The present application describes cross-connectors used to link bilateral spinal fixation constructs.
The spinal column is a highly complex system of bones and connective tissues that provide support for the body and protect the delicate spinal cord and nerves. The spinal column includes a series of vertebral bodies stacked one atop the other, each vertebral body including an inner or central portion of relatively weak cancellous bone and an outer portion of relatively strong cortical bone. Situated between each vertebral body is an intervertebral disc that cushions and dampens compressive forces exerted upon the spinal column. A vertebral canal containing the spinal cord is located behind the vertebral bodies.
There are many types of spinal column disorders including scoliosis (abnormal lateral curvature of the spine), excess kyphosis (abnormal forward curvature of the spine), excess lordosis (abnormal backward curvature of the spine), spondylothesis (forward displacement of one vertebra over another), and other disorders caused by abnormalities, disease or trauma, such as ruptured or slipped discs, degenerative disc disease, fractured vertebra and the like. Patients that suffer from such conditions usually experience extreme and debilitating pain, as well as diminished nerve function.
To correct these spinal column disorders, a pair of rods is usually implanted into the spine using pedicle screw systems on the vertebral bodies. Cross-connectors that attach directly to spinal rods provide added rigidity to the spinal rod fixation constructs.
Currently, some cross-connectors come in fixed configurations which limit a surgeon's ability to determine the optimal spacing between a pair of spinal rods. Other cross-connectors are adjustable to adjust overall length, however they are only moveable in the lateral direction, which prevents the surgeon from placing the cross-connector in any area of a patient's body where anatomical features would impede the movement of the cross-connector.
Therefore, a need exists for improved cross-connectors.
The present invention solves the above-identified drawbacks with the prior art by providing a cross-connector with an adjustable length that can be placed above and around any spinous processes.
The cross-connector includes a first coupling assembly, a second coupling assembly, and a connecting device extending therebetween. The first coupling assembly attaches to a first tulip head on a first pedicle screw, the second coupling assembly attaches to a second tulip head on a second pedicle screw, and the connecting device allows a surgeon to adjust the overall length of the cross-connector.
The first coupling assembly has nearly identical (e.g. mirror image) features and functions as the second coupling assembly. Each coupling assembly includes a coupler and a camming assembly. The connecting device includes a first arm element, a second arm element, and a screw, connecting both arm elements together.
The terms distal and proximal are relative to the screw in the connecting device. Distal refers to a location away from the screw, and proximal is an area closer to the screw.
The coupler is a polygon shaped body, having a distal end and a proximal end. The body further includes a first body section at the distal end and a second body section at the proximal end. A cut-out is in the wall between the first body section and the second body section for stability purposes.
The first body section of the coupler includes a side wall at the distal end and an aperture, having a first edge and a second edge. A surface extends proximally from the side wall and terminates at the first edge of the aperture. The side wall is curved and dimensioned to match the walls of the tulip head, and includes a protrusion that extends proximally from the side wall. The protrusion has a cylindrical shape and is sized and dimensioned for being received within the cylindrical recess in the tulip head. The protrusion also provides the first connection area between the coupler and the tulip head. The flange in the cam in the camming assembly in the second body section provides the second connection area between the coupler and the tulip head. The aperture, the first edge, and the second edge are all sized and dimensioned for receiving the tulip head and the set screw of a pedicle screw.
The second body section of the coupler extends proximally from the second edge of the aperture in the first body section. The second body section includes a tip at the proximal end, a first surface, a second surface, and a side surface, extending between the first surface and the second surface. A space separates the first surface from the second surface. An aperture extends through the second body section from the first surface to the second surface. The first surface has a perimeter of the aperture. The second surface includes a recess surrounding the aperture. The side surface includes a spherical cut-out and a rectangular cut-out.
The tip at the proximal end of the coupler has a flat surface for visual purposes and will always face the tip of the second coupler in the same horizontal line.
The aperture includes a first shelf and second shelf. The first shelf is located approximately midway through the aperture between the first surface and the second surface, and extends around the circumference of the aperture. The first shelf includes two ramps positioned on opposite sides of the aperture from one another. The curvature of the ramps corresponds with the ramped surfaces on the pin in the camming assembly. The pin will “move up” one of the ramps as it is rotated clockwise approximately 115 degrees to become “locked.” When the pin is “locked,” the first and second surfaces clamp around the spherical body of the first arm element, and the flange of the cam presses against the rectangular recess in the tulip head.
The second shelf in the aperture is located about three quarters of the distance from the first surface to the second surface, and extends around the circumference of the aperture. This shelf supports the cam in the camming assembly when the pin rotates the cam. The aperture terminates within a recess that is sized and dimensioned for receiving the weld cap of the camming assembly on the second surface.
The perimeter of the aperture includes a first recess and second recess, both of which have semi-circular shapes. The first recess and the second recess correspond with the first protrusion and the second protrusion on the head of the pin of the camming assembly. The first recess has a larger diameter than the second recess, and guides the first protrusion as the pin moves up the ramp. As the pin finishes rotating 115 degrees or reaches the top of the ramp, the second protrusion of the pin becomes positioned within the second recess. This positioning will be the result of a snap fit engagement between the second protrusion and the second recess. Thus, the surgeon knows by feel that the pin is locked and that this rotation is complete.
The spherical cut-out in the side surface is sized and dimensioned to receive the spherical body at the distal end of the first arm element. This cut-out acts like a ball joint by providing the greatest degree of movement for the spherical body when the surgeon is adjusting the length of the connecting device. Additionally, the spherical cut-out is surrounded by smaller spherical cut-outs. Adjacent to the smaller spherical cut-outs is the rectangular cut-out. The smaller spherical cut-outs and the rectangular cut-out provide extra flexibility to the coupler when the first and second surfaces clamp to the spherical body of the first arm element.
The space between the first surface and second surface of the coupler also provides flexibility to the coupler when the spherical body of the arm element rotates within the spherical cut-out when the surgeon adjusts the length of the connecting device.
The first and second embodiments of the cross-connector connect to the tulip heads on pedicle screws. The tulip head includes a U shaped body, having a top and a bottom. The body is dimensioned for receiving a rod, and further includes walls and an aperture. One of the walls has a cut-out at the top for visual purposes to allow a surgeon to line up the set screw with the body of the tulip head. Both of the walls have a rectangular recess that provides an area where the cam presses against the tulip head, thereby locking the tulip head in place. Additionally, each wall has a cylindrical recess that corresponds with the cylindrical protrusion in the coupler. The aperture has a threaded region that is sized and dimensioned for receiving a set screw that connects a rod to the tulip head.
The camming assembly in the coupler includes a pin, a cam, and a weld cap. While the pin rotates the cam, the pin cannot move the weld cap which is welded to the pin.
The pin includes a top and a bottom, having a head, a middle section, and a stem, between the top and the bottom. The head includes a recess at the top, ramped surfaces at the bottom, and a first protrusion and a second protrusion, extending between the top and bottom of the head. The recess is sized and dimensioned for receiving a driver to rotate the pin and the cam. The ramped surfaces correspond with the curvature of the ramps in the coupler. By way of example only, the first protrusion and the second protrusion are generally semi-circular in shape and match the shape of the first recess and second recess respectively in the aperture of the coupler. The first protrusion has a larger diameter than the second protrusion.
The middle section of the pin includes a step that is never in direct contact with the shelf of the cam such that the cam has space to move around the stem. The stem is sized and dimensioned to fit within the aperture of the cam and the aperture of the weld cap.
The cam includes a curved body, having a flange. The curved body further includes a circular opening having an aperture and a shelf. While the opening is sized and dimensioned for receiving both the middle section and the stem of the pin, the aperture can generally accommodate only the stem. The diameter of the aperture is larger than the diameter of the stem to allow the cam to move easily around the stem. The flange is curved so that the cam can easily move along the curved walls of the tulip head before pressing against the rectangular recess in the tulip head, thereby providing the second area of contact between the coupler and the tulip head.
The weld cap is disk shaped and sized and dimensioned for fitting within the recess in the second surface of the coupler. The weld cap also includes an aperture that is sized and dimensioned to contain the stem of the pin.
The connecting device includes a first arm element, a second arm element, and a screw.
The first arm element includes an elongated member, having a spherical body at the distal end, and a disk shaped body at the proximal end. By way of example only, the elongated member makes an angle of 27 degrees with the horizontal. The spherical body rotates within the spherical cut-out of the coupler. The disk shaped body includes an aperture and a threaded region that are both sized and dimensioned for receiving the threaded shank of the screw.
Similar to the first arm element, the second arm element includes an elongated member, having a spherical body at the distal end, and a disk shaped body at the proximal end. An angled surface with a cut-out for stability extends between the elongated member and the disk shaped body. The elongated member makes an angle of 27 degrees with the horizontal. The spherical body is sized and dimensioned to rotate within the spherical cut-out of the coupler when the surgeon adjusts the length of the connecting device. The disk shaped body includes an aperture, extending therethrough. The aperture includes a shelf that extends around the circumference of the aperture. The aperture and the shelf are both sized and dimensioned for receiving the head of the screw in the connecting device. The angled surface extends the overall length of the second arm element such that the disk shaped body of the second arm element rests vertically above the disk shaped body of the first arm element, and the screw can lock both disk shaped bodies together.
The screw includes a head, having a recess and a threaded shank. The head is rounded and dimensioned to pass through the aperture in the second arm element. The recess is sized and dimensioned for receiving a driver which allows a surgeon to engage the threaded shank with the threaded region in the aperture of the first arm element. When the threaded shank is completely engaged with the threaded region of the aperture, the cross-connector will not be able to rotate in the center and the head of the screw will rest on the shelf of the aperture in the second arm element.
The screw acts as a center pivot point for the connecting device, where the first arm element and second arm element move back and forth to adjust the overall length of the cross-connector. In the preferred embodiment, this range of movement is limited to 20 degrees in both directions. This angular movement allows a surgeon to place the connecting device around any features within the body.
In use, the cross-connector is applied after the pedicle screws and rods have been fully implanted in the spine. The cross-connector is then installed over the tulip heads of the pedicle screws. More specifically, the surgeon inserts the cylindrical protrusion in the first coupler into the cylindrical recess of the first tulip head of a first pedicle screw, and repeats this process to connect the second coupler to a second tulip head on a second pedicle screw on the same vertebral body. At this point, the tip of the first coupler will be in the same horizontal line as the tip of the second coupler.
To determine the optimal length of the cross-connector, the surgeon pivots the first arm element and the second arm element in the connecting device around the screw. During this process, the spherical body of the first arm element rotates within the spherical cut-out of the first coupler. Likewise, the spherical body of the second arm element rotates within the spherical cut-out of the second coupler.
After finding the desired length of the cross-connector, the surgeon inserts a driver into the recess of the pin in the camming assembly and rotates the pin clockwise approximately 115 degrees to “lock” the pin in the first coupling assembly. When the pin is “locked,” the ramped surfaces on the head of the pin have moved up the ramp in the aperture of the coupler; the first and second surfaces of the coupler are clamped around the spherical body of the first arm element; and the flange of the cam is pressed firmly against the rectangular recess in the tulip head, thereby securing the tulip head in place. The surgeon knows by feel that the pin is “locked” because the smaller semi-circular protrusion on the head of the pin is in smaller-semi-circular recess in the aperture of the coupler. The surgeon repeats this locking process with the camming assembly in the second coupling assembly.
To lock the center rotation of the cross-connector, the surgeon inserts a driver into the recess of the screw in the connecting device and rotates the screw clockwise until the threaded shank engages completely with the threaded region of the first arm element. The connecting device has a height above the center of the rod in the tulip head of a pedicle screw which allows the cross-connector to be placed above any features within the body.
In a second embodiment, the cross-connector is likewise sized and dimensioned for connecting to the tulip heads of pedicle screws on the same vertebral body. The cross-connector includes a first coupling assembly, a second coupling assembly, and a connecting device. The connecting device connects the coupling assemblies together and adjusts the overall length of the cross-connector. Both coupling assemblies have nearly identical (i.e. mirror image) features and functions. Each coupling assembly includes a coupler and a collet. The connecting device includes a first arm element, a second arm element, and a locking assembly.
Similar to the first embodiment of the cross-connector, the terms distal and proximal in the second embodiment are relative to the locking assembly in the connecting device. Distal refers to a location away from the locking assembly and proximal is an area closer to the locking assembly.
The coupler includes a first body portion and a second body portion. The first body portion includes an aperture and a side wall. The aperture is sized and dimensioned to fit around the tulip head of a pedicle screw. The side wall is generally curved to match the curvature of the walls of the tulip head. The size and shape of the aperture and the side wall give the coupler a low profile finish on the tulip head. A cylindrical protrusion, extends proximally from the side wall, and is sized and dimensioned for being received within the cylindrical recess in the tulip head.
The second body portion of the coupler makes an angle of 40 degrees with the first body portion and further includes an aperture, having a perimeter. The aperture is sized and dimensioned for receiving the cylindrical body of the first arm element, and is tapered from the distal end to the proximal end to provide a close fit with the collet. The perimeter is generally curved to allow the cylindrical body to rotate easily within the aperture.
The collet includes a first surface, a second surface, and an aperture, extending therebetween. The first surface includes a plurality of openings that extend to an area approximately three quarters of the distance from the first surface to the second surface. Similarly, the second surface includes a plurality of openings that extend to an area approximately three quarters of the distance from the second surface to the first surface. Both sets of openings are rectangular shaped and terminate at circular cut-outs to dissipate stresses within the collet. The collet has four openings on the first surface and four openings on the second surface, which alternate around the collet. This feature makes the collet flexible and allows the cylindrical body of the first arm element to rotate within the aperture of the collet.
The connecting device includes a first arm element, a second arm element, and a locking assembly.
The first arm element includes an elongated member, having a cylindrical body at the distal end and a rectangular body at the proximal end. By way of example only, the elongated member has an angle of 30 degrees to the horizontal. The cylindrical body is sized and dimensioned for fitting within the aperture of the collet and the aperture of the coupler.
The rectangular body of the first arm element includes an aperture that is sized and dimensioned for receiving the locking assembly in the connecting device. The rectangular body further includes a top, a bottom, and a first side, a second side, a third side, and a fourth side extending therebetween. The top is flat such that the head of the cap of the locking assembly rests on the top of the rectangular body when the cap is completely threaded with the base. The bottom has various features on the second and fourth sides which allow the rectangular body of the first arm element to move within the rectangular body of the second arm element.
The first side of the rectangular body connects to the elongated member. The second side includes teeth, contained within the aperture, and an elongated recess on the bottom. The teeth are sized and dimensioned for complimentary engagement with the teeth on the gear. The recess has a semi-cylindrical cross-sectional shape and is sized and dimensioned for receiving the elongated protrusion on the rectangular body of the second arm element. The length of the recess is longer than the elongated protrusion. The third side is parallel to the first side and connects the second side with the fourth side. The bottom of the fourth side includes a semi-cylindrical cross-sectional protrusion that is sized and dimensioned for moving within the elongated recess of the rectangular body of the second arm element.
Similar to the first arm element, the second arm element includes an elongated member, having a cylindrical body at the distal end and a rectangular body at the proximal end. The elongated member also has an angle of 30 degrees with the horizontal. The cylindrical body has identical features and functions as the cylindrical body of the first arm element.
The rectangular body of the second arm element includes an aperture that is sized and dimensioned for receiving the locking assembly. The second body further includes a top, a bottom, and a first side, second side, a third side, and fourth side extending therebetween. The top has various features on the second and fourth sides which allow the rectangular body of the second arm element to move within the rectangular body of the first arm element. The bottom is flat so that the bottom base of the locking device can easily move along the bottom of the rectangular body when the locking assembly rotates between the teeth of the first and second arm elements. Also, the flat bottom allows the bottom base of the locking device to press firmly against the rectangular body, thereby preventing lateral movement when the cap is completely threaded to the base.
The first side of the rectangular body of the second arm element connects with the elongated member. The second side includes an elongated protrusion on the top that has a semi-cylindrical cross-sectional shape and is dimensioned to move within the semi-cylindrical recess of the first arm element. The third side is parallel to the first side and connects the second side with the fourth side. The fourth side includes teeth, contained within the aperture, and a recess on the top. The teeth are sized and dimensioned for complimentary engagement with the teeth on the gear. The recess has a semi-cylindrical cross-sectional shape and is dimensioned for receiving the semi-cylindrical protrusion of the first arm element. The length of the recess is longer than the elongated protrusion.
The locking assembly includes a cap, a gear, and a base.
The cap includes a head and a shaft. The head further includes an aperture with a threaded region that extends the length of the shaft. The threaded region is sized and dimensioned to engage with the threaded shank of the base. The head has a torx shape for use with a driver, having a torx socket, to engage the cap with the base.
The gear includes an aperture and teeth along the outer surface of the aperture. The aperture further includes two protrusions. The aperture and protrusions are sized and dimensioned for fitting closely around the intermediate base of the base. The teeth are sized and dimensioned for cooperative engagement with the teeth of the first and second arm elements.
The base further includes a threaded shank, an intermediate base, and a bottom base. The threaded shank includes a recess which is sized and dimensioned for receiving a driver that allows the surgeon to rotate the gear between the first and second arm elements, thereby adjusting the overall length of the cross-connector. The intermediate base is disc shaped and includes flat surfaces that match with the protrusions in the gear. The bottom base is disc shaped. The intermediate base and bottom base are welded to the gear.
In use, the second embodiment of the cross-connector is applied after the pedicle screws and rods have been fully implanted in the spine. The cross-connector is then installed over the tulip heads of the pedicle screws. More specifically, a surgeon inserts the cylindrical protrusion of the first coupler into the cylindrical aperture in the tulip head of a first pedicle screw. The surgeon repeats this process to connect the second coupler to a tulip head on a second pedicle screw on the same vertebral body.
To determine the optimal length of the cross-connector, the surgeon inserts a driver into the recess of the base in the locking device to rotate the gear, which will move the first arm element and second arm element laterally. (The surgeon may also manually move the first and second arm elements.) When the gear rotates, the teeth of the gear will move within the teeth of the first and second arm elements. Additionally, the elongated protrusion on the bottom of the first arm element will move within the semi-cylindrical cross-sectional recess on the top of the second arm element, and the elongated protrusion on the top of the second arm element will move within the semi-cylindrical cross-sectional recess on the bottom of the first arm element.
To lock the lateral movement of the cross-connector, the surgeon places a driver around the head of the cap and rotates the cap clockwise until the threaded region of the cap is completely engaged with threaded shank of the base. At this point, the head of the cap will press down on the top of the rectangular body of the first arm element and the bottom base will press up against the bottom of the rectangular body of the second arm element. Thus, the gear will be prevented from moving within the teeth of the first and second arm elements. Finally, the cross-connector will have a height above the first and second couplers which allows the cross-connector to be placed above objects in the body.
The cross-connector in a third embodiment functions the same way and includes substantially the same structure as the cross-connector of the second embodiment. The cross-connector in the third embodiment has a different first coupler and second coupler in the first coupling assembly and the second coupling assembly respectively. The first and second couplers are hook shaped and snap directly onto a rod.
Many advantages of the present invention will be apparent to those skilled in the art with a reading of this specification in conjunction with the attached drawings, wherein like reference numerals are applied to like elements and wherein:
Illustrative embodiments of the invention are described below. In the interest of clarity, not all features of an actual implementation are described in this specification. It will of course be appreciated that in the development of any such actual embodiment, numerous implementation-specific decisions must be made to achieve the developers' specific goals, such as compliance with system-related and business-related constraints, which will vary from one implementation to another. Moreover, it will be appreciated that such a development effort might be complex and time-consuming, but would nevertheless be a routine undertaking for those of ordinary skill in the art having the benefit of this disclosure. The cross-connector disclosed herein boasts a variety of inventive features and components that warrant patent protection, both individually and in combination.
The first coupling assembly 20 includes a first coupler 26 and a camming assembly 28. Similarly, the second coupling assembly 22 includes a second coupler 30 and a camming assembly 28. The connecting device 24 includes a first arm element 32, a second arm element 34, and a screw 36, connecting both arm elements together.
The first coupling assembly 20 will now be described in further detail with specific reference to
The first body section 44 of the coupler 26 includes a side wall 50 at the distal end 40 and an aperture 52, having a first edge 54 and a second edge 56. A surface 58 extends proximally from the side wall 50 and terminates at the first edge 54 of the aperture 52 (
The second body section 46 of the coupler 26 extends proximally from the second edge 56 of the aperture 52 in the first body section 44. The second body section 46 includes a tip 61 at the proximal end 42, a first surface 62, a second surface 64, and a side surface 66, extending between the first surface 62 and the second surface 64. A space 68 separates the first surface 62 from the second surface 64 (
The tip 61 at the proximal end 42 of coupler 26 generally has a flat surface for visual purposes and faces the tip 61 in the second coupler 30 in the same horizontal line (
The aperture 70 includes a first shelf 82 and second shelf 84 (
The second shelf 84 in the aperture 70 is located about three quarters of the distance from the first surface 62 to the second surface 64, and extends around the circumference of the aperture 70. The second shelf 84 supports the cam 114 in the camming assembly 28 when the pin 112 rotates the cam 114. The aperture 70 terminates within a recess 74 that is sized and dimensioned for receiving the weld cap 116 of the camming assembly 28 on the second surface 64 (
Referring to
The side surface 66 of the second body section 46 of the coupler 26 will now be described in detail (
The space 68 between the first surface 62 and second surface 64 of the coupler 26 also provides flexibility to the coupler 26 when the spherical body 152 of the first arm element 32 rotates within the first cut-out 76 when the surgeon is adjusting the length of the connecting device 24.
Referring to
Referring to
The pin 112, shown in
The middle section 124 of the pin 112 includes a step 136 that is sized and dimensioned to fit above the shelf 146 in the cam 114. The step 136 rotationally fixes the cam 114 to the pin such that rotation of the pin 112 also rotates the cam. Finally, the stem 126 is sized and dimensioned to fit within aperture 144 of the cam 114 and the aperture 148 of the weld cap 116.
The cam 114, shown in
The weld cap 116, shown in
According to an alternate embodiment, the cam assembly may be replaced with a set screw. The position and size of the set screw may be such that when the set screw is advanced through the aperture 70 (which in this embodiment is threaded) the screw prevents the tulip head from moving such that the protrusion 60 cannot disengage from the recess 108). Additionally, the set screw may only thread into the second surface 64 and include a flange that rests above the first surface 62 such that tightening the setcrew also squeezes the first and second surfaces together to inhibit movement of the arm element 32.
Referring to
The first arm element, shown in
Similar to the first arm element 32, the second arm element 34, shown in
The second body 164 is generally disk shaped and includes an aperture 170 extending therethrough. The aperture 170 includes a shelf 172 that extends around the circumference of the aperture 170. Both the aperture 170 and the shelf 172 are sized and dimensioned for receiving the head 174 of the screw 36. The angled surface 166 extends the overall length of the second arm element 34 so that the second body 164 rests vertically above the second body 154 of the first arm element 32, and the screw 36 can lock the second body 154 of the first arm element 32 and second body 164 of the second arm element 34 together (
Referring to
The screw 36 acts as a center pivot point for the connecting device 24 where the first arm element 32 and second arm element 34 move around the screw 36 to adjust the overall length of the cross-connector 10. Although the first arm element 32 and the second arm element 34 can pivot 45 degrees in one direction and 45 degrees in the opposite direction around the screw 36, this range of movement is limited to 20 degrees in both directions in the preferred embodiment. Furthermore, this angular movement of the first arm element 32 and the second arm element 34 allows a surgeon to place the connecting device 24 around any features within the body.
In one embodiment of the cross-connector 10, the overall length has a range of 28-44 mm inclusive. A second embodiment has a range of 38-50 mm inclusive.
In use, the cross-connector 10 is applied after the pedicle screws 18 and rods 12 have been fully implanted in the spine. The cross-connector 10 is then installed over the tulip heads 14 of the pedicle screws 18. More specifically, the surgeon inserts the cylindrical protrusion 60 of the first coupler 26 into the cylindrical aperture 108 in the tulip head 14 of a first pedicle screw 18 (
To determine the optimal length of the cross-connector 10, a surgeon pivots the first arm element 32 and the second arm element 34 in the connecting device 24 around the screw 36. During this process, the spherical body 152 of the first arm element 32 will rotate within the spherical cut-out 76 of the first coupler 26. Likewise, the generally spherical first body portion 162 of the second arm element 34 rotates within the spherical cut-out 76 of the second coupler 30.
After finding the desired length of the cross-connector 10, the surgeon inserts a driver (not shown) into the recess 128 of the pin 112 in the camming assembly 28 and rotates the pin 112 clockwise approximately 115 degrees to “lock” the pin 112 in the first coupling assembly 20. When the pin 112 is “locked,” the ramped surfaces 130 on the head 122 of the pin 112 have moved up the ramp 86 in the aperture 70 of the coupler 26; the first surface 62 and the second surface 64 of the coupler 26 are clamped around the generally spherical first body portion 152 of the first arm element 32; and the flange 140 of the cam 114 is pressed firmly against the rectangular aperture 106 in the tulip head 14, thereby securing the tulip head 14 into place (
Finally, to lock the center rotation of the cross-connector 10, the surgeon inserts a driver (not shown) into the recess 176 of the screw 36 in the connecting device 24 and rotates the screw 36 clockwise until the threaded shank 178 engages with the threaded region 158 of the first arm element 32. The connecting device 24 has a height, h1, above the center of the rod 12 in the tulip head 14 of a pedicle screw 18, which allows the cross-connector 10 to be placed above any features within the body (
The first coupling assembly 212 will now be described in further detail with specific reference to
Referring first to
The second body portion 242 of the coupler 18 makes an angle, θ2, with the first body portion 240, and further includes an aperture 250, having a perimeter 252 (
The collet 220, shown in
The connecting device 216 includes a first arm element 226, a second arm element 228, and a locking assembly 229.
Referring to
The second body 268 of the first arm element 226 is generally rectangular in shape, and includes an aperture 270 that is sized and dimensioned for receiving the locking assembly 229 in the connecting device 216. The second body 268 further includes a top 272, a bottom 274, and a first side 276, a second side 278, a third side 280, and a fourth side 282 extending therebetween. The top 272 of the second body 268 is flat such that the head 318 of the cap 230 of the locking assembly 229 rests on the top 272 of the second body 268 when the cap 230 is completely threaded with the base 234. The bottom 274 has various features on the second side 278 and fourth side 282 which allow the second body 268 to move within the second body 294 of the second arm element 228, as will be explained below.
Referring now to
Referring now to
The second body 294 of the second arm element 228 includes an aperture 296 that is sized and dimensioned for receiving the locking assembly 229 in the connecting device 216. The second body 294 further includes a top 298, a bottom 300, and a first side 302, second side 304, a third side 306, and a fourth side 308 extending therebetween (
Referring now to
Referring now to
The cap 230 includes a head 318 and a shaft 320. The head 318 further includes an aperture 322 with a threaded region 324 that extends the length of the shaft 320 (
The gear 232 further includes an aperture 326 and teeth 328 along the outer surface of the aperture 326. The aperture 326 also includes two protrusions 330 (
The base 234 further includes a threaded shank 332, an intermediate base 334, and a bottom base 336. The threaded shank 332 includes a recess 338 which is sized and dimensioned for receiving a driver (not shown) that allows the surgeon to rotate the gear 232 between the first arm element 226 and second arm element 228, thereby adjusting the overall length of the cross-connector 210. The intermediate base 334 is generally disc shaped and includes flat surfaces 335 that match with the protrusions 330 in the gear 232. The bottom base 336 is also generally disc shaped. The intermediate base 334 and bottom base 336 are welded to the gear 232.
In use, the cross-connector 210 is applied after the pedicle screws 18 and rods 12 have been fully implanted in the spine. The cross-connector 210 is then installed over the tulip heads 14 of the pedicle screws 18. More specifically, a surgeon inserts the protrusion 248 of the first coupler 218 into the second aperture 108 in the tulip head 14 of a first pedicle screw 18. The surgeon repeats this process to connect the second coupler 222 to a tulip head 14 on a second pedicle screw 18 on the same vertebral body.
To determine the optimal length of the cross-connector 210, a surgeon inserts a driver (not shown) into the recess 338 of the base 234 in the locking devices 216 to rotate the gear 232, which will move the first arm element 226 and second arm element 228 laterally. When the gear 232 rotates, the teeth 328 of the gear 232 will move within the teeth 284 of the first arm element 226 and the teeth 312 of the second arm element 228. Additionally, the protrusion 288 on the bottom 274 of the first arm element 226 will move within the recess 314 on the top 298 of the second arm element 228, and the protrusion 310 on the top 298 of the second arm element 228 will move within the recess 286 on the bottom 274 of the first arm element 226 (
To lock the lateral movement of the cross-connector 210, the surgeon places a driver (not shown) around the head 318 of the cap 230 and rotates the cap 230 clockwise until the threaded region 324 of the cap is completely engaged with threaded shank 332 of the base 234. At this point, the head 318 of the cap 230 will press down on the top 272 of the rectangular body 268 of the first arm element 226 and the bottom base 336 will press up against the bottom 300 of the rectangular body 294 of the second arm element 228. Thus, the gear 232 will be prevented from moving within the teeth 284 in the first arm element 226 and the teeth 312 in the second arm element 228 (
While the invention is susceptible to various modifications and alternative forms, specific embodiments thereof have been shown by way of example in the drawings and are herein described in detail. It should be understood, however, that the description herein of specific embodiments is not intended to limit the invention to the particular forms disclosed, but on the contrary, the invention is to cover all modifications, equivalents, and alternative falling within the spirit and scope of the invention as described herein.
This application is a non-provisional patent application and claims the benefit of priority from commonly owned U.S. Provisional Patent Application Ser. No. 61/348,821, entitled “Cross-Connector and Related Methods,” filed on May 27, 2010, the entire contents of which are each hereby expressly incorporated by reference into this disclosure as if set forth in its entirety herein.
Number | Name | Date | Kind |
---|---|---|---|
4361141 | Tanner | Nov 1982 | A |
4569338 | Edwards | Feb 1986 | A |
4641636 | Cotrel | Feb 1987 | A |
4771767 | Steffee | Sep 1988 | A |
4805602 | Puno et al. | Feb 1989 | A |
4946458 | Harms et al. | Aug 1990 | A |
4998936 | Mehdian | Mar 1991 | A |
5005562 | Cotrel | Apr 1991 | A |
5034011 | Howland | Jul 1991 | A |
5042982 | Harms et al. | Aug 1991 | A |
5084049 | Asher et al. | Jan 1992 | A |
5092866 | Breard et al. | Mar 1992 | A |
5092867 | Harms et al. | Mar 1992 | A |
5092893 | Smith | Mar 1992 | A |
5129388 | Vignaud et al. | Jul 1992 | A |
5154718 | Cozad et al. | Oct 1992 | A |
5176680 | Vignaud et al. | Jan 1993 | A |
5196013 | Harms et al. | Mar 1993 | A |
5207678 | Harms et al. | May 1993 | A |
5234431 | Keller | Aug 1993 | A |
5261907 | Vagnaud et al. | Nov 1993 | A |
5275600 | Allard et al. | Jan 1994 | A |
5312405 | Korotko et al. | May 1994 | A |
5330473 | Howland | Jul 1994 | A |
5375823 | Navas | Dec 1994 | A |
5387213 | Breard et al. | Feb 1995 | A |
5397363 | Gelbard | Mar 1995 | A |
5403314 | Currier | Apr 1995 | A |
5466237 | Byrd, III et al. | Nov 1995 | A |
5474555 | Puno et al. | Dec 1995 | A |
5478340 | Kluger | Dec 1995 | A |
5480401 | Navas | Jan 1996 | A |
5498263 | Dinello et al. | Mar 1996 | A |
5501684 | Schlapfer et al. | Mar 1996 | A |
5505731 | Tornier | Apr 1996 | A |
5522816 | Dinello et al. | Jun 1996 | A |
5536268 | Griss | Jul 1996 | A |
5540688 | Navas | Jul 1996 | A |
5545163 | Miller et al. | Aug 1996 | A |
5545166 | Howland | Aug 1996 | A |
5562661 | Yoshimi et al. | Oct 1996 | A |
5569246 | Ojima et al. | Oct 1996 | A |
5601554 | Howland et al. | Feb 1997 | A |
5607425 | Rogozinski | Mar 1997 | A |
5624442 | Mellinger et al. | Apr 1997 | A |
5630816 | Kambin | May 1997 | A |
5643264 | Sherman et al. | Jul 1997 | A |
5645544 | Tai et al. | Jul 1997 | A |
5665122 | Kambin | Sep 1997 | A |
5667508 | Errico et al. | Sep 1997 | A |
5669910 | Korhonen et al. | Sep 1997 | A |
5669911 | Errico et al. | Sep 1997 | A |
5672176 | Biedermann et al. | Sep 1997 | A |
5676665 | Bryan | Oct 1997 | A |
5676703 | Gelbard | Oct 1997 | A |
5681311 | Foley et al. | Oct 1997 | A |
5688272 | Montague et al. | Nov 1997 | A |
5690630 | Errico et al. | Nov 1997 | A |
5693053 | Estes | Dec 1997 | A |
5702393 | Pfaifer | Dec 1997 | A |
5704936 | Mazel | Jan 1998 | A |
5716355 | Jackson et al. | Feb 1998 | A |
5725527 | Biedermann et al. | Mar 1998 | A |
5735852 | Amrein et al. | Apr 1998 | A |
5776135 | Errico et al. | Jul 1998 | A |
5800435 | Errico et al. | Sep 1998 | A |
5863293 | Richelsoph | Jan 1999 | A |
5873878 | Harms et al. | Feb 1999 | A |
5928232 | Howland et al. | Jul 1999 | A |
5928237 | Farris et al. | Jul 1999 | A |
5938663 | Petreto | Aug 1999 | A |
5944719 | Leban | Aug 1999 | A |
5944720 | Lipton | Aug 1999 | A |
5947966 | Drewry et al. | Sep 1999 | A |
5951555 | Rehak et al. | Sep 1999 | A |
5954722 | Bono | Sep 1999 | A |
5954725 | Sherman et al. | Sep 1999 | A |
5961516 | Graf | Oct 1999 | A |
5980521 | Montague et al. | Nov 1999 | A |
5980523 | Jackson et al. | Nov 1999 | A |
6004322 | Bernstein | Dec 1999 | A |
6030389 | Wagner et al. | Feb 2000 | A |
6063089 | Errico et al. | May 2000 | A |
6074391 | Metz-Stavenhagen | Jun 2000 | A |
6083226 | Fiz | Jul 2000 | A |
6113600 | Drummond et al. | Sep 2000 | A |
6136003 | Hoeck et al. | Oct 2000 | A |
6139548 | Errico | Oct 2000 | A |
6171311 | Richelsoph | Jan 2001 | B1 |
6179838 | Fiz | Jan 2001 | B1 |
6187005 | Brace et al. | Feb 2001 | B1 |
6190388 | Michelson | Feb 2001 | B1 |
6217578 | Crozet et al. | Apr 2001 | B1 |
6224598 | Jackson | May 2001 | B1 |
6234705 | Troxell | May 2001 | B1 |
6238396 | Lombardo | May 2001 | B1 |
6241730 | Alby | Jun 2001 | B1 |
6264658 | Lee et al. | Jul 2001 | B1 |
6267765 | Taylor et al. | Jul 2001 | B1 |
6273914 | Papas | Aug 2001 | B1 |
6280445 | Morrison et al. | Aug 2001 | B1 |
6283967 | Troxell et al. | Sep 2001 | B1 |
6296644 | Saurat et al. | Oct 2001 | B1 |
6306137 | Troxell | Oct 2001 | B2 |
6325802 | Frigg | Dec 2001 | B1 |
6328740 | Richelsoph | Dec 2001 | B1 |
6328741 | Richelsoph | Dec 2001 | B1 |
6379354 | Rogozinski | Apr 2002 | B1 |
6402751 | Hoeck et al. | Jun 2002 | B1 |
6413258 | Bernhardt, Jr. | Jul 2002 | B1 |
6482207 | Errico | Nov 2002 | B1 |
6485491 | Farris et al. | Nov 2002 | B1 |
6524310 | Lombardo et al. | Feb 2003 | B1 |
6554832 | Shluzas | Apr 2003 | B2 |
6602253 | Richelsoph et al. | Aug 2003 | B2 |
6616668 | Altarac et al. | Sep 2003 | B2 |
6626904 | Jammet et al. | Sep 2003 | B1 |
6641583 | Shluzas et al. | Nov 2003 | B2 |
6736817 | Troxell et al. | May 2004 | B2 |
6752807 | Lin et al. | Jun 2004 | B2 |
6761721 | Burgess et al. | Jul 2004 | B2 |
6783526 | Lin et al. | Aug 2004 | B1 |
6872208 | McBride et al. | Mar 2005 | B1 |
6875211 | Nichols et al. | Apr 2005 | B2 |
6887241 | McBride et al. | May 2005 | B1 |
6899714 | Vaughan | May 2005 | B2 |
6958066 | Richelsoph et al. | Oct 2005 | B2 |
6960212 | Richelsoph et al. | Nov 2005 | B2 |
7029474 | Richelsoph et al. | Apr 2006 | B2 |
7066938 | Slivka et al. | Jun 2006 | B2 |
7083622 | Simonson | Aug 2006 | B2 |
7104993 | Baynham et al. | Sep 2006 | B2 |
7122036 | Vanacker | Oct 2006 | B2 |
7137986 | Troxell et al. | Nov 2006 | B2 |
7160301 | Cordaro | Jan 2007 | B2 |
7406775 | Funk et al. | Aug 2008 | B2 |
7678112 | Rezach | Mar 2010 | B2 |
8062339 | Hammer et al. | Nov 2011 | B2 |
20010034521 | Bailey et al. | Oct 2001 | A1 |
20020052603 | Nichols et al. | May 2002 | A1 |
20020143330 | Shluzas | Oct 2002 | A1 |
20020169448 | Vanacker | Nov 2002 | A1 |
20030023244 | Richelsoph et al. | Jan 2003 | A1 |
20030028191 | Shluzas | Feb 2003 | A1 |
20030045878 | Petit et al. | Mar 2003 | A1 |
20030060823 | Bryan | Mar 2003 | A1 |
20030149432 | Frigg et al. | Aug 2003 | A1 |
20030153917 | Richelsoph et al. | Aug 2003 | A1 |
20030163133 | Altarac et al. | Aug 2003 | A1 |
20030212398 | Jackson | Nov 2003 | A1 |
20040116928 | Young et al. | Jun 2004 | A1 |
20040138662 | Landry et al. | Jul 2004 | A1 |
20040147928 | Landry et al. | Jul 2004 | A1 |
20040260287 | Ferree | Dec 2004 | A1 |
20050010217 | Dalton | Jan 2005 | A1 |
20050070901 | David | Mar 2005 | A1 |
20050080416 | Ryan et al. | Apr 2005 | A1 |
20050090821 | Berrevoets et al. | Apr 2005 | A1 |
20050192572 | Abdelgany et al. | Sep 2005 | A1 |
20050228326 | Kalfas et al. | Oct 2005 | A1 |
20050228382 | Richelsoph et al. | Oct 2005 | A1 |
20050277923 | Sweeney | Dec 2005 | A1 |
20050288670 | Panjabi et al. | Dec 2005 | A1 |
20060036252 | Baynham et al. | Feb 2006 | A1 |
20060052783 | Dant et al. | Mar 2006 | A1 |
20060052786 | Dant et al. | Mar 2006 | A1 |
20060058789 | Kim et al. | Mar 2006 | A1 |
20060064091 | Ludwig et al. | Mar 2006 | A1 |
20060064093 | Thramann et al. | Mar 2006 | A1 |
20060149229 | Kwak et al. | Jul 2006 | A1 |
20060217718 | Chervitz et al. | Sep 2006 | A1 |
20060229606 | Clement et al. | Oct 2006 | A1 |
20060235393 | Bono et al. | Oct 2006 | A1 |
20060247624 | Banouskou et al. | Nov 2006 | A1 |
20060264933 | Baker et al. | Nov 2006 | A1 |
20060271045 | Hubbard et al. | Nov 2006 | A1 |
20060282074 | Renaud et al. | Dec 2006 | A1 |
20060282075 | Labrom et al. | Dec 2006 | A1 |
20060282076 | Labrom et al. | Dec 2006 | A1 |
20060282077 | Labrom et al. | Dec 2006 | A1 |
20060282078 | Labrom et al. | Dec 2006 | A1 |
20060282079 | Labrom et al. | Dec 2006 | A1 |
20070049932 | Richelsoph et al. | Mar 2007 | A1 |
20070055239 | Sweeney et al. | Mar 2007 | A1 |
20070083201 | Jones et al. | Apr 2007 | A1 |
20070149973 | Clement et al. | Jun 2007 | A1 |
20070173829 | Drewry et al. | Jul 2007 | A1 |
20070173833 | Butler et al. | Jul 2007 | A1 |
20070213721 | Markworth et al. | Sep 2007 | A1 |
20070213723 | Markworth et al. | Sep 2007 | A1 |
20070233062 | Berry | Oct 2007 | A1 |
20070233090 | Naifeh | Oct 2007 | A1 |
20070233119 | Markworth | Oct 2007 | A1 |
20070270808 | Drewry et al. | Nov 2007 | A1 |
20070270809 | Drewry et al. | Nov 2007 | A1 |
20070288009 | Brown et al. | Dec 2007 | A1 |
20080021464 | Morin et al. | Jan 2008 | A1 |
20080051780 | Vaidya et al. | Feb 2008 | A1 |
20080071273 | Hawkes et al. | Mar 2008 | A1 |
20080091204 | Kuiper et al. | Apr 2008 | A1 |
20080109039 | Michielli et al. | May 2008 | A1 |
20080140075 | Ensign et al. | Jun 2008 | A1 |
20080172093 | Nilsson | Jul 2008 | A1 |
20080177315 | Usher | Jul 2008 | A1 |
20080177323 | Null et al. | Jul 2008 | A1 |
20080255617 | Cho et al. | Oct 2008 | A1 |
20080269742 | Levy et al. | Oct 2008 | A1 |
20080306534 | Winslow et al. | Dec 2008 | A1 |
20080306535 | Winslow et al. | Dec 2008 | A1 |
20080312692 | Brennan et al. | Dec 2008 | A1 |
20090018586 | Butler et al. | Jan 2009 | A1 |
20090043338 | Laager et al. | Feb 2009 | A1 |
20090062860 | Frasier et al. | Mar 2009 | A1 |
20090125065 | Laager et al. | May 2009 | A1 |
20090216277 | Tornier et al. | Aug 2009 | A1 |
20090318968 | Duggal et al. | Dec 2009 | A1 |
20100094345 | Saidha et al. | Apr 2010 | A1 |
20100094346 | Matityahu | Apr 2010 | A1 |
20100094349 | Hammer et al. | Apr 2010 | A1 |
20100160981 | Butler et al. | Jun 2010 | A1 |
20100191289 | Ludwig et al. | Jul 2010 | A1 |
20100198260 | Gabelberger et al. | Aug 2010 | A1 |
20100204733 | Rathbun et al. | Aug 2010 | A1 |
20100211100 | Mack | Aug 2010 | A1 |
20100268279 | Gabelberger et al. | Oct 2010 | A1 |
20100274286 | Blain et al. | Oct 2010 | A1 |
20100324599 | Montello et al. | Dec 2010 | A1 |
20110034957 | Biedermann | Feb 2011 | A1 |
20110046675 | Barrus et al. | Feb 2011 | A1 |
20110071569 | Black | Mar 2011 | A1 |
20110106178 | Schwab | May 2011 | A1 |
20110184462 | Gil et al. | Jul 2011 | A1 |
20120029566 | Rezach | Feb 2012 | A1 |
20120071926 | Jani et al. | Mar 2012 | A1 |
20120101529 | Ludwig et al. | Apr 2012 | A1 |
20120130436 | Haskins et al. | May 2012 | A1 |
Number | Date | Country |
---|---|---|
PI0801130 | Jun 2011 | BR |
3841008 | Jun 1990 | DE |
9004960.8 | Aug 1992 | DE |
0283373 | Sep 1988 | EP |
1743585 | Jan 2007 | EP |
2624720 | Jun 1989 | FR |
WO 9513754 | May 1995 | WO |
WO 2006025919 | Mar 2006 | WO |
WO 2007130007 | Nov 2007 | WO |
WO 2010045219 | Apr 2010 | WO |
WO 2011057178 | May 2011 | WO |
Entry |
---|
Beadling, “Harrington put the steel in spinal fixation”, Orthopedics Today, (Jun. 2000), 6 pgs. |
Dipreta, “The Iliac Nail/Screw in a Modified Galveston Technique for Sacropelvic Fixation”, Am. Acad. of Ortho. Surg., 67th mtg., PE184, (Mar. 19, 2000), 1 pg. |
Ebrahim, “Posterior Lateral Mass Screw Fixation: Anatomic and Radiographic Considerations”, U.P.O.J. vol. 12 (Spring 1999), 66-72. |
Erickson, “Biomechanical Assessment of Conventional Unit Rod Fixation Versus a Unit Rod Pedicle Screw Construct”, Spine, vol. 29, No. 12, (2004), 1314-1319. |
Pham, “Upper cervical spine surgery in rheumatoid arthritis: retrospective study of 30 patients followed for two years or more after Cotrel-Dubousset instrumentation”, Joint Bone Spine, 67 (2000), 434-440. |
Sanders, “Treating, managing spinal deformity in young patients”, Orthopedics Today (Jul. 2001), 12 pgs. |
Spiegel, “Anterior instrumentation in the Treatment of Scolisosis” U.P.O.J., vol. 11, (Spring 1998), 19-26. |
Wood, “Torsional Rigidity of Scoliosis Constructs”, Spine, vol. 25, No. 15, (2000), 1893-1898. |
Number | Date | Country | |
---|---|---|---|
61348821 | May 2010 | US |