This invention relates generally to polyaxial securement devices and, more particularly, to a screw for insertion into human bone having a polyaxial coupling for adjustably mounting a foreign object to the bone and, even more particularly, to a screw for insertion into spinal bone having a polyaxial coupling and locking mechanism for mounting a stabilizing rod to a sequence of vertebrae.
The use of fixation devices for the treatment of vertebrae deformities and injuries is well known in the art. Various fixation devices are used in medical treatment to correct curvatures and deformities, treat trauma and remedy various abnormal spinal conditions. Treatment of these conditions generally requires the implantation of various component pieces such as support rods, crosslinks, caudal facing hooks, cranial facing hooks and like components, which form a spinal implant system.
It is necessary in spinal implant systems to properly anchor the system to bone to provide necessary support of the implant. Bone screws are commonly used for anchoring spinal implant systems. However, there are several problems with the use of fixed screws for anchoring spinal implants. The exact final position of a bone screw is difficult, if not impossible, to predict prior to the exposure of the patient's bone. This unpredictability results from the uncertainty of exact bone formation and shape within an individual patient. Additionally, it can be difficult to predetermine the structure of the bone, i.e. whether the bone is soft or even osteoporotic. Even if the final position of the screw can be predetermined, the necessary shape and position of a spinal rod implant may create unwanted stress upon the bone screw or the bone itself. This is especially true where a plurality of screws is required along the spinal column for securement of an implant. The alignment of the rod with several screws along the vertebrae compounds this problem and makes undesired stress much more probable. Moreover, this misalignment may influence the extent and speed of correction of the spinal defect.
It is thus desirable to have a polyaxial securement method. There exists a number of patents drawn to polyaxial bone screws. Unfortunately, the advantage of many of these designs comes at the expense of bulk in the connection means or complexity of implantation. As the size of a bone screw increases, so too does the displacement of normal bodily formations, such as muscular tissue or bone. It is common in the insertion of spinal implants to necessarily remove portions of vertebral bone to allow proper insertion of a bone screw. Moreover, this bulk may result in long-term muscular displacement that may lead to a patient's pain or discomfort.
Increased complexity of the installation procedure is undesirable because it increases a patient's time in surgery. Increased operating time is known to increase the risk of many complications associated with surgery. The additional time necessary to remove, or even temporarily dislocate, bone or muscular tissue also increases operating time, and thus the risk of complications.
It is also desirable with some patients to have a spinal implant system that allows the vertebral column to settle naturally under the weight of the human body. Human bone heals more readily under some pressure. In a rigid spinal implant system, the patient's spinal column may be unnaturally held apart by the structure of the implant. It is possible that this stretching of the vertebrae, in relation to one another, results in delayed or incomplete healing of the bone.
In view of the above, there is a long felt but unsolved need for a method and system that avoids the above-mentioned deficiencies of the prior art and that provides an effective system that is relatively simple to employ and requires minimal displacement or removal of bodily tissue.
In accordance with the present invention, a polyaxial connector device is provided with a socket for receiving a headed connecting link. A surgical implant assembly employing the polyaxial connector device is also disclosed. The surgical implant assembly of the present invention includes an attachment device, a headed anchor shaft (or tension link), and a connector. The attachment device of the present invention has a shank with a securement mechanism on one end and an enlarged area on the other end. The securement mechanism may be selected from any known method of securing one article to another, for example, a hook, a plate, a flanged device, or an adhesive, however, it is anticipated that the most common securement mechanism used will be screw threads. The enlarged area includes a hollow core, i.e., a socket, and a central aperture providing access to the hollow core. The enlarged area need only be large enough to envelop the head of the anchoring shaft and provide a wall thickness necessary for strength considerations.
The attachment device may include additional features to enable the insertion of the head end of the tension link into the hollow core. The enlarged area of the attachment device may include an entry channel, leading to the hollow core, that accommodates the tension link head end so that the tension link may be advanced, shaft end first, until the head of the tension link is positioned within the hollow core. Additionally, the entry channel and the central aperture may be connected by an slot through the wall of the enlarged area. In this way, the tension link head end may be positioned within the hollow core without extending the entire length of the tension link beyond the enlarged area of the attachment device opposite the central aperture. The surgeon may place only the head end of the tension link at the entry channel, slide the tension link shaft through the tension link slot, and draw the head end into the hollow core. Alternatively, in lieu of an entry channel or tension link slot, the enlarged area may include one or more expansion slots. In this embodiment, the head of the tension link may be inserted into the hollow core through the central aperture by the application of enough force to expand the central aperture. Once the head of the tension link is properly received into the hollow core, the enlarged area returns to its original size and shape. Unwanted expansion of the enlarged area is prevented by the connector once the enlarged area is properly seated into a head receptacle on the connector during implantation. This maintains the head of the tension link within the hollow core.
The external surface of the enlarged area of the attachment device may be formed into one of limitless geometries. For example, the external surface may be spherical, or at least semi-spherical. The external surface may be at least slightly aspheric. By controlling the degree of asphericity, the contact surface between the attachment device and the connector can thereby control the degree of freedom of the connector relative to the attachment device. Alternatively, the external surface may be conical, or a truncated cone shape, to allow rotational freedom while maintaining a coaxial relationship between the attachment device and the connector. Also, the external surface may be polyhedral or provided with facets to allow angular displacement in only finite steps or prevented altogether. In embodiments including conical, truncated cone shape, polyhedral or faceted geometries of the external surface of the enlarged area, the mating head receptacle of the connector may have corresponding geometry.
The tension link secures and maintains the position of the connector relative to the attachment device. The tension link is a shaft with a head end and a thread end. The head end, as described above, is contained within the hollow core of the attachment device. The threaded end extends through the connector and is secured to the connector by a link nut threaded onto the thread end.
The tension link may be provided with a projection to prevent undesirable rotation of the link when tightening or loosening the link nut, yet still enable angular displacement necessary to provide a polyaxial connection. In one embodiment, a link retainer, or a projection, may be provided on the shaft of the tension link. In this embodiment, it is necessary to provide a link retainer recess within the tension link cavity of the connector. In an alternative embodiment, the link retainer, or projection, may be provided at the intersection of the tension link shaft and the head end, and extending over a portion of the surface of the head end. In this embodiment, used with the attachment device embodiment including a tension link slot, the rotation may be prevented by contacting the link retainer with one side of the tension link slot. In either of the two foregoing embodiments, it is desirable to undersize the link retainer, relative to the link retainer recess or the tension link slot, so that the polyaxial freedom of the tension link and attachment device combination is not unduly limited. In an alternative embodiment, a retaining process, or small projection, may be provided on the tension link head. The retaining process should be positioned such that the retaining process is within the entry channel. Undesired rotation may be prevented by contacting the small projection with the wall of the entry channel.
The connector couples the attachment device to the implant component, such as a spinal rod implant. The connector has a connecting end with a head receptacle, a rod end with a rod aperture, and a tension link cavity. The tension link, with its head positioned in the hollow core of the attachment device, is inserted through the tension link cavity so that an enlarged area of the attachment device nests in the head receptacle. The rod aperture secures the implant component in a desired position. The rod aperture may be secured by the tension link when the link nut is threaded and tightened on the link. In this embodiment, the rod end of the connector has a gap on one side of the rod aperture. The tension link cavity extends continuously through the tension link on both sides of the gap. The upper portion of the rod end forms a tab. As the tab is drawn toward the receiver end of the connector the gap narrows until the rod aperture firmly clamps the implant component or until the gap is drawn completely together.
In still other embodiments, it may also be desirable to provide a separate system for securing the connector to the attachment device and for securing the implant component to the connector. Therefore, in an alternative embodiment, the gap is connected to the rod aperture in a position that does not intersect the rod aperture. In this embodiment, a separate screw, or other connection device, is required to secure the implant component in the rod aperture. The tension link is then used to secure the connector to the attachment device.
In either of the two foregoing connector embodiments, it may be desirable to secure the rod within the rod aperture without clamping to the extent axial movement of the rod within the rod aperture is prevented. In this way, for example, the spine may settle under its own weight and provide a better healing environment for the bone. In conjunction with this embodiment, the implant component may be supplied with flanges, or other extensions to constrain axial movement of the implant component within a desired range.
To surgically implant a device of the present invention, the surgeon may attach an attachment device, selected from one of the embodiments of the present invention. After successful attachment, the surgeon may insert a tension link of the present invention by positioning the head end of the tension link within the hollow core of the attachment device. The surgeon may then place a connector, with a head receptacle designed for mating with the second end of the attachment device, upon the attachment device by inserting the tension link through the tension link cavity of the connector. At this point, the surgeon may select the desired angle of position of the connector for attaching a implant component. Once the connector is properly adjusted, the link nut may be secured to the tension link, thereby securing the elements together in the desired position. The link nut may be loosened, as necessary, to readjust the placement of the implant component. Alternatively, if a connector having a separate implant component securement device is used, the step of securing the link nut may be delayed until after the implant component is secured in the rod aperture and properly positioned.
Based on the foregoing summary, a number of worthwhile aspects of the present invention can be readily identified. A connector device is provided with a small and simple polyaxial adjustment mechanism. The minimal size of the enlarged area of the connector device allows attachment of the device to human bone without significant displacement of human tissue. Therefore, the complexity of surgery and the following pain and discomfort of the patient may be minimized. The polyaxial nature of the device, combined with the small size, may allow a surgeon to attach the securement device to a secure portion of the human body without the need to remove bony processes to accommodate a larger attachment device. Additionally, a simple surgical implant assembly, including the polyaxial attachment device, is provided. The simplicity of the elements, and the assembly process thereof, may reduce the patient's time in surgery, thus reducing the risk and probability of surgical complications. Finally, a number of embodiments of the present invention may be used in combination to allow the surgeon great latitude in selection of materials. The surgeon may select from different embodiments of the attachment device, the tension link, and the connector to best fit the surgical implant parameters. With these choices the surgeon may then best determine which embodiments of which elements to select to minimize removal or displacement of bodily tissue or bone, and thereby reduce both the patient's risk of surgical complications and post-surgical pain and discomfort.
Additional advantages of the present invention will become readily apparent from the following discussion, particularly when taken together with the accompanying drawings.
a is a partial cross-sectional view of one embodiment of the connector device of the present invention;
b is an end perspective view of an alternative embodiment of the connector device of the present invention;
a is an front elevation view of one embodiment of the tension link with a link retainer of the present invention;
b is a side elevation view of the tension link with link retainer shown in
c is an end view of the tension link with link retainer shown in
a is an front elevation view of an alternative embodiment of the tension link with a link retainer of the present invention;
b is a side elevation view of the tension link with link retainer shown in
a is a cross-sectional elevation view of another alternative embodiment of the surgical implant assembly of the present invention; and
b is a plan view of the surgical implant assembly shown in
With reference to
The second end 16 of the shank 12 generally comprises an enlarged area 20 including a central core 22 and an aperture 24. The second end 16 of
With reference to
With reference to
With reference to
With reference to
With reference to
In alternative embodiments not shown in the drawings, the exterior surface of the enlarged area 20 may other configurations. For example, the exterior surface of the enlarged area 20 may be formed as a polyhedron, such as a dodecahedron, or be provided with facets. In this embodiment, the head receptacle 42 of the connector 40 will also have a corresponding geometry. In this way, a polyaxial relationship is provided between the attachment device 10 and the connector 40, yet limiting this polyaxial relationship to a finite number of angular displacement.
The enlarged area 20 is shown in the drawings as at least approximately spheric. It is noted, however that the enlarged area 20 and/or the head receptacle 42 of the connector 40 may also be aspheric. The use of the aspheric construction of either the enlarged area 20 or the head receptacle 42, or both, may accommodate the elasticity and deformation of the material the structure. The amount of asphericity may be selected to control the area of surface contact between the enlarged area 20 and the head receptacle 42 of the connector 40. The amount of asphericity may also be selected to control or vary the degree of freedom required by the linkage.
Further, in any embodiment or configuration of the enlarged area 20, the external surface of the enlarged area 20 may be textured, i.e., provided with a specified surface roughness. The texture, or surface roughness, of the enlarged area 20 may be selected to properly control the friction between the enlarged area 20 and the head receptacle 42, and thus controlling, among other things, the tension force required to secure the devices together or degrees of freedom in their combination. It should be noted that the internal wall of the hollow core 22, the head end 34 of the tension link 28, and/or the head receptacle 42 of the connector 40 may also be provided with a texture, or surface roughness.
With reference to
a shows an embodiment of the tension link with a link retainer 44 in partial side elevation.
With reference to
With reference to
With reference to
Referring now to
With reference to
Referring now to
With reference to
As an aside, the head receptacle wall 68 is shown extending to approximately the “equator” or diameter of the enlarged area 20 of the attachment device 10. It should be noted that the extent that the head receptacle wall 68 engages the enlarged area 20 may be varied. For instance, a smaller wall 68 engagement may be desirable to increase the polyaxial adjustment of the assembly. Alternatively, it may be desirable to provide greater wall 68 engagement with the enlarged area 20 to prevent unnecessary deformation of the enlarged area 20, for example when the enlarged area 20 is provided with an expansion slot 38 or a tension link slot 36. Further, if the head receptacle wall 68 is designed for engagement beyond the “equator” of the enlarged area, the head receptacle wall 68 may match the contour of the enlarged area 20. In other words, the size of the head receptacle 42, at the farthest point on the receiving end 48 of the connector 40, may be smaller than the maximum size of the enlarged area 20 at its “equator.” This may provide an additional advantage to the surgeon. In this situation, a tactile or audible signal may be provided when the enlarged area 20 is properly received into the head receptacle 42.
With reference to
Referring now to
Although it is not shown in the drawings, it is also possible to use the retaining process 74 without the retaining recess 72. It this aspect, the longitudinal movement of the implant component 54 is arrested when the retaining process 74 contacts the exterior surface of the connector 40 at the rod aperture 52. It is also possible to use either of the two above embodiments on either side of the rod aperture 52, wherein the longitudinal movement of the implant component 54 can be constrained in one or both directions.
Additional embodiments of the present invention are not shown in the drawings. For example, it is expected that the attachment device 10 may be used in conjunction with a hook in place of the tension link 28. In this embodiment, the hook would have a ball end and a hook end. The ball end would be inserted into the central core 22 of the attachment device 10 and the hook end would be used to secure some bodily structure, such as a bone. The hook rod would be capable of polyaxial movement.
The present invention also relates to a method of using the embodiments as set forth above. In one embodiment, the method using a surgical implant system 70 would first require the selective insertion of the attachment device 10 into a human bone. The tension link head end 34 could then inserted into the hollow core 22 of the attachment device 10. The step of insertion of the head end 34 would depend upon the embodiment of the attachment device 10 selected. For example, if a attachment device 10 with an entry channel 26, but no tension link slot 36, is provided, the tension link 28 is positioned in the aperture 24 by way of the entry channel 26. The connector 40 is positioned on the tension link 28 by inserting the tension link 28 through the connector tension link cavity 56.
At this point, the surgeon can position the connector 40 such that the implant component 54, when properly inserted in connector rod aperture 52, is held in the desired position along the spinal column. The surgeon can then secure the position of the implant component 54 and the connector 40 in relation to the attachment device 10 by tightening the link nut 60 on the tension link threaded end 32. This process is repeated, as necessary, along the spinal column at various points along the implant component 54. In this way, the surgeon has implemented the above described embodiments as a method for using the surgical implant system, for example, in repairing a degenerative spinal condition.
It is understood that the present invention has application outside the surgical implantation field. The polyaxial securing mechanism of the present invention is not limited to medical implants. The present invention, for example, could be used to secure guy wires or rods. In this application, the anchor screw could be inserted into the ground, e.g., set directly in to the soil, mounted in a concrete footing, or similar mounting. The guy wire or rod (i.e., the tension link) could then be inserted through the anchor screw and connected to the structure to be secured. The guy rod may include a turnbuckle. The turn buckle can then be adjusted to the desired tension in the guy rod. In this way, some room for error in the location of the anchor bolt is built into the installation process. The guy rod may be installed between the anchor screw and the structure without placing undue stress on the guy rod, or requiring unnecessary bending of the guy rod, due to misalignment between the connection point on the structure and the anchor bolt position. This is especially beneficial when a turnbuckle is implemented in the guy rod. The polyaxial nature of the anchor screw would allow the turnbuckle to be more easily adjusted since the stress within the guy rod is limited to the axial direction of the rod, i.e., no bending stress on the turnbuckle.
This is just one example of the possible applications of the present invention outside the field of medical implants. Other applications, by no means exhaustive, may include connecting legs of a tripod to a base and mounting track lighting fixtures.
While various embodiments of the present invention have been described in detail, it is apparent that modifications and adaptations of those embodiments will occur to those skilled in the art. However, it is to be expressly understood that such modifications and adaptations are within the spirit and scope of the present invention, as set forth in the following claims.
This application is a divisional of U.S. patent application Ser. No. 09/898,478 filed on Jul. 2, 2001 now U.S. Pat. No. 6,736,816 and entitled “POLYAXIAL CONNECTION DEVICE AND METHOD”, which claimed priority from U.S. Provisional Patent Application No. 60/215,602 filed on Jun. 30, 2000. The entire disclosures of these applications are considered to be part of the disclosure of the present application and are hereby incorporated by reference in their entirety.
Number | Name | Date | Kind |
---|---|---|---|
2191 | Pitney | Jul 1841 | A |
569839 | Roeloffs | Oct 1896 | A |
605652 | Pitt | Jun 1898 | A |
1090746 | Nourse | Mar 1914 | A |
1097978 | Johnson | May 1914 | A |
3467079 | James | Sep 1969 | A |
3470872 | Grieshaber | Oct 1969 | A |
3875595 | Froning | Apr 1975 | A |
3893454 | Hagelin | Jul 1975 | A |
4041939 | Hall | Aug 1977 | A |
4232660 | Coles | Nov 1980 | A |
4440168 | Warren | Apr 1984 | A |
4481947 | Chester | Nov 1984 | A |
4545374 | Jacobson | Oct 1985 | A |
4573448 | Kambin | Mar 1986 | A |
4617922 | Griggs | Oct 1986 | A |
4620460 | Gonzales, Jr. | Nov 1986 | A |
4686972 | Kurland | Aug 1987 | A |
4736738 | Lipovsek | Apr 1988 | A |
4743260 | Burton | May 1988 | A |
4747394 | Watanabe | May 1988 | A |
4798111 | Cheeseman | Jan 1989 | A |
4803976 | Frigg | Feb 1989 | A |
4817587 | Janese | Apr 1989 | A |
4862891 | Smith | Sep 1989 | A |
4863423 | Wallace | Sep 1989 | A |
4882958 | McNeely | Nov 1989 | A |
4889112 | Schachner et al. | Dec 1989 | A |
4946458 | Harms et al. | Aug 1990 | A |
4995875 | Coes | Feb 1991 | A |
5002542 | Frigg | Mar 1991 | A |
5002576 | Fuhrmann et al. | Mar 1991 | A |
5018507 | Montaldi | May 1991 | A |
5024213 | Asher et al. | Jun 1991 | A |
5026373 | Ray et al. | Jun 1991 | A |
5030220 | Howland | Jul 1991 | A |
5030223 | Anderson et al. | Jul 1991 | A |
5035232 | Lutze et al. | Jul 1991 | A |
5048379 | Gramera | Sep 1991 | A |
5052373 | Michelson | Oct 1991 | A |
5055104 | Ray | Oct 1991 | A |
5084043 | Hertzmann | Jan 1992 | A |
5098435 | Stednitz | Mar 1992 | A |
5106376 | Mononen | Apr 1992 | A |
5129899 | Small et al. | Jul 1992 | A |
5129900 | Asher et al. | Jul 1992 | A |
5133720 | Greenberg | Jul 1992 | A |
5135525 | Biscoping | Aug 1992 | A |
5148724 | Rexford | Sep 1992 | A |
5158543 | Lazarus | Oct 1992 | A |
5165306 | Hellon | Nov 1992 | A |
5195541 | Obenchain | Mar 1993 | A |
5217007 | Ciaglia | Jun 1993 | A |
5275600 | Allard et al. | Jan 1994 | A |
5275611 | Behl | Jan 1994 | A |
5279567 | Ciaglia | Jan 1994 | A |
5292309 | Van Tassel | Mar 1994 | A |
5303694 | Mikhail | Apr 1994 | A |
5304179 | Wagner | Apr 1994 | A |
5306275 | Bryan | Apr 1994 | A |
5306309 | Wagner et al. | Apr 1994 | A |
5312360 | Behl | May 1994 | A |
5312405 | Korotko et al. | May 1994 | A |
5330473 | Howland | Jul 1994 | A |
5330474 | Lin | Jul 1994 | A |
5330476 | Hiot et al. | Jul 1994 | A |
5356413 | Martins et al. | Oct 1994 | A |
5363841 | Coker | Nov 1994 | A |
5415661 | Holmes | May 1995 | A |
5431639 | Shaw | Jul 1995 | A |
5431651 | Goble | Jul 1995 | A |
D361381 | Koros et al. | Aug 1995 | S |
5439464 | Shapiro | Aug 1995 | A |
5466238 | Lin | Nov 1995 | A |
5472426 | Bonati | Dec 1995 | A |
5474555 | Puno et al. | Dec 1995 | A |
5480401 | Navas | Jan 1996 | A |
5484440 | Allard | Jan 1996 | A |
5489274 | Chu | Feb 1996 | A |
5489308 | Kuslich et al. | Feb 1996 | A |
5498262 | Bryan | Mar 1996 | A |
5499983 | Hughes | Mar 1996 | A |
5501684 | Schlapfer et al. | Mar 1996 | A |
5512038 | O'Neal et al. | Apr 1996 | A |
5545166 | Howland | Aug 1996 | A |
5549612 | Yapp et al. | Aug 1996 | A |
5558622 | Greenberg | Sep 1996 | A |
5562663 | Wisnewski et al. | Oct 1996 | A |
5565502 | Glimcher et al. | Oct 1996 | A |
5569300 | Redmon | Oct 1996 | A |
5584831 | McKay | Dec 1996 | A |
5584833 | Fournet-Fayard et al. | Dec 1996 | A |
5591166 | Bernhardt et al. | Jan 1997 | A |
5591235 | Kuslich | Jan 1997 | A |
5593409 | Michelson | Jan 1997 | A |
5601550 | Esser | Feb 1997 | A |
5603714 | Kaneda et al. | Feb 1997 | A |
5611778 | Brinon | Mar 1997 | A |
5613968 | Lin | Mar 1997 | A |
5628740 | Mullane | May 1997 | A |
5643263 | Simonson | Jul 1997 | A |
5643264 | Sherman et al. | Jul 1997 | A |
5645544 | Tai et al. | Jul 1997 | A |
5645599 | Samani | Jul 1997 | A |
5667506 | Sutterlin | Sep 1997 | A |
5683392 | Richelsoph et al. | Nov 1997 | A |
5683463 | Godefroy et al. | Nov 1997 | A |
5687739 | McPherson | Nov 1997 | A |
5690632 | Schwartz et al. | Nov 1997 | A |
5691397 | Glimcher et al. | Nov 1997 | A |
5695993 | Fukudome | Dec 1997 | A |
5702455 | Saggar | Dec 1997 | A |
5716355 | Jackson et al. | Feb 1998 | A |
5716415 | Steffee | Feb 1998 | A |
5725528 | Errico et al. | Mar 1998 | A |
5735850 | Baumgartner et al. | Apr 1998 | A |
5735851 | Errico et al. | Apr 1998 | A |
5735899 | Schwartz et al. | Apr 1998 | A |
5743853 | Lauderdale | Apr 1998 | A |
5746720 | Stouder, Jr. | May 1998 | A |
5746741 | Kraus et al. | May 1998 | A |
5752957 | Ralph et al. | May 1998 | A |
5766221 | Benderev et al. | Jun 1998 | A |
5766253 | Brosnahan, III | Jun 1998 | A |
5772582 | Huttner et al. | Jun 1998 | A |
5782832 | Larsen et al. | Jul 1998 | A |
5785648 | Min | Jul 1998 | A |
5785710 | Michelson | Jul 1998 | A |
5785712 | Runciman et al. | Jul 1998 | A |
5792044 | Foley | Aug 1998 | A |
5797912 | Runciman et al. | Aug 1998 | A |
5800435 | Errico et al. | Sep 1998 | A |
5810816 | Roussouly et al. | Sep 1998 | A |
5810817 | Roussouly et al. | Sep 1998 | A |
D399955 | Koros et al. | Oct 1998 | S |
5816257 | Chin | Oct 1998 | A |
5827328 | Buttermann | Oct 1998 | A |
5836948 | Zucherman et al. | Nov 1998 | A |
RE36020 | Moore et al. | Dec 1998 | E |
5851207 | Cesarone | Dec 1998 | A |
5860977 | Zucherman et al. | Jan 1999 | A |
5865847 | Kohrs et al. | Feb 1999 | A |
5865848 | Baker | Feb 1999 | A |
5876404 | Zucherman et al. | Mar 1999 | A |
5882344 | Stouder, Jr. | Mar 1999 | A |
5885285 | Simonson | Mar 1999 | A |
5885299 | Winslow et al. | Mar 1999 | A |
5885300 | Tokuhashi et al. | Mar 1999 | A |
5891147 | Moskovitz et al. | Apr 1999 | A |
5895352 | Kleiner | Apr 1999 | A |
5895390 | Moran et al. | Apr 1999 | A |
5897593 | Kohrs et al. | Apr 1999 | A |
5899901 | Middleton | May 1999 | A |
5902231 | Foley | May 1999 | A |
5902304 | Walker et al. | May 1999 | A |
5904650 | Wells | May 1999 | A |
5906616 | Pavlov et al. | May 1999 | A |
5913818 | Co et al. | Jun 1999 | A |
5928139 | Koros | Jul 1999 | A |
5928233 | Apfelbaum et al. | Jul 1999 | A |
5931838 | Vito | Aug 1999 | A |
5938663 | Petreto | Aug 1999 | A |
5944658 | Koros et al. | Aug 1999 | A |
5947965 | Bryan | Sep 1999 | A |
5954635 | Foley | Sep 1999 | A |
5954671 | O'Neil | Sep 1999 | A |
5961516 | Graf | Oct 1999 | A |
5967970 | Cowan | Oct 1999 | A |
5968098 | Winslow | Oct 1999 | A |
5971920 | Nagel | Oct 1999 | A |
5976135 | Sherman et al. | Nov 1999 | A |
5976146 | Ogawa | Nov 1999 | A |
5984924 | Asher et al. | Nov 1999 | A |
5996447 | Bayouth | Dec 1999 | A |
5997539 | Errico et al. | Dec 1999 | A |
6004322 | Bernstein | Dec 1999 | A |
6007487 | Foley et al. | Dec 1999 | A |
6010520 | Pattison | Jan 2000 | A |
6017342 | Rinner | Jan 2000 | A |
6027533 | Olerud | Feb 2000 | A |
6045579 | Hochshuler et al. | Apr 2000 | A |
6048342 | Zucherman et al. | Apr 2000 | A |
6050997 | Mullane | Apr 2000 | A |
6063088 | Winslow | May 2000 | A |
6068630 | Zucherman et al. | May 2000 | A |
6074390 | Zucherman et al. | Jun 2000 | A |
6074393 | Sitoto | Jun 2000 | A |
6080155 | Michelson | Jun 2000 | A |
6080193 | Hochshuler et al. | Jun 2000 | A |
6081741 | Hollis | Jun 2000 | A |
6083225 | Winslow et al. | Jul 2000 | A |
6083226 | Fiz | Jul 2000 | A |
6090112 | Zucherman et al. | Jul 2000 | A |
6102948 | Brosnahan, III | Aug 2000 | A |
6113602 | Sand | Sep 2000 | A |
6117137 | Halm et al. | Sep 2000 | A |
6117174 | Nolan | Sep 2000 | A |
6120434 | Kimura | Sep 2000 | A |
6120506 | Kohrs et al. | Sep 2000 | A |
6123705 | Michelson | Sep 2000 | A |
6123706 | Lange | Sep 2000 | A |
6132430 | Wagner | Oct 2000 | A |
D433296 | Yamakawa | Nov 2000 | S |
6146383 | Studer et al. | Nov 2000 | A |
6149652 | Zucherman et al. | Nov 2000 | A |
6149686 | Kuslich et al. | Nov 2000 | A |
6152871 | Foley | Nov 2000 | A |
6152926 | Zucherman et al. | Nov 2000 | A |
6156006 | Brosens | Dec 2000 | A |
6156038 | Zucherman et al. | Dec 2000 | A |
6159179 | Simonson | Dec 2000 | A |
6162170 | Foley | Dec 2000 | A |
6162236 | Osada | Dec 2000 | A |
D436513 | Yamakawa | Jan 2001 | S |
6176823 | Foley | Jan 2001 | B1 |
6176861 | Bernstein et al. | Jan 2001 | B1 |
6179838 | Fiz | Jan 2001 | B1 |
D438074 | Marr | Feb 2001 | S |
6183471 | Zucherman et al. | Feb 2001 | B1 |
6187005 | Brace et al. | Feb 2001 | B1 |
6190387 | Zucherman et al. | Feb 2001 | B1 |
6190414 | Young et al. | Feb 2001 | B1 |
6196969 | Bester et al. | Mar 2001 | B1 |
6197002 | Peterson | Mar 2001 | B1 |
6206822 | Foley | Mar 2001 | B1 |
6206826 | Mathews et al. | Mar 2001 | B1 |
6206885 | Ghahremani et al. | Mar 2001 | B1 |
6206922 | Zdeblick et al. | Mar 2001 | B1 |
6206923 | Boyd et al. | Mar 2001 | B1 |
6210413 | Justis et al. | Apr 2001 | B1 |
6214004 | Coker | Apr 2001 | B1 |
6217509 | Foley | Apr 2001 | B1 |
6224597 | Coker | May 2001 | B1 |
6224608 | Ciccolella | May 2001 | B1 |
6224631 | Kohrs | May 2001 | B1 |
6231575 | Krag | May 2001 | B1 |
6235030 | Zucherman et al. | May 2001 | B1 |
6238397 | Zucherman et al. | May 2001 | B1 |
6245072 | Zdeblick et al. | Jun 2001 | B1 |
6248104 | Chopin et al. | Jun 2001 | B1 |
6248106 | Ferree | Jun 2001 | B1 |
6258097 | Cook | Jul 2001 | B1 |
6261287 | Metz-Stavenhagen | Jul 2001 | B1 |
6264658 | Lee et al. | Jul 2001 | B1 |
6267763 | Castro | Jul 2001 | B1 |
6267764 | Elberg | Jul 2001 | B1 |
6267765 | Taylor et al. | Jul 2001 | B1 |
6270498 | Michelson | Aug 2001 | B1 |
6273914 | Papas | Aug 2001 | B1 |
6283966 | Houfburg | Sep 2001 | B1 |
6287309 | Baccelli et al. | Sep 2001 | B1 |
6287313 | Sasso | Sep 2001 | B1 |
6287343 | Kuslich et al. | Sep 2001 | B1 |
6290700 | Schmotzer | Sep 2001 | B1 |
6293949 | Justis et al. | Sep 2001 | B1 |
6296609 | Brau | Oct 2001 | B1 |
6299614 | Kretschmer et al. | Oct 2001 | B1 |
6302842 | Auerbach et al. | Oct 2001 | B1 |
6309390 | Le Couedic et al. | Oct 2001 | B1 |
6309391 | Crandall et al. | Oct 2001 | B1 |
6312432 | Leppelmeier | Nov 2001 | B1 |
6332883 | Zucherman et al. | Dec 2001 | B1 |
6875211 | Nichols et al. | Dec 2001 | B2 |
6342057 | Brace | Jan 2002 | B1 |
6348058 | Melkent et al. | Feb 2002 | B1 |
6354176 | Nordlin | Mar 2002 | B1 |
6355038 | Pisharodi | Mar 2002 | B1 |
6361541 | Barnhart | Mar 2002 | B1 |
6368320 | Le Couedic et al. | Apr 2002 | B1 |
6368350 | Erickson et al. | Apr 2002 | B1 |
6368351 | Glenn et al. | Apr 2002 | B1 |
6371959 | Trice | Apr 2002 | B1 |
6371968 | Kogasaka | Apr 2002 | B1 |
6391058 | Kuslich et al. | May 2002 | B1 |
6395033 | Pepper | May 2002 | B1 |
6418821 | Yamakawa | Jul 2002 | B1 |
6425901 | Zhu et al. | Jul 2002 | B1 |
6428472 | Haas | Aug 2002 | B1 |
6440169 | Elberg et al. | Aug 2002 | B1 |
6440170 | Jackson | Aug 2002 | B1 |
6443953 | Perra et al. | Sep 2002 | B1 |
6443989 | Jackson | Sep 2002 | B1 |
6461330 | Miyagi | Oct 2002 | B1 |
6461359 | Tribus et al. | Oct 2002 | B1 |
6471724 | Zdeblick | Oct 2002 | B2 |
6478798 | Howland | Nov 2002 | B1 |
D466766 | Marty | Dec 2002 | S |
6506151 | Estes | Jan 2003 | B2 |
6520907 | Foley | Feb 2003 | B1 |
6524238 | Velikaris et al. | Feb 2003 | B2 |
6530880 | Pagliuca | Mar 2003 | B2 |
6530926 | Davison | Mar 2003 | B1 |
6540756 | Vaughan | Apr 2003 | B1 |
6551320 | Lieberman | Apr 2003 | B2 |
6554831 | Rivard et al. | Apr 2003 | B1 |
6554834 | Crozet et al. | Apr 2003 | B1 |
6562046 | Sasso | May 2003 | B2 |
6562073 | Foley | May 2003 | B2 |
6565569 | Assaker et al. | May 2003 | B1 |
6569164 | Assaker et al. | May 2003 | B1 |
6576017 | Foley et al. | Jun 2003 | B2 |
6579292 | Taylor | Jun 2003 | B2 |
6585738 | Mangione et al. | Jul 2003 | B1 |
6585769 | Muhanna et al. | Jul 2003 | B1 |
6595993 | Donno et al. | Jul 2003 | B2 |
6610062 | Bailey et al. | Aug 2003 | B2 |
6626904 | Jammet et al. | Sep 2003 | B1 |
6626906 | Young | Sep 2003 | B1 |
6648887 | Ashman | Nov 2003 | B2 |
6671725 | Noel, Jr. et al. | Dec 2003 | B1 |
6676661 | Benlloch et al. | Jan 2004 | B1 |
6679833 | Smith et al. | Jan 2004 | B2 |
6682532 | Johnson et al. | Jan 2004 | B2 |
6685705 | Taylor | Feb 2004 | B1 |
6692434 | Ritland | Feb 2004 | B2 |
6736816 | Ritland | May 2004 | B2 |
6743257 | Castro | Jun 2004 | B2 |
6749613 | Conchy et al. | Jun 2004 | B1 |
6749614 | Teitelbaum et al. | Jun 2004 | B2 |
6752832 | Neumann | Jun 2004 | B2 |
6761719 | Justis et al. | Jul 2004 | B2 |
6783528 | Vincent-Prestigiacomo | Aug 2004 | B2 |
6851430 | Tsou | Feb 2005 | B2 |
6916319 | Munting | Jul 2005 | B2 |
6916330 | Simonson | Jul 2005 | B2 |
6929606 | Ritland | Aug 2005 | B2 |
6951538 | Ritland | Oct 2005 | B2 |
6955678 | Gabriel et al. | Oct 2005 | B2 |
6966910 | Ritland | Nov 2005 | B2 |
6974480 | Messerli et al. | Dec 2005 | B2 |
6991632 | Ritland | Jan 2006 | B2 |
7008431 | Simonson | Mar 2006 | B2 |
7166073 | Ritland | Jan 2007 | B2 |
7207992 | Ritland | Apr 2007 | B2 |
20010005796 | Zdeblick et al. | Jun 2001 | A1 |
20010010021 | Boyd et al. | Jul 2001 | A1 |
20010012942 | Estes | Aug 2001 | A1 |
20010027320 | Sasso | Oct 2001 | A1 |
20010047207 | Michelson | Nov 2001 | A1 |
20020011135 | Hall | Jan 2002 | A1 |
20020016592 | Branch | Feb 2002 | A1 |
20020022764 | Smith | Feb 2002 | A1 |
20020029082 | Muhanna | Mar 2002 | A1 |
20020049368 | Ritland | Apr 2002 | A1 |
20020058948 | Arlettaz | May 2002 | A1 |
20020068973 | Jackson | Jun 2002 | A1 |
20020068975 | Teitelbaum et al. | Jun 2002 | A1 |
20020077632 | Tsou | Jun 2002 | A1 |
20020082695 | Neumann | Jun 2002 | A1 |
20020107571 | Foley | Aug 2002 | A1 |
20020107572 | Foley et al. | Aug 2002 | A1 |
20020120270 | Trieu et al. | Aug 2002 | A1 |
20020123668 | Ritland | Sep 2002 | A1 |
20020143235 | Pagliuca | Oct 2002 | A1 |
20030083688 | Simonson | May 2003 | A1 |
20030083689 | Simonson | May 2003 | A1 |
20030093078 | Ritland | May 2003 | A1 |
20030109880 | Shirado et al. | Jun 2003 | A1 |
20030139812 | Garcia et al. | Jul 2003 | A1 |
20030144665 | Munting | Jul 2003 | A1 |
20030171749 | Le Couedic et al. | Sep 2003 | A1 |
20030171751 | Ritland | Sep 2003 | A1 |
20030187431 | Simonson | Oct 2003 | A1 |
20030191470 | Ritland | Oct 2003 | A1 |
20030220689 | Ritland | Nov 2003 | A1 |
20030236447 | Ritland | Dec 2003 | A1 |
20040002708 | Ritland | Jan 2004 | A1 |
20040106997 | Lieberson | Jun 2004 | A1 |
20040138534 | Ritland | Jul 2004 | A1 |
20040181223 | Ritland | Sep 2004 | A1 |
20040254428 | Ritland | Dec 2004 | A1 |
20050004593 | Simonson | Jan 2005 | A1 |
20050020920 | Ritland | Jan 2005 | A1 |
20050027360 | Webb et al. | Feb 2005 | A1 |
20050119656 | Ferrante et al. | Jun 2005 | A1 |
20050143737 | Paffard et al. | Jun 2005 | A1 |
20050149023 | Ritland | Jul 2005 | A1 |
20050149191 | Cragg et al. | Jul 2005 | A1 |
20050203517 | Jahng et al. | Sep 2005 | A1 |
20050203519 | Harms et al. | Sep 2005 | A1 |
20050209694 | Loeb | Sep 2005 | A1 |
20050228233 | Ritland | Oct 2005 | A1 |
20060009768 | Ritland | Jan 2006 | A1 |
20060041259 | Paul et al. | Feb 2006 | A1 |
20060064090 | Park | Mar 2006 | A1 |
20060069390 | Frigg et al. | Mar 2006 | A1 |
20060079899 | Ritland | Apr 2006 | A1 |
20060195087 | Sacher et al. | Aug 2006 | A1 |
20070016193 | Ritland | Jan 2007 | A1 |
Number | Date | Country |
---|---|---|
2320821 | Aug 1999 | CA |
0 820 731 | Jan 1998 | EP |
2796828 | Feb 2001 | FR |
2812185 | Feb 2002 | FR |
2000-33091 | Feb 2000 | JP |
9629947 | Oct 1996 | WO |
9706742 | Feb 1997 | WO |
WO 9940866 | Aug 1999 | WO |
WO 0018305 | Apr 2000 | WO |
0057801 | May 2000 | WO |
0167973 | Sep 2001 | WO |
WO 0202022 | Jan 2002 | WO |
WO 0207621 | Jan 2002 | WO |
0236026 | May 2002 | WO |
WO 02060330 | Aug 2002 | WO |
WO 03026523 | Apr 2003 | WO |
WO 03073908 | Sep 2003 | WO |
WO 03094699 | Nov 2003 | WO |
WO 2004075778 | Sep 2004 | WO |
WO 2004089244 | Oct 2004 | WO |
Number | Date | Country | |
---|---|---|---|
20040172023 A1 | Sep 2004 | US |
Number | Date | Country | |
---|---|---|---|
60215602 | Jun 2000 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 09898478 | Jul 2001 | US |
Child | 10776094 | US |