Vertebral body replacement

Information

  • Patent Grant
  • 11458025
  • Patent Number
    11,458,025
  • Date Filed
    Friday, July 12, 2019
    5 years ago
  • Date Issued
    Tuesday, October 4, 2022
    2 years ago
Abstract
The present invention involves a system and methods for assembling and implanting a vertebral body implant. The vertebral body implant includes, but is not necessarily limited to, an expandable core body and endplates that can be attached at both ends. Endplates of various shapes, sizes and angles are attachable to the expandable core in a plurality of positions so that a suitable vertebral body implant can be implanted between vertebrae from an anterior, anterior-lateral, lateral, posterior or posterior-lateral approach.
Description
FIELD

The present invention relates generally to spinal implants.


BACKGROUND

The spine is formed of a column of vertebra that extends between the cranium and pelvis. The three major sections of the spine are known as the cervical, thoracic and lumbar regions. There are 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae, with each of the 24 vertebrae being separated from each other by an intervertebral disc. A series of about 9 fused vertebrae extend from the lumbar region of the spine and make up the pelvic region of the vertebral column. These fused vertebrae consist of the sacral and coccygeal region of the vertebral column.


The main functions of the spine are to provide skeletal support and protect the spinal cord. Even slight disruptions to either the intervertebral discs or vertebrae can result in serious discomfort due to compression of nerve fibers either within the spinal cord or extending from the spinal cord. If a disruption to the spine becomes severe enough, damage to a nerve or part of the spinal cord may occur and can result in partial to total loss of bodily functions (e.g. walking, talking, and breathing). Therefore, it is of great interest and concern to be able to both correct and prevent any ailments of the spine.


Trauma to the spine (e.g. car accident, sports injury) can cause fracturing of one or more vertebrae. Certain diseases affecting the spine (e.g. tumors, osteoporosis) can cause degeneration of the spine. Both trauma and degeneration may result in severe disruption to the spine. In these circumstances, the complete removal of one or more vertebrae may be required. If one or more vertebrae are removed, a replacement support system must be implanted in order to protect the spinal cord and maintain, or improve, the structure and integrity of the spine.


The present invention is directed at overcoming, or at least improving upon, the disadvantages of the prior art.





BRIEF DESCRIPTION OF THE DRAWINGS


FIG. 1 is an exploded view of the vertebral body implant assembly, according to one embodiment of the present invention;



FIG. 2 is a perspective view of an alternative embodiment of the vertebral body implant assembly;



FIG. 2A is a cross section view of the vertebral body implant assembly of FIG. 2 taken along lines 2-2 of FIG. 2;



FIG. 3 is an exploded view of an alternative embodiment of the core expanding body forming part of the implant assembly of FIG. 1;



FIG. 4 is an exploded view of an alternative embodiment of the core expanding body forming part of the implant assembly of FIG. 1;



FIG. 5 is a perspective view of the core expanding body forming part of the implant assembly of FIG. 1;



FIG. 5A is a cross section view of the core expanding body of FIG. 5 taken along lines 5-5 of FIG. 5;



FIG. 6 is a perspective view of the outer core forming part of the implant assembly of FIG. 1;



FIG. 7 is a perspective view of an alternative embodiment of the outer core forming part of the implant assembly of FIG. 1;



FIG. 8 is a perspective view of an alternative embodiment of the outer core forming part of the implant assembly of FIG. 1;



FIG. 9 is a perspective view of the inner core forming part of the implant assembly of FIG. 1;



FIG. 10 is a perspective view of an alternative embodiment of the inner core forming part of the implant assembly of FIG. 1;



FIG. 11 is a perspective view of an alternative embodiment of the inner core forming part of the implant assembly of FIG. 1;



FIG. 12 is a perspective view of the adjustment ring forming part of the implant assembly of FIG. 1;



FIG. 12A is a cross section view of the adjustment ring of FIG. 12 taken along lines 12-12 of FIG. 12;



FIG. 13 is a top view of the endplate forming part of the implant assembly of FIG. 1;



FIG. 14 is a top view of an alternative embodiment of the endplate forming part of the implant assembly of FIG. 1;



FIG. 15 is a perspective view of the bottom of the endplate of FIG. 13;



FIG. 16 is a side view of the endplate of FIG. 13;



FIG. 17 is a perspective view of one example of a combined insertion and expansion, according to one embodiment of the present invention;



FIG. 18 is a perspective view of the expanding tool of FIG. 17 with the outer cover removed;



FIG. 19 is a side view of the adjustment region of the expanding tool of FIG. 17;



FIG. 20 is an exploded view of the large bezel forming part of the expanding tool of FIG. 17;



FIG. 21 is a cross section view of adjustment region taken along line 18-18 of FIG. 18;



FIG. 22 is a cross section view of the distal handle taken along line 18-18 of FIG. 18;



FIG. 23 is a cross section view of the proximal engagement region taken along line 18-18 of FIG. 18;



FIG. 24 is a perspective view of the proximal engagement region with the outer cover and elongated first shaft removed;



FIG. 25 is a side view of the outer cover forming part of the expanding tool of FIG. 17;



FIG. 26 is an exploded view of an alternative embodiment of the expanding tool;



FIG. 27 is a perspective view of the expanding tool of FIG. 26;



FIG. 28A-28D is a series of side views of the implant assembly of FIG. 1 engaged with the expanding tool of FIG. 17 and the process of implanting the expandable vertebral body between a first vertebra and second vertebra.





DETAILED DESCRIPTION

Illustrative embodiments of the invention are described below. In the interest of clarity, not all features of an actual implementation are described in this specification. It will of course be appreciated that in the development of any such actual embodiment, numerous implementation-specific decisions must be made to achieve the developers' specific goals, such as a compliance with system-related and business-related constraints, which will vary from one implementation to another. Moreover, it will be appreciated that such a development effort might be complex and time-consuming, but would nevertheless be a routine undertaking for those of ordinary skill in the art having the benefit of this disclosure. The expandable vertebral body replacement disclosed herein boasts a variety of inventive features and components that warrant patent protection, both individually and in combination.



FIG. 1 illustrates an example of an expandable vertebral body replacement implant assembly 10 according to a first embodiment. The vertebral body replacement implant assembly 10 includes endplates 11 fixed at the superior and inferior ends of an expanding core body 12 wherein the expandable implant can be customized to accommodate various needs by attaching one from a selection of different endplates. The customization of the expandable core can be done in situ or moments before implantation of the expandable vertebral body replacement, which gives the benefit of customizing the implant based on expected and unexpected circumstances and conditions of the surrounding vertebral bodies.


The expanding core body 12 includes an adjustment ring 13, an outer core 14, an inner core 15, one or more guide pins 20, and one or more set screws 16. As will be explained in greater detail below, the vertebral body replacement implant assembly 10 of the present invention may be inserted into a space left by the removal of at least part of one or more vertebra in order to maintain a desired spacing between the remaining vertebrae and to stabilize the affected spinal segments. To do so, the vertebral body replacement implant assembly 10 is placed, preferably in a collapsed state, in the space between the remaining superior and inferior vertebral bodies. Rotation of the adjustment ring 13, which is fixed at one end of the outer core 14 of the core expanding body 12, results in the expansion of the core expanding body 12 due to the outer core 14 and inner core 15 moving in opposite directions along their central axis. Expansion of the core expanding body 12 may be continued until the desired spacing between the vertebral bodies is achieved. Once the desired spacing is reached, a set screw 16 in the wall of the outer core 14 is engaged into the exterior threads 31 or non-threaded area 49 of the inner core 15 to secure the expanded position of the vertebral body implant assembly 10 and prevent further height alterations of the vertebral body implant assembly 10.



FIGS. 2 and 2A show an alternative embodiment of the vertebral body replacement implant assembly 10. FIG. 2A is a cutaway view with the adjustment ring 13 removed for greater detail of the first end 39 of the outer core 15 and the inner core 14. FIGS. 3 and 4 show exploded views of alternative embodiments of the core expanding body 12. All of the displayed configurations, shown as examples only, may be used without departing from the scope of the invention.


Referring to FIGS. 2-8, the outer core 14 includes indented slots 23, an opening 24, a first end 39, a second end 41, a plurality of flanges 25 with a distal step 26 forming a groove 44, a set screw opening 35, and a specially sized aperture 88. Indented slots 23 on the exterior wall of the outer core 14 allow for the anti-rotational attachment of the expanding tool, described below. The openings 24 in the wall of the outer core 14 allow the transport of blood and nutrients through the core expanding body 12 once implanted, which assists in new bone growth between the remaining vertebra. Larger openings 24 in the side of the outer core 14 allow the placement of additional bone growth promoting material to be added once the vertebral body implant assembly 10 has been positioned in the body and expanded to a desired height. A plurality of flanges 25 with a distal step 26 extend from the first end 39 of the outer core 14 and function to secure the attachment of the adjustment ring 13 to the first end 39.


As seen in FIG. 5, the outer core 14 may have a specially sized aperture 88 directly adjacent to the set screw opening 35 that allows for the insertion of the expanding tool 200, described below. The outer core 14, shown by way of examples in FIGS. 6 and 8, may include a second end slot 47 and second end groove 46 which allow similarly configured endplates 11 to slide on to the outer core 12 and hold the endplate 11 in place. The connection may be augmented through the use of a endplate attachment screw 90 placed through the endplate hole 62 and in the screw slot flange 68 through to base threaded hole 45 on the second end 41 of the outer core 14.


By way of example in the embodiment as seen in FIG. 7, the outer core 14 may have base threaded holes 45 encircling a central aperture at the second end 41 defining a generally sinusoidal or flower-shaped perimeter of the attachment portion. The base threaded holes 45 allow for an endplate 11 to be placed in different rotational positions that provides for additional customization. Though no set configuration or number of base threaded holes 45 is needed to fall within the scope of the invention, in the illustrated embodiment there are 12 threaded holes 45 to allow for attachment of the endplate 11 at 12 different angles relative to the expandable core body 12. It is contemplated that the attachment portion of the outer core and corresponding recess in the endplate 11 may be any configuration that allows for placement of the endplate 11 at one of a plurality of angles relative to the outer core 14. The inner surface of the outer core 14 is generally round with 1 or more flat sides. The flat surface contains the set screw opening 35 in which the set screw 16 is placed and tightened to assist in locking the inner core 15 in place.


The indented slots 23, best seen in FIG. 5, serve to allow secure connection between the core expanding body 12 and the expanding tool 200. The indented slots 23 are placed on the outer core 14 without disrupting the functioning of the adjustment ring 13 or the inner core 15, and may be provided in any number of suitable shapes or dimensions without departing for the scope of the invention.


The largest diameter of the outer core 14 is preferably dimensioned to be generally in the range of 12 mm to 22 mm, respectively. The height of the outer core 14 is preferably dimensioned to be generally in the range of 14 mm to 68 mm. The height of the expandable core body assembly 12 (i.e. endplates not included in the height measurement) is preferably dimensioned to be generally in the range of 15 mm to 121 mm.


The adjustment ring 13, shown by way of example in FIGS. 5 and 6 includes external features 21, internal threads 17, and an annular under-step 18 forming a groove 19. When assembled, the annular under-step 18 of adjustment ring 13 engages in the groove 41 of the core expanding body 12 and the distal step 26 engages in the groove 19 of the adjustment ring 13, longitudinally fixing the adjustment ring 13 and core expanding body 12 together while permitting rotational movement therebetween. External features 21 on the adjustment ring 13 are configured to engage a combination inserter/expansion tool which may be operated to rotate adjustment ring 13 to expand core expanding body 12. The internal threads 17 of the adjustment ring 13 engage with the external threads 31 of the inner core 15 so that as the adjustment ring 13 rotates, it acts as a nut and forces the linear translation of the inner core 15 along its central axis. The longitudinal fixation of the outer core 14 to the adjustment ring 13 ensures the relative displacement of the inner core 15 to the outer core 14 as the adjustment ring 13 rotates. The diameter of the adjustment ring 13 is preferably dimensioned generally in the range of 12 mm to 22 mm. The height of the adjustment ring 13 is preferably dimensioned to be generally in the range of 5 mm to 10 mm.


The inner core 15, illustrated in FIGS. 9-11, is composed of a first end 40 and a generally elongated body 51 extending from the first end 40, and with at least one generally helical exterior thread 31. One or more guide tracks 19 ingrained into the exterior wall of the body 51 run parallel to the central axis of the body 51. The guide track 19 receives guide pins 20 which extend through the outer core 14. A guide pin 20 travels along a guide track 19, rotationally fixing inner core 15 to outer core 14, while permitting longitudinal movement therebetween. A guide pin 20 may have threaded features that allow it to screw into threaded holes in the wall of the outer core. The rotational fixation between the inner core 15 to outer core 14 ensures that the inner core 15 and outer core 14 (and the vertebrae engaging endplates 11) remain in the desired orientation as the vertebral body implant assembly 10 is adjusted, and for the duration that it is implanted. A central lumen 27 through the inner core 15 enables additional bone growth promoting material to be placed within the expanding core body 12, and ultimately to allow new bone to form uninterrupted through the entire central axis of the vertebral body replacement implant assembly 10. The central lumen 27 may be generally cylindrical in shape (having a generally circular cross-section) or in the alternative may have a cross section having any geometric shape without departing from the scope of the present invention.


The inner core 15 may also contain a flat, non-threaded area 49 running some distance vertically along the outer surface. The non-threaded area 49 is designed to fit next to the inner flat surface of the outer core 14. The inner core 15 can be locked in place via the friction created when the set screw 16 is tightened into the non-threaded area 49.


The first end 40 of the inner core 15 may have a number of different configurations in which attachment to the endplate 11 is possible. As shown in FIG. 10, the first end 40 may consist of encircling threaded holes 48—with the same features as described above for the exemplary configuration of second end 41 on the outer core 14. The threaded holes 48 allow for secure attachment through the use of an endplate attachment screw 90 to attach the inner core 15 to the endplate 11 configured to accept a screw. This arrangement allows for rotational customization of the endplate prior to insertion into the patient.


An alternative embodiment for the first end 40 of the inner core 15 includes a side flange 70 and groove 71 best seen in FIG. 9. The side flanges 70 and groove 71 are specifically designed to fit with a variation of endplate 11 (as shown, for example, in FIG. 15) with matching endplate flanges 69 and endplate grooves 67 by sliding the endplate 11 along the surface of the first end 40 so the flanges on each piece rest within the grooves of the other. While shown in FIG. 15 with the attachment feature of the endplate 11 configured for insertion of the engagement feature on the inner core 15 parallel to the longitudinal axis of the endplate, it is also contemplated that the attachment feature of the endplate may be configured for insertion of the inner core at an angle oblique to the longitudinal axis. Both the first end 40 and the endplate 11 may contain a hole for the insertion of an endplate attachment screw 90 to lock the endplate 11 in place. This screw connection feature may be accomplished in similar ways without departing from the scope of the patent. The perimeter shape of the first end 40 may be provided in any number of suitable shapes or dimensions without departing from the scope of the invention, provided that the perimeter shape corresponds to the perimeter shape of the attachment features of the endplate 11.


The endplate attachment features discussed above allow for the unique ability to customize the core expanding body 12 with various endplate 11 configurations. The ability to customize the core expanding body 12 may provide numerous advantages. By way of example, the customizable core expanding body 12 can be used in a variety of surgical approaches (e.g. anterior, anterior-lateral, lateral, posterior or posterior-lateral). By way of further example, the customizable core expanding body 12 can be placed in a variety of positions along the spine, and the customizable core expanding body 12 can be made compatible with a variety of conditions of the surrounding vertebral bodies (e.g. partial removal of vertebral body).


The vertebral body implant assembly 10 is preferably composed of either metal (e.g. titanium, stainless steel, etc.) or polymer (e.g. poly-ether-ether-ketone (PEEK)). When the implant assembly is made out of a polymer, one or more marker rods 61 are preferably composed of a radiopaque material (e.g. titanium) and are positioned within the vertebral body implant assembly 10 so that the positioning of the vertebral body implant assembly 10 can be visible upon X-ray imaging. This visual indication may be obtained either post-operatively or intra-operatively to confirm placement of the vertebral body implant assembly 10. Additionally, in patients where one or more vertebral bodies have been removed due to diseases, such as tumors, and an vertebral body implant assembly 10 has been implanted between the remaining vertebral bodies, it is beneficial during post-operative x-ray imaging to be able to see through the implant in order to detect any reoccurrence of the disease.



FIGS. 13-14 illustrate the second surface 34 of the endplate 11 which includes one or more liner ridges 60, the center hole 62, an anterior side 64, a posterior side 66, lateral sides 65, a screw slot 63, a screw slot flange 68, one or more windows 30, and one or more marker rods 61. When implanted, the second surface 34 is configured to be positioned against the adjacent vertebral body with the anterior side 64 positioned generally towards the anterior side of the adjacent vertebral body. The generally larger radii corners at the ends of the anterior side 64 are configured to generally conform to the natural shape of the anterior portion of a vertebral body. In the exemplary embodiment shown, for example, in FIG. 14, the endplate 11 is configured for a preferred use through a lateral approach to the spine, and preferably when endplate coverage is desired to span across the ring apophysis of the vertebra. The distance between the two lateral sides 65 has a length dimensioned to extend generally across the space from the apophyseal ring at one lateral aspect of the spine to the apophyseal ring at the other lateral aspect of the spine. This allows the endplate 11 to provide more support and distribute the weight more evenly throughout the adjacent vertebral body, which lessens stress and potential damage to the adjacent vertebral body. The ridges 60, provide additional placement stabilization and are shown in this embodiment to be generally parallel to the lateral sides 65. The ridges 60 may also travel parallel to or in angled directions from the anterior or posterior side 64, 66, without departing from the scope of the invention. While the ridges 60 are shown as linear, it will be appreciated that the ridges 60 may be non-linear without departing from the scope of the present invention. The travel of the ridge 60 is generally along the entire length of the lateral side 65, but it may only travel a portion of the lateral side 65, or any side, without departing from the scope of the invention, and therefore is not limited to the length of travel that the ridge 60 makes along the second surface 34 of the endplate 11.


The endplate attachment screw 90, best seen in FIG. 1, provides a locking mechanism for attachment of the endplate 11 to the inner core 15. As discussed above, the first end 40 of the inner core 15 and the second end 41 of the outer core 14 may consist of different configurations to attach the endplate 11 such as, by way of example, a sliding flange and groove method and a variable screw placement method. The screw slot 63 allows for the insertion of an endplate attachment screw 90 to connect the endplate 11 to the inner core 15. The endplate attachment screw 90 can hold the endplate to the inner core 15 by means of the screw slot flange 68 within the screw slot 63.


In addition to the endplates shown, there are many other shapes and sizes that can be alternative embodiments of the present invention. According to the embodiments of the present invention, it is contemplated that the endplates 11 may be generally oval or rectangular in shape (as shown in FIGS. 13-14) meaning they have a length dimension longer than a width dimension. Alternatively, the endplates 11 may be circular in shape. By way of example only, the different directions of travel of the ridges 60 on the second surface 34 cater to different spinal procedures, particularly pertaining to the direction of implant insertion. Also, an asymmetrical shape of endplate 11 is possible. This type of endplate is configured for a preferred use through a lateral approach, and generally under the circumstance where a partial removal of the adjacent vertebral body has been performed and endplate coverage is to be biased in one direction relative to the core expanding body 12. The width of an endplate is defined as the distance between the anterior side and posterior side of an endplate. Therefore, in one particular embodiment, the width of endplate 11 is preferably dimensioned generally in the range of 12-22 mm. The length of an endplate is defined as the distance between the opposing lateral sides of an endplate. Therefore, in one particular embodiment, the length of endplate 11 is preferably dimensioned generally in the range of 15-60 mm. The variable lengths of the sides of endplate 11 make the core expanding body 12 even more customizable and enable the vertebral body replacement implant assembly 10 to maximize the surface area contact between the endplates 11 and the adjacent vertebral body, resulting in the ability to provide the most stable support.


The endplate 11 may also have a variety of shapes of the first and or second surfaces. For example, second surface 34 may be generally planar or the second surface 34 may be convexly curved to complement the contoured surface of a vertebral body endplate. According to another embodiment, the endplate 11 may be provided with one of a variety of angles between the first surface 33 and second surface 34 of endplate 11. FIG. 16 demonstrates an exemplary embodiment of an angled endplate 94. The angle 97 that will be described for endplate 94 is available in any of the previously described endplates and is therefore not limited to only endplate 94. By way of example only, the angle 97 of the endplate 94 is preferably dimensioned generally in the range of −4-15 degrees and functions to improve the natural curvature of the spine when implanted. The preferred direction of the angle 97 formed between the first surface 33 and second surface 34 lies generally in a plane that is either along or parallel to a ridge 60, which in this example also happens to be parallel to the lateral sides 96. This configuration is intended to accompany specific procedures and directions that the endplate 94 will be implanted relative to adjacent vertebral bodies. Additionally, the angle 97 that is formed between the first surface 33 and second surface 34 may benefit the maintenance or correction of, for example, either the lordotic or kyphotic curvature of the spine, depending on the direction of angulation. By way of example only, if the distance between the first surface 33 and second surface 34 is greater at the anterior side 95 than the posterior side 98 of the endplate 94, then it can be assumed that the endplate 94 is configured to have the preferred use to correct or maintain lordosis.


One or more windows 30 provide for the insertion of bone growth material, blood and nutrient access throughout the area, and new bone growth to form around the implant. Windows 30 can be of various shapes and sizes, and placed in different configurations on the second surface 34 in conjunction with the ridges 60 without departing from the scope of the present invention. At least one marker rod 61 is press fit into the second side 34 of the endplate 11. The shape of the marker rod 61 is generally conical. The formation of the marker rods 61 are shown by example to be positioned in a rectangular formation, but can be positioned in other configurations without departing from the scope of the present invention.


Although described with respect to specific examples of the different embodiments, any feature of the endplates disclosed herein by way of example only may be applied to any of the embodiments without departing from the scope of the present invention. Furthermore, procedures described, for example only, involving specific regions of the spine (e.g. thoracic and lumbar) may be applied to another region of the spine without departing from the scope of the present invention and dimensioning of the implant may be adjusted to accommodate any region.



FIGS. 17-27 illustrate examples of an expanding tool 200 for use with the vertebral body replacement implant assembly 10 described above. By way of example only, the expanding tool 200 includes distal handle 201, outer cover 204, a proximal engagement region 202, adjustment region 203, and an elongated first shaft 144. The proximal engagement region 202, best viewed in FIG. 23, includes a plurality of engagement arms 166, pusher arm 120 with pusher arm tip 161, locking pins 127, pushing spacer 160, extension piece 117 with engagement lip 118, one or more springs 125, slot pins 121, blocker bar 126, outer cover slots 122, and lower cover 156. The adjustment region 203 includes large bezel 140, stopper rings 141, one or more holding rings 142, and a spur gear 142.


The outer cover 204 has a number of features that allow it to securely interface with vertebral body implant assembly 10, and specifically, the outer core 14. The outer cover 204 consists of engagement arms 116 that are sized and dimensioned to securely slide into the indented slots 23 and secure the anti-rotation of the vertebral body implant assembly 10. The fitting block 119 is sized and dimensioned to fit securely within the specially sized hole 88 in the outer core 14. As best seen in FIG. 22, the distal handle 201 is connected to the elongated first shaft 110 such that the elongated first shaft 110 will rotate in conjunction with the rotation of the distal handle 201 due to the sleeve 211 and securing pin 212. The outer cover 204 is connected to the distal handle 201 by the holding ring 142 that allows for the outer cover 204 to remain non-rotational. The second shaft 144 will also not rotate with the rotation of the distal handle because the second shaft 144 is connected to the outer cover 204 (best seen in FIGS. 19 and 22).


The large bezel 140, best seen in FIGS. 19-21, is held in place by one or more stopping rings 141 and one or more holding rings 142. A geared track 145 with teeth features 146 is inside of the large bezel 140 in which the spur gear 142 sits. The spur gear teeth 147 interact with the teeth features 146 on the geared track 145 so that when the large bezel 140 is rotated, the spur gear rotates in the opposite direction. Inner threads on the inside of the spur gear 142 match the threaded features 151 on the second shaft 144. As the spur gear 142 rotates via the rotation of the large bezel 140, the inner threads interact with the threaded features 151 to transfer the rotational motion to axially motion and push the second shaft 144 horizontally parallel to the outer cover 204. The spur gear 142 is kept in place by the stopper rings 141. The second shaft 144 is held in place by the outer cover 204 and the lower cover 156. FIG. 21 shows adjustment region 203 with the large bezel 140 so that the inner workings can be appreciated.


As show in FIG. 23, the chief mechanisms for interface with the vertebral body implant assembly 10 are in the proximal engagement region 202. The second shaft 144 is connected to the pushing spacer 160 by a locking pin 127. The pushing spacer 160 is connected to the pusher arm 120 by another locking pin 127 that allows for horizontal movement of the pusher arm 120 when the pushing spacer 160 is moved closer to the engagement arms 116. The spring 125 flexes so that the extension piece 117 will not move with the pusher arm 120. The blocker bar 126 prevents the pusher arm 120 and extension piece 117 from moving vertically. As the pusher arm 120 moves, the slot pins 121, specially designed to fit within the outer cover slots 122 (best seen in FIG. 25), force the pusher arm 120 vertically upward because the slot pins 121 are traveling a prescribed path set by the outer cover slots 122. The pusher arm tip 161, at the end of the pusher arm, acts on the extension piece 117 forcing it upward.


The extension piece 117 can be engaged when the outer cover 204 is in place with the engagement arms 116 securely in the indented slots 23 and the fitting block 119 resting in the specially sized hole 88. As described above, the rotation of the large bezel 140 pushes the extension piece 117 vertically upward where it can lock into the inside of the outer core 14 by the engagement lip 118. The engagement lip 118 ensures the outer core 14 will not move away from the expanding tool 200 when the expanding tool 200 is pushed up against the outer core 14 in order to rotate the adjustment ring 13. The shaft end 130 sits inside the set screw opening 35 when the expanding tool 200 is properly connected to the vertebral body assembly 10. The shaft end 130 includes adjustment features 131 that are sized and dimensioned to interact with external features 21 of the adjustment ring 13. The rotation of the distal handle 201 simultaneously rotates the elongated first shaft 110 and the shaft end 130 whereby the adjustment features 131 interact with the external features 21 so that the adjustment ring 13 rotates increasing or decreasing the distance between the endplates 11.



FIGS. 26 and 27 show an alternative embodiment of the expanding tool 200. The expanding tool 200 consists of a distal handle, outer cover 204, elongated first shaft 110, first shaft cover 209, second shaft 144, lover case cover 156, rotational gear 149, stopper rings 141, extension piece 117, and pusher arm 120. The outer cover 204 includes a similar embodiment of the fitting block 119, discussed above, whereupon the fitting block 119 fits securely in the specially sized hole 88. The shaft end 130 of the elongated first shaft 110 rests in the set screw opening 35. When the distal handle 201 is rotated, the adjustment features 131 engage with the external features 21 of the adjustment ring 13. The adjustment ring 13 then rotates changing the distance between the endplates 11. This embodiment of the expanding tool 200 contains no mechanism to secure the vertebral body implant assembly 10 to the expanding tool 200.



FIGS. 28A-28D illustrates one example of a preferred use of a vertebral body implant assembly 10 and the expanding tool 200. FIG. 28A shows an anterior view of a portion of a spine, which includes a superior vertebra, a medial vertebra and an inferior vertebra which are shown labeled as V1, V2, and V3 respectively. In FIG. 28B, the medial vertebra has been removed so that there is now a large space between the superior and inferior vertebral bodies. In the following figure, FIG. 28C, endplates 11 have been chosen that are preferred for being positioned against the surfaces of the superior and inferior vertebral bodies. These selected endplates 11 are shown being attached to the inner core 15 and outer core 14 of the core expanding body 12. The expanding tool 200 can then interface with the indented slots 23 of the outer core 14 by turning the distal handle 201. Once the core expanding body 12 is positioned between the engagement arms 116 and the shaft end 130 is in the set screw opening 35, the large bezel 140 is rotated to that the engagement lip 118 grasps the inside of the outer core 14 so that the core expanding body will not move when the distal handle 201 is rotated to change the axial distance between the endplates 11.


By way of example only, FIG. 28C illustrates the vertebral body implant assembly 10 being inserted in its collapsed state from a lateral direction into the space remaining between the superior and inferior vertebral bodies using the expanding tool 200. While shown inserting from a lateral direction, the implant may also be inserted from an anterior approach, an anterior-lateral approach, a posterior approach or a posterior-lateral approach. To accommodate insertion from various approaches, the endplates 11 are coupled to the expandable body 12 in a position relative to the transverse axis of the expandable body 12 to facilitate the chosen approach. The height of the vertebral body implant assembly 10 is then increased by rotating the distal handle 201 which causes the adjustment ring 13 to rotate, as described above. Since the vertebral body implant assembly 10 is secured between the engagement arms 116, the adjustment features 131 of the shaft end 130 can engage the external features 21 of the adjustment ring 13 so that when the distal handle 201 and the elongated first shaft 144 rotate, the adjustment ring 13 rotates in concert. As detailed above, rotation of the adjustment ring 13 causes expansion of the vertebral body implant assembly 10, as shown in FIG. 28D. The vertebral body implant assembly 10 is expanded until its desired height has been achieved. It is also possible to rotate the distal handle 201 in the opposite direction in order to cause the vertebral body implant assembly 10 to decrease in height. Once the desired height has been achieved, the large bezel 140 is rotated in the direction to cause the retraction of the second shaft 144 and thereby the lowering of the extension piece 117 and engagement tip 118 to release the vertebral body implant assembly 10. The expanding tool 200 is then separated from the vertebral body implant assembly 10 so that at least one set screw 16 from the outer core 14 can be engaged into the outer wall of the inner core 15 in order to secure the expanded height of the vertebral body implant assembly 10. Additional bone growth promoting material can then be added to the vertebral body implant assembly 10 before it is left to remain implanted between the first and second vertebrae.


While not specifically described above, it will be understood that various other steps may be performed in using and implanting the devices disclosed herein, including but not limited to creating an incision in a patient's skin, distracting and retracting tissue to establish an operative corridor to the surgical target site, advancing the implant through the operative corridor to the surgical target site, removing instrumentation from the operative corridor upon insertion of the implant, and closing the surgical wound.


While this invention has been described in terms of a best mode for achieving this invention's objectives, it will be appreciated by those skilled in the art that variations may be accomplished in view of these teachings without deviating from the spirit or scope of the invention.

Claims
  • 1. An implant for providing support in a space remained after removal of at least part of a vertebra, comprising: an expandable body configured to expand from a first end to a second end along a longitudinal axis, the expandable body having an outer core and an inner core threadedly coupled and moveable relative to each other along the longitudinal axis, an adjustment ring rotatable about the longitudinal axis to adjust a relative location of the outer core to the inner core thereby adjusting a body length of the expandable body, a first attachment feature at the first end, and a second attachment feature at the second end;a first endplate coupled to the extendable body at the first end via the first attachment feature of the expandable body and a first matching attachment feature of the first endplate, the first matching attachment feature comprising a first receptacle configured to receive at least part of the first attachment feature along a transverse axis perpendicular to the longitudinal axis, wherein the first attachment feature of the expandable body includes a plurality of threaded holes disposed about a central aperture thereby allowing the first endplate to be coupled to the first end via the plurality of threaded holes in a plurality of rotational positions relative to the transverse axis; anda second endplate coupled to the expandable body at the second end via the second attachment feature and a second matching attachment feature, the second matching attachment feature comprising a second receptacle configured to receive at least part of the second attachment feature along the transverse axis perpendicular to the longitudinal axis.
  • 2. The implant of claim 1, wherein the first receptacle comprises a groove, a flange, or both.
  • 3. The implant of claim 2, wherein the groove, the flange, or both are extending along the transverse axis.
  • 4. The implant of claim 2, wherein the first end comprises a first matching plate asymmetric about an axis perpendicular to the side of the first end.
  • 5. The implant of claim 4, wherein the expandable body further comprises a threaded screw hole in the first matching plate and the first endplate further comprises a screw opening configured to align with the threaded screw hole to receive a set screw therethrough thereby locking the first endplate to the expandable body.
  • 6. The implant of claim 1, wherein the first receptacle is configured to slidably receive the at least part of the first attachment feature along the transverse axis.
  • 7. The implant of claim 5, wherein the screw opening is positioned along the transverse axis.
  • 8. The implant of claim 1, wherein the adjustment ring is longitudinally coupled to the outer core.
  • 9. The implant of claim 8, wherein the adjustment ring further comprises inner threads that couples to external threads of the inner core to cause longitudinal movement of the inner core relative to the outer core.
  • 10. The implant of claim 1, wherein the adjustment ring further comprises external features evenly distributed along a circumference thereof and protruding along the longitudinal axis, the external features when engaged by proximal adjustment features of an inserter of the implant cause rotation of the adjustment ring in concert with rotation at a distal end of the inserter.
  • 11. The implant of claim 1, wherein the first endplate and the second endplate are dimensioned to span from a lateral aspect of a vertebral body endplate to another lateral aspect of the vertebral body endplate.
  • 12. An implant for providing support in a space remained after removal of at least part of a vertebra, comprising: an expandable body configured to expand from a first end to a second end along a longitudinal axis, the expandable body having an outer core and an inner core coupled and moveable to each other along the longitudinal axis, an adjustment ring rotatable about the longitudinal axis to adjust a relative position of the outer core to the inner core thereby adjusting a body length of the expandable body, a first attachment feature at the first end, and a second attachment feature at the second end;a first endplate slidably coupled to the expandable body at the first end via the first attachment feature of the expandable body and a first matching attachment feature of the first endplate, the first matching attachment feature comprising a first receptable configured to receive at least part of the first attachment feature along a transverse axis perpendicular to the longitudinal axis and an opening configured to align with the at least part of the first attachment feature for receiving a threaded fastener therethrough, wherein the first attachment feature of the expandable body includes a plurality of threaded holes disposed about a central aperture thereby allowing the first endplate to be coupled to the first end via the plurality of threaded holes in a plurality of rotational positions relative to the transverse axis; anda second endplate slidable coupled to the expandable body at the second end via the second attachment feature and a second matching attachment feature.
  • 13. The implant of claim 12, wherein the first receptacle comprises a groove, a flange, or both.
  • 14. The implant of claim 13, wherein the first end is asymmetric about an axis perpendicular to the side of the first end.
  • 15. The implant of claim 12, wherein the opening is positioned along the transverse axis.
  • 16. The implant of claim 12, wherein the adjustment ring is longitudinally coupled to the outer core.
  • 17. The implant of claim 16, wherein the adjustment ring further comprises inner threads that couples to external threads of the inner core to cause longitudinal movement of the inner core relative to the outer core.
  • 18. The implant of claim 12, wherein the adjustment ring further comprises external features evenly distributed along a circumference thereof and protruding along the longitudinal axis, the external features when engaged by proximal adjustment features of an inserter of the implant cause rotation of the adjustment ring in concert with rotation at a distal end of the inserter.
  • 19. The implant of claim 12, wherein the first endplate and the second endplate are dimensioned to span from a lateral aspect of a vertebral body endplate to another lateral aspect of the vertebral body endplate.
  • 20. An implant for providing support in a space remained after removal of at least part of a vertebra, comprising: an expandable body configured to expand along a longitudinal axis from a first end to a second end, the expandable body having an outer core and an inner core coupled and moveable relative to each other along the longitudinal axis, an adjustment ring rotatable about the longitudinal axis to adjust a relative location of the outer core to the inner core thereby adjusting a body length of the expandable body, a first attachment feature at the first end, and a second attachment feature at the second end,wherein the adjustment ring comprises external features evenly distributed along a circumference thereof and protruding along the longitudinal axis, the external features when engaged by proximal adjustment features of an inserter of the implant cause rotation of the adjustment ring in concert with rotation at a distal end of the inserter;a first endplate coupled to the expandable body at the first end via the first attachment feature and a first matching attachment feature, the first matching attachment feature comprising a first receptacle configured to receive at least part of the first attachment feature along a transverse axis perpendicular to the longitudinal axis, wherein the first attachment feature of the expandable body includes a plurality of threaded holes disposed about a central aperture thereby allowing the first endplate to be coupled to the first end via the plurality of threaded holes in a plurality of rotational positions relative to the transverse axis; anda second endplate coupled to the expandable body at the second end via the second attachment feature and a second matching attachment feature, the second matching attachment feature comprising a second receptacle configured to receive at least part of the second attachment feature along the transverse axis perpendicular to the longitudinal axis.
CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 15/635,087, filed Jun. 27, 2017, which is a continuation of U.S. patent application Ser. No. 14/177,100, filed Feb. 10, 2014, now U.S. Pat. No. 9,687,357, which is a continuation of PCT/US2012/050218, filed Aug. 9, 2012, now expired, which claims the benefit of the filing date of U.S. Provisional Application No. 61/521,704, which was filed on Aug. 9, 2011. U.S. patent application Ser. No. 14/177,100, filed Feb. 10, 2014, now U.S. Pat. No. 9,687,357 is also a Continuation-in-Part application of U.S. patent application Ser. No. 12/661,206, filed on Mar. 12, 2010, which claims the benefit of priority to U.S. Provisional Application No. 61/159,792, filed Mar. 12, 2009 and U.S. Provisional Application No. 61/260,375, filed Nov. 11, 2009, the contents of which are incorporated herein entirely by reference.

US Referenced Citations (262)
Number Name Date Kind
1238863 Willour Sep 1917 A
1486723 Bemson Mar 1924 A
1896715 Martinetti Feb 1933 A
3486505 Morrison Dec 1969 A
3518993 Blake Jul 1970 A
3604487 Gilbert Sep 1971 A
3745995 Kraus Jul 1973 A
3848601 Ma et al. Nov 1974 A
3867728 Stubstad et al. Feb 1975 A
4026304 Levy May 1977 A
4026305 Brownlee et al. May 1977 A
4501269 Bagby Feb 1985 A
4545374 Jacobson Oct 1985 A
4646738 Trott Mar 1987 A
4657550 Daher Apr 1987 A
4743256 Brantigan May 1988 A
4781591 Allen Nov 1988 A
4834757 Brantigan May 1989 A
4877020 Vich Oct 1989 A
4878915 Brantigan Nov 1989 A
4932975 Main et al. Jun 1990 A
4950296 McIntyre Aug 1990 A
4961740 Ray et al. Oct 1990 A
4962766 Herzon Oct 1990 A
5015247 Michelson May 1991 A
5026373 Ray et al. Jun 1991 A
5047055 Bao et al. Sep 1991 A
5055104 Ray Oct 1991 A
5062845 Kuslich et al. Nov 1991 A
5071437 Steffee Dec 1991 A
5092572 Litwak et al. Mar 1992 A
5133717 Chopin Jul 1992 A
5133755 Brekke Jul 1992 A
5171278 Pisharodi Dec 1992 A
5192327 Brantigan Mar 1993 A
5217497 Mehdian Jun 1993 A
5236460 Barber Aug 1993 A
5263953 Bagby Nov 1993 A
5269785 Bonutti Dec 1993 A
5284153 Raymond et al. Feb 1994 A
5290494 Coombes et al. Mar 1994 A
5300076 Lerich Apr 1994 A
5304210 Crook Apr 1994 A
5306307 Senter et al. Apr 1994 A
5306309 Wagner et al. Apr 1994 A
5322505 Krause et al. Jun 1994 A
5334205 Cain Aug 1994 A
5336223 Rogers Aug 1994 A
5364400 Rego, Jr. et al. Nov 1994 A
5395372 Holt et al. Mar 1995 A
5397363 Gelbard Mar 1995 A
5397364 Kozak Mar 1995 A
5405391 Henderson et al. Apr 1995 A
5413602 Metz- Stavenhagen May 1995 A
5425772 Brantigan Jun 1995 A
5431658 Moskovich Jul 1995 A
5443514 Steffee Aug 1995 A
5443515 Cohen et al. Aug 1995 A
5445639 Kuslich et al. Aug 1995 A
5454811 Huebner Oct 1995 A
5458638 Kuslich et al. Oct 1995 A
5480442 Bertagnoli Jan 1996 A
5484403 Yoakum et al. Jan 1996 A
5484437 Michelson Jan 1996 A
5489307 Kuslich et al. Feb 1996 A
5489308 Kuslich et al. Feb 1996 A
5514180 Heggeness et al. May 1996 A
5522879 Scopelianos Jun 1996 A
5522899 Michelson Jun 1996 A
5524624 Tepper et al. Jun 1996 A
5527312 Ray Jun 1996 A
5534030 Navarro et al. Jul 1996 A
5540688 Navas Jul 1996 A
5545222 Bonutti Aug 1996 A
5562736 Ray et al. Oct 1996 A
5565005 Erickson et al. Oct 1996 A
5571190 Ulrich Nov 1996 A
5571192 Schonhoffer Nov 1996 A
5575790 Chen et al. Nov 1996 A
5593409 Michelson Jan 1997 A
5609636 Kohrs et al. Mar 1997 A
5611800 Davis et al. Mar 1997 A
5611810 Arnold et al. Mar 1997 A
5632747 Scarborough et al. May 1997 A
5645598 Brosnahan et al. Jul 1997 A
5653761 Pisharodi Aug 1997 A
5653762 Pisharodi Aug 1997 A
5658336 Pisdharodi Aug 1997 A
5658337 Kohrs et al. Aug 1997 A
5662710 Bonutti Sep 1997 A
5665122 Kambin Sep 1997 A
5669909 Zdeblick et al. Sep 1997 A
5676703 Gelbard Oct 1997 A
5683394 Rinner Nov 1997 A
5683400 McGuire Nov 1997 A
5683464 Wagner et al. Nov 1997 A
5690629 Asher et al. Nov 1997 A
5693100 Pisharodi Dec 1997 A
5700264 Zucherman et al. Dec 1997 A
5700291 Kuslich et al. Dec 1997 A
5700292 Marguiles Dec 1997 A
5702449 McKay Dec 1997 A
5702451 Biedermann et al. Dec 1997 A
5702453 Rabbe et al. Dec 1997 A
5702454 Baumgartner Dec 1997 A
5702455 Saggar Dec 1997 A
5703451 Yamamichi et al. Dec 1997 A
5707373 Sevrain et al. Jan 1998 A
5711957 Patat et al. Jan 1998 A
5716415 Steffee Feb 1998 A
5720748 Kuslich et al. Feb 1998 A
5720751 Jackson Feb 1998 A
5723013 Jeanson et al. Mar 1998 A
5728159 Stroever et al. Mar 1998 A
5741253 Michelson Apr 1998 A
5741261 Moskovitz et al. Apr 1998 A
5755797 Baumgartner May 1998 A
5766252 Henry et al. Jun 1998 A
5772661 Michelson Jun 1998 A
5775331 Raymond et al. Jul 1998 A
5775797 Henstra Jul 1998 A
5776197 Rabbe et al. Jul 1998 A
5776198 Rabbe et al. Jul 1998 A
5779642 Nightengale Jul 1998 A
5782830 Farris Jul 1998 A
5782919 Zdeblick et al. Jul 1998 A
5785710 Michelson Jul 1998 A
5797909 Michelson Aug 1998 A
5800549 Bao et al. Sep 1998 A
5800550 Sertich Sep 1998 A
5814084 Grivas et al. Sep 1998 A
5851208 Trott Dec 1998 A
5860973 Michelson Jan 1999 A
5865845 Thalgott Feb 1999 A
5865848 Baker Feb 1999 A
5885299 Winslow et al. Mar 1999 A
5888219 Bonutti Mar 1999 A
5888224 Beckers et al. Mar 1999 A
5893890 Pisharodi Apr 1999 A
5904719 Errico et al. May 1999 A
5910315 Stevenson et al. Jun 1999 A
5942698 Stevens Aug 1999 A
5954769 Rosenlicht Sep 1999 A
5968098 Winslow Oct 1999 A
5989290 Biedermann et al. Nov 1999 A
5993474 Ouchi Nov 1999 A
6003426 Kobayashi et al. Dec 1999 A
6004326 Castro et al. Dec 1999 A
6008433 Stone Dec 1999 A
6015436 Schonhoffer Jan 2000 A
6033405 Winslow et al. Mar 2000 A
6039761 Li et al. Mar 2000 A
6042582 Ray Mar 2000 A
6045580 Scarborough et al. Apr 2000 A
6048342 Zucherman et al. Apr 2000 A
6059829 Schlapfer et al. May 2000 A
6063088 Winslow May 2000 A
6083225 Winslow et al. Jul 2000 A
6096080 Nicholson et al. Aug 2000 A
6102948 Brosnahan, III Aug 2000 A
6120503 Michelson Sep 2000 A
6120506 Kohrs et al. Sep 2000 A
6132472 Bonutti Oct 2000 A
6143033 Paul et al. Nov 2000 A
6159211 Boriani et al. Dec 2000 A
6159215 Urbahns et al. Dec 2000 A
6176881 Schar et al. Jan 2001 B1
6190413 Sutcliffe Feb 2001 B1
6193756 Studer et al. Feb 2001 B1
6200347 Anderson Mar 2001 B1
6200348 Biedermann et al. Mar 2001 B1
6214050 Huene Apr 2001 B1
6224607 Michelson May 2001 B1
6224631 Kohrs May 2001 B1
6241769 Nicholson et al. Jun 2001 B1
6241771 Gresser et al. Jun 2001 B1
6251140 Marino et al. Jun 2001 B1
6258125 Paul et al. Jul 2001 B1
6277149 Boyle et al. Aug 2001 B1
6296665 Strnad et al. Oct 2001 B1
6319257 Carignan et al. Nov 2001 B1
6344057 Rabbe et al. Feb 2002 B1
6352556 Kretschmer et al. Mar 2002 B1
6371989 Chauvin et al. Apr 2002 B1
6383221 Scarborough et al. May 2002 B1
6409766 Brett Jun 2002 B1
6425772 Bernier et al. Jul 2002 B1
6432140 Lin Aug 2002 B1
6440142 Ralph et al. Aug 2002 B1
6442814 Landry et al. Sep 2002 B1
6447547 Michelson Sep 2002 B1
6454806 Cohen et al. Sep 2002 B1
6468311 Boyd et al. Oct 2002 B2
6491724 Ferree Dec 2002 B1
6524341 Lang et al. Feb 2003 B2
6527773 Lin et al. Mar 2003 B1
D472634 Anderson Apr 2003 S
D473650 Anderson Apr 2003 S
6547823 Scarborough et al. Apr 2003 B2
6595998 Johnson et al. Jul 2003 B2
6626905 Schmiel et al. Sep 2003 B1
6635086 Lin Oct 2003 B2
6648895 Burkus et al. Nov 2003 B2
6672019 Wenz Jan 2004 B1
6676703 Biscup Jan 2004 B2
6706067 Shimp et al. Mar 2004 B2
6730088 Yeh May 2004 B2
6743255 Ferree Jun 2004 B2
6746484 Liu et al. Jun 2004 B1
6755841 Fraser et al. Jun 2004 B2
6761739 Shepard Jul 2004 B2
6824564 Crozet Nov 2004 B2
6866682 An et al. Mar 2005 B1
D503801 Jackson Apr 2005 S
6896517 Bjorn et al. May 2005 B1
6902579 Harms et al. Jun 2005 B2
6923814 Hildebrand et al. Aug 2005 B1
6942698 Jackson Sep 2005 B1
6964687 Bernard et al. Nov 2005 B1
6979353 Bresina Dec 2005 B2
6984245 McGahan et al. Jan 2006 B2
6986788 Paul et al. Jan 2006 B2
6989031 Michelson Jan 2006 B2
7018416 Hanson et al. Mar 2006 B2
7022138 Mashburn Apr 2006 B2
7056343 Schafer et al. Jun 2006 B2
D530423 Miles et al. Oct 2006 S
D594986 Miles et al. Jun 2009 S
D599019 Pimenta et al. Aug 2009 S
7621953 Braddock, Jr. et al. Nov 2009 B2
7641693 Gutlin et al. Jan 2010 B2
D621509 Lovell Aug 2010 S
7914581 Dickson Mar 2011 B2
7918891 Curran et al. Apr 2011 B1
8268002 Blackwell Sep 2012 B2
8992617 Woodburn Mar 2015 B2
20020058950 Winterbottom et al. May 2002 A1
20020082695 Neumann Jun 2002 A1
20030105528 Shimp et al. Jun 2003 A1
20030139812 Garcia et al. Jul 2003 A1
20040153155 Chung et al. Aug 2004 A1
20040186569 Berry Sep 2004 A1
20050060034 Berry Mar 2005 A1
20050090898 Berry Apr 2005 A1
20050107878 Conchy May 2005 A1
20050143820 Zucherman et al. Jun 2005 A1
20050197702 Coppes et al. Sep 2005 A1
20060058879 Metz-Stavenhagen Mar 2006 A1
20060100710 Gutlin et al. May 2006 A1
20060129241 Boyer, II et al. Jun 2006 A1
20060235528 Buettner-Janz Oct 2006 A1
20060241770 Rhoda et al. Oct 2006 A1
20070028710 Kraus et al. Feb 2007 A1
20070129805 Braddock, Jr. et al. Jun 2007 A1
20070191945 Yu et al. Aug 2007 A1
20080114467 Capote et al. May 2008 A1
20090112324 Refai Apr 2009 A1
20090138089 Doubler et al. May 2009 A1
20100076559 Bagga et al. Mar 2010 A1
20100106251 Kast Apr 2010 A1
20110106258 Blackwell et al. May 2011 A1
20110218631 Woodburn, Sr. Sep 2011 A1
Foreign Referenced Citations (39)
Number Date Country
2015507 Jan 1999 CA
369603 May 1990 EP
517030 May 1992 EP
667127 Aug 1995 EP
706876 Apr 1996 EP
716840 Jun 1996 EP
737448 Oct 1996 EP
796593 Sep 1997 EP
880938 Feb 1998 EP
809974 Apr 1998 EP
809975 Apr 1998 EP
811356 Apr 1998 EP
1080703 Mar 2000 EP
9000037 Jan 1990 WO
9106261 May 1992 WO
9214423 Sep 1992 WO
9404100 Mar 1994 WO
9410928 May 1994 WO
9501810 Jan 1995 WO
9608205 Mar 1996 WO
9617564 Jun 1996 WO
9641582 Dec 1996 WO
9720513 Jun 1997 WO
9733525 Sep 1997 WO
9737620 Oct 1997 WO
9809586 Mar 1998 WO
9814142 Apr 1998 WO
9817208 Apr 1998 WO
9825539 Jun 1998 WO
9908627 Feb 1999 WO
9938461 Aug 1999 WO
0045712 Aug 2000 WO
0045713 Aug 2000 WO
0141681 Jun 2001 WO
0149333 Jul 2001 WO
04210312 Oct 2004 WO
04100837 Nov 2004 WO
05037134 Apr 2005 WO
13025448 Feb 2013 WO
Non-Patent Literature Citations (22)
Entry
Alleyne, Cargill, H., et al., “Current and future approaches to lumbar disc surgery: A literature review”, Medscape Orthopedics & Sports Medicine, 1, [www.medscape.com/Medscape/OrthoSportsMed/1997/v01 .nll/.../mos3057], (1997).
Benini, et al., “Undercutting decompression and posterior fusion with translaminar facet screw fixation in degenerative lumbar spinal stenosis: Technique and results”, Neuro-Orthopedics, 17/18, 159-172 (1995).
Kambin, et al., “History and current status of percutaneous arthroscopic disc surgery”, Spine, 21(24S):57S-61S (1996).
Stein, et al., “Percutaneous facet joint fusion: Preliminary experience”, Journal of Vascular and Interventional Radiology, 4:69-74 (1993).
Vamvanij, et al., “Surgical treatment of internal disc disruption: An outcome study of four fusion techniques”, Journal of Spinal Disorders, 11(5):375-382 (1998).
Baulot, et al., “Complementary anterior spondylodesis by thoracoscopy. Technical note regarding an observation”, Lyon Surg., 90(5):347-351 (1994).
Berry, et al., “A morphometric study of human lumbar and selected thoracic vertebrae, study of selected vertebrae” Spine 12(4):362-367 (1996).
Crock, H. V., “A Short Practice of Spinal Surgery”, Second, revised edition, published by Springer-Verlag/Wein, New York (1993).
Crock. H. V., “Anterior Lumbar Interbody Fusion” Clinical Orthopaedics & Related Research, Marshall R. Urist, Editor-in-Chief, J. B. Lippincott Company (1982).
Edeland, H.G., “Some additional suggestions for an intervertebral disc prosthesis”, Journal of Biomedical Engineering, 7:57-62 (1985).
Kemp, H. B. S., “Anterior fusion of the spine for infective lesions in adults”, Journal of Bone & Joint Surgery, 558(4):715-734 (1973).
Nuvasive, Inc., Corrected Final Invalidity Contentions Regarding U.S. Pat. No. 5,860,973, U.S. Pat. No. 6,592,586 and U.S. Pat. No. 6,945,933 filed in the United States District Court, Southern District of California on Jun. 14, 2010 (and 23 appendices).
CoRoent™ Marketing Brochure (9004001 A.0), NuVasive, Inc., 2004, 2 pages.
CoRoent™ Marketing Brochure (9004001 C.0), NuVasive, Inc., 2005, 2 pages.
CoRoentTM XL & XLR Marketing Brochure (9004225 A.0), NuVasive, Inc., 2005, 2 pages.
CoRoent® XL & XLR Marketing Brochure (9004225 B.0), NuVasive, Inc., 2006, 2 pages.
CoRoent® XL & XLR Marketing Brochure (9004225 C.0), NuVasive, Inc., 2007, 2 pages.
Telamon Verte-Stack PEEK Vertebral Body Spacer Brochure, medtronic Sofamor Danek, 2003, 2 pages.
Telamon Implantation Guide, Medtronic Sofamor Danek, 2003, 10 pages.
Synthes Vertebral Spacer-PR Brochure, Synthes Spine, 2002, 2 pages.
Verte-Stack PEEK Stackable Corpectomy Device, Medtronic Sofamor Danek, 2002, 11 pages.
Synthes Vertebral Spacer—AR brochure, Synthes Spine, 2006, 4 pages.
Related Publications (1)
Number Date Country
20190328542 A1 Oct 2019 US
Provisional Applications (3)
Number Date Country
61521704 Aug 2011 US
61159792 Mar 2009 US
61260375 Nov 2009 US
Continuations (3)
Number Date Country
Parent 15635087 Jun 2017 US
Child 16510123 US
Parent 14177100 Feb 2014 US
Child 15635087 US
Parent PCT/US2012/050218 Aug 2012 US
Child 14177100 US
Continuation in Parts (1)
Number Date Country
Parent 12661206 Mar 2010 US
Child 14177100 Feb 2014 US