TREA

Expandable inter-body device, system, and method

Follow

Information

  • Patent Grant
  • 11969196
  • Patent Number
    11,969,196
  • Date Filed
    Friday, February 3, 2023
    a year ago
  • Date Issued
    Tuesday, April 30, 2024
    22 days ago
Information
Abstract
Expandable spinal implants, systems and methods are disclosed. An expandable spinal implant may include a first endplate, a second endplate, and a moving mechanism that is operably coupled to the first and second endplates. The moving mechanism may include a wedge, a first sliding frame and a second sliding frame disposed on opposite sides of the wedge, a screw guide housing a rotatable first set screw and a rotatable second set screw opposite the first set screw. The first set screw may be operably coupled to the second sliding frame and the second set screw may be operably coupled to the wedge. The moving mechanism may operably adjust a spacing between the first and second endplates upon simultaneous rotation of the first and second set screws and operably adjust an angle of inclination between the first and second endplates upon translating the first set screw or second set screw.
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 spine.


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, e.g., grafting.


More recently, interbody devices have been introduced that provide additional capability beyond static spacing of the vertebral bodies. For example, some devices have expansion capability such that the implant may be introduced to the interbody space in a collapsed state and then expanded to produce additional spacing and, in some cases, introduce or restore curvature to the spine by expanding selectively. However, many existing expandable interbody designs have limited ranges of expansion.


An additional problem exists related to subsidence of spinal surfaces due to existing interbody devices having inadequately-sized load-bearing surfaces. In the case of expandable devices, the loads on the load-bearing surfaces, including loads generated during expansion of the implant, are often significant. An expandable implant with relatively large surface areas is needed to bear the loads, including the loads generated during implant expansion, in an attempt to avoid a need for follow-on surgery due to subsidence of spinal surfaces.


A further problem is instability of existing expandable interbody devices as they are expanded. Often, the load-bearing surfaces move relative to one another, as well as relative to an inserter, as the interbody device is expanded such that there is a risk of undesired shifts in the positioning of the interbody device within the interverterbral space. Additionally, and depending at least partly on the particular insertion technique employed, anatomical features such as the iliac crest and rib cage pose challenges to the adjustment of inter-body designs in situ.


The present disclosure seeks to address these and other shortcomings in the existing relevant arts.


SUMMARY

The techniques of this disclosure generally relate to highly adjustable interbody devices that are expandable to selectively increase/decrease a spacing distance between endplates of the interbody device. Additionally, the disclosed interbody devices are selectively adjustable to increase/decrease an angle of inclination between endplates of the interbody device.


In one aspect, the present disclosure provides an expandable spinal implant deployable between a contracted position and an expanded position. The spinal implant may include a first endplate having a first outside surface and a first inside surface opposite the first outside surface, a first proximal end and a first distal end opposite the first proximal end, and a first lateral surface and a second lateral surface opposite the first lateral surface, the first and second lateral surfaces extending between the first proximal end and the first distal end. The spinal implant may include a second endplate having a second outside surface and a second inside surface opposite the second outside surface, a second proximal end and a second distal end opposite the second proximal end, and a third lateral surface and a fourth lateral surface opposite the third lateral surface, the third and fourth lateral surfaces extending between the second proximal end and the second distal end. The spinal implant may include a moving mechanism operably coupled to the first endplate and the second endplate and positioned therebetween, the moving mechanism may have a wedge, a first sliding frame and a second sliding frame disposed on opposite sides of the wedge, a screw guide housing a rotatable first set screw and a rotatable second set screw opposite the first set screw, the first set screw being operably coupled to the second sliding frame and the second set screw being operably coupled to the wedge. In some embodiments, the first set screw and second set screw are configured to rotate in a first rotation direction and a second rotation direction about a rotation axis projecting in a longitudinal direction of the moving mechanism. In some embodiments, the moving mechanism is configured to operably adjust a spacing between the first and second endplates upon simultaneous rotation of the first and second set screws along the rotation axis, and the moving mechanism is configured to operably adjust an angle of inclination between the first and second endplates upon translating the first set screw or second set screw along the rotation axis.


In another aspect, the present disclosure provides that the second sliding frame is operably coupled to the first set screw and second endplate and movable in the longitudinal direction of the moving mechanism by rotation of the first set screw along the rotation axis.


In another aspect, the present disclosure provides that in some embodiments the second sliding frame includes a pair of first protrusions that are operably coupled to corresponding first channels of the first sliding frame, and upon movement of the second sliding frame in the longitudinal direction the first sliding frame also moves in the longitudinal direction.


In another aspect, the present disclosure provides that in some embodiments, the first endplate further includes a first plurality of inclined ramps and the second endplate further includes a second plurality of inclined ramps.


In another aspect, the present disclosure provides that in some embodiments, the first plurality of inclined ramps further include a first plurality of grooves and the second plurality of inclined ramps includes a second plurality of grooves.


In another aspect, the present disclosure provides that in some embodiments, the first sliding frame further includes first distal contact surfaces and first proximate contact surfaces configured to act against the first plurality of inclined ramps of the first endplate.


In another aspect, the present disclosure provides that in some embodiments, the first sliding frame further includes a first plurality of guide walls operably coupled to the first plurality of grooves of the first endplate.


In another aspect, the present disclosure provides that in some embodiments the second sliding frame further includes a second plurality of guide walls operably coupled to the second plurality of grooves of the second endplate.


In another aspect, the present disclosure provides that in some embodiments, the second sliding frame further includes a third plurality of ramps.


In another aspect, the present disclosure provides that in some embodiments, the wedge further includes a plurality of engagement surfaces configured to operably engage the third plurality of ramps of the second sliding frame.


In another aspect, the present disclosure provides that in some embodiments, the wedge further includes a plurality of lateral protrusions.


In another aspect, the present disclosure provides that in some embodiments, the first sliding frame further includes a first plurality of channels.


In another aspect, the present disclosure provides that in some embodiments, the wedge further includes a second plurality of protrusions operably coupled to the first plurality of channels of the first sliding frame.


In another aspect, the present disclosure provides that in some embodiments, the first and second endplates are configured to promote bone growth therebetween.


In another aspect, the present disclosure provides that in some embodiments, the first and second endplates each have a footprint configured for at least one surgical technique chosen from: anterior surgical insertion and adjustment techniques, oblique surgical insertion and adjustment techniques, and lateral surgical insertion and adjustment techniques.


In another aspect, the present disclosure provides that in some embodiments, at least one of the first endplate and second endplate includes at least one aperture that is configured to receive an anchoring screw therein.


In another aspect, the present disclosure provides that in some embodiments, each of the first and second apertures are further configured to abut an end portion of a vertebrae of a patient and incline a corresponding anchoring screw.


In another aspect, the present disclosure provides a spinal implant system adjustable in situ between vertebral bodies of a patient. The system may include an expandable spinal implant deployable between a contracted position and an expanded position. The spinal implant may include a first endplate having a first outside surface and a first inside surface opposite the first outside surface, a first proximal end and a first distal end opposite the first proximal end, and a first lateral surface and a second lateral surface opposite the first lateral surface, the first and second lateral surfaces extending between the first proximal end and the first distal end. The spinal implant may include a second endplate having a second outside surface and a second inside surface opposite the second outside surface, a second proximal end and a second distal end opposite the second proximal end, and a third lateral surface and a fourth lateral surface opposite the third lateral surface, the third and fourth lateral surfaces extending between the second proximal end and the second distal end. The spinal implant may include a moving mechanism operably coupled to the first endplate and the second endplate and positioned therebetween, the moving mechanism may have a wedge, a first sliding frame and a second sliding frame disposed on opposite sides of the wedge, a screw guide housing a rotatable first set screw and a rotatable second set screw opposite the first set screw, the first set screw being operably coupled to the second sliding frame and the second set screw being operably coupled to the wedge. In some embodiments, the first set screw and second set screw are configured to rotate in a first rotation direction and a second rotation direction about a rotation axis projecting in a longitudinal direction of the moving mechanism. In some embodiments, the moving mechanism is configured to operably adjust a spacing between the first and second endplates upon simultaneous rotation of the first and second set screws along the rotation axis, and the moving mechanism is configured to operably adjust an angle of inclination between the first and second endplates upon translating the first set screw or second set screw along the rotation axis. Additionally, the system may include a first surgical tool configured to adjust the expandable spinal implant.


In another aspect, the present disclosure provides that the system may include a second surgical tool configured to install at least one anchoring screw.


In another aspect, the present disclosure provides an expandable spinal implant, including a first endplate and a second endplate extending in a longitudinal direction. The spinal implant may further include a wedge and a sliding frame operably coupled to the wedge, at least one of the wedge and sliding frame being operably coupled to one endplate of the first and second endplates, and a moving mechanism operably coupled to the wedge and sliding frame, the moving mechanism defining a rotation axis extending in the longitudinal direction. In some embodiments, the moving mechanism is configured to selectively move at least one of the wedge and sliding frame forward/backward in the longitudinal direction. In some embodiments, upon moving both the wedge and sliding frame simultaneously forward/backward the first and second endplates expand/contract with respect to one another, and the wedge and sliding frame are further configured to selectively rotate, at least partially, about the rotation axis upon movement of the wedge in the longitudinal direction to thereby adjust an inclination of the first endplate with respect to the second endplate in a lateral direction perpendicular to the longitudinal direction.


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. 1 is an exploded parts view of an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 2 is a perspective view of an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 3 is a top down view of an expandable spinal implant in accordance with the principles of the present disclosure;



FIGS. 4A and 4B are lateral side views of an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 5 is a perspective view of a cross section of the expandable spinal implant of line C2 from FIGS. 4A and 4B in accordance with the principles of the present disclosure;



FIG. 6 is a perspective view of a cross section of the expandable spinal implant of line C1 from FIG. 3 in accordance with the principles of the present disclosure;



FIG. 7 is a perspective view of a top endplate and bottom endplate of an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 8 is a perspective view of a bottom endplate in accordance with the principles of the present disclosure;



FIG. 9 is a perspective view of a top endplate in accordance with the principles of the present disclosure;



FIGS. 10A-10D are various perspective views of an exemplary top sliding frame in accordance with the principles of the present disclosure;



FIG. 11 is a perspective view of an exemplary bottom sliding frame in accordance with the principles of the present disclosure;



FIGS. 12A-12E are partial parts perspective views of various components for use with expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 13 is a perspective view of a screw guide body for use with an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 14 is a perspective view of an expandable spinal implant with the top endplate removed in accordance with the principles of the present disclosure;



FIG. 15 is an alternate perspective view of an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 16 is rear side profile view of an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 17 is front side profile view of an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 18A is a perspective view of one embodiment of a first surgical tool for use with disclosed expandable spinal implants in accordance with the principles of the present disclosure;



FIG. 18B is an enlarged side view of a handle portion of the first surgical tool of FIG. 18 in accordance with the principles of the present disclosure;



FIG. 19A-19B are side views of a first surgical tool for use with disclosed expandable spinal implants in accordance with the principles of the present disclosure;



FIG. 20 is a side view of an adjustment rod for use with disclosed first surgical tool in accordance with the principles of the present disclosure;



FIG. 21 is a perspective view of a different embodiment of a first surgical tool for use with disclosed expandable spinal implants in accordance with the principles of the present disclosure;



FIG. 22 is an enlarged side view of a tip portion of the first surgical tool of FIG. 21 in accordance with the principles of the present disclosure;



FIG. 23A is a perspective view of a different embodiment of a first surgical tool for use with disclosed expandable spinal implants in accordance with the principles of the present disclosure;



FIG. 23B is a perspective view of a different embodiment of a first surgical tool being inserted into an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 24A is a perspective view of an expandable spinal implant between adjacent vertebrae and a first surgical tool in an adjustment position;



FIG. 24B is a perspective view of an expandable spinal implant between adjacent vertebrae and a curved first surgical tool in an adjustment position;



FIG. 25 is a top down cut out view of an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 26 is a top down cut out view of the expandable spinal implant of FIG. 25 and a first surgical tool in a first adjustment position in accordance with the principles of the present disclosure;



FIG. 27 is a lateral side profile view of an expandable spinal implant showing movement of relevant parts upon rotation of the first surgical tool in a first direction when the first surgical tool is in the first adjustment position of FIG. 26 in accordance with the principles of the present disclosure;



FIG. 28 is a lateral side profile view of an expandable spinal implant showing movement of relevant parts upon rotation of the first surgical tool in a second direction when the first surgical tool is in the first adjustment position of FIG. 26 in accordance with the principles of the present disclosure;



FIG. 29 is a top down cut out view of the expandable spinal implant of FIG. 25 and a first surgical tool in a second adjustment position in accordance with the principles of the present disclosure;



FIG. 30A is a perspective view of an expandable spinal implant showing movement of relevant parts upon rotation of the first surgical tool in a first direction when the first surgical tool is in the second adjustment position of FIG. 29 in accordance with the principles of the present disclosure;



FIG. 30B is a front side view of an expandable spinal implant showing movement of relevant parts upon rotation of the first surgical tool in a first direction when the first surgical tool is in the second adjustment position of FIG. 29 in accordance with the principles of the present disclosure;



FIG. 31A is a perspective view of an expandable spinal implant showing movement of relevant parts upon rotation of the first surgical tool in a second direction when the first surgical tool is in the second adjustment position of FIG. 29 in accordance with the principles of the present disclosure;



FIG. 31B is a front side view of an expandable spinal implant showing movement of relevant parts upon rotation of the first surgical tool in a second direction when the first surgical tool is in the second adjustment position of FIG. 29 in accordance with the principles of the present disclosure;



FIGS. 32A-32F are various side views illustrating some exemplary expansion ranges of an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 33 and FIG. 34 are top down views illustrating some exemplary expansion ranges of an expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 35 is a perspective view of an expandable spinal implant including a pair of anchoring screws in accordance with the principles of the present disclosure;



FIG. 36 is a lateral side view of the expandable spinal implant including a pair of anchoring screws of FIG. 35 in accordance with the principles of the present disclosure;



FIG. 37 is a front side view of the expandable spinal implant including a pair of anchoring screws of FIG. 35 in accordance with the principles of the present disclosure;



FIG. 38A is a side view of a second surgical device suitable for use with disclosed expandable spinal implants in accordance with the principles of the present disclosure;



FIG. 38B is a side view of an enlarged region of FIG. 38 in accordance with the principles of the present disclosure;



FIGS. 39A-39C are various perspective views of exemplary anchoring screws suitable for use in conjunction with the second surgical tool FIGS. 38A-38B in accordance with the principles of the present disclosure;



FIG. 40 is a front side view of an expandable spinal implant including a pair of anchoring screws installed into adjacent vertebrae of a patient in accordance with the principles of the present disclosure;



FIG. 41 is a lateral side view of the expandable spinal implant of FIG. 40 in accordance with the principles of the present disclosure;



FIG. 42 is a top down view of the expandable spinal implant of FIG. 40 in accordance with the principles of the present disclosure;



FIG. 43 is a perspective view of a different expandable spinal implant including an offset moving mechanism in accordance with the principles of the present disclosure;



FIG. 44 is a perspective view of the embodiment of FIG. 43 with the top endplate removed in accordance with the principles of the present disclosure;



FIG. 45 is perspective view of a top endplate for use with the embodiment of FIG. 43 in accordance with the principles of the present disclosure;



FIG. 46A is perspective view of an endplate for use with the embodiment of FIG. 43 in accordance with the principles of the present disclosure;



FIG. 46B is perspective view of an endplate for use with the embodiment of FIG. 43 in accordance with the principles of the present disclosure;



FIG. 47 is a perspective view of a different expandable spinal implant in accordance with the principles of the present disclosure;



FIG. 48 is a top down view of the embodiment of FIG. 47 in accordance with the principles of the present disclosure;



FIGS. 49A-49B are a front side views of the embodiment of FIG. 47 in accordance with the principles of the present disclosure;



FIG. 50 is a reference diagram illustrating various cardinal directions and planes with respect to a patient that the exemplary embodiments of FIGS. 1-49B may operate, adjust, and/or move along in accordance with the principles of the present disclosure.





DETAILED DESCRIPTION

The exemplary embodiments of, for example, an anterior expandable inter-body device, lateral expandable inter-body device, inter-body device systems, and inter-body device methods of use are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of various inter-body devices suitable as spinal implants for anterior surgical techniques, oblique surgical techniques, and lateral surgical techniques. Exemplary embodiments are also discussed with related emphasis on specialized adjustment instruments such as, for example, an instrument capable of adjusting a spacing of the aforementioned various interbody devices between adjacent vertebrates of a spine by expansion and contraction as well as adjusting an angle of inclination with respect to the coronal plane and/or sagittal plane of a patient. Disclosed devices and systems may be capable of adjusting the curvature of a patient's spine for lordosis correction and a kyphosis correction. Likewise, an instrument capable of installing various anchoring screws is described in conjunction with disclosed inter-body devices. Apertures for receiving anchoring screws may optionally be provided on one of the top or bottom portions of the implant, both, or neither, to the extent desired to further secure the implant to the vertebra after insertion in the disc space. Although disclosed, for example, as one aperture on each of the top and bottom, multiple apertures can be provided on either the top or bottom portion or both. Additionally, such apertures may be formed along the proximal end of the implant in various positions, including adjacent to the corner or corners of the proximal face of the implant or near the center of the proximal face of the implant.


As used herein, standard anatomical terms of location have their ordinary meaning as they would be understood by a person of ordinary skill in the art unless clearly defined or explained otherwise. 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, characteristics of one embodiment may be combined or substituted with characteristics of another different embodiment unless those characteristics are clearly explained as being mutually exclusive. 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 disclosed techniques and methods). In addition, while certain aspects of this disclosure are described as being performed by a single module or unit for purposes of clarity, it should be understood that the techniques of this disclosure may be performed by a combination of units or modules associated with, for example, a medical device.


In some embodiments, the present system includes an expandable spinal implant suitable for insertion for oblique techniques, postero-lateral procedures and/or transforaminal lumbar interbody fusions (sometimes referred to as TLIF procedures), direct posterior (sometimes referred to as PLIF procedures), direct lateral (sometimes referred to as DLIF procedures), anterior lumbar interbody fusions (sometimes refered to as ALIF procedures), or variations of these procedures, in which the present implant is inserted into an interverterbral space and then expanded in order to impart and/or augment a lordotic and/or kyphotic curve of the spine.


In some embodiments, the spinal implant system may also be employed to restore and/or impart sagittal balance to a patient by increasing and/or restoring an appropriate lordotic and/or kyphotic angle between vertebral bodies at a selected level where the spinal implant is implanted and expanded. Additionally, some embodiments may also be employed to restore and/or impart coronal balance for correction of, for example, scoliosis. In the various embodiments described, the spinal implant system may be useful in a variety of complex spinal procedures for treating spinal conditions beyond one-level fusions. Furthermore, the spinal implant system described in the enclosed embodiments may also be used as a fusion device with an expandable height for tailoring the implant to a particular interbody disc space to restore the spacing between adjacent vertebral bodies and facilitate spinal fusion between the adjacent vertebral bodies.


In some embodiments, and as mentioned above, the present disclosure may be employed to treat spinal disorders such as, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor and fractures. In some embodiments, the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. In some embodiments, the disclosed spinal implant system may be alternatively employed in a surgical treatment with a patient in a prone or supine position, and/or employ various surgical approaches to the spine, including anterior, posterior, posterior mid-line, direct lateral, postero-lateral oblique, and/or antero lateral oblique approaches, and in other body regions. The present disclosure may also be alternatively employed with procedures for treating the lumbar, cervical, thoracic, sacral and pelvic regions of a spinal column. The spinal implant system of the present disclosure may also be used on animals, bone models and other non-living substrates, such as, for example, in training, testing and demonstration.


The present disclosure may be understood more readily by reference to the following detailed description of the embodiments taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this application is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting. In some embodiments, as used in the specification and including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” or “approximately” one particular value and/or to “about” or “approximately” another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. It is also understood that all spatial references, such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure. For example, the references “upper” and “lower” are relative and used only in the context to the other, and are not necessarily “superior” and “inferior”. Generally, similar spatial references of different aspects or components, e.g., a “proximal end” of an end plate and a “proximal end” of a wedge, indicate similar spatial orientation and/or positioning, i.e., that each “proximal end” is situated on or directed towards the same end of the device. Further, the use of various spatial terminology herein should not be interpreted to limit the various insertion techniques or orientations of the implant relative to the positions in the spine.


As used in the specification and including the appended claims, “treating” or “treatment” of a disease or condition refers to performing a procedure that may include administering one or more drugs, biologics, bone grafts (including allograft, autograft, xenograft, for example) or bone-growth promoting materials to a patient (human, normal or otherwise or other mammal), employing implantable devices, and/or employing instruments that treat the disease, such as, for example, micro-discectomy instruments used to remove portions bulging or herniated discs and/or bone spurs, in an effort to alleviate signs or symptoms of the disease or condition. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, treating or treatment includes preventing or prevention of disease or undesirable condition (e.g., preventing the disease from occurring in a patient, who may be predisposed to the disease but has not yet been diagnosed as having it). In addition, treating or treatment does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes procedures that have only a marginal effect on the patient. Treatment can include inhibiting the disease, e.g., arresting its development, or relieving the disease, e.g., causing regression of the disease. For example, treatment can include reducing acute or chronic inflammation; alleviating pain and mitigating and inducing re-growth of new ligament, bone and other tissues; as an adjunct in surgery; and/or any repair procedure. Also, as used in the specification and including the appended claims, the term “tissue” includes soft tissue, ligaments, tendons, cartilage and/or bone unless specifically referred to otherwise. The term “bone growth promoting material” as used herein may include, but is not limited to: bone graft (autograft, allograft, xenograft) in a variety of forms and compositions (including but not limited to morselized bone graft); osteoinductive material such as bone morphogenetic proteins (BMP) (including but not limited to INFUSED available from Medtronic) and alternative small molecule osteoinductive substances; osteoconductive materials such as demineralized bone matrix (DBM) in a variety of forms and compositions (putty, chips, bagged (including but not limited to the GRAFTON® family of products available from Medtronic)); collagen sponge; bone putty; ceramic-based void fillers; ceramic powders; and/or other substances suitable for inducing, conducting or facilitating bone growth and/or bony fusion of existing bony structures. Such bone growth promoting materials may be provided in a variety of solids, putties, liquids, colloids, solutions, or other preparations suitable for being packed or placed into or around the various implants 100, 200, 300 and embodiments described herein.


The components of the expandable spinal implant systems described herein can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics and bone material and/or their composites. For example, the components of expandable spinal implant system, individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, stainless steel alloys, superelastic metallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUM METAL®), ceramics and composites thereof such as calcium phosphate (e.g., SKELITE™), thermoplastics such as polyaryletherketone (PAEK) including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO4 polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers, elastomeric composites, rigid polymers including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone material including autograft, allograft, xenograft or transgenic cortical and/or corticocancellous bone, and tissue growth or differentiation factors, partially resorbable materials, such as, for example, composites of metals and calcium-based ceramics, composites of PEEK and calcium based ceramics, composites of PEEK with resorbable polymers, totally resorbable materials, such as, for example, calcium based ceramics such as calcium phosphate, tri-calcium phosphate (TCP), hydroxyapatite (HA)-TCP, calcium sulfate, or other resorbable polymers such as polyaetide, polyglycolide, polytyrosine carbonate, polycaprolactone and their combinations.


Various components of spinal implant system may be formed or constructed of material composites, including but not limited to the above-described materials, to achieve various desired characteristics such as strength, rigidity, elasticity, compliance, biomechanical performance, durability and radiolucency or imaging preference. The components of expandable spinal implant system, individually or collectively, may also be fabricated from a heterogeneous material such as a combination of two or more of the above-described materials. The components of the expandable spinal implant systems may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein. For example, in some embodiments the expandable spinal implant systems may comprise expandable spinal implants 100, 200, 300 comprising PEEK and/or titanium structures (or combinations thereof) with radiolucent markers (such as tantalum pins and/or spikes) selectively placed in the implant to provide a medical practitioner with placement and/or sizing information when the expandable spinal implant 100, 200, 300 may be placed in the spine. The components of the expandable spinal implant system may be formed using a variety of subtractive and additive manufacturing techniques, including, but not limited to machining, milling, extruding, molding, 3D-printing, sintering, coating, vapor deposition, and laser/beam melting. These components and/or implants may further be customized or custom made for a specific patient or patient population. Furthermore, various components of the expandable spinal implant system may be coated or treated with a variety of additives or coatings to improve biocompatibility, bone growth promotion or other features. For example, endplates 110, 120, may be selectively coated with bone growth promoting or bone ongrowth promoting surface treatments that may include, but are not limited to: titanium coatings (solid, porous or textured), hydroxyapatite coatings, or titanium plates (solid, porous or textured), and/or may have various nano-coated or nano-sized features for enhanced bone ingrowth surfaces.


The expandable spinal implant system may be employed, for example, with a minimally invasive procedure, including percutaneous techniques, mini-open and open surgical techniques to deliver and introduce instrumentation and/or one or more spinal implants at a surgical site within a body of a patient, for example, a section of a spine. In some embodiments, the expandable spinal implant system may be employed with surgical procedures, as described herein, and/or, for example, corpectomy, discectomy, fusion and/or fixation treatments that employ spinal implants to restore the mechanical support function of vertebrae. In some embodiments, the expandable spinal implant system may be employed with surgical approaches, including but not limited to: anterior lumbar interbody fusions (ALIF), posterior lumbar interbody fusion (PLIF), oblique lumbar interbody fusion, transforaminal lumbar interbody fusion (TLIF), various types of anterior fusion procedures, and any fusion procedure in any portion of the spinal column (sacral, lumbar, thoracic, and cervical, for example).


Generally in FIGS. 1-50, exemplary embodiments of expandable spinal implants 100, 200, and 300 are shown. Exemplary embodiments of surgical tools 400, 450, and 500 are highlighted in exemplary FIGS. 18A-24B and 38A-39C and are disclosed in conjunction with expandable spinal implant 100 as an inter-body spinal implant system. For example, surgical tools 400, 450, and 500 are discussed concurrently with exemplary spinal implant 100. It shall be understood that the same or similar surgical tools highlighted in exemplary FIGS. 18A-24B and 38A-39C may be employed with expandable spinal implants 100, 200, and 300. Similar and/or identical numbering of corresponding elements may be used interchangeably between the two exemplary embodiments of an expandable spinal implants 100, 200, and 300 for ease of understanding and convenience in explanation. For example, moving mechanism 250 is predominately discussed concurrently with exemplary spinal implant 100 although the same or similar moving mechanism 250 may be employed with expandable spinal implant 200. FIG. 50 is provided solely as a reference illustration showing a patient 1 and various standard medical terms and orientations with respect to cardinal directions and planes of the body of patient 1 in which expandable spinal implants 100 and 200 may act.


Referring generally to FIGS. 1-42 exemplary expandable spinal implant 100, moving mechanism 250, first surgical tool 400, and second surgical tool 500 are illustrated. Spinal implant 100 may be configured to be inserted in an intervertebral disc space between adjacent vertebral bodies accordingly to a variety of surgical techniques, e.g., anterior techniques, oblique techniques, and lateral techniques. Referring generally to FIGS. 43-46 a second exemplary expandable spinal implant 200 is illustrated. Spinal implant 200 may be configured to be inserted in an intervertebral disc space between adjacent vertebral bodies accordingly to a variety of surgical techniques, e.g., anterior techniques, and oblique techniques.



FIG. 1 is an exploded parts view of an expandable spinal implant 100 and FIG. 2 is a perspective view of the expandable spinal implant 100 in accordance with the principles of the present disclosure. Exemplary spinal implant 100 includes a top endplate 110 (first endplate) and a bottom endplate 120 (second endplate) and a moving mechanism 250. Spinal implant 100 includes a proximal end 101 and a distal end 102 opposite the proximal end 101, and a first lateral end 103 and a second lateral end 104 opposite the first lateral end 103. The first and second lateral ends 103, 104 extend between the proximal end 101 and the distal end 102. The proximal end 101 may, for example, include one or more exposed screw guide endplates 105 defining a corresponding screw guide aperture 107, or multiple apertures, if any, which are disposed between endplates 110 and 120. The screw guide endplate 105 and screw guide aperture 107 will be described in greater detail below. Additionally, it shall be understood that reference to other parts of spinal implant 100 may be in terms of the above orientation with reference to spinal implant 100 generally, e.g., endplate 110 may also include a proximal end 101 and a distal end 102 opposite the proximal end 101, and a first lateral end 103 and a second lateral end 104 opposite the first lateral end 103.


Exemplary spinal implant 100 includes a moving mechanism 250 that may be operably coupled to top endplate 110 and bottom endplate 120 as will be explained in greater detail below. Moving mechanism 250 may include, for example, a first set screw 252 and an axially aligned second set screw 254. First and second set screws 252, 254 each may feature a retaining portion 252a, 254a that may be operably coupled to an interior retaining portion of sliding block 253. Sliding block 253 may be retained within a central guide cavity of screw guide body 256 and configured to slide back and forth within central guide cavity along rail portion 256a (see FIG. 13) while coupled to first and second set screws 252, 254. First and second set screws 252, 254 may be configured to rotate about first reference axis A1 and slide forward/backward via sliding block 253 along rotation axis A1. In the disclosed embodiment, rotation axis A1 extends longitudinally along the center of expandable spinal implant and may be defined, at least partly, by first and second set screws 252, 254. First reference axis A1 may be understood as a projection passing through a central portion of screw guide aperture 107 in a direction parallel to an extension direction of screw guide body 256. First reference axis A1 may also be understood as a rotation axis that first and second set screws 252, 254 may rotate about. Additionally, first and second set screws 252, 254 may move forward and backward along first reference axis A1.


Exemplary spinal implant 100 may further include a bottom sliding frame 130, an angled wedge 140, and a top sliding frame 150 that are operably coupled to each other. Additionally, bottom sliding frame 130 may be operably coupled to first set screw 252 and angled wedge 140 may be operably coupled to second set screw 254. Bottom sliding frame 130, angled wedge 140, and top sliding frame 150 may be configured to move forward and backwards by rotation of first and second screws 252, 254. As will be explained in further detail below, the various geometries of the acting surfaces between bottom sliding frame 130, angled wedge 140, and top sliding frame 150 may facilitate the expansion/contraction and angular adjustment of endplates 110, 120 of expandable spinal implant 100.


A first functional feature of moving mechanism 250 is that it may be further configured to increase and decrease a spacing between the top and bottom endplates 110, 120 upon simultaneous rotation of the first and second set screws 252, 254 in a clockwise and counterclockwise direction, respectively. A second functional feature of moving mechanism 250 is that it may be further configured to increase and decrease an angle of inclination between the top and bottom endplates 110, 120 upon rotation of the first set screw 252 in a clockwise and counterclockwise direction, respectively. Additional functions and attributes of moving mechanism 250 will be described in greater detail below.



FIG. 3 is a top down view of expandable spinal implant 100 showing a first cross section C1 extending through a mid-section plane of expandable spinal implant 100 in the width wise direction. As illustrated, spinal implant 100 may include a plurality of openings in each of top endplate 110 and bottom endplate 120. In the disclosed embodiment, top and bottom endplates 110, 120 may, for example, feature a textured outside surface having a diamond tread pattern. In other embodiments, the plurality of openings may have alternate shapes and/or be disposed in alternate locations in other embodiments. For example, top and bottom endplates 110, 120 may comprise various anti-migration, anti-expulsion, and/or osseointegration features including, but not limited to: ridges, teeth, pores, and coatings (including but not limited to porous titanium coatings such as those provided on Capstone PTC™ implants available from Medtronic). The endplates 110, 120 may each further comprise at least one opening 110x, 120x (see FIGS. 8-9) defined therein, and configured to allow bone growth materials to be packed, placed, or loaded into spinal implant 100. In the exemplary embodiment 110x, 120x are shown having a rectangular shape, although other embodiments may have alternating shapes.



FIG. 4A is a lateral side view of first lateral end 103 and FIG. 4B is a lateral side view of second lateral end 104 in accordance with the principles of the present disclosure. As shown in FIGS. 4A and 4B, a second cross section C2 extending through a mid-section plane of expandable spinal implant 100 in the length wise (longitudinal) direction is shown. In the exemplary embodiment, expandable spinal implant 100 may be in a contracted position where a lateral height between endplates 110, 120 of first lateral end 103 may be greater than a lateral height between endplates 110, 120 of second lateral end 104. FIG. 5 is a perspective view illustrating the second cross section C2 of expandable spinal implant 100 and FIG. 6 is a perspective view illustrating the first cross section C1 of expandable spinal implant 100.



FIGS. 4A and 4B illustrate top sliding frame 150 contacting top endplate 110 on an underside thereof. For example, first distal contact surfaces 150a may be curved surfaces of top sliding frame 150 that are configured to contact an underside of top endplate 110 at distal indented surfaces 110c and corresponding inclined surfaces of first distal ramps 116. Similarly, first proximate contact surfaces 150b may be curved surfaces configured to contact an underside of top endplate 110 at proximate indented surfaces 110b and corresponding proximate sides of first proximal ramps 114. Additionally, top sliding frame 150 includes inclined contact surfaces 150c configured to contact a proximate side of first distal ramps 116. Furthermore, in a collapsed position, a first distal tip portion 110z of first distal ramps 116 may extend into a corresponding first distal extension recess 120z of bottom endplate 120. Similarly, in a collapsed position a first proximate tip portion 110y of first proximal ramps 114 may extend into a corresponding first proximate extension recess 120y of bottom endplate 120. At least one advantage of this arrangement is that the spinal implant 100 may feature a relatively large expansion\contraction range and a relatively large inclination range while maintaining a relatively small footprint.


Referring generally to FIGS. 5 and 6, top sliding frame 150 is operably coupled to top endplate 110 on an underside thereof. FIG. 5 is a perspective view of a cross section of the expandable spinal implant of line C2 from FIGS. 4A and 4B and FIG. 6 is a perspective view of a cross section of the expandable spinal implant of line C1 from FIG. 3. In the disclosed embodiment, top sliding frame 150 may feature curved interior surfaces facing first and second set screws 252, 254. Additionally, top sliding frame 130 may include first top rail portions 150d-1 and first bottom rail portions 150d-2 extending lengthwise along an interior side of top sliding frame 150. First top rail portions 150d-1 and first bottom rail portions 150d-2 may extend lengthwise through first top channel portions 110e-1 and first bottom channel portions 120e-1 in a direction parallel with first reference axis A1, respectively. In this way, top sliding frame 150 may operably move forward and backwards between first and second endplates 110, 120 in a direction parallel with first reference axis A1.


Referring to FIG. 6, angled wedge 140 may feature curved exterior surfaces facing the curved interior surfaces of top sliding frame 150. Additionally, angled wedge 140 may include second top rail portions 140d-1 extending lengthwise along an interior side of angled wedge 140. Second top rail portions 140d-1 may extend lengthwise through second top channel portions 110e-2 in a direction parallel with first reference axis A1. In the exemplary embodiment, second top rail portions 140d-1 are inclined such that a gap exists between second top rail portions 140d-1 and second top channel portions 110e-2. In this way, angled wedge 140 may operably move forward and backwards within second top channel portions 110e-2 in a direction parallel with first reference axis A1 and first endplate 110 may pivot laterally side to side in a direction perpendicular with first reference axis A1.


Bottom sliding frame 130 may feature curved exterior surfaces facing the curved interior surfaces of top sliding frame 150. Additionally, bottom sliding frame 130 may also include a central aperture 130b (see FIG. 11) such that the central aperture 130b surrounds sliding block 253 and screw guide body 256, at least partly. Furthermore, bottom sliding frame 130 may feature a curved upper surface 130a (see FIG. 11) that is concave with respect to first set screw 252 and a flat lower surface 130c. In this way, bottom sliding frame 130 may operably move forward and backwards within second bottom channel portion 120e-2 in a direction parallel with first reference axis A1 and first endplate 110 may pivot laterally side to side in a direction perpendicular with first reference axis A1.


Referring generally to FIGS. 7-9 various perspective views of a top endplate 110 and bottom endplate 120 of an expandable spinal implant 100 in accordance with the principles of the present disclosure are illustrated. One of the top endplate 110 and/or bottom endplate 120 may include an anchoring aperture 110s, 120s on a proximal end 101 thereof for receiving an anchoring screw, if such is optionally desired, as will be explained in further detail below. Top endplate 110 may include a first outside surface 111 and a first inside surface 112 opposite the first outside surface 111. Similarly, bottom endplate 120 may include a second outside surface 121 and a second inside surface 122. The outside surfaces 111, 121 may be configured to be positioned between and/or contact vertebral bodies in a patients spine and have various surface characteristics. For example, in some embodiments, outside surfaces 111 and 122 may have substantially linear surface profiles extending across faces of textured surfaces thereof. In other embodiments, outside surfaces 111 and 122 may have curved surface profiles extending across faces of textured surfaces thereof. Inside surfaces 112, 122, may surround moving mechanism 250 and have various contours, guides, cavities, ramps, and other operable characteristics that facilitate movement and/or provide mechanical advantage to other operable and movable corresponding parts to facilitate expansion, contraction, angular adjustment, lateral pivoting, absorption of compression forces, shear forces, etc. as will be explained in greater detail below.


In the exemplary embodiment, top endplate 110 includes a pair of first proximal ramps 114 and a pair of first distal ramps 116 opposite the first proximal ramps 114. Each ramp of the first proximal ramps 114 includes an inclined surface extending away from inside surface 112. Additionally, each ramp of first proximal ramps 114 includes a first proximal groove 114a on an inside surface thereof. Similarly, each ramp of first distal ramps 116 includes inclined surfaces extending away from inside surface 112. Additionally, each ramp of first distal ramps 116 includes a first distal groove 116a on an inside surface thereof. Each of first distal ramps 116 and first proximal ramps 114 may include an outside lateral surface that partly defines a respective lateral end 103, 104 of expandable spinal implant 100. Bottom endplate 120 includes a pair of second proximal ramps 124 and a pair of second distal ramps 126 opposite the second proximal ramps 124. Each ramp of the second proximal ramps 124 includes an inclined surface extending away from inside surface 122. Additionally, each ramp of second proximal ramps 124 includes a second proximal groove 124a on an outside lateral surface thereof. Similarly, each ramp of second distal ramps 126 includes inclined surfaces extending away from inside surface 112 and moving mechanism 250. Additionally, each ramp of second distal ramps 126 includes a second distal groove 126a on an outside lateral surface thereof. Each of second distal ramps 126 and second proximate ramps 124 may include an outside lateral surface that is inset (spaced inside) from first distal ramps 116 and first proximal ramps 114 towards moving mechanism 250. Furthermore, each groove 114a, 116a, 124a, and 126a may extend in a parallel direction with a corresponding inclined surface of a corresponding ramp 114, 116, 124, and 126.


Referring generally to FIGS. 10-14 various perspective views of top sliding frame 150, angled wedge 140, and bottom sliding frame 130 for use with expandable spinal implant 100 in accordance with the principles of the present disclosure are illustrated. FIGS. 10A-10D are various perspective views of an exemplary top sliding frame 150 in accordance with the principles of the present disclosure. FIG. 11 is a perspective view of an exemplary bottom sliding frame 130 in accordance with the principles of the present disclosure. FIGS. 12A-12E are partial parts perspective views of various components for use with expandable spinal implant 100 in accordance with the principles of the present disclosure. FIG. 13 is a perspective view of a screw guide body for use with an expandable spinal implant 100 and FIG. 14 is a perspective view of an expandable spinal implant 100 with the top endplate 110 removed in accordance with the principles of the present disclosure.



FIG. 10A illustrates top sliding frame 150 turned upside down from its normal upright position as compared to when top sliding frame 150 is installed in expandable spinal implant 100. FIGS. 10B and 10C illustrate top sliding frame 150 right side up in different perspective views for ease of explanation. Top sliding frame 150 may include a pair of first proximate guide walls 154a and a pair of first distal guide walls 156a. In the disclosed embodiment, guide walls 154a and 156a are wedge shaped and have a corresponding size relative to the width of first proximate grooves 114a and first distal grooves 116a, respectively. However, in other embodiments they make take any shape provided they enable top sliding frame 150 to be slidably connected to top endplate 110. In the disclosed embodiment, top sliding frame 150 may be slidably coupled to first proximate grooves 114a by first proximate guide walls 154a. Similarly, top sliding frame 150 may be slidably coupled to first distal grooves 116a by first distal guide walls 156a.


Additionally, top sliding frame 150 may include a plurality of channels 158a, 158b, 158c on the inside lateral surfaces thereof. For example, the first inside lateral surface 103a of top sliding frame 150 includes a first pair of channels 158a and the second inside lateral surface 104a of top sliding frame 150 includes a second pair of channels 158b. In the disclosed embodiment, the first and second pair of channels 158a, 158b may be inclined with respect to the longitudinal direction of top sliding frame 150 and may be hemispherical shaped, although in other embodiments different cross sectional shapes, e.g., conical, dovetail, tongue and groove, etc. may be used. Additionally, the first and second pair of channels 158a, 158b may be inclined oppositely from one another, e.g., first pair of channels 158a may extend from a bottom portion of distal end 102 of top sliding frame 150 towards a top portion of the proximal end 101 of top sliding frame 150 (see FIG. 10C) and second pair of channels 158b may extend from a bottom portion of the proximal end 101 of top sliding frame 150 towards a top portion the distal end 102 (see FIG. 10B). Furthermore, second pair of channels 158b may have an opening on an underside thereof extending through a bottom portion of top sliding frame 150 (see FIG. 10b). Top sliding frame 150 may also include a pair of third channels 158c. Third channels 158c may extend vertically along first inside lateral surface 103a and second inside lateral surface 104a. Top sliding frame 150 may further include a pair of guide rails 155 disposed on outside surfaces of first lateral end 103 and second lateral end 104, respectively. Guide rails 155 may extend substantially parallel to the longitudinal direction of top sliding frame 150.



FIG. 10D illustrates top sliding frame 150 operably coupled to top endplate 110 in an upside down orientation for ease of explanation. As illustrated, first proximate guide walls 154a and first distal guide walls 156a are operably coupled to first proximate grooves 114a and first distal grooves 116a, respectively. First distal contact surfaces 150a, first proximate contact surfaces 150b, and inclined contact surfaces 150c may each act against a correspond ramp 114, 116 of top endplate 110 to facilitate expansion and angular adjustment of expandable spinal implant 100, as will be explained in more detail below.



FIG. 11 illustrates bottom sliding frame 130 and FIG. 12A illustrates bottom sliding frame 130 operably coupled to bottom endplate 120. Bottom sliding frame 130 may include a pair of proximal contact surfaces 134aa and a pair of distal contact surfaces 136aa configured to act against a corresponding surface of ramps 124, 126, of bottom endplate 120. Bottom sliding frame 130 may further include a pair of second proximate guide walls 134a and a pair of second distal guide walls 136a. In the disclosed embodiment, guide walls 134a and 136a are wedge shaped, although in other embodiments they make take any shape provided they enable bottom sliding frame 130 to be slidably connected to bottom endplate 120. In the disclosed embodiment, bottom sliding frame 130 may be slidably coupled to second proximate grooves 124a by second proximate guide walls 134a. Similarly, bottom sliding frame 130 may be slidably coupled to second distal grooves 126a by second distal guide walls 136a. Additionally, bottom sliding frame 130 includes a pair of protrusions 138c disposed on opposite outside lateral surfaces of bottom sliding frame 130. For example, each protrusion 138c has a curved wedge shaped profile and may be disposed at a longitudinal mid-section area on an outside surface of lateral ends 103 and 104, respectively. Protrusions 138c may be configured to engage with third channels 158c of top sliding frame 150 and are designed to facilitate expansion/contraction and angular adjustment of expandable spinal implant 100. For example, the curved wedge shape of protrusions 138c enables a freedom of movement within third channels 158c. Bottom sliding frame may further include a pair of third proximate ramps 135a, 135b and a pair of third distal ramps 137a, 137b. Each ramp of third proximate ramps 135a, 135b may be inclined oppositely with respect to a longitudinal direction of bottom sliding frame 130 and each ramp of third distal ramps 137a, 137b may be inclined oppositely with respect to a longitudinal direction of bottom sliding frame 130. Additionally, ramps 135a and 137a may be inclined in the same direction and ramps 135b and 137b may also be inclined in the same direction. Bottom sliding frame 130 may further include a first threaded portion 130d that may be configured to engage first set screw 252. In this way, first set screw 252 may be configured to move bottom sliding frame 130 forward upon rotation of first set screw 252 in a first direction and move bottom sliding frame 130 backwards upon rotation of first set screw 252 in a second direction.



FIG. 12B illustrates angled wedge 140 in a first perspective view and FIG. 12C illustrates angled wedge 140 in a second perspective view. As illustrated, angled wedge 140 can include a pair of proximate engagement surfaces 145a and 145b and a pair of distal engagement surfaces 147a and 147b. Proximate engagement surfaces 145a and 145b may be configured to engage third proximate ramps 135a and 135b of bottom sliding frame 130 and distal engagement surfaces 147a and 147b may be configured to engage third distal ramps 137a and 137b. For example, engagement surfaces 145a, 145b, 147a, and 147b may be configured to slide along the corresponding surface of ramps 135a, 135b, 137a, and 137b of bottom sliding frame 130.


Additionally, angled wedge 140 may include a plurality of protrusions 148a, 148b on the outside lateral surfaces thereof. For example, the first outside lateral surface 103 of angled wedge 140 includes a first pair of protrusions 148a and the second outside lateral surface 104 of top sliding frame 150 includes a second pair of protrusions 148b. In the disclosed embodiment, the first and second pair of protrusions 148a and 148b may be inclined and protrude laterally from a corresponding lateral surface and have an elongated hemispherical shape, although in other embodiments different cross sectional shapes, e.g., conical, dovetail, tongue and groove, etc. may be used. Additionally, the first and second pair of protrusions 148a, 148b may be inclined oppositely from one another, e.g., first pair of protrusions 148a may extend from a bottom portion of distal end 102 of angled wedge 140 towards a top portion of proximal end 101 of top sliding frame 150 (see FIG. 12B) and second pair of protrusions 148b may extend from a bottom portion of proximal end 101 of angled wedge 140 to a top portion of the distal end 102 (see FIG. 12C). Protrusions 148a, 148b may be configured to operably couple to channels 158a, 158b and slide forward and backwards along an interior surface of channels 158a, 158b. For example, protrusions 148a, 148b may correspond in cross sectional shape and angular orientation to that of channels 158a, 158b.



FIG. 12D illustrates angled wedge 140 operably coupled with bottom sliding frame 130 such that engagement surfaces 145a, 145b, 147a, and 147b are engaged with a corresponding one of ramps 135a, 135b, 137a, and 137b. In turn, bottom sliding frame 130 may be operably coupled to bottom endplate 120. FIG. 12E illustrates top sliding frame 150 operably coupled to angled wedge 140 such that protrusions 148a, 148b may be configured to slide forward and backwards along an interior surface of channels 158a, 158b (not visible).



FIG. 13 illustrates screw guide body 256 operably coupled to sliding block 253. As illustrated screw guide body 256 may include a rail portion 256a extending longitudinally along top and bottom portions of screw guide body 256 in the lengthwise direction. Sliding block 253 may be operably coupled to screw guide body 256 such that sliding block 253 may be configured to slide forward and backwards along rail portion 256a. As explained above, sliding block 253 may also be coupled to first and second set screws 252, 254. Accordingly, sliding block 253 and first and second set screws 252, 254 may be operably coupled to screw guide body 256 such that sliding block 253 may be configured to slide forward and backwards along rail portion 256a while remaining coupled to first and second set screws 252, 254. Additionally, screw guide body 256 may include threaded portion 107a, which will be explained in further detail below.



FIG. 14 illustrates bottom sliding frame 130 being operably coupled to bottom endplate 120. In turn, angled wedge 140 may be operably coupled to top sliding frame 150 and bottom sliding frame 130. Additionally, screw guide body 256 may be operably coupled to sliding block 253. FIG. 15 is an alternate perspective view of an assembled expandable spinal implant 100. FIG. 16 is rear side profile view of an assembled expandable spinal implant 100 in accordance with the principles of the present disclosure. FIG. 17 is front side profile view of an assembled expandable spinal implant 100 in accordance with the principles of the present disclosure.


Referring generally to FIGS. 18A-24B various surgical tools for use with expandable spinal implant 100 are illustrated. FIGS. 18A-18B are perspective views of a first surgical tool 400 of an adjustable spinal implant system in accordance with the principles of the present disclosure. FIGS. 19A-19B are side views of the first surgical tool 400 and FIG. 20 illustrates a corresponding adjustment rod 450 configured for insertion inside of first surgical tool 400. Tip 406 may be configured to connect to spinal implant 100 such that spinal implant 100 may be securely attached to first surgical tool 400 by engaging locking mechanism 408. Similarly, tip 406 may be configured to disconnect from spinal implant 100 such that spinal implant 100 is no longer securely attached to first surgical tool 400 by disengaging locking mechanism 408. For example, FIG. 19A shows tip 406 in a first locking position with tip grips 406a being expanded for gripping onto spinal implant 100 and FIG. 19B shows tip 406 in a second locking position with tip grips 406a being retracted. Locking mechanism 408 may be configured to toggle between the first locking position and second locking position. In some embodiments, when locking mechanism 408 is engaged in the first locking position, spinal implant 100 may be fixedly coupled to first surgical tool 400. This may be advantageous for initial positioning of spinal implant 100 between vertebral bodies during surgery. Additionally, first surgical tool 400 includes a positioning mechanism 410 configured to position adjustment rod 450 in a first position and a second position. First surgical tool 400 may also include a push button 420 to toggle between positioning adjustment rod 450 in a first position to engage both first and second set screws 252, 254 and a second position to engage only the first set screw 252 (see FIG. 18B). Furthermore, in some embodiments first surgical tool 400 may include a window 421 to identify whether both first and second set screws 252254 are engaged for parallel expansion/contraction of spinal implant 100 or whether only the first set screw 252 is engaged for adjusting an angle of inclination of spinal implant 100.


In the exemplary embodiment, first surgical tool 400 includes a central shaft aperture 409 extending through handle 402, shaft 404, and tip 406. Central shaft aperture 409 may be configured to receive adjustment rod 450 therein such that adjustment knob 452 is rotatable therein and protrudes, at least partly, from both ends. Adjustment rod 450 includes an adjustment knob 452, first and second positioning surfaces 453, 454 and keyed circumferential surface 456. When adjustment rod 450 is positioned within central shaft aperture 409, adjustment knob 452 protrudes from one end and keyed circumferential surface 456 protrudes from the other end. With adjustment rod 450 inserted within central shaft aperture 409 positioning mechanism 410 can extend and retract adjustment rod 450 in the longitudinal direction of shaft 404. When first surgical tool 400 is in a first position, keyed circumferential surface 456 may engage with both first and second set screws 252, 254 along the axis A1 and when first surgical tool 400 is in the second position, keyed circumferential surface 456 may engage only the first set screw 252 along axis A1. Positioning mechanism 410 may be configured to be toggled between a first position and a second position where it can act against positioning surfaces 453, 454 to extend and retract adjustment rod 450 in the longitudinal direction of shaft 404. For example, in the first position positioning mechanism 410 may extend adjustment rod 450 from tip 406 to an extended position where circumferential surface 456 may engage with internal circumferential surfaces of the first and second set screws 252, 254. In the second position, positioning mechanism 410 may retract adjustment rod 450 through tip 406 to a partially retracted position where circumferential surface 456 may only engage with internal circumferential surface of the first set screw 252. An internal gearing of positioning mechanism 410 may include internal locking pins and surfaces that act against positioning surfaces 453, 454 such that when an exposed turn dial knob of positioning mechanism 410 is turned to a particular position, the internal locking pins and surfaces act against the inclined and recessed surfaces of positioning surfaces 453, 454.


Additionally, in some embodiments, first surgical tool 400 may be configured to receive adjustment rods 450 of varying lengths having varying outside circumferential surfaces 456 and positioning surfaces 453, 454. For example, first surgical tool 400 may be configured to receive a first relatively shorter adjustment rod 450 optimized for use for a spinal implant 100 using corresponding relatively smaller endplates 110, 120 and a corresponding smaller moving mechanism 250 having a relatively shorter longitudinal axis and/or length optimized for such relatively shorter endplates. For example still, first surgical tool 400 may be configured to receive a second relatively longer adjustment rod 450 optimized for use for a spinal implant 100 using corresponding relatively larger endplates and a corresponding larger moving mechanism 250 having a relatively longer longitudinal axis optimized for such relatively longer endplates.


Furthermore, in some embodiments, first surgical tool 400 may be configured to operate in three modes. In the first mode, tip grips 406a are securely connected to spinal implant 100. In the second mode, adjustment rod 450 may be positioned in a first position such that upon selective rotation of adjustment knob 452 a spacing between endplates 110, 120 may selectively increase/decrease in minute increments. For example, by translating each of first set screw 252 and second set screw 254. In the third mode, adjustment rod 450 may be positioned in a second position such that upon selective rotation of adjustment knob 452 an angle of inclination between endplates 110, 120 may selectively increase/decrease in minute increments. For example, by only translating first set screw 252 an angle of inclination between endplates 110, 120 may increase/decrease by moving one lateral side of the endplates 110,120 towards/away from each other and moving the opposite lateral side of the endplates 110,120 in an opposite direction. In some embodiments, this may also happen by only translating second set screw 254 e.g., by a surgical tool 400 having a circumferential engagement surface 456 that will only engage a single set screw 252, 254 at a time.


Additionally, in some embodiments, first surgical tool 400 may be configured to receive multiple types of adjustment rods 450. In at least one embodiment, first surgical tool 400 may receive a first adjustment rod 450 with an outside circumferential surface 456 that is configured to engage (1) both the first and second set screws 252, 254 at the same time and (2) the first set screw 252. For example, the first adjustment rod 450 may be toggled between (1) a first position where outside circumferential surface 456 is fully extended and configured to engage both the first and second set screws 252, 254, and (2) a second position where outside circumferential surface 456 is partially extended (and/or partially retracted) to engage only the first set screw 252. In an alternate embodiment, first surgical tool 400 may receive a second adjustment rod 450 with an outside circumferential surface 456 that is configured to engage only one set screw 252, 254 at a time. For example, the outside circumferential surface 456 may have an engagement surface with a longitudinal length that corresponds to a single set screw 252, 254 such that it only engages with a single set screw 252, 254 at a time. For example, the second adjustment rod 450 may be toggled between (1) a first position where outside circumferential surface 456 is fully extended and configured to engage the second set screw 254 independently of the first set screw 252 and (2) a second position where outside circumferential surface 456 is partially extended (and/or partially retracted) to engage only the first set screw 252. At least one advantage of having first surgical tool 400 being configured to receive multiple types of adjustment rods 450 of varying lengths and having outside circumferential surfaces of different lengths is that a surgeon can quickly and easily select the appropriate adjustment rod 450. For example, a surgeon may select first adjustment rod 450 to expand/contract a spacing between endplates 110, 120 by the same or substantially the same amount while maintaining the angle of inclination between endplates 110, 120, i.e., by engaging both first and second set screws 252, 254. Additionally, a surgeon may select second adjustment rod 450 to selectively increase/decrease an angle of inclination between endplates of spinal implant 100 at the first lateral side 103 and second lateral side 104, i.e., by only engaging one of first and second set screws 252, 254 at a time.


In some embodiments, spinal implant 100 may comprise a three position inner drive shaft (not illustrated) complimentary to or in place of components of moving mechanism 250. The three position inner drive shaft may enable the first and second set screws 252, 254 to be adjusted independently from one another as well as enabling the first and second set screws 252, 254 to be adjusted concurrently or simultaneously. In other embodiments, spinal implant 100 may include a screw guide aperture 107 on both sides of the spinal implant 100 thereby providing access to the first set screw 252 independently from second set screw 254.



FIG. 21 is a perspective view of a different embodiment of a first surgical tool 400 for use with disclosed expandable spinal implants 100 and FIG. 22 is an enlarged side view of a tip portion 406 of the first surgical tool 400 of FIG. 21 in accordance with the principles of the present disclosure. In the disclosed embodiment, first surgical tool 400 may further include a threaded portion 400a operably configured to engage with a corresponding threaded portion 107a (see FIG. 13) of an expandable spinal implant 100. An advantage of this arrangement may be that the spinal implant 100 may be rigidly secured to first surgical tool 400 for insertion, removal, and/or adjustment.



FIG. 23A is a perspective view of a different embodiment of a first surgical tool and FIG. 23B is a perspective view of the embodiment of FIG. 23A fixedly and operably engaged with expandable spinal implant 100 in accordance with the principles of the present disclosure. As illustrated, first surgical tool 400 includes a bent portion 400b adjacent the tip end 406. In some embodiments, bent portion 400b may be bent by about 5-25 degrees with respect to shaft 404. In other embodiments, bent portion 400b may be bent by about 10-15 degrees with respect to shaft 404. In at least one embodiment, bent portion 400b may be bent by about 15 degrees with respect to shaft 404. FIG. 24A is a perspective view of an expandable spinal implant 100 between adjacent vertebrae and a straight first surgical tool 400 in an adjustment position and FIG. 24B is a perspective view of an expandable spinal implant 100 between adjacent vertebrae and a curved first surgical tool 400 in an adjustment position.


Spinal implant systems of the present disclosure can be employed with a surgical arthrodesis procedure, such as, for example, an interbody fusion for treatment of an applicable condition or injury of an affected section of a spinal column and adjacent areas within a body, such as, for example, intervertebral disc space between adjacent vertebrae, and with additional surgical procedures and methods. In some embodiments, spinal implant systems can include an intervertebral implant that can be inserted between adjacent vertebral bodies to space apart articular joint surfaces, provide support for and maximize stabilization of vertebrae. In some embodiments, spinal implant systems may be employed with one or a plurality of vertebra.


Consistent with the disclosed embodiments herein, a medical practitioner may obtain access to a surgical site including vertebrae such as through incision and retraction of tissues. Spinal implant systems of the present disclosure can be used in any existing surgical method or technique including open surgery, mini-open surgery, minimally invasive surgery and percutaneous surgical implantation, whereby vertebrae are accessed through a mini-incision, retractor, tube or sleeve that provides a protected passageway to the area, including, for example, an expandable retractor wherein the sleeve may be formed from multiple portions that may be moved apart or together and may be inserted with the portions closed or together and then expanded to allow for insertion of implants of larger size than the closed cross section of the unexpanded retractor portions. In one embodiment, the components of the spinal implant system are delivered through a surgical pathway to the surgical site along a surgical approach into intervertebral disc space between vertebrae. Various surgical approaches and pathways may be used.


As will be appreciated by one of skill in the art, a preparation instrument (not shown) may be employed to remove disc tissue, fluids, adjacent tissues and/or bone, and scrape and/or remove tissue from endplate surfaces of a first vertebra and/or endplate surface of a second vertebra in preparation for or as part of the procedures utilizing a system of the present disclosure. In some embodiments, the footprint of spinal implant 100 may be selected after trialing using trialing instruments (not shown) that may approximate the size and configuration of spinal implant 100. In some embodiments, such trials may be fixed in size and/or be fitted with moving mechanisms 250 similar to embodiments described herein. In some embodiments, spinal implant 100 may be visualized by fluoroscopy and oriented before introduction into intervertebral disc space. Furthermore, first and second surgical tools 400, 500 (see FIG. 38A) and spinal implant 100 may be fitted with fiducial markers to enable image guided surgical navigation to be used prior to and/or during a procedure.


Components of a spinal implant systems of the present disclosure can be delivered or implanted as a pre-assembled device or can be assembled in situ. In one embodiment, spinal implant 100 may be made of a single piece construction that may not be disassembled without destroying the device. In other embodiments, spinal implant 100 may comprise removable parts. Components of spinal implant systems may be expanded, contracted, completely or partially revised, removed or replaced in situ. In some embodiments, spinal implant 100 can be delivered to the surgical site via mechanical manipulation and/or a free hand technique.


Additionally, components of spinal implant 100 can include radiolucent materials, e.g., polymers. Radiopaque markers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. Furthermore, first and second surgical tools 400, 500 (see FIGS. 18A, 38A) may be radiolucent and may optionally include markers added at a tip portion thereof to permit them to be seen on fluoroscopy/x-ray while advancing into the patient. At least one advantage to having spinal implant 100 may be that a medical practitioner can verify the positioning of spinal implant 100 relative to adjacent vertebral bodies and make further adjustments to the spacing between endplates 110, 120, angle of inclination between endplates 110, 120, and the overall positioning of the device within a patient's body. In this way, spinal implant 100 may correct alignment of a patient's spine in a coronal plane.


Referring generally to FIGS. 25-34B, operable functional characteristics of moving mechanism 250 and expandable spinal implant 100 will be disclosed. FIG. 25 is a top down cut out view of an expandable spinal implant 100 and FIG. 26 is a top down cut out view of the expandable spinal implant of FIG. 25 and a first surgical tool 400 in a first adjustment position in accordance with the principles of the present disclosure. As illustrated in FIG. 26, tip 406 may be inserted through screw guide aperture 107 and into moving mechanism 250. Moving mechanism 250 includes a first set screw 252 and a second set screw 254 having respective internal cavities configured to operably receive tip 406. As explained above, the first and second set screws 252, 254 may be operably coupled to angled wedge 140 and bottom sliding frame 130, respectively. In the exemplary embodiment, the second set screw 254 has a reverse thread pitch relative to the first set screw 252. In some embodiments, the thread pitch may be an M6 thread pitch, however other embodiments may have other thread pitches.


Each internal cavity of set screws 252, 254 comprises an internal circumferential surface that may be keyed to the outside circumferential surface 412 of tip 406 of first surgical tool 400. For example, the outside circumferential surface 412 may resemble the geometry of the tip of a torx driver, hex driver, or the like and the internal circumferential surfaces of the first and second set screws 252, 254 may resemble the geometry of the cavity of the head of a torx screw, hex screw, or the like. In some embodiments, the internal circumferential surfaces of the first and second set screws 252, 254 may be configured for a Torx T20 driver or the like, however other embodiments may be differently sized. In other embodiments, the connection between the outside circumferential surface 412 and the inner circumferential surfaces of first and second set screws 252, 254 may comprise a variety of drive interfaces including but not limited to: multi-lobular drives; hexalobular drives; cross or Phillips head drives; straight or “flat head” drives; square or other polygonal drives; and/or combinations thereof. It shall be understood that any suitable geometrical shape or surface profile may be used by the exemplary embodiments disclosed herein provided the outside circumferential surface 412 is operably keyed to engage with the internal circumferential surfaces of the first and second set screws 252, 254.


In the exemplary embodiment of FIG. 26, outside circumferential surface 412 may be engaged with both the first and second set screws 252, 254 and when first surgical tool 400 is rotated in a first direction (clockwise direction) the outside circumferential surface 412 rotates both set screws 252, 254 thereby causing angled wedge 140 and bottom sliding frame 130 to move forward towards distal end 102 and away from proximal end 101 (because angled wedge 140 and bottom sliding frame 130 are directly coupled to first and second set screws 252, 254, respectively). Additionally, because protrusions 138c of bottom sliding frame 130 (see FIG. 11) are operably coupled to third channels 158c of top sliding frame 150 (see FIGS. 10C-10D), movement of bottom sliding frame 130 towards distal end 102 and away from proximal end 101 also causes the same longitudinal movement of top sliding frame 150, i.e., movement of bottom sliding frame forward and backward also causes movement of top sliding frame forwards and backwards in a direction parallel to first reference axis A1. For example, as shown in FIG. 27, top sliding frame 150 and bottom sliding frame 130 are represented as moving from proximal end 101 to distal end 102 by arrows to thereby move endplates 110, 120 to a collapsed position, i.e., spinal implant 100 may be in a vertically collapsed position in FIG. 27.


Similarly, when outside circumferential surface 412 is engaged with both the first and second set screws 252, 254 and when first surgical tool 400 is rotated in a second direction (counter-clockwise direction) the outside circumferential surface 412 rotates both set screws 252, 254 thereby causing angled wedge 140 and bottom sliding frame 130 to move backwards towards proximal end 101 and away from distal end 102 (because angled wedge 140 and bottom sliding frame 130 are directly coupled to first and second set screws 252, 254, respectively). Additionally, bottom sliding frame 130 may be operably coupled to top sliding frame 150 as explained above, top sliding frame 150 also moves towards proximal end 101 and away from distal end 102. For example, as shown in FIG. 28, top sliding frame 150 and bottom sliding frame 130 are represented as moving from distal end 102 to proximal end 101 to thereby move endplates 110, 120 to an expanded position, i.e., spinal implant 100 may be in a vertically expanded position in FIG. 28.


Top sliding frame 150 effectuates the above explained expansion/contraction motion because first distal contact surfaces 150a and first proximate contact surfaces 150b (see FIG. 10D) act against inclined surfaces of corresponding ramps 114, 116 of top endplate 110 (represented by arrows) and first proximate guide walls 154a and first distal guide walls 156a (see FIG. 10B) are retained by first proximal grooves 114a and first distal grooves 116a, respectively. Similarly, bottom sliding frame 130 effectuates this expansion motion because inclined contact surfaces 136aa and 134aa (see FIG. 11) act against corresponding inclined surfaces of ramps 124, 126 of bottom endplate 120 (represented by arrows) and second proximate guide walls 134a and second distal guide walls 136a (see FIG. 11) are retained by second proximal grooves 124a and second distal grooves 126a. In summary, when positioning the first surgical tool 400 in the first position and translating the first surgical tool 400 in either the first or second direction the moving mechanism 250 operably adjusts a spacing between the top and bottom endplates by simultaneous rotation of the first and second set screws 252, 254.


In the exemplary embodiment of FIG. 29, outside circumferential surface 412 may be engaged with only the first set screw 252 and when first surgical tool 400 is rotated in a first direction (clockwise direction) the outside circumferential surface 412 rotates set screw 252 thereby causing angled wedge 140 to move forward towards distal end 102 and away from proximate end 101. This occurs because angled wedge 140 may be coupled to first set screw 252. For example, as shown in FIG. 30A, angled wedge 140 is represented as moving from proximal end 101 to distal end 102 by arrows. As illustrated by arrows in FIG. 30B, when angled wedge 140 moves forward towards distal end 102 it causes top sliding frame 150 and bottom sliding frame 130 to move away from one another at second lateral end 104 and move towards one another at first lateral end 104. For example, when angled wedge 140 moves forward towards distal end 102 it causes a distance between endplates 110, 120 at corresponding first lateral ends thereof to increase and also causes a distance between endplates 110, 120 at corresponding second lateral ends thereof to decrease. Therefore, rotation of only the first set screw 252 adjusts an angle of inclination between endplates 110, 120.


Similarly, when outside circumferential surface 412 is engaged with only the first set screw 252 and when first surgical tool 400 is rotated in a second direction (counter-clockwise direction) the outside circumferential surface 412 rotates first set screw 252 thereby causing angled wedge 140 to move backwards towards proximal end 101 and away from distal end 102. For example, as shown in FIG. 31A, angled wedge 140 is represented as moving from distal end 102 towards proximal end 101 by arrows. As illustrated by arrows in FIG. 31B, when angled wedge 140 moves backwards towards proximal end 101 it causes top sliding frame 150 and bottom sliding frame 130 to move away from one another at first lateral end 103 and move towards one another at second lateral end 104. For example, when angled wedge 140 moves backward towards proximal end 101 it causes a distance between endplates 110, 120 at corresponding second lateral ends thereof to increase and also causes a distance between endplates 110, 120 at corresponding first lateral ends thereof to decrease. Therefore, rotation of only the first set screw 252 adjusts an angle of inclination between endplates 110, 120.


Angled wedge 140 effectuates this inclination type motion because it acts against both top sliding frame 150 and bottom sliding frame 130. For example, angled wedge 140 effectuates inclination of top sliding frame 150 because protrusions 148a are oppositely inclined from protrusions 148b are operably retained within corresponding oppositely inclined channels 158a, 158b of top sliding frame 150. In this way forward and backward movement of angled wedge 140 causes top sliding frame 150 to rotate. Similarly, angled wedge 140 effectuates inclination of bottom sliding frame 130 because engagement surfaces 145a, 145b, 147a, and 147b (see FIGS. 12B-12C) slide along and act against ramps 135a, 135b, 137a, and 137b (where ramps 135a, 137a are inclined oppositely from ramps 135b and 137b) of bottom sliding frame 130 (see FIG. 11). In summary, when positioning the first surgical tool 400 in the second position and translating the first surgical tool 400 in either the first or second direction the moving mechanism 250 operably adjusts an inclination between the top and bottom endplates 110, 120 by rotation of the first set screw 252. Furthermore, in some embodiments, such inclination type motion may occur by rotation of only the second set screw 254.



FIGS. 32A-32F are various side views illustrating some exemplary expansion ranges of an expandable spinal implant 100 in six alternate configurations accordance with the principles of the present disclosure. FIG. 32A illustrates spinal implant 100 in a first position and FIG. 32B illustrates spinal implant 100 in a second position. In the first position, a first height H1A between endplates 110, 120 of first lateral end 103 may be about 9.4 mm, a first height H1B between endplates 110, 120 of second lateral end 104 may be about 9.1 mm, and a first angle of inclination Oi between endplates 110, 120 may be about 0.8°. In the second position, a second height H2A between endplates 110, 120 of first lateral end 103 may be about 10.9 mm, a second height H2B between endplates 110, 120 of second lateral end 104 may be about 7.6 mm, and a second angle of inclination θ2 between endplates 110, 120 may be about 9.7°.



FIG. 32C illustrates spinal implant 100 in a third position and FIG. 32D illustrates spinal implant 100 in a fourth position. In the third position, a third height H3A between endplates 110, 120 of first lateral end 103 may be about 12.6 mm, a third height H3B between endplates 110, 120 of second lateral end 104 may be about 5.9 mm, and a third angle of inclination θ3 between endplates 110, 120 may be about 19.2°. In the fourth position, a fourth height H4A between endplates 110, 120 of first lateral end 103 may be about 12.7 mm, a fourth height H2B between endplates 110, 120 of second lateral end 104 may be about 12.4 mm, and a fourth angle of inclination θ4 between endplates 110, 120 may be about 0.8°.



FIG. 32E illustrates spinal implant 100 in a fifth position and FIG. 32F illustrates spinal implant 100 in a sixth position. In the fifth position, a fifth height H5A between endplates 110, 120 of first lateral end 103 may be about 19.5 mm, a fifth height H5B between endplates 110, 120 of second lateral end 104 may be about 12.5 mm, and a third angle of inclination θ5 between endplates 110, 120 may be about 10.2°. In the sixth position, a sixth height H6A between endplates 110, 120 of first lateral end 103 may be about 16 mm, a sixth height H6B between endplates 110, 120 of second lateral end 104 may be about 12.7 mm, and a fourth angle of inclination θ4 between endplates 110, 120 may be about 9.7°. It shall be appreciated that the foregoing disclosure is exemplary in nature and the ranges disclosed herein are non-limiting examples intended merely to showcase six viable positions of expandable spinal implant 100. Additionally, although specific ranges are provided herein with reference to exemplary spinal implant 100, other embodiments may have alternate corresponding dimensions, i.e., height, from those provided above.



FIGS. 33 and 34 are top down views illustrating some exemplary dimensions and expansion range differences of an expandable spinal implant 100 in accordance with the principles of the present disclosure. In FIG. 33, expandable spinal implant 100 has a first length L1 and a first width W1 in a first position. For example, spinal implant 100 is illustrated with top sliding frame 150 relatively far forward towards distal end 102 and moving mechanism 250 near proximal end 101. In the illustrated position, a total length of expandable spinal implant 100 may be about 53 mm, in part because a tip portion of top sliding frame 150 partially extends from a tip portion of endplates 110, 120. In FIG. 34, expandable spinal implant 100 has a second length L2 and a second width W2 in a second position. For example, spinal implant 100 is illustrated with top sliding frame 150 relatively far rearward towards proximal end 101 and moving mechanism 250 relatively near distal side 102. In the illustrated position, a total length of expandable spinal implant 100 may be about 50.3 mm, in part because only endplates 110, 120 define the length of expandable spinal implant 100. Additionally, in each of first and second positions a width of spinal implant 100 remains constant, although in other embodiments having relatively narrower endplates a width may ostensibly be defined, at least partly, by other internal components of spinal implant 100. FIGS. 33 and 34 also illustrate a functional aspect of moving mechanism 250 in that sliding block 253, and set screws 252, 254 may slide back and forth along screw guide body 256.


Referring generally to FIGS. 35-42, exemplary spinal implant 100 is discussed in view of second surgical tool 500. FIGS. 35-37 illustrate various perspective views, lateral side views and front side views of spinal implant 100 with first and second anchoring screws 510a, 510b. Anchoring screws 510a, 510b may penetrate through anchoring apertures 110s, 120s of top and bottom endplates 110, 120, respectively. As best illustrated in FIGS. 36, 37 one or more anchoring apertures 110s, 120s may be disposed adjacent a proximal end 101 of expandable spinal implant 100 and be shaped such that one or more anchoring screws 510a, 510b are inclined away from endplates 110, 120 from a corner region where first lateral end 103 and proximal end 101 adjoin one another towards a region where second lateral end 104 and distal end 102 adjoin each other. For example, anchoring apertures 110s, 120s may be inclined with respect to endplates 110, 120 and may be shaped and/or oriented such that anchoring screws extend diagonally from proximal end 101 to distal end 102. These apertures may further include features, thread forms, and/or protrusions for enhanced screw retention and/or separate screw retention features and/or internal or external locking features and or partial or full covers.



FIG. 38A is a side view of a second surgical tool 500 suitable for use with disclosed embodiments and systems herein, e.g., to drive one or more anchoring screws, for example, 510a-510b. FIG. 39 is a side view of an enlarged region of FIG. 38. Exemplary, second surgical tool 500 includes a ratcheting drive shaft 555, a positioning handle 520, a tip portion 530, a drive shaft housing 540, and a trigger 550. Ratcheting drive shaft 555 may be configured to connect and disconnect with a ratcheting handle (not shown) and rotate within ratcheting drive shaft housing 540. For example, the drivable connection may comprise a variety of drive interfaces including but not limited to: multi-lobular drives; hexalobular drives; cross or Phillips head drives; straight or “flat head” drives; square or other polygonal drives; and/or combinations thereof. Positioning handle 520 may be configured to assist with maintaining and controlling the second surgical tool 500, e.g., in view of torque transmitted through ratcheting drive shaft 555. Tip portion 530 may be angled at a degree 13 with respect to a longitudinal direction of drive shaft housing 540. In some embodiments, tip portion 530 may be angled such that the degree 13 corresponds to the inclination of anchoring screws 510a, 510b and the inclination of anchoring aperture 110s, 120s. For example, anchoring apertures 110s, 120s may be inclined about 30°-50°, and more particularly about 40°, with respect to an outside surface 111, 121 of endplates 110, 120. This arrangement may be advantageous for driving anchoring screws 510a-510b while spinal implant 100 is positioned between adjacent vertebral bodies. Tip portion 530 may secure an anchoring screw 510a, 510b in an internal cavity therein such that the anchoring screw 510a, 510b may not disconnect during initial positioning of the anchoring screw 510a, 510b. For example, tip portion 530 may have a flexible elastic member configured to securely retain a head portion of the anchoring screw 510a, 510b. Tip portion 530 may, however, release the anchoring screw 510a, 510b when it is sufficiently anchored into an anatomical feature, such as a vertebrae for example. This feature may be particularly advantageous during surgery for maintaining the anchoring screw 510a, 510b in tip portion 530 such that the anchoring screw 510a, 510b does not uncouple from tip portion 530 when initially positioning the anchoring screw 510a, 510b in an anchoring aperture, for example anchoring apertures 110s, 120s. Additionally, in some embodiments tip portion 530 may be operably coupled with trigger 550 such that trigger 550 may disconnect the anchoring screw 510a, 510b when the anchoring screw 510a, 510b is installed. In some embodiments, trigger 550 may not be necessary because tip portion 530 may self-release the anchoring screw 510a, 510b after installation.



FIGS. 39A-39C are various perspective views of exemplary anchoring screws suitable for use with disclosed embodiments herein in conjunction with the second surgical tool 500. FIG. 39A shows a trocar tip bone screw 510e, FIG. 39B shows a flutes or fluted tip bone screw 510f, and FIG. 39C shows a speed bone screw 510g. Each bone screw 510e-510g may have a thread pitch and sizing that corresponds to a size of anchoring apertures 110s, 120s. Trocar tip bone screw 510e includes an angled tip portion 510e-1 and a thread pattern including threads 510e-2. Threads 510e-2 may be spaced back from angled tip portion 510e-1 which may facilitate with aligning bone screw 510e with anchoring apertures 110s, 120s. For example, in some embodiments, threads 510e-2 are spaced back about 3 mm from angled tip portion 510e-1. Fluted tip bone screw 510f includes a cutting tip 510f-1 and a thread pattern included threads 510f-2. Cutting tip 510f-1 may extend a relatively long distance from the beginning of threads 510f-2 such that the cutting tip 510f-1 may pre-drill into an adjacent vertebral body before the threads 510f-2 engage with anchoring apertures 110s, 120s. For example, in some embodiments, threads 510f-2 are spaced back about 8 mm from cutting tip 510f-1. Speed bone screw 510g includes a conical tip 510g-1 and a thread pattern including threads 510g-2. Different from trocar tip bone screw 510e and fluted tip bone screw 510f, threads 510g-2 of speed bone screw 510g may begin immediately adjacent conical tip 510g-1.



FIG. 40 is a front side view of an expandable spinal implant 100 that may include none, one or a pair of anchoring screws installed into adjacent vertebrae of a patient, FIG. 41 is a lateral side view of the expandable spinal implant of FIG. 40, and FIG. 42 is a top down view of the expandable spinal implant of FIG. 40 in accordance with the principles of the present disclosure. As illustrated best in FIGS. 41, and 42, interior surfaces of anchoring apertures 110s, 120s, abut (directly contact an edge portion) a corresponding end portion of an adjacent vertebrae. At least one advantage of this geometry may be that anchoring apertures 110s, 120s can provide further lateral stability and facilitate with positioning of expandable spinal implant 100 in a correct position. An additional advantage is that this arrangement may assist a surgeon in being able to install and/or access bone screws.


Referring generally to FIGS. 43-47 various perspective views an expandable spinal implant 200 are shown. Spinal implant 200 may feature the same, or substantially the same features and components, or a selection of some features or aspects, as described with respect to spinal implant 100. Accordingly, duplicative description thereof will be omitted. As illustrated, spinal implant 200 includes a moving mechanism 2500 that may be miss aligned. For example, second reference axis A2 may extend diagonally in the longitudinal direction of moving mechanism 2500 and may be offset with respect to first reference axis A1 of spinal implant 100 (see FIG. 2). In the disclosed embodiment, moving mechanism 2500 features the same parts as moving mechanism 250 and may operate under the same principles as explained previously. In the disclosed embodiment, moving mechanism 2500 may be miss aligned by about 10° when compared with moving mechanism 250 of spinal implant 100. In other embodiments, moving mechanism 2500 may be miss aligned within any suitable range, e.g., from about 5° to 25°. FIG. 44 is a perspective view of the embodiment of FIG. 43 with a top endplate 1100 removed for ease of understanding. As illustrated, moving mechanism 2500 may be misaligned and the top and bottom endplates 1100, 1200 have a different geometry to accommodate the miss aligned moving mechanism 2500. Top and bottom endplates 1100, 1200 may feature the same or substantially the same characteristics as previously disclosed. FIG. 45 is an alternate perspective view of the embodiment of FIG. 44 with a top endplate 1100 removed for ease of understanding. FIG. 46A is a top down view of an exemplary top endplate 1100 for use with the embodiment of FIG. 43 and FIG. 46B is a top down view of an exemplary bottom endplate 120 for use with the embodiment of FIG. 43.


Referring generally to FIGS. 47-49 various views of an expandable spinal implant 300 are disclosed. Spinal implant 300 may be configured for anterior and/or oblique surgical techniques. Spinal implant 300 may adjust the alignment of a patient's spine in the sagittal plane (see FIG. 50). Spinal implant 300 may feature the same, or substantially the same features and components, or a selection of some features or aspects, as described above with respect to spinal implant 100. Accordingly, duplicative description thereof will be omitted. Similar to spinal implant 100, spinal implant 300 may feature a moving mechanism 250 configured to move forward and backwards along a third reference axis A3. Third spinal implant 300 differs from spinal implant 100, in that top endplate 310 and bottom endplate 320 each have a footprint configured for anterior and/or oblique surgical techniques. Additionally, the interior surfaces of endplates 310, 320 may have a substantially similar arrangement of acting surfaces, ramps, channels, grooves, and etc. as explained above with respect to spinal implant 100.



FIG. 49A illustrates spinal implant 300 in a first position and FIG. 49B illustrates spinal implant 300 in a second position. In the first position, a first height H1A between endplates 310, 320 of first lateral end 103 may be relatively greater than a first height H1B between endplates 310, 320 of second lateral end 104. In the second position, a second height H2A between endplates 310, 320 of first lateral end 103 may be relatively smaller than a second height H2B between endplates 310, 320 of second lateral end 104. Similarly, a first angle of inclination Oi between endplates 310, 320 may be relatively less than a second angle of inclination θ2 between endplates 310, 320. Spinal implant 300 may be adjusted into the first position and second position in the same, or substantially the same, way as explained above with respect to spinal implant 100. For example, first surgical tool 400 may be insert into a first position to operably adjust the height between endplates 310, 320 and first surgical tool 400 may be insert into a second position to operably adjust an inclination between endplates 310, 320.



FIG. 50 is a reference diagram illustrating various cardinal directions and planes with respect to a patient that the exemplary embodiments of FIGS. 1-49B may operate, adjust, and/or move along in accordance with the principles of the present disclosure.

Claims
  • 1. An expandable spinal implant, comprising: a first endplate and a second endplate extending in a longitudinal direction;a sliding frame coupled to a wedge, at least one of the sliding frame and the wedge being coupled to at least one of the first endplate and second endplate; anda moving mechanism coupled to the sliding frame and the wedge, the moving mechanism having a rotation axis extending in the longitudinal direction and an aperture configured to engage with a corresponding surgical tool;wherein the moving mechanism comprises a first set screw and a set screw and the moving mechanism is configured to selectively move at least one of the sliding frame and the wedge forward and backward in the longitudinal direction such that the first and second endplates expand and contract with respect to one another, andwherein the sliding frame is further configured to selectively rotate about the rotation axis upon movement of the wedge in the longitudinal direction to thereby adjust an angle of inclination between the first endplate and the second endplate.
  • 2. The expandable spinal implant of claim 1, wherein the sliding frame includes a bottom sliding frame component and a top sliding frame component.
  • 3. The expandable spinal implant of claim 2, wherein: the wedge includes a first protrusion on a first outside lateral side surface thereof and a second protrusion on a second outside lateral side surface thereof, andthe bottom sliding frame component includes a first channel on a first inside lateral side surface thereof for disposal of the first protrusion therein and a second channel on a second inside lateral side surface thereof for disposal of the second protrusion therein.
  • 4. The expandable spinal implant of claim 2, wherein the top sliding frame component includes at least one inclined contact surface that is configured to contact an interior surface of the first endplate and the bottom sliding frame component includes at least one inclined contact surface that is configured to contact an interior surface of the second endplate.
  • 5. The expandable spinal implant of claim 4, wherein the top sliding frame component includes a plurality of channels on inside lateral surfaces of the top sliding frame component.
  • 6. The expandable spinal implant of claim 5, wherein the bottom sliding frame component includes a plurality of protrusions on outside lateral surfaces of the bottom sliding frame component that correspond in size, shape, and orientation to the plurality of channels of the top sliding frame component.
  • 7. The expandable spinal implant of claim 2, wherein the top sliding frame component is operably coupled to the interior surface of the first endplate and the bottom sliding frame component is operably coupled to the interior surface of the second endplate.
  • 8. The expandable spinal implant of claim 7, wherein the top sliding frame component comprises a plurality of guide walls that are operably coupled to a plurality of grooves of the first endplate.
  • 9. The expandable spinal implant of claim 1, wherein the first set screw is operably coupled to the bottom sliding frame component and the second set screw is operably coupled to the wedge.
  • 10. The expandable spinal implant of claim 9, wherein the bottom sliding frame component, the top sliding frame component, and the wedge are configured to move forward and backwards in the longitudinal direction upon rotation of the first set screw and second set screw.
  • 11. The expandable spinal implant of claim 1, wherein: the sliding frame includes a bottom sliding frame component and a top sliding frame component,the moving mechanism further comprises a screw guide body operably coupled to a screw guide endplate at a proximal end of the expandable spinal implant, andthe screw guide body is configured to support the first set screw and the second set screw.
  • 12. The expandable spinal implant of claim 11, wherein the first set screw is operably coupled to the bottom sliding frame component and the second set screw is operably coupled to the wedge and the wedge is operably coupled to the top sliding frame component.
  • 13. The expandable spinal implant of claim 12, wherein the first set screw and second set screw are coupled to opposite sides of a sliding block that is moveable forward and backward in the longitudinal direction of the screw guide body.
  • 14. A system for performing a spinal surgery, comprising: an expandable spinal implant and a surgical tool for inserting and expanding the expandable spinal implant;the expandable spinal implant extending in a first longitudinal direction from a proximal end to a distal end and comprising:a first endplate and a second endplate opposite the first endplate;a sliding frame coupled to a wedge, at least one of the sliding frame and the wedge being coupled to at least one of the first endplate and the second endplate; anda moving mechanism comprising a screw guide body defining a rotation axis extending in the longitudinal direction and being configured to rotatably support a first set screw and a second set screw therein, the first set screw being operably coupled to the sliding frame and the second set screw being operably coupled to the wedge,wherein the surgical tool extends in a second longitudinal direction from a proximal end to a distal end, the distal end comprising a circumferential surface configured to rotate either one or both of the first set screw and second set screw,wherein the moving mechanism is configured to move at least one of the sliding frame and the wedge forward and backward in the first longitudinal direction upon rotation of the first set screw and/or second set screw via the surgical tool such that the first and second endplates expand and contract with respect to one another, andwherein the sliding frame is further configured to rotate about the rotation axis upon movement of the wedge in the first longitudinal direction to thereby adjust an angle of inclination between the first endplate and the second endplate.
  • 15. The system of claim 14, wherein: the screw guide body is operably coupled to a screw guide endplate disposed at the proximal end of the expandable spinal implant, andthe circumferential surface of the surgical tool is configured to extend through an aperture of the screw guide endplate to the first set screw and second set screw.
  • 16. The system of claim 15, wherein the aperture of the screw guide body is defined by a first threaded portion configured to engage with a corresponding threaded portion of the surgical tool such that the expandable spinal implant is releasably locked to the surgical tool.
  • 17. The system claim 14, wherein: the sliding frame comprises a top sliding frame component and a bottom sliding frame component, andfirst set screw is operably coupled to the bottom sliding frame component and the second set screw is operably coupled to the wedge.
  • 18. The system of claim 14, wherein: the surgical tool further comprises a positioning mechanism including an actuator configured to position an adjustment rod supporting the circumferential surface in a first extended position and a second extended position,in the first extended position the circumferential surface is configured to engage with both of the first set screw and the second set screw, andin the second extended position the circumferential surface is configured to engage with only the first set screw.
  • 19. The system of claim 14, wherein the surgical tool comprises a bent portion adjacent the distal end thereof.
  • 20. An expandable spinal implant, comprising: a first endplate and a second endplate extending in a longitudinal direction;a sliding frame coupled to a wedge, at least one of the sliding frame and the wedge being coupled to at least one of the first endplate and second endplate; anda moving mechanism coupled to the sliding frame and the wedge, the moving mechanism having a rotation axis extending in the longitudinal direction and an aperture configured to engage with a corresponding surgical tool;wherein the moving mechanism is configured to selectively move at least one of the sliding frame and the wedge forward and backward in the longitudinal direction such that the first and second endplates expand and contract with respect to one another,wherein the sliding frame is further configured to selectively rotate about the rotation axis upon movement of the wedge in the longitudinal direction to thereby adjust an angle of inclination between the first endplate and the second endplate,wherein the sliding frame includes a bottom sliding frame component and a top sliding frame component,wherein the wedge includes a first protrusion on a first outside lateral side surface thereof and a second protrusion on a second outside lateral side surface thereof, andwherein the bottom sliding frame component includes a first channel on a first inside lateral side surface thereof for disposal of the first protrusion therein and a second channel on a second inside lateral side surface thereof for disposal of the second protrusion therein.
Priority Claims (3)
Number Date Country Kind
PCT/IB2020/000932 Nov 2020 WO international
PCT/IB2020/000942 Nov 2020 WO international
PCT/IB2020/000953 Nov 2020 WO international
CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 17/123,897, titled Expandable Inter-Body Device, System, and Method, filed Dec. 16, 2020 which claims priority to: PCT/IB2020/000942, titled Expandable inter-body device and system, filed Nov. 5, 2020; PCT/IB2020/000932, titled Screwdriver and complimentary screws, filed Nov. 5, 2020; and PCT/IB2020/000953, titled Expandable inter-body device and system, filed Nov. 5, 2020. The contents of each of the above applications are hereby incorporated in their entireties.

US Referenced Citations (980)
Number Name Date Kind
1677337 Grove Jul 1928 A
3847154 Nordin Nov 1974 A
4553273 Wu Nov 1985 A
4636217 Ogilvie et al. Jan 1987 A
4716894 Lazzeri et al. Jan 1988 A
4759769 Hedman et al. Jul 1988 A
5059193 Kuslich Oct 1991 A
5171278 Pisharodi Dec 1992 A
5228811 Potter Jul 1993 A
5284483 Johnson et al. Feb 1994 A
5336223 Rogers Aug 1994 A
5390683 Pisharodi Feb 1995 A
5522899 Michelson Jun 1996 A
5554191 Lahille et al. Sep 1996 A
5575790 Chen et al. Nov 1996 A
5609635 Michelson Mar 1997 A
5653762 Pisharodi Aug 1997 A
5653763 Errico et al. Aug 1997 A
5658336 Pisharodi Aug 1997 A
5665122 Kambin Sep 1997 A
5693100 Pisharodi Dec 1997 A
5697977 Pisharodi Dec 1997 A
5702391 Lin Dec 1997 A
5702453 Rabbe et al. Dec 1997 A
5702455 Saggar Dec 1997 A
5797918 McGuire et al. Aug 1998 A
5800550 Sertich Sep 1998 A
5865848 Baker Feb 1999 A
5893890 Pisharodi Apr 1999 A
5931777 Sava Aug 1999 A
5941885 Jackson Aug 1999 A
5971987 Huxel et al. Oct 1999 A
5980522 Koros et al. Nov 1999 A
6045579 Hochshuler et al. Apr 2000 A
6074343 Nathanson et al. Jun 2000 A
6080193 Hochshuler et al. Jun 2000 A
6099531 Bonutti Aug 2000 A
6102949 Biedermann et al. Aug 2000 A
6102950 Vaccaro Aug 2000 A
6106557 Robioneck et al. Aug 2000 A
6113638 Williams et al. Sep 2000 A
6117174 Nolan Sep 2000 A
6132465 Ray et al. Oct 2000 A
6159211 Boriani et al. Dec 2000 A
6159244 Suddaby Dec 2000 A
6176882 Biedermann et al. Jan 2001 B1
6179873 Zientek Jan 2001 B1
6190414 Young et al. Feb 2001 B1
6193757 Foley et al. Feb 2001 B1
6217579 Koros Apr 2001 B1
6245108 Biscup Jun 2001 B1
6309421 Pisharodi Oct 2001 B1
6342074 Simpson Jan 2002 B1
6371989 Chauvin et al. Apr 2002 B1
6395031 Foley et al. May 2002 B1
6423063 Bonutti Jul 2002 B1
6432106 Fraser Aug 2002 B1
6436140 Liu et al. Aug 2002 B1
6443989 Jackson Sep 2002 B1
6443990 Aebi et al. Sep 2002 B1
6454806 Cohen et al. Sep 2002 B1
6454807 Jackson Sep 2002 B1
6461359 Tribus et al. Oct 2002 B1
6491724 Ferree Dec 2002 B1
6520991 Huene Feb 2003 B2
6520993 James et al. Feb 2003 B2
6524238 Velikaris et al. Feb 2003 B2
6527803 Crozet et al. Mar 2003 B1
6562074 Gerbec et al. May 2003 B2
6576016 Hochshuler et al. Jun 2003 B1
6623525 Ralph et al. Sep 2003 B2
6629998 Lin Oct 2003 B1
6635086 Lin Oct 2003 B2
6648917 Gerbec et al. Nov 2003 B2
6676703 Biscup Jan 2004 B2
6685742 Jackson Feb 2004 B1
6723126 Berry Apr 2004 B1
6770096 Bolger et al. Aug 2004 B2
6773460 Jackson Aug 2004 B2
6821298 Jackson Nov 2004 B1
6835206 Jackson Dec 2004 B2
6849093 Michelson Feb 2005 B2
6852129 Gerbec et al. Feb 2005 B2
6863673 Gerbec et al. Mar 2005 B2
6923814 Hildebrand et al. Aug 2005 B1
6926737 Jackson Aug 2005 B2
6953477 Berry Oct 2005 B2
6964687 Bernard et al. Nov 2005 B1
6974480 Messerli et al. Dec 2005 B2
6984234 Bray Jan 2006 B2
7112222 Fraser et al. Sep 2006 B2
7135043 Nakahara et al. Nov 2006 B2
7137997 Paul Nov 2006 B2
7172627 Fiere et al. Feb 2007 B2
7188626 Foley et al. Mar 2007 B2
7204853 Gordon et al. Apr 2007 B2
7232464 Mathieu et al. Jun 2007 B2
7238203 Bagga et al. Jul 2007 B2
7255700 Kaiser et al. Aug 2007 B2
7316532 Matthys-Mark Jan 2008 B2
7316714 Gordon et al. Jan 2008 B2
7407483 Perez-Cruet et al. Aug 2008 B2
7481766 Lee et al. Jan 2009 B2
7491168 Raymond et al. Feb 2009 B2
7537565 Bass May 2009 B2
7618456 Mathieu et al. Nov 2009 B2
7625394 Molz, IV et al. Dec 2009 B2
7635366 Abdou Dec 2009 B2
7637909 Lechot et al. Dec 2009 B2
7655046 Dryer et al. Feb 2010 B2
7678148 Peterman Mar 2010 B2
7703727 Selness Apr 2010 B2
7708778 Gordon et al. May 2010 B2
7708779 Edie et al. May 2010 B2
7727280 McLuen Jun 2010 B2
7753958 Gordon et al. Jul 2010 B2
7780594 Hutton Aug 2010 B2
7806932 Webb et al. Oct 2010 B2
7815682 Peterson et al. Oct 2010 B1
7819801 Miles et al. Oct 2010 B2
7824428 Mikkonen et al. Nov 2010 B2
7828849 Lim Nov 2010 B2
7846167 Garcia et al. Dec 2010 B2
7846207 Lechmann et al. Dec 2010 B2
7850731 Brittan et al. Dec 2010 B2
7850733 Baynham et al. Dec 2010 B2
7862616 Lechmann et al. Jan 2011 B2
7875076 Mathieu et al. Jan 2011 B2
7883542 Zipnick Feb 2011 B2
7892173 Miles et al. Feb 2011 B2
7909869 Gordon et al. Mar 2011 B2
7914559 Carls et al. Mar 2011 B2
7967821 Sicvol et al. Jun 2011 B2
7981031 Frasier et al. Jul 2011 B2
8016836 Corrao et al. Sep 2011 B2
8062375 Glerum et al. Nov 2011 B2
8105382 Olmos et al. Jan 2012 B2
8118870 Gordon et al. Feb 2012 B2
8118871 Gordon et al. Feb 2012 B2
8123810 Gordon et al. Feb 2012 B2
8147550 Gordon et al. Apr 2012 B2
8172903 Gordon et al. May 2012 B2
8182539 Tyber et al. May 2012 B2
8257442 Edie et al. Sep 2012 B2
8262570 White et al. Sep 2012 B2
8262662 Beardsley et al. Sep 2012 B2
8262710 Freedman et al. Sep 2012 B2
8287597 Pimenta et al. Oct 2012 B1
8303498 Miles et al. Nov 2012 B2
8303658 Peterman Nov 2012 B2
8303663 Jimenez et al. Nov 2012 B2
8317866 Palmatier et al. Nov 2012 B2
8323185 Perez-Cruet et al. Dec 2012 B2
8328872 Duffield et al. Dec 2012 B2
8343048 Warren, Jr. Jan 2013 B2
8353826 Weiman Jan 2013 B2
8355780 Miles et al. Jan 2013 B2
8382842 Greenhalgh et al. Feb 2013 B2
8388527 Miles et al. Mar 2013 B2
8398713 Weiman Mar 2013 B2
8403990 Dryer et al. Mar 2013 B2
8419797 Biedermann et al. Apr 2013 B2
8425528 Berry et al. Apr 2013 B2
8435298 Weiman May 2013 B2
8480576 Sandhu Jul 2013 B2
8496706 Ragab et al. Jul 2013 B2
8500634 Miles et al. Aug 2013 B2
8506635 Palmatier et al. Aug 2013 B2
8517935 Marchek et al. Aug 2013 B2
8518120 Glerum et al. Aug 2013 B2
8535380 Greenhalgh et al. Sep 2013 B2
8550994 Miles et al. Oct 2013 B2
8556808 Miles et al. Oct 2013 B2
8556979 Glerum et al. Oct 2013 B2
8579809 Parker Nov 2013 B2
8579898 Prandi et al. Nov 2013 B2
8579979 Edie et al. Nov 2013 B2
8579981 Lim et al. Nov 2013 B2
8602984 Raymond et al. Dec 2013 B2
8608785 Reed et al. Dec 2013 B2
8628576 Triplett et al. Jan 2014 B2
8628578 Miller et al. Jan 2014 B2
8632595 Weiman Jan 2014 B2
8641768 Duffield et al. Feb 2014 B2
8647386 Gordon et al. Feb 2014 B2
8663329 Ernst Mar 2014 B2
8668419 Hardt et al. Mar 2014 B2
8668715 Sandhu Mar 2014 B2
8679183 Glerum et al. Mar 2014 B2
8685095 Miller et al. Apr 2014 B2
8685098 Glerum et al. Apr 2014 B2
8696559 Miles et al. Apr 2014 B2
8709083 Duffield et al. Apr 2014 B2
8709085 Lechmann et al. Apr 2014 B2
8709086 Glerum Apr 2014 B2
8715285 Lewis et al. May 2014 B2
8715353 Bagga et al. May 2014 B2
8740983 Arnold et al. Jun 2014 B1
8753271 Miles et al. Jun 2014 B1
8753396 Hockett et al. Jun 2014 B1
8764649 Miles et al. Jul 2014 B2
8771360 Jimenez et al. Jul 2014 B2
8778025 Ragab et al. Jul 2014 B2
8778027 Medina Jul 2014 B2
8795366 Varela Aug 2014 B2
8808305 Kleiner Aug 2014 B2
8827902 Dietze, Jr. et al. Sep 2014 B2
8828085 Jensen Sep 2014 B1
8840668 Donahoe et al. Sep 2014 B1
8845731 Weiman Sep 2014 B2
8845732 Weiman Sep 2014 B2
8845734 Weiman Sep 2014 B2
8852252 Venturini et al. Oct 2014 B2
8852282 Farley et al. Oct 2014 B2
8864833 Glerum et al. Oct 2014 B2
8882813 Jones et al. Nov 2014 B2
8888853 Glerum et al. Nov 2014 B2
8894708 Thalgott et al. Nov 2014 B2
8894711 Varela Nov 2014 B2
8894712 Varela Nov 2014 B2
8906095 Christensen et al. Dec 2014 B2
8920500 Pimenta et al. Dec 2014 B1
8926704 Glerum et al. Jan 2015 B2
8936641 Cain Jan 2015 B2
8940049 Jimenez et al. Jan 2015 B1
8968363 Weiman et al. Mar 2015 B2
8986344 Sandhu Mar 2015 B2
8992425 Karpowicz et al. Mar 2015 B2
8992544 Sasing Mar 2015 B2
9005292 Melamed Apr 2015 B2
9005293 Moskowitz et al. Apr 2015 B2
9005295 Kueenzi et al. Apr 2015 B2
9017412 Wolters et al. Apr 2015 B2
9034045 Davenport et al. May 2015 B2
9050146 Woolley et al. Jun 2015 B2
9050194 Thibodeau Jun 2015 B2
9060877 Kleiner Jun 2015 B2
9072548 Matityahu Jul 2015 B2
9072563 Garcia et al. Jul 2015 B2
9084591 Reglos et al. Jul 2015 B2
9113854 Ellman Aug 2015 B2
9119730 Glerum et al. Sep 2015 B2
9125757 Weiman Sep 2015 B2
9132021 Mermuys et al. Sep 2015 B2
9138217 Smith et al. Sep 2015 B2
9138330 Hansell et al. Sep 2015 B2
9138331 Aferzon Sep 2015 B2
9149367 Davenport et al. Oct 2015 B2
9155628 Glerum et al. Oct 2015 B2
9155631 Seifert et al. Oct 2015 B2
9161841 Kana et al. Oct 2015 B2
9179903 Cianfrani et al. Nov 2015 B2
9179952 Biedermann et al. Nov 2015 B2
9186193 Kleiner et al. Nov 2015 B2
9186258 Davenport et al. Nov 2015 B2
9192482 Pimenta et al. Nov 2015 B1
9192483 Radcliffe et al. Nov 2015 B1
9198772 Weiman Dec 2015 B2
9204972 Weiman et al. Dec 2015 B2
9204974 Glerum et al. Dec 2015 B2
9211194 Bagga et al. Dec 2015 B2
9211196 Glerum et al. Dec 2015 B2
9216095 Glerum et al. Dec 2015 B2
9226836 Glerum Jan 2016 B2
9233007 Sungarian et al. Jan 2016 B2
9233009 Gray et al. Jan 2016 B2
9233010 Thalgott et al. Jan 2016 B2
9259327 Niemiec et al. Feb 2016 B2
9271846 Lim et al. Mar 2016 B2
9308099 Triplett et al. Apr 2016 B2
9320610 Alheidt et al. Apr 2016 B2
9351845 Pimenta et al. May 2016 B1
9351848 Glerum et al. May 2016 B2
9357909 Perez-Cruet et al. Jun 2016 B2
9358126 Glerum et al. Jun 2016 B2
9358127 Duffield et al. Jun 2016 B2
9358128 Glerum et al. Jun 2016 B2
9358129 Weiman Jun 2016 B2
9364341 Gowan Jun 2016 B2
9364343 Duffield et al. Jun 2016 B2
9370434 Weiman Jun 2016 B2
9370435 Walkenhorst et al. Jun 2016 B2
9381008 Thornburg Jul 2016 B2
9386916 Predick et al. Jul 2016 B2
9387092 Mermuys et al. Jul 2016 B2
9402673 Cormier et al. Aug 2016 B2
9402739 Weiman et al. Aug 2016 B2
9408596 Blain Aug 2016 B2
9408708 Greenhalgh Aug 2016 B2
9414828 Abidin et al. Aug 2016 B2
9414934 Cain Aug 2016 B2
9414937 Carlson et al. Aug 2016 B2
9421110 Masson et al. Aug 2016 B2
9427331 Amin Aug 2016 B2
9445919 Palmatier Sep 2016 B2
9452063 Glerum et al. Sep 2016 B2
9456903 Glerum et al. Oct 2016 B2
9456906 Gray et al. Oct 2016 B2
9468405 Miles et al. Oct 2016 B2
9474622 McLaughlin et al. Oct 2016 B2
9474625 Weiman Oct 2016 B2
9480573 Perloff et al. Nov 2016 B2
9480576 Pepper et al. Nov 2016 B2
9480579 Davenport et al. Nov 2016 B2
9486133 Lee et al. Nov 2016 B2
9486325 Davenport et al. Nov 2016 B2
9486327 Martynova et al. Nov 2016 B2
9486328 Jimenez et al. Nov 2016 B2
9492287 Glerum et al. Nov 2016 B2
9492288 Wagner et al. Nov 2016 B2
9492289 Davenport et al. Nov 2016 B2
9498349 Patterson et al. Nov 2016 B2
9510954 Glerum et al. Dec 2016 B2
9517098 Anderson Dec 2016 B2
9522070 Flower et al. Dec 2016 B2
9526620 Slivka et al. Dec 2016 B2
9526625 Cain Dec 2016 B2
9532821 Moskowitz et al. Jan 2017 B2
9539103 McLaughlin et al. Jan 2017 B2
9539108 Glerum et al. Jan 2017 B2
9545320 Padovani et al. Jan 2017 B2
9549723 Hynes et al. Jan 2017 B2
9549824 McAfee Jan 2017 B2
9561116 Weiman et al. Feb 2017 B2
9566163 Suddaby et al. Feb 2017 B2
9566166 Parry et al. Feb 2017 B2
9566168 Glerum et al. Feb 2017 B2
9572560 Mast et al. Feb 2017 B2
9572677 Davenport et al. Feb 2017 B2
9572681 Mathieu et al. Feb 2017 B2
9579124 Gordon et al. Feb 2017 B2
9579139 Cormier et al. Feb 2017 B2
9579213 Bal et al. Feb 2017 B2
9585649 Blain et al. Mar 2017 B2
9585762 Suddaby et al. Mar 2017 B2
9585766 Robinson Mar 2017 B2
9585767 Robinson Mar 2017 B2
9592129 Slivka et al. Mar 2017 B2
9597195 Cain Mar 2017 B2
9603643 Reed et al. Mar 2017 B2
9603713 Moskowitz et al. Mar 2017 B2
9603717 Ibarra et al. Mar 2017 B2
9615818 Baudouin et al. Apr 2017 B2
9615936 Duffield et al. Apr 2017 B2
9622732 Martinelli et al. Apr 2017 B2
9622875 Moskowitz et al. Apr 2017 B2
9622876 Greenhalgh et al. Apr 2017 B1
9629729 Grimberg, Jr. et al. Apr 2017 B2
9636097 Bass May 2017 B2
9642720 Radcliffe et al. May 2017 B2
9649198 Wolters et al. May 2017 B2
9655746 Seifert May 2017 B2
9655747 Glerum et al. May 2017 B2
9662224 Weiman et al. May 2017 B2
9668784 Brumfield et al. Jun 2017 B2
9668876 Blain et al. Jun 2017 B2
9668879 Jimenez et al. Jun 2017 B2
9675465 Padovani et al. Jun 2017 B2
9675467 Duffield et al. Jun 2017 B2
9675468 Jensen Jun 2017 B1
9693871 Richerme et al. Jul 2017 B2
9700428 Niemiec et al. Jul 2017 B2
9707092 Davenport et al. Jul 2017 B2
9713536 Foley et al. Jul 2017 B2
9717601 Miller Aug 2017 B2
9730684 Beale et al. Aug 2017 B2
9730806 Capote Aug 2017 B2
9737288 Karpowicz et al. Aug 2017 B2
9750617 Lim et al. Sep 2017 B2
9750618 Daffinson Sep 2017 B1
9757249 Radcliffe et al. Sep 2017 B2
9763722 Roybal Sep 2017 B2
9770343 Weiman Sep 2017 B2
9782265 Weiman et al. Oct 2017 B2
9788971 Stein Oct 2017 B1
9795370 O'Connell et al. Oct 2017 B2
9795371 Miles et al. Oct 2017 B2
9801733 Wolters et al. Oct 2017 B2
9801734 Stein et al. Oct 2017 B1
9808352 Suddaby et al. Nov 2017 B2
9826966 Mast et al. Nov 2017 B2
9827024 Cormier et al. Nov 2017 B2
9827107 Arnin Nov 2017 B1
9833333 Duffield et al. Dec 2017 B2
9833336 Davenport et al. Dec 2017 B2
9839527 Robinson Dec 2017 B2
9839528 Weiman et al. Dec 2017 B2
9848993 Moskowitz et al. Dec 2017 B2
9848996 Faulhaber Dec 2017 B2
9855151 Weiman Jan 2018 B2
9867715 McLaughlin et al. Jan 2018 B2
9872779 Miller et al. Jan 2018 B2
9889019 Rogers et al. Feb 2018 B2
9907671 Fessler Mar 2018 B2
9907673 Weiman et al. Mar 2018 B2
9918709 Sandhu Mar 2018 B2
9924859 Lee et al. Mar 2018 B2
9924940 Moskowitz et al. Mar 2018 B2
9925062 Glerum et al. Mar 2018 B2
9925064 Duffield et al. Mar 2018 B2
9931223 Cain Apr 2018 B2
9937053 Melkent et al. Apr 2018 B2
9943342 Tanaka et al. Apr 2018 B2
9943418 Davenport et al. Apr 2018 B2
9949775 Reed et al. Apr 2018 B2
9949841 Glerum et al. Apr 2018 B2
9956087 Seifert et al. May 2018 B2
9962202 Anderson May 2018 B2
9962270 Alheidt et al. May 2018 B2
9962271 Glerum May 2018 B2
9962272 Daffinson et al. May 2018 B1
9968461 Zappacosta et al. May 2018 B2
9968462 Weiman May 2018 B2
9974531 Miles et al. May 2018 B2
9974662 Hessler et al. May 2018 B2
9974664 Emerick et al. May 2018 B2
9980825 Nichols et al. May 2018 B2
9980826 Martynova et al. May 2018 B2
9987141 Duffield et al. Jun 2018 B2
9987143 Robinson et al. Jun 2018 B2
9987144 Seifert et al. Jun 2018 B2
9987146 Lentner et al. Jun 2018 B1
9993239 Karpowicz et al. Jun 2018 B2
9993350 Cain Jun 2018 B2
10004607 Weiman et al. Jun 2018 B2
10016282 Seifert et al. Jul 2018 B2
10016284 Moskowitz et al. Jul 2018 B2
10022239 Lentner et al. Jul 2018 B1
10028842 Gray et al. Jul 2018 B2
10034765 Blain et al. Jul 2018 B2
10034769 Baynham Jul 2018 B2
10034771 Capote et al. Jul 2018 B2
10034772 Glerum et al. Jul 2018 B2
10034773 McLaughlin et al. Jul 2018 B2
10039539 Friedrich et al. Aug 2018 B2
10039650 Lamborne et al. Aug 2018 B2
10052214 Jimenez et al. Aug 2018 B2
10058431 Tyber et al. Aug 2018 B2
10060469 Jimenez et al. Aug 2018 B2
10070852 Mast et al. Sep 2018 B2
10076320 Mast et al. Sep 2018 B2
10076423 Miller et al. Sep 2018 B2
10080666 Suddaby et al. Sep 2018 B2
10080669 Davenport et al. Sep 2018 B2
10085846 Grotz Oct 2018 B2
10085849 Weiman et al. Oct 2018 B2
10092417 Weiman et al. Oct 2018 B2
10098758 Matthews et al. Oct 2018 B2
10098759 Weiman Oct 2018 B2
10111755 Foley et al. Oct 2018 B2
10111758 Robinson Oct 2018 B2
10117754 Davenport et al. Nov 2018 B2
10117755 Emerick et al. Nov 2018 B2
10137002 Padovani et al. Nov 2018 B2
10137006 Dewey Nov 2018 B2
10137007 Dewey et al. Nov 2018 B2
10137009 Weiman et al. Nov 2018 B2
10149671 Predick et al. Dec 2018 B2
10149710 Tanaka et al. Dec 2018 B2
10154781 Weiman Dec 2018 B2
10154912 Glerum Dec 2018 B2
10154914 Robinson Dec 2018 B2
10159584 Carnes et al. Dec 2018 B2
10166117 Daffinson et al. Jan 2019 B1
10172515 Lee et al. Jan 2019 B2
10172652 Woolley et al. Jan 2019 B2
10178987 Predick et al. Jan 2019 B2
10179053 Zappacosta et al. Jan 2019 B2
10182922 Nichols et al. Jan 2019 B2
10188527 Rogers et al. Jan 2019 B2
10195050 Palmatier et al. Feb 2019 B2
10201431 Slater et al. Feb 2019 B2
10213192 Capote Feb 2019 B2
10213193 Karpowicz et al. Feb 2019 B2
10219798 Capote Mar 2019 B2
10219913 Matthews et al. Mar 2019 B2
10219914 Faulhaber Mar 2019 B2
10219915 Stein Mar 2019 B1
10226356 Grotz Mar 2019 B2
10226359 Glerum et al. Mar 2019 B2
10238375 O'Connell et al. Mar 2019 B2
10238383 Moskowitz et al. Mar 2019 B2
10238503 Branch et al. Mar 2019 B2
10245015 Predick et al. Apr 2019 B2
10251643 Moskowitz et al. Apr 2019 B2
10265191 Lim et al. Apr 2019 B2
10278686 Baudouin et al. May 2019 B2
10278786 Friedrich et al. May 2019 B2
10278830 Walker et al. May 2019 B1
10278831 Sandul May 2019 B2
10278832 Nichols et al. May 2019 B2
10285680 Friedrich et al. May 2019 B2
10285819 Greenhalgh May 2019 B2
10285824 Robinson May 2019 B2
10292828 Greenhalgh May 2019 B2
10299777 Mast et al. May 2019 B2
10299934 Seifert et al. May 2019 B2
10299937 McAfee May 2019 B2
10307268 Moskowitz et al. Jun 2019 B2
10314622 Brumfield et al. Jun 2019 B2
10314719 Hessler et al. Jun 2019 B2
10322007 Masson et al. Jun 2019 B2
10322009 Aghayev et al. Jun 2019 B2
10327909 Baynham Jun 2019 B2
10327912 Suddaby Jun 2019 B1
10327917 Glerum et al. Jun 2019 B2
10342675 Alheidt Jul 2019 B2
10350085 Glerum et al. Jul 2019 B2
10357233 Miles et al. Jul 2019 B2
10363142 McClintock et al. Jul 2019 B2
10363144 Overes et al. Jul 2019 B2
10369004 Faulhaber Aug 2019 B2
10369008 Jimenez et al. Aug 2019 B2
10369010 Robinson et al. Aug 2019 B2
10369012 Fessler Aug 2019 B2
10376377 Seifert et al. Aug 2019 B2
10390962 Weiman Aug 2019 B2
10390964 Faulhaber Aug 2019 B2
10398563 Engstrom Sep 2019 B2
10398566 Olmos et al. Sep 2019 B2
10413419 Thibodeau Sep 2019 B2
10413422 Flower et al. Sep 2019 B2
10413423 Overes et al. Sep 2019 B2
10426450 Vogel et al. Oct 2019 B2
10426633 Moskowitz et al. Oct 2019 B2
10426634 Al-Jazaeri et al. Oct 2019 B1
10441430 Ludwig et al. Oct 2019 B2
10449056 Cain Oct 2019 B2
10456122 Koltz et al. Oct 2019 B2
10470894 Foley et al. Nov 2019 B2
10478319 Moskowitz et al. Nov 2019 B2
10492912 Gregersen et al. Dec 2019 B2
10492922 Mathieu et al. Dec 2019 B2
10492924 Stein et al. Dec 2019 B2
10500064 Robinson Dec 2019 B2
10512550 Bechtel et al. Dec 2019 B2
10517645 van der Pol Dec 2019 B2
10524924 Davenport et al. Jan 2020 B2
10531903 Daly et al. Jan 2020 B2
10537436 Maguire et al. Jan 2020 B2
10537438 Martynova et al. Jan 2020 B2
10555729 Cole et al. Feb 2020 B1
10561411 Cole et al. Feb 2020 B1
10575889 Roybal Mar 2020 B2
10575960 Duffield et al. Mar 2020 B2
10582959 Langer et al. Mar 2020 B2
10583015 Olmos et al. Mar 2020 B2
10603078 Simpson et al. Mar 2020 B2
10610376 Kuyler et al. Apr 2020 B2
10624757 Bost et al. Apr 2020 B2
10624758 Slivka et al. Apr 2020 B2
10624761 Davenport et al. Apr 2020 B2
10639163 Tyber et al. May 2020 B2
10639166 Weiman et al. May 2020 B2
10653458 Tanaka et al. May 2020 B2
10667925 Emerick et al. Jun 2020 B2
10667927 Lamborne et al. Jun 2020 B2
10675157 Zakelj et al. Jun 2020 B2
10682241 Glerum et al. Jun 2020 B2
10687963 Jimenez et al. Jun 2020 B2
10702393 Davenport et al. Jul 2020 B2
10709569 McLaughlin et al. Jul 2020 B2
10709571 Iott et al. Jul 2020 B2
10709572 Daffinson et al. Jul 2020 B2
10709575 Robinson Jul 2020 B2
10722377 Glerum et al. Jul 2020 B2
10722379 McLaughlin et al. Jul 2020 B2
10729561 Glerum Aug 2020 B2
10743858 Cole et al. Aug 2020 B1
10744002 Glerum et al. Aug 2020 B2
10758366 Daffinson et al. Sep 2020 B2
10758367 Weiman et al. Sep 2020 B2
10758369 Rogers et al. Sep 2020 B2
10765528 Weiman et al. Sep 2020 B2
10772737 Gray et al. Sep 2020 B2
10779955 Kuyler et al. Sep 2020 B2
10779957 Weiman et al. Sep 2020 B2
10786364 Davenport et al. Sep 2020 B2
10786369 Carnes et al. Sep 2020 B2
10799368 Glerum et al. Oct 2020 B2
10835387 Weiman et al. Nov 2020 B2
10842640 Weiman et al. Nov 2020 B2
10842644 Weiman et al. Nov 2020 B2
10856997 Cowan et al. Dec 2020 B2
10869769 Eisen et al. Dec 2020 B2
10874447 Tanaka et al. Dec 2020 B2
10874522 Weiman Dec 2020 B2
10874523 Weiman et al. Dec 2020 B2
10874524 Bjork Dec 2020 B2
10881524 Eisen et al. Jan 2021 B2
10881531 Berry Jan 2021 B2
10888431 Robinson Jan 2021 B1
10898344 Alheidt et al. Jan 2021 B2
10898346 Suddaby Jan 2021 B1
10925656 Cole et al. Feb 2021 B2
10925750 Zappacosta et al. Feb 2021 B2
10925752 Weiman Feb 2021 B2
10932920 Dewey et al. Mar 2021 B2
10940014 Greenhalgh Mar 2021 B2
10945858 Bechtel et al. Mar 2021 B2
10952866 Warren et al. Mar 2021 B2
10959855 Miller et al. Mar 2021 B2
10959856 Seifert et al. Mar 2021 B2
10973649 Weiman et al. Apr 2021 B2
10973650 Stein Apr 2021 B2
10980642 Glerum et al. Apr 2021 B2
10980644 Purcell et al. Apr 2021 B2
10993814 Wolters May 2021 B2
11007067 Masson et al. May 2021 B2
11013617 Weiman et al. May 2021 B2
11020238 Nichols et al. Jun 2021 B2
11020239 Miller et al. Jun 2021 B2
11026804 Jimenez et al. Jun 2021 B2
11026812 Daffinson et al. Jun 2021 B2
11033401 Shoshtaev Jun 2021 B2
11033402 Melkent et al. Jun 2021 B2
11033404 Faulhaber Jun 2021 B2
11039935 McAfee Jun 2021 B2
11045326 Seifert et al. Jun 2021 B2
11045327 Nichols et al. Jun 2021 B2
11051949 Walker et al. Jul 2021 B2
11051951 Robinson et al. Jul 2021 B2
11058469 Mahajan et al. Jul 2021 B2
11065127 Lentner et al. Jul 2021 B1
11065129 Sandul Jul 2021 B2
11065130 Branch et al. Jul 2021 B2
11076966 Faulhaber Aug 2021 B2
11083584 Lauf et al. Aug 2021 B2
11083595 Robinson Aug 2021 B2
11090167 Emerick et al. Aug 2021 B2
11096795 Padovani et al. Aug 2021 B2
11096797 Moskowitz et al. Aug 2021 B2
11103366 Glerum et al. Aug 2021 B2
RE48719 Suddaby et al. Sep 2021 E
11109980 Seifert et al. Sep 2021 B2
11116644 Marrocco et al. Sep 2021 B2
11123198 Black et al. Sep 2021 B2
11123200 Faulhaber Sep 2021 B2
11129731 Miller et al. Sep 2021 B2
11135071 Dewey et al. Oct 2021 B2
11147680 Tyber et al. Oct 2021 B2
11154404 Freedman et al. Oct 2021 B2
11160666 Burkhardt et al. Nov 2021 B2
11160669 Rogers et al. Nov 2021 B2
11166826 Huang Nov 2021 B2
11173044 Jones et al. Nov 2021 B1
11179234 Dacosta et al. Nov 2021 B2
11285014 Josse Mar 2022 B1
11376134 Dewey et al. Jul 2022 B1
11617658 Josse Apr 2023 B2
11723780 Seifert Aug 2023 B2
20020045943 Uk Apr 2002 A1
20020045945 Liu et al. Apr 2002 A1
20020055741 Schlapfer et al. May 2002 A1
20020116066 Chauvin et al. Aug 2002 A1
20020128713 Ferree Sep 2002 A1
20020151976 Foley et al. Oct 2002 A1
20020183762 Anderson et al. Dec 2002 A1
20030050701 Michelson Mar 2003 A1
20030130739 Gerbec et al. Jul 2003 A1
20030163132 Chin Aug 2003 A1
20040102778 Huebner et al. May 2004 A1
20040172134 Berry Sep 2004 A1
20040186570 Rapp Sep 2004 A1
20040193158 Lim et al. Sep 2004 A1
20040204713 Abdou Oct 2004 A1
20040249461 Ferree Dec 2004 A1
20040254643 Jackson Dec 2004 A1
20040254644 Taylor Dec 2004 A1
20050015149 Michelson Jan 2005 A1
20050033429 Kuo Feb 2005 A1
20050033439 Gordon et al. Feb 2005 A1
20050147478 Greenberg Jul 2005 A1
20050209698 Gordon Sep 2005 A1
20050228398 Rathbun et al. Oct 2005 A1
20060122701 Kiester Jun 2006 A1
20060129244 Ensign Jun 2006 A1
20060260446 Chang Nov 2006 A1
20060276901 Zipnick Dec 2006 A1
20070173840 Huebner Jul 2007 A1
20070218750 Corrao et al. Sep 2007 A1
20070233150 Blain et al. Oct 2007 A1
20070270859 Companioni et al. Nov 2007 A1
20080058804 Lechot et al. Mar 2008 A1
20080132959 Mikkonen et al. Jun 2008 A1
20080140207 Olmos et al. Jun 2008 A1
20090024158 Viker Jan 2009 A1
20090093830 Miller Apr 2009 A1
20090292361 Lopez Nov 2009 A1
20100076440 Pamichev et al. Mar 2010 A1
20100082109 Greenhalgh et al. Apr 2010 A1
20100152853 Kirschman Jun 2010 A1
20100191336 Greenhalgh Jul 2010 A1
20100211176 Greenhalgh Aug 2010 A1
20100286777 Errico et al. Nov 2010 A1
20110118843 Mathieu et al. May 2011 A1
20110130838 Morgenstern Lopez Jun 2011 A1
20110153020 Abdelgany et al. Jun 2011 A1
20110218572 Lechmann et al. Sep 2011 A1
20110301577 Simmen et al. Dec 2011 A1
20120004732 Goel et al. Jan 2012 A1
20120095515 Hamilton Apr 2012 A1
20120101581 Mathieu et al. Apr 2012 A1
20120109142 Dayan May 2012 A1
20120109309 Mathieu et al. May 2012 A1
20120109310 Mathieu et al. May 2012 A1
20120109312 Mathieu et al. May 2012 A1
20120109313 Mathieu et al. May 2012 A1
20120123546 Medina May 2012 A1
20120143195 Sander Jun 2012 A1
20120150237 Combrowski Jun 2012 A1
20120197401 Duncan et al. Aug 2012 A1
20120209385 Aferzon Aug 2012 A1
20120215313 Saidha et al. Aug 2012 A1
20120215316 Mohr et al. Aug 2012 A1
20130158664 Palmatier et al. Jun 2013 A1
20130184823 Malberg Jul 2013 A1
20130190876 Drochner et al. Jul 2013 A1
20130211526 Alheidt et al. Aug 2013 A1
20130226191 Thoren et al. Aug 2013 A1
20130231747 Olmos et al. Sep 2013 A1
20130304136 Gourlaouen-Preissler et al. Nov 2013 A1
20130317312 Eastlack et al. Nov 2013 A1
20140018816 Fenn et al. Jan 2014 A1
20140107790 Combrowski Apr 2014 A1
20140114321 Davenport et al. Apr 2014 A1
20140114420 Robinson Apr 2014 A1
20140148904 Robinson May 2014 A1
20140163682 Iott et al. Jun 2014 A1
20140180419 Dmuschewsky Jun 2014 A1
20140194992 Medina Jul 2014 A1
20140249631 Weiman Sep 2014 A1
20140277471 Gray Sep 2014 A1
20140277473 Perrow Sep 2014 A1
20140277487 Davenport Sep 2014 A1
20140277500 Logan et al. Sep 2014 A1
20140303674 Sasing Oct 2014 A1
20140364855 Stoll et al. Dec 2014 A1
20150223945 Weiman et al. Aug 2015 A1
20150230931 Greenhalgh Aug 2015 A1
20150238236 Sasing Aug 2015 A1
20150354635 McClymont et al. Dec 2015 A1
20150374507 Wolters Dec 2015 A1
20160008924 Canourgues et al. Jan 2016 A1
20160022434 Robinson Jan 2016 A1
20160051373 Faulhaber Feb 2016 A1
20160058571 McLaughlin Mar 2016 A1
20160081681 Waugh et al. Mar 2016 A1
20160089247 Nichols et al. Mar 2016 A1
20160095710 Juszczyk et al. Apr 2016 A1
20160095718 Burkhardt et al. Apr 2016 A1
20160199073 Nino et al. Jul 2016 A1
20160242930 Duffield et al. Aug 2016 A1
20160256291 Miller Sep 2016 A1
20160278830 Arrington Sep 2016 A1
20160296340 Gordon et al. Oct 2016 A1
20160310291 Greenhalgh Oct 2016 A1
20160345952 Kucharzyk et al. Dec 2016 A1
20160367377 Faulhaber Dec 2016 A1
20170010025 Mayershofer Jan 2017 A1
20170029635 Doll et al. Feb 2017 A1
20170035406 Abidin et al. Feb 2017 A1
20170049651 Lim et al. Feb 2017 A1
20170049653 Lim et al. Feb 2017 A1
20170095345 Davenport et al. Apr 2017 A1
20170100255 Hleihil et al. Apr 2017 A1
20170100257 Weiman et al. Apr 2017 A1
20170105844 Kuyler et al. Apr 2017 A1
20170112630 Kuyler et al. Apr 2017 A1
20170151065 Warren et al. Jun 2017 A1
20170156882 Rathbun et al. Jun 2017 A1
20170156884 Rathbun et al. Jun 2017 A1
20170189204 Riemhofer et al. Jul 2017 A1
20170202678 Duffield et al. Jul 2017 A1
20170215856 Martinelli et al. Aug 2017 A1
20170224502 Wolters et al. Aug 2017 A1
20170224504 Butler et al. Aug 2017 A1
20170231675 Combrowski Aug 2017 A1
20170246006 Carnes et al. Aug 2017 A1
20170290677 Olmos et al. Oct 2017 A1
20170296352 Richerme et al. Oct 2017 A1
20170367842 Predick et al. Dec 2017 A1
20170367843 Eisen et al. Dec 2017 A1
20170367844 Eisen et al. Dec 2017 A1
20170367845 Eisen et al. Dec 2017 A1
20180000606 Hessler et al. Jan 2018 A1
20180030362 Kosler et al. Feb 2018 A1
20180031810 Hsu et al. Feb 2018 A1
20180036136 Duffield et al. Feb 2018 A1
20180036138 Robinson Feb 2018 A1
20180104066 Bae et al. Apr 2018 A1
20180116891 Beale et al. May 2018 A1
20180193160 Hsu et al. Jul 2018 A1
20180193164 Shoshtaev Jul 2018 A1
20180206999 Suddaby Jul 2018 A1
20180256356 Robinson et al. Sep 2018 A1
20180256359 Greenhalgh Sep 2018 A1
20180256360 Cain Sep 2018 A1
20180256362 Slivka et al. Sep 2018 A1
20180263784 Bechtel et al. Sep 2018 A1
20180271513 Perrow et al. Sep 2018 A1
20180280142 Schultz et al. Oct 2018 A1
20180303473 Spann et al. Oct 2018 A1
20180303621 Brotman et al. Oct 2018 A1
20180303625 Alheidt et al. Oct 2018 A1
20180311048 Glerum et al. Nov 2018 A1
20180318101 Engstrom Nov 2018 A1
20180318102 Seifert et al. Nov 2018 A1
20180325574 Bjork et al. Nov 2018 A1
20180338838 Cryder et al. Nov 2018 A1
20180338841 Miller et al. Nov 2018 A1
20180344307 Hynes et al. Dec 2018 A1
20180360616 Luu Dec 2018 A1
20190000640 Weiman Jan 2019 A1
20190000702 Lim et al. Jan 2019 A1
20190000707 Lim et al. Jan 2019 A1
20190020121 Paulotto et al. Jan 2019 A1
20190021716 Waugh et al. Jan 2019 A1
20190021873 Dmuschewsky Jan 2019 A1
20190046329 Padovani et al. Feb 2019 A1
20190046381 Lim et al. Feb 2019 A1
20190046383 Lim et al. Feb 2019 A1
20190060083 Weiman et al. Feb 2019 A1
20190082949 Weiman Mar 2019 A1
20190083081 Ortiz et al. Mar 2019 A1
20190091033 Dewey et al. Mar 2019 A1
20190105175 Zappacosta et al. Apr 2019 A1
20190125328 Blain May 2019 A1
20190133434 Lee et al. May 2019 A1
20190133645 Gordon et al. May 2019 A1
20190133779 McLaughlin et al. May 2019 A1
20190133780 Matthews et al. May 2019 A1
20190133784 Gunn et al. May 2019 A1
20190133788 Weiman et al. May 2019 A1
20190142480 Woolley et al. May 2019 A1
20190151115 Nichols et al. May 2019 A1
20190183656 Stein Jun 2019 A1
20190201209 Branch et al. Jul 2019 A1
20190201210 Besaw et al. Jul 2019 A1
20190209155 Mast et al. Jul 2019 A1
20190216453 Predick et al. Jul 2019 A1
20190231552 Sandul Aug 2019 A1
20190240039 Walker et al. Aug 2019 A1
20190240043 Greenhalgh Aug 2019 A1
20190247098 Brumfield et al. Aug 2019 A1
20190254650 Martinelli et al. Aug 2019 A1
20190254838 Miller et al. Aug 2019 A1
20190254839 Nichols et al. Aug 2019 A1
20190262009 Cheng Aug 2019 A1
20190262139 Wolters Aug 2019 A1
20190269521 Shoshtaev Sep 2019 A1
20190274670 O'Connell et al. Sep 2019 A1
20190274671 Lauf et al. Sep 2019 A1
20190274836 Eisen et al. Sep 2019 A1
20190282373 Alheidt Sep 2019 A1
20190290446 Masson et al. Sep 2019 A1
20190290447 Stein Sep 2019 A1
20190298416 Rezach Oct 2019 A1
20190298524 Lauf et al. Oct 2019 A1
20190298540 Aghayev et al. Oct 2019 A1
20190321022 Karpowicz et al. Oct 2019 A1
20190321190 Wagner et al. Oct 2019 A1
20190328539 Suh et al. Oct 2019 A1
20190328540 Seifert et al. Oct 2019 A1
20190329388 Erickson et al. Oct 2019 A1
20190336301 Engstrom Nov 2019 A1
20190336304 Burkhardt et al. Nov 2019 A1
20190350573 Vogel et al. Nov 2019 A1
20190358049 Faulhaber Nov 2019 A1
20190358050 Fessler Nov 2019 A1
20190358051 Flower et al. Nov 2019 A1
20190380840 Tyber et al. Dec 2019 A1
20190388232 Purcell et al. Dec 2019 A1
20200008951 McClintock et al. Jan 2020 A1
20200030114 Cain Jan 2020 A1
20200030116 Jimenez et al. Jan 2020 A1
20200038200 Foley et al. Feb 2020 A1
20200054461 Marrocco et al. Feb 2020 A1
20200060844 Mathieu et al. Feb 2020 A1
20200069316 DeSoutter et al. Mar 2020 A1
20200078190 Rogers et al. Mar 2020 A1
20200093526 Daly et al. Mar 2020 A1
20200093607 Davenport et al. Mar 2020 A1
20200093609 Shoshtaev Mar 2020 A1
20200100904 Stein et al. Apr 2020 A1
20200129306 Miller et al. Apr 2020 A1
20200129307 Hunziker et al. Apr 2020 A1
20200138591 Moskowitz et al. May 2020 A1
20200138593 Martynova et al. May 2020 A1
20200146840 Black et al. May 2020 A1
20200179120 Bielenstein et al. Jun 2020 A1
20200205993 Davenport et al. Jul 2020 A1
20200214754 Bowen et al. Jul 2020 A1
20200222202 Kuyler et al. Jul 2020 A1
20200229944 Suh et al. Jul 2020 A1
20200246159 Suh et al. Aug 2020 A1
20200246162 Schultz et al. Aug 2020 A1
20200261242 Bost et al. Aug 2020 A1
20200268524 Glerum et al. Aug 2020 A1
20200276028 Blain et al. Sep 2020 A1
20200281741 Grotz Sep 2020 A1
20200289287 Emerick et al. Sep 2020 A1
20200297507 Iott et al. Sep 2020 A1
20200330239 Davenport et al. Oct 2020 A1
20200330245 Glerum Oct 2020 A1
20200345511 Daffinson et al. Nov 2020 A1
20200352731 Berry Nov 2020 A1
20200352738 Berry Nov 2020 A1
20200360153 Weiman et al. Nov 2020 A1
20200375753 McLaughlin et al. Dec 2020 A1
20200375755 Cain Dec 2020 A1
20200383797 Predick et al. Dec 2020 A1
20200383799 Cain Dec 2020 A1
20200390565 Jimenez et al. Dec 2020 A1
20200397593 Davenport et al. Dec 2020 A1
20200405497 Olmos et al. Dec 2020 A1
20200405498 Gray et al. Dec 2020 A1
20200405499 Gerbec et al. Dec 2020 A1
20200405500 Cain Dec 2020 A1
20210007860 Glerum et al. Jan 2021 A1
20210015626 Suddaby Jan 2021 A1
20210030555 Weiman et al. Feb 2021 A1
20210030561 Gleason Feb 2021 A1
20210045891 Rogers et al. Feb 2021 A1
20210045892 Rogers et al. Feb 2021 A1
20210052395 Iott et al. Feb 2021 A1
20210068959 McLuen et al. Mar 2021 A1
20210068974 Cowan et al. Mar 2021 A1
20210068982 Carnes et al. Mar 2021 A1
20210077271 Sharabani Mar 2021 A1
20210077272 Eisen et al. Mar 2021 A1
20210085479 Weiman et al. Mar 2021 A1
20210093462 Lucasiewicz et al. Apr 2021 A1
20210106434 Alheidt et al. Apr 2021 A1
20210113349 Weiman et al. Apr 2021 A1
20210121299 Hyder Apr 2021 A1
20210121300 Weiman et al. Apr 2021 A1
20210137697 Weiman May 2021 A1
20210137699 Jang et al. May 2021 A1
20210137701 Miller et al. May 2021 A1
20210154811 Spreiter et al. May 2021 A1
20210161678 Dewey et al. Jun 2021 A1
20210177618 Branch et al. Jun 2021 A1
20210186706 Spitler et al. Jun 2021 A1
20210186709 Weiman et al. Jun 2021 A1
20210196470 Shoshtaev Jul 2021 A1
20210205092 Glerum et al. Jul 2021 A1
20210205094 Weiman et al. Jul 2021 A1
20210220145 Stein Jul 2021 A1
20210220147 Berry Jul 2021 A1
20210236298 Weiman et al. Aug 2021 A1
20210251770 Purcell et al. Aug 2021 A1
20210251776 Daffinson et al. Aug 2021 A1
20210259848 Kang et al. Aug 2021 A1
20210259849 Robinson et al. Aug 2021 A1
20210259850 Eisen et al. Aug 2021 A1
20210267767 Stein Sep 2021 A1
20210275317 Spetzger Sep 2021 A1
20210275318 Reimels Sep 2021 A1
20210275319 Reimels Sep 2021 A1
20210275321 Seifert et al. Sep 2021 A1
20210282938 Nichols et al. Sep 2021 A1
20210298915 Faulhaber Sep 2021 A1
20210298916 Melkent et al. Sep 2021 A1
20210307920 Walker et al. Oct 2021 A1
20210315705 Altarac et al. Oct 2021 A1
20210322179 Miller et al. Oct 2021 A1
20210322181 Predick Oct 2021 A1
20210322182 Faulhaber Oct 2021 A1
20210330472 Shoshtaev Oct 2021 A1
20210346174 Flint et al. Nov 2021 A1
20220015924 Freedman et al. Jan 2022 A1
20220047312 Seykora et al. Feb 2022 A1
20220133336 Tsai et al. May 2022 A1
20220133497 Dewey et al. May 2022 A1
20220133498 Josse et al. May 2022 A1
20220133499 Josse et al. May 2022 A1
20220218325 Josse Jul 2022 A1
20220387184 Josse et al. Dec 2022 A1
20230027836 Predick et al. Jan 2023 A1
Foreign Referenced Citations (36)
Number Date Country
107 137 166 Sep 2017 CN
44 16 605 Jun 1995 DE
0 767 636 Apr 1997 EP
0 880 950 Dec 1998 EP
0 857 042 Nov 2001 EP
1 442 732 Aug 2004 EP
1 124 512 Sep 2004 EP
1 107 711 Oct 2004 EP
1 506 753 Feb 2005 EP
1 459 711 Jul 2007 EP
2954860 Dec 2015 EP
3031424 Jun 2016 EP
3 069 694 Sep 2016 EP
3213720 Sep 2017 EP
2781998 Feb 2000 FR
3082115 Dec 2019 FR
2 377 387 Jan 2003 GB
102192022 Dec 2020 KR
9214423 Sep 1992 WO
97 00054 Jan 1997 WO
99 26562 Jun 1999 WO
9966867 Dec 1999 WO
0012033 Mar 2000 WO
0025706 May 2000 WO
00 49977 Aug 2000 WO
0219952 Mar 2002 WO
03105673 Dec 2003 WO
2006116850 Nov 2006 WO
2012139022 Oct 2012 WO
2014133755 Sep 2014 WO
2015063721 May 2015 WO
2015198335 Dec 2015 WO
2016057940 Apr 2016 WO
2017168208 Oct 2017 WO
2018049227 Mar 2018 WO
2021055323 Mar 2021 WO
Non-Patent Literature Citations (13)
Entry
International Search Report and Written Opinion in Application No. PCT/US2019/019067 dated Jun. 3, 2019.
International Search Report and Written Opinion in Application No. PCT/US2019/019060 dated Jun. 5, 2019.
International Search Report and Written Opinion in Application No. PCT/IB2020/000932 dated Jul. 29, 2021.
International Search Report and Written Opinion in Application No. PCT/IB2020/000942 dated Aug. 10, 2021.
European Search Report in Application No. EP19756905 dated Oct. 18, 2021.
International Search Report and Written Opinion in Application No. PCT/US2022/016809 dated Jul. 27, 2022.
International Search Report and Written Opinion in Application No. PCT/US2022/027695 dated Jul. 27, 2022.
International Search Report and Written Opinion in Application No. PCT/US2022/027200 dated Aug. 19, 2022.
International Search Report and Written Opinion in Application No. PCT/US2022/030094 dated Sep. 16, 2022.
International Search Report and Written Opinion in Application No. PCT/US2022/016831 dated Sep. 29, 2022.
Chinese Office Action in Application No. 201980010758.4 dated Sep. 16, 2023.
International Search Report and Written Opinion in Application No. PCT/IB2023/057720 dated Nov. 8, 2023.
International Search Report and Written Opinion in Application No. PCT/IB2023/058417 dated Dec. 7, 2023.
Related Publications (1)
Number Date Country
20230172729 A1 Jun 2023 US
Continuations (1)
Number Date Country
Parent 17123897 Dec 2020 US
Child 18163989 US