Facet device and method

Information

  • Patent Grant
  • 8114158
  • Patent Number
    8,114,158
  • Date Filed
    Tuesday, July 8, 2008
    16 years ago
  • Date Issued
    Tuesday, February 14, 2012
    12 years ago
Abstract
A spine prosthesis is provided and in particular, related to the facet joint of a spine. A spinal implant comprises a facet prosthesis including an insert to be positioned within a joint capsule between facets of a zygapophyseal joint. The insert may comprise a member having two opposing facet interfacing portions. A facet prosthesis exerts a distraction force between facets of a facet joint and may comprise a curable material to be injected into the facet joint. A facet prosthesis may also comprise a pair of magnets, each magnet coupled to a facet and oriented with like poles facing each other to provide a distracting force away from each other. A spine implant may also include an insert to be positioned within the joint capsule, a securing member comprising an elongate portion extending through part of a facet, and an anchor to anchor the securing member to the facet.
Description
FIELD OF THE INVENTION

The invention relates to devices to treat the spine, in particular in association with a facet joint, including but not limited to spinal stabilization devices, spinal distraction devices, spinal prostheses, devices to treat pain associated with the spine, and other spinal treatment devices.


DESCRIPTION OF THE RELATED ART

Certain spine conditions, defects, deformities (e.g., scoliosis) as well as injuries may lead to structural instabilities, nerve or spinal cord damage, pain or other manifestations. Back pain (e.g., pain associated with the spinal column or mechanical back pain) may be caused by structural defects, by injuries or over the course of time from the aging process. For example, back pain is frequently caused by repetitive and/or high stress loads on or increased motion around certain boney or soft tissue structures. The natural course of aging leads to degeneration of the disc, loss of disc height, and instability of the spine among other structural manifestations at or around the spine. With disc degeneration, the posterior elements of the spine bear increased loads with disc height loss, and subsequently attempt to compensate with the formation of osteophytes and thickening of various stabilizing spinal ligaments. The facet joints may develop pain due to arthritic changes caused by increased loads. Furthermore, osteophytes in the neural foramina and thickening of spinal ligaments can lead to spinal stenosis, or impingement of nerve roots in the spinal canal or neural foramina. Scoliosis also creates disproportionate loading on various elements of the spine and may require correction, stabilization or fusion.


Pain caused by abnormal motion of the spine has long been treated by fixation of the motion segment. Spinal fusion is one way of stabilizing the spine to reduce pain. In general, it is believed that anterior interbody or posterior fusion prevents movement between one or more joints where pain is occurring from irritating motion. Fusion typically involves removal of the native disc, packing bone graft material into the resulting intervertebral space, and anterior stabilization, e.g., with intervertebral fusion cages or posterior stabilization, e.g., supporting the spinal column with internal fixation devices such as rods and screws. Internal fixation is typically an adjunct to attain intervertebral fusion. Many types of spine implants are available for performing spinal fixation, including the Harrington hook and rod, pedicle screws and rods, interbody fusion cages, and sublaminar wires.


Alternatives have been proposed and tested to replace the need for spinal fusion to treat patients with back pain. These implants include artificial discs and artificial nucleus technologies that preserve motion. However, these implants do not directly address the forces borne by the facet joints.


The facet joints provide a means for load transmission, support and motion of the posterior spinal column. Disc height loss from degenerative disc disease and aging leads to increased load on the facet joints, which can lead to arthritic, painful, degenerative changes.


Often over the course of degenerative disc disease there is a narrowing of the neural foramen through which the nerves exit the spine. In addition to the degeneration of discs causing the narrowing of the foramen, there is also calcification around the foramen causing further narrowing or stenosis resulting in pain to the patient. Currently, these conditions may be treated by removing some or all of the lamina (laminectomy) or posterior bone adjacent or around the stenotic neural foramen


Given that the facet joint and its environs is a source of pain for some patients, some procedures have been developed or proposed to relieve pain associated with the facet joint. Partial or complete removal of the pathological facets, and replacement with a mechanical joint that preserves motion similar to a facet has been proposed. Additionally, individual degenerative facet articulations have been replaced with caps.


It would be desirable to provide improved devices and methods for relieving pain associated with the facet joints.


Spinal stenosis pain or from impingement of nerve roots in the neural foramina has been treated by laminectomy and foraminotomy, and sometimes reinforced with rod and screw fixation of the posterior spine.


More recently, as an alternative to laminectomies and related procedures, implants have been proposed that distract the spine from a posterior approach. In particular, a wedge-like implant inserted between two adjacent spinous processes has been proposed to relieve pressure on spinal nerves and nerve roots. A kyphosis is induced, which opens the space of the spinal canal and neural foramen, thereby reducing the effect of spinal stenosis. However, this type of distraction of adjacent spinous processes is suboptimal for several reasons: The resulting kyphosis is non-physiologic, leading to increased load on the anterior portion of the disc and the vertebral bodies. This can increase the risk of disc degeneration and vertebral compression fracture. The implant tends to bend the spine forward. The spinous processes may fracture due to the distraction forces of the wedge implant. Bone may collapse around the spinous process. The implant may weaken, tear, or stretch stabilizing ligaments of the spine, such as the supraspinous ligament, interspinous ligament, ligamentum flavum, posterior longitudinal ligament, or capsule of the zygapophyseal joint. The amount of distraction is not adjustable to the specific amount of stenosis, and cannot be easily readjusted months to years after the device has been implanted.


It would accordingly be desirable to provide a distraction device that reduces or avoids some or all of these issues.


Pain due to instability of the spine has also been treated with dynamic stabilization of the posterior spine, using elastic bands that connect pedicles of adjacent vertebrae.


The typical techniques for fusion, decompression, and dynamic stabilization require open surgical procedures with removal of stabilizing muscles from the spinal column, leading to pain, blood loss, and prolonged recovery periods after surgery due in part to the disruption of associated body structures or tissue during the procedures.


Accordingly, it would be desirable to provide less invasive devices and methods for treating pain or discomfort associated with the spinal column. It would also be desirable to provide such devices and methods that are less damaging to associated tissue.


Spine surgeons commonly use metallic or polymeric implants to effect or augment the biomechanics of the spine. The implants frequently are attached or anchored to bone of the spine. Sites typically considered appropriate for boney attachment have high density or surface area, such as, for example, the pedicle bone, the vertebral body or the cortical bone of the lamina. The spinous process contains thin walls of cortical bone, and thus, has been considered as not ideal for anchoring spinal implants as they may not support the implants under physiologic loads, or the intermittent high loads seen in traumatic situations. Fixation has been attempted from spinous process to spinous process with poor results.


A translaminar facet screw as used by some surgeons goes through the base of spinous process to access the cancellous bone of the lamina. A disadvantage of this device is that it is not suitable for attaching to a pedicle screw and the depth and angle during deployment can be very difficult to track or visualize, thus increasing the possibility that the screw would extend into the spinal canal. A facet screw is screwed between opposing facets of a zygapophyseal joint.


SUMMARY OF THE INVENTION

One aspect of the present invention is directed to providing a device and method for alleviating discomfort and or deformity associated with the spinal column. Another aspect of the present invention is directed to providing a minimally invasive implant and method for alleviating discomfort associated with the spinal column. Another aspect of the present invention provides an anchoring device and method that requires less surrounding tissue damage or disruption. Other aspects of the invention may supplement or bear load for degenerated or painful joints, e.g., the facet joint.


One aspect of the invention provides for repair or reconstruction of a dysfunctional facet joint. For example, by entering the capsule of the facet joint, creating a space between articulating facets by removing synovium, cartilage, and some bone from within the zygapophysial joint, and, then, inserting a motion preserving prosthesis. Motion preserving prostheses may include a smooth and/or curved surface, a sphere, an egg shaped/oval implant, or a self contained “ball and socket” joint. Magnetic plates with like poles facing each other may be attached to interfacing articulating portions of the facets. Attachment of the motion preserving prosthesis may involve extensions from the prosthesis that partially or completely penetrate each of the facets.


Another aspect of the invention provides for repairing the encapsulating ligaments with suture, adhesive, a patch, or other materials after a capsule of the zygapophysial joint has been invaded for tissue removal and insertion of a prosthesis. One aspect of the invention includes an elastic encapsulating wrap used to stabilize the facet joints.


According to an embodiment of the invention, a facet distraction implant is provided for maintaining a space that is formed between the facet articulations of adjacent vertebrae when the joints are distracted. The facets may be distracted using a known distraction method or technique and an implant may be placed between the facets. A securing device according to the invention may be positioned to anchor each of the facet articulations of a facet joint to each other in distraction to maintain the opening of the corresponding neural foramen. The prosthesis may include a distraction element that exerts a distracting force on the joint.


Various aspects of the invention are set forth in the description and/or claims herein.





BRIEF DESCRIPTION OF THE DRAWINGS


FIG. 1 is a schematic side view of a facet implant in accordance with the invention.



FIG. 2 is a schematic side view of a facet implant in accordance with the invention.



FIG. 3 is a schematic posterior lateral perspective view of a facet implant in accordance with the invention.



FIG. 4 is a side partial cross section of a facet implant in accordance with the invention.



FIG. 5 is a side partial cross section of a facet implant in accordance with the invention.



FIG. 6 is a schematic posterior lateral perspective view of a stenotic neural foramen of a posterior spine.



FIG. 7 is a schematic posterior lateral view of a facet implant in accordance with the invention.



FIG. 8 is a side schematic view of a facet implant in accordance with the invention.



FIG. 9 is a side schematic view of a facet implant in accordance with the invention.



FIG. 10 is a side schematic view of a facet implant in accordance with the invention.



FIG. 11 is a side schematic view of a facet implant in accordance with the invention.



FIG. 12 is a side schematic view of a facet implant in accordance with the invention.



FIG. 13 is a side schematic view of a facet implant in accordance with the invention.





DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT


FIGS. 1-5 illustrate facet repair prostheses in accordance with an embodiment of the invention. Prosthesis 410 comprises a ball bearing 411 implanted between the caudal and the cephalic facets 412, 413 of the zygapopyhseal joint. (FIG. 1) The joint is prepared by removing soft tissue between the joints and creating a concavity on adjacent facet plates for receiving the ball bearing.


In FIG. 2, magnets 415, 416 including smooth interacting bearing surfaces are respectively screwed into the cephalic and caudal facets 417, 418 of the zygapopyhseal joint 419. The magnets 415, 416 are oriented so that like poles face each other (e.g. North-North or South-South) to provide a distraction force at the joint. The magnets may have a center hole through which a rod is inserted to resist the tendency of one magnet to move relative to the other. Each end of the rod may have a diameter larger than the center holes. This system may be used in other joints in the body to maintain separation between the joints.


Referring to FIG. 3, a joint prosthesis 420 is positioned between the cephalic and caudal facets 426, 427. The prosthesis comprises a ball 421 providing a bearing surface for the motion of the facets 426, 427, and opposing posts 422, 423 screwed in or otherwise implanted in the facets 426, 427, respectively for securing the ball 421 within the joint. The ball 421 may include openings for receiving the posts, e.g., in a tapered interference type fitting, to secure the posts 422, 423 to the ball 421 and to secure the ball 421 within the joint.


This facet repair may be performed percutaneously or via minimally invasive surgical techniques, for example using percutaneously positioned distracting instruments to distract the joint, for example, an expanding balloon or forceps like distractors. Using a hollow needle percutaneously positioned into the joint an expandable or self-expanding facet distraction implant may be placed in position through the hollow lumen of the needle into the joint. A polymer material may be injected into the joint through a percutaneously inserted needle.



FIG. 4 illustrates a material 440 such as a polymer injected between the cephalic and caudal facets 426, 427. The material 440 forms a flexible member 441 that allows some movement of the joint due to the flexible properties and/or the shape that permit articulation of the joint. A securing member 442 extends through the facets 426, 427 and the material 440 to further hold the member 441 in place in the joint capsule and/or to prevent implant extrusion. The securing member 442 includes anchors 443, 444 that anchor to the outside or within the facets 426, 427 to hold the securing member 442 in place while permitting some motion for example through spacing at or in the joint. The securing member 442 may for example, comprise a screw, or may be constructed of a flexible material such as a flexible polymer. The securing member may also comprise a band constructed of fibers strands such as Kevlar™, polypropylene or polyethylene, or constructed of a fiber reinforced polymer. The anchors 443, 444 may be of a material such as titanium, or PEAK that may be screwed or crimped on to the securing member 442. The polymer may be injected into the joint capsule into opening 443a in the anchor 443, through a lumen 442a in the securing member 442 and through holes 442b or pores in the securing member 442. This may be done when the joint is distracted or otherwise positioned as desired.



FIG. 5 illustrates a material 450 such as a polymer injected between the cephalic and caudal facets 426, 427. The material 450 forms an implant 451 that allows some movement of the joint due to the flexible properties and/or a shape that permits articulation of the joint. A securing member 452 extends through the facets 426, 427 and the material 450 to further hold the implant 451 in place in the joint capsule. The securing member 452 includes an anchor 453 that anchors the member to the outside or within the facet 426, (or alternatively to the outside or within the facet 427) to hold the securing member 452 in place. The securing member 452 further includes a tapered end that allows the securing member 452 to be inserted through the joint capsule and anchored into facet 427. The securing member may be a screw with a threaded tip 454 that screws into the bone. The securing member can further include a flexible portion that allows some movement of the securing member and joint. The anchor 453 may include an opening 453a into a lumen 452a in the securing member 452, for injecting a polymer into a lumen 452a in the member and then through holes 452b into the joint capsule to form the implant 451.


According to the invention, a facet joint device as described herein may be used in combination with an artificial disc or other spinal implants, e.g., to maintain the integrity of the facets. The facet joint distraction or replacement devices and procedures described herein may be used in conjunction with anteriorly placed implants, e.g., in a load sharing arrangement. The facet joint resurfacing, distraction or augmentation as well as the anterior implants may be used with a process to pedicle distraction or stabilizing device as described herein. Various spinal implants may also be used with facet resurfacing, facet distraction or augmentation procedures.


In accordance with one aspect of the invention, narrowing or stenosis of the neural foramen may be treated using a device configured to distract the facet joint. Accordingly, a distraction system is provided for distracting the facet joint.


Referring to FIG. 6, a portion of the spine is illustrated with adjoining vertebrae prior to distraction. The neural foramen 250 between a first vertebra 251 and a second vertebra 252 is stenotic. At the zygapophyseal joint capsule 253, there is no gap between the cephalic and caudal facets 254, 255.


Referring to FIG. 7, the portion of the spine of FIG. 6 is illustrated with a facet distracter implant 256 in place between the cephalic facet 254 and the caudal facet 255. The implant 256 comprises a distracting portion 257 and anchors 258, 259 comprising barbs or bone anchors. The distracting portion may include a distracting element as described with respect to FIGS. 8-13 herein. The anchor 258 is positioned in bone above the cephalic facet 254 while the anchor 259 is positioned in the bone below the caudal facet 255. The facet distracter implant 256 includes a sensor 256a, the type of which may be selected to sense one of a number of different parameters. Pressure sensors, strain gauges, or other sensors may be used to sense load seen by the facet joint. This information may be used to monitor the condition of the facet joint or determine if fusion may be necessary. The other facet joint implants described herein may also include similar sensors.


The procedure for implanting the device generally includes opening the zygapophyseal joint capsule with a scalpel. Then the adjacent vertebrae are distracted by one of a number of known distraction methods or by distracting the joint mechanically using devices such as a wedge or expanding rod or balloon between adjacent spinous processes, or between other parts of adjacent vertebrae. The tissue between the facets 254, 255 is then debrided and/or denervated. The implant is then inserted between the facets 254, 255 after the joint is distracted. The anchors 258, 259 engage the interfacing portions of the bone of the facets 254, 255.



FIG. 8 illustrates a distracter implant 260 positioned between facets 254, 255. The distracter implant 260 comprises a block 261 wedged between the facets 254, 255. In FIG. 9 an alternative distracter 262 implant comprises a ball 263. In FIG. 10 an active distracter implant 265 comprise a coiled spring 266. In FIG. 11, the distracter implant 265a comprises an expandable polymer 266a, e.g., a hydrogel or expandable gel foam. In FIG. 12 the distracter implant 267 comprise an expandable member 268 that may be expanded to distract the joint 253 by inflating with a curable polymer, a liquid, gas or other material. The distraction may occur after implantation to adjust the level of distraction. The expandable member may also be adjusted after implanting by increasing or removing the inflation medium, e.g. using a needle or accessing the member through a one-way valve. FIG. 13 illustrates a shrink-wrap 269 placed partially around the joint 253. The shrink-wrap or other material comprises, e.g., a Dacron material that holds the block 261 or other implant in place between facets 254, 255. The material may encourage ingrowth of tissue. The material may be coated with a material that reduces tissue ingrowth to permit the joint to move or reduces adhesions to prevent pain. The material may include burrs or barbs that secure the material to the bone or it may be secured, e.g. with suture anchors. The implants may be constructed, for example, of a metal, polymer or ceramic, may be coated or imbedded with therapeutic agents (e.g. a steroid or lidocaine) or other material.

Claims
  • 1. A spine implant comprising: a facet joint capsule insert configured to be positioned within a joint capsule between a first facet and a second facet forming a zygapophyseal joint, wherein the insert comprises a first facet interfacing portion, a second facet interfacing portion, and a rod, the first facet interfacing portion being sized to fit entirety within the joint capsule and having an articulating surface and an engagement surface configured to engage with the joint surface of the first facet and the second facet interfacing portion being sized to fit entirely within the joint capsule and having an articulating surface and an engagement surface configured to engage with the joint surface of the second facet, the first facet interfacing portion being configured to be opposed to the second facet interfacing portion with the articulating surfaces of the first and second facet interfacing portions facing toward one another, the facet joint capsule insert being configured to exert a distraction force between the first and second facets, the first facet interfacing portion including a first magnet and the second facet interfacing portion including a second magnet, the first magnet and second magnet being oriented with like poles facing each other so as to provide a distracting force away from each other, and the rod being disposed between the first and second magnets and configured to limit movement of the first and second magnets relative to one another.
  • 2. The spine implant of claim 1, wherein the first and second interfacing portions are configured to permit articulation of the facets.
  • 3. The spine implant of claim 1, wherein the facet joint capsule insert is configured to exert a distraction force between facets of a facet joint.
  • 4. The spine implant of claim 1, further comprising: a securing member comprising an elongate portion configured to extend through at least a portion of the facet prosthesis; and an anchor coupled to the elongate portion, and configured to anchor the securing member to at least one facet.
  • 5. The spine implant of claim 1, further comprising a securing member including a wrap configured to wrap around at least a portion of the facet joint.
  • 6. A spine implant system comprising: an elongate member including a first portion and a second portion, the first portion being configured to extend into a first facet of a facet joint, the second portion being configured to extend into a second facet of a facet joint, the elongate member further having a lumen extending longitudinally within the elongate member that is in fluid communication with at least one port configured open into a space between the first and second facets; anda material adapted to cure into a flexible polymer, the material being adapted to be injected into the lumen and flow through the at least one port.
  • 7. The spine implant of claim 6, further comprising an anchor configured to anchor the elongate member to at least one facet of the facet joint.
  • 8. A method of repairing a facet joint, the method comprising: inserting an elongate member at least partially through a first and second facet of a facet joint, the elongate member comprising a longitudinally extending lumen in fluid communication with at least one port configured to open into a space between the first and second facets; andinjecting a material into the lumen and through the at least one port, the material being adapted to cure into a flexible polymer.
CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation-in-part of application Ser. No. 11/197,566, filed Aug. 3, 2005 and entitled “Facet Device and Method,” which claims the benefit of U.S. Provisional Application No. 60/598,882, filed Aug. 3, 2004 and entitled “Spine Treatment Devices and Methods.”

US Referenced Citations (423)
Number Name Date Kind
2774350 Cleveland Sep 1952 A
3242922 Thomas Mar 1966 A
3352226 Nelsen Nov 1967 A
3648691 Lumb et al. Mar 1972 A
3693616 Roaf et al. Sep 1972 A
3865105 Lode Feb 1975 A
4024588 Janssen et al. May 1977 A
4078559 Nissinen Mar 1978 A
4269178 Keene May 1981 A
4274401 Miskew Jun 1981 A
4355645 Mitani et al. Oct 1982 A
4361141 Tanner Nov 1982 A
4369769 Edwards Jan 1983 A
4404967 Bacal et al. Sep 1983 A
4411259 Drummond Oct 1983 A
4411545 Roberge Oct 1983 A
4448191 Rodnyansky et al. May 1984 A
4505268 Sgandurra Mar 1985 A
4554914 Kapp et al. Nov 1985 A
4573454 Hoffman Mar 1986 A
4604995 Stephens et al. Aug 1986 A
4611581 Steffee Sep 1986 A
4611582 Duff Sep 1986 A
4648388 Steffee Mar 1987 A
4653481 Howland et al. Mar 1987 A
4697582 William Oct 1987 A
4738251 Plaza Apr 1988 A
4773402 Asher et al. Sep 1988 A
4805602 Puno et al. Feb 1989 A
4815453 Cotrel Mar 1989 A
4827918 Olerud May 1989 A
4854311 Steffee Aug 1989 A
4936848 Bagby Jun 1990 A
5000166 Karpf Mar 1991 A
5005562 Cotrel Apr 1991 A
5011484 Breard Apr 1991 A
5030220 Howland Jul 1991 A
5042982 Harms et al. Aug 1991 A
5084049 Asher et al. Jan 1992 A
5092866 Breard et al. Mar 1992 A
5092867 Harms et al. Mar 1992 A
5127912 Ray et al. Jul 1992 A
5129900 Asher et al. Jul 1992 A
5133716 Plaza Jul 1992 A
5147363 Härle Sep 1992 A
5176679 Lin Jan 1993 A
5176680 Vignaud et al. Jan 1993 A
5181917 Rogozinski Jan 1993 A
5190543 Schläpfer et al. Mar 1993 A
5196014 Lin Mar 1993 A
5207678 Harms et al. May 1993 A
5209752 Ashman et al. May 1993 A
5219349 Krag et al. Jun 1993 A
5242443 Kambin Sep 1993 A
5254118 Mirkovic Oct 1993 A
5257994 Lin Nov 1993 A
5259398 Vrespa Nov 1993 A
5282862 Baker et al. Feb 1994 A
5306275 Bryan Apr 1994 A
5312404 Asher et al. May 1994 A
5312410 Miller et al. May 1994 A
5330474 Lin Jul 1994 A
5352226 Lin Oct 1994 A
5366455 Dove et al. Nov 1994 A
5368594 Martin et al. Nov 1994 A
5380323 Howland Jan 1995 A
5380325 Lahille et al. Jan 1995 A
5382248 Jacobson et al. Jan 1995 A
5387212 Yuan et al. Feb 1995 A
5387213 Breard et al. Feb 1995 A
5391168 Sanders et al. Feb 1995 A
5397363 Gelbard Mar 1995 A
5413576 Rivard May 1995 A
5436542 Petelin et al. Jul 1995 A
5437669 Yuan et al. Aug 1995 A
5437671 Lozier et al. Aug 1995 A
5456722 McLeod et al. Oct 1995 A
5470333 Ray Nov 1995 A
5480440 Kambin Jan 1996 A
5486174 Fournet-Fayard et al. Jan 1996 A
5487744 Howland Jan 1996 A
5490851 Nenov et al. Feb 1996 A
5496318 Howland et al. Mar 1996 A
5498262 Bryan Mar 1996 A
5501684 Schlapfer et al. Mar 1996 A
5520688 Lin May 1996 A
5540689 Sanders et al. Jul 1996 A
5544993 Härle Aug 1996 A
5549679 Kuslich Aug 1996 A
5562660 Grob Oct 1996 A
5569246 Ojima et al. Oct 1996 A
5571191 Fitz Nov 1996 A
5584626 Assmundson Dec 1996 A
5586983 Sanders et al. Dec 1996 A
5591165 Jackson Jan 1997 A
5611800 Davis et al. Mar 1997 A
5643259 Sasso et al. Jul 1997 A
5645599 Samani Jul 1997 A
5649926 Howland Jul 1997 A
5658284 Sebastián et al. Aug 1997 A
5672175 Martin Sep 1997 A
5676703 Gelbard Oct 1997 A
5702395 Hopf Dec 1997 A
5702399 Kipela et al. Dec 1997 A
5704936 Mazel Jan 1998 A
5713898 Stücker et al. Feb 1998 A
5725582 Bevan et al. Mar 1998 A
5728097 Mathews Mar 1998 A
5733284 Martin Mar 1998 A
5735852 Amrein et al. Apr 1998 A
5782831 Sherman et al. Jul 1998 A
5797910 Martin Aug 1998 A
5810817 Roussouly et al. Sep 1998 A
5810819 Errico et al. Sep 1998 A
5814046 Hopf Sep 1998 A
5891145 Morrison et al. Apr 1999 A
5902305 Beger et al. May 1999 A
5910142 Tatar Jun 1999 A
5928232 Howland et al. Jul 1999 A
5938663 Petreto Aug 1999 A
5947967 Barker Sep 1999 A
5964769 Wagner et al. Oct 1999 A
5976135 Sherman et al. Nov 1999 A
5980521 Montague et al. Nov 1999 A
5984924 Asher et al. Nov 1999 A
5989256 Kuslich et al. Nov 1999 A
6015409 Jackson Jan 2000 A
6039738 Sanders et al. Mar 2000 A
6053921 Wagner et al. Apr 2000 A
6077268 Farris et al. Jun 2000 A
6080156 Asher et al. Jun 2000 A
6086590 Margulies et al. Jul 2000 A
6123706 Lange Sep 2000 A
6132431 Nilsson et al. Oct 2000 A
6132464 Martin Oct 2000 A
6136000 Louis et al. Oct 2000 A
6176861 Bernstein et al. Jan 2001 B1
6231575 Krag May 2001 B1
6248106 Ferree Jun 2001 B1
6251111 Barker et al. Jun 2001 B1
6261288 Jackson Jul 2001 B1
6277120 Lawson Aug 2001 B1
6293949 Justis et al. Sep 2001 B1
6296643 Hopf et al. Oct 2001 B1
6299613 Ogilvie et al. Oct 2001 B1
6325805 Ogilvie et al. Dec 2001 B1
6328739 Liu et al. Dec 2001 B1
6358254 Anderson Mar 2002 B1
6364883 Santilli Apr 2002 B1
6364885 Kilpela et al. Apr 2002 B1
6391030 Wagner et al. May 2002 B1
6402752 Schäffler-Wachter et al. Jun 2002 B2
6419703 Fallin et al. Jul 2002 B1
6423065 Ferree Jul 2002 B2
6451019 Zucherman et al. Sep 2002 B1
6458131 Ray Oct 2002 B1
6514255 Ferree Feb 2003 B1
6520962 Taylor et al. Feb 2003 B1
6537276 Metz-Stavenhagen Mar 2003 B2
6547789 Ventre et al. Apr 2003 B1
6551320 Lieberman Apr 2003 B2
6554831 Rivard et al. Apr 2003 B1
6562038 Morrison May 2003 B1
6565569 Assaker et al. May 2003 B1
6565605 Goble et al. May 2003 B2
6569164 Assaker et al. May 2003 B1
6579292 Taylor Jun 2003 B2
6579319 Goble et al. Jun 2003 B2
6582433 Yun Jun 2003 B2
6589243 Viart et al. Jul 2003 B1
6602818 Choi et al. Aug 2003 B2
6610091 Reiley Aug 2003 B1
6616669 Ogilvie et al. Sep 2003 B2
6623484 Betz et al. Sep 2003 B2
6626909 Chin Sep 2003 B2
6641585 Sato et al. Nov 2003 B2
6645207 Dixon et al. Nov 2003 B2
6651320 Yagi et al. Nov 2003 B1
6656185 Gleason et al. Dec 2003 B2
6669729 Chin Dec 2003 B2
6682532 Johnson et al. Jan 2004 B2
6682533 Dinsdale et al. Jan 2004 B1
6685705 Taylor Feb 2004 B1
6689133 Morrison et al. Feb 2004 B2
6709435 Lin Mar 2004 B2
6755828 Shevtsov et al. Jun 2004 B2
6773437 Ogilvie et al. Aug 2004 B2
6802844 Ferree Oct 2004 B2
6811567 Reiley Nov 2004 B2
6902580 Fallin et al. Jun 2005 B2
6946000 Senegas et al. Sep 2005 B2
6966910 Ritland Nov 2005 B2
6966930 Arnin et al. Nov 2005 B2
6974478 Reiley et al. Dec 2005 B2
6986771 Paul et al. Jan 2006 B2
7018379 Drewry et al. Mar 2006 B2
7029475 Panjabi Apr 2006 B2
7041136 Goble et al. May 2006 B2
7048736 Robinson et al. May 2006 B2
7051451 Augostino et al. May 2006 B2
7074237 Goble et al. Jul 2006 B2
7083621 Shaolian et al. Aug 2006 B2
7087056 Vaughan Aug 2006 B2
7090698 Goble et al. Aug 2006 B2
7104992 Bailey Sep 2006 B2
RE39325 Bryan Oct 2006 E
7128743 Metz-Stavenhagen Oct 2006 B2
7220262 Hynes May 2007 B1
7270665 Morrison et al. Sep 2007 B2
7290347 Augostino et al. Nov 2007 B2
7294129 Hawkins et al. Nov 2007 B2
7316684 Baccelli et al. Jan 2008 B1
7335203 Winslow et al. Feb 2008 B2
7338490 Ogilvie et al. Mar 2008 B2
7361196 Fallin et al. Apr 2008 B2
7367978 Drewry et al. May 2008 B2
7406775 Funk et al. Aug 2008 B2
7445635 Fallin et al. Nov 2008 B2
7481828 Mazda et al. Jan 2009 B2
7507242 Triplett et al. Mar 2009 B2
7566345 Fallin et al. Jul 2009 B1
7588578 Triplett et al. Sep 2009 B2
7588590 Chervitz et al. Sep 2009 B2
7618453 Goble et al. Nov 2009 B2
7618455 Goble et al. Nov 2009 B2
7621955 Goble et al. Nov 2009 B2
7674293 Kuiper et al. Mar 2010 B2
7691145 Reiley et al. Apr 2010 B2
7722647 Wang et al. May 2010 B1
7753937 Chervitz et al. Jul 2010 B2
7758581 Chervitz et al. Jul 2010 B2
7819902 Abdelgany et al. Oct 2010 B2
20020055739 Lieberman May 2002 A1
20020133155 Ferree Sep 2002 A1
20020143329 Serhan et al. Oct 2002 A1
20020151978 Zacouto et al. Oct 2002 A1
20030040746 Mitchell et al. Feb 2003 A1
20030093117 Saadat May 2003 A1
20030109881 Shirado et al. Jun 2003 A1
20030153915 Nekozuka et al. Aug 2003 A1
20030220643 Ferree Nov 2003 A1
20040006391 Reiley Jan 2004 A1
20040049274 Reiley Mar 2004 A1
20040049277 Reiley Mar 2004 A1
20040097931 Mitchell May 2004 A1
20040106921 Cheung et al. Jun 2004 A1
20040149065 Moran Aug 2004 A1
20040167520 Zucherman et al. Aug 2004 A1
20040215190 Nguyen et al. Oct 2004 A1
20040230201 Yuan et al. Nov 2004 A1
20040230304 Yuan et al. Nov 2004 A1
20050027361 Reiley Feb 2005 A1
20050033295 Wisnewski Feb 2005 A1
20050043797 Lee Feb 2005 A1
20050043799 Reiley Feb 2005 A1
20050049705 Hale et al. Mar 2005 A1
20050055096 Serhan et al. Mar 2005 A1
20050080420 Farris et al. Apr 2005 A1
20050080486 Fallin et al. Apr 2005 A1
20050131537 Hoy et al. Jun 2005 A1
20050131538 Chervitz et al. Jun 2005 A1
20050149030 Serhan et al. Jul 2005 A1
20050154390 Biedermann et al. Jul 2005 A1
20050165396 Fortin et al. Jul 2005 A1
20050171538 Sgier et al. Aug 2005 A1
20050177240 Blain Aug 2005 A1
20050203509 Chinnaian et al. Sep 2005 A1
20050203511 Wilson-MacDonald et al. Sep 2005 A1
20050203516 Biedermann et al. Sep 2005 A1
20050209603 Zucherman et al. Sep 2005 A1
20050216004 Schwab Sep 2005 A1
20050228326 Kalfas et al. Oct 2005 A1
20050228377 Chao et al. Oct 2005 A1
20050240264 Tokish et al. Oct 2005 A1
20050245929 Winslow et al. Nov 2005 A1
20050261685 Fortin et al. Nov 2005 A1
20050261770 Kuiper et al. Nov 2005 A1
20050267470 McBride Dec 2005 A1
20050267579 Reiley et al. Dec 2005 A1
20060004449 Goble et al. Jan 2006 A1
20060009767 Kiester Jan 2006 A1
20060009847 Reiley Jan 2006 A1
20060009849 Reiley Jan 2006 A1
20060036246 Carl et al. Feb 2006 A1
20060036256 Carl et al. Feb 2006 A1
20060036259 Carl et al. Feb 2006 A1
20060036323 Carl et al. Feb 2006 A1
20060036324 Sachs et al. Feb 2006 A1
20060047282 Gordon Mar 2006 A1
20060058790 Carl et al. Mar 2006 A1
20060058791 Broman et al. Mar 2006 A1
20060058792 Hynes Mar 2006 A1
20060064091 Ludwig et al. Mar 2006 A1
20060084976 Borgstrom et al. Apr 2006 A1
20060084996 Metz-Stavenhagen Apr 2006 A1
20060116686 Crozet Jun 2006 A1
20060142758 Petit Jun 2006 A1
20060142760 McDonnell Jun 2006 A1
20060149234 de Coninck Jul 2006 A1
20060189984 Fallin et al. Aug 2006 A1
20060200149 Hoy et al. Sep 2006 A1
20060212034 Triplett et al. Sep 2006 A1
20060217712 Mueller et al. Sep 2006 A1
20060217715 Serhan et al. Sep 2006 A1
20060217718 Chervitz et al. Sep 2006 A1
20060241594 McCarthy et al. Oct 2006 A1
20060253118 Bailey Nov 2006 A1
20060271050 Piza Vallespir Nov 2006 A1
20060276787 Zubok et al. Dec 2006 A1
20060293663 Walkenhorst et al. Dec 2006 A1
20070005062 Lange et al. Jan 2007 A1
20070016296 Triplett et al. Jan 2007 A1
20070055373 Hudgins et al. Mar 2007 A1
20070073293 Martz et al. Mar 2007 A1
20070079517 Augostino et al. Apr 2007 A1
20070083200 Gittings et al. Apr 2007 A1
20070093814 Callahan, II et al. Apr 2007 A1
20070093833 Kuiper et al. Apr 2007 A1
20070161987 Capote et al. Jul 2007 A1
20070161994 Lowery et al. Jul 2007 A1
20070162002 Tornier Jul 2007 A1
20070167946 Triplett et al. Jul 2007 A1
20070167947 Gittings Jul 2007 A1
20070168035 Koske Jul 2007 A1
20070185492 Chervitz et al. Aug 2007 A1
20070191846 Bruneau et al. Aug 2007 A1
20070198014 Graf et al. Aug 2007 A1
20070213716 Lenke et al. Sep 2007 A1
20070219556 Altarac et al. Sep 2007 A1
20070225712 Altarac et al. Sep 2007 A1
20070225713 Altarac et al. Sep 2007 A1
20070233075 Dawson Oct 2007 A1
20070233090 Naifeh et al. Oct 2007 A1
20070233093 Falahee Oct 2007 A1
20070238335 Veldman et al. Oct 2007 A1
20070270805 Miller et al. Nov 2007 A1
20070270817 Rezach Nov 2007 A1
20070270836 Bruneau et al. Nov 2007 A1
20070270837 Eckhardt et al. Nov 2007 A1
20070270838 Bruneau et al. Nov 2007 A1
20070270967 Fallin et al. Nov 2007 A1
20070276374 Broman et al. Nov 2007 A1
20070288011 Logan Dec 2007 A1
20080015577 Loeb Jan 2008 A1
20080021466 Shadduck et al. Jan 2008 A1
20080021469 Holt Jan 2008 A1
20080045954 Reiley et al. Feb 2008 A1
20080065069 Betz et al. Mar 2008 A1
20080077143 Shluzas Mar 2008 A1
20080086213 Reiley Apr 2008 A1
20080091202 Reiley Apr 2008 A1
20080091210 Reiley Apr 2008 A1
20080091268 Reiley Apr 2008 A1
20080097437 Reiley Apr 2008 A1
20080097438 Reiley Apr 2008 A1
20080097439 Reiley Apr 2008 A1
20080097440 Reiley et al. Apr 2008 A1
20080097441 Hayes et al. Apr 2008 A1
20080097446 Reiley Apr 2008 A1
20080097609 Reiley Apr 2008 A1
20080097612 Reiley Apr 2008 A1
20080097613 Reiley et al. Apr 2008 A1
20080132951 Reiley et al. Jun 2008 A1
20080140202 Allard et al. Jun 2008 A1
20080167688 Fauth et al. Jul 2008 A1
20080177326 Thompson Jul 2008 A1
20080183209 Robinson et al. Jul 2008 A1
20080183212 Veldman et al. Jul 2008 A1
20080195100 Capote et al. Aug 2008 A1
20080195153 Thompson Aug 2008 A1
20080195154 Brown et al. Aug 2008 A1
20080200953 Reiley et al. Aug 2008 A1
20080221622 Triplett et al. Sep 2008 A1
20080228227 Brown et al. Sep 2008 A1
20080234737 Boschert Sep 2008 A1
20080234739 Hudgins et al. Sep 2008 A1
20080262546 Calvosa et al. Oct 2008 A1
20080275507 Triplett et al. Nov 2008 A1
20080292161 Funk et al. Nov 2008 A1
20080306535 Winslow et al. Dec 2008 A1
20080306536 Frigg et al. Dec 2008 A1
20080319483 Triplett et al. Dec 2008 A1
20080319484 Fauth Dec 2008 A1
20080319485 Fauth et al. Dec 2008 A1
20080319488 Helgerson Dec 2008 A1
20080319489 Triplett Dec 2008 A1
20090012565 Sachs et al. Jan 2009 A1
20090012566 Fauth Jan 2009 A1
20090018583 Song et al. Jan 2009 A1
20090024134 Triplett et al. Jan 2009 A1
20090024135 Triplett et al. Jan 2009 A1
20090024166 Carl et al. Jan 2009 A1
20090024167 Chervitz et al. Jan 2009 A1
20090024168 Chervitz et al. Jan 2009 A1
20090024169 Triplett et al. Jan 2009 A1
20090030459 Hoy et al. Jan 2009 A1
20090030460 Chervitz et al. Jan 2009 A1
20090030461 Hoy et al. Jan 2009 A1
20090036929 Reglos et al. Feb 2009 A1
20090048632 Firkins et al. Feb 2009 A1
20090062864 Ludwig et al. Mar 2009 A1
20090062915 Kohm et al. Mar 2009 A1
20090069849 Oh et al. Mar 2009 A1
20090082871 Fallin et al. Mar 2009 A1
20090088802 Fallin Apr 2009 A1
20090093820 Trieu et al. Apr 2009 A1
20090099607 Fallin et al. Apr 2009 A1
20090112207 Walker et al. Apr 2009 A1
20090112262 Pool et al. Apr 2009 A1
20090112263 Pool et al. Apr 2009 A1
20090125062 Arnin May 2009 A1
20090194206 Jeon et al. Aug 2009 A1
20100057129 Goble et al. Mar 2010 A1
20100076493 Fauth et al. Mar 2010 A1
20100082107 Fauth et al. Apr 2010 A1
20100087880 Fauth et al. Apr 2010 A1
20100100130 Carl et al. Apr 2010 A1
20100100133 Carl et al. Apr 2010 A1
20100249836 Seme Sep 2010 A1
20100249837 Seme et al. Sep 2010 A1
20100256684 Seme et al. Oct 2010 A1
20100318129 Seme et al. Dec 2010 A1
20110066188 Seme et al. Mar 2011 A1
Foreign Referenced Citations (22)
Number Date Country
2845647 May 1980 DE
0260044 Mar 1988 EP
0322334 Jun 1989 EP
0418387 Mar 1991 EP
1281361 Feb 2003 EP
2697744 May 1994 FR
2736535 Jan 1997 FR
2781359 Jan 2000 FR
2801492 Jun 2001 FR
2872021 Dec 2005 FR
780652 Jul 1955 GB
888968 Jan 1979 SU
WO 9213496 Aug 1992 WO
WO 2006010844 Feb 2006 WO
WO 2006017641 Feb 2006 WO
WO 2006136937 Dec 2006 WO
WO 2007051924 May 2007 WO
2008086467 Jul 2008 WO
WO 2008154313 Dec 2008 WO
WO 2010053662 May 2010 WO
WO 2010056650 May 2010 WO
2010111500 Sep 2010 WO
Related Publications (1)
Number Date Country
20090024166 A1 Jan 2009 US
Provisional Applications (1)
Number Date Country
60598882 Aug 2004 US
Continuation in Parts (1)
Number Date Country
Parent 11197566 Aug 2005 US
Child 12169370 US