Dual wedge expandable implant with eyelets, system, and method of use

Abstract

An expandable implant movable between a contracted position and an expanded position, is disclosed. In various embodiments, the implant may include a superior endplate and an inferior endplate having proximal ramps and distal ramps disposed on an interior surface thereof, respectively. In various embodiments, a proximal set screw and a distal set screw may be independently coupled to a proximal wedge and a distal wedge. Upon rotation of the proximal set screw, the proximal wedge may act against the proximal ramps of the superior and inferior endplates and cause the implant to expand at the proximal end. Upon rotation of the distal set screw, the distal wedge may act against the distal ramps of the superior and inferior endplates and cause the implant to expand at the distal end. In some embodiments, a first eyelet and a second eyelet for supporting a corresponding bone screw, respectively, may be included.

Description

FIELD

The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical device that includes an expandable spinal implant, systems for implanting and manipulating the expandable spinal implant, and a method for treating a human spine. In some embodiments, disclosed implants may be used in an anterior cervical discectomy and fusion (ACDF) procedure although other uses in other areas of the spine or for other orthopedic applications are also contemplated.

BACKGROUND

Spinal disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including pain, nerve damage, and partial or complete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercise can be effective; however, they may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes fusion, fixation, correction, discectomy, laminectomy and implantable prosthetics. As part of these surgical treatments, spinal constructs, such as, for example, bone fasteners, spinal rods and interbody devices can be used to provide stability to a treated region. For example, during surgical treatment, interbody devices may be introduced to a space between adjacent vertebral bodies (the interbody space) to properly space the vertebral bodies and provide a receptacle for bone growth promoting materials (BGM), e.g., bone graft and/or synthetic materials.

Mechanically operated interbody implants may be used to align and/or realign a patient's spine during a medical procedure. Conventional implants designed for the Thoracic and Lumbar region of the spine often include top and bottom endplates and a mechanical means to separate the top and bottom endplates. The mechanical mechanisms to separate the top and bottom endplates are often cumbersome and require a large footprint that is often unsuitable for ACDF type surgeries of the cervical portion of the spine.

SUMMARY

The techniques of this disclosure generally relate, for example, to highly adjustable interbody devices that are expandable to selectively increase and decrease a spacing distance between superior and inferior endplates of the interbody device at either or both of a proximal end and/or a distal end of the implant.

In one aspect, an expandable implant movable between a contracted position and an expanded position, is disclosed. The implant may include, an expandable body extending from a proximal end to a distal end in a proximal-to-distal direction, extending from a first lateral side to a second lateral side in a widthwise direction, and extending from a superior end to an inferior end in a vertical direction, for example. In various embodiments, the expandable body may be defined by a superior endplate and an inferior endplate opposite the superior endplate, for example. In various embodiments, the superior endplate may include a first outside surface and a first inside surface opposite the first outside surface, the first inside surface may include first proximal ramps and first distal ramps disposed opposite the first proximal ramps, for example. In various embodiments, the inferior endplate may include a second outside surface and a second inside surface opposite the second outside surface, the second inside surface may include second proximal ramps and second distal ramps disposed opposite the second proximal ramps, for example. In various embodiments, a support block may be coupled to the superior endplate and the inferior endplate, the support block may have a proximal screw guide and a distal screw guide opposite the proximal screw guide, for example. In various embodiments, a proximal set screw rotatably supported by the proximal screw guide and a distal set screw rotatably supported by the distal screw guide may be provided, for example. In various embodiments, a proximal wedge may include first superior ramped surfaces and first inferior ramped surfaces, the proximal wedge may be coupled to the proximal set screw; and a distal wedge may include second superior ramped surfaces and second inferior ramped surfaces, the distal wedge may be coupled to the distal set screw, for example. In some embodiments, at least one eyelet may be disposed on a proximal end of the expandable body. In other embodiments, at least two eyelets may be disposed on opposite lateral ends of the expandable body. In various embodiments, in a contracted position the proximal wedge and the distal wedge are disposed in a medial position of the body, for example. Additionally, in some embodiments, in a first expanded position a spacing between the superior and inferior endplates at the proximal side is greater than a spacing between the superior and inferior endplates at the proximal side in the contracted position, in the first expanded position the proximal wedge may contact the first superior ramped surfaces and the first inferior ramped surfaces and is disposed proximate the proximal side, for example. Additionally, in some embodiments, in a second expanded position a spacing between the superior and inferior endplates at the distal side is greater than a spacing between the superior and inferior endplates at the distal side in the contracted position, in the second expanded position the distal wedge may contact the first and second proximal ramps and is disposed proximate the proximal side with respect to the medial position, for example.

In another aspect, a spinal implant system is disclosed. The spinal implant system may include an expandable implant movable between a contracted position and an expanded position. The implant may include, an expandable body extending from a proximal end to a distal end in a proximal-to-distal direction, extending from a first lateral side to a second lateral side in a widthwise direction, and extending from a superior end to an inferior end in a vertical direction, for example. In various embodiments, the expandable body may be defined by a superior endplate and an inferior endplate opposite the superior endplate, for example. In various embodiments, the superior endplate may include a first outside surface and a first inside surface opposite the first outside surface, the first inside surface may include first proximal ramps and first distal ramps disposed opposite the first proximal ramps, for example. In various embodiments, the inferior endplate may include a second outside surface and a second inside surface opposite the second outside surface, the second inside surface may include second proximal ramps and second distal ramps disposed opposite the second proximal ramps, for example. In various embodiments, a support block may be coupled to the superior endplate and the inferior endplate, the support block may have a proximal screw guide and a distal screw guide opposite the proximal screw guide, for example. In various embodiments, a proximal set screw rotatably supported by the proximal screw guide and a distal set screw rotatably supported by the distal screw guide may be provided, for example. In various embodiments, a proximal wedge may include first superior ramped surfaces and first inferior ramped surfaces, the proximal wedge may be coupled to the proximal set screw; and a distal wedge may include second superior ramped surfaces and second inferior ramped surfaces, the distal wedge may be coupled to the distal set screw, for example. In various embodiments, in a contracted position the proximal wedge and the distal wedge are disposed in a medial position of the body, for example. Additionally, in some embodiments, in a first expanded position a spacing between the superior and inferior endplates at the proximal side is greater than a spacing between the superior and inferior endplates at the proximal side in the contracted position, in the first expanded position the proximal wedge may contact the first superior ramped surfaces and the first inferior ramped surfaces and is disposed proximate the proximal side, for example. Additionally, in some embodiments, in a second expanded position a spacing between the superior and inferior endplates at the distal side is greater than a spacing between the superior and inferior endplates at the distal side in the contracted position, in the second expanded position the distal wedge may contact the first and second proximal ramps and is disposed proximate the proximal side with respect to the medial position, for example. Additionally, in various embodiments, the support block may further include a plurality of engagement prongs extending towards the proximal end in the proximal-to-distal direction, for example. Additionally, the system may include an insertion tool extending in a longitudinal direction from a proximal end to a distal end thereof, and the insertion tool may include a plurality of engagement arms that may have a size and shape corresponding to the plurality of engagement prongs, for example.

In another aspect, a spinal implant system is disclosed. The spinal implant system may include an expandable implant and a bone screw driving tool. The expandable implant may be movable between a contracted position and an expanded position. The implant may include, an expandable body extending from a proximal end to a distal end in a proximal-to-distal direction, extending from a first lateral side to a second lateral side in a widthwise direction, and extending from a superior end to an inferior end in a vertical direction, for example. In various embodiments, the expandable body may be defined by a superior endplate and an inferior endplate opposite the superior endplate, for example. In various embodiments, the superior endplate may include a first outside surface and a first inside surface opposite the first outside surface, the first inside surface may include first proximal ramps and first distal ramps disposed opposite the first proximal ramps, for example. In various embodiments, the inferior endplate may include a second outside surface and a second inside surface opposite the second outside surface, the second inside surface may include second proximal ramps and second distal ramps disposed opposite the second proximal ramps, for example. In various embodiments, a support block may be coupled to the superior endplate and the inferior endplate, the support block may have a proximal screw guide and a distal screw guide opposite the proximal screw guide, for example. In various embodiments, a proximal set screw rotatably supported by the proximal screw guide and a distal set screw rotatably supported by the distal screw guide may be provided, for example. In various embodiments, a proximal wedge may include first superior ramped surfaces and first inferior ramped surfaces, the proximal wedge may be coupled to the proximal set screw; and a distal wedge may include second superior ramped surfaces and second inferior ramped surfaces, the distal wedge may be coupled to the distal set screw, for example. In various embodiments, in a contracted position the proximal wedge and the distal wedge are disposed in a medial position of the body, for example. Additionally, in some embodiments, in a first expanded position a spacing between the superior and inferior endplates at the proximal side is greater than a spacing between the superior and inferior endplates at the proximal side in the contracted position, in the first expanded position the proximal wedge may contact the first superior ramped surfaces and the first inferior ramped surfaces and is disposed proximate the proximal side, for example. Additionally, in some embodiments, in a second expanded position a spacing between the superior and inferior endplates at the distal side is greater than a spacing between the superior and inferior endplates at the distal side in the contracted position, in the second expanded position the distal wedge may contact the first and second proximal ramps and is disposed proximate the proximal side with respect to the medial position, for example. Additionally, in various embodiments, the support block may further include a plurality of engagement prongs extending towards the proximal end in the proximal-to-distal direction, for example. Additionally, the system may include an insertion tool extending in a longitudinal direction from a proximal end to a distal end thereof, and the insertion tool may include a plurality of engagement arms that may have a size and shape corresponding to the plurality of engagement prongs, for example. In various embodiments, the bone screw driver comprises a handle portion and a drive portion disposed at a distal end of the handle portion, the drive portion further including a ratcheting mechanism, for example.

The details of one or more aspects of the disclosure are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the techniques described in this disclosure will be apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1A is a front perspective view of an expandable implant.

FIG. 1B is an alternate front perspective view of an expandable implant.

FIG. 2 is a top down view of an expandable implant.

FIG. 3 is a front perspective view of an expandable implant.

FIG. 4 is an alternate front perspective view of an expandable implant.

FIG. 5 is an exploded parts view of an expandable implant.

FIG. 6 is an alternate exploded parts view of an expandable implant.

FIG. 7 is an interior view of a superior endplate.

FIG. 8 is an alternate interview of a superior endplate.

FIG. 9 is an interior view of an inferior endplate.

FIG. 10 is an alternate interview of a inferior endplate.

FIG. 11 is a front perspective view of a superior portion of expandable implant.

FIG. 12 is a front perspective view of an inferior portion of expandable implant.

FIG. 13 is a front perspective view of an expandable implant in a first expanded configuration.

FIG. 14 is an alternate front perspective view of an expandable implant in a first expanded configuration.

FIG. 15 is a front perspective view of an expandable implant in a second expanded configuration.

FIG. 16 is an alternate front perspective view of an expandable implant in a second expanded configuration.

FIG. 17 is a perspective view of a cross section cut of an expandable implant in a contracted configuration.

FIG. 18 is a perspective view of a cross section cut of an expandable implant in an expanded configuration.

FIG. 19 is a perspective view of a cross section cut of an expandable implant in an expanded configuration.

FIG. 20 is a perspective view of a cross section cut of an expandable implant in an expanded configuration.

FIG. 21 is a perspective view of an inserter tool for use with disclosed expandable implants.

FIG. 22 is a perspective view of an inserter tool for use with disclosed expandable implants.

FIG. 23 is a perspective view of an inserter tool for use with disclosed expandable implants.

FIG. 24A is a perspective view of an inserter tool for use with disclosed expandable implants.

FIG. 24B is a perspective view of a distal region of an inserter tool for use with disclosed expandable implants.

FIG. 25 is a perspective view of an inserter tool coupled to an expandable implant.

FIG. 26 is a perspective view of an inserter tool and a driver tool for use with disclosed expandable implants.

FIG. 27 is a perspective view of a drive tool for use with disclosed expandable implants.

FIG. 28A is an enlarged view of a proximal end of an inserter tool in an unlocked position.

FIG. 28B is an enlarged view of a proximal end of an inserter tool in a locked position.

FIG. 29 is a cross section cut showing an inserter tool and a drive tool operably engaged with an expandable implant.

FIG. 30 is a cross section cut showing an inserter tool and a drive tool operably engaged with an expandable implant.

FIG. 31 is a perspective view of an alternate drive tool for use with disclosed expandable implants.

FIG. 32 is a cross section cut of the alternate drive tool of FIG. 31 engaged with an expandable implant.

FIG. 33 is a cross section cut of an inserter tool and an example method of use of the inserter tool.

FIG. 34 is a reference drawing showing the human spine of which various disclosed implant embodiments may be installed in.

FIG. 35 is a reference drawing showing various planes and reference directions of which the various disclosed implant embodiments may move in or act in.

FIG. 36 is a front perspective view of expandable implant.

FIG. 37 is a front perspective view of an expandable implant and a superior bone screw and inferior bone screw.

FIG. 38 is a top down view of an expandable implant.

FIG. 39A is a front view of an expandable implant showing various bone screw trajectories.

FIG. 39B is a top down view an expandable implant showing various bone screw trajectories.

FIG. 40 is a front view of an expandable implant positioned between a superior vertebrae and an inferior vertebrae.

FIG. 41 is a perspective view of a bone screw driver.

FIG. 42 is a partially removed parts view of a tip region of the bone screw driver of FIG. 41.

FIG. 43A illustrates a first aspect of an installation procedure utilizing an expandable implant and a bone screw driver.

FIG. 43B illustrates a second aspect of an installation procedure utilizing an expandable implant and a bone screw driver.

FIG. 43C illustrates a third aspect of an installation procedure utilizing an expandable implant and a bone screw driver.

FIG. 43D illustrates a fourth aspect of an installation procedure utilizing an expandable implant and a bone screw driver.

FIG. 44 illustrates a front perspective view of a bone screw plate for use with disclosed expandable implants.

FIG. 45 illustrates an alternate front perspective view of a bone screw plate for use with disclosed expandable implants.

FIG. 46 illustrates a top down view of a bone screw plate.

FIG. 47 illustrates an exploded parts view of a bone screw plate.

FIG. 48 illustrates a front perspective view of a bone screw plate securely coupled to an expandable implant.

FIG. 49 illustrates a front view of a bone screw plate securely coupled to an expandable implant.

FIG. 50 illustrates a top down view of a bone screw plate securely coupled to an expandable implant.

DETAILED DESCRIPTION

Embodiments of the present disclosure relate generally, for example, to spinal implants, spinal stabilization systems, surgical instruments for use with spinal stabilization systems, and more particularly to spinal implants having eyelets. Embodiments of the devices and methods are described below with reference to the Figures.

The following discussion omits or only briefly describes certain components, features and functionality related to medical implants, installation tools, and associated surgical techniques, which are apparent to those of ordinary skill in the art. It is noted that various embodiments are described in detail with reference to the drawings, in which like reference numerals represent like parts and assemblies throughout the several views, where possible. Reference to various embodiments does not limit the scope of the claims appended hereto because the embodiments are examples of the inventive concepts described herein. Additionally, any example(s) set forth in this specification are intended to be non-limiting and set forth some of the many possible embodiments applicable to the appended claims. Further, particular features described herein can be used in combination with other described features in each of the various possible combinations and permutations unless the context or other statements clearly indicate otherwise.

Terms such as “same,” “equal,” “planar,” “coplanar,” “parallel,” “perpendicular,” etc. as used herein are intended to encompass a meaning of exactly the same while also including variations that may occur, for example, due to manufacturing processes. The term “substantially” may be used herein to emphasize this meaning, particularly when the described embodiment has the same or nearly the same functionality or characteristic, unless the context or other statements clearly indicate otherwise.

Referring generally to FIGS. 1-4 various views of an expandable implant are illustrated. For example, FIGS. 1A-1B and 3-4 are various perspective views of an expandable implant 100 and FIG. 2 is a top down view of an expandable implant showing various axes and points of reference. As illustrated, expandable implant 100 may include a proximal end 100p, a distal end 100d, and first and second lateral sides 100l. The proximal end 100p may include an adjustment aperture 101 and an engagement cutout 103 for use with various surgical tools disclosed in FIGS. 21-33. As shown in FIG. 2, implant 100 may extend in a proximal-to-distal direction from the proximal end 100p to the distal end 100d though axis P-D through the center of the implant 100, for example. Implant 100 may extend in a widthwise direction from the first lateral side 100l to the second lateral side 100l through a widthwise axis W-W through the center of the implant 100, for example. Axis P-D may be perpendicular and/or substantially perpendicular to the widthwise axis B-B. Various example section cuts through cross section C-C are illustrated in FIGS. 17-20. In various embodiments, superior endplate 10 may include connection points 11 and inferior endplate 20 may include connection points 21. Connection points 11, 21 may be indentations along the proximal end of each of superior and inferior endplates 10, 20, for example. In various embodiments, connection points 11, 21 may be used to secure a bone screw plate (not illustrated) and the bone screw plate may include various apertures and fasteners for securing bone screws to a boney structure, such as a vertebrae. Superior endplate 10 may include a first slot 13 and a second slot 14 on opposite lateral ends thereof, for example. Similarly, inferior endplate 20 may include a third slot 23 and a fourth slot 24 on opposite lateral ends thereof, for example. Slots 13, 14, 23, 24 may be used to constrain a support block 30 (see FIG. 5) within the interior of the superior and inferior endplates 10, 20. A distal side of superior endplate 10 may include a curved indentation 16 for accommodating the spinal canal. Similarly, inferior endplate 20 may include a curved indentation 26 for accommodating the spinal canal. The curved indentations may be curved inward towards a medial portion of implant (e.g., from a distal end 100d towards a proximal end 100p) and extend in the width wise direction W-W, for example.

FIGS. 5-6 are various exploded parts views of an expandable implant 100. The superior and inferior endplates 10, 20 may be movable with respect to one another in the vertical direction and also may be inclinable, e.g., capable of distraction and lordosis and even kyphotic adjustments. The superior endplate 10 and inferior endplate 20 may be operably engaged and/or coupled with one another by a support block 30, for example. Support block 30 may include a first post 34 and a second post 33 on each lateral side surface of support block 30. For example, first post 34 may be an elongate cylindrical post extending in the widthwise direction W-W from support block and second post 33 may be a relatively shorter elongate cylindrical post extending in the widthwise direction, for example. Additionally in some embodiments, post 34 and post 33 may have an inclined end cap having a planar end surface approximating the shape of an oval. Similarly, the other lateral side of support block 30 may also include a first post 34 and a second post 33. In some embodiments, the posts 34, 33 on opposite lateral ends may be transposed. For example, on a first lateral end, post 34 may be above post 33 and on the other lateral end post 33 may be above post 34. This arrangement may facilitate the symmetrical transference of forces throughout implant 100, for example. Additionally, posts 34 may extend through slotted apertures 14, 24 of superior and inferior endplates 10, 20, for example. Similarly, posts 33 may extend through slotted apertures 13, 23 of superior and inferior endplates 10, 20, for example.

Support block 30 may include a plurality of engagement prongs 32 or post like structures extending towards proximal end 100p. In the example illustration, four engagement prongs 32 are symmetrically distributed at respective corners of a proximal end of support block 30. However, other embodiments may include more or less engagement prongs 32, for example, 1, 2, 3, 5, 6, etc. Engagement prongs 32 may be used to couple implant 100 to an inserter tool 200, as will be explained in further detail below. Support block 30 may include a proximal screw guide 31p and a distal screw guide 31d. The proximal and distal screw guides 31p, 31d may each be defined by a circular aperture having an internal circumferential surface including a thread pattern and define a rotation axis extending through a center of the thread pattern, respectively. In some embodiments, the thread patterns may be reversed and in other embodiments they may be the same. The proximal screw guide 31p may rotatably support a proximal set screw 40 and the distal screw guide 31d may rotatably support a distal set screw 50, for example. The proximal set screw 40 may include a thread pattern 41 extending along a portion of the outside circumferential surface thereof and a drive engagement surface 43 extending along a portion of the inside circumferential surface thereof. A remaining portion of the outside circumferential surface thereof may be defined by a diameter that is less than a diameter of the portion of set screw 40 having thread pattern 41, for example. For example, a smooth circumferential surface 44 that is inset towards an axial centerline of set screw 40 and with respect to thread pattern 41. For example still, one end of set screw 40 may include a thread pattern 41 and the other end may include an inset circumferential surface 44 having at least one flange 42 on an end thereof. In some embodiments, an upper and lower flange 42 are provided, and in other embodiments the flange 42 extends all the way around the end of circumferential surface 44 as an annular ring. Similarly, the distal set screw 50 may include a thread pattern 51 extending along a portion of the outside circumferential surface thereof and a drive engagement surface 53 extending along a portion of the inside circumferential surface thereof. A remaining portion of the outside circumferential surface thereof may be defined by a diameter that is less than a diameter of the portion of set screw 50 having thread pattern 51, for example. For example, a smooth circumferential surface 54 that is inset towards an axial centerline of set screw 50 with respect to thread pattern 51. For example still, one end of set screw 50 may include a thread pattern 51 and the other end may include an inset circumferential surface 54 having at least one flange 52 extending from an end thereof. In some embodiments, an upper and lower flange 52 are provided, and in other embodiments the flange 52 extends all the way around the end of circumferential surface 54 as an annular ring.

Implant 100 may include a proximal wedge structure 60 and a distal wedge structure 70. Proximal wedge structure 60 may be operably coupled to proximal set screw 40 and distal wedge structure 70 may be operably coupled to distal set screw 50, for example. Proximal wedge 60 may include an aperture 61 having a size and shape corresponding to circumferential surface 44. For example, set screw 40 may be coupled to proximal wedge 60 by disposing the circumferential surface 44 within aperture 61 such that flanges 42 extend through aperture 61 and securely couple the proximal wedge 60 with proximal set screw 40 such that proximal set screw 40 may rotate within aperture 61. Additionally, flange 42 may permit axial translation of forces, for example by pushing and/or pulling. Proximal wedge 60 may further include a pair of superior ramped surfaces 63 and a pair of inferior ramped surfaces 64. Superior ramped surfaces 63 may be disposed on opposite lateral ends of proximal wedge 60 from one another and inferior ramped surface 64 may be disposed on opposite lateral ends of proximal wedge 60 from one another. Similarly, distal wedge structure 70 may include an aperture 71 having a size and shape corresponding to circumferential surface 54 of distal set screw 50. For example, set screw 50 may be coupled to distal wedge 70 by disposing the circumferential surface 54 within aperture 71 such that flanges 52 extend through aperture 71 and securely couple the distal wedge 70 with distal set screw 50 such that distal set screw 50 may rotate within aperture 71 and permit axial translation of forces. Distal wedge 70 may further include a pair of superior ramped surfaces 73 and a pair of inferior ramped surfaces 74. Superior ramped surfaces 73 may be disposed on opposite lateral ends of distal wedge 70 from one another and inferior ramped surfaces 74 may be disposed on opposite lateral ends of distal wedge 70 from one another.

Referring generally to FIGS. 7-8, there are various interior views of an interior of a superior endplate 10 and referring generally to FIGS. 9-10, there are various views of an interior of an inferior endplate. The proximal wedge 60 and distal wedge 70 may act against various surfaces of superior and inferior endplates 10, 20 to expand, contract, and incline implant 100 in various positions. For example, superior endplate 10 may include a pair of proximal ramps 18 that are disposed proximate the proximal end of superior endplate 10 and are inclined from a medial position of superior endplate 10 towards the proximal end 100p of implant 100, for example. In the disclosed embodiment, a first proximal ramp 18 and a second proximal ramp 18 are disposed on opposite sides of superior engagement cutout 103s. Additionally, superior endplate 10 may include a pair of distal ramps 19 that are disposed proximate the distal end of superior endplate 10 and are inclined from a medial position of superior endplate 10 towards the distal end 100d of implant 100. In the disclosed embodiment, a first distal ramp 19 and a second distal ramp 19 are disposed on opposite sides of curved indentation 16, for example.

Similarly, inferior endplate 20 may include a pair of proximal ramps 28 that are disposed proximate the proximal end of inferior endplate 20 and are inclined from a medial position of inferior endplate 20 towards the proximal end 100p of implant 100, for example. For example, inferior endplate 20 may include a pair of proximal ramps 28 that are disposed proximate the proximal end of inferior endplate 20 and are inclined from a medial position of inferior endplate 20 towards the proximal end 100p of implant 100, for example. In the disclosed embodiment, a first proximal ramp 28 and a second proximal ramp 28 are disposed on opposite sides of inferior engagement cutout 103i. Additionally, inferior endplate 20 may include a pair of distal ramps 29 that are disposed proximate the distal end of inferior endplate 20 and are inclined from a medial position of inferior endplate 20 towards the distal end 100d of implant 100. In the disclosed embodiment, a first distal ramp 29 and a second distal ramp 29 are disposed on opposite sides of curved indentation 26, for example. As will be explained in more detail below, superior ramped surfaces 63 of proximal wedge 60 may directly contact and act against proximal ramps 18 of superior endplate 10 and inferior ramped surfaces 64 of proximal wedge 60 may directly contact and act against proximal ramps 28 of inferior endplate 20. As will be explained in more detail below, superior ramped surfaces 73 of distal wedge 70 may directly contact and act against distal ramps 19 of superior endplate 10 and inferior ramped surfaces 74 of distal wedge 70 may directly contact and act against distal ramps 29 of inferior endplate 20.

Referring generally to FIGS. 11-16, there are various perspective views of an expandable implant 100 in a contracted position and in various expanded configurations. As shown in FIG. 11, superior endplate 10 is bi-concave. For example, superior endplate 10 is concave in the proximal-to-distal direction P-D along curved line 10-P-D and superior endplate 10 is concave in the widthwise direction W-W along curved line 10-W-W. This arrangement may be advantageous for mating with the concavity of a lower surface of a superior endplate of an adjacent vertebrae (not illustrated), for example. Other embodiments may have substantially planar upper surfaces and/or be concave in only one of the proximal-to-distal direction P-D and widthwise direction W-W. For example, inferior endplate 20 may be uni-convex. As shown in FIG. 12, the inferior endplate 20 is convex in at least one direction. For example, inferior endplate is convex in a widthwise direction W-W along curved line 20-W-W. This arrangement may be advantageous for mating with the concavity of an upper surface of an inferior endplate of an adjacent vertebrae (not illustrated). In some embodiments, the curvature of the superior endplate 10 and inferior endplate 20 may be lordotic relative to one another. In some embodiments, the curvature of the superior endplate 10 and inferior endplate 20 may have different amounts of lordosis relative to a central horizontal plane of support block 30, for example.

FIG. 13 illustrates an example configuration of implant 100 in an expanded and inclined position, e.g., a partially distracted and lordosed position. In FIGS. 13-14, it is illustrated that the proximal wedge 60 has moved towards the proximal end 100p of implant 100 in the proximal-to-distal direction P-D, for example. Proximal wedge 60 may have moved towards the proximal end 100p from a medial position due to proximal set screw 40 being rotated within proximal screw guide 31p such that proximal set screw 40 is linearly translated towards proximal end 100p of implant 100. In doing so, proximal set screw 40 pushes proximal wedge 60 towards proximal end 100p. Due to the inclination of superior ramps 64 and inferior ramps 63, the superior and inferior endplates 10, 20 are pushed apart at the proximal end 100p. For example, superior ramps 64 may slide along proximal ramps 18 of superior endplate 10 and inferior ramps 63 may slide along proximal ramps 28 of inferior endplate 20. In this way, set screw 40 linearly translates proximal wedge 60 such that superior and inferior ramps 64, 63 act against the superior and inferior endplates 10, 20 to urge them apart from one another at the proximal end 100p of implant 100.

As shown in FIGS. 15-16, implant 100 may be distracted in a parallel manner where the superior and inferior endplates 10, 20 are substantially parallel to one another and/or a height between superior and inferior endplates 10, 20 is about the same at the proximal end 100p and distal end 100d of implant 100, for example. The distal end 100d of implant 100 may have been expanded as illustrated due to distal wedge 70 being moved towards the distal end 100d of implant 100 in the proximal-to-distal direction P-D, for example. Distal wedge 70 may have moved towards the distal end 100d from a medial position due to distal set screw 50 being rotated within distal screw guide 31d such that distal set screw 50 is linearly translated towards distal end 100d of implant 100. In doing so, distal set screw 50 pushes distal wedge 70 towards distal end 100d. Due to the inclination of superior ramps 74 and inferior ramps 73, the superior and inferior endplates 10, 20 are pushed apart at the distal end 100d. For example, superior ramps 74 may slide along distal ramps 19 of superior endplate 10 and inferior ramps 73 may slide along distal ramps 29 of inferior endplate 20. In this way, set screw 50 linearly translates distal wedge 70 such that superior and inferior ramps 74, 73 act against the superior and inferior endplates 10, 20 to urge them apart from one another at the distal end 100d of implant 100.

Referring generally to FIGS. 17-20, various cross section views of an expandable implant 100 in a contracted configuration and an expanded configuration are shown. As shown in FIG. 17, implant 100 is in a contracted position and each of the proximal wedge 60 and distal wedge 70 are in a medial position. Furthermore, posts 34, 33 of support block 30 are engaged with the superior and inferior endplates 10, 20 by extending through slots 14, 23, respectively. As shown in FIG. 18, posts 34, 33 of support block 30 have changed a relative position within slots 14, 23 (relative to FIG. 17) to accommodate the increase in height at the proximal end 100p. For example, posts 34, 33 are fixed to support block 30 and the superior and inferior endplates 10, 20 may have expanded relative to support block 30 and therefore posts 34, 33 are shown in a different position relative to slots 14, 23. In FIG. 18, proximal wedge 60 may have moved towards the proximal end 100p due to proximal set screw 40 being rotated and thereby pushing proximal wedge 60 towards proximal end 100p, for example. Additionally, superior ramps 64 and inferior ramps 63, may act against the superior and inferior endplates 10, 20 to push them apart. For example, superior ramps 64 may slide along proximal ramps 18 of superior endplate 10 and inferior ramps 63 may slide along proximal ramps 28 of inferior endplate 20. In this way, set screw 40 linearly translates proximal wedge 60 towards proximal end 100p such that superior and inferior ramps 64, 63 act against the superior and inferior endplates 10, 20 to urge them apart from one another. Additionally, in some embodiments lower proximal ramps 18a may be provided at the proximal end of superior endplate 10. Lower proximal ramps 18a may act as a catch surface such that when set screw 40 is rotated in the opposite direction a lower surface 63a of superior ramps 63 may push against lower proximal ramps 18a to facilitate closing of the implant 100, for example.

FIG. 19 is a cross section drawing through line C-C of FIG. 2. As shown in FIG. 19, posts 34, 33 of support block 30 have changed a relative position within slots 14, 23 (relative to FIG. 18) to accommodate the increase in height at the distal end 100d. For example, post 34 has moved through slot 14 to a lower position and post 33 has moved to an upper position within slot 23. With reference back to FIG. 15, slots 14, 23 extend in a lateral direction and posts 34, 14 are engaged within slots 14, 23 throughout the full range of expansion (although it may appear that in FIGS. 18-19 slot 14 is open at a bottom end this is due to the section being drawn through line C-C of FIG. 2, for example). In this way, support block 30 may remain coupled to implant 100. Additionally, distal wedge 70 may have moved towards the distal end 100d due to distal set screw 50 pushing distal wedge 70 towards distal end 100d. Additionally, superior ramps 74 and inferior ramps 73 may act against the superior and inferior endplates 10, 20 and push them apart at the distal end 100d. For example, set screw 50 linearly translates distal wedge 70 such that superior and inferior ramps 74, 73 act against the superior and inferior endplates 10, 20 to urge them apart from one another at the distal end 100d of implant 100. In some embodiments, upper distal ramps 29a may act as a catch surface such that when set screw 50 is rotated in the opposite direction an upper surface 74a of inferior ramps 74 may push against upper distal ramps 29a to facilitate closing of the implant 100, for example. For example, as shown in FIG. 20, a height between the superior and inferior endplates 10, 20 at distal end 100d is less than a height between the superior and inferior endplates 10, 20 at distal end 100d of FIG. 19. This may occur due to distal wedge 70 being moved in the proximal-to-distal direction towards a medial position of implant and upper distal ramps 29a acting as a catch surface as explained above, for example. Those with skill in the art will appreciate that implant 100 is continuously adjustable at any level of distraction and/or lordosis between the fully collapsed position (see FIG. 17) and a fully expanded position (see FIG. 19).

Referring generally to FIGS. 21-28B various views of an inserter tool 200 and a drive tool 300 for use with disclosed expandable implants 100 are shown. Inserter tool 200 may extend from a proximal end to distal end and include a hollow outer shaft 201 and a hollow inner shaft 203. The hollow outer shaft 201 may include support walls 207 at a distal end thereof having a size and shape close the flexible tip of shaft 203. For example, seam 203s may enable the distil end of shaft 203 to be compressed together when shaft 203 is insert within outer shaft 201 such that engagement arms 204 are moved closer together. Hollow outer shaft 201 may include a gripping handle 202 extending therefrom and in various embodiments, gripping handle 202 may be a stationary handle or a movable handle (not illustrated). Additionally, hollow inner shaft 203 may include engagement arms 204 at a distal end thereof, for example. Engagement arms 204 may be used to grip implant 100 at engagement prongs 32, for example (see FIGS. 24A and 24B). Additionally, engagement arms 204 may have a size and shape generally corresponding to a size and shape of engagement prongs 32. For example, engagement arms 204 may surround (or at least partially surround) engagement prongs 32 and securely grip engagement prongs 32 such that implant 100 may be retained by inserter tool 200 and inserted into a disc space. In various embodiments, engagement arms 204 may have outdents and/or protrusions that engage corresponding grooves and/or recesses of engagement prongs 32 (not illustrated). Inserter tool 200 may include a hollow outer shaft 201 and a hollow inner shaft 203. As shown in FIG. 22, hollow inner shaft 203 may be inserted within and disposed within hollow outer shaft 201, for example. Hollow inner shaft 203 may include a threaded end 205 at a proximal end thereof. Threaded end 205 may extend beyond the proximal end of hollow outer shaft 201 such that a coupling member 206 having an internal thread pattern corresponding to the threaded end 205 may be attached to a proximal end of hollow inner shaft 203. Once coupling member 206 is sufficiently tightened the hollow outer shaft 201 and hollow inner shaft 203 may be securely coupled. Additionally, as coupling member 206 is rotated, the inner shaft 203 is pulled deeper within outer shaft 205 such that a compressive force may be applied at the engagement arms 204 via interior surfaces of support walls 207 thereby providing a strong clamping force around engagement prongs 32 of implant 100 (see FIGS. 21-25).

Once the coupling member 206 is sufficiently tightened such that engagement arms 204 are secured to engagement prongs 32, a drive tool 300 may be inserted through an aperture of coupling member 206 and into the hollow interior of inner shaft 203 (see FIG. 26). Drive tool 300 may extend in a proximal to distal direction and include a handle 302 at a proximal end and a drive end 301 at a distal end, for example. Additionally, drive tool 300 may include a first circumferential channel 303 and a second circumferential channel 304 that may be indented along an outside surface of drive tool 300. In the example, embodiment, a depressible lock 207 of coupling member 206 may selectively engage and disengage with either one of the first circumferential channel 303 and a second circumferential channel 304 to position drive tool 300 at relative axially aligned positions within the interior of hollow interior shaft 203. For example, as shown in FIG. 28A depressible lock 207 is disengaged and as shown in FIG. 28B depressible lock 207 is depressed such that an indent or the like may b retained circumferential channels 303 or 304. A relative distance between the first circumferential channel 303 and a second circumferential channel 304 may correspond to a distance between the proximal set screw 40 and distal set screw 50, for example.

In this way, toggling between engaging the depressible lock 207 with either one of the first and second circumferential channels 303, 304 may affect whether drive end 301 engages with both the distal set screw 50 and proximal set screw 40 or alternatively just the proximal set screw 40, for example. As shown in FIG. 29, the depressible lock 207 may be engaged with the second circumferential channel 304 such that drive end 301 may simultaneously drive both the distal set screw 50 and proximal set screw 40. As shown in FIG. 30, the depressible lock 207 may be engaged with the first circumferential channel 303 such that drive end 301 is only engaged with the proximal set screw 40. At least one advantage of this configuration is that an end user such as a surgeon may simultaneously rotate the proximal and distal set screws 40, 50 to cause parallel distraction or rotate only the proximal set screw 40 to cause lordosis.

FIG. 31 illustrates an alternate drive tool 300a. Alternate drive tool 300a may include the same, substantially the same, and or similar characteristics as explained above with respect to drive tool 300. However, alternate drive tool 300a may include a necked down portion 305 and a drive end 301a having a size and shape suitable for only engaging one of the proximal set screw 40 or distal set screw 50 at a time. For example, the necked down portion 305 may have a smaller cross sectional diameter (thickness) than the drive end 301a. This arrangement may be particularly advantageous for engaging only the distal set screw 50 to change a relative height between the superior and inferior endplates 10, 20 at the distal end 100d only, for example. As shown in FIG. 32, drive end 301a is only engaged with the distal set screw 50 and the necked down portion 305 is narrow enough such that it does not contact the interior circumferential surface of set screw 40, for example. Similarly, this arrangement may be particularly advantageous for engaging only the proximal set screw 40 to change a relative height between the superior and inferior endplates 10, 20 at the proximal end 100p only, for example. Furthermore, when engaging only distal set screw 50, a relative height between the superior and inferior endplates 10, 20 at the distal end 100d may be changed, for example to create kyphosis.

In some embodiments, after implant 100 is expanded into a target configuration suitable for a particular patient, bone graft material (BGM) may be injected into implant 100. For example, flowable bone graft material may be injected under pressure. For example, as shown in FIG. 33, the drive tool 300 (or alternate drive tool 300a) may be removed from within the hollow interior of inner shaft 203. Thereafter, bone growth promoting material may be injected through the hollow interior of inner shaft 203 and into the interior of implant 100. For example, bone growth promoting material may flow through shaft 203, through set screw 40, through a central cavity of block support block 30 and into contact with the endplates of adjacent vertebrae. Additionally, lateral holes between posts 34, 33 of support block 30 may allow additional bone growth promoting material to flow out in a lateral direction and into the interior of implant 100 and to surround wedges 60, 70. In this way, the entire interior space of implant 100 may be filled with bone growth promoting material to promote fusion. In some embodiments, flexible curtains (not illustrated) may extend from superior endplate 10 and/or inferior endplate 20 across gaps that may be created between endplates 10, 20 due to expanding the endplates. In some embodiments, a distal most end of distal set screw 50 may also be closed to prevent material from flowing out of distal set screw 50. Additionally, and depending on the type of surgery performed and the various patient anatomy that may contact the implant 100, curtains may not be required, as the patient anatomy would provide a retaining surface to keep material within implant 100.

FIG. 34 is a reference drawing showing the human spine of which various disclosed implant embodiments may be installed in. FIG. 35 is a reference drawing showing various planes and reference directions of which the various disclosed implant embodiments may move in or act in with reference to a patient 1.

Referring generally to FIGS. 36-40, various views of an expandable implant 400 having eyelets 82, 84 is disclosed. Implant 400 may include the same, similar, and/or substantially the same components and functionality as implant 100. For example, implant 400 may include the same, similar, and/or substantially the same moving mechanism as implant 100 (see FIGS. 5-6). Additionally implant 400 may utilize the inserter tool 200 and drive tool 300 in the same, similar, and/or substantially the same manner as explained above. Furthermore, implant 400 may include similar geometric attributes such as curvature (see FIGS. 11, 12) and/or cutouts 11, 21, 16, 26 (see FIGS. 1A, 1B, and 3).

In various embodiments, implant 400 may include at least one eyelet 82, 84. In some embodiments, eyelets 82, 84 may be referred to as apertures and/or lumens and may be shaped to orient and support a bone screw 90 along a corresponding target trajectory, for example. In the example embodiment, superior endplate 10 may include an eyelet 82 disposed on a proximal side 100p at a farthest lateral end 1001 thereof, e.g., the front right corner when viewed from the perspective of FIG. 36. Additionally, superior endplate 10 may include a superior aperture 83 in a superior endplate surface such that a bone screw 90 may pass through eyelet 82 and superior aperture 83. In various embodiments, eyelet 82 may take a circular and/or conical shape and include a rim 82a which may serve as a stop feature for a head 91 of a bone screw 90, for example. In this way, rim 82a may securely orient a bone screw 90 in a target trajectory. In various embodiments, rim 82a may be continuous around the inside of eyelet 82 and in other embodiments rim 82a may be discontinuous, for example to accommodate lateral cutouts in the side portions of eyelet 82 and/or other geometric features. It shall be understood that eyelets 84 and 82 may include the same, similar, and/or substantially the same features although some attributes of eyelets 82, 84 may not be fully visible from the various orientations shown in the drawings. Accordingly, where one eyelet 82, 84 illustrates a feature it shall be understood the other eyelet 82, 84 may include the same feature.

Inferior endplate 20 may include an eyelet 84 disposed on a proximal side 100p at a farthest lateral end 100l thereof, e.g., the front left corner when viewed from the perspective of FIG. 36. Inferior endplate 20 may include an inferior aperture 85 in an outermost surface thereof such that a bone screw 90 may pass through eyelet 84 and inferior aperture 85. In various embodiments, eyelet 84 may take a circular and/or conical shape and include a rim 84a which may serve as a stop feature for a head 91 of a bone screw 90, for example. In this way, rim 84a may securely orient a bone screw 90 in a target trajectory. In various embodiments, rim 84a may be continuous around the inside of eyelet 84 and in other embodiments rim 84a may be discontinuous, for example to accommodate lateral cutouts in the side portions of eyelet 84 and/or other geometric features.

As shown in FIGS. 39A and 39B, eyelets 82, 84 may orient a bone screw 90 in a target trajectory. Eyelet 82 may orient a bone screw 90 in first target trajectory 93, e.g., a superior direction along a lateral-to medial trajectory. As shown in FIGS. 39A and 39B, eyelets 82, 84 may orient a corresponding bone screw in a lateral-to-medial direction. For example, as seen in the plan view of FIG. 39B, the first target trajectory 93 extends in a lateral-to-medial trajectory across the top surface (outside surface) of superior endplate 10. Similarly, eyelet 84 may orient a bone screw 90 in a second target trajectory 94, e.g., an inferior direction along a lateral-to medial trajectory. As shown in FIG. 39B, in a plan view the second target trajectory 94 extends in a lateral-to-medial trajectory underneath the bottom surface (outside surface) of inferior endplate 20. At least one advantage of this lateral-to-medial trajectory is that each eyelet 82, 84 may allow a relatively great acute angle-of-incidence with a corresponding boney member, such as a superior and inferior vertebrae, for example. This orientation provides a relatively greater anchoring force because the associated force to pull the bone screw out may be greater because the associated forces are more perpendicular to the corresponding bone screws 90. As shown in FIG. 39B, in various embodiments an internal angle of trajectory 93 (and trajectory 94) may be about 20 degrees to about 30 degrees with respect to the longitudinal axis, for example. In some embodiments, the internal angle may be about 25 degrees.

Additionally, in various embodiments the eyelets 82, 84 protrude laterally to a corresponding side farther than the remaining lateral sides of implant 400 in the medial and distal portions. For example, in the plan view shown in FIG. 39B, eyelet 82 is disposed on a farthest lateral edge from a central longitudinal axis extending in the proximal to distal direction P-D through a center of implant 400. Similarly, eyelet 84 is disposed on a farthest lateral edge from a central longitudinal axis extending in the proximal to distal P-D direction through a center of implant 400. As shown in FIG. 40, implant 400 is installed between a superior vertebrae and an inferior vertebrae and each bone screw 90 extends in a lateral-to-medial trajectory.

Referring generally to FIGS. 41-42 a bone screw driver 500 is illustrated. FIGS. 43A, 43B, 43C, and 43D illustrate an installation sequence utilizing a bone screw driver 500 and an expandable implant 400. In various embodiments, bone screw driver 500 may include a handle 501 that extends in a proximal to distal direction and is securely coupled to a driving tip 502. Those with skill in the art will appreciate that a lenght of handle 501 may directly correspond to an ultimate force (torque) provided at driving tip 502. Driving tip 502 may extend in a perpendicular direction relative to an extension direction of handle 501, for example. In the illustrated embodiment, driving tip 502 extends away from handle 501 at about 90 degrees. However, in other embodiments, driving tip 502 may be angled at about 60 degrees, and in other embodiments driving tip may be angled at about 45 degrees. It shall be understood that driving tip 502 may be angled relative to handle 501 at any angle within a range of about 45 degrees to about 90 degrees, for example. At least one advantage of an angled driving tip 502 may be that it facilitates driving bone screws 90 in the target trajectory in situations where space may be limited. For example, space may be limited when installing bone screws 90 due to incision size, the particular location of implant 400 in the human body, and/or the relatively great angle of repose eyelets 82, 84 accommodate. Additionally, the lateral-to-medial trajectory may make it difficult for other drivers to be able to access the head portion 91 at this angle. However, a straight head drive tool, such as drive tool 300 shown in FIG. 31 may be used in some situations.

As shown in FIG. 42, a removed parts view of a proximal end of bone screw driver 500 is illustrated. In the example embodiment, it is shown that an interior of driver tip 502 includes a toothed ratchet 504 (may also be referred to as a toothed gear) that is in contact with pawl 503. Pawl 503 may be biased towards ratchet 504 by a coil spring 506, for example. Pawl 503 allow ratchet 504 (and driver tip 502) to rotate in a single direction when it is engaged and prevent rotation in the opposite direction. In the example configuration and from the particular perspective shown in FIG. 42, as the ratchet rotates clockwise, the teeth of ratchet 504 may lift or move the pawl out of the way, allowing the driver handle 501 to be rotated without transferring a rotation force to driver tip 502. This may allow an end user such as a surgeon to reset a position of handle 501 to perform an additional drive rotation without requiring the drive tip 502 to be uncoupled from the head portion 91 of a bone screw 90, for example. Conversely, as the ratchet spins counter-clockwise, the pawl 503 binds against the ratchet and prevents its rotation thereby transferring the rotational force of the handle 501 through to the driving tip 502. In some embodiments, pawl 506 may slide forward and backward in a proximal-to-distal direction along a dovetail shaped track that prevents it from slipping out in a lateral direction while also allowing it to slide forward and backward in the proximal-to-distal direction, for example.

In FIG. 43A an implant 400 may be positioned beneath a superior vertebrae and in FIG. 43B bone screw driver 500 may be rotated clockwise (to the right in the perspective view of FIG. 43B) to tighten the bone screw 90 within the superior vertebrae, for example. As the bone screw driver 500 is rotated clockwise, the pawl 503 may bind against ratchet 504 thereby transmitting the full rotational force from handle 501 to drive end 502 as explained above. Thereafter, as shown in FIG. 43C the bone screw driver 500 may be rotated counter-clockwise (to the left in the perspective view of FIG. 43C). As the bone screw driver 500 is rotated counter-clockwise the pawl 503 may disengage from ratchet 504 thereby preventing the rotational force from handle 501 to drive end 502 as explained above. Thereafter, as shown in FIG. 43D, the bone screw driver 500 is rotated clockwise again, thereby continuing to drive the bone screw 90 farther into the superior vertebrae. Once the bone screw 90 is driven to a target depth, an end user may reposition bone screw driver 500 to finish driving the other bone screw 90 into the inferior vertebrae, for example.

Referring generally to FIGS. 44-50, a modular bone screw endplate 600 for use with various implants 100, 400 disclosed herein is illustrated. As shown in FIG. 44 a bone screw endplate 600 including four bone screw apertures 601 is illustrated. Bone screw endplate 600 may include a retaining pin 620 which may facilitate securely coupling to and uncoupling from implant 400, as will be explained in further detail below. Bone screw endplate 600 may include a rotatable lock 610 which may be rotated clockwise and/or counterclockwise to block various bone screws 90 when installed into a final position through bone screw aperture 601, for example. As shown in the top down view of FIG. 46, bone screw endplate 600 may be curved and include a the same, similar, and/or substantially the same curvature as the proximal end of implant 400, for example. Accordingly, the curvature of implant 400 wont restrict securing the bone screw endplate 600 to the implant 400 and vice-versa. Bone screw endplate may further include other geometric indentations to accommodate eyelets 82, 84. For example, a profile of curvature of the medial section may include an eyelet profile portion 630 at a region corresponding to a location of eyelets 82, 84. In various embodiments, eyelet profile portions 630 directly contact eyelets 82, 84 and have various mating features. In other embodiments, eyelet profile portions 630 may snuggly fit against eyelets 82, 84 and facilitate a secure connection between implant 400 and bone screw endplate 600 by providing a counter torque surface to prevent rotation of bone screw endplate 600.

FIG. 47 illustrates an exploded parts view of bone screw endplate 600. In the example embodiment, it is shown that locking wheel 610 includes a drive engagement aperture 611 for rotating the locking wheel 610, for example. In the example embodiment, locking wheel 610 includes four locking arms 612 which correspond in number to the four bone screw apertures 601. Additionally, locking arms 612 correspond in length to a distance from central aperture 614 to about a center of bone screw head 91. In this way, as the locking wheel 610 is rotated it may prevent and/or suppress the bone screws 90 from backing out by blocking them on the proximal side of implant 400, for example. In some embodiments, a small gap may exist between the distal side of locking arms 612 (rear side from the perspective of FIG. 47) and the head 91 of a bone screw when it is fully installed. In other embodiments, the locking arms 612 may directly contact a head 91 of a corresponding bone screw 90 when it is fully installed. In the example embodiment, retaining pin 620 may be securely positioned in retaining pin cavity 621 which may enable bone screw endplate 600 to securely couple to implant 400 between the inferior engagement cutout 103i and superior engagement cutout 103s adjacent engagement prongs 32, for example (see FIG. 36).

FIG. 48 illustrates a perspective view of a fully assembled implant system including an implant 400 having eyelets 82, 84 and a bone screw endplate 600 coupled thereto. FIG. 49 illustrates a front view of the fully assembled implant system. In the front view it is shown that drive engagement aperture 611 is coaxially aligned with aperture 614 therefore allowing a drive tool, such as the drive tool 300 illustrated in FIG. 31 to adjust a kyphotic and/or lordotic angle of implant 400 by actuation of set screw 40 and 50 (see FIG. 5) as explained previously. In this way, an end user such as a surgeon may continue to adjust the kypotic and/or lordotic angle of implant 400 if needed, for example.

It should be understood that various aspects disclosed herein may be combined in different combinations than the combinations specifically presented in the description and accompanying drawings. For example, features, functionality, and components from one embodiment may be combined with another embodiment and vice versa unless the context clearly indicates otherwise. Similarly, features, functionality, and components may be omitted unless the context clearly indicates otherwise. It should also be understood that, depending on the example, certain acts or events of any of the processes or methods described herein may be performed in a different sequence, may be added, merged, or left out altogether (e.g., all described acts or events may not be necessary to carry out the techniques).

Unless otherwise specifically defined herein, all terms are to be given their broadest possible interpretation including meanings implied from the specification as well as meanings understood by those skilled in the art and/or as defined in dictionaries, treatises, etc. It must also be noted that, as used in the specification and the appended claims, the singular forms “a,” “an” and “the” include plural referents unless otherwise specified, and that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof.

Claims

1. An expandable implant movable between a contracted position and an expanded position, comprising: an expandable body having a longitudinal axis extending through a center of the expandable body from a proximal end to a distal end in a proximal-to-distal direction, the expandable body extending from a first lateral side to a second lateral side in a widthwise direction, and extending from a superior end to an inferior end in a vertical direction, the expandable body being defined by a superior endplate and an inferior endplate opposite the superior endplate,the superior endplate including a first outside surface and a first inside surface opposite the first outside surface, the first inside surface including first proximal ramps and first distal ramps disposed opposite the first proximal ramps,the inferior endplate including a second outside surface and a second inside surface opposite the second outside surface, the second inside surface including second proximal ramps and second distal ramps disposed opposite the second proximal ramps;a support block coupled to the superior endplate and the inferior endplate, the support block having a proximal screw guide and a distal screw guide opposite the proximal screw guide,a proximal set screw rotatably supported by the proximal screw guide and a distal set screw rotatably supported by the distal screw guide;a proximal wedge including first superior ramped surfaces and first inferior ramped surfaces, the proximal wedge being coupled to the proximal set screw;a distal wedge including second superior ramped surfaces and second inferior ramped surfaces, the distal wedge being coupled to the distal set screw; andat least one eyelet disposed on the proximal end of the expandable body;wherein: in the contracted position the proximal wedge and the distal wedge are disposed in a medial position of the body,in a first expanded position a spacing between the superior and inferior endplates at a proximal side is greater than a spacing between the superior and inferior endplates at the proximal side in the contracted position, in the first expanded position the proximal wedge contacts the the first proximal ramps and the second proximal ramps and is disposed proximate the proximal side, andin a second expanded position a spacing between the superior and inferior endplates at a distal side is greater than a spacing between the superior and inferior endplates at the distal side in the contracted position, in the second expanded position the distal wedge contacts the first distal ramps and the second distal ramps and is disposed proximate the distal side with respect to the medial position.

2. The expandable implant of claim 1, wherein the at least one eyelet comprises a first eyelet and a second eyelet, the superior endplate comprises the first eyelet, and the inferior endplate comprises the second eyelet.

3. The expandable implant of claim 2, wherein the first eyelet is disposed adjacent the first lateral side and configured to support a first bone screw in a first target trajectory and the second eyelet is disposed adjacent the second lateral side and configured to support a second bone screw in a second target trajectory.

4. The expandable implant of claim 2, wherein: the superior endplate comprises a first bone screw aperture that is coaxially aligned with the first target trajectory and the inferior endplate comprises a second bone screw aperture that is coaxially aligned with the second target trajectory.

5. The expandable implant of claim 3, wherein: the first target trajectory comprises a first internal angle measured between the first target trajectory and the longitudinal axis;the second target trajectory comprises a second internal angle measured between the second target trajectory and the longitudinal axis; andthe first internal angle and the second internal angle are within a range of 20 degrees to 30 degrees.

6. The expandable implant of claim 1, further comprising a bone screw endplate configured to couple to the proximal end of the expandable body.

7. The expandable implant of claim 1, further comprising: a bone screw endplate,wherein: the at least one eyelet comprises a first eyelet and a second eyelet, the superior endplate comprises the first eyelet, and the inferior endplate comprises the second eyelet, andthe bone screw endplate is disposed between and contacts the first eyelet and second eyelet.

8. The expandable implant of claim 7, wherein: the bone screw endplate comprises a plurality of bone screw apertures and a rotatable locking wheel having a plurality of locking arms, andin a locked position, a locking arm of the plurality of locking arms blocks a corresponding bone screw aperture of the plurality of bone screw apertures of the bone screw endplate.

9. The expandable implant of claim 8, wherein the rotatable locking wheel comprises a drive aperture that is coaxially aligned with the proximal set screw and the distal set screw.

10. The expandable implant of claim 7, wherein the bone screw endplate is securely coupled to the expandable body at a superior engagement cutout region and an inferior engagement cutout region.

11. The expandable implant of claim 7, wherein the bone screw endplate is securely coupled to the expandable body via a retaining pin.

12. The expandable spinal implant of claim 7, wherein the proximal end of the expandable body is concave in the widthwise direction and the bone screw endplate is contoured to the concavity of the expandable body in the widthwise direction.

13. The expandable implant of claim 1, wherein the at least one eyelet comprises a rim disposed on an internal surface thereof, the rim having a circumferential profile.

14. An expandable spinal implant system, comprising: an expandable implant and a bone screw driving tool,the expandable implant being movable between a contracted position and an expanded position and comprising: an expandable body having a longitudinal axis extending through a center of the expandable body from a proximal end to a distal end in a proximal-to-distal direction, the expandable body extending from a first lateral side to a second lateral side in a widthwise direction, and extending from a superior end to an inferior end in a vertical direction, the expandable body being defined by a superior endplate and an inferior endplate opposite the superior endplate,the superior endplate including a first outside surface and a first inside surface opposite the first outside surface, the first inside surface including first proximal ramps and first distal ramps disposed opposite the first proximal ramps,the inferior endplate including a second outside surface and a second inside surface opposite the second outside surface, the second inside surface including second proximal ramps and second distal ramps disposed opposite the second proximal ramps;a support block coupled to the superior endplate and the inferior endplate, the support block having a proximal screw guide and a distal screw guide opposite the proximal screw guide,a proximal set screw rotatably supported by the proximal screw guide and a distal set screw rotatably supported by the distal screw guide;a proximal wedge including first superior ramped surfaces and first inferior ramped surfaces, the proximal wedge being coupled to the proximal set screw;a distal wedge including second superior ramped surfaces and second inferior ramped surfaces, the distal wedge being coupled to the distal set screw; andat least one eyelet disposed on the proximal end of the expandable body;wherein: in the contracted position the proximal wedge and the distal wedge are disposed in a medial position of the body,in a first expanded position a spacing between the superior and inferior endplates at a proximal side is greater than a spacing between the superior and inferior endplates at the proximal side in the contracted position, in the first expanded position the proximal wedge contacts the first proximal ramps and the second proximal ramps and is disposed proximate the proximal side, andin a second expanded position a spacing between the superior and inferior endplates at a distal side is greater than a spacing between the superior and inferior endplates at the distal side in the contracted position, in the second expanded position the distal wedge contacts the first distal ramps and the second distal ramps and is disposed proximate the proximal side with respect to the medial position;the bone screw driving tool comprising a handle portion and a drive portion disposed at a distal end of the handle portion, the drive portion further including a ratcheting mechanism.

15. The expandable spinal implant system of 14, wherein the at least one eyelet comprises a first eyelet and a second eyelet, the first eyelet disposed on the superior endplate and the second eyelet disposed on the inferior endplate.

16. The expandable spinal implant system of claim 15, wherein the first eyelet is disposed adjacent the first lateral side and configured to support a first bone screw in a first target trajectory and the second eyelet is disposed adjacent the second lateral side and configured to support a second bone screw in a second target trajectory.

17. The expandable spinal implant system of claim 15, further comprising a bone screw endplate, wherein:the bone screw endplate comprises a plurality of bone screw apertures and a rotatable locking wheel having a plurality of locking arms, andin a locked position, a locking arm of the plurality of locking arms blocks a corresponding bone screw aperture of the plurality of bone screw apertures of the bone screw endplate.

18. The expandable spinal implant of claim 14, further comprising: an insertion tool,wherein the support block further comprises at least one engagement prong extending towards the proximal end in the proximal-to-distal direction, andwherein the insertion tool comprises:a hollow outer shaft and a hollow inner shaft disposable within the hollow outer shaft; andat least one engagement arm having a size and shape corresponding to the at least one engagement prong.

19. The spinal implant system of claim 18, further comprising: a first set screw driving tool disposable within the hollow inner shaft and comprising a drive end having a first cross-sectional diameter and a necked down portion having a second cross-sectional diameter, the first cross-sectional diameter being greater than the second cross-sectional diameter,wherein the first set screw driving tool is extendable in a longitudinal direction through the hollow inner shaft such that the drive end of the first set screw driving tool is engageable with either one of the proximal set screw or distal set screw.

20. The spinal implant system of claim 19, further comprising: a second set screw driving tool disposable within the hollow inner shaft and having a drive end,wherein the second set screw driving tool is extendable in a longitudinal direction through the hollow inner shaft such the drive end of the second set screw driving tool is engageable with both of the proximal set screw and distal set screw.