External adjustment device for distraction device

Description

BACKGROUND
Related Applications

Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57.

Field of the Invention

The field of the invention generally relates to medical devices for treating disorders of the skeletal system.

DESCRIPTION OF THE RELATED ART

Scoliosis is a general term for the sideways (lateral) curving of the spine, usually in the thoracic or thoracolumbar region. Scoliosis is commonly broken up into different treatment groups, Adolescent Idiopathic Scoliosis, Early Onset Scoliosis and Adult Scoliosis.

Adolescent Idiopathic Scoliosis (AIS) typically affects children between ages 10 and 16, and becomes most severe during growth spurts that occur as the body is developing. One to two percent of children between ages 10 and 16 have some amount of scoliosis. Of every 1000 children, two to five develop curves that are serious enough to require treatment. The degree of scoliosis is typically described by the Cobb angle, which is determined, usually from x-ray images, by taking the most tilted vertebrae above and below the apex of the curved portion and measuring the angle between intersecting lines drawn perpendicular to the top of the top vertebrae and the bottom of the bottom. The term idiopathic refers to the fact that the exact cause of this curvature is unknown. Some have speculated that scoliosis occurs when, during rapid growth phases, the ligamentum flavum of the spine is too tight and hinders symmetric growth of the spine. For example, as the anterior portion of the spine elongates faster than the posterior portion, the thoracic spine begins to straighten, until it curves laterally, often with an accompanying rotation. In more severe cases, this rotation actually creates a noticeable deformity, wherein one shoulder is lower than the other. Currently, many school districts perform external visual assessment of spines, for example in all fifth grade students. For those students in whom an “S” shape or “C” shape is identified, instead of an “I” shape, a recommendation is given to have the spine examined by a physician, and commonly followed-up with periodic spinal x-rays.

Typically, patients with a Cobb angle of 20° or less are not treated, but are continually followed up, often with subsequent x-rays. Patients with a Cobb angle of 40° or greater are usually recommended for fusion surgery. It should be noted that many patients do not receive this spinal assessment, for numerous reasons. Many school districts do not perform this assessment, and many children do not regularly visit a physician, so often, the curve progresses rapidly and severely. There is a large population of grown adults with untreated scoliosis, in extreme cases with a Cobb angle as high as or greater than 90°. Many of these adults, though, do not have pain associated with this deformity, and live relatively normal lives, though oftentimes with restricted mobility and motion. In AIS, the ratio of females to males for curves under 10° is about one to one, however, at angles above 30°, females outnumber males by as much as eight to one. Fusion surgery can be performed on the AIS patients or on adult scoliosis patients. In a typical posterior fusion surgery, an incision is made down the length of the back and Titanium or stainless steel straightening rods are placed along the curved portion. These rods are typically secured to the vertebral bodies, for example with hooks or bone screws, or more specifically pedicle screws, in a manner that allows the spine to be straightened. Usually, at the section desired for fusion, the intervertebral disks are removed and bone graft material is placed to create the fusion. If this is autologous material, the bone is harvested from a hip via a separate incision.

Alternatively, the fusion surgery may be performed anteriorly. A lateral and anterior incision is made for access. Usually, one of the lungs is deflated in order to allow access to the spine from this anterior approach. In a less-invasive version of the anterior procedure, instead of the single long incision, approximately five incisions, each about three to four cm long are made in several of the intercostal spaces (between the ribs) on one side of the patient. In one version of this minimally invasive surgery, tethers and bone screws are placed and are secured to the vertebra on the anterior convex portion of the curve. Currently, clinical trials are being performed which use staples in place of the tether/screw combination. One advantage of this surgery in comparison with the posterior approach is that the scars from the incisions are not as dramatic, though they are still located in a visible area, when a bathing suit, for example, is worn. The staples have had some difficulty in the clinical trials. The staples tend to pull out of the bone when a critical stress level is reached.

In some cases, after surgery, the patient will wear a protective brace for a few months as the fusing process occurs. Once the patient reaches spinal maturity, it is difficult to remove the rods and associated hardware in a subsequent surgery, because the fusion of the vertebra usually incorporates the rods themselves. Standard practice is to leave this implant in for life. With either of these two surgical methods, after fusion, the patient's spine is now straight, but depending on how many vertebra were fused, there are often limitations in the degree of flexibility, both in bending and twisting. As these fused patients mature, the fused section can impart large stresses on the adjacent non-fused vertebra, and often, other problems including pain can occur in these areas, sometimes necessitating further surgery. This tends to be in the lumbar portion of the spine that is prone to problems in aging patients. Many physicians are now interested in fusionless surgery for scoliosis, which may be able to eliminate some of the drawbacks of fusion.

One group of patients in which the spine is especially dynamic is the subset known as Early Onset Scoliosis (EOS), which typically occurs in children before the age of five, and more often in boys than in girls. This is a more rare condition, occurring in only about one or two out of 10,000 children, but can be severe, sometimes affecting the normal development of organs. Because of the fact that the spines of these children will still grow a large amount after treatment, non-fusion distraction devices known as growing rods and a device known as the EPTRVertical Expandable Prosthetic Titanium Rib (“Titanium Rib”) have been developed. These devices are typically adjusted approximately every six months, to match the child's growth, until the child is at least eight years old, sometimes until they are 15 years old. Each adjustment requires a surgical incision to access the adjustable portion of the device. Because the patients may receive the device at an age as early as six months old, this treatment requires a large number of surgeries. Because of the multiple surgeries, these patients have a rather high preponderance of infection.

Returning to the AIS patients, the treatment methodology for those with a Cobb angle between 20° and 40° is quite controversial. Many physicians proscribe a brace (for example, the Boston Brace), that the patient must wear on their body and under their clothes 18 to 23 hours a day until they become skeletally mature, for example to age 16. Because these patients are all passing through their socially demanding adolescent years, it is quite a serious prospect to be forced with the choice of either wearing a somewhat bulky brace that covers most of the upper body, having fusion surgery that may leave large scars and also limit motion, or doing nothing and running the risk of becoming disfigured and possibly disabled. It is commonly known that many patients have at times hidden their braces, for example, in a bush outside of school, in order to escape any related embarrassment. The patient compliance with brace wearing has been so problematic that there have been special braces constructed which sense the body of the patient, and keep track of the amount of time per day that the brace is worn. Patients have even been known to place objects into unworn braces of this type in order to fool the sensor. Coupled with the inconsistent patient compliance with brace usage, is a feeling by many physicians that braces, even if used properly, are not at all effective at curing scoliosis. These physicians may agree that bracing can possibly slow down or even temporarily stop curve (Cobb angle) progression, but they have noted that as soon as the treatment period ends and the brace is no longer worn, often the scoliosis rapidly progresses, to a Cobb angle even more severe than it was at the beginning of treatment. Some say the reason for the supposed ineffectiveness of the brace is that it works only on a portion of the torso, and not on the entire spine. Currently a prospective, randomized 500 patient clinical trial known as BrAIST (Bracing in Adolescent Idiopathic Scoliosis Trial) is enrolling patients, 50% of whom will be treated with the brace and 50% of who will simply be watched. The Cobb angle data will be measured continually up until skeletal maturity, or until a Cobb angle of 50° is reached, at which time the patient will likely undergo surgery. Many physicians feel that the BrAIST trial will show that braces are completely ineffective. If this is the case, the quandary about what to do with AIS patients who have a Cobb angle of between 20° and 40° will only become more pronounced. It should be noted that the “20° to 40°” patient population is as much as ten times larger than the “40° and greater” patient population.

Distraction osteogenesis, also known as distraction callotasis and osteodistraction has been used successfully to lengthen long bones of the body. Typically, the bone, if not already fractured, is purposely fractured by means of a corticotomy, and the two segments of bone are gradually distracted apart, which allows new bone to form in the gap. If the distraction rate is too high, there is a risk of nonunion, if the rate is too low, there is a risk that the two segments will completely fuse to each other before the distraction period is complete. When the desired length of the bone is achieved using this process, the bone is allowed to consolidate. Distraction osteogenesis applications are mainly focused on the growth of the femur or tibia, but may also include the humerus, the jaw bone (micrognathia), or other bones. The reasons for lengthening or growing bones are multifold, the applications including, but not limited to: post osteosarcoma bone cancer; cosmetic lengthening (both legs-femur and/or tibia) in short stature or dwarfism/achondroplasia; lengthening of one limb to match the other (congenital, post-trauma, post-skeletal disorder, prosthetic knee joint), nonunions.

Distraction osteogenesis using external fixators has been done for many years, but the external fixator can be unwieldy for the patient. It can also be painful, and the patient is subject to the risk of pin track infections, joint stiffness, loss of appetite, depression, cartilage damage and other side effects. Having the external fixator in place also delays the beginning of rehabilitation.

In response to the shortcomings of external fixator distraction, intramedullary distraction nails have been surgically implanted which are contained entirely within the bone. Some are automatically lengthened via repeated rotation of the patient's limb. This can sometimes be painful to the patient, and can often proceed in an uncontrolled fashion. This therefore makes it difficult to follow the strict daily or weekly lengthening regime that avoids nonunion (if too fast) or early consolidation (if too slow). Lower limb distraction rates are on the order of one mm per day. Other intramedullary nails have been developed which have an implanted motor and are remotely controlled by an antenna. These devices are therefore designed to be lengthened in a controlled manner, but due to their complexity, may not be manufacturable as an affordable product. Others have proposed intramedullary distractors containing and implanted magnet, which allows the distraction to be driven electromagnetically by an external stator. Because of the complexity and size of the external stator, this technology has not been reduced to a simple and cost-effective device that can be taken home, to allow patients to do daily lenthenings.

SUMMARY

In one embodiment, an external adjustment device includes at least one permanent magnet configured for rotation about an axis. The external adjustment device further includes a first handle extending linearly at a first end of the device and a second handle disposed at a second end of the device, the second handle extending in a direction that is angled relative to the first handle. The external adjustment device includes a motor mounted inside the first handle and a first button located in the proximity to one of the first handle or the second handle, the first button configured to be operated by the thumb of a hand that grips the one of the first handle or second handle. The first button is configured to actuate the motor causing the at least one permanent magnet to rotate about the axis in a first direction.

In another embodiment, an external adjustment device includes at least one permanent magnet configured for rotation about an axis and a motor configured for rotating the at least one permanent magnet about the axis. The external adjustment device includes a first handle extending linearly at a first end of the device and a second handle disposed at a second end of the device, the second handle extending in a direction that is substantially off axis with respect to the first handle, wherein one of the first and second handle comprises a looped shape. A first drive button is located in the proximity to one of the first handle or the second handle, the first drive button configured to be operated by the thumb of a hand that grips the one of the first handle or second handle. The first drive button is configured to actuate the motor causing the at least one permanent magnet to rotate about the axis in a first direction.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates an external adjustment device configured to operate a distraction device.

FIG. 2 illustrates a detailed view of the display and control panel of the external adjustment device.

FIG. 3 illustrates the lower or underside surfaces of the external adjustment device.

FIG. 4 illustrates a sectional view of the external adjustment device taken along line 4-4 of FIG. 3.

FIG. 5 illustrates a sectional view of the external adjustment device taken along line 5-5 of FIG. 3.

FIG. 6 schematically illustrates the orientation of the magnets of the external adjustment device while driving an implanted magnet of a distraction device.

FIG. 7 illustrates various sensors connected to a printed circuit board of the external adjustment device.

FIG. 8 illustrates a view of the clock positions of Hall effect sensors on the printed circuit board of the external adjustment device.

FIG. 9A illustrates a particular configuration of Hall effect sensors according to one embodiment.

FIG. 9B illustrates output voltage of the Hall effect sensors of the configuration in FIG. 9A.

FIG. 9C illustrates the configuration of FIG. 9A, with the magnets in a nonsynchronous condition.

FIG. 9D illustrates the output voltage of the Hall effect sensors of the configuration in FIG. 9C.

FIG. 10A illustrates a particular configuration of Hall effect sensors according to another embodiment.

FIG. 10B illustrates the output voltage of the Hall effect sensors of the configuration in FIG. 10A.

FIG. 11 illustrates the orientation of two external magnets of an external adjustment device in relation to an internal, implanted magnet.

FIGS. 12A-12C illustrate pairs of external magnets of an external adjustment device having different intermagnet gaps.

FIGS. 13A-13B illustrate schematics of magnetic field lines surrounding external magnets of an external adjustment device.

FIG. 14 illustrates a graph of magnetic flux density plotted against gap distance for two external magnets having various intermagnet gaps.

FIG. 15 illustrates a graph of magnetic flux density plotted against gap distance for two different pairs of two external magnets systems in which intermagnet gap and rotational offset are varied.

FIGS. 16A-16D illustrate the orientation of two external magnets of the external adjustment device having various positive unilateral rotational offsets.

FIGS. 17A-17D illustrate the orientation of two external magnets of the external adjustment device having various negative unilateral rotational offsets.

FIG. 18 illustrates a graph of implant torque plotted against unilateral angle of rotation.

FIGS. 19A-19D illustrate the orientation of two external magnets of the external adjustment device having various positive bilateral rotational offsets.

FIGS. 20A-20D illustrate the orientation of two external magnets of the external adjustment device having various negative bilateral rotational offsets.

FIGS. 21A-21E illustrate schematics of magnetic field lines surrounding external magnets of an external adjustment device in a reference orientation and various bilateral rotational offsets.

FIGS. 22A-22B illustrate graphs of implant torque plotted against bilateral angle of rotation.

FIG. 23 illustrates a graph of flux density plotted against gap distance for external magnets having various rotational offsets.

FIG. 24 illustrates the orientation of three external magnets of an external adjustment device in relation to an internal, implanted magnet.

FIGS. 25A-25C illustrate various orientations of three external magnets of an external adjustment device.

FIGS. 26A-26C illustrate various cylindrical magnets having shaped magnetic fields.

FIG. 27 illustrates a magnetic flux map of a two magnet system

FIG. 28A illustrates a schematic diagram of three magnet system

FIGS. 28B-C illustrate flux maps of three magnet systems.

DETAILED DESCRIPTION

FIGS. 1-3 illustrate an external adjustment device 700 that is configured for adjusting a distraction device 1000. The distraction device 1000 may include any number of distraction devices such as those disclosed in U.S. patent application Ser. Nos. 12/121,355, 12/250,442, 12/391,109, 11/172,678 which are incorporated by reference herein. The distraction device 1000 generally includes a rotationally mounted, internal permanent magnet 1010 that rotates in response to the magnetic field applied by the external adjustment device 700. Rotation of the magnet 1010 in one direction effectuates distraction while rotation of the magnet 1010 in the opposing direction effectuates retraction. External adjustment device 700 may be powered by a rechargeable battery or by a power cord 711. The external adjustment device 700 includes a first handle 702 and a second handle 704. The second handle 704 is in a looped shape, and can be used to carry the external adjustment device 700. The second handle 704 can also be used to steady the external adjustment device 700 during use. Generally, the first handle 702 extends linearly from a first end of the external adjustment device 700 while the second handle 704 is located at a second end of the external adjustment device 700 and extends substantially off axis or is angled with respect to the first handle 702. In one embodiment, the second handle 704 may be oriented substantially perpendicular relative to the first handle 702 although other The first handle 702 contains the motor 705 that drives a first external magnet 706 and a second external magnet 708 as best seen in FIG. 3, via gearing, belts and the like. On the first handle 702 is an optional orientation image 804 comprising a body outline 806 and an optional orientation arrow 808 that shows the correct direction to place the external adjustment device 700 on the patient's body, so that the distraction device is operated in the correct direction. While holding the first handle 702, the operator presses with his thumb the distraction button 722, which has a distraction symbol 717, and is a first color, for example green. This distracts the distraction device 1000. If the distraction device 1000 is over-distracted and it is desired to retract, or to lessen the distraction of the device 1000, the operator presses with his thumb the retraction button 724 which has a retraction symbol 719.

Distraction turns the magnets 706, 708 one direction and retraction turns the magnets 706, 708 in the opposite direction. Magnets 706, 708 have stripes 809 that can be seen in window 811. This allows easy identification of whether the magnets 706, 708 are stationary or turning, and in which direction they are turning. This allows quick trouble shooting by the operator of the device. The operator can determine the point on the patient where the magnet of the distraction device 1000 is implanted, and can then put the external adjustment device 700 in correct location with respect to the distraction device 1000, by marking the corresponding portion of the skin of the patient, and then viewing this spot through the alignment window 716 of the external adjustment device 700.

A control panel 812 includes several buttons 814, 816, 818, 820 and a display 715. The buttons 814, 816, 818, 820 are soft keys, and able to be programmed for an array of different functions. In one configuration, the buttons 814, 816, 818, 820 have corresponding legends which appear in the display. To set the length of distraction to be performed on the distraction device 1000, the target distraction length 830 is adjusted using an increase button 814 and a decrease button 816. The legend with a green plus sign graphic 822 corresponds to the increase button 814 and the legend with a red negative sign graphic 824 corresponds to the decrease button 816. It should be understood that mention herein to a specific color used for a particular feature should be viewed as illustrative. Other colors besides those specifically recited herein may be used in connection with the inventive concepts described herein. Each time the increase button 814 is depressed, it causes the target distraction length 830 to increase 0.1 mm. Each time the decrease button 816 is depressed it causes the target distraction length 830 to decrease 0.1 mm. Of course, other decrements besides 0.1 mm could also be used. When the desired target distraction length 830 is displayed, and the external adjustment device 700 is correctly placed on the patient, the operator then holds down the distraction button 722 and the External Distraction Device 700 operates, turning the magnets 706, 708, until the target distraction length 830 is achieved. Following this, the external adjustment device 700 stops. During the distraction process, the actual distraction length 832 is displayed, starting at 0.0 mm and increasing until the target distraction length 830 is achieved. As the actual distraction length 832 increases, a distraction progress graphic 834 is displayed. For example a light colored box 833 that fills with a dark color from the left to the right. In FIG. 2, the target distraction length 830 is 3.5 mm, and 2.1 mm of distraction has occurred. 60% of the box 833 of the distraction progress graphic 834 is displayed. A reset button 818 corresponding to a reset graphic 826 can be pressed to reset one or both of the numbers back to zero. An additional button 820 can be assigned for other functions (help, data, etc.). This button can have its own corresponding graphic 828. Alternatively, a touch screen can be used, for example capacitive or resistive touch keys. In this embodiment, the graphics/legends 822, 824, 826, 828 may also be touch keys, replacing or augmenting the buttons 814, 816, 818, 820. In one particular embodiment, touch keys at 822, 824, 826, 828 perform the functions of buttons 814, 816, 818, 820 respectively, and the buttons 814, 816, 818, 820 are eliminated.

The two handles 702, 704 can be held in several ways. For example the first handle 702 can be held with palm facing up while trying to find the location on the patient of the implanted magnet of the distraction device 1000. The fingers are wrapped around the handle 702 and the fingertips or mid-points of the four fingers press up slightly on the handle 702, balancing it somewhat. This allows a very sensitive feel that allows the magnetic field between the magnet in the distraction device 1000 and the magnets 706, 708 of the external adjustment device 700 to be more obvious. During the distraction of the patient, the first handle 702 may be held with the palm facing down, allowing the operator to push the device down firmly onto the patient, to minimize the distance between the magnets 706, 708 of the external adjustment device and the magnet 1010 of the distraction device 1000, thus maximizing the torque coupling. This is especially appropriate if the patient is large or somewhat obese. The second handle 704 may be held with the palm up or the palm down during the magnet sensing operation and the distraction operation, depending on the preference of the operator.

FIG. 3 illustrates the underside or lower surface of the external adjustment device 700. At the bottom of the external adjustment device 700, the contact surface 836 may be made of material of a soft durometer, such as elastomeric material, for example PEBAX® or Polyurethane. This allows for anti-shock to protect the device 700 if it is dropped. Also, if placing the device on patient's bare skin, materials of this nature do not pull heat away from patient as quickly, and so they “don't feel as cold” as hard plastic or metal. The handles 702, 704 may also have similar material covering them, in order to act as non-slip grips.

FIG. 3 also illustrates child friendly graphics 837, including the option of a smiley face. Alternatively this could be an animal face, such as a teddy bear, a horsey or a bunny rabbit. A set of multiple faces can be removable and interchangeable to match the likes of various young patients. In addition, the location of the faces on the underside of the device, allows the operator to show the faces to a younger child, but keep it hidden from an older child, who may not be so amused. Alternatively, sock puppets or decorative covers featuring human, animal or other characters may be produced so that the device may be thinly covered with them, without affecting the operation of the device, but additionally, the puppets or covers may be given to the young patient after a distraction procedure is performed. It is expected that this can help keep a young child more interested in returning to future procedures.

FIGS. 4 and 5 are sectional views that illustrate the internal components of the external adjustment device 700 taken along various centerlines. FIG. 4 is a sectional view of the external adjustment device 700 taken along the line 4-4 of FIG. 3. FIG. 5 is a sectional view of the external adjustment device 700 taken along the line 5-5 of FIG. 3. The external adjustment device 700 comprises a first housing 868, a second housing 838 and a central magnet section 725. First handle 702 and second handle 704 include grip 703 (shown on first handle 702). Grip 703 may be made of an elastomeric material and may have a soft feel when gripped by the hand. The material may also have a tacky feel, in order to aid firm gripping. Power is supplied via power cord 711, which is held to second housing 838 with a strain relief 844. Wires 727 connect various electronic components including motor 840 which rotates magnets 706, 708 via gear box 842, output gear 848, center gear 870 respectively, center gear 870 rotating two magnet gears 852, one on each magnet 706, 708 (one such gear 852 is illustrated in FIG. 5). Output gear 848 is attached to motor output via coupling 850, and both motor 840 and output gear 848 are secured to second housing 838 via mount 846. Magnets 706, 708 are held within magnet cups 862. Magnets and gears are attached to bearings 872, 874, 856, 858, which aid in low friction rotation. Motor 840 is controlled by motor printed circuit board (PCB) 854, while the display is controlled by display printed circuit board (PCB) 866 (FIG. 4). Display PCB 866 is attached to frame 864.

FIG. 6 illustrates the orientation of poles of the first and second external magnets 706, 708 and the implanted magnet 1010 of the distraction device 1000 during a distraction procedure. For the sake of description, the orientations will be described in relation to the numbers on a clock. First external magnet 706 is turned (by gearing, belts, etc.) synchronously with second external magnet 708 so that north pole 902 of first external magnet 706 is pointing in the twelve o'clock position when the south pole 904 of the second external magnet 708 is pointing in the twelve o'clock position. At this orientation, therefore, the south pole 906 of the first external magnet 706 is pointing is pointing in the six o'clock position while the north pole 908 of the second external magnet 708 is pointing in the six o'clock position. Both first external magnet 706 and second external magnet 708 are turned in a first direction as illustrated by respective arrows 914, 916. The rotating magnetic fields apply a torque on the implanted magnet 1010, causing it to rotate in a second direction as illustrated by arrow 918. Exemplary orientation of the north pole 1012 and south pole 1014 of the implanted magnet 1010 during torque delivery are shown in FIG. 6. When the first and second external magnets 706, 708 are turned in the opposite direction from that shown, the implanted magnet 1010 will be turned in the opposite direction from that shown. The orientation of the first external magnet 706 and the second external magnet 708 in relation to each other serves to optimize the torque delivery to the implanted magnet 1010. During operation of the external adjustment device 700, it is often difficult to confirm that the two external magnets 706, 708 are being synchronously driven as desired. Turning to FIGS. 7 and 8, in order to ensure that the external adjustment device 700 is working properly, the motor printed circuit board 854 comprises one or more encoder systems, for example photointerrupters 920, 922 and/or Hall effect sensors 924, 926, 928, 930, 932, 934, 936, 938. Photointerrupters 920, 922 each comprise an emitter and a detector. A radially striped ring 940 may be attached to one or both of the external magnets 706, 708 allowing the photointerrupters to optically encode angular motion. Light 921, 923 is schematically illustrated between the radially striped ring 940 and photointerrupters 920, 922.

Independently, Hall effect sensors 924, 926, 928, 930, 932, 934, 936, 938 may be used as non-optical encoders to track rotation of one or both of the external magnets 706, 708. While eight (8) such Hall effect sensors are illustrated in FIG. 7 it should be understood that fewer or more such sensors may be employed. The Hall effect sensors are connected to the motor printed circuit board 854 at locations that allow the Hall effect sensors to sense the magnetic field changes as the external magnets 706, 708 rotate. Each Hall effect sensor 924, 926, 928, 930, 932, 934, 936, 938 outputs a voltage that corresponds to increases or decreases in the magnetic field. FIG. 9A indicates one basic arrangement of Hall effect sensors relative to sensors 924, 938. A first Hall effect sensor 924 is located at nine o'clock in relation to first external magnet 706. A second Hall effect sensor 938 is located at three o'clock in relation to second external magnet 708. As the magnets 706, 708 rotate correctly in synchronous motion, the first voltage output 940 of first Hall effect sensor 924 and second voltage output 942 of second Hall effect sensor have the same pattern, as seen in FIG. 9B, which graphs voltage for a full rotation cycle of the external magnets 706, 708. The graph indicates a sinusoidal variance of the output voltage, but the clipped peaks are due to saturation of the signal. Even if Hall effect sensors used in the design cause this effect, there is still enough signal to compare the first voltage output 940 and the second voltage output 942 over time. If either of the two Hall effect sensors 924, 938 does not output a sinusoidal signal during the operation or the external adjustment device 700, this demonstrates that the corresponding external magnet has stopped rotating, for example due to adhesive failure, gear disengagement, etc. FIG. 9C illustrates a condition in which both the external magnets 706, 708 are rotating at the same approximate angular speed, but the north poles 902, 908 are not correctly synchronized. Because of this, the first voltage output 940 and second voltage output 942 are now out-of-phase, and exhibit a phase shift (0). These signals are processed by a processor 915 and an error warning is displayed on the display 715 of the external adjustment device 700 so that the device may be resynchronized.

If independent stepper motors are used, the resynchronization process may simply be one of reprogramming, but if the two external magnets 706, 708 are coupled together, by gearing or belt for example, then a mechanical rework may be required. An alternative to the Hall effect sensor configuration of FIG. 9A is illustrated in FIG. IOA. In this embodiment, a third Hall effect sensor 928 is located at twelve o'clock in relation to the first external magnet 706 and a fourth Hall effect sensor 934 is located at twelve o'clock in relation to the second external magnet 708. With this configuration, the north pole 902 of the first external magnet 706 should be pointing towards the third Hall effect sensor 928 when the south pole 904 of the second external magnet 708 is pointing towards the fourth Hall effect sensor 934. With this arrangement, the third Hall effect sensor 928 outputs a third output voltage 944 and the fourth Hall effect sensor 934 outputs a fourth output voltage 946 (FIG. 1OB). The third output voltage 944 is by design out of phase with the fourth output voltage 946. An advantage of the Hall effect sensor configuration of FIG. 9A is that the each sensor has a larger distance between it and the opposite magnet, for example first Hall effect sensor 924 in comparison to second external magnet 708, so that there is less possibility of interference. An advantage to the Hall effect sensor configuration of FIG. IOA is that it may be possible to make a more compact external adjustment device 700 (less width). The out-of-phase pattern of FIG. IOB can also be analyzed to confirm magnet synchronicity.

Returning to FIGS. 7 and 8, additional Hall effect sensors 926, 930, 932, 936 are shown. These additional sensors allow additional precision to the rotation angle feedback of the external magnets 706, 708 of the external adjustment device 700. Again, the particular number and orientation of Hall effect sensors may vary. In place of the Hall effect sensors, magnetoresistive encoders may also be used.

In still another embodiment, additional information may be processed by processor 915 and may be displayed on display 715. For example, distractions using the external adjustment device 700 may be performed in a doctor's office by medical personnel, or by patients or members of patient's family in the home. In either case, it may be desirable to store information from each distraction session that can be accessed later. For example, the exact date and time of each distraction, and the amount of distraction attempted and the amount of distraction obtained. This information may be stored in the processor 915 or in one or more memory modules (not shown) associated with the processor 915. In addition, the physician may be able to input distraction length limits, for example the maximum amount that can be distracted at each session, the maximum amount per day, the maximum amount per week, etc. The physician may input these limits by using a secure entry using the keys or buttons of the device, that the patient will not be able to access.

Returning to FIG. 1, in some patients, it may be desired to place a first end 1018 of the distraction device 1000 proximally in the patient, or towards the head, and second end 1020 of the distraction device 1000 distally, or towards the feet. This orientation of the distraction device 1000 may be termed antegrade. In other patients, it may be desired to orient the distraction device 1000 with the second end 1020 proximally in the patient and the first end 1018 distally. In this case, the orientation of the distraction device 1000 may be termed retrograde. In a distraction device 1000 in which the magnet 1010 rotates in order to turn a screw within a nut, the orientation of the distraction device 1000 being either antegrade or retrograde in patient could mean that the external adjustment device 700 would have to be placed in accordance with the orientation image 804 when the distraction device 1000 is placed antegrade, but placed the opposite of the orientation image 804 when the distraction device 1000 is placed retrograde. Alternatively, software may be programmed so that the processor 915 recognizes whether the distraction device 1000 has been implanted antegrade or retrograde, and then turns the magnets 706, 708 in the appropriate direction when the distraction button 722 is placed.

For example, the motor 705 would be commanded to rotate the magnets 706, 708 in a first direction when distracting an antegrade placed distraction device 1000, and in a second, opposite direction when distracting a retrograde placed distraction device 1000. The physician may, for example, be prompted by the display 715 to input using the control panel 812 whether the distraction device 1000 was placed antegrade or retrograde. The patient may then continue to use the same external adjustment device 700 to assure that the motor 705 turns the magnets 706, 708 in the proper directions for both distraction and retraction. Alternatively, the distraction device may incorporate an RFID chip 1022 which can be read and written to by an antenna 1024 on the external adjustment device 700. The position of the distraction device 1000 in the patient (antegrade or retrograde) is written to the RFID chip 1022, and can thus be read by the antenna 1024 of any external adjustment device 700, allowing the patient to get correct distractions or retractions, regardless of which external adjustment device 700 is used.

FIG. 11 illustrates the orientation of the poles of two external magnets, the first external magnet 706 and the second external magnet 708 of an external adjustment device in relation to an internal, implanted magnet 1010, for example, in an implanted distraction device. As with FIG. 6, above, the orientations of each magnet may be described in relation to the numbers on a clock. First external magnet 706 has a north pole 902 and a south pole 906. In the same way, second external magnet 708 has a south pole 904 and a north pole 908. Each external magnet is physically defined by a diameter and a length (i.e., to form a substantially right cylinder): the first external magnet 706 has a first magnet diameter 1134 while the second external magnet 708 has a second magnet diameter 1132. In some embodiments, the first magnet diameter 1134 and the second magnet diameter 1132 are equal. However, this need not always be the case. In other embodiments, the first magnet diameter 1134 is larger than the second magnet diameter 1132. And in still other embodiments the second magnet diameter 1132 is larger than the first magnet diameter 1134.

FIG. 11 is included primarily to illustrate the first external magnet 706 and the second external magnet 708-implanted magnet 1010 is included mainly for reference. However, in much the same way as the first external magnet 706 and the second external magnet 708, the implanted magnet 1010 has a north pole 1012 and a south pole 1014. The implanted magnet 1010, too, may be defined by an internal magnet diameter 1136 and a length (i.e., the implanted magnet 1010 may be a substantially right cylinder as well). It should be understood that any of the first external magnet 706, second external magnet 708, and implanted magnet 1010 may be magnets other than substantially right cylinders.

As explained above, with respect to FIG. 6, external magnet 706 is configured to rotate about a first elongate rotational axis. In FIGS. 6 and 11, the first elongate rotational axis is a line through the center of the first external magnet 706 extending into the page through the center of the first external magnet 706. Likewise, the second external magnet 708 is configured to rotate about a second elongate rotational axis. Again, in FIGS. 6 and 11, the second elongate rotational axis is a line through the center of the second external magnet 708 extending into the page through the center of the second external magnet 708. As the first elongate rotational axis and the second elongate rotational axis are essentially points, the two define a line between the first external magnet 706 and the second external magnet 708. The line on which they lie is shown in FIG. 11 as horizontal axis 1110.

Each of the first external magnet 706 and second external magnet 708 defines its own vertical axis, perpendicular to the horizontal axis 1110 and through the magnet's elongate rotational axis. First external magnet 706 has a first magnet vertical axis 1113 that is perpendicular to the horizontal axis 1110 and intersects the first elongate rotational axis (i.e., the horizontal axis 1110 and the first magnet vertical axis 1113 intersect at the center of the circle defined by any plane perpendicular to the longitudinal axis of the first external magnet 706). In the same way, second external magnet 708 has a second magnet vertical axis 1112 that is perpendicular to the horizontal axis 1110 and intersects the second elongate rotational axis (i.e., the horizontal axis 1110 and the second magnet vertical axis 1112 intersect at the center of the circle defined by any plane perpendicular to the longitudinal axis of the second external magnet 708).

The first external magnet 706 and the second external magnet 708 are separated by an intermagnet gap 1130, which is defined as the distance along the horizontal axis 1110 between the rightmost edge of the first external magnet 706 and the leftmost edge of the second external magnet 708. A central vertical axis 1111 bisects the horizontal axis 1110 in the center of the intermagnet gap 1130, perpendicular to the horizontal axis 1110. Therefore, the distance from the center of the first external magnet 706 (i.e., the first elongate rotational axis) to the center of the second external magnet 708 (i.e., the second elongate rotational axis) is equal to one half the first magnet diameter 1134 plus one half the second magnet diameter 1132 plus the intermagnet gap 1130. When the first magnet diameter 1134 of the first external magnet 706 and second magnet diameter 1132 of the second external magnet 708 are equal, as shown in FIG. 11, the first elongate rotational axis and the second elongate rotational axis are equidistant from the central vertical axis 1111. However, while some embodiments include equally sized first external magnet 706 and second external magnet 708, not all do. Therefore, not all possible pairs of first elongate rotational axis and second elongate rotational axis are equidistant from the central vertical axis 1111.

An ideal reference location for the implanted magnet 1010 is on the central vertical axis 1111. In the case where first magnet diameter 1134 and second magnet diameter 1132 are equal, the first external magnet 706 and second external magnet 708 create equal magnetic fields. Therefore, any point along central vertical axis 1111 will experience equal effects by first external magnet 706 and second external magnet 708. The distance between the lowermost edge of the external magnets (i.e., first external magnet 706 and second external magnet 708) and the uppermost edge of the implanted magnet 1010 is defined as the gap distance 1138. It should be understood that, while a reference location for the implanted magnet 1010 on the central vertical axis 1111 is conceptually helpful, the implanted magnet 1010 may also lie off the central vertical axis 1111.

Turning to FIGS. 12A-12C, a series of external magnet pairs is shown with varying intermagnet gaps 1130. FIG. 12A shows a first external magnet 706 and second external magnet 708 that both lie on a horizontal axis 1110 separated by a first example intermagnet gap 1130′. FIG. 12B shows a first external magnet 706 and a second external magnet 708 that both lie on a horizontal axis 1110 separated by a second example intermagnet gap 1130″. The second example intermagnet gap 1130″ of FIG. 12B is generally smaller than the first example intermagnet gap 1130′ of FIG. 12A. FIG. 12C shows a first external magnet 706 and a second external magnet 708 that both lie on a horizontal axis 1110 separated by a third example intermagnet gap 1130′. The third example intermagnet gap 1130′″ is generally smaller than both the second example intermagnet gap 1130″ and the first example intermagnet gap 1130′. It should be understood that any intermagnet gap 1130 may be used between the first external magnet 706 and second external magnet 708.

The intermagnet gap 1130 can have an effect on the magnetic flux density observed along the central vertical axis 1111. Magnetic flux density drops off at approximately 1/r³(an inverse cube). Therefore, a very small gap distance may observe relatively high flux densities along the central vertical axis 1111. By contrast, because of how quickly the flux density drops off, a lower limit of flux density is reached relatively quickly with medium and large intermagnet gaps 1130. FIG. 13A illustrates a schematic of the magnetic field lines surrounding a first external magnet 706 and second external magnet 708. The intermagnet gap 1130 between the first external magnet 706 and second external magnet 708 is comparatively small. It can be seen that the flux lines along the central vertical axis 1111 are relatively dense, particularly along the central vertical axis 1111 near, and/or between, the first external magnet 706 and second external magnet 708. By contrast, FIG. 13B illustrates a schematic of the magnetic field lines surrounding a first external magnet 706 and second external magnet 708 separated by a intermagnet gap 1130 significantly larger than that shown in FIG. 13A. The flux lines along the central vertical axis 1111 of FIG. 13B are noticeably less dense than the flux lines along the central vertical axis 1111 of FIG. 13A. That is due, solely, to an increase in the intermagnet gap 1130.

FIG. 14 illustrates a graph of magnetic flux density generated by a first external magnet 706 and a second external magnet 708 versus gap distance 1138. The modeled flux density is measured at a reference point along the central vertical axis 1111 as the reference point moves further away from the bottom of the first external magnet 706 and second external magnet 708 (i.e., as the gap distance 1138 increases from a zero reference point). FIG. 14's first line 1410 illustrates a graph of magnetic flux density versus gap distance 1138 for a first external magnet 706 and second external magnet 708 having a intermagnet gap 1130 of 50.8 mm (i.e., 2 inches). Second line 1420 illustrates a graph of magnetic flux density versus gap distance 1138 for a first external magnet 706 and second external magnet 708 having an intermagnet gap 1130 of 55.88 mm (i.e., 2.2 inches). Third line 1430 illustrates a graph of magnetic flux density versus gap distance 1138 for a first external magnet 706 and second external magnet 708 having an intermagnet gap 1130 of 60.96 mm (i.e., 2.4 inches). Fourth line 1440 illustrates a graph of magnetic flux density versus gap distance 1138 for a first external magnet 706 and second external magnet 708 having an intermagnet gap 1130 of 66.04 mm (i.e., 2.6 inches). Fifth line 1450 illustrates a graph of magnetic flux density versus gap distance 1138 for a first external magnet 706 and second external magnet 708 having an intermagnet gap 1130 of 71.12 mm (i.e., 2.8 inches). And, finally, sixth line 1460 illustrates a graph of magnetic flux density versus gap distance 1138 for a first external magnet 706 and second external magnet 708 having an intermagnet gap 1130 of 76.2 mm (i.e., 3.0 inches). FIG. 14's lines illustrate that at small gap distances 1138 (e.g., zero gap distances 1138), decreasing the intermagnet gap 1130 increases the observed flux density. In fact, at a gap distance 1138 of zero, an intermagnet gap 1130 of 50.8 mm has a flux density about 135% higher than an intermagnet gap 1130 of 76.2 mm at the same gap distance. However, the gains realized by decreasing the intermagnet gap 1130 exist only at fairly small gap distances 1138. FIG. 14's lines illustrate near convergence of the first line 1410, second line 1420, third line 1430, fourth line 1440, fifth line 1450, and sixth line 1460 at approximately 25 mm. After about 25 mm, there is little difference between the flux densities along central vertical axis 1111 for varying intermagnet gaps 1130.

Turning again to FIG. 12A-12C, in view of FIG. 14's lines, it can be seen that for small gap distances, the system illustrated in FIG. 12A having a larger first example intermagnet gap 1130′ will have a smaller flux density than the system illustrated in FIG. 12B having a smaller second example intermagnet gap 1130″ which will, in turn, have a smaller flux density than the system illustrated in FIG. 12C having the smallest third example intermagnet gap 1130′″. In some circumstances, a large magnetic flux density is desirable. However, in other circumstances, diminished magnetic flux densities are desirable. The desirability of varying magnetic flux densities will be discussed in additional detail, below.

As can be seen, in applications for which a small gap distance is possible or required, intermagnet gap may be varied to increase or decrease the flux density. If higher flux densities are useful or required (such as when higher torques are useful or required), the intermagnet gap may be decreased while holding the gap distance constant—i.e., first external magnet 706 and the second external magnet 708 may be brought closer together on horizontal axis 1110. By contrast, if lower flux densities are useful or required (such as when high torques are not needed or could be detrimental), the intermagnet gap may be increased while holding the gap distance constant—i.e., the first external magnet 706 and the second external magnet 708 may be moved apart on the horizontal axis 1110. Of course, both intermagnet gap and gap distance may be varied.

In some embodiments, the external adjustment device 700 may be “smart” and able to vary the intermagnet gap based one or more factors, such as, but not limited to, user input and a sensed parameter. Therefore, such a “smart” external adjustment device 700 may manipulate intermagnet gap to increase or decrease the flux density as needed. For example, a user may input several parameters that allow the external adjustment device to select the appropriate intermagnet gap distance for the given application. Such variable may include implant location, patient age, patient weight, patient body mass index (BMI), gap distance, etc. By contrast to input parameters, a “smart” external adjustment device 700 may be able to use sensed parameters such as gap distance magnetic coupling slippage, torque generated, force generated, etc.

In response to one or more of these user inputs and sensed parameters, the intermagnet gap may be adjusted. In some embodiments, the external adjustment device 700 may inform a user that a given adjustment could improve treatment efficacy. In such a case, the user could use any of a number of tools, systems, and methods to increase the intermagnet gap. Alternatively, a “smart” external adjustment device 700 may process the user inputs and/or sensed parameters, determine that a change (increase or decrease) in flux density or torque generation would be advantageous, and automatically adjust the intermagnet gap to the optimum intermagnet gap that remains within system capabilities (i.e., due to physical constraints, there are both lower and upper limits on the intermagnet gap).

As explained with reference to FIG. 6, first external magnet 706 is turned (by gearing, belts, etc.) synchronously with second external magnet 708 so that the north pole 902 of first external magnet 706 is pointing in the twelve o'clock position when the south pole 904 of the second external magnet 708 is pointing in the twelve o'clock position. At this orientation, therefore, the south pole 906 of the first external magnet 706 is pointing in the six o'clock position while the north pole 908 of the second external magnet 708 is pointing in the six o'clock position. Both first external magnet 706 and second external magnet 708 may be turned in a first direction, such as in a clockwise direction. The rotating magnetic fields apply a torque on the implanted magnet 1010, causing it to rotate in a second direction, such as in a counterclockwise direction. When the first and second external magnets 706, 708 are turned in the opposite direction, i.e., a counterclockwise direction, the implanted magnet 1010 will also be turned in the opposite direction, i.e., a clockwise direction.

FIG. 6 illustrates the reference configuration of the first external magnet 706 and the second external magnet 708. The first external magnet 706 is positioned such that the center of the north pole 902 points up and the center of the south pole 906 points down. In the same way, the second external magnet 708 is positioned such that the center of the south pole 904 points up and the center of the north pole 908 points down. Thereafter, in FIG. 6, the two magnets rotate at fixed angular positioned with respect to each other. Therefore, the north pole 902 of the first external magnet 706 and the south pole 904 of the second external magnet 708 are always at the same angular position. And, the south pole 906 of the first external magnet 706 and the north pole 908 of the second external magnet 708 are also always at the same angular position.

Turning again to FIG. 11, the first external magnet 706 has a first central magnetic axis 1122 that extends through the center of the first external magnet's 706 north pole 902, through the center of the first external magnet 706 to intersect the first elongate rotational axis, and through the center of the first external magnet's 706 south pole 906. The first central magnetic axis 1122 is discussed with respect to the orientation of the first external magnet's 706 north pole 902. In the same way, the second external magnet 708 has a second central magnetic axis 1120 that extends through the center of the second external magnet's 708 south pole 904 of the second external magnet 708, through the center of the second external magnet 708 to intersect the second elongate rotational axis, and through the center of the second external magnet's 708 north pole 908. The second central magnetic axis 1120 is discussed with respect to the orientation of the second external magnet's 708 south pole 904.

In its reference orientation, shown in both FIG. 6 and FIG. 11, the first central magnetic axis 1122 is directly aligned with the first magnet vertical axis 1113. This aligned orientation has no angular offset (i.e., the angular offset of the first external magnet 706 is 0°). Rotations of the first external magnet 706 and second external magnet 708 are referred to by reference to the location of the implanted magnet 1010. As shown in FIG. 11, in which the implanted magnet 1010 is “above” the first external magnet 706 and second external magnet 708, rotations of the first external magnet 706 about the first elongate rotational axis in a counterclockwise direction are denoted as being positive, while rotations of the first external magnet 706 about the first elongate rotational axis in a clockwise direction are denoted as being negative. By contrast, in FIG. 11, in which the implanted magnet 1010 is “above” the second external magnet 708, rotations of the second external magnet 708 about the second elongate rotational axis in a clockwise direction are denoted as being positive, while rotations of the second external magnet 708 about the second elongate rotational axis in a counterclockwise direction are denoted as being negative.

FIG. 6 illustrates two magnets that may be turned in unison. For example, first external magnet 706 may be turned (by gearing, belts, etc.) synchronously with second external magnet 708 so that the north pole 902 of first external magnet 706 is pointing in the twelve o'clock position when the south pole 904 of the second external magnet 708 is pointing in the twelve o'clock position. By extension, both the south pole 906 of the first external magnet 706 and the north pole 908 of the second external magnet 708 are pointing in the six o'clock position. As illustrated in FIG. 6, both external magnets may be turned in a first direction illustrated by respective arrows 914, 916. The rotating magnetic fields apply a torque on the implanted magnet 1010, causing it to rotate in a second direction as illustrated by arrow 918. When the first and second external magnets 706, 708 are turned in the opposite direction from that shown, the implanted magnet 1010 will be turned in the opposite direction from that shown. While the magnets may be rotated with a zero angular offset, as just described, the magnets may also be rotated with a positive angular offset.

The first external magnet 706 may be rotated to an example first central magnetic axis 1122′ by a first angle of rotation 1123. In some embodiments, as just mentioned, the first angle of rotation 1123 is positive, and in some embodiments the first angle of rotation 1123 is negative. The first angle of rotation 1123 may rotate the first central magnetic axis 1122 in a positive direction from 0° to 360°. Additionally, the first angle of rotation 1123 may rotate the first central magnetic axis 1122 in a negative direction from 0° to −360°. Rotations of the first external magnet 706 such that the first central magnetic axis 1122 is rotationally offset by a first angle of rotation 1123 of >0° to <180° are uniquely positive rotational offsets. In the same way, rotations of the first external magnet 706 such that the first central magnetic axis 1122 is rotationally offset by first angle of rotation 1123 of <0° to >−180° are uniquely negative rotational offsets. As will be readily understood, rotations of the first external magnet 706 by a first angle of rotation 1123 of >180° to <360° are equivalent to rotations of the first external magnet 706 by a first angle of rotation 1123 of <0° to >−180°, and rotations of the first external magnet 706 by a first angle of rotation 1123 of <−180° to <−360° are equivalent to rotations of the first external magnet 706 by a first angle of rotation 1123 of >0° to <180°. Rotations of the first external magnet 706 by a first angle of rotation 1123 of >0° to <180° are uniquely positive rotational offsets that are known as “upward rotations” or “upward offsets.” By contrast, rotations of the first external magnet 706 by a first angle of rotation 1123 of <0° to >−180° are uniquely negative rotational offsets that are known as “downward rotations” or “downward offsets.”

The second external magnet 708 may also have a rotational offset. The second external magnet 708 may be rotated to an example second central magnetic axis 1120′ by a second angle of rotation 1121. In some embodiments, the second angle of rotation 1121 is positive, and in some embodiments the second angle of rotation 1121 is negative. The second external magnet 708, including the second central magnetic axis 1120, may be rotated by a second angle of rotation 1121 in a positive direction from 0° to 360°. Additionally, the second external magnet 708, including the second central magnetic axis 1120, may be rotated by a second angle of rotation 1121 in a negative direction from 0° to −360°. Rotations of the second external magnet 708 such that the second central magnetic axis 1120 is rotationally offset by a second angle of rotation 1121 of >0° to <180° are uniquely positive rotational offsets. In the same way, rotations of the second external magnet 708 such that the second central magnetic axis 1120 is rotationally offset by second angle of rotation 1121 of <0° to >−180° are uniquely negative rotational offsets. As discussed with respect to the first external magnet 706, rotations of the second external magnet 708 by a second angle of rotation 1121 of >180° to <360° are equivalent to rotations of the second external magnet 708 by a second angle of rotation 1121 of <0° to >−180°, and rotations of the second external magnet 708 by a second angle of rotation 1121 of <−180° to <−360° are equivalent to rotations of the second external magnet 708 by a second angle of rotation 1121 of >0° to <180°. Rotations of the second external magnet 708 by a second angle of rotation 1121 of >0° to <180° are uniquely positive rotational offsets that are known as “upward rotations” or “upward offsets.” By contrast, rotations of the second external magnet 708 by a second angle of rotation 1121 of <0° to >−180° are uniquely negative rotational offsets that are known as “downward rotations” or “downward offsets.”

Either one or both magnets may be rotationally offset. In some embodiments, only the first external magnet 706 is rotated in one of a positive and a negative direction (i.e., upward rotation or downward rotation). In other embodiments, only the second external magnet 708 is rotated in one of a positive and a negative direction (i.e., upward rotation or downward rotation). In yet other embodiments, both magnets are rotated. Any permutation of dual magnet rotation is possible: both first external magnet 706 and second external magnet 708 being rotated upward (by equal or different amounts); both first external magnet 706 and second external magnet 708 being rotated downward (by equal or different amounts); first external magnet 706 being rotated upward while second external magnet 708 being rotated downward (by equal or different amounts); and first external magnet 706 being rotated downward while second external magnet 708 being rotated upward (by equal or different amounts). When both the first external magnet 706 and the second external magnet 708 are rotated equally upward, the rotational systemic offset is the sum of the magnitude of the two offsets. For example, when the first external magnet 706 has an upward rotation of 40° and the second external magnet 708 has a rotation of 40°, the system's rotation is termed, for example, an “upward 80°” or “80° upward.” In the same fashion, if the first external magnet 706 has a downward rotation of −15° and the second external magnet 708 has a downward rotation of −15°, the system's rotation is termed, for example, a “downward 30°” or “30° downward.”

Depending on the point on the central vertical axis 1111, changing the rotational offset of one or both the first external magnet 706 and the second external magnet 708 may either increase or decrease the observed flux density for a given gap distance 1138. For example, as will be discussed in greater detail, below, an upward rotational offset (i.e., >0° to <180°) generally increases flux density on the central vertical axis 1111 at a given gap distance 1138. By contrast, a downward offset (i.e., <0° to >−180° generally decreases flux density on the central vertical axis 1111 at a given gap distance 1138 (however, downward offsets may increase flux density on the central vertical axis 1111 at small gap distances 1138). Once the first external magnet 706 and second external magnet 708 are unilaterally or bilaterally rotated out of phase in either an upward or a downward direction, they may be rotationally locked with respect to each other and rotated as described above (e.g., at the same angular velocity).

FIGS. 16A-16D illustrate unilateral rotational offset of a single magnet while holding the other at the zero reference. Note that each of FIGS. 16A-16D shows flux reference/measurement point 1177 being “above” the magnets. FIG. 16A shows the second central magnetic axis 1120 of the second external magnet 708 with an upward rotation of about 20° with respect to flux reference/measurement point 1177. It also shows the first central magnetic axis 1122 of the first external magnet 706 being held constant at the zero reference point. FIG. 16B shows the second central magnetic axis 1120 of the second external magnet 708 with an upward rotation of about 45° with respect to flux reference/measurement point 1177. It also shows the first central magnetic axis 1122 of the first external magnet 706 being held constant at the zero reference point. FIG. 16C shows the second central magnetic axis 1120 of the second external magnet 708 with an upward rotation of about 90° with respect to flux reference/measurement point 1177. It also shows the first central magnetic axis 1122 of the first external magnet 706 being held constant at the zero reference point. FIG. 16D shows the second central magnetic axis 1120 of the second external magnet 708 with an upward rotation of about 135° with respect to flux reference/measurement point 1177. It also shows the first central magnetic axis 1122 of the first external magnet 706 being held constant at the zero reference point.

FIGS. 17A-17D illustrate unilateral rotational offset of a single magnet while holding the other at the zero reference. Each of FIGS. 17A-17D shows flux reference/measurement point 1177 being “above” the magnets. FIG. 17A shows the second central magnetic axis 1120 of the second external magnet 708 with a downward rotation of about −20° with respect to flux reference/measurement point 1177. It also shows the first central magnetic axis 1122 of the first external magnet 706 being held constant at the zero reference point. FIG. 17B shows the second central magnetic axis 1120 of the second external magnet 708 with a downward rotation of about −45° with respect to flux reference/measurement point 1177. It also shows the first central magnetic axis 1122 of the first external magnet 706 being held constant at the zero reference point. FIG. 17C shows the second central magnetic axis 1120 of the second external magnet 708 with a downward rotation of about −90° with respect to flux reference/measurement point 1177. It also shows the first central magnetic axis 1122 of the first external magnet 706 being held constant at the zero reference point. FIG. 17D shows the second central magnetic axis 1120 of the second external magnet 708 with a downward rotation of about −135° with respect to flux reference/measurement point 1177. It also shows the first central magnetic axis 1122 of the first external magnet 706 being held constant at the zero reference point.

FIG. 18A illustrates a graph of implant torque (which is directly proportional to flux density) generated by a first external magnet 706 and a second external magnet 708 versus unilateral angle of rotation (i.e., where only one of the first external magnet 706 and the second external magnet 708 is given a rotational offset while the other is given no rotational offset, as shown in FIGS. 16A-16D and FIGS. 17A-17D).

FIGS. 19A-19D illustrate equal, bilateral rotational offset of two magnets, a first external magnet 706 and a second external magnet 708. Again, each of FIGS. 19A-19D shows flux reference/measurement point 1177 being “above” the magnets. FIG. 19A shows the first central magnetic axis 1122 of the first external magnet 706 and the second central magnetic axis 1120 of the second external magnet 708 each having an upward rotation of about 20° with respect to flux reference/measurement point 1177. The system shown in FIG. 19A has a rotational offset of an upward 40°. FIG. 19B shows the first central magnetic axis 1122 of the first external magnet 706 and the second central magnetic axis 1120 of the second external magnet 708 each having an upward rotation of about 45° with respect to flux reference/measurement point 1177. The system shown in FIG. 19B has a rotational offset of an upward 80°. FIG. 19C shows the first central magnetic axis 1122 of the first external magnet 706 and the second central magnetic axis 1120 of the second external magnet 708 each having an upward rotation of about 90° with respect to flux reference/measurement point 1177. The system shown in FIG. 19C has a rotational offset of an upward 180°. And, finally, FIG. 19D shows the first central magnetic axis 1122 of the first external magnet 706 and the second central magnetic axis 1120 of the second external magnet 708 each having an upward rotation of about 135° with respect to flux reference/measurement point 1177. The system shown in FIG. 19D has a rotational offset of an upward 270°.

FIGS. 20A-20D illustrate equal, bilateral rotational offset of two magnets, a first external magnet 706 and a second external magnet 708. Each of FIGS. 20A-20D shows flux reference/measurement point 1177 being “above” the magnets. FIG. 20A shows the first central magnetic axis 1122 of the first external magnet 706 and the second central magnetic axis 1120 of the second external magnet 708 each having a downward rotation of about −20° with respect to flux reference/measurement point 1177. The system shown in FIG. 20A has a rotational offset of a downward 40°. FIG. 20B shows the first central magnetic axis 1122 of the first external magnet 706 and the second central magnetic axis 1120 of the second external magnet 708 each having a downward rotation of about −45° with respect to flux reference/measurement point 1177. The system shown in FIG. 20B has a rotational offset of a downward 90°. FIG. 20C shows the first central magnetic axis 1122 of the first external magnet 706 and the second central magnetic axis 1120 of the second external magnet 708 each having a downward rotation of about −90° with respect to flux reference/measurement point 1177. The system shown in FIG. 20C has a rotational offset of a downward 180°. And, finally, FIG. 20D shows the first central magnetic axis 1122 of the first external magnet 706 and the second central magnetic axis 1120 of the second external magnet 708 each having a downward rotation of about −135° with respect to flux reference/measurement point 1177. The system shown in FIG. 20D has a rotational offset of a downward 270°.

FIG. 21A illustrates a schematic of the magnetic field lines surrounding a first external magnet 706 and a second external magnet 708 in a reference configuration. North pole 902 of the first external magnet 706 is oriented at the zero reference direction and south pole 904 of the second external magnet 708 is also oriented at the zero reference direction. The flux reference/measurement point 1177 is taken to be “above” the magnets, again. By contrast to FIG. 21A, FIG. 21B illustrates a schematic of the magnetic field lines surrounding a first external magnet 706 and a second external magnet 708 that have a systemic rotational offset of an upward 40°. That is to say that the north pole 902 of the first external magnet 706 and the south pole 904 of the second external magnet 708 have each been rotated by 20° (an upward 20 degrees). The flux reference/measurement point 1177 is taken to be “above” the magnets, again. The flux lines above the magnets and along the central vertical axis 1111 in FIG. 21B are denser than the flux lines above the magnets and along the central vertical axis 1111 in FIG. 21A. As mentioned previously, for a given gap distance 1138, upward rotations tend to increase flux density. FIG. 21C illustrates a schematic of the magnetic field lines surrounding a first external magnet 706 and a second external magnet 708 that have a systemic rotational offset of an upward 80°. That is to say that the north pole 902 of the first external magnet 706 and the south pole 904 of the second external magnet 708 have each been rotated by 40° (an upward 40 degrees). The flux reference/measurement point 1177 is taken to be “above” the magnets, again. The flux lines above the magnets and along the central vertical axis 1111 in FIG. 21C are notably denser than the flux lines above the magnets and along the central vertical axis 1111 in FIG. 21A. As mentioned previously, for a given gap distance 1138, upward rotations tend to increase flux density. FIG. 21D illustrates a schematic of the magnetic field lines surrounding a first external magnet 706 and a second external magnet 708 that have a systemic rotational offset of a downward 40°. That is to say that the north pole 902 of the first external magnet 706 and the south pole 904 of the second external magnet 708 have each been rotated by −20° (a downward 20 degrees). The flux reference/measurement point 1177 is taken to be “above” the magnets, again. The flux lines above the magnets and along the central vertical axis 1111 in FIG. 21D are sparser than the flux lines above the magnets and along the central vertical axis 1111 in FIG. 21A (in which the first external magnet 706 and the second external magnet 708 are in their reference configurations). However, it should be noted that these flux lines are even less dense than the flux lines shown above the magnets and along the central vertical axis 1111 in FIG. 21C (in which the first external magnet 706 and the second external magnet 708 have a rotational offset of an upward 80°). For a given gap distance 1138, downward rotations tend to decrease flux density (except at small gap distances 1138 where they may increase, even dramatically, the flux density). Therefore, a downward rotation will produce a lower flux density than the reference system and an even lower flux density than a system having an upward offset/rotation. Finally, FIG. 21E illustrates a schematic of the magnetic field lines surrounding a first external magnet 706 and a second external magnet 708 that have a systemic rotational offset of a downward 80°. That is to say that the north pole 902 of the first external magnet 706 and the south pole 904 of the second external magnet 708 have each been rotated by −40° (a downward 40 degrees). The flux reference/measurement point 1177 is taken to be “above” the magnets. As can be seen, the flux lines above the magnets and along the central vertical axis 1111 in FIG. 21E are very dense at very small gap distances 1138, perhaps even denser than the density observed from an upward 80° offset. However, as the gap distance 1138 increases, the flux density rapidly decreases.

FIGS. 22A-22B illustrate graphs of implant torque (which is directly proportional to flux density) generated by a first external magnet 706 and a second external magnet 708 versus bilateral angle of rotation (i.e., where both the first external magnet 706 and the second external magnet 708 are given an equal rotational offset, as shown in FIGS. 19A-19D and FIGS. 20A-20D).

By contrast to FIGS. 22A-22B, FIG. 23 illustrates a graph of flux density (measured in units of mTesla) versus gap distance in several scenarios, in which no rotation is present. With reference to FIG. 11, the various plots included in FIG. 23 are plots of the static magnetic field strength experienced along the central vertical axis 1111 extending from the edge of the magnet(s), i.e., where the gap distance 1138 is zero, outwards (still on the central vertical axis 1111), to a gap distance 1138 of approximately 5 inches.

First line 2310 is a plot of magnetic flux density versus gap distance for a two magnet system (e.g., a system having a first external magnet 706 and a second external magnet 708) in which the magnets have a intermagnet gap of 0.75 inches and no angular offset (i.e., neither the first external magnet 706 nor the second external magnet 708 is rotated out of phase). An example flux map of such a system is shown in FIG. 21A. Therefore, the first line 2310 may be conceptualized as the flux density along the vertical line immediately between the two magnets (e.g., central vertical axis 1111). The first point on first line 2310 is at the intersection of a line connecting the outermost horizontal edges of the first external magnet 706 and the second external magnet 708. The decreasing values of flux density are illustrated by FIG. 21A in which the flux lines become less as the distance away from the magnets increases. First line 2310 may be considered a reference line against which “increased” and/or “decreased” flux densities are evaluated.

Second line 2320 is a plot of magnetic flux density versus gap distance for a two magnet system (e.g., a system having a first external magnet 706 and a second external magnet 708) in which the magnets have an intermagnet gap of 0.75 inches and a systemic angular offset of an upward 40 degrees (i.e., each of first external magnet 706 and second external magnet 708 has an upward rotation of 20 degrees). An example flux map of such a system is shown in FIG. 21B. Here, the second line 2320 may be conceptualized as the flux density along the vertical line immediately between the two magnets shown in FIG. 21B (e.g., the central vertical axis 1111). The first point on the second line 2320 is at the intersection of a line connecting the outermost horizontal edges of the first external magnet 706 and the second external magnet 708. The value of flux density drops off quicker for second line 2320 than it does for the reference line, first line 2310.

Third line 2330 is a plot of magnetic flux density versus gap distance for a two magnet system (e.g., a system having a first external magnet 706 and a second external magnet 708) in which the magnets have an intermagnet gap of 0.75 inches and a systemic angular offset of a downward 40 degrees (i.e., each of the first external magnet 706 and the second external magnet 708 has a downward rotation of 20 degrees). An example flux map of such a system is shown in FIG. 21D. The third line 2330 may be understood as the flux density along the central vertical axis 1111, just as described with respect to first line 2310 and second line 2320. The flux density starts slightly lower than the reference flux density (i.e., of first line 2310), however, the flux density stays higher than the reference flux density for gap distances of larger than about 15 mm. In a system in which higher torques or flux densities are desired, such a configuration may be useful.

Finally, fourth line 2340 is a plot of magnetic flux density versus gap distance for a two magnet system (e.g., a system having a first external magnet 706 and a second external magnet 708) in which the magnets have an intermagnet gap of 0.75 inches and a systemic angular offset of a downward 80 degrees (i.e., each of the first external magnet 706 and the second external magnet 708 has a downward rotation of 40 degrees). An example flux map of such a system is shown in FIG. 21E. The fourth line 2340 may be understood as the flux density along the central vertical axis 1111, as was described with respect to first line 2310, second line 2320, and third line 2330. Here, by contrast to those lines, the flux density starts lower, but drops off slower than the other lines. Such a configuration may be useful in applications in which gap distances are necessarily larger (e.g., in the 50-100 mm range), but still require relatively high torques.

FIG. 15 illustrates flux density (measured in mTesla) plotted against gap distance for two different two magnet systems in which two variables are changed: intermagnet gap and rotational offset. First line 1510 and second line 1520 illustrate flux density plots generated by a two magnet system having a zero rotational offset. That is to say, both magnets are in the reference position. By contrast, third line 1530 and fourth line 1540 illustrate flux density plots generated by a two magnet system having a systemic downward 80 degree rotational offset. That is to say that the first external magnet 706 and the second external magnet 708 each have a downward rotation of 40 degrees. First, the first line 1510 and the second line 1520 are compared.

As just mentioned, the two magnet system that produced first line 1510 and second line 1520 have a zero degree rotational offset. However, the first two magnet system that produced first line 1510 had an intermagnet gap of about 0.2 inches whereas the second two magnet system that produced second line 1520 had an intermagnet gap of about 0.75 inches. The system in which the magnets were closer together initially has a significantly higher flux density than the system in which the magnets were farther apart—in fact, it is approximately 30% higher at a gap distance of zero. The graph illustrates that the gains achieved through small intermagnet gaps are realized at only relatively short gap distance. The first line 1510 and the second line 1520 substantially converge at about 30 mm, after which they remain approximately equal. This is entirely consistent with FIG. 14 which shows varying intermagnet gaps. Again, FIG. 14 illustrates that magnetic flux density approaches a limit (for any given two magnets) when gap distance is zero and when intermagnet gap is zero. As intermagnet gap increases, flux density decreases (even when gap distance is maintained at a constant zero). Additionally, at least for relatively small increases in intermagnet gap, the effect of intermagnet gap is no longer felt at about 25 mm (regardless of intermagnet gap). That is to say that the flux density plots generated by the systems in which only intermagnet gap varies all converge at about 25 mm at which point in time they continue to track each other (dropping to a limit of zero at approximately an inverse cube).

As discussed above, and by contrast to the zero rotational offset system just discussed, the two magnet system that produced third line 1530 and fourth line 1540 have a systemic downward 80 degree rotational offset. However, the first two magnet system that produced third line 1530 had an intermagnet gap of about 0.2 inches whereas the second two magnet system that produced fourth line 1540 had an intermagnet gap of about 0.75 inches. The system in which the magnets were closer together initially had a significantly higher flux density than the system in which the magnets were farther apart—in fact, it is approximately 70% higher at a gap distance of zero. The graph illustrates that the gains achieved through small intermagnet gaps in systems having a downward rotational offset are realized across a much broader range of gap distances than for systems having no rotational offset. As mentioned above, systems having no rotational offset maintain an increased flux density only for gap distances lower than about 25 mm. By marked contrast, the system having a downward 80 degree rotational offset still experienced an increased flux density at about 50 mm—twice the gap distance. The rotationally offset systems converged at about 50 mm at which point in time they continued to track each other. However, they remain above the systems having no rotational offset.

FIG. 15 illustrates that examples of systems in which both intermagnet gap and gap distance have been manipulated to achieve different results. It will be understood that there are some applications in which small gap distances are possible. One example of such an application is in magnetically adjustable scoliosis rods implanted in children. These rods frequently lie close beneath the skin just above the posterior of the spine—some examples of these devices are disclosed in U.S. Pat. Nos. 8,197,490, 8,057,472, 8,343,192, and 9,179,938, which are incorporated by reference in their entirety herein. In applications such as these (where gap distances are small), the magnitude of torque required must be assessed. When high levels of torque are required, as is illustrated by FIG. 15, a small intermagnet gap may be desirable (decreasing intermagnet gap generally increases magnetic flux) and a downward rotational offset may be undesirable (at small to medium gap distances, downward rotational offsets tend to decrease the flux density). However, high levels of torque may be unnecessary or even detrimental. In these cases, a large intermagnet gap may be desirable (increasing intermagnet gap generally decreases magnetic flux). If even further/greater decrease in torque is desirable, a downward rotational offset may be used.

It will also be understood that there are some applications in which small gap distances are uncommon if not impossible, and where medium to large gap distances must be addressed. An instance of such an application is in magnetically adjustable intramedullary femoral nails. Such nails are placed in the intramedullary canal of the femur; consequently, while adipose, fascia, and muscle may be compressed to some degree, the gap distance is substantially increased by the tissues overlying the femur. Some examples of such devices are disclosed in U.S. Pat. Nos. 8,449,543 and 8,852,187, which are incorporated by reference in their entirety herein. As noted above, a downward rotational offset generally causes an increase in flux density as gap distance increases. Therefore, in these applications, downward rotational offset systems will likely be more effective than their aligned counterparts. For systems having a downward rotational offset of 80 degrees, any increase in flux density due to decreased intermagnet gap is generally lost by about 50 mm. Therefore, if an application for which increased torque (and therefore flux density) is desirable, has a gap distance of greater than about 50 mm, decreasing the intermagnet gap will play very little role in increasing torque. However, if the gap distance is less than about 50 mm, decreasing the gap distance could dramatically increase the possible torque. While it is unlikely that any femoral intramedullary nail would ever experience a small gap distance, if the gap distance is smaller than about 25 mm, having a downward rotational offset would degrade the system's ability to generate higher torques. In that case, a rotationally aligned system having a small gap distance would be better. It should be noted that the effects of rotational offset and intermagnet gap have been discussed here in only a very limited context, and for example's sake only. As is discussed herein there are additional ranges and variables that may be altered to either increase or decrease the magnetic flux density experienced at a given point.

FIG. 24 illustrates another magnet system similar to that shown in FIG. 11, except that a third external magnet 2408 has been added to further shape the magnetic fields created by the system. Like the first external magnet 706 and the second external magnet 708, the third external magnet 2408 has a south pole 2406, a north pole 2404, a third magnet diameter 2432, and a third elongate rotational axis. While the third external magnet 2408 is shown here as having a third magnet diameter 2432 that is smaller than the second magnet diameter 1132 or the first magnet diameter 1134, it should be understood that this is for illustration purposes only. Depending on the flux shaping goals of any given system, the third magnet diameter 2432 may be smaller than, the same as, or larger than the second magnet diameter 1132 and/or the first magnet diameter 1134.

With continued reference to FIG. 24, the third elongate rotational axis (like the first and second elongate rotational axes) is a line through the center of the third external magnet 2408 extending into the page through the center of the third external magnet 2408. While the first external magnet 706 has its first magnet vertical axis 1113 and the second external magnet 708 has its second magnet vertical axis 1112, the third external magnet 2408 is shown as lying directly on the central vertical axis 1111, the line bisecting the intermagnet gap 1130. Placing the third external magnet 2408 on the central vertical axis 1111 may allow an advantageously uniform system across the central vertical axis 1111. However, it should also be understood that the third external magnet 2408 may be placed at anywhere with respect to the first external magnet 706 and the second external magnet 708. As shown in FIG. 24, the position of the third external magnet 2408 is also defined by the third magnet vertical offset 1139, which is the distance along the central vertical axis 1111 from the horizontal axis 1110 to the third external magnet 2408's third magnet horizontal axis 2410.

The third external magnet 2408 may be rotated by a third angle of rotation 2425 to a third central magnetic axis 2424 (shown in FIG. 24). The third external magnet 2408 has a reference configuration such that. The frame of reference for the third external magnet 2408 is the same as that for the second external magnet 708. That is to say that rotations of the third external magnet 2408 about the third elongate rotational axis in a clockwise direction are denoted as being positive, while rotations of the third external magnet 2408 about the third elongate rotational axis in a counterclockwise direction are denoted as being negative. The third external magnet 2408 may also have a rotational offset, just like the first external magnet 706 and the second external magnet 708. In some embodiments, the third angle of rotation 2425 is positive, and in some embodiments the third angle of rotation 2425 is negative. The third external magnet 2408, including the third central magnetic axis 2424, may be rotated by a third angle of rotation 2425 in a positive direction from 0° to 360°. Additionally, the third external magnet 2408, including third central magnetic axis 2424, may be rotated by a third angle of rotation 2425 in a negative direction from 0° to −360°. Like the second external magnet 708, rotations of the third external magnet 2408 such that the third central magnetic axis 2424 is rotationally offset by a third angle of rotation 2425 of >0° to <180° are uniquely positive rotational offsets. In the same way, rotations of the third external magnet 2408 such that the third central magnetic axis 2424 is rotationally offset by third angle of rotation 2425 of <0° to >−180° are uniquely negative rotational offsets. As will be readily understood, rotations of the third external magnet 2408 by a third angle of rotation 2425 of >180° to <360° are equivalent to rotations of the third external magnet 2408 by a third angle of rotation 2425 of <0° to >−180°, and rotations of the third external magnet 2408 by a third angle of rotation 2425 of <−180° to <−360° are equivalent to rotations of the third external magnet 2408 by third angle of rotation 2425 of >0° to <180°. Rotations of the third external magnet 2408 by a third angle of rotation 2425 of >0° to <180° are uniquely positive rotational offsets that are known as “upward rotations” or “upward offsets.” By contrast, rotations of the third external magnet 2408 by a third angle of rotation 2425 of <0° to >−180° are uniquely negative rotational offsets that are known as “downward rotations” or “downward offsets.”

While FIG. 24 illustrates the third magnet horizontal axis 2410 of the third external magnet 2408 as being between the horizontal axis 1110 and the implanted magnet 1010, other placements are possible. FIGS. 25A-25C illustrate various examples of where the third external magnet 2408 may be placed. In FIGS. 25A-25C, the position of the implanted magnet 1010 is identified by the direction of orientation 2480: while the implanted magnet 1010 in FIG. 24 is shown as being “above” the first external magnet 706, second external magnet 708 and third external magnet 2408, in FIGS. 25A-25C it is noted as being “below” the first external magnet 706, second external magnet 708, and third external magnet 2408.

FIG. 25A illustrates a three magnet system in which the third magnet vertical offset 1139 is positive, such that the third external magnet 2408 is positioned above the horizontal axis 1110, the first external magnet 706 and the second external magnet 708. The third magnet vertical offset 1139 may have any positive value that is magnetically meaningful. Because magnetic fields drop off at about an inverse square, as the third magnet vertical offset 1139 increases (as shown in FIG. 25), the effect of the third external magnet 2408 will rapidly drop off. In FIG. 25A, both the first external magnet 706 and the second external magnet 708 are closer to the implanted magnet 1010 (defined either by center to center distance). Therefore, as long as the first external magnet 706 and the second external magnet 708 have larger diameters than the third magnet diameter 2432, the effect felt by the implanted magnet 1010 from the third external magnet 2408 will be less than the effect felt by the implanted magnet 1010 from either the first external magnet 706 or the second external magnet 708. Of course, if the third magnet diameter 2432 were increased sufficiently, the third external magnet 2408 could have a sufficiently strong field that the opposite were true. By the same token, parameters could be optimized such that each of the three magnets affects the implanted magnet 1010 equally.

FIG. 25B illustrates a second three magnet system in which the third magnet vertical offset 1139 is zero (i.e., the third magnet horizontal axis 2410 and the horizontal axis 1110 lie on/are the same line). In FIG. 25B, the third external magnet 2408 will always be closer to the implanted magnet (when lying along the central vertical axis 1111 and defined by center to center distance). Therefore, to have an equal effect as the first external magnet 706 and the second external magnet 708, the third magnet diameter 2432 may be smaller than either the second magnet diameter 1132 and/or the first magnet diameter 1134 (at a threshold diameter). However, rather than having an equal effect, it may be desirable for the third external magnet 2408 to have a stronger effect than the first external magnet 706 or the second external magnet 708. In such a case, the third magnet diameter 2432 may be increased above the threshold diameter. Of course, in some embodiments, it is desirable to have a lesser effect produced by the third magnet diameter 2432 than that felt from the first external magnet 706 or the second external magnet 708. In those cases, the third magnet diameter 2432 may be decreased below the threshold diameter.

FIG. 25C illustrates a third three magnet system in which the third magnet vertical offset 1139 is negative, such that the third external magnet 2408 is positioned below the horizontal axis 1110, the first external magnet 706 and the second external magnet 708. The third magnet vertical offset 1139 may have any negative value that is magnetically meaningful. Because magnetic fields drop off at about an inverse square, as the third magnet vertical offset 1139 becomes increasingly negative, the effect (along the central vertical axis 1111) of the first external magnet 706 and the second external magnet 708 will rapidly drop off. FIG. 25C illustrates a third external magnet 2408 having a third magnet diameter 2432 that is smaller than the first magnet diameter 1134 and the second magnet diameter 1132. Because the third external magnet 2408 is further down the central vertical axis 1111 (e.g., closer to the theoretical implanted magnet 1010), the effect it has on flux density in the direction of orientation 2480 may be more pronounced than either the first external magnet 706 or the second external magnet 708. However, as described above, depending on system requirements, the diameters of the various magnets may be changed to balance or emphasize the magnetic input of one magnet over another (while the first external magnet 706 and the second external magnet 708 may generally have the same diameter, they may have different diameters). For example, the third magnet diameter 2432 could be increased to emphasize the effect of the third external magnet 2408. Or, one or more of the first magnet diameter 1134 and the second magnet diameter 1132 could be increased (while possibly decreasing the third magnet diameter 2432) to increase the effect of the first external magnet 706 and the second external magnet 708 vis-à-vis the third external magnet 2408.

In addition to simple magnets, such as a compass, a horseshoe magnet, or even a rotational poled cylindrical magnet such as the first external magnet 706 and second external magnet 708, it is possible to create complex magnets in which the flux direction for each pole may be selected at will. A common example of a complex magnet is the refrigerator magnet in which magnetism exists only on one side—the back of the magnet will stick to a refrigerator while the front will not. This phenomenon is due to selective orientation of the flux direction during construction of the magnet that allows magnetic field to only to be present on one side of the magnet. The phenomenon is known as the Halbach effect and the arrangement known as a Halbach array. Straight magnets may be created in Halbach arrays so that a magnetic field exists on only one side by simply arranging north-south poled pieces side-by-side so that each consecutive piece's north pole has been rotated a quarter turn from the previous magnet. Once aligned as described, the direction of magnetization will be rotating uniformly as you progress in a particular direction.

Generally a Halbach array is an arrangement of permanent magnets that can augment the magnetic field on one side of the Halbach array while canceling the magnetic field to near zero or substantially near zero on the other side of the Halbach array. For example, the magnetic field can be enhanced on the bottom side of the Halbach array and cancelled on the top side (a one-sided flux) of the Halbach array. The quarter turn rotating pattern of permanent magnets can be continued indefinitely and have the same effect. Increasingly complex Halbach arrays may be used to shape the magnetic field for any magnet, including cylindrical magnets.

FIGS. 26A-26C illustrate various cylindrical magnets in which the magnetic flux direction of the individual poles may be manipulated. FIG. 26A illustrates a two-poled magnet 2610 having a first pole 2611 and a second pole 2612 each of which has a magnetic flux field 2626. Using Halbach arrays, the magnetic flux field 2626 may be “pointed” in any direction. For example, a magnetic field could be created substantially only one side of the magnet. FIG. 26B illustrates a four-poled magnet 2620 having a first pole 2621, a second pole 2622, a third pole 2623, and a fourth pole 2624, each of which has a magnetic flux field 2626. As described with respect to FIG. 26A, each magnetic flux field 2626 may be “pointed” in any direction. Finally, FIG. 26C illustrates an eight-poled magnet 2630 having a first pole 2631, a second pole 2632, a third pole 2633, a fourth pole 2634, a fifth pole 2635, a sixth pole 2636, a sixth pole 2636, and an eighth pole 2638, each of which has a magnetic flux field 2626. Using the principles of Halbach arrays with increasing numbers of poles, complex magnets with advantageous properties may be created. For example, it may be possible to create a cylindrical magnet having a single, intensely focused field on one side of the magnet. By contrast, it may be possible to create a cylindrical magnet having four, less weaker fields that are separated by magnetic dead zones (i.e., a zone in which there is little to no magnetic flux present). These complex magnets may be advantageously applied to implants, such as the implanted magnet 1010. Implanted magnets with more intensely focused magnetic fields may be able to generate higher coupling torques. Alternatively, rather than increasing torques, it may be possible to decrease the size of the implanted magnet 1010. For example focused magnetic fields on a smaller, complex implanted magnet 1010 (having one or more Halbach array) may be capable of generating coupling torques equivalent, or even greater, than a standard two-poled magnet with comparatively unfocused magnetic fields. Such complex magnets may also be incorporated into the external adjustment device 700. Again, the one or more Halbach array may allow a decrease in magnet size, an increase in coupling torque, or even both. The effect may be increased if complex magnets were used in both the implanted magnet 1010 and the external adjustment device 700.

FIG. 27 illustrates a magnetic flux map of a two magnet system, such as that shown in FIG. 11. By contrast to FIG. 11, both magnets have been rotated 90 degrees in the clockwise direction. Therefore, the north pole 902 of the first external magnet 706 is directly facing the north pole 908 of the south pole 904. This flux map is very similar to the flux map shown in FIG. 13B.

FIG. 28A illustrates a schematic diagram of three magnet system, similar to that illustrated in FIG. 24, and FIGS. 25A-25C. In FIG. 28A, the implanted magnet is “below” the three magnet system, such that the smaller of the three magnets is on the same side of the horizontal axis 1110 as the implanted magnet 1010. FIG. 28A illustrates one potential configuration of a three magnet system. The larger two of the three magnets are configured just as shown in FIG. 27. However, the smaller of the three magnets (similar to the third external magnet 2408 of FIG. 24), has a south pole that is 90 degrees offset from the larger magnets. That is to say that the line dividing the north and south poles on the small magnet is perpendicular to the (parallel) lines dividing the south and north poles of the larger magnets. It has been observed that this configuration may shape the magnetic field toward the direction of the implanted magnet to provide an increased magnetic field density at that location. In at least one embodiment, this configuration (depending on the distances between magnets, magnet size, gap distance, etc.) can provide 50% more magnetic flux density, and therefore 50% more force than 2 magnet systems (such as that shown in FIG. 27).

FIG. 28B illustrates a flux map of a three magnet system similar to that shown in FIG. 28A. The north poles of both larger magnets are, again, pointed toward the vertical line dividing the two magnets. Additionally, the north pole of the smaller third magnet is pointed downward, toward the implanted magnet. In this way, the magnetic flux density on the implanted magnet side of the three-magnet system may be increased. FIG. 28B illustrates an increased density of magnetic flux density lines. FIG. 28C, by contrast, illustrates the larger magnets in the same position, but the smaller magnet with the north pole pointed up, and away from the implanted magnet. In this configuration, the system decreases the flux density observed by the implanted magnet. Depending on the distances between magnets, magnet size, gap distance, etc.) this configuration can provide 50% less (decreased) magnetic flux density and therefore 50% less force than two magnet systems (such as that shown in FIG. 27.

The International Commission on Non-Ionizing Radiation Protection has issued “Guidelines for Limiting Exposure to Time-Varying Electric, Magnetic, and Electromagnetic Fields (Up To 300 GHz)” and “Guidelines on Limits of Exposure to Static Magnetic Fields.” Both sets of guidelines are incorporated by reference in their entirety herein. These guidelines limit exposure to both time-varying magnetic fields and static magnetic fields to protect health. The limits are, however, different for different areas of the body. For example, a finger may have a higher limit than the brain. For time varying magnetic field limits, two variables are particularly important: field strength and field movement speed (e.g., with respect to the body). A weak magnetic field could generally be moved around the body relatively quickly while staying within the prescribed limits. By contrast, a very strong magnet would need to be move very slowly around the body to stay within the prescribed limits. This is one reason that patients undergoing MRI scans are told not to move—they are being subjected to incredibly strong magnetic fields. Much movement by a person in an MRI machine would likely exceed the prescribed limits. By contrast to time varying magnetic field limits, static field limits are concerned primarily with field strength. However, the guidelines note that they “do not apply to the exposure of patients undergoing medical diagnosis or treatment.” If they did apply, it is almost certain that MRI machines would fall outside the limits.

In view of the guidelines discussed above, it can be seen that magnetic medical devices should ideally use the weakest magnetic field possible in the slowest manner possible to still achieve the desired clinical outcome. Several of the systems disclosed herein, including the external adjustment device 700 shown in FIG. 1, have many fixed parameters, including magnet sizes, intermagnet gaps, etc. For such an external adjustment device 700, there are not many ways to decrease the time-varying magnetic field exposure. Some might include increasing the gap distance (which may be difficult as stabilization against the patient is likely beneficial) and decreasing the rotation speed of the first external magnet 706 and the second external magnet 708.

Parameters that may be varied by a user in an external adjustment device 700 or by a “smart” external adjustment device 700 itself, include: intermagnet gap; gap distance; rotational offset (unilateral and bilateral); and magnet rotational velocity. Selectively varying one or more of these variable may allow the user or the “smart” external adjustment device 700 to optimize the system to have the lowest flux (weakest magnetic field) that is still clinically effective.

Although this invention has been disclosed in the context of certain preferred embodiments and examples, it will be understood by those skilled in the art that the present invention extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention and obvious modifications and equivalents thereof. In addition, while a number of variations of the invention have been shown and described in detail, other modifications, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combinations or sub-combinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the invention. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed invention. Thus, it is intended that the scope of the present invention herein disclosed should not be limited by the particular disclosed embodiments described above, but should be determined only by a fair reading of the claims that follow.

Similarly, this method of disclosure, is not to be interpreted as reflecting an intention that any claim require more features than are expressly recited in that claim. Rather, as the following claims reflect, inventive aspects lie in a combination of fewer than all features of any single foregoing disclosed embodiment. Thus, the claims following the Detailed Description are hereby expressly incorporated into this Detailed Description, with each claim standing on its own as a separate embodiment.

Claims

1. A controller, for magnetically generating rotational motion in a remote device, comprising: a first driver magnet, having a first elongate rotational axis, a north pole on a first side of the rotational axis, a south pole on a second side of the rotational axis and a first central magnetic axis extending transversely to the rotational axis and through the centers of the north and south poles;a second driver magnet, having a second elongate rotational axis, a north pole on a first side of the rotational axis, a south pole on a second side of the rotational axis and a second central magnetic axis extending transversely to the rotational axis and through the centers of the north and south poles; anda drive system for synchronous rotation of the first and second driver magnets about the first and second rotational axes;wherein the first and second central magnetic axes are oriented at an angular offset relative to each other.
2. The controller as in claim 1, wherein at least one of the first and second driver magnets is a permanent magnet.
3. The controller as in claim 1, wherein at least one of the first and second driver magnets is an electromagnet.
4. The controller as in claim 1, further comprising a control mechanism for adjusting the angle between the first and second central magnetic axes.
5. The controller as in claim 4, wherein the control mechanism is manually adjustable.
6. The controller as in claim 4, wherein the control mechanism is automatically adjustable.
7. The controller as in claim 6, wherein the control mechanism is automatically adjustable in response to a signal transmitted from the remote device.
8. The controller as in claim 7, wherein the signal transmitted from the remote device indicates insufficient rotational motion in the remote device.
9. The controller as in claim 1, further comprising a third magnet.
10. The controller as in claim 9, wherein the third magnet is vertically offset from the first and second magnets.
11. The controller as in claim 10, wherein the first, second and third magnets are arranged in a Halbach array.
12. A controller, for magnetically generating rotational motion in a remote device, comprising: a first driver magnet, having a first elongate rotational axis, a north pole on a first side of the rotational axis, a south pole on a second side of the rotational axis and a first central magnetic axis extending transversely to the rotational axis and through the centers of the north and south poles;a second driver magnet, having a second elongate rotational axis, a north pole on a first side of the rotational axis, a south pole on a second side of the rotational axis and a second central magnetic axis extending transversely to the rotational axis and through the centers of the north and south poles;a third driver magnet vertically offset from the first and second driver magnets; anda drive system for synchronous rotation of the first and second driver magnets about the first and second rotational axes;wherein the first and second central magnetic axes are oriented to maintain a bilaterally asymmetric magnetic flux density so as to shape the magnetic field produced by the first and the second driver magnets.
13. The controller as in claim 12 wherein the first, second and third driver magnets are arranged in a Halbach array.
14. An adjustable flux field controller for magnetically generating rotational motion in a remote device, comprising: first and second magnets which collectively generate a three dimensional flux field surrounding the magnets, each of the first and second magnets rotatable about respective first and second rotational axes; anda control unit for adjusting the relative rotational orientation of at least one of the first and second magnets to the other of the first and second magnet;wherein adjustment of the relative rotational orientation changes the shape of the three dimensional flux field.
15. The controller as in claim 14, wherein at least one of the first and second magnets is a permanent magnet.
16. The controller as in claim 14, wherein at least one of the first and second magnets is an electromagnet.
17. The controller as in claim 14, further comprising a control mechanism for adjusting the angle between the first and second rotational axes.
18. The controller as in claim 17, wherein the control mechanism is manually adjustable.
19. The controller as in claim 17, wherein the control mechanism is automatically adjustable.
20. The controller as in claim 19, wherein the control mechanism is automatically adjustable in response to a signal transmitted from the remote device.

US Referenced Citations (1241)

Number	Name	Date	Kind
1599538	Ludger	Sep 1926	A
3111945	Von	Nov 1963	A
3372476	Richard et al.	Mar 1968	A
3377576	Edwin et al.	Apr 1968	A
3397928	Galle	Aug 1968	A
3512901	Law	May 1970	A
3527220	Summers	Sep 1970	A
3597781	Eibes et al.	Aug 1971	A
3655968	Moore et al.	Apr 1972	A
3726279	Barefoot et al.	Apr 1973	A
3749098	De Bennetot	Jul 1973	A
3750194	Summers	Aug 1973	A
3810259	Summers	May 1974	A
3840018	Heifetz	Oct 1974	A
3866510	Eibes et al.	Feb 1975	A
3900025	Barnes, Jr.	Aug 1975	A
3915151	Kraus	Oct 1975	A
RE28907	Eibes et al.	Jul 1976	E
3976060	Hildebrandt et al.	Aug 1976	A
4010758	Rockland et al.	Mar 1977	A
4056743	Clifford et al.	Nov 1977	A
4068821	Morrison	Jan 1978	A
4078559	Nissinen	Mar 1978	A
4118805	Reimels	Oct 1978	A
4204541	Kapitanov	May 1980	A
4222374	Sampson et al.	Sep 1980	A
4235246	Weiss	Nov 1980	A
4256094	Kapp et al.	Mar 1981	A
4286584	Sampson et al.	Sep 1981	A
4300223	Maire	Nov 1981	A
4357946	Dutcher et al.	Nov 1982	A
4386603	Mayfield	Jun 1983	A
4395259	Prestele et al.	Jul 1983	A
4448191	Rodnyansky et al.	May 1984	A
4486176	Tardieu et al.	Dec 1984	A
4501266	McDaniel	Feb 1985	A
4522501	Shannon	Jun 1985	A
4537520	Ochiai et al.	Aug 1985	A
4550279	Klein	Oct 1985	A
4561798	Elcrin et al.	Dec 1985	A
4573454	Hoffman	Mar 1986	A
4592339	Kuzmak et al.	Jun 1986	A
4592355	Antebi	Jun 1986	A
4595007	Mericle	Jun 1986	A
4642257	Chase	Feb 1987	A
4658809	Ulrich et al.	Apr 1987	A
4696288	Kuzmak et al.	Sep 1987	A
4700091	Wuthrich	Oct 1987	A
4747832	Buffet	May 1988	A
4760837	Petit	Aug 1988	A
4854304	Zielke	Aug 1989	A
4872515	Lundell	Oct 1989	A
4904861	Epstein et al.	Feb 1990	A
4931055	Bumpus et al.	Jun 1990	A
4940467	Tronzo	Jul 1990	A
4957495	Kluger	Sep 1990	A
4973331	Pursley et al.	Nov 1990	A
4978323	Freedman	Dec 1990	A
4998013	Epstein et al.	Mar 1991	A
5010879	Moriya et al.	Apr 1991	A
5030235	Campbell, Jr.	Jul 1991	A
5041112	Mingozzi et al.	Aug 1991	A
5053047	Yoon	Oct 1991	A
5064004	Lundell	Nov 1991	A
5074868	Kuzmak	Dec 1991	A
5074882	Grammont et al.	Dec 1991	A
5092889	Campbell, Jr.	Mar 1992	A
5133716	Plaza	Jul 1992	A
5142407	Varaprasad et al.	Aug 1992	A
5152770	Bengmark et al.	Oct 1992	A
5156605	Pursley et al.	Oct 1992	A
5176618	Freedman	Jan 1993	A
5180380	Pursley et al.	Jan 1993	A
5222976	Yoon	Jun 1993	A
5226429	Kuzmak	Jul 1993	A
5261908	Campbell, Jr.	Nov 1993	A
5263955	Baumgart et al.	Nov 1993	A
5290289	Sanders et al.	Mar 1994	A
5306275	Bryan	Apr 1994	A
5330503	Yoon	Jul 1994	A
5334202	Carter	Aug 1994	A
5336223	Rogers	Aug 1994	A
5356411	Spievack	Oct 1994	A
5356424	Buzerak et al.	Oct 1994	A
5360407	Leonard et al.	Nov 1994	A
5364396	Robinson et al.	Nov 1994	A
5381943	Allen et al.	Jan 1995	A
5399168	Wadsworth, Jr. et al.	Mar 1995	A
5403322	Herzenberg et al.	Apr 1995	A
5429638	Muschler et al.	Jul 1995	A
5433721	Hooven et al.	Jul 1995	A
5437266	McPherson et al.	Aug 1995	A
5449368	Kuzmak	Sep 1995	A
5466261	Richelsoph	Nov 1995	A
5468030	Walling	Nov 1995	A
5480437	Draenert	Jan 1996	A
5498262	Bryan	Mar 1996	A
5509888	Miller	Apr 1996	A
5516335	Kummer et al.	May 1996	A
5527309	Shelton	Jun 1996	A
5536269	Spievack	Jul 1996	A
5536296	Ten Eyck et al.	Jul 1996	A
5549610	Russell et al.	Aug 1996	A
5573496	McPherson et al.	Nov 1996	A
5575790	Chen et al.	Nov 1996	A
5582616	Bolduc et al.	Dec 1996	A
5601224	Bishop et al.	Feb 1997	A
5620445	Brosnahan et al.	Apr 1997	A
5620449	Faccioli et al.	Apr 1997	A
5626579	Muschler et al.	May 1997	A
5626613	Schmieding	May 1997	A
5628888	Bakhir et al.	May 1997	A
5632744	Campbell, Jr.	May 1997	A
5659217	Petersen	Aug 1997	A
5662683	Kay	Sep 1997	A
5672175	Martin	Sep 1997	A
5672177	Seldin	Sep 1997	A
5676162	Larson, Jr. et al.	Oct 1997	A
5693091	Larson, Jr. et al.	Dec 1997	A
5700263	Schendel	Dec 1997	A
5702430	Larson, Jr. et al.	Dec 1997	A
5704893	Timm	Jan 1998	A
5704938	Staehlin et al.	Jan 1998	A
5704939	Justin	Jan 1998	A
5720746	Soubeiran	Feb 1998	A
5722429	Larson, Jr. et al.	Mar 1998	A
5722930	Larson, Jr. et al.	Mar 1998	A
5743910	Bays et al.	Apr 1998	A
5758666	Larson, Jr. et al.	Jun 1998	A
5762599	Sohn	Jun 1998	A
5766208	McEwan	Jun 1998	A
5771903	Jakobsson	Jun 1998	A
5800434	Campbell, Jr.	Sep 1998	A
5810815	Morales	Sep 1998	A
5824008	Bolduc et al.	Oct 1998	A
5827286	Incavo et al.	Oct 1998	A
5829662	Allen et al.	Nov 1998	A
5830221	Stein et al.	Nov 1998	A
5843129	Larson, Jr. et al.	Dec 1998	A
5874796	Petersen	Feb 1999	A
5879375	Larson, Jr. et al.	Mar 1999	A
5902304	Walker et al.	May 1999	A
5935127	Border	Aug 1999	A
5938669	Klaiber et al.	Aug 1999	A
5945762	Chen et al.	Aug 1999	A
5954915	Voorhees et al.	Sep 1999	A
5961553	Coty et al.	Oct 1999	A
5964763	Incavo et al.	Oct 1999	A
5976138	Baumgart et al.	Nov 1999	A
5979456	Magovern	Nov 1999	A
5983424	Naslund	Nov 1999	A
5985110	Bakhir et al.	Nov 1999	A
5997490	McLeod et al.	Dec 1999	A
6009837	McClasky	Jan 2000	A
6022349	McLeod et al.	Feb 2000	A
6033412	Losken et al.	Mar 2000	A
6034296	Elvin et al.	Mar 2000	A
6067991	Forsell	May 2000	A
6074341	Anderson et al.	Jun 2000	A
6074882	Eckardt	Jun 2000	A
6092531	Chen et al.	Jul 2000	A
6102922	Jakobsson et al.	Aug 2000	A
6106525	Sachse	Aug 2000	A
6126660	Dietz	Oct 2000	A
6126661	Faccioli et al.	Oct 2000	A
6138681	Chen et al.	Oct 2000	A
6139316	Sachdeva et al.	Oct 2000	A
6162223	Orsak et al.	Dec 2000	A
6183476	Gerhardt et al.	Feb 2001	B1
6200317	Aalsma et al.	Mar 2001	B1
6210347	Forsell	Apr 2001	B1
6217847	Contag et al.	Apr 2001	B1
6221074	Cole et al.	Apr 2001	B1
6234299	Voorhees et al.	May 2001	B1
6234956	He et al.	May 2001	B1
6241730	Alby	Jun 2001	B1
6245075	Betz et al.	Jun 2001	B1
6283156	Motley	Sep 2001	B1
6296643	Hopf et al.	Oct 2001	B1
6296656	Bolduc et al.	Oct 2001	B1
6299613	Ogilvie et al.	Oct 2001	B1
6315784	Djurovic	Nov 2001	B1
6319255	Grundei et al.	Nov 2001	B1
6321106	Lemelson	Nov 2001	B1
6325805	Ogilvie et al.	Dec 2001	B1
6327492	Lemelson	Dec 2001	B1
6331744	Chen et al.	Dec 2001	B1
6336929	Justin	Jan 2002	B1
6343568	McClasky	Feb 2002	B1
6353949	Falbo	Mar 2002	B1
6358283	Hogfors et al.	Mar 2002	B1
6375682	Fleischmann et al.	Apr 2002	B1
6386083	Hwang	May 2002	B1
6389187	Greenaway et al.	May 2002	B1
6400980	Lemelson	Jun 2002	B1
6402753	Cole et al.	Jun 2002	B1
6409175	Evans et al.	Jun 2002	B1
6416516	Stauch et al.	Jul 2002	B1
6417750	Sohn	Jul 2002	B1
6423061	Bryant	Jul 2002	B1
6432040	Meah	Aug 2002	B1
6450173	Forsell	Sep 2002	B1
6450946	Forsell	Sep 2002	B1
6453907	Forsell	Sep 2002	B1
6454698	Forsell	Sep 2002	B1
6454699	Forsell	Sep 2002	B1
6454700	Forsell	Sep 2002	B1
6454701	Forsell	Sep 2002	B1
6460543	Forsell	Oct 2002	B1
6461292	Forsell	Oct 2002	B1
6461293	Forsell	Oct 2002	B1
6463935	Forsell	Oct 2002	B1
6464628	Forsell	Oct 2002	B1
6470892	Forsell	Oct 2002	B1
6471635	Forsell	Oct 2002	B1
6475136	Forsell	Nov 2002	B1
6482145	Forsell	Nov 2002	B1
6494879	Lennox et al.	Dec 2002	B2
6499907	Baur	Dec 2002	B1
6500110	Davey et al.	Dec 2002	B1
6503189	Forsell	Jan 2003	B1
6508820	Bales	Jan 2003	B2
6510345	Van Bentem	Jan 2003	B1
6511490	Robert	Jan 2003	B2
6527701	Sayet et al.	Mar 2003	B1
6527702	Whalen et al.	Mar 2003	B2
6536499	Voorhees et al.	Mar 2003	B2
6537196	Creighton, IV et al.	Mar 2003	B1
6547801	Dargent et al.	Apr 2003	B1
6554831	Rivard et al.	Apr 2003	B1
6558400	Deem et al.	May 2003	B2
6562051	Bolduc et al.	May 2003	B1
6565573	Ferrante et al.	May 2003	B1
6565576	Stauch et al.	May 2003	B1
6573706	Mendes et al.	Jun 2003	B2
6582313	Perrow	Jun 2003	B2
6583630	Mendes et al.	Jun 2003	B2
6587719	Barrett et al.	Jul 2003	B1
6595912	Lau et al.	Jul 2003	B2
6602184	Lau et al.	Aug 2003	B2
6604529	Kim	Aug 2003	B2
6607363	Domroese	Aug 2003	B1
6609025	Barrett et al.	Aug 2003	B2
6612978	Lau et al.	Sep 2003	B2
6612979	Lau et al.	Sep 2003	B2
6616669	Ogilvie et al.	Sep 2003	B2
6621956	Greenaway et al.	Sep 2003	B2
6626899	Houser et al.	Sep 2003	B2
6626917	Craig	Sep 2003	B1
6627206	Lloyd	Sep 2003	B2
6649143	Contag et al.	Nov 2003	B1
6656135	Zogbi et al.	Dec 2003	B2
6656194	Gannoe et al.	Dec 2003	B1
6657351	Chen et al.	Dec 2003	B2
6667725	Simons et al.	Dec 2003	B1
6669687	Saadat	Dec 2003	B1
6673079	Kane	Jan 2004	B1
6676674	Dudai	Jan 2004	B1
6682474	Lau et al.	Jan 2004	B2
6689046	Sayet et al.	Feb 2004	B2
6702732	Lau et al.	Mar 2004	B1
6702816	Buhler	Mar 2004	B2
6706042	Taylor	Mar 2004	B2
6709293	Mori et al.	Mar 2004	B2
6709385	Forsell	Mar 2004	B2
6730087	Butsch	May 2004	B1
6749556	Banik	Jun 2004	B2
6752754	Feng et al.	Jun 2004	B1
6761503	Breese	Jul 2004	B2
6765330	Baur	Jul 2004	B2
6769499	Cargill et al.	Aug 2004	B2
6773437	Ogilvie et al.	Aug 2004	B2
6774624	Anderson et al.	Aug 2004	B2
6789442	Forch	Sep 2004	B2
6796984	Soubeiran	Sep 2004	B2
6802844	Ferree	Oct 2004	B2
6802847	Carson et al.	Oct 2004	B1
6809434	Duncan et al.	Oct 2004	B1
6835183	Lennox et al.	Dec 2004	B2
6835207	Zacouto et al.	Dec 2004	B2
6849076	Blunn et al.	Feb 2005	B2
6852113	Nathanson et al.	Feb 2005	B2
6864647	Duncan et al.	Mar 2005	B2
6884248	Bolduc et al.	Apr 2005	B2
6890515	Contag et al.	May 2005	B2
6908605	Contag et al.	Jun 2005	B2
6915165	Forsell	Jul 2005	B2
6916462	Contag et al.	Jul 2005	B2
6918838	Schwarzler et al.	Jul 2005	B2
6918910	Smith et al.	Jul 2005	B2
6921360	Banik	Jul 2005	B2
6921400	Sohngen	Jul 2005	B2
6923951	Contag et al.	Aug 2005	B2
6926719	Sohngen et al.	Aug 2005	B2
6939533	Contag et al.	Sep 2005	B2
6953429	Forsell	Oct 2005	B2
6961553	Zhao et al.	Nov 2005	B2
6971143	Domroese	Dec 2005	B2
6980921	Anderson et al.	Dec 2005	B2
6997952	Furukawa et al.	Feb 2006	B2
7001327	Whalen et al.	Feb 2006	B2
7001346	White	Feb 2006	B2
7008425	Phillips	Mar 2006	B2
7011621	Sayet et al.	Mar 2006	B2
7011658	Young	Mar 2006	B2
7011682	Lashinski et al.	Mar 2006	B2
7018380	Cole	Mar 2006	B2
7029475	Panjabi	Apr 2006	B2
7041105	Michelson	May 2006	B2
7060075	Govari et al.	Jun 2006	B2
7060080	Bachmann	Jun 2006	B2
7063706	Wittenstein	Jun 2006	B2
7077802	Lau et al.	Jul 2006	B2
7081086	Lau et al.	Jul 2006	B2
7083629	Weller et al.	Aug 2006	B2
7096148	Anderson et al.	Aug 2006	B2
7097611	Lau et al.	Aug 2006	B2
7105029	Doubler et al.	Sep 2006	B2
7105968	Nissen	Sep 2006	B2
7114501	Johnson et al.	Oct 2006	B2
7115129	Heggeness	Oct 2006	B2
7115130	Michelson	Oct 2006	B2
7124493	Lau et al.	Oct 2006	B2
7128707	Banik	Oct 2006	B2
7135022	Kosashvili et al.	Nov 2006	B2
7160312	Saadat	Jan 2007	B2
7163538	Altarac et al.	Jan 2007	B2
7172607	Hofle et al.	Feb 2007	B2
7175589	Deem et al.	Feb 2007	B2
7175660	Cartledge et al.	Feb 2007	B2
7186262	Saadat	Mar 2007	B2
7188627	Nelson et al.	Mar 2007	B2
7189005	Ward	Mar 2007	B2
7189202	Lau et al.	Mar 2007	B2
7189251	Kay	Mar 2007	B2
7191007	Desai et al.	Mar 2007	B2
7194297	Talpade et al.	Mar 2007	B2
7195608	Burnett	Mar 2007	B2
7198774	Contag et al.	Apr 2007	B2
7211094	Gannoe et al.	May 2007	B2
7216648	Nelson et al.	May 2007	B2
7217284	Houser et al.	May 2007	B2
7218232	DiSilvestro et al.	May 2007	B2
7232449	Sharkawy et al.	Jun 2007	B2
7234468	Johnson et al.	Jun 2007	B2
7234544	Kent	Jun 2007	B2
7238152	Lau et al.	Jul 2007	B2
7238191	Bachmann	Jul 2007	B2
7241300	Sharkawy et al.	Jul 2007	B2
7243719	Baron et al.	Jul 2007	B2
7255682	Bartol, Jr. et al.	Aug 2007	B1
7255714	Malek	Aug 2007	B2
7255851	Contag et al.	Aug 2007	B2
7276022	Lau et al.	Oct 2007	B2
7282023	Frering	Oct 2007	B2
7285087	Moaddeb et al.	Oct 2007	B2
7288064	Boustani et al.	Oct 2007	B2
7288099	Deem et al.	Oct 2007	B2
7288101	Deem et al.	Oct 2007	B2
7296577	Lashinski et al.	Nov 2007	B2
7297150	Cartledge et al.	Nov 2007	B2
7299091	Barrett et al.	Nov 2007	B2
7302858	Walsh et al.	Dec 2007	B2
7306614	Weller et al.	Dec 2007	B2
7311690	Burnett	Dec 2007	B2
7314372	Belfor et al.	Jan 2008	B2
7314443	Jordan et al.	Jan 2008	B2
7320706	Al-Najjar	Jan 2008	B2
7331995	Eisermann et al.	Feb 2008	B2
7333013	Berger	Feb 2008	B2
7338433	Coe	Mar 2008	B2
7340306	Barrett et al.	Mar 2008	B2
7351198	Byrum et al.	Apr 2008	B2
7351240	Hassler, Jr. et al.	Apr 2008	B2
7353747	Swayze et al.	Apr 2008	B2
7357037	Hnat et al.	Apr 2008	B2
7357635	Belfor et al.	Apr 2008	B2
7360542	Nelson et al.	Apr 2008	B2
7361192	Doty	Apr 2008	B2
7364542	Jambor et al.	Apr 2008	B2
7364589	Eisermann	Apr 2008	B2
7367340	Nelson et al.	May 2008	B2
7367937	Jambor et al.	May 2008	B2
7367938	Forsell	May 2008	B2
7371244	Chatlynne et al.	May 2008	B2
7374557	Conlon et al.	May 2008	B2
7390007	Helms et al.	Jun 2008	B2
7390294	Hassler, Jr.	Jun 2008	B2
7400926	Forsell	Jul 2008	B2
7402134	Moaddeb et al.	Jul 2008	B2
7402176	Malek	Jul 2008	B2
7410461	Lau et al.	Aug 2008	B2
7416528	Crawford et al.	Aug 2008	B2
7422566	Miethke	Sep 2008	B2
7429259	Cadeddu et al.	Sep 2008	B2
7431692	Zollinger et al.	Oct 2008	B2
7441559	Nelson et al.	Oct 2008	B2
7442196	Fisher et al.	Oct 2008	B2
7445010	Kugler et al.	Nov 2008	B2
7455690	Cartledge et al.	Nov 2008	B2
7458981	Fielding et al.	Dec 2008	B2
7468060	Utley et al.	Dec 2008	B2
7476195	Sayet et al.	Jan 2009	B2
7476238	Panjabi	Jan 2009	B2
7481224	Nelson et al.	Jan 2009	B2
7481763	Hassler, Jr. et al.	Jan 2009	B2
7481841	Hazebrouck et al.	Jan 2009	B2
7485149	White	Feb 2009	B1
7489495	Stevenson	Feb 2009	B2
7494459	Anstadt et al.	Feb 2009	B2
7500484	Nelson et al.	Mar 2009	B2
7503922	Deem et al.	Mar 2009	B2
7503934	Eisermann et al.	Mar 2009	B2
7507252	Lashinski et al.	Mar 2009	B2
7510559	Deem et al.	Mar 2009	B2
7530981	Kutsenko	May 2009	B2
7531002	Sutton et al.	May 2009	B2
7547291	Lennox et al.	Jun 2009	B2
7553298	Hunt et al.	Jun 2009	B2
7559951	DiSilvestro et al.	Jul 2009	B2
7561916	Hunt et al.	Jul 2009	B2
7562660	Saadat	Jul 2009	B2
7566297	Banik	Jul 2009	B2
7569057	Liu et al.	Aug 2009	B2
7578821	Fisher et al.	Aug 2009	B2
7584788	Baron et al.	Sep 2009	B2
7594887	Moaddeb et al.	Sep 2009	B2
7601156	Robinson	Oct 2009	B2
7601162	Hassler, Jr. et al.	Oct 2009	B2
7601171	Ainsworth et al.	Oct 2009	B2
7611526	Carl et al.	Nov 2009	B2
7615001	Jambor et al.	Nov 2009	B2
7615068	Timm et al.	Nov 2009	B2
7618435	Opolski	Nov 2009	B2
7621886	Burnett	Nov 2009	B2
7635379	Callahan et al.	Dec 2009	B2
7651483	Byrum et al.	Jan 2010	B2
7658753	Carl et al.	Feb 2010	B2
7666132	Forsell	Feb 2010	B2
7666184	Stauch	Feb 2010	B2
7666210	Franck et al.	Feb 2010	B2
7678136	Doubler et al.	Mar 2010	B2
7678139	Garamszegi et al.	Mar 2010	B2
7691144	Chang et al.	Apr 2010	B2
7695512	Lashinski et al.	Apr 2010	B2
7704279	Moskowitz et al.	Apr 2010	B2
7704282	Disilvestro et al.	Apr 2010	B2
7708737	Kraft et al.	May 2010	B2
7708762	McCarthy et al.	May 2010	B2
7708765	Carl et al.	May 2010	B2
7708779	Edie et al.	May 2010	B2
7713287	Timm et al.	May 2010	B2
7717959	William et al.	May 2010	B2
7727141	Hassler, Jr. et al.	Jun 2010	B2
7727143	Birk et al.	Jun 2010	B2
7749224	Cresina et al.	Jul 2010	B2
7753913	Szakelyhidi, Jr. et al.	Jul 2010	B2
7753915	Eksler et al.	Jul 2010	B1
7757552	Bogath et al.	Jul 2010	B2
7762998	Birk et al.	Jul 2010	B2
7763053	Gordon	Jul 2010	B2
7763080	Southworth	Jul 2010	B2
7766815	Ortiz	Aug 2010	B2
7775099	Bogath et al.	Aug 2010	B2
7775215	Hassler, Jr. et al.	Aug 2010	B2
7776061	Garner et al.	Aug 2010	B2
7776068	Ainsworth et al.	Aug 2010	B2
7776075	Bruneau et al.	Aug 2010	B2
7776091	Mastrorio et al.	Aug 2010	B2
7780590	Birk et al.	Aug 2010	B2
7787958	Stevenson	Aug 2010	B2
7789912	Manzi et al.	Sep 2010	B2
7793583	Radinger et al.	Sep 2010	B2
7794447	Dann et al.	Sep 2010	B2
7794476	Wisnewski	Sep 2010	B2
7798954	Birk et al.	Sep 2010	B2
7799080	Doty	Sep 2010	B2
7803106	Whalen et al.	Sep 2010	B2
7803157	Michelson	Sep 2010	B2
7811275	Birk et al.	Oct 2010	B2
7811298	Birk	Oct 2010	B2
7811328	Molz, IV et al.	Oct 2010	B2
7815643	Johnson et al.	Oct 2010	B2
7828714	Feng et al.	Nov 2010	B2
7828813	Mouton	Nov 2010	B2
7833228	Hershberger	Nov 2010	B1
7835779	Anderson et al.	Nov 2010	B2
7837669	Dann et al.	Nov 2010	B2
7837691	Cordes et al.	Nov 2010	B2
7842036	Phillips	Nov 2010	B2
7845356	Paraschac et al.	Dec 2010	B2
7846188	Moskowitz et al.	Dec 2010	B2
7850660	Uth et al.	Dec 2010	B2
7850735	Eisermann et al.	Dec 2010	B2
7854769	Hershberger	Dec 2010	B2
7862546	Conlon et al.	Jan 2011	B2
7862574	Deem et al.	Jan 2011	B2
7862586	Malek	Jan 2011	B2
7867235	Fell et al.	Jan 2011	B2
7871368	Zollinger et al.	Jan 2011	B2
7875033	Richter et al.	Jan 2011	B2
7887566	Hynes	Feb 2011	B2
7901381	Birk et al.	Mar 2011	B2
7901419	Bachmann et al.	Mar 2011	B2
7909790	Burnett	Mar 2011	B2
7909838	Deem et al.	Mar 2011	B2
7909839	Fields	Mar 2011	B2
7909852	Boomer et al.	Mar 2011	B2
7918844	Byrum et al.	Apr 2011	B2
7921850	Nelson et al.	Apr 2011	B2
7922765	Reiley	Apr 2011	B2
7927354	Edidin et al.	Apr 2011	B2
7927357	Sacher et al.	Apr 2011	B2
7931679	Heggeness	Apr 2011	B2
7932825	Berger	Apr 2011	B2
7938836	Ainsworth et al.	May 2011	B2
7938841	Sharkawy et al.	May 2011	B2
7942903	Moskowitz et al.	May 2011	B2
7942908	Sacher et al.	May 2011	B2
7947011	Birk et al.	May 2011	B2
7951067	Byrum et al.	May 2011	B2
7951180	Moskowitz et al.	May 2011	B2
7958895	Nelson et al.	Jun 2011	B2
7958896	Nelson et al.	Jun 2011	B2
7959552	Jordan et al.	Jun 2011	B2
7972315	Birk et al.	Jul 2011	B2
7972346	Bachmann et al.	Jul 2011	B2
7972363	Moskowitz et al.	Jul 2011	B2
7976545	Hershberger et al.	Jul 2011	B2
7983763	Stevenson et al.	Jul 2011	B2
7985256	Grotz et al.	Jul 2011	B2
7987241	St Jacques, Jr. et al.	Jul 2011	B2
7988707	Panjabi	Aug 2011	B2
7988709	Clark et al.	Aug 2011	B2
7993342	Malandain et al.	Aug 2011	B2
7993397	Lashinski et al.	Aug 2011	B2
7998174	Malandain et al.	Aug 2011	B2
7998208	Kohm et al.	Aug 2011	B2
8002801	Carl et al.	Aug 2011	B2
8002809	Baynham	Aug 2011	B2
8007458	Lennox et al.	Aug 2011	B2
8007474	Uth et al.	Aug 2011	B2
8007479	Birk et al.	Aug 2011	B2
8011308	Picchio	Sep 2011	B2
8012162	Bachmann	Sep 2011	B2
8016745	Hassler, Jr. et al.	Sep 2011	B2
8016837	Giger et al.	Sep 2011	B2
8016860	Carl et al.	Sep 2011	B2
8026729	Kroh et al.	Sep 2011	B2
8029477	Byrum et al.	Oct 2011	B2
8029567	Edidin et al.	Oct 2011	B2
8034080	Malandain et al.	Oct 2011	B2
8037871	McClendon	Oct 2011	B2
8038680	Ainsworth et al.	Oct 2011	B2
8038698	Edidin et al.	Oct 2011	B2
8043206	Birk	Oct 2011	B2
8043290	Harrison et al.	Oct 2011	B2
8043299	Conway	Oct 2011	B2
8043338	Dant	Oct 2011	B2
8043345	Carl et al.	Oct 2011	B2
8048169	Burnett et al.	Nov 2011	B2
8057473	Orsak et al.	Nov 2011	B2
8057513	Kohm et al.	Nov 2011	B2
8066650	Lee et al.	Nov 2011	B2
8070670	Deem et al.	Dec 2011	B2
8070671	Deem et al.	Dec 2011	B2
8070695	Gupta et al.	Dec 2011	B2
8070813	Grotz et al.	Dec 2011	B2
8074654	Paraschac et al.	Dec 2011	B2
8075577	Deem et al.	Dec 2011	B2
8079974	Stergiopulos	Dec 2011	B2
8079989	Birk et al.	Dec 2011	B2
8080022	Deem et al.	Dec 2011	B2
8080025	Deem et al.	Dec 2011	B2
8088166	Makower et al.	Jan 2012	B2
8092459	Malandain	Jan 2012	B2
8092499	Roth	Jan 2012	B1
8095317	Ekseth et al.	Jan 2012	B2
8096302	Nelson et al.	Jan 2012	B2
8096938	Forsell	Jan 2012	B2
8096995	Kohm et al.	Jan 2012	B2
8097018	Malandain et al.	Jan 2012	B2
8097038	Malek	Jan 2012	B2
8100819	Banik	Jan 2012	B2
8100943	Malandain et al.	Jan 2012	B2
8100967	Makower et al.	Jan 2012	B2
8105360	Connor	Jan 2012	B1
8105363	Fielding et al.	Jan 2012	B2
8105364	McCarthy et al.	Jan 2012	B2
8109974	Boomer et al.	Feb 2012	B2
8114158	Carl et al.	Feb 2012	B2
8123765	Deem et al.	Feb 2012	B2
8123805	Makower et al.	Feb 2012	B2
8128628	Freid et al.	Mar 2012	B2
8133280	Voellmicke et al.	Mar 2012	B2
8137349	Soubeiran	Mar 2012	B2
8137366	Deem et al.	Mar 2012	B2
8137367	Deem et al.	Mar 2012	B2
8142454	Harrison et al.	Mar 2012	B2
8142494	Randert et al.	Mar 2012	B2
8147517	Trieu et al.	Apr 2012	B2
8147549	Metcalf, Jr. et al.	Apr 2012	B2
8157841	Malandain et al.	Apr 2012	B2
8162897	Byrum	Apr 2012	B2
8162979	Sachs et al.	Apr 2012	B2
8163013	Machold et al.	Apr 2012	B2
8177789	Magill et al.	May 2012	B2
8182411	Dlugos	May 2012	B2
8187324	Webler et al.	May 2012	B2
8197544	Manzi et al.	Jun 2012	B1
8202305	Reiley	Jun 2012	B2
8211127	Uth et al.	Jul 2012	B2
8211149	Justis	Jul 2012	B2
8211151	Schwab et al.	Jul 2012	B2
8211179	Molz, IV et al.	Jul 2012	B2
8216275	Fielding et al.	Jul 2012	B2
8221420	Keller	Jul 2012	B2
8226690	Altarac et al.	Jul 2012	B2
8236002	Fortin et al.	Aug 2012	B2
8241292	Collazo	Aug 2012	B2
8241293	Stone et al.	Aug 2012	B2
8241331	Arnin	Aug 2012	B2
8246630	Manzi et al.	Aug 2012	B2
8251888	Roslin et al.	Aug 2012	B2
8252063	Stauch	Aug 2012	B2
8257370	Moskowitz et al.	Sep 2012	B2
8257442	Edie et al.	Sep 2012	B2
8263024	Wan et al.	Sep 2012	B2
8267969	Altarac et al.	Sep 2012	B2
8273112	Garamszegi et al.	Sep 2012	B2
8278941	Kroh et al.	Oct 2012	B2
8282671	Connor	Oct 2012	B2
8287540	LeCronier et al.	Oct 2012	B2
8298133	Wiley et al.	Oct 2012	B2
8298240	Giger et al.	Oct 2012	B2
8308779	Reiley	Nov 2012	B2
8313423	Forsell	Nov 2012	B2
8316856	Nelson et al.	Nov 2012	B2
8317761	Birk et al.	Nov 2012	B2
8317802	Manzi et al.	Nov 2012	B1
8323290	Metzger et al.	Dec 2012	B2
8326435	Stevenson	Dec 2012	B2
8328807	Brigido	Dec 2012	B2
8328854	Baynham et al.	Dec 2012	B2
8333204	Saadat	Dec 2012	B2
8333790	Timm et al.	Dec 2012	B2
8353913	Moskowitz et al.	Jan 2013	B2
8357169	Henniges et al.	Jan 2013	B2
8357182	Seme	Jan 2013	B2
8357183	Seme et al.	Jan 2013	B2
8360955	Sayet et al.	Jan 2013	B2
8366628	Denker et al.	Feb 2013	B2
8372078	Collazo	Feb 2013	B2
8382652	Sayet et al.	Feb 2013	B2
8386018	Stauch et al.	Feb 2013	B2
8388667	Reiley et al.	Mar 2013	B2
8394124	Biyani	Mar 2013	B2
8394143	Grotz et al.	Mar 2013	B2
8403958	Schwab	Mar 2013	B2
8409203	Birk et al.	Apr 2013	B2
8409281	Makower et al.	Apr 2013	B2
8414584	Brigido	Apr 2013	B2
8414648	Reiley	Apr 2013	B2
8419755	Deem et al.	Apr 2013	B2
8419801	DiSilvestro et al.	Apr 2013	B2
8425570	Reiley	Apr 2013	B2
8425608	Dewey et al.	Apr 2013	B2
8433519	Ekseth et al.	Apr 2013	B2
8435268	Thompson et al.	May 2013	B2
8439915	Harrison et al.	May 2013	B2
8439926	Bojarski et al.	May 2013	B2
8444693	Reiley	May 2013	B2
8449553	Kam et al.	May 2013	B2
8449580	Voellmicke et al.	May 2013	B2
8454695	Grotz et al.	Jun 2013	B2
8469908	Asfora	Jun 2013	B2
8469978	Fobi et al.	Jun 2013	B2
8470003	Voellmicke et al.	Jun 2013	B2
8470004	Reiley	Jun 2013	B2
8475354	Phillips et al.	Jul 2013	B2
8475356	Feng et al.	Jul 2013	B2
8475499	Cournoyer et al.	Jul 2013	B2
8480554	Phillips et al.	Jul 2013	B2
8480668	Fernandez et al.	Jul 2013	B2
8480741	Grotz et al.	Jul 2013	B2
8486070	Morgan et al.	Jul 2013	B2
8486076	Chavarria et al.	Jul 2013	B2
8486110	Fielding et al.	Jul 2013	B2
8486113	Malek	Jul 2013	B2
8486147	de Villiers et al.	Jul 2013	B2
8491589	Fisher et al.	Jul 2013	B2
8494805	Roche et al.	Jul 2013	B2
8496662	Novak et al.	Jul 2013	B2
8500810	Mastrorio et al.	Aug 2013	B2
8506517	Stergiopulos	Aug 2013	B2
8506569	Keefer et al.	Aug 2013	B2
8517973	Burnett	Aug 2013	B2
8518062	Cole et al.	Aug 2013	B2
8518086	Seme et al.	Aug 2013	B2
8522790	Nelson et al.	Sep 2013	B2
8523865	Reglos et al.	Sep 2013	B2
8523866	Sidebotham et al.	Sep 2013	B2
8523883	Saadat	Sep 2013	B2
8529474	Gupta et al.	Sep 2013	B2
8529606	Alamin et al.	Sep 2013	B2
8529607	Alamin et al.	Sep 2013	B2
8529630	Bojarski et al.	Sep 2013	B2
8545384	Forsell	Oct 2013	B2
8545508	Collazo	Oct 2013	B2
8545814	Contag et al.	Oct 2013	B2
8551092	Morgan et al.	Oct 2013	B2
8551142	Altarac et al.	Oct 2013	B2
8551422	Wan et al.	Oct 2013	B2
8556901	Anthony et al.	Oct 2013	B2
8556911	Mehta et al.	Oct 2013	B2
8556975	Ciupik et al.	Oct 2013	B2
8562653	Alamin et al.	Oct 2013	B2
8568416	Schmitz et al.	Oct 2013	B2
8568457	Hunziker	Oct 2013	B2
8574267	Linares	Nov 2013	B2
8579919	Bolduc et al.	Nov 2013	B2
8579979	Edie et al.	Nov 2013	B2
8585595	Heilman	Nov 2013	B2
8585702	Orsak et al.	Nov 2013	B2
8585738	Linares	Nov 2013	B2
8585740	Ross et al.	Nov 2013	B1
8591549	Lange	Nov 2013	B2
8597362	Shenoy et al.	Dec 2013	B2
8613749	Deem et al.	Dec 2013	B2
8613758	Linares	Dec 2013	B2
8617212	Linares	Dec 2013	B2
8617220	Skaggs	Dec 2013	B2
8617243	Eisermann et al.	Dec 2013	B2
8622936	Schenberger et al.	Jan 2014	B2
8623036	Harrison et al.	Jan 2014	B2
8623042	Roslin et al.	Jan 2014	B2
8623056	Linares	Jan 2014	B2
8632544	Haaja et al.	Jan 2014	B2
8632547	Maxson et al.	Jan 2014	B2
8632548	Soubeiran	Jan 2014	B2
8632563	Nagase et al.	Jan 2014	B2
8632594	Williams et al.	Jan 2014	B2
8636770	Hestad et al.	Jan 2014	B2
8636771	Butler et al.	Jan 2014	B2
8636802	Serhan et al.	Jan 2014	B2
8641719	Gephart et al.	Feb 2014	B2
8641723	Connor	Feb 2014	B2
8652175	Timm et al.	Feb 2014	B2
8657765	Asfora	Feb 2014	B2
8657856	Gephart et al.	Feb 2014	B2
8657885	Burnett et al.	Feb 2014	B2
8663139	Asfora	Mar 2014	B2
8663140	Asfora	Mar 2014	B2
8663285	Dall et al.	Mar 2014	B2
8663287	Butler et al.	Mar 2014	B2
8663338	Burnett et al.	Mar 2014	B2
8668719	Alamin et al.	Mar 2014	B2
8673001	Cartledge et al.	Mar 2014	B2
8679161	Malandain et al.	Mar 2014	B2
8690858	Machold et al.	Apr 2014	B2
8707959	Paraschac et al.	Apr 2014	B2
8709090	Makower et al.	Apr 2014	B2
8715243	Uth et al.	May 2014	B2
8715290	Fisher et al.	May 2014	B2
8721570	Gupta et al.	May 2014	B2
8721643	Morgan et al.	May 2014	B2
8728125	Bruneau et al.	May 2014	B2
8734318	Forsell	May 2014	B2
8734516	Moskowitz et al.	May 2014	B2
8734519	de Villiers et al.	May 2014	B2
8747444	Moskowitz et al.	Jun 2014	B2
8752552	Nelson et al.	Jun 2014	B2
8758303	Uth et al.	Jun 2014	B2
8758347	Weiner et al.	Jun 2014	B2
8758355	Fisher et al.	Jun 2014	B2
8758372	Cartledge et al.	Jun 2014	B2
8762308	Najarian et al.	Jun 2014	B2
8764713	Uth et al.	Jul 2014	B2
8771272	LeCronier et al.	Jul 2014	B2
8777947	Zahrly et al.	Jul 2014	B2
8777995	McClintock et al.	Jul 2014	B2
8781744	Ekseth et al.	Jul 2014	B2
8784482	Rahdert et al.	Jul 2014	B2
8790343	McClellan et al.	Jul 2014	B2
8790380	Buttermann	Jul 2014	B2
8790409	Van den Heuvel et al.	Jul 2014	B2
8794243	Deem et al.	Aug 2014	B2
8795339	Boomer et al.	Aug 2014	B2
8801795	Makower et al.	Aug 2014	B2
8808206	Asfora	Aug 2014	B2
8813727	McClendon	Aug 2014	B2
8814869	Freid et al.	Aug 2014	B2
8828058	Elsebaie et al.	Sep 2014	B2
8828087	Stone et al.	Sep 2014	B2
8840623	Reiley	Sep 2014	B2
8840651	Reiley	Sep 2014	B2
8845692	Wisnewski	Sep 2014	B2
8845724	Shenoy et al.	Sep 2014	B2
8864717	Conlon et al.	Oct 2014	B2
8864823	Cartledge et al.	Oct 2014	B2
8870881	Rezach et al.	Oct 2014	B2
8870918	Boomer et al.	Oct 2014	B2
8870959	Arnin	Oct 2014	B2
8882699	Burnett	Nov 2014	B2
8882830	Cartledge et al.	Nov 2014	B2
8888672	Phillips et al.	Nov 2014	B2
8888673	Phillips et al.	Nov 2014	B2
8894663	Giger et al.	Nov 2014	B2
8915915	Harrison et al.	Dec 2014	B2
8915917	Doherty et al.	Dec 2014	B2
8920422	Homeier et al.	Dec 2014	B2
8932247	Stergiopulos	Jan 2015	B2
8939924	Paulos	Jan 2015	B1
8945188	Rezach et al.	Feb 2015	B2
8945210	Cartledge et al.	Feb 2015	B2
8956407	Macoviak et al.	Feb 2015	B2
8961386	Phillips et al.	Feb 2015	B2
8961521	Keefer et al.	Feb 2015	B2
8961567	Hunziker	Feb 2015	B2
8968402	Myers et al.	Mar 2015	B2
8968406	Arnin	Mar 2015	B2
8986348	Reiley	Mar 2015	B2
8992527	Guichet	Mar 2015	B2
9005251	Heggeness	Apr 2015	B2
9005293	Moskowitz et al.	Apr 2015	B2
9005298	Makower et al.	Apr 2015	B2
9011491	Carl et al.	Apr 2015	B2
9015057	Phillips et al.	Apr 2015	B2
9022917	Kasic et al.	May 2015	B2
9028550	Shulock et al.	May 2015	B2
9033957	Cadeddu et al.	May 2015	B2
9033988	Gephart et al.	May 2015	B2
9034016	Panjabi	May 2015	B2
9044218	Young	Jun 2015	B2
9060810	Kercher et al.	Jun 2015	B2
9060844	Kagan et al.	Jun 2015	B2
9072530	Mehta et al.	Jul 2015	B2
9072606	Lucas et al.	Jul 2015	B2
9078703	Arnin	Jul 2015	B2
9084632	Orsak et al.	Jul 2015	B2
9089348	Chavarria et al.	Jul 2015	B2
9095436	Boyden et al.	Aug 2015	B2
9095437	Boyden et al.	Aug 2015	B2
9101422	Freid et al.	Aug 2015	B2
9101427	Globerman et al.	Aug 2015	B2
9107706	Alamin et al.	Aug 2015	B2
9113967	Soubeiran	Aug 2015	B2
9114016	Shenoy et al.	Aug 2015	B2
9125746	Clifford et al.	Sep 2015	B2
9138266	Stauch	Sep 2015	B2
9144482	Sayet	Sep 2015	B2
9155565	Boomer et al.	Oct 2015	B2
9161856	Nelson et al.	Oct 2015	B2
9168071	Seme et al.	Oct 2015	B2
9168076	Patty et al.	Oct 2015	B2
9173681	Seme	Nov 2015	B2
9173715	Baumgartner	Nov 2015	B2
9186158	Anthony et al.	Nov 2015	B2
9186185	Hestad et al.	Nov 2015	B2
9198771	Ciupik	Dec 2015	B2
9204899	Buttermann	Dec 2015	B2
9204908	Buttermann	Dec 2015	B2
9220536	Skaggs	Dec 2015	B2
9226783	Brigido	Jan 2016	B2
9242070	Tieu	Jan 2016	B2
9259243	Giger et al.	Feb 2016	B2
9272159	Phillips et al.	Mar 2016	B2
9278004	Shenoy et al.	Mar 2016	B2
9278046	Asfora	Mar 2016	B2
9282997	Hunziker	Mar 2016	B2
9301792	Henniges et al.	Apr 2016	B2
9301854	Moskowitz et al.	Apr 2016	B2
9308089	Vicatos et al.	Apr 2016	B2
9308387	Phillips et al.	Apr 2016	B2
9320618	Schmitz et al.	Apr 2016	B2
9326728	Demir et al.	May 2016	B2
9333009	Kroll et al.	May 2016	B2
9339197	Griswold et al.	May 2016	B2
9339300	Kantelhardt	May 2016	B2
9339307	McClintock et al.	May 2016	B2
9339312	Doherty et al.	May 2016	B2
9358044	Seme et al.	Jun 2016	B2
9364267	Northcutt et al.	Jun 2016	B2
9370388	Globerman et al.	Jun 2016	B2
9393123	Lucas et al.	Jul 2016	B2
9408644	Zahrly et al.	Aug 2016	B2
9421347	Burnett	Aug 2016	B2
9427267	Homeier et al.	Aug 2016	B2
9439744	Forsell	Sep 2016	B2
9439797	Baym et al.	Sep 2016	B2
9445848	Anderson et al.	Sep 2016	B2
9451997	Carl et al.	Sep 2016	B2
9456953	Asfora	Oct 2016	B2
9474612	Haaja et al.	Oct 2016	B2
9492199	Orsak et al.	Nov 2016	B2
9492276	Lee et al.	Nov 2016	B2
9498258	Boomer et al.	Nov 2016	B2
9498366	Burnett et al.	Nov 2016	B2
9510834	Burnett et al.	Dec 2016	B2
9532804	Clifford et al.	Jan 2017	B2
9561062	Hayes et al.	Feb 2017	B2
9561063	Reiley	Feb 2017	B2
9572588	Fisher et al.	Feb 2017	B2
9572746	Asfora	Feb 2017	B2
9572910	Messersmith et al.	Feb 2017	B2
9579110	Bojarski et al.	Feb 2017	B2
9579203	Soubeiran	Feb 2017	B2
9603605	Collazo	Mar 2017	B2
9603713	Moskowitz et al.	Mar 2017	B2
9610161	Macoviak et al.	Apr 2017	B2
9622875	Moskowitz et al.	Apr 2017	B2
9642735	Burnett	May 2017	B2
9655651	Panjabi	May 2017	B2
9668868	Shenoy et al.	Jun 2017	B2
9687243	Burnett et al.	Jun 2017	B2
9687414	Asfora	Jun 2017	B2
9693867	Lucas et al.	Jul 2017	B2
9700419	Clifford et al.	Jul 2017	B2
9700450	Burnett	Jul 2017	B2
9717537	Gordon	Aug 2017	B2
9724135	Koch et al.	Aug 2017	B2
9724265	Asfora	Aug 2017	B2
9730738	Gephart et al.	Aug 2017	B2
9743969	Reiley	Aug 2017	B2
9782206	Mueckter et al.	Oct 2017	B2
9795410	Shenoy et al.	Oct 2017	B2
9814600	Shulock et al.	Nov 2017	B2
9820789	Reiley	Nov 2017	B2
9826987	Keefer et al.	Nov 2017	B2
9833291	Baumgartner	Dec 2017	B2
9848894	Burley et al.	Dec 2017	B2
9848993	Moskowitz et al.	Dec 2017	B2
9861376	Chavarria et al.	Jan 2018	B2
9861390	Hunziker	Jan 2018	B2
9861404	Reiley	Jan 2018	B2
9867719	Moskowitz et al.	Jan 2018	B2
10751094	Green et al.	Aug 2020	B2
20010011543	Forsell	Aug 2001	A1
20020019580	Lau et al.	Feb 2002	A1
20020050112	Koch et al.	May 2002	A1
20020072758	Reo et al.	Jun 2002	A1
20020164905	Bryant	Nov 2002	A1
20030019498	Forsell	Jan 2003	A1
20030040671	Somogyi et al.	Feb 2003	A1
20030066536	Forsell	Apr 2003	A1
20030114731	Cadeddu et al.	Jun 2003	A1
20030187447	Ferrante et al.	Oct 2003	A1
20030208212	Cigaina	Nov 2003	A1
20030220643	Ferree	Nov 2003	A1
20030220644	Thelen et al.	Nov 2003	A1
20040006342	Altarac et al.	Jan 2004	A1
20040011137	Hnat et al.	Jan 2004	A1
20040011365	Govari et al.	Jan 2004	A1
20040019353	Freid et al.	Jan 2004	A1
20040023623	Stauch et al.	Feb 2004	A1
20040055610	Forsell	Mar 2004	A1
20040064030	Forsell	Apr 2004	A1
20040068205	Zogbi et al.	Apr 2004	A1
20040092939	Freid et al.	May 2004	A1
20040098121	Opolski	May 2004	A1
20040116773	Furness et al.	Jun 2004	A1
20040133219	Forsell	Jul 2004	A1
20040138725	Forsell	Jul 2004	A1
20040153106	Dudai	Aug 2004	A1
20040158254	Eisermann	Aug 2004	A1
20040172040	Heggeness	Sep 2004	A1
20040173222	Kim	Sep 2004	A1
20040193266	Meyer	Sep 2004	A1
20040220567	Eisermann et al.	Nov 2004	A1
20040220668	Eisermann et al.	Nov 2004	A1
20040230307	Eisermann	Nov 2004	A1
20040250820	Forsell	Dec 2004	A1
20040260287	Ferree	Dec 2004	A1
20040260319	Egle	Dec 2004	A1
20050002984	Byrum et al.	Jan 2005	A1
20050043802	Eisermann et al.	Feb 2005	A1
20050055025	Zacouto et al.	Mar 2005	A1
20050070937	Jambor et al.	Mar 2005	A1
20050080427	Govari et al.	Apr 2005	A1
20050080439	Carson et al.	Apr 2005	A1
20050090823	Bartimus	Apr 2005	A1
20050096750	Kagan et al.	May 2005	A1
20050120479	Habashi et al.	Jun 2005	A1
20050131352	Conlon et al.	Jun 2005	A1
20050159754	Odrich	Jul 2005	A1
20050159755	Odrich	Jul 2005	A1
20050165440	Cancel et al.	Jul 2005	A1
20050171543	Timm et al.	Aug 2005	A1
20050177164	Walters et al.	Aug 2005	A1
20050182400	White	Aug 2005	A1
20050182401	Timm et al.	Aug 2005	A1
20050182412	Johnson et al.	Aug 2005	A1
20050192629	Saadat et al.	Sep 2005	A1
20050222489	Rahdert et al.	Oct 2005	A1
20050234289	Anstadt et al.	Oct 2005	A1
20050234448	McCarthy	Oct 2005	A1
20050234462	Hershberger	Oct 2005	A1
20050246034	Soubeiran	Nov 2005	A1
20050251109	Soubeiran	Nov 2005	A1
20050261779	Meyer	Nov 2005	A1
20050272976	Tanaka et al.	Dec 2005	A1
20050288672	Ferree	Dec 2005	A1
20060020278	Burnett et al.	Jan 2006	A1
20060036251	Reiley	Feb 2006	A1
20060036259	Carl et al.	Feb 2006	A1
20060036323	Carl et al.	Feb 2006	A1
20060036324	Sachs et al.	Feb 2006	A1
20060079897	Harrison et al.	Apr 2006	A1
20060116757	Lashinski et al.	Jun 2006	A1
20060124140	Forsell	Jun 2006	A1
20060136062	DiNello et al.	Jun 2006	A1
20060142634	Anstadt et al.	Jun 2006	A1
20060142767	Green et al.	Jun 2006	A1
20060155279	Ogilvie	Jul 2006	A1
20060155347	Forsell	Jul 2006	A1
20060184240	Jimenez et al.	Aug 2006	A1
20060184248	Edidin et al.	Aug 2006	A1
20060195102	Malandain	Aug 2006	A1
20060204156	Takehara et al.	Sep 2006	A1
20060211909	Anstadt et al.	Sep 2006	A1
20060235299	Martinelli	Oct 2006	A1
20060235424	Vitale et al.	Oct 2006	A1
20060241746	Shaoulian et al.	Oct 2006	A1
20060249914	Dulin	Nov 2006	A1
20060252983	Lembo et al.	Nov 2006	A1
20060271107	Harrison et al.	Nov 2006	A1
20060276812	Hill et al.	Dec 2006	A1
20060282073	Simanovsky	Dec 2006	A1
20060289014	Purdy et al.	Dec 2006	A1
20060293671	Heggeness	Dec 2006	A1
20060293683	Stauch	Dec 2006	A1
20070010814	Stauch	Jan 2007	A1
20070015955	Tsonton	Jan 2007	A1
20070021644	Woolson et al.	Jan 2007	A1
20070031131	Griffitts	Feb 2007	A1
20070038410	Tunay	Feb 2007	A1
20070043376	Leatherbury et al.	Feb 2007	A1
20070050030	Kim	Mar 2007	A1
20070055237	Edidin et al.	Mar 2007	A1
20070055368	Rhee et al.	Mar 2007	A1
20070118215	Moaddeb	May 2007	A1
20070135913	Moaddeb et al.	Jun 2007	A1
20070162032	Johnson et al.	Jul 2007	A1
20070163367	Sherman	Jul 2007	A1
20070173837	Chan et al.	Jul 2007	A1
20070173869	Gannoe et al.	Jul 2007	A1
20070179493	Kim	Aug 2007	A1
20070189461	Sommer	Aug 2007	A1
20070213751	Scirica et al.	Sep 2007	A1
20070239159	Altarac et al.	Oct 2007	A1
20070250084	Sharkawy et al.	Oct 2007	A1
20070255088	Jacobson et al.	Nov 2007	A1
20070256693	Paraschac et al.	Nov 2007	A1
20070260270	Assell et al.	Nov 2007	A1
20070264605	Belfor et al.	Nov 2007	A1
20070270631	Nelson et al.	Nov 2007	A1
20070276369	Allard et al.	Nov 2007	A1
20070276372	Malandain et al.	Nov 2007	A1
20070276373	Malandain	Nov 2007	A1
20070276493	Malandain et al.	Nov 2007	A1
20070288024	Gollogly	Dec 2007	A1
20070288183	Bulkes et al.	Dec 2007	A1
20080015577	Loeb	Jan 2008	A1
20080021454	Chao et al.	Jan 2008	A1
20080021455	Chao et al.	Jan 2008	A1
20080021456	Gupta et al.	Jan 2008	A1
20080033431	Jung et al.	Feb 2008	A1
20080051784	Gollogly	Feb 2008	A1
20080051895	Malandain et al.	Feb 2008	A1
20080058936	Malandain et al.	Mar 2008	A1
20080058937	Malandain et al.	Mar 2008	A1
20080065077	Ferree	Mar 2008	A1
20080065215	Reiley	Mar 2008	A1
20080066764	Paraschac et al.	Mar 2008	A1
20080071275	Ferree	Mar 2008	A1
20080071276	Ferree	Mar 2008	A1
20080082118	Edidin et al.	Apr 2008	A1
20080082167	Edidin et al.	Apr 2008	A1
20080083413	Forsell	Apr 2008	A1
20080086128	Lewis	Apr 2008	A1
20080091059	Machold et al.	Apr 2008	A1
20080097523	Bolduc et al.	Apr 2008	A1
20080108995	Conway et al.	May 2008	A1
20080140188	Randert et al.	Jun 2008	A1
20080147139	Barrett et al.	Jun 2008	A1
20080147192	Edidin et al.	Jun 2008	A1
20080161933	Grotz et al.	Jul 2008	A1
20080167685	Allard et al.	Jul 2008	A1
20080172063	Taylor	Jul 2008	A1
20080177319	Schwab	Jul 2008	A1
20080177326	Thompson	Jul 2008	A1
20080195156	Ainsworth et al.	Aug 2008	A1
20080226563	Contag et al.	Sep 2008	A1
20080228186	Gall et al.	Sep 2008	A1
20080255615	Vittur et al.	Oct 2008	A1
20080272928	Shuster	Nov 2008	A1
20080275552	Makower et al.	Nov 2008	A1
20080275555	Makower et al.	Nov 2008	A1
20080275557	Makower et al.	Nov 2008	A1
20080275567	Makower et al.	Nov 2008	A1
20080293995	Moaddeb et al.	Nov 2008	A1
20090076597	Dahlgren et al.	Mar 2009	A1
20090082815	Zylber et al.	Mar 2009	A1
20090088803	Justis et al.	Apr 2009	A1
20090093820	Trieu et al.	Apr 2009	A1
20090093890	Gelbart	Apr 2009	A1
20090118699	Utley et al.	May 2009	A1
20090171356	Klett	Jul 2009	A1
20090177203	Reiley	Jul 2009	A1
20090182356	Coe	Jul 2009	A1
20090192514	Feinberg et al.	Jul 2009	A1
20090198144	Phillips et al.	Aug 2009	A1
20090204055	Lennox et al.	Aug 2009	A1
20090216113	Meier et al.	Aug 2009	A1
20090216262	Burnett et al.	Aug 2009	A1
20090240173	Hsia et al.	Sep 2009	A1
20090259236	Burnett et al.	Oct 2009	A2
20090270871	Liu et al.	Oct 2009	A1
20090275984	Kim et al.	Nov 2009	A1
20090318919	Robinson	Dec 2009	A1
20100004654	Schmitz et al.	Jan 2010	A1
20100030281	Gollogly	Feb 2010	A1
20100057127	McGuire et al.	Mar 2010	A1
20100081868	Moaddeb et al.	Apr 2010	A1
20100100185	Trieu et al.	Apr 2010	A1
20100106192	Barry	Apr 2010	A1
20100106193	Barry	Apr 2010	A1
20100114103	Harrison et al.	May 2010	A1
20100121457	Clifford et al.	May 2010	A1
20100130941	Conlon et al.	May 2010	A1
20100137872	Kam et al.	Jun 2010	A1
20100145449	Makower et al.	Jun 2010	A1
20100145462	Ainsworth et al.	Jun 2010	A1
20100147314	Lees	Jun 2010	A1
20100168751	Anderson et al.	Jul 2010	A1
20100179601	Jung et al.	Jul 2010	A1
20100198261	Trieu et al.	Aug 2010	A1
20100217271	Pool et al.	Aug 2010	A1
20100228167	Ilovich et al.	Sep 2010	A1
20100241168	Franck et al.	Sep 2010	A1
20100249782	Durham	Sep 2010	A1
20100249839	Alamin et al.	Sep 2010	A1
20100249847	Jung et al.	Sep 2010	A1
20100256626	Muller et al.	Oct 2010	A1
20100274290	Jung et al.	Oct 2010	A1
20100286730	Gordon	Nov 2010	A1
20100286791	Goldsmith	Nov 2010	A1
20100318129	Seme et al.	Dec 2010	A1
20100324684	Eisermann et al.	Dec 2010	A1
20100331883	Schmitz et al.	Dec 2010	A1
20110004076	Janna et al.	Jan 2011	A1
20110057756	Marinescu et al.	Mar 2011	A1
20110060422	Makower et al.	Mar 2011	A1
20110098748	Jangra	Apr 2011	A1
20110130702	Stergiopulos	Jun 2011	A1
20110184505	Sharkawy et al.	Jul 2011	A1
20110196371	Forsell	Aug 2011	A1
20110196435	Forsell	Aug 2011	A1
20110202138	Shenoy et al.	Aug 2011	A1
20110230883	Zahrly et al.	Sep 2011	A1
20110237861	Pool	Sep 2011	A1
20110257655	Copf, Jr.	Oct 2011	A1
20110275879	Nelson et al.	Nov 2011	A1
20110284014	Cadeddu et al.	Nov 2011	A1
20120004494	Payne	Jan 2012	A1
20120019341	Gabay et al.	Jan 2012	A1
20120019342	Gabay et al.	Jan 2012	A1
20120053633	Stauch	Mar 2012	A1
20120088953	King	Apr 2012	A1
20120089186	Carl et al.	Apr 2012	A1
20120089191	Altarac et al.	Apr 2012	A1
20120109207	Trieu	May 2012	A1
20120116522	Makower et al.	May 2012	A1
20120116535	Ratron et al.	May 2012	A1
20120130426	Thompson	May 2012	A1
20120136449	Makower et al.	May 2012	A1
20120172883	Sayago	Jul 2012	A1
20120179273	Clifford et al.	Jul 2012	A1
20120185040	Rahdert et al.	Jul 2012	A1
20120221101	Moaddeb et al.	Aug 2012	A1
20120271353	Barry	Oct 2012	A1
20120277747	Keller	Nov 2012	A1
20120296234	Wilhelm et al.	Nov 2012	A1
20120312307	Paraschac et al.	Dec 2012	A1
20130013066	Landry et al.	Jan 2013	A1
20130018468	Moskowitz et al.	Jan 2013	A1
20130018469	Moskowitz et al.	Jan 2013	A1
20130023991	Moskowitz et al.	Jan 2013	A1
20130079830	Garamszegi et al.	Mar 2013	A1
20130138017	Jundt et al.	May 2013	A1
20130138154	Reiley	May 2013	A1
20130150889	Fening et al.	Jun 2013	A1
20130178903	Abdou	Jul 2013	A1
20130197639	Clifford et al.	Aug 2013	A1
20130204266	Heilman	Aug 2013	A1
20130204376	DiSilvestro et al.	Aug 2013	A1
20130238094	Voellmicke et al.	Sep 2013	A1
20130253587	Carls et al.	Sep 2013	A1
20130261623	Voellmicke et al.	Oct 2013	A1
20130261672	Horvath	Oct 2013	A1
20130296863	Globerman et al.	Nov 2013	A1
20130325006	Michelinie et al.	Dec 2013	A1
20130325071	Niemiec et al.	Dec 2013	A1
20130331889	Alamin et al.	Dec 2013	A1
20130345802	Cartledge et al.	Dec 2013	A1
20140018913	Cartledge et al.	Jan 2014	A1
20140031826	Bojarski et al.	Jan 2014	A1
20140031929	Cartledge et al.	Jan 2014	A1
20140039558	Alamin et al.	Feb 2014	A1
20140051914	Fobi et al.	Feb 2014	A1
20140052134	Orisek	Feb 2014	A1
20140058392	Mueckter et al.	Feb 2014	A1
20140058450	Arlet	Feb 2014	A1
20140067075	Makower et al.	Mar 2014	A1
20140080203	Wan et al.	Mar 2014	A1
20140107704	Serhan et al.	Apr 2014	A1
20140135838	Alamin et al.	May 2014	A1
20140142698	Landry et al.	May 2014	A1
20140163664	Goldsmith	Jun 2014	A1
20140172097	Clifford et al.	Jun 2014	A1
20140194932	Bruneau et al.	Jul 2014	A1
20140222138	Machold et al.	Aug 2014	A1
20140296918	Fening et al.	Oct 2014	A1
20140303539	Baym et al.	Oct 2014	A1
20140303540	Baym et al.	Oct 2014	A1
20140336756	Lee et al.	Nov 2014	A1
20140358150	Kaufman et al.	Dec 2014	A1
20150013687	Paraschac et al.	Jan 2015	A1
20150032109	Pool et al.	Jan 2015	A1
20150057490	Forsell	Feb 2015	A1
20150073565	Nelson et al.	Mar 2015	A1
20150105782	D'Lima et al.	Apr 2015	A1
20150105824	Moskowitz et al.	Apr 2015	A1
20150132174	Marinescu et al.	May 2015	A1
20150134007	Alamin et al.	May 2015	A1
20150142110	Myers et al.	May 2015	A1
20150150561	Burnett et al.	Jun 2015	A1
20150196332	Pool et al.	Jul 2015	A1
20150272600	Mehta et al.	Oct 2015	A1
20150313649	Alamin et al.	Nov 2015	A1
20150313745	Cheng	Nov 2015	A1

Foreign Referenced Citations (102)

Number	Date	Country
20068468	Mar 2001	AU
101040807	Sep 2007	CN
202505467	Nov 2015	CN
204744374	Nov 2015	CN
1541262	Jun 1969	DE
8515687	Dec 1985	DE
685156876	Dec 1985	DE
19626230	Jan 1998	DE
19751733	Dec 1998	DE
19745654	Apr 1999	DE
102005045070	Apr 2007	DE
102007053362	May 2009	DE
213290	Nov 2015	DE
0663184	Jul 1995	EP
1547549	Jun 2005	EP
1745765	Jan 2007	EP
1905388	Apr 2008	EP
2802406	Jun 2001	FR
2823663	Oct 2002	FR
2827756	Jan 2003	FR
2892617	May 2007	FR
2900563	Nov 2007	FR
2901991	Dec 2007	FR
2916622	Dec 2008	FR
2961386	Dec 2011	FR
1174814	Dec 1969	GB
1274470	Nov 2015	GB
223454	Apr 2002	HU
05-104022	Apr 1993	JP
09-056736	Mar 1997	JP
2001-507608	Jun 2001	JP
2003-172372	Jun 2003	JP
2003-530195	Oct 2003	JP
2007-050339	Mar 2007	JP
WO8604498	Aug 1986	WO
WO8707134	Dec 1987	WO
WO8906940	Aug 1989	WO
WO9601597	Jan 1996	WO
WO9808454	Mar 1998	WO
WO9830163	Jul 1998	WO
WO1998044858	Oct 1998	WO
WO9850309	Nov 1998	WO
WO9903348	Jan 1999	WO
WO9923744	May 1999	WO
WO9951160	Oct 1999	WO
WO1999051160	Oct 1999	WO
WO9963907	Dec 1999	WO
WO0000108	Jan 2000	WO
WO0072768	Dec 2000	WO
WO0105463	Jan 2001	WO
WO0112108	Feb 2001	WO
WO0124742	Apr 2001	WO
WO2001024697	Apr 2001	WO
WO0141671	Jun 2001	WO
WO0145485	Jun 2001	WO
WO0145487	Jun 2001	WO
WO0145597	Jun 2001	WO
WO0158390	Aug 2001	WO
WO0167973	Sep 2001	WO
WO0178614	Oct 2001	WO
WO0236975	May 2002	WO
WO03059215	Jul 2003	WO
WO2004014245	Feb 2004	WO
WO2004019796	Mar 2004	WO
WO2004021870	Mar 2004	WO
WO2004043280	May 2004	WO
WO2005023090	Mar 2005	WO
WO2005072195	Aug 2005	WO
WO2005072664	Aug 2005	WO
WO2005105001	Nov 2005	WO
WO2006019520	Feb 2006	WO
WO2006019521	Feb 2006	WO
WO2006089085	Aug 2006	WO
WO2006090380	Aug 2006	WO
WO2006103071	Oct 2006	WO
WO2006103074	Oct 2006	WO
WO2006105084	Oct 2006	WO
WO2007013059	Feb 2007	WO
WO2007015239	Feb 2007	WO
WO2007025191	Mar 2007	WO
WO2007048012	Apr 2007	WO
WO2007081304	Jul 2007	WO
WO2007118179	Oct 2007	WO
WO2007140180	Dec 2007	WO
WO2007149555	Dec 2007	WO
WO20071144489	Dec 2007	WO
WO2008003952	Jan 2008	WO
WO2008013623	Jan 2008	WO
WO2008015679	Feb 2008	WO
WO2008040880	Apr 2008	WO
WO2008140756	Nov 2008	WO
WO2010017649	Feb 2010	WO
WO2010050891	May 2010	WO
WO2010056650	May 2010	WO
WO2011018778	Feb 2011	WO
WO2011116158	Sep 2011	WO
WO2013119528	Aug 2013	WO
WO2013181329	Dec 2013	WO
WO2014040013	Mar 2014	WO
WO2011041398	Apr 2015	WO
WO0234131	Nov 2015	WO
WO2014070681	Nov 2015	WO

Non-Patent Literature Citations (103)

Entry
US 9,161,784 B2, 10/2015, Buttermann (withdrawn)
Abe, Jun, Kensei Nagata, Mamoru Ariyoshi, and Akio Inoue. “Experimental external fixation combined with percutaneous discectomy in the management of scoliosis.” Spine 24, No. 7 (1999): 646-653.
Amer, A. R. A. L., and Ashraf A. Khanfour. “Evaluation of treatment of late-onset tibia vara using gradual angulationtranslation high tibial osteotomy.” Acta orthopaedica Belgica 76, No. 3 (2010): 360.
Angrisani, L., F. Favretti, F. Furbetta, S. Gennai, G. Segato, V. Borrelli, A. Sergio, T. Lafullarde, G. Vander Velpen, and M Lorenzo. “Lap-Band ((R)) Rapid Port (TM) System: Preliminary results in 21 patients.” In Obesity Surgery, vol. 15, No. 7,pp. 936-936.
Baumgart, Rainer, Stefan Hinterwimmer, Michael Krammer, Oliver Muensterer, and Wolf Mutschler. “The bioexpandable prosthesis: a new perspective after resection of malignant bone tumors in children.” Journal of pediatric hematology/oncology 27, No. 8 (2005): 452-455.
Baumgart, R., P. Thaller, S. Hinterwimmer, M. Krammer, T. Hierl, and W. Mutschler. “A fully implantable, programmable distraction nail (Fitbone)—new perspectives for corrective and reconstructive limb surgery.” In Practice of Intramedullary Locked Nails, pp. 189-198. Springer Berlin Heidelberg, 2006.
Bodó, László, László Hangody, Balázs Borsitzky, György Béres, Gabriella Arató, Péter Nagy, and Gábor K. Ráthonyi. “Development of a tension-adjustable implant for anterior cruciate ligament reconstruction.” Eklem Hast Cerrahisi 19, No. 1 (2008): 27-32.
Boudjemline, Younes, Emmanuelle Pineau, Caroline Bonnet, Alix Mollet, Sylvia Abadir, Damien Bonnet, Daniel Sidi, and Gabriella Agnoletti. “Off-label use of an adjustable gastric banding system for pulmonary artery banding.” The Journal of thoracic and cardiovascular surgery 131, No. 5 (2006): 1130-1135.
Brochure-VEPTR II Technique Guide Apr. 2008.
Brochure-VEPTR Patient Guide dated Feb. 2005.
Brown, S. “Single Port Surgery and the Dundee Endocone.” SAGES Annual Scientific Sessions, Poster Abstracts (2007): 323-324.
Buchowski, Jacob M., Rishi Bhatnagar, David L. Skaggs, and Paul D. Sponseller. “Temporary internal distraction as an aid to correction of severe scoliosis.” The Journal of Bone & Joint Surgery 88, No. 9 (2006): 2035-2041.
Burghardt, R. D., J. E. Herzenberg, S. C. Specht, and D. Paley. “Mechanical failure of the Intramedullary Skeletal Kinetic Distractor in limb lengthening.” Journal of Bone & Joint Surgery, British vol. 93, No. 5 (2011): 639-643.
Burke, John Gerard. “Design of a minimally invasive non fusion device for the surgical management of scoliosis in the skeletally immature.” Studies in health technology and informatics 123 (2005): 378-384.
Carter, D. R., and W. E. Caler. “A cumulative damage model for bone fracture.” Journal of Orthopaedic Research 3, No. 1 (1985): 84-90.
Chapman, Andrew E., George Kiroff, Philip Game, Bruce Foster, Paul O'Brien, John Ham, and Guy J. Maddern. “Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review.” Surgery 135, No. 3 (2004): 326-351.
Cole, J. Dean, Daniel Justin, Tagus Kasparis, Derk DeVlught, and Carl Knobloch. “The intramedullary skeletal distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia.” Injury 32 (2001):129-139.
Cole, J., D. Paley, and M. Dahl. “Operative Technique. ISKD. Intramedullary Skeletal Kinetic Distractor. Tibial Surgical Technique.” IS-0508 (A)-OPT-US© Orthofix Inc 28 (2005).
Dailey, Hannah L., Charles J. Daly, John G. Galbraith, Michael Cronin, and James A. Harty. “A novel intramedullary nail for micromotion stimulation of tibial fractures.” Clinical Biomechanics 27, No. 2 (2012): 182-188.
Daniels, A. U., Patrick Gemperline, Allen R. Grahn, and Harold K. Dunn. “A new method for continuous intraoperative measurement of Harrington rod loading patterns.” Annals of biomedical engineering 12, No. 3 (1984): 233-246.
De Giorgi, G., G. Stella, S. Becchetti, G. Martucci, and D. Miscioscia. “Cotrel-Dubousset instrumentation for the treatment of severe scoliosis.” European Spine Journal 8, No. 1 (1999): 8-15.
Dorsey, W. O., Bruce S. Miller, Jared P. Tadje, and Cari R. Bryant. “The stability of three commercially available implants used in medial opening wedge high tibial osteotomy.” The journal of knee surgery 19, No. 2 (2006): 95-98.
Edeland, H. G., G. Eriksson, and E. Dahlberg. “Instrumentation for distraction by limited surgery in scoliosis treatment.” Journal of biomedical engineering 3, No. 2 (1981): 143-146.
Ember, T., and H. Noordeen. “Distraction forces required during growth rod lengthening.” Journal of Bone & Joint Surgery, British vol. 88, No. SUPP II (2006): 229-229.
Fabry, Hans, Robrecht Van Hee, Leo Hendrickx, and Eric Totté. “A technique for prevention of port adjustable silicone gastric banding.” Obesity surgery 12, No. 2 (2002): 285-288.
Fried, M., W. Lechner, and K. Kormanova. “In vivo measurements of different gastric band pressures towards the gastric wall at the stoma region.” In Obesity Surgery, vol. 14, No. 7, pp. 914-914. 3100 Bayview Ave, Unit 4, Toronto, Ontario M2N 5L3, Canada: F D-Communications Inc, 2004.
Gao, Xiaochong, Derek Gordon, Dongping Zhang, Richard Browne, Cynthia Helms, Joseph Gillum, Samuel Weber et al. “CHD7 gene polymorphisms are associated with susceptibility to idiopathic scoliosis.” The American Journal of Human Genetics 80, No. 5 (2007): 957-965.
Gebhart, M., M. Neel, A. Soubeiran, and J. Dubousset. “Early clinical experience with a custom made growing endoprosthesis in children with malignant bone tumors of the lower extremity actioned by an external permanent magnet: the Phenix M system.” In International Society of Limb Salvage 14th International Symposium on Limb Salvage.2007.
Gillespie, R., and J. Obrien. “Harrington instrumentation without fusion.” In Journal of Bone and Joint Surgerybritish Volume, vol. 63, No. 3, pp. 461-461. 22 Buckingham Street, London, England WC2N 6ET: British Editorial Soc Bone Joint Surgery, 1981.
Goodship, Allen E., James L. Cunningham, and John Kenwright. “Strain rate and timing of stimulation in mechanical modulation of fracture healing.” Clinical orthopaedics and related research 355 (1998): S105-S115.
Grass, P. Jose, A. Valentin Soto, and H. Paula Araya. “Intermittent distracting rod for correction of high neurologic risk congenital scoliosis.” Spine 22, No. 16 (1997): 1922-1927.
Gray's Anatomy, http://education.yahoo.com/reference/gray/subjects/subject/128, published Jul. 1, 2007.
Grimer, R., S. Carter, R. Tillman, A. Abudu, and L. Jeys. “Non-Invasive Extendable Endoprostheses for Children-Expensive but Worth It!.” Journal of Bone & Joint Surgery, British vol. 93, No. Supp I (2011): 5-5.
Grünert, R. D. “[The development of a totally implantable electronic sphincter].” Langenbecks Archiv fur Chirurgie 325 (1968): 1170-1174.
Guichet, Jean-Marc, Barbara Deromedis, Leo T. Donnan, Giovanni Peretti, Pierre Lascombes, and Flavio Bado. “Gradual femoral lengthening with the Albizzia intramedullary nail.” The Journal of Bone & Joint Surgery 85, No. 5 (2003): 838-848.
Gupta, A., J. Meswania, R. Pollock, S. R. Cannon, T. W. R. Briggs, S. Taylor, and G. Blunn. “Non-invasive distal femoral expandable endoprosthesis for limb-salvage surgery in paediatric tumours.” Journal of Bone & Joint Surgery, British vol. 88, No. 5 (2006): 649-654.
Hankemeier S, Gösling T, Pape HC, et al. Limb lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD) Oper Orthop Traumatol. 2005;17:79-101.
Harrington PR (1962) Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am 44-A:591-610.
Hazem Elsebaie, M. D. “Single Growing Rods.” Changing the Foundations: Does it affect the Results., J Child Orthop. (2007) 1:258.
Hennig, Alex C.; Incavo, Stephen J.; Beynnon, Bruce D.; Abate, Joseph A.; Urse, John S.; Kelly, Stephen / The safety and efficacy of a new adjustable plate used for proximal tibial opening wedge osteotomy in the treatment of unicompartmental knee osteoarthrosis. In: The journal of knee surgery, vol. 20, No. 1, Jan. 1, 2007, p. 6-14.
Hofmeister, M., C. Hierholzer, and V. Bühren. “Callus Distraction with the Albizzia Nail.” In Practice of Intramedullary Locked Nails, pp. 211-215. Springer Berlin Heidelberg, 2006.
Horbach, T., D. Herzog, and I. Knerr. “First experiences with the routine use of the Rapid Port (TM) system with the Lap- Band (R).” In Obesity Surgery, vol. 16, No. 4, pp. 418-418. 3100 Bayview Ave, Unit 4, Toronto, Ontario M2N 5L3, Canada: F D-Communications Inc, 2006.
Hyodo, Akira, Helmuth Kotschi, Helen Kambic, and George Muschler. “Bone transport using intramedullary fixation and a single flexible traction cable.” Clinical orthopaedics and related research 325 (1996): 256-268.
Ahlbom, A., U. Bergqvist, J. H. Bernhardt, J. P. Cesarini, M. Grandolfo, M. Hietanen, A. F. Mckinlay et al. “Guidelines for limiting exposure to time-varying electric, magnetic, and electromagnetic fields (up to 300 GHz). International Commission on Non-Ionizing Radiation Protection.” Health Phys 74, No. 4 (1998): 494-522.
International Commission on Non-Ionizing Radiation Protection. “Guidelines on limits of exposure to static magnetic fields.” Health Physics 96, No. 4 (2009): 504-514.
INVIS®/Lamello Catalog, 2006, Article No. 68906A001 GB.
Kasliwal, Manish K., Justin S. Smith, Adam Kanter, Ching-Jen Chen, Praveen V. Mummaneni, Robert A. Hart, and Christopher I. Shaffrey. “Management of high-grade spondylolisthesis.” Neurosurgery Clinics of North America 24, No. 2 (2013): 275-291.
Kenawey, Mohamed, Christian Krettek, Emmanouil Liodakis, Ulrich Wiebking, and Stefan Hankemeier. “Leg lengthening using intramedullay skeletal kinetic distractor: results of 57 consecutive applications.” Injury 42, No. 2 (2011): 150-155.
Kent, Matthew E., Arvind Arora, P. Julian Owen, and Vikas Khanduja. “Assessment and correction of femoral malrotation following intramedullary nailing of the femur.” Acta Orthop Belg 76, No. 5 (2010): 580-4.
Klemme, William R., Francis Denis, Robert B. Winter, John W. Lonstein, and Steven E. Koop. “Spinal instrumentation without fusion for progressive scoliosis in young children.” Journal of Pediatric Orthopaedics 17, No. 6 (1997): 734-742.
Korenkov, M., S. Sauerland, N. Yücel, L. Köhler, P. Goh, J. Schierholz, and H. Troidl. “Port function after laparoscopic adjustable gastric banding for morbid obesity.” Surgical Endoscopy And Other Interventional Techniques 17, No. 7 (2003): 1068-1071.
Krieg, Andreas H., Bernhard M. Speth, and Bruce K. Foster. “Leg lengthening with a motorized nail in adolescents.” Clinical orthopaedics and related research 466, No. 1 (2008): 189-197.
Kucukkaya, Metin, Raffi Armagan, and Unal Kuzgun. “The new intramedullary cable bone transport technique.” Journal of orthopaedic trauma 23, No. 7 (2009): 531-536.
Lechner, W. L., W. Kirchmayr, and G. Schwab. “In vivo band manometry: a new method in band adjustment.” In Obesity Surgery, vol. 15, No. 7, pp. 935-935. 3100 Bayview Ave, Unit 4, Toronto, Ontario M2N 5L3, Canada: F D-Communicationsinc, 2005.
Lechner, W., M. Gadenstatter, R. Ciovica, W. Kirchmayer, and G. Schwab. “Intra-band manometry for band adjustments: The basics.” In Obesity Surgery, vol. 16, No. 4, pp. 417-418. 3100 Bayview Ave, Unit 4, Toronto, Ontario M2N 5L3, Canada: F D-Communications Inc, 2006.
Li, G., S. Berven, N. A. Athanasou, and A. H. R. W. Simpson. “Bone transport over an intramedullary nail: A case report with histologic examination of the regenerated segment.” Injury 30, No. 8 (1999): 525-534.
Lonner, Baron S. “Emerging minimally invasive technologies for the management of scoliosis.” Orthopedic Clinics of North America 38, No. 3 (2007): 431-440.
Teli, Marco MD. “Measurement of Forces Generated During Distraction of Growing Rods, J.” Marco Teli. Journal of Child Orthop 1 (2007): 257-258.
Matthews, Michael Wayne, Harry Conrad Eggleston, Steven D. Pekarek, and Greg Eugene Hilmas. “Magnetically adjustable intraocular lens.” Journal of Cataract & Refractive Surgery 29, No. 11 (2003): 2211-2216.
Micromotion “Micro Drive Engineering•General catalogue” pp. 14•24; Jun. 2009.
Mineiro, Jorge, and Stuart L. Weinstein. “Subcutaneous rodding for progressive spinal curvatures: early results.” Journal of Pediatric Orthopaedics 22, No. 3 (2002): 290-295.
Moe, John H., Khalil Kharrat, Robert B. Winter, and John L. Cummine. “Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children.” Clinical orthopaedics and related research 185 (1984): 35-45.
Montague, R. G., C. M. Bingham, and K. Atallah. “Magnetic gear dynamics for servo control.” In MELECON 2010-2010 15th IEEE Mediterranean Electrotechnical Conference, pp. 1192-1197. IEEE, 2010.
Montague, Ryan, Chris Bingham, and Kais Atallah. “Servo control of magnetic gears.” Mechatronics, IEEE/ASME Transactions on 17, No. 2 (2012): 269-278.
Nachemson, Alf, and Gösta Elfström. “Intravital wireless telemetry of axial forces in Harrington distraction rods in patients with idiopathic scoliosis.” The Journal of Bone & Joint Surgery 53, No. 3 (1971): 445-465.
Nachlas, I. William, and Jesse N. Borden. “The cure of experimental scoliosis by directed growth control.” The Journal of Bone & Joint Surgery 33, No. 1 (1951): 24-34.
Newton, P. “Fusionless Scoliosis Correction by Anterolateral Tethering . . . Can it Work?.” In 39th Annual Scoliosis Research Society Meeting. 2004.
Observations by a third party under Article 115 EPC issued by the European Patent Office dated Feb. 15, 2010 in European Patent Application No. 08805612.2, Applicant: Soubeiran, Arnaud (7 pages).
Oh, Chang-Wug, Hae-Ryong Song, Jae-Young Roh, Jong-Keon Oh, Woo-Kie Min, Hee-Soo Kyung, Joon-Woo Kim, Poong- Taek Kim, and Joo-Chul Ihn. “Bone transport over an intramedullary nail for reconstruction of long bone defects in tibia.” Archives of orthopaedic and trauma surgery 128, No. 8 (2008): 801-808.
Ozcivici, Engin, Yen Kim Luu, Ben Adler, Yi-Xian Qin, Janet Rubin, Stefan Judex, and Clinton T. Rubin. “Mechanical signals as anabolic agents in bone.” Nature Reviews Rheumatology 6, No. 1 (2010): 50-59.
Patient Guide, VEPTR Vertical Expandable Prosthetic Titanium Rib, Synthes Spine (2005) (23pages).
Piorkowski, James R., Scott J. Ellner, Arun A. Mavanur, and Carlos A. Barba. “Preventing port site inversion in laparoscopic adjustable gastric banding.” Surgery for Obesity and Related Diseases 3, No. 2 (2007): 159-161.
Prontes, Isabel, http://wwwehow.com/about_4795793_longest-bone-body.html, published Jun. 12, 2012.
Rathjen, Karl, Megan Wood, Anna McClung, and Zachary Vest. “Clinical and radiographic results after implant removal in idiopathic scoliosis.” Spine 32, No. 20 (2007): 2184-2188.
Ren, Christine J., and George A. Fielding. “Laparoscopic adjustable gastric banding: surgical technique.” Journal of Laparoendoscopic & Advanced Surgical Techniques 13, No. 4 (2003): 257-263.
Reyes-Sánchez, Alejandro, Luis Miguel Rosales, and Víctor Miramontes. “External fixation for dynamic correction of severe scoliosis.” The Spine Journal 5, No. 4 (2005): 418-426.
Rinsky, Lawrence A., James G. Gamble, and Eugene E. Bleck. “Segmental Instrumentation Without Fusion in Children With Progressive Scoliosis.” Journal of Pediatric Orthopedics 5, No. 6 (1985): 687-690.
Rode, V., F. Gay, A. J. Baraza, and J. Dargent. “A simple way to adjust bands under radiologic control.” In Obesity Surgery, vol. 16, No. 4, pp. 418-418. 3100 Bayview Ave, Unit 4, Toronto, Ontario M2N 5L3, Canada: F Dcommunications Inc, 2006.
Schmerling, M. A., M. A. Wilkov, A. E. Sanders, and J. E. Woosley. “Using the shape recovery of nitinol in the Harrington rod treatment of scoliosis.” Journal of biomedical materials research 10, No. 6 (1976): 879-892.
Scott, D. J., S. J. Tang, R. Fernandez, R. Bergs, and J. A. Cadeddu. “Transgastric, transcolonic, and transvaginal cholecystectomy using magnetically anchored instruments.” In SAGES Meeting, p. P511. 2007.
Sharke, Paul. “The machinery of life.” Mechanical Engineering 126, No. 2 (2004): 30.
Shiha, Anis, Mohamed Alam El-Deen, Abdel Rahman Khalifa, and Mohamed Kenawey. “Ilizarov gradual correction of genu varum deformity in adults.” Acta Orthop Belg 75 (2009): 784-91.
Simpson, A. H. W. R., H. Shalaby, and G. Keenan. “Femoral lengthening with the intramedullary skeletal kinetic distractor.” Journal of Bone & Joint Surgery, British vol. 91, No. 7 (2009): 955-961.
Smith, John T. “The use of growth-sparing instrumentation in pediatric spinal deformity.” Orthopedic Clinics of North America 38, No. 4 (2007): 547-552.
Soubeiran, A., M. Gebhart, L. Miladi, J. Griffet, M. Neel, and J. Dubousset. “The Phenix M System. A Mechanical Fully Implanted Lengthening Device Externally Controllable Through the Skin with a Palm Size Permanent Magnet; Applications to Pediatric Orthopaedics.” In 6th European Research Conference in Pediatric Orthopaedics. 2006.
Stokes, Oliver M., Elizabeth J. O'Donovan, Dino Samartzis, Cora H. Bow, Keith DK Luk, and Kenneth MC Cheung. Reducing radiation exposure in early-onset scoliosis surgery patients: novel use of ultrasonography to measure lengthening in magnet.
Sun, Zongyang, Katherine L. Rafferty, Mark A. Egbert, and Susan W. Herring. “Masticatory mechanics of a mandibular distraction osteogenesis site: interfragmentary micromovement.” Bone 41, No. 2 (2007): 188-196.
Takaso, Masashi, Hideshige Moriya, Hiroshi Kitahara, Shohei Minami, Kazuhisa Takahashi, Keijiro Isobe, Masatsune Yamagata, Yoshinori Otsuka, Yoshinori Nakata, and Masatoshi Inoue. “New remote-controlled growing-rod spinal instrumentation possibly applicable for scoliosis in young children.” Journal of orthopaedic science 3, No. 6 (1998): 336-340.
Tello, Carlos A. “Harrington instrumentation without arthrodesis and consecutive distraction program for young children with severe spinal deformities. Experience and technical details.” The Orthopedic clinics of North America 25, No. 2 (1994): 333-351.
Thaller, Peter Helmut, Julian Fürmetz, Florian Wolf, Thorsten Eilers, and Wolf Mutschler. “Limb lengthening with fully implantable magnetically actuated mechanical nails (PHENIX®)—Preliminary results.” Injury 45 (2014): S60-S65.
Thompson, George H., Lawrence G. Lenke, Behrooz A. Akbarnia, Richard E. McCarthy, and Robert M. Campbell. “Early onset scoliosis: future directions.” The Journal of Bone & Joint Surgery 89, No. suppl 1 (2007): 163-166.
Thonse, Raghuram, John E. Herzenberg, Shawn C. Standard, and Dror Paley. “Limb lengthening with a fully implantable, telescopic, intramedullary nail.” Operative Techniques in Orthopedics 15, No. 4 (2005): 355-362.
Trias, A., P. Bourassa, and M. Massoud. “Dynamic loads experienced in correction of idiopathic scoliosis using two types of Harrington rods.” Spine 4, No. 3 (1978): 228-235.
VEPTR II. Vertical Expandable Prosthetic Titanium Rib II, Technique Guide, Systhes Spine (2008) (40 pages).
Verkerke, G. J., Koops H. Schraffordt, R. P. Veth, H. J. Grootenboer, L. J. De Boer, J. Oldhoff, and A. Postma. “Development and test of an extendable endoprosthesis for bone reconstruction in the leg.” The International journal of artificial organs 17, No. 3 (1994): 155-162.
Verkerke, G. J., H. Schraffordt Koops, R. P. H. Veth, J. Oldhoff, H. K. L. Nielsen, H. H. Van den Kroonenberg, H. J. Grootenboer, and F. M. Van Krieken. “Design of a lengthening element for a modular femur endoprosthetic system.” Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 203, No. 2 (1989): 97-102.
Verkerke, G. J., H. Schraffordt Koops, R. P. H. Veth, H. H. van den Kroonenberg, H. J. Grootenboer, H. K. L. Nielsen, J. Oldhoff, and A. Postma. “An extendable modular endoprosthetic system for bone tumour management in the leg.” Journal of biomedical engineering 12, No. 2 (1990): 91-96.
Weiner, Rudolph A., Michael Korenkov, Esther Matzig, Sylvia Weiner, and Woiteck K. Karcz. “Initial clinical experience with telemetrically adjustable gastric banding.” Surgical technology international 15 (2005): 63-69.
Wenger, H. L. “Spine Jack Operation in the Correction of Scoliotic Deformity: A Direct Intrathoracic Attack to Straighten the Laterally Bent Spine: Preliminary Report.” Archives of Surgery 83, No. 6 (1961): 901-910.
White III, Augustus A., and Manohar M. Panjabi. “The clinical biomechanics of scoliosis.” Clinical orthopaedics and related research 118 (1976): 100-112.
Yonnet, Jean-Paul. “Passive magnetic bearings with permanent magnets.” Magnetics, IEEE Transactions on 14, No. 5 (1978): 803-805.
Yonnet, Jean-Paul. “A new type of permanent magnet coupling.” Magnetics, IEEE Transactions on 17, No. 6 (1981): 2991-2993.
Zheng, Pan, Yousef Haik, Mohammad Kilani, and Ching-Jen Chen. “Force and torque characteristics for magnetically driven blood pump.” Journal of Magnetism and Magnetic Materials 241, No. 2 (2002): 292-302.

Related Publications (1)

	Number	Date	Country
	20180353215 A1	Dec 2018	US

Provisional Applications (2)

	Number	Date	Country
	62276196	Jan 2016	US
	62265430	Dec 2015	US

Continuations (1)

	Number	Date	Country
Parent	PCT/US2016/066179	Dec 2016	US
Child	16004099		US

External adjustment device for distraction device

Information

Patent Number

Date Filed

Date Issued

Inventors

Original Assignees

Examiners

Agents

CPC

Field of Search

US

CPC

International Classifications

Term Extension

Abstract