introduction of one or more implant structures 20 in association with compression stem assemblies 10, as previously described, laterally through the ilium, the SI-Joint, and into the sacrum S1. This path and resulting placement of the implant structures are best shown in FIGS. 16A and 16B. As in the embodiment shown in FIGS. 11 to 13A/B, three implant structures 20 are placed in this manner. Also, as in the embodiment shown in FIGS. 11 to 13A/B, the implant structures are triangular in cross section, but it still should be appreciated that implant structures having other cross sections, as previously described, can be used. In this embodiment of the lateral approach, the implant structure 20 is not inserted immediately following the formation of the broached bore 48. Instead, components of the compression stem assembly 10 are installed first in the broached bore 48 to receive the implant structure 20.

More particularly, following formation of the broached bore 48, as previously described, the guide pin 38 is removed, while keeping the soft tissue protector in place. The anchor screw 14 of the compression stem assembly 10 is seated in bone in the sacrum S beyond the terminus of the broached bore 48, in the manner generally shown in FIGS. 8E to 8G. In this arrangement, to accommodate placement of the anchor screw 14 of the compression stem assembly 10, an extent of bone in the sacrum S1 is left native and undrilled beyond the terminus of the pilot bore 42 and broached bore 48. The anchor screw 14 is advanced and buried in this extent of native and undrilled bone in the sacrum S1, as FIGS. 16A and 16B show, to be coupled to the threaded distal end 28 of the anchor body 12.

The threaded proximal end 28 of the anchor body 12 is threaded into and mated to the anchor screw 14 within the sacrum S1, as previously described and as shown in FIG. 8H, with the remainder of the anchor body 12 extending proximally through the SI-Joint and ilium, to project an exposed distance outside the lateral wall of the ilium, as FIGS. 16A and 16B show. The implant structure 20 is then placed by sliding it over the anchor body 12, until flush against the lateral wall of the ilium, as previously described and as shown in FIG. 8. The anchor washer 18 and nut are then installed and tightened on the proximal end of the anchor body 12, as previously described and shown in FIGS. 8J to 8L, putting the assembly into compression. The resulting assembly is shown in FIGS. 15 and 16A/B.

As shown in FIGS. 14 and 15, three compression stem assemblies 10 can be installed by lateral approach across the SI-Joint. As individual compression stem assemblies are placed into compression by tightening the anchor nut 16, the implant structures of neighboring compression stem assemblies may advance to project slightly beyond the lateral wall of the ilium. If this occurs, the projecting implant structures 20 can be gently tapped further into the ilium over their respective anchor pins 12.

B. The Postero-Lateral Approach

1. Without Association of a Compression Stem Assembly

As shown in FIGS. 17 to 19A/B, one or more implant structures can be introduced (without use of a compression stem assembly 10) in a postero-lateral approach entering from the posterior iliac spine of the ilium, angling through the SI-Joint, and terminating in the sacral alae. This path and resulting placement of the implant structures 20 are best shown in FIGS. 18 and 19A/B. In the illustrated embodiment, three implant structures 20 are placed in this manner. Also in the illustrated embodiment, the implant structures 20 are triangular in cross section, but it should be appreciated that implant structures 20 of other cross sections as previously described can be used.

The postero-lateral approach involves less soft tissue disruption that the lateral approach, because there is less soft tissue overlying the entry point of the posterior iliac spine of the ilium. Introduction of the implant structure 20 from this region therefore makes possible a smaller, more mobile incision. Further, the implant structure 20 passes through more bone along the postero-lateral route than in a strictly lateral route, thereby involving more surface area of the SI-Joint and resulting in more fusion and better fixation of the SI-Joint. Employing the postero-lateral approach also makes it possible to bypass all nerve roots, including the L5 nerve root.

The set-up for a postero-lateral approach is generally the same as for a lateral approach. It desirably involves the identification of the SI-Joint segments that are to be fixated or fused (arthrodesed) using, e.g., the Faber Test, or CT-guided injection, or X-ray/MRI of SI Joint. It is desirable performed with the patient lying in a prone position (on their stomach) and is aided by lateral and anterior-posterior (A-P) c-arms. The same surgical tools are used to form the pilot bore 42 over a guide pin 38, except the path of the pilot bore 42 now starts from the posterior iliac spine of the ilium, angles through the SI-Joint, and terminates in the sacral alae. The pilot bore 42 is shaped into the desired profile using a broach, as before described (shown in FIG. 17), and the implant structure 20 is inserted into the broached bore 48 the manner shown in FIGS. 18 and 19A/B. The triangular implant structure 20 is tapped (in this embodiment, without an associated compression sleeve assembly 10) through the soft tissue protector over the guide pin 38 from the posterior iliac spine of the ilium, angling through the SI-Joint, and terminating in the sacral alae, until the proximal end of the implant structure 20 is flush against the posterior iliac spine of the ilium, as FIG. 18 shows. As shown in FIGS. 17 to 19A/B, three implant structures 20 are introduced in this manner. Because of the anatomic morphology of the bone along the postero-lateral route, it may be advisable to introduce implant structures of difference sizes, with the most superior being the longest in length, and the others being smaller in length.

2. With Association of a Compression Stem Assembly

As shown in FIGS. 20 to 22A/B, the postero-lateral approach also lends itself to the introduction of one or more implant structures 20 in association with compression stem assemblies 10, as previously described, entering from the posterior iliac spine of the ilium, angling through the SI-Joint, and advancing into the sacral alae. This path and resulting placement of the implant structures 20 with compression stem assemblies 10 are best shown in FIGS. 22A/B. As in the embodiment shown in FIGS. 17 to 19A/B, three implant structures 20 are placed in this-manner. Also, as in the embodiment shown in FIGS. 17 to 19A/B, the implant structures 20 are triangular in cross section, but it still should be appreciated that implant structures 20 of other cross sections as previously described can be used. In this embodiment of the posterior-lateral approach, the implant structure 20 is not inserted immediately following the formation of the broached bore 48. Instead, components of the compression stem assembly 10 are installed in the broached bore 48 first to receive the implant structure 20, as have been previously described as is shown in FIG. 20.

As before explained, the set-up for a postero-lateral approach is generally the same as for a lateral approach. It is desirable performed with the patient lying in a prone position (on their stomach) and is aided by lateral and anterior-posterior (A-P) c-arms. The same surgical tools are used to form the pilot bore 42 over a guide pin 38 that starts from the posterior iliac spine of the ilium, angles through the SI-Joint, and terminates in the sacral alae. The pilot bore 42 is shaped into the desired profile using a broach 44, as before described (and as shown in FIG. 20). In this arrangement, to accommodate placement of the anchor screw 14 of the compression stem assembly 10, an extent of bone in the sacral alae is left native and undrilled beyond the terminus of the formed pilot bore 42 and broached bore 48. The anchor screw 14 is advanced and buried in this extent of native and undrilled bone in the sacral alae, as FIGS. 22A/B show, to be coupled to the threaded distal end 28 of the anchor body 12. Due to the morphology of the sacral alae, the anchor screw 14 may be shorter than it would be if buried in the sacrum S1 by the lateral approach.

The threaded proximal end 28 of the anchor body 12 is threaded into and mated to the anchor screw 14 within the sacral alae, as previously described and as shown in FIG. 8H, with the remainder of the anchor body 12 extending proximally through the SI-Joint to project an exposed distance outside the superior iliac spine of the ilium, as FIGS. 21 to 22A/B show. The implant structure 20 is then placed by sliding it over the anchor body 12, until flush against the superior iliac spine of the ilium, as previously described and as shown in FIG. 8I. The anchor washer 18 and nut are then installed and tightened on the proximal end of the anchor body 12, as previously described and shown in FIGS. 8J to 8L, putting the assembly 10 into compression. The resulting assembly 10 is shown in FIGS. 21 and 22A/B.

As shown in FIGS. 20 and 21, three compression stem assemblies 10 can be installed by postero-lateral approach across the SI-Joint. As before explained, as individual compression stem assemblies 10 are placed into compression by tightening the anchor nut 16, the implant structures 20 of neighboring compression stem assemblies 10 may advance to project slightly beyond the superior iliac spine of the ilium. If this occurs, the projecting implant structures 20 can be gently tapped further into the superior iliac spine of the ilium over their respective anchor bodies 12.

C. Conclusion

Using either a posterior approach or a postero-lateral approach, one or more implant structures 20 can be individually inserted in a minimally invasive fashion, with or without association of compression stem assemblies 10, or combinations thereof, across the SI-Joint, as has been described. Conventional tissue access tools, obturators, cannulas, and/or drills can be used for this purpose. No joint preparation, removal of cartilage, or scraping are required before formation of the insertion path or insertion of the implant structures 20, so a minimally invasive insertion path sized approximately at or about the maximum outer diameter of the implant structures 20 need be formed.

The implant structures 20, with or without association of compression stem assemblies 10, obviate the need for autologous bone graft material, additional pedicle screws and/or rods, hollow modular anchorage screws, cannulated compression screws, threaded cages within the joint, or fracture fixation screws.

In a representative procedure, one to six, or perhaps eight, implant structures 20 might be needed, depending on the size of the patient and the size of the implant structures 20. After installation, the patient would be advised to prevent loading of the SI-Joint while fusion occurs. This could be a six to twelve week period or more, depending on the health of the patient and his or her adherence to post-op protocol.

The implant structures 20 make possible surgical techniques that are less invasive than traditional open surgery with no extensive soft tissue stripping. The lateral approach and the postero-lateral approach to the SI-Joint provide straightforward surgical approaches that complement the minimally invasive surgical techniques. The profile and design of the implant structures 20 minimize rotation and micromotion. Rigid implant structures 20 made from titanium provide immediate post-op SI Joint stability. A bony in-growth region 24 comprising a porous plasma spray coating with irregular surface supports stable bone fixation/fusion. The implant structures 20 and surgical approaches make possible the placement of larger fusion surface areas designed to maximize post-surgical weight bearing capacity and provide a biomechanically rigorous implant designed specifically to stabilize the heavily loaded SI-Joint.

III. Arthrodesis of the Sacroiliac Joint Using Other Structures

The Lateral Approach and the Postero-Lateral Approach to the SI-Joint, aided by conventional lateral and/or anterior-posterior (A-P) visualization techniques, make possible the fixation of the SI-Joint in a minimally invasive manner using other forms of fixation/fusion structures. Either approach makes possible minimal incision size, with minimal soft tissue stripping, minimal tendon irritation, less pain, reduced risk of infection and complications, and minimal blood loss.

For example (see FIGS. 23 and 24A/B, one or more screw-like structures 52, e.g., a hollow modular anchorage screw, or a cannulated compression screw, or a fracture fixation screw, can be introduced using the lateral approach described herein, being placed laterally through the ilium, the SI-Joint, and into the sacrum S1. This path and resulting placement of the screw-like structures 52 are shown in FIGS. 23 and 24A/B. Desirably, the screw-like structure carry a bony in-growth material or a bony through-growth configuration, as described, as well as being sized and configured to resist rotation after implantation.

Likewise, one or more of the screw-like structures 52 can be introduced using the postero-lateral approach described herein, entering from the posterior iliac spine of the ilium, angling through the SI-Joint, and terminating in the sacral alae. This path and resulting placement of the screw-like structure are shown in FIGS. 25 and 26A/B. Desirably, the screw-like structures 52 carry a bony in-growth material or a bony through-growth configuration, as described, as well as being sized and configured to resist rotation after implantation, as before described.

As another example, one or more fusion cage structures 54 containing bone graft material can be introduced using the lateral approach described herein, being placed laterally through the ilium, the SI-Joint, and into the sacrum S1. This path and resulting placement of the fusion cage structures 54 are shown in FIGS. 27 and 28A/B. Such a structure 54 may include an anchor screw component 56, to be seated in the sacrum S1, as shown in FIGS. 27 and 28A/B.

Likewise, one or more of the fusion cage structures 54 can be introduced using the postero-lateral approach described herein, entering from the posterior iliac spine of the ilium, angling through the SI-Joint, and terminating in the sacral alae. This path and resulting placement of the fusion cage structures 54 are shown in FIGS. 29 and 30A/B. Such a structure 54 may include an anchor screw component 56, to be seated in the sacral alae, as shown in FIGS. 27 and 28A/B.

IV. Conclusion

The foregoing is considered as illustrative only of the principles of the invention. Furthermore, since numerous modifications and changes will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation shown and described. While the preferred embodiment has been described, the details may be changed without departing from the invention, which is defined by the claims.

Part II

The following describes embodiments of the implant for the fusion or fixation of other joints or bone segments.

I. The Implant Structure

FIG. 40 shows a representative embodiment of an elongated, stem-like, cannulated implant structure 20. As will be described in greater detail later, the implant structure 20 is sized and configured for the fixation of bones which are to be fused (arthrodesed) (i.e. fixation of two or more individual bones that are adjacent and/or jointed) and/or the stabilization of adjacent bone structures. In particular, and as will be demonstrated, the implant structure is well suited for the fusion or stabilization of adjacent bone structures in the lumbar region of the spine, either across the intervertebral disc or across one or more facet joints.

Alternatively, the implant structure 20 may be formed from a suitable durable biologic material or a combination of metal and biologic material, such as a biocompatible bone-filling material. The implant structure 20 may be molded from a flowable biologic material, e.g., acrylic bone cement, that is cured, e.g., by UV light, to a non-flowable or solid material.

As FIGS. 41 to 44 show, the implant structure 20 can take various shapes and have various cross-sectional geometries. The implant structure 20 can have, e.g., a generally curvilinear (i.e., round or oval) cross-section—as FIG. 41 shows for purposes of illustration—or a generally rectilinear cross section (i.e., square or rectangular or hexagon or H-shaped or triangular—as FIG. 42 shows for purposes of illustration—or combinations thereof. In FIG. 40, the implant structure 20 is shown to be triangular in cross section, which effectively resists rotation and micromotion once implanted.

As FIGS. 43 and 44 show, the implant structure 20, whether curvilinear (FIG. 43) or rectilinear (FIG. 44) can include a tapered region 34 at least along a portion of its axial length, meaning that the width or diameter of the implant structure 20 incrementally increases along its axial length. Desirably, the tapered region 34 corresponds with, in use, the proximal region of the implant structure 20 (i.e., the last part of the implant structure 20 to enter bone). The amount of the incremental increase in width or diameter can vary. As an example, for an implant structure 20 having a normal diameter of 7 mm, the magnitude of the incremental increase at its maximum can range between about 0.25 mm to 1.25 mm. The tapered region 34 enhances the creation and maintenance of compression between bone segments or regions.

As FIG. 40 shows, the implant structure 20 includes a region 24 formed along at least a portion of its length to promote bony in-growth onto or into surface of the structure and/or bony growth entirely through all or a portion of the structure. The bony in-growth or through-growth region 24 along the surface of the implant structure 20 accelerates bony in-growth or through-growth onto, into, or through the implant structure 20. Bony in-growth or through-growth onto, into, or through the implant structure 20 helps speed up the fusion process of the adjacent bone regions fixated by the implant structure 20.

The bony in-growth or through-growth region 24 desirably extends along the entire outer surface of the implant structure 20, as shown in FIGS. 40 to 44. The bony in-growth region 24 or through-growth can comprise, e.g., through holes, and/or various surface patterns, and/or various surface textures, and/or pores, or combinations thereof. The configuration of the bony in-growth or through-growth region 24 can, of course, vary. By way of examples, the bony in-growth or through-growth region 24 can comprise an open mesh configuration; or beaded configuration; or a trabecular configuration; or include holes or fenestrations. Any configuration conducive to bony in-growth and/or bony through-growth will suffice.

The bony in-growth or through-growth region 24 can be coated or wrapped or surfaced treated to provide the bony in-growth or through-growth region, or it can be formed from a material that itself inherently possesses a structure conducive to bony in-growth or through-growth, such as a porous mesh, hydroxyapetite, or other porous surface. The bony in-growth or through-growth region can includes holes that allow bone to grow throughout the region.

The implant structure includes an interior bore that accommodates its placement in a non-invasive manner by sliding over a guide pin, as will be described in greater detail later.

As before stated, the implant structure 20 is well suited for the fusion and/or stabilization of adjacent bone structures in the lumbar region of the spine. Representative examples of the placement of the implant structure 20 in the lumbar region of the spine will now be described.

A. Use of the Implant Structures to Achieve Anterior Lumbar Interbody Fusion

FIG. 45 shows, in an exploded view prior to implantation, a representative configuration of an assembly of one or more implant structures 20 sized and configured to achieve anterior lumbar interbody fusion, in a non-invasive manner and without removal of the intervertebral disc. FIGS. 46 to 48 show the assembly after implantation, respectively, in an anterior view, a right lateral view, and a superior left lateral perspective view.

In the representative embodiment illustrated in FIGS. 46 to 48, the assembly comprises three implant structures 20. It should be appreciated, however, that a given assembly can include a greater or lesser number of implant structures 20.

In the representative embodiment shown in FIGS. 46 to 48, the three implant structures 20 are spaced in an adjacent lateral array. The implant structures 20 extend from an anterolateral region of a selected vertebral body (i.e., a lateral region anterior to a transverse process), across the intervertebral disc into an opposite anterolateral region of an adjacent caudal (inferior) vertebra. As shown in FIGS. 46 to 48, the array of implant structures 20 extends in an angled path (e.g., about 20.degree. to about 40.degree. off horizontal) through the cranial (superior) lumbar vertebral body (shown as L4) in an inferior direction, through the adjoining intervertebral disc, and terminates in the next adjacent caudal (inferior) lumbar vertebral body (shown as L5).

More particularly, in the representative embodiment shown in FIGS. 45 to 48, the implant structures 20 enter the right anterolateral region of vertebra L4 and terminate within the left anterolateral interior of vertebra L5, spanning the intervertebral disc between L4 and L5.

Alternatively, or in combination, an array of implant structures 20 can likewise extend between L5 and S1 in the same trans-disc formation.

The implant structures 20 are sized according to the local anatomy. The implant structures 20 can be sized differently, e.g., 3 mm, 4 mm, 6 mm, etc.), to accommodate anterolateral variations in the anatomy. The implant structures 20 can be sized for implantation in adults or children.

The intimate contact created between the bony in-growth or through-growth region 24 along the surface of the implant structure 20 accelerates bony in-growth or through-growth onto, into, or through the implant structure 20, to accelerate trans-disc fusion between these lumbar vertebrae.

FIGS. 49A to 49G diagrammatically show, for purposes of illustration, a representative lateral (or posterolateral) procedure for implanting the assembly of implant structures 20 shown in FIGS. 46 to 48.

The physician identifies the vertebrae of the lumbar spine region that are to be fused using, e.g., the Faber Test, or CT-guided injection, or X-ray/MRI of the lumbar spine. Aided by lateral and anterior-posterior (A-P) c-arms, and with the patient lying in a prone position (on their stomach), the physician makes a 3 mm incision laterally or posterolaterally from the side (see FIG. 49A). Aided by conventional visualization techniques, e.g., using X-ray image intensifiers such as a C-arms or fluoroscopes to produce a live image feed which is displayed on a TV screen, a guide pin 38 is introduced by conventional means into L4 (see FIG. 49B) for the first, most anterolateral implant structure (closest to the right transverse process of L4), in the desired angled inferiorly-directed path through the intervertebral disc and into the interior left anterolateral region of vertebra L5.

When the guide pin 38 is placed in the desired orientation, the physician desirable slides a soft tissue protector over the guide pin 38 before proceeding further. To simplify the illustration, the soft tissue protector is not shown in the drawings.

Through the soft tissue protector, a cannulated drill bit 40 is next passed over the guide pin 38 (see FIG. 49C). The cannulated drill bit 40 forms a pilot insertion path or bore 42 along the first angled path defined by the guide pin 38. A single drill bit or multiple drill bits 40 can be employed to drill through bone fragments or bone surfaces to create a pilot bore 42 of the desired size and configuration.

When the pilot bore 42 is completed, the cannulated drill bit 40 is withdrawn over the guide pin 38.

Through the soft tissue protector, a broach 44 having the external geometry and dimensions matching the external geometry and dimensions of the implant structure 20 (which, in the illustrated embodiment, is triangular) (see FIG. 49D) is tapped through the soft tissue protector over the guide pin 38 and into the pilot bore 42. The shaped broach 44 cuts along the edges of the pilot bore 42 to form the desired profile (which, in the illustrated embodiment, is triangular) to accommodate the implant structure 20.

The broach 44 is withdrawn (see FIG. 49E), and the first, most anterolateral implant structure 20 is passed over the guide pin 38 through the soft tissue protector into the broached bore 48. The guide pin 38 and soft tissue protector are withdrawn from the first implant structure 20.

The physician repeats the above-described procedure sequentially for the next anterolateral implant structures 20: for each implant structure, inserting the guide pin 38, forming the pilot bore, forming the broached bore, inserting the respective implant structure, withdrawing the guide pin, and then repeating the procedure for the next implant structure, and so on until all implant structures 20 are placed (as FIGS. 49F and 49G indicate). The incision site(s) are closed.

In summary, the method for implanting the assembly of the implant structures 20 comprises (i) identifying the bone structures to be fused and/or stabilized; (ii) opening an incision; (iii) using a guide pin to established a desired implantation path through bone for the implant structure 20; (iv) guided by the guide pin, increasing the cross section of the path; (v) guided by the guide pin, shaping the cross section of the path to correspond with the cross section of the implant structure 20; (vi) inserting the implant structure 20 through the path over the guide pin; (vii) withdrawing the guide pin; (viii) repeating, as necessary, the procedure sequentially for the next implant structure(s) until all implant structures 20 contemplated are implanted; and (ix) closing the incision.

As FIGS. 50 and 51 show, assemblies comprising one or more implant structures 20 can be inserted from left and/or right anterolateral regions of a given lumbar vertebra, in an angled path through the intervertebral disc and into an opposite anterolateral interior region of the next inferior lumbar vertebra.

For purposes of illustration, FIG. 50 shows two implant structures 20 entering on the right anterolateral side of L4, through the intervertebral disc and into the left anterolateral region of L5, and one implant structure 20 entering on the left anterolateral side of L4, through the intervertebral disc and into the right anterolateral region of L5. In this arrangement, the left and right implant structures 20 cross each other in transit through the intervertebral disc.

As another illustration of a representative embodiment, FIG. 51 shows one implant structure 20 entering on the right anterolateral side of L4, through the intervertebral disc and into the left anterolateral region of L5, and one implant structure 20 entering on the left anterolateral side of L4, through the intervertebral disc and into the right anterolateral region of L5. In this arrangement as well, the left and right implant structures 20 cross each other in transit through the intervertebral disc.

B. Use of Implant Structures to Achieve Translaminal Lumbar Fusion (Posterior Approach)

FIG. 52 shows, in an exploded view prior to implantation, a representative configuration of an assembly of one or more implant structures 20 sized and configured to achieve translaminar lumbar fusion in a non-invasive manner and without removal of the intervertebral disc. FIG. 53 shows the assembly after implantation, respectively, in an inferior transverse plane view.

As can be seen in the representative embodiment illustrated in FIGS. 52 and 53, the assembly comprises two implant structures 20. The first implant structure 20 extends from the left superior articular process of vertebra L5, through the adjoining facet capsule into the left inferior articular process of vertebra L4, and, from there, further through the lamina of vertebra L4 into an interior right posterolateral region of vertebra L4 adjacent the spinous process. The second implant structure 20 extends from the right superior articular process of vertebra L5, through the adjoining facet capsule into the right inferior articular process of vertebra L4, and, from there, further through the lamina of vertebra L4 into an interior left posterolateral region of vertebra L4 adjacent the spinous process. The first and second implant structures 20 cross each other within the medial lamina of vertebra L4.

The first and second implant structures 20 are sized and configured according to the local anatomy. The selection of a translaminar lumbar fusion (posterior approach) is indicated when the facet joints are aligned with the sagittal plane. Removal of the intervertebral disc is not required, unless the condition of the disc warrants its removal.

A procedure incorporating the technical features of the procedure shown in FIGS. 49A to 49G can be tailored to a posterior procedure for implanting the assembly of implant structures 20 shown in FIGS. 52 and 53. The method comprises (i) identifying the vertebrae of the lumbar spine region that are to be fused; (ii) opening an incision, which comprises, e.g., with the patient lying in a prone position (on their stomach), making a 3 mm posterior incision; and (iii) using a guide pin to established a desired implantation path through bone for the first (e.g., left side) implant structure 20, which, in FIGS. 52 and 53, traverses through the left superior articular process of vertebra L5, through the adjoining facet capsule into the left inferior articular process of vertebra L4, and then through the lamina of vertebra L4 into an interior right posterolateral region of vertebra L4 adjacent the spinous process. The method further includes (iv) guided by the guide pin, increasing the cross section of the path; (v) guided by the guide pin, shaping the cross section of the path to correspond with the cross section of the implant structure; (vi) inserting the implant structure 20 through the path over the guide pin; (vii) withdrawing the guide pin; and (viii) using a guide pin to established a desired implantation path through bone for the second (e.g., right side) implant structure 20, which, in FIGS. 52 and 53, traverses through the right superior articular process of vertebra L5, through the adjoining facet capsule into the right inferior articular process of vertebra L4, and through the lamina of vertebra L4 into an interior left posterolateral region of vertebra L4 adjacent the spinous process. The physician repeats the remainder of the above-described procedure sequentially for the right implant structure 20 as for the left, and, after withdrawing the guide pin, closes the incision.

The intimate contact created between the bony in-growth or through-growth region 24 along the surface of the implant structure 20 across the facet joint accelerates bony in-growth or through-growth onto, into, or through the implant structure 20, to accelerate fusion of the facets joints between L4 and L5. Of course, translaminar lumbar fusion between L5 and S1 can be achieved using first and second implant structures in the same manner.

C. Use of Implant Structures to Achieve Lumbar Facet Fusion (Posterior Approach)

FIG. 54 shows, in an exploded view prior to implantation, a representative configuration of an assembly of one or more implant structures 20 sized and configured to lumbar facet fusion, in a non-invasive manner and without removal of the intervertebral disc. FIGS. 55 and 56 show the assembly after implantation, respectively, in an inferior transverse plane view and a lateral view.

As can be seen in the representative embodiment illustrated in FIGS. 54 and 56, the assembly comprises two implant structures 20. The first implant structure 20 extends from the left inferior articular process of vertebra L4, through the adjoining facet capsule into the left superior articular process of vertebra L5 and into the pedicle of vertebra L5. The second implant structure 20 extends from the right inferior articular process of vertebra L5, through the adjoining facet capsule into the right superior articular process of vertebra L5 and into the pedicle of vertebra L5. In this arrangement, the first and second implant structures 20 extend in parallel directions on the left and right pedicles of vertebra L5. The first and second implant structures 20 are sized and configured according to the local anatomy. The selection of lumbar facet fusion (posterior approach) is indicated when the facet joints are coronally angled. Removal of the intervertebral disc is not necessary, unless the condition of the disc warrants its removal.

A procedure incorporating the technical features of the procedure shown in FIGS. 49A to 49G can be tailored to a posterior procedure for implanting the assembly of implant structures 20 shown in FIGS. 54 to 56. The method comprises (i) identifying the vertebrae of the lumbar spine region that are to be fused; (ii) opening an incision, which comprises, e.g., with the patient lying in a prone position (on their stomach), making a 3 mm posterior incision; and (iii) using a guide pin to established a desired implantation path through bone for the first (e.g., left side) implant structure 20, which, in FIGS. 54 to 56, traverses through the left inferior articular process of vertebra L4, through the adjoining facet capsule into the left superior articular process of vertebra L5 and into the pedicle of vertebra L5. The method further includes (iv) guided by the guide pin, increasing the cross section of the path; (v) guided by the guide pin, shaping the cross section of the path to correspond with the cross section of the implant structure 20; (vi) inserting the implant structure 20 through the path over the guide pin; (vii) withdrawing the guide pin; and (viii) using a guide pin to established a desired implantation path through bone for the second (e.g., right side) implant structure 20, which, in FIGS. 54 to 56, traverses through the right inferior articular process of vertebra L5, through the adjoining facet capsule into the right superior articular process of vertebra L5 and into the pedicle of vertebra L5. The physician repeats the remainder of the above-described procedure sequentially for the right implant structure 20 as for the left and, withdrawing the guide pin, closes the incision.

Of course, translaminar lumbar fusion between L5 and S1 can be achieved using first and second implant structures in the same manner.

D. Use of Implant Structures to Achieve Trans-Iliac Lumbar Fusion (Anterior Approach)

FIG. 57A shows, in an exploded view prior to implantation, a representative configuration of an assembly of one or more implant structures 20 sized and configured to achieve fusion between lumbar vertebra L5 and sacral vertebra S1, in a non-invasive manner and without removal of the intervertebral disc. FIG. 57B shows the assembly after implantation.

In the representative embodiment illustrated in FIGS. 57A and 57B, the assembly comprises two implant structures 20. It should be appreciated, however, that a given assembly can include a greater or lesser number of implant structures 20.

As FIGS. 57A and 57B show, the assembly comprises two implant structures 20 inserted from left and right anterolateral regions of lumbar vertebra L5, in an angled path (e.g., about 20.degree. to about 40.degree. off horizontal) through the intervertebral disc in an inferior direction, into and through opposite anterolateral interior regions of sacral vertebra S1, through the sacro-iliac joint, and terminating in the ilium. In this arrangement, the left and right implant structures 20 cross each other in transit through the intervertebral disc. As before described, the implant structures 20 are sized according to the local anatomy.

A physician can employ the lateral (or posterolateral) procedure as generally shown in FIGS. 49A to 49G for implanting the assembly of implant structures 20 shown in FIGS. 57A and 57B, including forming a pilot bore over a guide pin inserted in the angled path, forming a broached bore, inserting the right implant 20 structure, withdrawing the guide pin, and repeating for the left implant structure 20, or vice versa. The incision site(s) are closed.

The assembly as described makes possible the achievement of trans-iliac lumbar fusion using an anterior in a non-invasive manner, with minimal incision, and without necessarily removing the intervertebral disc between L5 and S1.

E. Use of Implant Structures to Achieve Trans-Iliac Lumbar Fusion (Postero-Lateral Approach from Posterior Iliac Spine)

FIG. 58A shows, in an exploded view prior to implantation, another representative configuration of an assembly of one or more implant structures 20 sized and configured to achieve fusion between lumbar vertebra L5 and sacral vertebra S1, in a non-invasive manner and without removal of the intervertebral disc. FIGS. 58B and 58C show the assembly after implantation.

As FIGS. 58A and 58B show, the one or more implant structures are introduced in a postero-lateral approach entering from the posterior iliac spine of the ilium, angling through the SI-Joint into and through the sacral vertebra S1, and terminating in the lumbar vertebra L5. This path and resulting placement of the implant structures 20 are also shown in FIG. 58C. In the illustrated embodiment, two implant structures 20 are placed in this manner, but there can be more or fewer implant structures 20. Also in the illustrated embodiment, the implant structures 20 are triangular in cross section, but it should be appreciated that implant structures 20 of other cross sections as previously described can be used.

The set-up for a postero-lateral approach is generally the same as for a lateral approach. It desirably involves the identification of the lumbar region that is to be fixated or fused (arthrodesed) using, e.g., the Faber Test, or CT-guided injection, or X-ray/MRI of SI Joint. It is desirable performed with the patient lying in a prone position (on their stomach) and is aided by lateral and anterior-posterior (A-P) c-arms. The same surgical tools are used to form the pilot bore over a guide pin (e.g., on the right side), except the path of the pilot bore now starts from the posterior iliac spine of the ilium, angles through the SI-Joint, and terminates in the lumbar vertebra L5. The broached bore is formed, and the right implant 20 structure is inserted. The guide pin is withdrawn, and the procedure is repeated for the left implant structure 20, or vice versa. The incision site(s) are closed.

The assembly as described makes possible the achievement of trans-iliac lumbar fusion using a postero-lateral approach in a non-invasive manner, with minimal incision, and without necessarily removing the intervertebral disc between L5 and S1.

F. Use of Implant Structures to Stabilize a Spondylolisthesis

FIG. 59 shows a spondylolisthesis at the L5/S1 articulation, in which the lumbar vertebra L5 is displaced forward (anterior) of the sacral vertebra S1. As FIG. 59 shows, the posterior fragment of L5 remains in normal relation to the sacrum, but the anterior fragment and the L5 vertebral body has moved anteriorly. Spondylolisthesis at the L5/S1 articulation can result in pressure in the spinal nerves of the cauda equine as they pass into the superior part of the sacrum, causing back and lower limb pain.

FIG. 60A shows, in an exploded view prior to implantation, a representative configuration of an assembly of one or more implant structures 20 sized and configured to stabilize the spondylolisthesis at the L5/S1 articulation. FIGS. 60B and 60C show the assembly after implantation.

As shown, the implant structure 20 extends from a posterolateral region of the sacral vertebra S1, across the intervertebral disc into an opposite anterolateral region of the lumbar vertebra L5. The implant structure 20 extends in an angled path (e.g., about 20.degree. to about 40.degree. off horizontal) through the sacral vertebra S1 in a superior direction, through the adjoining intervertebral disc, and terminates in the lumbar vertebra L5.

A physician can employ a posterior approach for implanting the implant structure 20 shown in FIGS. 60A, 60B, and 60C, which includes forming a pilot bore over a guide pin inserted in the angled path from the posterior of the sacral vertebra S1 through the intervertebral disc and into an opposite anterolateral region of the lumbar vertebra L5, forming a broached bore, inserting the implant structure 20, and withdrawing the guide pin. The incision site is then closed. As previously described, more than one implant structure 20 can be placed in the same manner to stabilize a spondylolisthesis. Furthermore, a physician can fixate the implant structure(s) 20 using the anterior trans-iliac lumbar path, as shown in FIG. 57A/B or 58A/B/C.

The physician can, if desired, combine stabilization of the spondylolisthesis, as shown in FIGS. 60A/B/C, with a reduction, realigning L5 and S-1. The physician can also, if desired, combine stabilization of the spondylolisthesis, as shown in FIGS. 60 A/B/C (with or without reduction of the spondylolisthesis), with a lumbar facet fusion, as shown in FIGS. 54 to 56. The physician can also, if desired, combine stabilization of the spondylolisthesis, as shown in FIGS. 60A/B/C, with a decompression, e.g., by the posterior removal of the spinous process and laminae bilaterally.

II. Conclusion

The various representative embodiments of the assemblies of the implant structures 20, as described, make possible the achievement of diverse interventions involving the fusion and/or stabilization of lumbar and sacral vertebra in a non-invasive manner, with minimal incision, and without the necessitating the removing the intervertebral disc. The representative lumbar spine interventions described can be performed on adults or children and include, but are not limited to, lumbar interbody fusion; translaminar lumbar fusion; lumbar facet fusion; trans-iliac lumbar fusion; and the stabilization of a spondylolisthesis. It should be appreciated that such interventions can be used in combination with each other and in combination with conventional fusion/fixation techniques to achieve the desired therapeutic objectives.

Significantly, the various assemblies of the implant structures 20 as described make possible lumbar interbody fusion without the necessity of removing the intervertebral disc. For example, in conventional anterior lumbar interbody fusion procedures, the removal of the intervertebral disc is a prerequisite of the procedure. However, when using the assemblies as described to achieve anterior lumbar interbody fusion, whether or not the intervertebral disc is removed depends upon the condition of the disc, and is not a prerequisite of the procedure itself. If the disc is healthy and has not appreciably degenerated, one or more implant structures 20 can be individually inserted in a minimally invasive fashion, across the intervertebral disc in the lumbar spine area, leaving the disc intact.

In all the representative interventions described, the removal of a disc, or the scraping of a disc, is at the physician's discretion, based upon the condition of the disc itself, and is not dictated by the procedure.

The bony in-growth or through-growth regions 24 of the implant structures 20 described provide both extra-articular and intra osseous fixation, when bone grows in and around the bony in-growth or through-growth regions 24.

Conventional tissue access tools, obturators, cannulas, and/or drills can be used during their implantation. No disc preparation, removal of bone or cartilage, or scraping are required before and during formation of the insertion path or insertion of the implant structures 20, so a minimally invasive insertion path sized approximately at or about the maximum outer diameter of the implant structures 20 need be formed. Still, the implant structures 20, which include the elongated bony in-growth or through-growth regions 24, significantly increase the size of the fusion area, from the relatively small surface area of a given joint between adjacent bones, to the surface area provided by an elongated bony in-growth or through-growth regions 24. The implant structures 20 can thereby increase the surface area involved in the fusion and/or stabilization by 3-fold to 4-fold, depending upon the joint involved.

The implant structures 20 can obviate the need for autologous grafts, bone graft material, additional pedicle screws and/or rods, hollow modular anchorage screws, cannulated compression screws, cages, or fixation screws. Still, in the physician's discretion, bone graft material and other fixation instrumentation can be used in combination with the implant structures 20.

The implant structures 20 make possible surgical techniques that are less invasive than traditional open surgery with no extensive soft tissue stripping and no disc removal. The assemblies make possible straightforward surgical approaches that complement the minimally invasive surgical techniques. The profile and design of the implant structures 20 minimize rotation and micro-motion. Rigid implant structures 20 made from titanium provide immediate post-op fusion stability. A bony in-growth region 24 comprising a porous plasma spray coating with irregular surface supports stable bone fixation/fusion. The implant structures 20 and surgical approaches make possible the placement of larger fusion surface areas designed to maximize post-surgical weight bearing capacity and provide a biomechanically rigorous implant designed specifically to stabilize the heavily loaded lumbar spine.

Claims

1. An orthopedic implant configured for fusing a bone joint, the implant comprising: an elongated bone fixation/fusion implant body having a central longitudinal axis extending along a direction of elongation of the implant body, and a cross-sectional profile transverse to the central longitudinal axis and defined by a plurality of longitudinal apices that extend along the implant body parallel to the central longitudinal axis, the implant body having an overall length in the direction of elongation that is at least 3.6 times a maximum width of the implant body in a direction transverse to the direction of elongation, wherein the elongated implant body is provided with a central lumen extending therethrough and adapted to receive a guide pin to assist in the placement of the implant within the bone segments, the implant body being sized and configured to be inserted in a direction of the central longitudinal axis, first through a first bone segment, then transversely across a joint region and then at least partially into a second bone segment, the implant being configured to be left in place in the bone segments postoperatively.
2. The implant of claim 1, wherein the cross-sectional profile of the elongated implant body is defined by exactly three longitudinal apices.
3. The implant of claim 1, wherein the elongated implant body is provided with a porous surface configured to be conducive to bony in-growth.
4. The implant of claim 1, wherein the elongated implant body is coated with hydroxyapatite to be conducive to bony in-growth.
5. The implant of claim 1, wherein the implant body has an overall length in the direction of elongation that is no greater than about 6.7 times the maximum width of the implant body in the direction transverse to the direction of elongation.
6. The implant of claim 5, wherein the central lumen has a nominal inside diameter that is no more than about 30% of the maximum width of the implant body in the direction transverse to the direction of elongation.
7. An implant system comprising: the implant of claim 6; anda guide pin being configured to be inserted first through the first bone segment, then transversely across the joint region, and then at least partially into the second bone segment without preparing a path for the guide pin through the bone segments first, the guide pin having a nominal outside diameter that is the same as the nominal inside diameter of the central lumen such that a close sliding fit is achieved when the implant is placed over the guide pin.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 15/952,102, filed Apr. 12, 2018, now abandoned, which is a continuation of U.S. patent application Ser. No. 15/195,955, filed Jun. 28, 2016, now U.S. Pat. No. 9,949,843, titled “APPARATUS, SYSTEMS, AND METHODS FOR THE FIXATION OR FUSION OF BONE”, which is a continuation-in-part of U.S. patent application Ser. No. 13/858,814, filed Apr. 8, 2013, titled “APPARATUS, SYSTEMS, AND METHODS FOR ACHIEVING TRANS-ILIAC LUMBAR FUSION,” now U.S. Pat. No. 9,375,323, which is a continuation of U.S. patent application Ser. No. 12/960,831, filed Dec. 6, 2010, titled “APPARATUS, SYSTEMS, AND METHODS FOR ACHIEVING TRANS-ILIAC LUMBAR FUSION,” now U.S. Pat. No. 8,414,648, which is a continuation-in-part of U.S. patent application Ser. No. 11/136,141, filed May 24, 2005, titled “SYSTEMS AND METHODS FOR THE FIXATION OR FUSION OF BONE,” now U.S. Pat. No. 7,922,765, which is a continuation-in-part of U.S. patent application Ser. No. 10/914,629, filed Aug. 9, 2004, titled “SYSTEMS AND METHODS FOR THE FIXATION OR FUSION OF BONE,” U.S. Patent Publication No. 2006-003625-A1, now abandoned. U.S. patent application Ser. No. 15/952,102, filed Apr. 12, 2018, is a continuation of U.S. patent application Ser. No. 15/195,955, filed Jun. 28, 2016, titled “APPARATUS, SYSTEMS, AND METHODS FOR THE FIXATION OR FUSION OF BONE”, now U.S. Pat. No. 9,949,843, which is also a continuation-in-part of U.S. patent application Ser. No. 14/274,486, filed May 9, 2014, now U.S. Pat. No. 9,486,264, which is a continuation of U.S. patent application Ser. No. 13/786,037, filed Mar. 5, 2013, titled “SYSTEMS AND METHODS FOR THE FIXATION OR FUSION OF BONE USING COMPRESSIVE IMPLANTS,” now U.S. Pat. No. 8,734,462, which is a continuation of U.S. patent application Ser. No. 12/924,784, filed Oct. 5, 2010, titled “SYSTEMS AND METHODS FOR THE FIXATION OR FUSION OF BONE USING COMPRESSIVE IMPLANTS,” now U.S. Pat. No. 8,388,667, which is a continuation-in-part of U.S. patent application Ser. No. 11/136,141, filed May 24, 2005, titled “SYSTEMS AND METHODS FOR THE FIXATION OR FUSION OF BONE,” now U.S. Pat. No. 7,922,765 B2, each of which are herein incorporated by reference in their entirety.

US Referenced Citations (721)

Number	Name	Date	Kind
1951278	Ericsson	Mar 1934	A
2136471	Schneider	Nov 1938	A
2243717	Moreira	May 1941	A
2414882	Longfellow	Jul 1947	A
2562419	Ferris	Jul 1951	A
2675801	Bambara et al.	Apr 1954	A
2697433	Zehnder	Dec 1954	A
3076453	Tronzo	Feb 1963	A
3506982	Steffee	Apr 1970	A
3694821	Moritz	Oct 1972	A
3709218	Halloran	Jan 1973	A
3744488	Cox	Jul 1973	A
4059115	Jumashev et al.	Nov 1977	A
4156943	Collier	Jun 1979	A
4197645	Scheicher	Apr 1980	A
4292964	Ulrich	Oct 1981	A
4341206	Perrett et al.	Jul 1982	A
4344190	Lee et al.	Aug 1982	A
4399813	Barber	Aug 1983	A
4423721	Otte et al.	Jan 1984	A
4475545	Ender	Oct 1984	A
4501269	Bagby	Feb 1985	A
4569338	Edwards	Feb 1986	A
4612918	Slocum	Sep 1986	A
4622959	Marcus	Nov 1986	A
4630601	Harder	Dec 1986	A
4638799	Moore	Jan 1987	A
4657550	Daher	Apr 1987	A
4743256	Brantigan	May 1988	A
4773402	Asher et al.	Sep 1988	A
4787378	Sodhi	Nov 1988	A
4790303	Steffee	Dec 1988	A
4834757	Brantigan	May 1989	A
4846162	Moehring	Jul 1989	A
4877019	Vives	Oct 1989	A
4878915	Brantigan	Nov 1989	A
4898186	Ikada et al.	Feb 1990	A
4904261	Dove et al.	Feb 1990	A
4950270	Bowman et al.	Aug 1990	A
4961740	Ray et al.	Oct 1990	A
4969888	Scholten et al.	Nov 1990	A
4981481	Kranz et al.	Jan 1991	A
5034011	Howland	Jul 1991	A
5034013	Kyle et al.	Jul 1991	A
5035697	Frigg	Jul 1991	A
5041118	Wasilewski	Aug 1991	A
5053035	McLaren	Oct 1991	A
5059193	Kuslich	Oct 1991	A
5066296	Chapman et al.	Nov 1991	A
5098434	Serbousek	Mar 1992	A
5102414	Kirsch	Apr 1992	A
5108397	White	Apr 1992	A
5122141	Simpson et al.	Jun 1992	A
5139498	Astudillo Ley	Aug 1992	A
5139500	Schwartz	Aug 1992	A
5147367	Ellis	Sep 1992	A
5147402	Bohler et al.	Sep 1992	A
5190551	Chin et al.	Mar 1993	A
5197961	Castle	Mar 1993	A
5242444	MacMillan	Sep 1993	A
5298254	Prewett et al.	Mar 1994	A
5334205	Cain	Aug 1994	A
5380325	Lahille et al.	Jan 1995	A
5390683	Pisharodi	Feb 1995	A
5433718	Brinker	Jul 1995	A
5443466	Shah	Aug 1995	A
5458638	Kuslich et al.	Oct 1995	A
5470334	Ross et al.	Nov 1995	A
5480402	Kim	Jan 1996	A
5569249	James et al.	Oct 1996	A
5591235	Kuslich	Jan 1997	A
5593409	Michelson	Jan 1997	A
5607424	Tropiano	Mar 1997	A
5609635	Michelson	Mar 1997	A
5609636	Kohrs et al.	Mar 1997	A
5626616	Speece	May 1997	A
5643264	Sherman et al.	Jul 1997	A
5645599	Samani	Jul 1997	A
5658337	Kohrs et al.	Aug 1997	A
5667510	Combs	Sep 1997	A
5669909	Zdeblick et al.	Sep 1997	A
5672178	Petersen	Sep 1997	A
5683391	Boyd	Nov 1997	A
5709683	Bagby	Jan 1998	A
5713904	Errico et al.	Feb 1998	A
5716358	Ochoa et al.	Feb 1998	A
5725581	Brånemark	Mar 1998	A
5743912	LaHille et al.	Apr 1998	A
5759035	Ricci	Jun 1998	A
5766174	Perry	Jun 1998	A
5766252	Henry et al.	Jun 1998	A
5766261	Neal et al.	Jun 1998	A
5788699	Bobst et al.	Aug 1998	A
5800440	Stead	Sep 1998	A
5868749	Reed	Feb 1999	A
5897556	Drewry et al.	Apr 1999	A
5928239	Mirza	Jul 1999	A
5941885	Jackson	Aug 1999	A
5961522	Mehdizadeh	Oct 1999	A
5961554	Janson et al.	Oct 1999	A
6010507	Rudloff	Jan 2000	A
6015409	Jackson	Jan 2000	A
6030162	Huebner et al.	Feb 2000	A
6053916	Moore	Apr 2000	A
6056749	Kuslich	May 2000	A
6066175	Henderson et al.	May 2000	A
6086589	Kuslich et al.	Jul 2000	A
6096080	Nicholson et al.	Aug 2000	A
6120292	Buser et al.	Sep 2000	A
6120504	Brumback et al.	Sep 2000	A
6143031	Knothe et al.	Nov 2000	A
6197062	Fenlin	Mar 2001	B1
6206924	Timm	Mar 2001	B1
6210442	Wing et al.	Apr 2001	B1
6214049	Gayer et al.	Apr 2001	B1
6221074	Cole et al.	Apr 2001	B1
6224607	Michelson	May 2001	B1
6241732	Overaker et al.	Jun 2001	B1
6264657	Urbahns et al.	Jul 2001	B1
6270528	McKay	Aug 2001	B1
6287343	Kuslich et al.	Sep 2001	B1
6302885	Essiger	Oct 2001	B1
6302914	Michelson	Oct 2001	B1
6306140	Siddiqui	Oct 2001	B1
6319253	Ackeret et al.	Nov 2001	B1
6406498	Tormala et al.	Jun 2002	B1
6409768	Tepic et al.	Jun 2002	B1
6451020	Zucherman et al.	Sep 2002	B1
6471707	Miller et al.	Oct 2002	B1
6485518	Cornwall et al.	Nov 2002	B1
6497707	Bowman et al.	Dec 2002	B1
6517541	Sesic	Feb 2003	B1
6520969	Lambrecht et al.	Feb 2003	B2
6524314	Dean et al.	Feb 2003	B1
6527775	Warburton	Mar 2003	B1
6556857	Estes et al.	Apr 2003	B1
6558386	Cragg	May 2003	B1
6565566	Wagner et al.	May 2003	B1
6575899	Foley et al.	Jun 2003	B1
6575991	Chesbrough et al.	Jun 2003	B1
6579293	Chandran	Jun 2003	B1
6582431	Ray	Jun 2003	B1
6582467	Teitelbaum et al.	Jun 2003	B1
6595998	Johnson et al.	Jul 2003	B2
6602293	Biermann et al.	Aug 2003	B1
6605090	Trieu et al.	Aug 2003	B1
6607530	Carl et al.	Aug 2003	B1
6620163	Michelson	Sep 2003	B1
6635059	Randall et al.	Oct 2003	B2
6666868	Fallin	Dec 2003	B2
6669529	Scaries	Dec 2003	B1
6673075	Santilli	Jan 2004	B2
6692501	Michelson	Feb 2004	B2
6712852	Chung et al.	Mar 2004	B1
6723099	Goshert	Apr 2004	B1
6723100	Biedermann et al.	Apr 2004	B2
6740118	Eisermann et al.	May 2004	B2
6743257	Castro	Jun 2004	B2
D493533	Blain	Jul 2004	S
6793656	Mathews	Sep 2004	B1
6827740	Michelson	Dec 2004	B1
6984235	Huebner	Jan 2006	B2
6989033	Schmidt	Jan 2006	B1
6991461	Gittleman	Jan 2006	B2
6993406	Cesarano et al.	Jan 2006	B1
7018416	Hanson et al.	Mar 2006	B2
7118579	Michelson	Oct 2006	B2
7147666	Grisoni	Dec 2006	B1
7175663	Stone	Feb 2007	B1
7211085	Michelson	May 2007	B2
7223269	Chappuis	May 2007	B2
7314488	Reiley	Jan 2008	B2
7335205	Aeschlimann et al.	Feb 2008	B2
7338500	Chappuis	Mar 2008	B2
7396365	Michelson	Jul 2008	B2
7452359	Michelson	Nov 2008	B1
7452369	Barry	Nov 2008	B2
7481831	Bonutti	Jan 2009	B2
7527649	Blain	May 2009	B1
7534254	Michelson	May 2009	B1
7537616	Branch et al.	May 2009	B1
7569054	Michelson	Aug 2009	B2
7569059	Cerundolo	Aug 2009	B2
7601155	Petersen	Oct 2009	B2
7608097	Kyle	Oct 2009	B2
7648509	Stark	Jan 2010	B2
7686805	Michelson	Mar 2010	B2
7699852	Frankel et al.	Apr 2010	B2
7708761	Petersen	May 2010	B2
7727235	Contiliano et al.	Jun 2010	B2
7758646	Khandkar et al.	Jul 2010	B2
7780704	Markworth et al.	Aug 2010	B2
7846162	Nelson et al.	Dec 2010	B2
7850732	Heinz	Dec 2010	B2
7857832	Culbert et al.	Dec 2010	B2
7887565	Michelson	Feb 2011	B2
7892265	Perez-Cruet et al.	Feb 2011	B2
7901439	Horton	Mar 2011	B2
7909832	Michelson	Mar 2011	B2
7922765	Reiley	Apr 2011	B2
7942879	Christie et al.	May 2011	B2
8052728	Hestad	Nov 2011	B2
8062365	Schwab	Nov 2011	B2
8066705	Michelson	Nov 2011	B2
8066709	Michelson	Nov 2011	B2
8092505	Sommers	Jan 2012	B2
8142481	Warnick	Mar 2012	B2
8202305	Reiley	Jun 2012	B2
8221499	Lazzara et al.	Jul 2012	B2
8268099	O'Neill et al.	Sep 2012	B2
8308779	Reiley	Nov 2012	B2
8308783	Morris et al.	Nov 2012	B2
8317862	Troger et al.	Nov 2012	B2
8348950	Assell et al.	Jan 2013	B2
8350186	Jones et al.	Jan 2013	B2
8388667	Reiley et al.	Mar 2013	B2
8394129	Morgenstern Lopez	Mar 2013	B2
8398635	Vaidya	Mar 2013	B2
8414648	Reiley	Apr 2013	B2
8425570	Reiley	Apr 2013	B2
8430930	Hunt	Apr 2013	B2
8444693	Reiley	May 2013	B2
8449585	Wallenstein et al.	May 2013	B2
8467851	Mire et al.	Jun 2013	B2
8470004	Reiley	Jun 2013	B2
8475505	Nebosky et al.	Jul 2013	B2
8529608	Terrill et al.	Sep 2013	B2
8608802	Bagga et al.	Dec 2013	B2
D697209	Walthall et al.	Jan 2014	S
8641737	Matthis et al.	Feb 2014	B2
8663332	To et al.	Mar 2014	B1
8672986	Klaue et al.	Mar 2014	B2
8734462	Reiley et al.	May 2014	B2
8778026	Mauldin	Jul 2014	B2
8840623	Reiley	Sep 2014	B2
8840651	Reiley	Sep 2014	B2
8845693	Smith et al.	Sep 2014	B2
8858601	Reiley	Oct 2014	B2
8920477	Reiley	Dec 2014	B2
8945190	Culbert et al.	Feb 2015	B2
8945193	Kirschman	Feb 2015	B2
8951254	Mayer et al.	Feb 2015	B2
8951293	Glazer et al.	Feb 2015	B2
8951295	Matityahu et al.	Feb 2015	B2
8961571	Lee et al.	Feb 2015	B2
8979911	Martineau et al.	Mar 2015	B2
8986348	Reiley	Mar 2015	B2
RE45484	Foley et al.	Apr 2015	E
9039743	Reiley	May 2015	B2
9044321	Mauldin et al.	Jun 2015	B2
9060876	To et al.	Jun 2015	B1
9089371	Faulhaber	Jul 2015	B1
D738498	Frey et al.	Sep 2015	S
9131955	Swofford	Sep 2015	B2
9149286	Greenhalgh et al.	Oct 2015	B1
9198676	Pilgeram et al.	Dec 2015	B2
9220535	Röbling et al.	Dec 2015	B2
9314348	Emstad	Apr 2016	B2
9358057	Whipple et al.	Jun 2016	B1
9375243	Vestgaarden	Jun 2016	B1
9375323	Reiley	Jun 2016	B2
9445852	Sweeney	Sep 2016	B2
9451999	Simpson et al.	Sep 2016	B2
9452065	Lawson	Sep 2016	B1
9486264	Reiley et al.	Nov 2016	B2
9492201	Reiley	Nov 2016	B2
9498264	Harshman et al.	Nov 2016	B2
9510872	Donner et al.	Dec 2016	B2
9517095	Vaidya	Dec 2016	B2
9526543	Asfora	Dec 2016	B2
9554909	Donner	Jan 2017	B2
9561063	Reiley	Feb 2017	B2
9566100	Asfora	Feb 2017	B2
9603613	Schoenefeld et al.	Mar 2017	B2
9603644	Sweeney	Mar 2017	B2
9615856	Arnett et al.	Apr 2017	B2
9622783	Reiley et al.	Apr 2017	B2
9655656	Whipple	May 2017	B2
9662124	Assell et al.	May 2017	B2
9662128	Reiley	May 2017	B2
9662157	Schneider et al.	May 2017	B2
9662158	Reiley	May 2017	B2
9675394	Reiley	Jun 2017	B2
9743969	Reiley	Aug 2017	B2
9757154	Donner et al.	Sep 2017	B2
9763695	Mirda	Sep 2017	B2
9820789	Reiley	Nov 2017	B2
9839448	Reckling et al.	Dec 2017	B2
9848892	Biedermann et al.	Dec 2017	B2
9936983	Mesiwala et al.	Apr 2018	B2
9949776	Mobasser et al.	Apr 2018	B2
9949843	Reiley et al.	Apr 2018	B2
9956013	Reiley et al.	May 2018	B2
9993276	Russell	Jun 2018	B2
10004547	Reiley	Jun 2018	B2
10058430	Donner et al.	Aug 2018	B2
10166033	Reiley et al.	Jan 2019	B2
10194962	Schneider et al.	Feb 2019	B2
10201427	Mauldin et al.	Feb 2019	B2
10219885	Mamo et al.	Mar 2019	B2
10258380	Sinha	Apr 2019	B2
10271882	Biedermann et al.	Apr 2019	B2
10335217	Lindner	Jul 2019	B2
10363140	Mauldin et al.	Jul 2019	B2
10426533	Mauldin et al.	Oct 2019	B2
10492921	McShane, III et al.	Dec 2019	B2
10531904	Kolb	Jan 2020	B2
10653454	Frey et al.	May 2020	B2
10729475	Childs	Aug 2020	B2
10743995	Fallin et al.	Aug 2020	B2
10758283	Frey et al.	Sep 2020	B2
10799367	Vrionis et al.	Oct 2020	B2
10806597	Sournac et al.	Oct 2020	B2
10842634	Pasini et al.	Nov 2020	B2
10932838	Mehl et al.	Mar 2021	B2
20010012942	Estes et al.	Aug 2001	A1
20010046518	Sawhney	Nov 2001	A1
20010047207	Michelson	Nov 2001	A1
20010049529	Cachia et al.	Dec 2001	A1
20020019637	Frey et al.	Feb 2002	A1
20020029043	Ahrens et al.	Mar 2002	A1
20020038123	Visotsky et al.	Mar 2002	A1
20020049497	Mason	Apr 2002	A1
20020077641	Michelson	Jun 2002	A1
20020082598	Teitelbaum	Jun 2002	A1
20020120275	Schmieding et al.	Aug 2002	A1
20020120335	Angelucci et al.	Aug 2002	A1
20020128652	Ferree	Sep 2002	A1
20020143334	von Hoffmann et al.	Oct 2002	A1
20020143335	von Hoffmann et al.	Oct 2002	A1
20020151903	Takei et al.	Oct 2002	A1
20020169507	Malone	Nov 2002	A1
20020183858	Contiliano et al.	Dec 2002	A1
20020198527	Mückter	Dec 2002	A1
20030018336	Vandewalle	Jan 2003	A1
20030032961	Pelo et al.	Feb 2003	A1
20030050642	Schmieding et al.	Mar 2003	A1
20030065332	TenHuisen et al.	Apr 2003	A1
20030074000	Roth et al.	Apr 2003	A1
20030078660	Clifford et al.	Apr 2003	A1
20030083668	Rogers et al.	May 2003	A1
20030083688	Simonson	May 2003	A1
20030088251	Braun et al.	May 2003	A1
20030097131	Schon et al.	May 2003	A1
20030139815	Grooms et al.	Jul 2003	A1
20030181979	Ferree	Sep 2003	A1
20030181982	Kuslich	Sep 2003	A1
20030199983	Michelson	Oct 2003	A1
20030229358	Errico et al.	Dec 2003	A1
20030233146	Grinberg et al.	Dec 2003	A1
20030233147	Nicholson et al.	Dec 2003	A1
20040010315	Song	Jan 2004	A1
20040024458	Senegas et al.	Feb 2004	A1
20040034422	Errico et al.	Feb 2004	A1
20040073216	Lieberman	Apr 2004	A1
20040073314	White et al.	Apr 2004	A1
20040082955	Zirkle	Apr 2004	A1
20040087948	Suddaby	May 2004	A1
20040097927	Yeung et al.	May 2004	A1
20040106925	Culbert	Jun 2004	A1
20040117022	Marnay et al.	Jun 2004	A1
20040127990	Bartish, Jr. et al.	Jul 2004	A1
20040138750	Mitchell	Jul 2004	A1
20040138753	Ferree	Jul 2004	A1
20040147929	Biedermann et al.	Jul 2004	A1
20040158324	Lange	Aug 2004	A1
20040176287	Harrison et al.	Sep 2004	A1
20040176853	Sennett et al.	Sep 2004	A1
20040181282	Zucherman et al.	Sep 2004	A1
20040186572	Lange et al.	Sep 2004	A1
20040210221	Kozak et al.	Oct 2004	A1
20040225360	Malone	Nov 2004	A1
20040230305	Gorensek et al.	Nov 2004	A1
20040260286	Ferree	Dec 2004	A1
20040267369	Lyons et al.	Dec 2004	A1
20050015059	Sweeney	Jan 2005	A1
20050015146	Louis et al.	Jan 2005	A1
20050033435	Belliard et al.	Feb 2005	A1
20050049590	Alleyne et al.	Mar 2005	A1
20050055023	Sohngen et al.	Mar 2005	A1
20050075641	Singhatat et al.	Apr 2005	A1
20050080415	Keyer et al.	Apr 2005	A1
20050107878	Conchy	May 2005	A1
20050112397	Rolfe et al.	May 2005	A1
20050113919	Cragg et al.	May 2005	A1
20050124993	Chappuis	Jun 2005	A1
20050131409	Chervitz et al.	Jun 2005	A1
20050137605	Assell et al.	Jun 2005	A1
20050143837	Ferree	Jun 2005	A1
20050149192	Zucherman et al.	Jul 2005	A1
20050159749	Levy et al.	Jul 2005	A1
20050159812	Dinger et al.	Jul 2005	A1
20050165398	Reiley	Jul 2005	A1
20050192572	Abdelgany et al.	Sep 2005	A1
20050216082	Wilson	Sep 2005	A1
20050228384	Zucherman et al.	Oct 2005	A1
20050246021	Ringeisen et al.	Nov 2005	A1
20050251146	Martz et al.	Nov 2005	A1
20050273101	Schumacher	Dec 2005	A1
20050277940	Neff	Dec 2005	A1
20060036247	Michelson	Feb 2006	A1
20060036251	Reiley	Feb 2006	A1
20060036252	Baynham et al.	Feb 2006	A1
20060054171	Dall	Mar 2006	A1
20060058793	Michelson	Mar 2006	A1
20060058800	Ainsworth et al.	Mar 2006	A1
20060062825	Maccecchini	Mar 2006	A1
20060084986	Grinberg et al.	Apr 2006	A1
20060089656	Allard et al.	Apr 2006	A1
20060111779	Petersen	May 2006	A1
20060129247	Brown et al.	Jun 2006	A1
20060142772	Ralph et al.	Jun 2006	A1
20060161163	Shino	Jul 2006	A1
20060178673	Curran	Aug 2006	A1
20060195094	McGraw et al.	Aug 2006	A1
20060217717	Whipple	Sep 2006	A1
20060241776	Brown et al.	Oct 2006	A1
20060271054	Sucec et al.	Nov 2006	A1
20060293662	Boyer, II et al.	Dec 2006	A1
20070027544	McCord et al.	Feb 2007	A1
20070038219	Matthis et al.	Feb 2007	A1
20070049933	Ahn et al.	Mar 2007	A1
20070066977	Assell et al.	Mar 2007	A1
20070083265	Malone	Apr 2007	A1
20070088362	Bonutti et al.	Apr 2007	A1
20070093841	Hoogland	Apr 2007	A1
20070093898	Schwab et al.	Apr 2007	A1
20070106383	Abdou	May 2007	A1
20070149976	Hale et al.	Jun 2007	A1
20070156144	Ulrich et al.	Jul 2007	A1
20070156241	Reiley et al.	Jul 2007	A1
20070156246	Meswania et al.	Jul 2007	A1
20070161989	Heinz et al.	Jul 2007	A1
20070173820	Trieu	Jul 2007	A1
20070219634	Greenhalgh et al.	Sep 2007	A1
20070233080	Na et al.	Oct 2007	A1
20070233146	Henniges et al.	Oct 2007	A1
20070233247	Schwab	Oct 2007	A1
20070250166	McKay	Oct 2007	A1
20070270879	Isaza et al.	Nov 2007	A1
20070282443	Globerman et al.	Dec 2007	A1
20080021454	Chao et al.	Jan 2008	A1
20080021455	Chao et al.	Jan 2008	A1
20080021456	Gupta et al.	Jan 2008	A1
20080021461	Barker et al.	Jan 2008	A1
20080021480	Chin et al.	Jan 2008	A1
20080065093	Assell et al.	Mar 2008	A1
20080065215	Reiley	Mar 2008	A1
20080071356	Greenhalgh et al.	Mar 2008	A1
20080109083	Van Hoeck et al.	May 2008	A1
20080125868	Branemark et al.	May 2008	A1
20080132901	Recoules-Arche et al.	Jun 2008	A1
20080140082	Erdem et al.	Jun 2008	A1
20080147079	Chin et al.	Jun 2008	A1
20080154374	Labrom	Jun 2008	A1
20080161810	Melkent	Jul 2008	A1
20080183204	Greenhalgh et al.	Jul 2008	A1
20080234758	Fisher et al.	Sep 2008	A1
20080255562	Gil et al.	Oct 2008	A1
20080255618	Fisher et al.	Oct 2008	A1
20080255622	Mickiewicz et al.	Oct 2008	A1
20080255664	Hogendijk et al.	Oct 2008	A1
20080255666	Fisher et al.	Oct 2008	A1
20080255667	Horton	Oct 2008	A1
20080275454	Geibel	Nov 2008	A1
20080294202	Peterson et al.	Nov 2008	A1
20080306554	McKinley	Dec 2008	A1
20090012529	Blain et al.	Jan 2009	A1
20090018660	Roush	Jan 2009	A1
20090024174	Stark	Jan 2009	A1
20090036927	Vestgaarden	Feb 2009	A1
20090037148	Lin et al.	Feb 2009	A1
20090043393	Duggal et al.	Feb 2009	A1
20090082810	Bhatnagar et al.	Mar 2009	A1
20090082869	Slemker et al.	Mar 2009	A1
20090099602	Aflatoon	Apr 2009	A1
20090099610	Johnson et al.	Apr 2009	A1
20090105770	Berrevooets et al.	Apr 2009	A1
20090118771	Gonzalez-Hernandez	May 2009	A1
20090131986	Lee et al.	May 2009	A1
20090138053	Assell et al.	May 2009	A1
20090157119	Hale	Jun 2009	A1
20090163920	Hochschuler et al.	Jun 2009	A1
20090187247	Metcalf, Jr. et al.	Jul 2009	A1
20090216238	Stark	Aug 2009	A1
20090270929	Suddaby	Oct 2009	A1
20090287254	Nayet et al.	Nov 2009	A1
20090312798	Varela	Dec 2009	A1
20090319043	McDevitt et al.	Dec 2009	A1
20090324678	Thorne et al.	Dec 2009	A1
20100003638	Collins et al.	Jan 2010	A1
20100022535	Lee et al.	Jan 2010	A1
20100076502	Guyer et al.	Mar 2010	A1
20100081107	Bagambisa et al.	Apr 2010	A1
20100094290	Vaidya	Apr 2010	A1
20100094295	Schnieders et al.	Apr 2010	A1
20100094420	Grohowski	Apr 2010	A1
20100106194	Bonutti et al.	Apr 2010	A1
20100106195	Serhan et al.	Apr 2010	A1
20100114174	Jones et al.	May 2010	A1
20100114317	Lambrecht et al.	May 2010	A1
20100131011	Stark	May 2010	A1
20100137990	Apatsidis et al.	Jun 2010	A1
20100145461	Landry et al.	Jun 2010	A1
20100160977	Gephart et al.	Jun 2010	A1
20100168798	Clineff et al.	Jul 2010	A1
20100191292	DeMeo et al.	Jul 2010	A1
20100262242	Chavatte et al.	Oct 2010	A1
20100268228	Petersen	Oct 2010	A1
20100280619	Yuan et al.	Nov 2010	A1
20100280622	McKinley	Nov 2010	A1
20100286778	Eisermann et al.	Nov 2010	A1
20100331851	Huene	Dec 2010	A1
20100331893	Geist et al.	Dec 2010	A1
20110009869	Marino et al.	Jan 2011	A1
20110022089	Assell et al.	Jan 2011	A1
20110029019	Ainsworth et al.	Feb 2011	A1
20110040362	Godara et al.	Feb 2011	A1
20110046737	Teisen	Feb 2011	A1
20110060373	Russell et al.	Mar 2011	A1
20110060375	Bonutti	Mar 2011	A1
20110066190	Schaller et al.	Mar 2011	A1
20110082551	Kraus	Apr 2011	A1
20110093020	Wu	Apr 2011	A1
20110098747	Donner et al.	Apr 2011	A1
20110098816	Jacob et al.	Apr 2011	A1
20110098817	Eckhardt et al.	Apr 2011	A1
20110106175	Rezach	May 2011	A1
20110153018	Walters et al.	Jun 2011	A1
20110160866	Laurence et al.	Jun 2011	A1
20110178561	Roh	Jul 2011	A1
20110184417	Kitch et al.	Jul 2011	A1
20110184518	Trieu	Jul 2011	A1
20110184519	Trieu	Jul 2011	A1
20110184520	Trieu	Jul 2011	A1
20110196372	Murase	Aug 2011	A1
20110230966	Trieu	Sep 2011	A1
20110238074	Ek	Sep 2011	A1
20110238124	Richelsoph	Sep 2011	A1
20110238181	Trieu	Sep 2011	A1
20110245930	Alley et al.	Oct 2011	A1
20110257755	Bellemere et al.	Oct 2011	A1
20110264229	Donner	Oct 2011	A1
20110276098	Biedermann et al.	Nov 2011	A1
20110295272	Assell et al.	Dec 2011	A1
20110295370	Suh et al.	Dec 2011	A1
20110313471	McLean et al.	Dec 2011	A1
20110313532	Hunt	Dec 2011	A1
20110319995	Voellmicke et al.	Dec 2011	A1
20120004730	Castro	Jan 2012	A1
20120083887	Purcell et al.	Apr 2012	A1
20120095560	Donner	Apr 2012	A1
20120179256	Reiley	Jul 2012	A1
20120191191	Trieu	Jul 2012	A1
20120226318	Wenger et al.	Sep 2012	A1
20120253398	Metcalf et al.	Oct 2012	A1
20120259372	Glazer et al.	Oct 2012	A1
20120271424	Crawford	Oct 2012	A1
20120277866	Kalluri et al.	Nov 2012	A1
20120296428	Donner	Nov 2012	A1
20120323285	Assell et al.	Dec 2012	A1
20130018427	Pham et al.	Jan 2013	A1
20130030456	Assell et al.	Jan 2013	A1
20130030529	Hunt	Jan 2013	A1
20130035727	Datta	Feb 2013	A1
20130053852	Greenhalgh et al.	Feb 2013	A1
20130053854	Schoenefeld et al.	Feb 2013	A1
20130053902	Trudeau	Feb 2013	A1
20130053963	Davenport	Feb 2013	A1
20130072984	Robinson	Mar 2013	A1
20130085535	Greenhalgh et al.	Apr 2013	A1
20130096683	Kube	Apr 2013	A1
20130116793	Kloss	May 2013	A1
20130123850	Schoenefeld et al.	May 2013	A1
20130123935	Hunt et al.	May 2013	A1
20130131678	Dahners	May 2013	A1
20130144343	Arnett et al.	Jun 2013	A1
20130158609	Mikhail et al.	Jun 2013	A1
20130172736	Abdou	Jul 2013	A1
20130197590	Assell et al.	Aug 2013	A1
20130203088	Baerlecken et al.	Aug 2013	A1
20130218215	Ginn et al.	Aug 2013	A1
20130218282	Hunt	Aug 2013	A1
20130231746	Ginn et al.	Sep 2013	A1
20130237988	Mauldin	Sep 2013	A1
20130245703	Warren et al.	Sep 2013	A1
20130245763	Mauldin	Sep 2013	A1
20130267836	Mauldin et al.	Oct 2013	A1
20130267961	Mauldin et al.	Oct 2013	A1
20130267989	Mauldin et al.	Oct 2013	A1
20130274890	McKay	Oct 2013	A1
20130325129	Huang	Dec 2013	A1
20140012334	Armstrong et al.	Jan 2014	A1
20140012340	Beck et al.	Jan 2014	A1
20140031934	Trieu	Jan 2014	A1
20140031935	Donner et al.	Jan 2014	A1
20140031938	Lechmann et al.	Jan 2014	A1
20140031939	Wolfe et al.	Jan 2014	A1
20140046380	Asfora	Feb 2014	A1
20140074175	Ehler et al.	Mar 2014	A1
20140088596	Assell et al.	Mar 2014	A1
20140088707	Donner et al.	Mar 2014	A1
20140121776	Hunt	May 2014	A1
20140135927	Pavlov et al.	May 2014	A1
20140142700	Donner et al.	May 2014	A1
20140172027	Biedermann et al.	Jun 2014	A1
20140200618	Donner et al.	Jul 2014	A1
20140207240	Stoffman et al.	Jul 2014	A1
20140257294	Gedet et al.	Sep 2014	A1
20140257408	Trieu et al.	Sep 2014	A1
20140276846	Mauldin et al.	Sep 2014	A1
20140276851	Schneider et al.	Sep 2014	A1
20140277139	Vrionis et al.	Sep 2014	A1
20140277165	Katzman et al.	Sep 2014	A1
20140277460	Schifano et al.	Sep 2014	A1
20140277462	Yerby et al.	Sep 2014	A1
20140277463	Yerby et al.	Sep 2014	A1
20140288649	Hunt	Sep 2014	A1
20140288650	Hunt	Sep 2014	A1
20140296982	Cheng	Oct 2014	A1
20140330382	Mauldin	Nov 2014	A1
20140364917	Sandstrom et al.	Dec 2014	A1
20150012051	Warren et al.	Jan 2015	A1
20150039037	Donner et al.	Feb 2015	A1
20150080951	Yeh	Mar 2015	A1
20150080972	Chin et al.	Mar 2015	A1
20150094765	Donner et al.	Apr 2015	A1
20150112444	Aksu	Apr 2015	A1
20150147397	Altschuler	May 2015	A1
20150150683	Donner et al.	Jun 2015	A1
20150173805	Donner et al.	Jun 2015	A1
20150173904	Stark	Jun 2015	A1
20150182268	Donner et al.	Jul 2015	A1
20150190149	Assell et al.	Jul 2015	A1
20150190187	Parent et al.	Jul 2015	A1
20150209094	Anderson	Jul 2015	A1
20150216566	Mikhail et al.	Aug 2015	A1
20150238203	Asfora	Aug 2015	A1
20150250513	De Lavigne Sainte	Sep 2015	A1
20150250611	Schifano et al.	Sep 2015	A1
20150250612	Schifano et al.	Sep 2015	A1
20150257892	Lechmann et al.	Sep 2015	A1
20150313720	Lorio	Nov 2015	A1
20150320450	Mootien et al.	Nov 2015	A1
20150320451	Mootien et al.	Nov 2015	A1
20150320469	Biedermann et al.	Nov 2015	A1
20150342753	Donner et al.	Dec 2015	A1
20160000488	Cross, III	Jan 2016	A1
20160022429	Greenhalgh et al.	Jan 2016	A1
20160095711	Castro	Apr 2016	A1
20160095721	Schell et al.	Apr 2016	A1
20160100870	Lavigne et al.	Apr 2016	A1
20160106477	Hynes et al.	Apr 2016	A1
20160106479	Hynes et al.	Apr 2016	A1
20160120661	Schell et al.	May 2016	A1
20160143671	Jimenez	May 2016	A1
20160016630	Papangelou et al.	Jun 2016	A1
20160157908	Cawley et al.	Jun 2016	A1
20160166301	Papangelou et al.	Jun 2016	A1
20160175113	Lins	Jun 2016	A1
20160184103	Fonte et al.	Jun 2016	A1
20160213487	Wilson et al.	Jul 2016	A1
20160242820	Whipple et al.	Aug 2016	A1
20160242912	Lindsey et al.	Aug 2016	A1
20160249940	Stark	Sep 2016	A1
20160287171	Sand et al.	Oct 2016	A1
20160287301	Mehl et al.	Oct 2016	A1
20160310188	Marino et al.	Oct 2016	A1
20160310197	Black et al.	Oct 2016	A1
20160324643	Donner et al.	Nov 2016	A1
20160324656	Morris et al.	Nov 2016	A1
20160374727	Greenhalgh et al.	Dec 2016	A1
20170014235	Jones et al.	Jan 2017	A1
20170020573	Cain et al.	Jan 2017	A1
20170020585	Harshman et al.	Jan 2017	A1
20170049488	Vestgaarden	Feb 2017	A1
20170086885	Duncan et al.	Mar 2017	A1
20170128083	Germain	May 2017	A1
20170128214	Mayer	May 2017	A1
20170135733	Donner et al.	May 2017	A1
20170135737	Krause	May 2017	A1
20170143513	Sandstrom et al.	May 2017	A1
20170156879	Janowski	Jun 2017	A1
20170156880	Halverson et al.	Jun 2017	A1
20170202511	Chang et al.	Jul 2017	A1
20170209155	Petersen	Jul 2017	A1
20170216036	Cordaro	Aug 2017	A1
20170224393	Lavigne et al.	Aug 2017	A1
20170246000	Pavlov et al.	Aug 2017	A1
20170258498	Redmond et al.	Sep 2017	A1
20170258506	Redmond et al.	Sep 2017	A1
20170258606	Afzal	Sep 2017	A1
20170266007	Gelaude et al.	Sep 2017	A1
20170296344	Souza et al.	Oct 2017	A1
20170303938	Rindal et al.	Oct 2017	A1
20170333205	Joly et al.	Nov 2017	A1
20180104071	Reckling et al.	Apr 2018	A1
20180177534	Mesiwala et al.	Jun 2018	A1
20180200063	Kahmer et al.	Jul 2018	A1
20180228617	Srour et al.	Aug 2018	A1
20180228621	Reiley et al.	Aug 2018	A1
20180368894	Wieland et al.	Dec 2018	A1
20190090888	Sand et al.	Mar 2019	A1
20190133613	Reiley et al.	May 2019	A1
20190133783	Unger et al.	May 2019	A1
20190142606	Freudenberger	May 2019	A1
20190159818	Schneider et al.	May 2019	A1
20190159901	Mauldin et al.	May 2019	A1
20190298528	Lindsey et al.	Oct 2019	A1
20190298542	Kloss	Oct 2019	A1
20190343640	Donner et al.	Nov 2019	A1
20190343641	Mauldin et al.	Nov 2019	A1
20190343653	McKay	Nov 2019	A1
20200000595	Jones et al.	Jan 2020	A1
20200008817	Reiley et al.	Jan 2020	A1
20200008850	Mauldin et al.	Jan 2020	A1
20200246158	Bergey	Aug 2020	A1
20200261240	Mesiwala et al.	Aug 2020	A1
20200268525	Mesiwala et al.	Aug 2020	A1
20220031474	Reckling et al.	Feb 2022	A1
20220151668	Mauldin et al.	May 2022	A1

Foreign Referenced Citations (58)

Number	Date	Country
1128944	Aug 1996	CN
1190882	Aug 1998	CN
1909848	Feb 2007	CN
101795632	Aug 2010	CN
102361601	Feb 2012	CN
102011001264	Sep 2012	DE
102012106336	Jan 2014	DE
1287796	Mar 2003	EP
2070481	Feb 2012	EP
2796104	Oct 2014	EP
2590576	Oct 2015	EP
274923881	Mar 2017	EP
2887899	Aug 2017	EP
2341852	Aug 2018	EP
2496162	Oct 2018	EP
3616634	Mar 2020	EP
2408389	Apr 2021	EP
59200642	Nov 1984	JP
05-176942	Jul 1993	JP
05184615	Jul 1993	JP
09149906	Oct 1997	JP
10-85231	Apr 1998	JP
11318931	Nov 1999	JP
2002509753	Apr 2002	JP
2003511198	Mar 2003	JP
2003533329	Nov 2003	JP
2003534046	Nov 2003	JP
2004121841	Apr 2004	JP
2004512895	Apr 2004	JP
2004516866	Jun 2004	JP
2006506181	Feb 2006	JP
2007535973	Dec 2007	JP
2008540036	Nov 2008	JP
2009521990	Jun 2009	JP
2009533159	Sep 2009	JP
2010137016	Jun 2010	JP
2015510506	Apr 2015	JP
WO9731517	Aug 1997	WO
WO0117445	Mar 2001	WO
WO0238054	May 2002	WO
WO03007839	Jan 2003	WO
WO0402344	Jan 2004	WO
WO2004043277	May 2004	WO
WO2005009729	Feb 2005	WO
WO2006003316	Jan 2006	WO
WO2006023793	Mar 2006	WO
WO2006074321	Jul 2006	WO
WO2009025884	Feb 2009	WO
WO2009029074	Mar 2009	WO
WO2010105196	Sep 2010	WO
WO2011010463	Jan 2011	WO
WO2011110865	Sep 2011	WO
WO2011124874	Oct 2011	WO
WO2011149557	Dec 2011	WO
WO2012015976	Feb 2012	WO
WO2013000071	Jan 2013	WO
WO2013119907	Aug 2013	WO
WO2017147537	Aug 2017	WO

Non-Patent Literature Citations (18)

Entry
Sand et al.; U.S. Appl. No. 17/447,550 entitled “Systems and methods for decorticating the sacroloac joint,” filed Sep. 13, 2021.
Mesiwala et al.; U.S. Appl. No. 17/217,794 entitled “Implants for spinal fization or fusion,” filed Mar. 30, 2021.
Reckling et al.; U.S. Appl. No. 17/116,903 entitled “Sacro-iliac joint stabilizing implants and methods of implantation,” filed Dec. 9, 2020.
Acumed; Acutrak Headless Compressioin Screw (product information); 12 pgs: © 2005; retrieved Sep. 25, 2014 from http://www.rcsed.ac.uk/fellows/lvanrensburg/classification/surgtech/acumed/manuals/acutrak-brochure%200311.pdf.
Al-Khayer et al.; Percutaneous sacroiliac joint arthrodesis, a novel technique; J Spinal Disord Tech; vol. 21; No. 5; pp. 359-363; Jul. 2008.
Khurana et al.; Percutaneous fusion of the sacroiliac joint with hollow modular anchorage screws, clinical and radiological outcome, J Bone Joint Surg; vol. 91-B; No. 5; pp. 627-631; May 2009.
Lu et al.; Mechanical properties of porous materials; Journal of Porous Materials; 6(4); pp. 359-368; Nov. 1, 1999.
Peretz et al.; The internal bony architecture of the sacrum; Spine; 23(9); pp. 971-974; May 1, 1998.
Richards et al.; Bone density and cortical thickness in normal, osteopenic, and osteoporotic sacra; Journal of Osteoporosis; 2010(ID 504078); 5 pgs; Jun. 9, 2010.
Wise et al.; Minimally invasive sacroiliac arthrodesis, outcomes of a new technique; J Spinal Disord Tech; vol. 21; No. 8; pp. 579-584; Dec. 2008.
Reiley; U.S. Appl. No. 16/930,174 entitled Apparatus, system, and methods for the fixation or fusion of bone,: filed Jul. 15, 2020.
Reiley; U.S. Appl. No. 16/932,001 entitled “Apparatus, systems, and methods for the fixation or fusion of bone,” filed Jul. 17, 2020.
Reiley; U.S. Appl. No. 16/933,108 entitled “Apparatus, systems, and methods for the fixation or fusion of bone,” filed Jul. 20, 2020.
Stuart et al.; U.S. Appl. No. 17/104,753 entitled “Bone stabilizing implants and methods of placement across SI joints,” filed Nov. 25, 2020.
Schneider et al.; U.S. Appl. No. 17/443,388 entitled “Matrix implant,” filed Jul. 26, 2021.
Mesiwala et al.; U.S. Appl. No. 17/649,265 entitled “Implants for spinal fixation and or fusion,” filed Jan. 28, 2022.
Mesiwala et al.; U.S. Appl. No. 17/649,296 entitled “Implants for spinal fixation and or fusion,” filed Jan. 28, 2022.
Mauldin et al.; U.S. Appl. No. 17/650,473 entitled “Fenestrated implant,” filed Feb. 9, 2022.

Related Publications (1)

	Number	Date	Country
	20200345509 A1	Nov 2020	US

Continuations (6)

	Number	Date	Country
Parent	15952102	Apr 2018	US
Child	16933084		US
Parent	15195955	Jun 2016	US
Child	15952102		US
Parent	12960831	Dec 2010	US
Child	13858814		US
Parent	15195955	Jun 2016	US
Child	15952102	Apr 2018	US
Parent	13786037	Mar 2013	US
Child	14274486		US
Parent	12924784	Oct 2010	US
Child	13786037		US

Continuation in Parts (4)

	Number	Date	Country
Parent	13858814	Apr 2013	US
Child	15195955		US
Parent	11136141	May 2005	US
Child	12960831		US
Parent	14274486	May 2014	US
Child	15195955		US
Parent	11136141	May 2005	US
Child	12924784		US

Apparatus, systems, and methods for the fixation or fusion of bone

Information

Patent Number

Date Filed

Date Issued

Inventors

Original Assignees

Examiners

Agents

CPC

Field of Search

US

CPC

International Classifications

Term Extension

Abstract