Zero-profile interbody spacer and coupled plate assembly

Information

  • Patent Grant
  • 11517444
  • Patent Number
    11,517,444
  • Date Filed
    Wednesday, January 8, 2020
    4 years ago
  • Date Issued
    Tuesday, December 6, 2022
    a year ago
Abstract
An implant for insertion into the disc space between vertebrae. The implant including a spacer portion, a plate portion coupled to the spacer portion, a plurality of bone fixation elements for engaging the vertebrae and a retention mechanism for preventing the bone fixation elements from postoperatively uncoupling from the implant.
Description
BACKGROUND OF THE INVENTION

Intervertebral implants including interbody spacer portions and mechanically coupled plate portions are known in the art for restoring disc height, allowing fusion to occur between the adjacent vertebral bodies, and for providing stable fixation during healing.


It is desirable to construct a zero-profile implant wherein the bone fixation elements that secure the implant to the vertebral bodies are blocked from backing-out of the bone and/or plate. Additionally, it is desirable to construct a zero-profile implant that includes polyaxial bone fixation element couplings and features that prevent the implant from being implanted too deeply into a prepared disc space. Both screw back-out and over-insertion of the implant into a prepared disc space can have an adverse impact on the performance of the implant.


BRIEF SUMMARY OF THE INVENTION

The present invention relates generally to a spinal implant. More specifically, the present invention relates to a zero profile interbody spacer and coupled plate assembly for insertion into a disc space between adjacent superior and inferior vertebral bodies. Preferably, the implant is sized and configured for use in the cervical region of the spine, where a very limited amount of space is available.


The implant preferably includes a spacer portion, a plate portion coupled to the spacer portion, a plurality of bone fixation elements for engaging the vertebral bodies and a retention mechanism for preventing the bone fixation elements from postoperatively uncoupling from the implant.


The spacer portion preferably includes a top surface for contacting the superior vertebral body, a bottom surface for contacting the inferior vertebral body, a first side surface, a second side surface, a leading surface and a trailing surface. The plate portion includes a top surface, a bottom surface, a first side surface, a second side surface, a leading surface, a trailing surface and one or more bone fixation holes for receiving the one or more bone fixation elements. Preferably, the implant includes at least two bone fixation holes for receiving at least two bone fixation elements. The first bone fixation hole is angled so that the first bone fixation element engages the superior vertebral body while the second bone fixation hole is angled so that the second bone fixation element engages the inferior vertebral body.


The retention mechanism may be in the form of any of the numerous retention mechanisms disclosed herein. The retention mechanism generally operates to engage or block subsequent movement of the bone fixation elements in order to prevent the bone fixation elements from backing-out of the bone fixation holes formed in the plate portion (e.g., from postoperatively uncoupling from the implant).


The implant preferably also includes one or more stops, more preferably first and second stops, to prevent over-insertion of the implant during implantation and to assist in securing a position of the implant during insertion of the bone fixation elements. The first stop preferably extends superiorly of the top surface of the plate portion for contacting the superior vertebral body while the second stop extends inferiorly of the bottom surface of the plate portion for contacting the inferior vertebral body. The first and second stops are preferably integrally formed with the plate portion.





BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

The foregoing summary, as well as the following detailed description of preferred embodiments of the application, will be better understood when read in conjunction with the appended drawings. For the purposes of illustrating the implant of the present application, there is shown in the drawings preferred embodiments. It should be understood, however, that the application is not limited to the precise arrangements and instrumentalities shown. In the drawings:



FIG. 1 illustrates an anterior perspective view of an implant according to a first preferred embodiment of the present application;



FIGS. 2A-2E illustrate various perspective views of an implant according to a second preferred embodiment, the implant being inserted into an intervertebral disc space between adjacent vertebral bodies via an exemplary implant inserter instrument.



FIG. 3A illustrates an anterior perspective view of an implant according to a third preferred embodiment of the present application;



FIG. 3B illustrates an anterior perspective view of the implant of FIG. 3A with a blocking plate retention mechanism coupled thereto;



FIG. 4A illustrates an anterior perspective view of an implant according to a fourth preferred embodiment of the present application;



FIG. 4B illustrates an anterior perspective view of the implant of FIG. 4A with a blocking plate retention mechanism coupled thereto;



FIGS. 5A-5D illustrate various perspective views of additional blocking plate geometries and securing mechanisms;



FIG. 6A illustrates an anterior perspective view of an implant according to a fifth preferred embodiment of the present application;



FIG. 6B illustrates an anterior elevational view of the implant of FIG. 6A;



FIG. 6C illustrates a perspective view of the retention mechanism of the implant of FIG. 6A;



FIG. 7 illustrates a partial anterior perspective view of an implant according to a sixth preferred embodiment of the present application, the implant incorporating first and second stops;



FIG. 8 illustrates an alternate anterior perspective view of the implant of FIG. 7, the implant incorporating first, second, third and fourth stops;



FIG. 9A illustrates an anterior perspective view of an implant according to a seventh preferred embodiment of the present application;



FIG. 9B illustrates an anterior elevational view of the plate portion of the implant of FIG. 9A;



FIG. 9C illustrates a side elevational view of the bone fixation element of the implant of FIG. 9A;



FIG. 10 illustrates a partial cross-sectional view of a plate portion, a bone fixation element and a retention mechanism of an implant according to an eighth preferred embodiment of the present invention;



FIG. 11 illustrates a partial cross-sectional view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a ninth preferred embodiment of the present invention;



FIG. 12 illustrates a partial cross-sectional view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a tenth preferred embodiment of the present invention;



FIG. 13 illustrates a cross-sectional view of an implant according to an eleventh preferred embodiment of the present invention;



FIG. 14A illustrates a partial cross-sectional elevational view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a twelfth preferred embodiment of the present invention;



FIG. 14B illustrates an elevational view of the retention mechanism of the implant of FIG. 14A, the retention mechanism being illustrated in a deformed, reduced configuration;



FIG. 15 illustrates a partial cross-sectional view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a thirteenth preferred embodiment of the present invention;



FIG. 16A illustrates an elevational view of a retention mechanism of an implant according to a fourteenth preferred embodiment, the retention mechanism being illustrated in an open, enlarged configuration;



FIG. 16B illustrates an elevational view of the retention mechanism of FIG. 16A, the retention mechanism being illustrated in a closed, biased configuration;



FIG. 17 illustrates a partial perspective view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a fifteenth preferred embodiment of the present invention;



FIG. 18 illustrates a partial cross-sectional view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a sixteenth preferred embodiment of the present invention;



FIG. 19A illustrates a partial cross-sectional view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a seventeenth preferred embodiment of the present invention;



FIG. 19B illustrates an alternate partial cross-sectional view of a plate portion, a bone fixation element and a retention mechanism of the implant of FIG. 19A;



FIG. 19C illustrates an alternate partial cross-sectional view of a bone fixation element and a retention mechanism of the implant of FIG. 19A;



FIG. 19D illustrates a side elevational view of a bone fixation element and a retention mechanism of the implant of FIG. 19A;



FIG. 20A illustrates a partial anterior, perspective view of a plate portion, a bone fixation element and a retention mechanism of an implant according to an eighteenth preferred embodiment of the present invention;



FIG. 20B illustrates a cross-sectional view of the bone fixation elements and retention mechanism of the implant of FIG. 20A;



FIG. 20C illustrates an alternate partial anterior, perspective view of a plate portion, a bone fixation element and a retention mechanism of the implant of FIG. 20A;



FIG. 21 illustrates a partial cross-sectional elevational view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a nineteenth preferred embodiment of the present invention;



FIG. 22 illustrates a partial cross-sectional elevational view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a twentieth preferred embodiment of the present invention;



FIG. 22A illustrates an alternate partial cross-sectional elevational view of a plate portion, a bone fixation element and a retention mechanism of the implant of FIG. 22;



FIG. 23A illustrates a cross-sectional view of a bone fixation element and a retention mechanism of an implant according to a twenty-first preferred embodiment of the present invention, the bone fixation element and retention mechanism being illustrated in a first insertion configuration;



FIG. 23B illustrates a cross-sectional view of the bone fixation element of FIG. 23A, the bone fixation element being illustrated in a second inserted configuration;



FIG. 24A illustrates a partial anterior view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a twenty-second preferred embodiment of the present invention, the bone fixation element and retention mechanism being illustrated in a first insertion configuration;



FIG. 24B illustrates a partial anterior view of the bone fixation element and retention mechanism of FIG. 24A, the bone fixation element being illustrated in a second inserted configuration;



FIGS. 25A-25C illustrate various views of a bone fixation element and a retention mechanism of an implant according to a twenty-third preferred embodiment of the present invention;



FIG. 26 illustrates a partial cross-sectional view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a twenty-fourth preferred embodiment of the present invention;



FIG. 27 illustrates a partial anterior perspective view of a plate portion, a bone fixation element and a retention mechanism of an implant according to a twenty-fifth preferred embodiment of the present invention;



FIG. 28 illustrates a cross-sectional elevational view of a spacer portion, a plate portion, a bone fixation element and a retention mechanism of an implant according to a twenty-sixth preferred embodiment of the present invention;



FIG. 29 illustrates a partial cross-sectional elevational view of a spacer portion, a plate portion, a bone fixation element and a retention mechanism of an implant according to a twenty-seventh preferred embodiment of the present invention;



FIG. 30 illustrates an anterior elevational view of a plate portion and a retention mechanism of an implant according to a twenty-eight preferred embodiment of the present invention;



FIG. 31A illustrates a cross-sectional elevational view of a spacer portion, a plate portion, a bone fixation element and a retention mechanism of an implant according to a twenty-ninth preferred embodiment of the present invention; and



FIG. 31B illustrates a partial anterior elevational view the plate portion and the retention mechanism of the implant of FIG. 31A.





DETAILED DESCRIPTION OF THE INVENTION

Certain terminology is used in the following description for convenience only and is not limiting. The words “right”, “left”, “lower” and “upper” designate directions in the drawings to which reference is made. The words “inwardly” or “distally” and “outwardly” or “proximally” refer to directions toward and away from, respectively, the geometric center of the implant and related parts thereof. The words, “anterior”, “posterior”, “superior,” “inferior” and related words and/or phrases designate preferred positions and orientations in the human body to which reference is made and are not meant to be limiting. The terminology includes the above-listed words, derivatives thereof and words of similar import.


Similar reference numerals will be utilized throughout the application to describe similar or the same components of each of the preferred embodiments of the implant described herein and the descriptions will focus on the specific features of the individual embodiments that distinguish the particular embodiment from the others.


Preferred embodiments of the present application are directed to an implant 10-2800. It should be understood that while the various embodiments of the implant 10-2800 will be described in connection with spinal surgery, those skilled in the art will appreciate that the implant 10-2800, as well as the components thereof, may be used for implantation into other parts of the body, including, for example, long bones or bones in the knee, hip, shoulder, or other joint replacement or for bone augmentation.


The various embodiments of the implant 10-2800 are preferably sized and configured to be implanted between adjacent vertebral bodies V. The implant 10-2800 may be sized and configured to replace all or substantially all of an intervertebral disc space D between adjacent vertebral bodies V or only part of the intervertebral disc space D. In addition, the preferred implant 10-2800 may be configured to replace an entire vertebral body V and related disc spaces D or multiple disc spaces D in a patient's spine, as would be apparent to one having ordinary skill in the art based upon a review of the present application. The implant 10-2800 may be adapted for use in the anterior, anterolateral, direct lateral, extra-foraminal, transforaminal, and posterior approaches for insertion into the spine.


The implant 10-2800 of each of the preferred embodiments includes an interbody spacer portion 20-2820 and a plate portion 50-2850. The spacer portion 20-2820 is preferably sized and configured for implantation into the intervertebral disc space D between adjacent vertebral bodies V. The spacer portion 20-2820 of each of the preferred embodiments includes a top surface 22, a bottom surface 24, a first side surface 26, a second side surface 28, a leading surface 30 and a trailing surface 32. The top and bottom surfaces 22, 24 are suitable for contacting and are adapted for being secured relative to the end plates of adjacent vertebral bodies V. The spacer portion 20-2820 is preferably sized and configured to maintain and/or restore a desired intervertebral disc height between the adjacent vertebral bodies V. Accordingly, the top and bottom surfaces 22, 24 may include a series of teeth, ridges, spikes or other similar projections 25 to aid in securing the implant 10-2800 to the endplates of the adjacent vertebral bodies V.


The top and bottom surfaces 22, 24 may also include a curved or a tapered surface to help provide an anatomical shape for mating with the patient's spine or to orient the endplates of the adjacent vertebral bodies V in a desired manner. The particular surface shape and curvature, taper or alternate surface feature in the anterior-posterior direction, as well as the particular surface shape and curvature, taper or alternate surface feature in the medial-lateral direction will depend upon the location where the implant 10-2800 is intended to be implanted and/or surgeon preferences or whether the implant 10-2800 is utilized in another area in the body.


The spacer portion 20-2820 may also include one or more boreholes, openings, windows or channels for receiving bone graft material. For example, the implant 10-2800 may include one or more vertical openings, windows or channels extending through the spacer portion from the top surface 22 to the bottom surface 24 for insertion of bone graft material, such that bone growth is promoted through the vertical openings, windows or channels following implantation of the implant 10-2800. One or more boreholes, openings, windows or channels is especially preferred if the spacer portion 20-2820 is constructed of a non-allograft or non-bone-growth material, such as Polyetheretherketone (“PEEK”).


The plate portion 50-2850 is preferably coupled to the spacer portion 20-2820 to provide increased implant stability during healing as well as to optimally orient the trajectory of bone fixation elements 70 during implantation.


The plate portion 50-2850 of each of the preferred embodiments includes a top surface 52, a bottom surface 54, a first side surface 56, a second side surface 58, a leading surface 60 and a trailing surface 62. The plate portion 50-2850 preferably contacts the trailing surface 32 of the spacer portion 20-2820 and preferably does not extend beyond or does not increase greatly the vertical or lateral perimeter of the spacer portion 20-2820. In this manner, the implant 10-2800 has a low profile. Additionally, in this manner, the plate portion 50-2850 is preferably entirely implanted within the intervertebral disc space D between the adjacent vertebral bodies V such that the plate portion 50-2850 has little or no external profile (e.g., the plate portion 50-2850 does not extend anterior beyond an edge of the disc space D). In this manner, little or no structure protrudes outside of the bounds of the disc space D or the profile of the vertebral bodies V, thereby limiting dysphasia and patient discomfort. In use, the plate portion 50-2850 may be sized and configured so that the top and bottom surfaces 52, 54 of the plate portion 50-2850 contact the endplates of the adjacent vertebral bodies V. Alternatively, the plate portion 50-2850 may be sized and configured so that only the spacer portion 20-2820 contacts the adjacent vertebral bodies V. For example, the height of the plate portion 50-2850 may be small enough so that it does not contact the vertebral bodies V when connected to the spacer portion 20-2820 in an implanted position.


The plate portion 50-2850 may be coupled to the spacer portion 20-2820 by any coupling mechanism now or hereafter known. For example, the spacer portion 20-2820 may include one or more recesses 36 formed in the side or trailing surfaces for engaging one or more projections 64 extending from the plate portion 50-2850. Preferably the spacer portion 20-2820 includes a recess 36 formed in each of the side surfaces 26, 28 thereof for engaging projections 64 extending from the plate portion 50-2850. The recesses 36 may extend completely from the top surface 22 to the bottom surface of the spacer portion 20-2820 or may extend only partially from either the top or bottom surface 20, 22. Other coupling mechanisms for coupling the plate portion 50-2850 to the spacer portion 20-2820 are disclosed in International Application No. PCT/US2008/082473 filed on Nov. 5, 2008 and entitled, “Low Profile Intervertebral Implant”, the contents of which are hereby incorporated by reference in their entirety.


The trailing surface 62 of the plate portion 50-2850 preferably includes a tool engagement feature (not shown) for engaging one or more insertion tools. The tool engagement feature may be in any form now or hereafter known for such purpose including one or more recesses (not shown) formed in the trailing surface 62 of the plate portion 50-2850, the recesses extending from top and bottom surfaces 52, 54, respectively, for engaging arms of the insertion tool (not shown). Alternatively, the tool engagement feature may be a threaded bore (not shown) formed in the trailing surface 62 of the plate portion 50-2850 for engaging a threaded stem extending from the insertion tool, etc.


The implant 10-2800 preferably includes one or more bone fixation holes 40 for receiving one or more bone fixation elements 70, preferably bone screws so that, in use, after the implant 10-2800 has been inserted into the intervertebral disc space D between adjacent vertebral bodies V, the implant 10-2800 may be secured to the adjacent vertebral bodies V. The bone fixation elements 70 preferably include a threaded shaft 72 and a partially spherical head portion 74 that is generally smooth where it contacts the bone fixation hole 40. The threaded shaft 72 may be self-drilling, i.e. does not necessitate the drilling of pilot holes, but are not so limited. The bone fixation elements 70 are not limited to bone screws 70 and may be comprised of a helical nail, a distally expanding nail or screw, etc. The bone fixation holes 40 are preferably sized and configured so that the head portion 74 of the bone fixation elements 70 do not protrude proximally beyond the trailing surface 62 of the plate portion 50, when the bone fixation elements 70 have been fully implanted.


The bone fixation holes 40 preferably include a curved or frusta-spherical surface for contacting an underside of the generally smooth or frustaspherical surface of the head portion 74 of the bone fixation elements 70 so that the bone fixation elements 70 can polyaxially rotate with respect to the plate portion 50-2850 and a variety of trajectory angles can be chosen for the bone fixation elements 70 according to surgeons' preferences or needs as well as to enable the implant 10-2800 to settle during healing. Post implantation, the bone fixation elements 70 are preferably free to toggle to allow for settling during postoperative healing. If a surgeon decides the placement of the implant 10-2800 is not optimal, adjustments can be made by moving the retention mechanism (as will be described in greater detail below) with, for example a blunt instrument, to allow the bone fixation elements 70 to be removed.


The plate portion 50-2850 preferably includes at least first and second bone fixation holes 40 for receiving at least first and second bone fixation elements 70 with the first bone fixation element 70 being angled upwardly for engaging the superior vertebral body V and the second bone fixation element 70 being angled downwardly for engaging the inferior vertebral body V. That is, the bone fixation holes 40 preferably have a longitudinal axis that is oriented obliquely with respect to the implant 10-2800 so that the bone fixation elements 70 form a fastener angle with respect to the top and bottom surfaces 22, 24 of the spacer portion 20-2820 wherein bone fixation angle may be in the range between twenty degrees (20°) and sixty degrees (60°), and more preferably between thirty degrees (30°) and fifty degrees (50°). The bone fixation angle may be the same for all of the holes 40 or may be different for each of the holes 40. In addition, the bone fixation holes 40 may be directed inwardly toward the center of the implant 10-2800 or outwardly away from the center of the implant 10-2800, preferably at a lateral bone fixation angle α so that the bone fixation elements 70 extend laterally inward toward a center plane of the implant 10-2800 or laterally outward away from the center plane of the implant 10-2800. The lateral bone fixation angle α may be in the range between plus sixty degrees (60°) and minus sixty degree (−60°), preferably between zero degrees (0°) and plus or minus thirty degrees (30°), and more preferably about plus or minus fifteen degrees (15°). The lateral bone fixation angle α may be the same for all holes 40 or may be different for each hole 40. However, as would be understood by one of ordinary skill in the art based upon a reading of this disclosure, a plurality of potential angles is possible since the bone fixation elements 70 are polyaxial, as will be described in greater detail below.


It should be understood however that the implant 10-2800 may include any number of bone fixation holes 40 configured to receive a corresponding number of bone fixation elements 70 in any number of configurations. In addition, the number of bone fixation elements 70 extending from the top and bottom surfaces 22, 24 may be varied and the number of bone fixation elements 70 extending from the top surface 22 need not equal the number of bone fixation elements 70 extending from the bottom surface 24.


Exit openings for the bone fixation holes 40 preferably are formed at least partially in the top or bottom surfaces 52, 54 of the plate portion 50-2850. The exit openings may also be formed at least partially or entirely in the top or bottom surfaces 22, 24 of the spacer portion 20-2820. The bone fixation holes 40 may also include a partially spherical interior volume to accommodate the partially spherical geometry of the head portion 74 of the bone fixation elements 70 to enable a range of polyaxial orientations to be chosen for the bone fixation elements 70 with respect to the vertebral bodies V.


The implant 10-2800 preferably includes a retention mechanism for reducing the likelihood that the bone fixation elements 70 may postoperatively uncouple from the implant 10-2800 and migrate from the disc space D. In use, the retention mechanism preferably engages or contacts the bone fixation element 70 or blocks or covers at least a portion of the bone fixation holes 40 and hence the bone fixation elements 70 to prevent the bone fixation elements 70 from backing-out, as will be described in greater detail below.


The implant 10-2800 including the spacer portion 20-2820 and the plate portion 50-2850 may be constructed of any suitable biocompatible material or combination of materials including, but not limited to one or more of the following metals such as titanium, titanium alloys, stainless steel, aluminum, aluminum alloy, magnesium, etc., polymers such as, PEEK, porous PEEK, carbon fiber PEEK, resorbable polymers, PLLA, etc., allograft, synthetic allograft substitute, ceramics in the form of bioglass, tantalum, Nitinol, or alternative bone growth material or some composite material or combination of these materials.


The spacer portion 20-2820 may be formed of a different material than the plate portion 50-2850. For example, the plate portion 50-2850 may be formed of a metallic material such as, a titanium or a titanium alloy, and the spacer portion 20-2820 may be formed of a non-metallic material such as, a polymer such as, PEEK, an allograft, a bioresorbable material, a ceramic, etc. Alternatively, the plate portion 50-2850 and the spacer portion 20-2820 may be formed from the same material. In addition, the plate portion 50-2850 and spacer portion 20-2820 may be integrally formed, pre-assembled or separately provided to a surgeon and assembled in the operating room.


As will be appreciated by one of ordinary skill in the art, the implant 10-2800, or portions thereof, may also be coated with various compounds to increase bony on-growth or bony in-growth, to promote healing or to allow for revision of the implant 10-2800, including hydroxyapatite, titanium-nickel, vapor plasma spray deposition of titanium, or plasma treatment to make the surface hydrophilic.


Referring to FIG. 1, the intervertebral implant 10 of a first preferred embodiment includes the interbody spacer portion 20, the plate portion 50, first, second and third bone fixation elements 70 and the retention mechanism. In the first preferred embodiment, the retention mechanism is in the form of a retaining clip 80 coupled to the plate portion 50 via a blocking plate 82. Alternatively, the implant 10 may include a plurality of retaining clips 80 coupled to the plate portion 50 via the blocking plate 82. The retaining clip 80 is preferably coupled to the blocking plate 82 before the blocking plate 82 is coupled to the plate portion 50.


The blocking plate 82 preferably includes a pair of elastically deflectable spring fingers 84 extending distally therefrom for engaging corresponding recesses formed in the side surfaces 56, 58 of the plate portion 50. The blocking plate 82 preferably is sized and configured to snap over the trailing surface 62 of the plate portion 50 so that, in operation, the retaining clip 80 is coupled to the blocking plate 82 and the blocking plate 82 and the retaining clip 80 assembly is coupled to, e.g., snapped over, the trailing surface 62 of the plate portion 50. The implant 10 is then inserted into the disc space D and the bone fixation elements 70 are inserted. Alternatively, the blocking plate 82 and the retaining clip 80 assembly may be coupled to the plate portion 50 subsequent to the insertion of the bone fixation elements 70 through the boreholes 40 formed in the plate portion 50. Alternatively, a variety of other now or hereafter developed coupling mechanisms may be used for coupling the blocking plate 82 to the plate portion 50 including snap-locks, screw(s) and borehole(s), etc.


Referring to FIGS. 2A-2E, the intervertebral implant 100 of a second preferred embodiment includes the spacer portion 120, the plate portion 150, first and second bone fixation elements (not shown) and the retention mechanism. In the second preferred embodiment, the retention mechanism is in the form of an externally threaded retaining screw 180, a threaded borehole 185 formed in the plate portion 150 preferably between the bone fixation holes 40 and a blocking plate 190 for covering, contacting and/or interacting with at least a portion of the first and second bone fixation elements to block the first and second bone fixation elements and limit the first and second bone fixation elements from backing-out of the bone fixation holes 40.


The implant 100 may further include an implant inserter instrument 195 including an inner shaft 196 having a set of external threads 197 protruding from a distal end thereof for threadably engaging the threaded borehole 185 formed in the plate portion 150 of the implant 100. The implant inserter instrument 195 preferably also includes an outer tubular member 198 housed concentrically around the inner shaft 196 and configured to enable the inner shaft 196 to rotate with respect thereto.


The implant inserter instrument 195, and more particularly, the outer tubular member 198 preferably includes one or more stops 199 for preventing over-insertion of the implant 100. More preferably, the implant inserter instrument 195 includes first and second stops 199, the first stop 199 protruding superiorly for contacting the superior vertebral body V while the second stop 199 protrudes inferiorly for contacting the inferior vertebral body V. Incorporation of more or less stops 199 is envisioned. Incorporation of the first and second stops 199 facilitates fully seating the implant 100 with respect to the adjacent vertebral bodies V regardless of the irregular anatomy of a patient's spine, which often characterizes the outer surface of the vertebral bodies V.


In use, the stops 199 are configured to abut the anterior aspects of the vertebral bodies V during implantation, although the stops 199 may abut the lateral or antero-lateral aspects of the vertebral bodies V depending upon the surgical procedure and insertion path being utilized. The stops 199 assist in preventing over-insertion of the implant 100 during implantation and assist in securing the position of the implant 100 during insertion of the bone fixation elements, as will be described in greater detail below.


In operation, the implant inserter instrument 195 is coupled to the implant 100 via threadably mating the threads 197 formed on the distal end of the inner shaft 196 with the threaded borehole 185 formed in the plate portion 150. The implant inserter instrument 195 is then used to insert the implant 100 into the disc space D between the adjacent vertebral bodies V until the stops 199 abut the anterior (or lateral or antero-lateral) aspects of the vertebral bodies V. The first and second bone fixation elements are then inserted through the boreholes 40 and into the vertebral bodies V while lagging of the implant 100 is limited by interaction of the stops 199 with the anterior aspects of the vertebral bodies V. That is, advancement of the bone fixation elements into the bone fixation holes 40 causes the head portion of the bone fixation elements to contact the inner spherical portions of the bone fixation holes 40 and tends to draw the vertebral bodies V into alignment as opposed to resulting in the over-insertion of the implant 100 since the stops 199 guide the movement of the vertebral bodies V during bone fixation manipulation. That is, because the stops 199 contact the adjacent vertebral bodies V and prevents over-insertion of the implant 100 into the disc space D, advancement of the bone fixation elements tends to pull and/or reposition the adjacent vertebral bodies V together to promote fusion.


The position of the implant 100 can be adjusted with respect to the disc space D by rotating the inner shaft 196, e.g., by rotating a handle portion of the inner shaft 196. The bone fixation elements are inserted through the boreholes 40 and into the vertebral bodies V, while the implant inserter instrument 195 remains coupled to the implant 100 such that the stops 199 remain abutted to the anterior aspects of the vertebral bodies V to limit movement of the implant 100 while the bone fixation elements are being inserted. The implant inserter instrument 195 may then be decoupled from the implant 100 and the blocking plate 190 may be coupled to the plate portion 150 via the retaining screw 180 to block the bone fixation elements from backing-out.


Referring to FIGS. 3A and 3B, the intervertebral implant 200 of a third preferred embodiment includes the interbody spacer portion 220, the plate portion 250, first, second and third bone fixation elements 70 and the retention mechanism. In the third preferred embodiment, the retention mechanism includes a blocking plate 280 having a pair of elastically deflectable spring fingers 284 extending distally therefrom for engaging corresponding recesses 286 formed in the side surfaces 56, 58 of the plate portion 250. The blocking plate 280 is preferably sized and configured to snap over the trailing surface 62 of the plate portion 250 so that, in operation, the blocking plate 280 may be coupled to the plate portion 250 subsequent to the insertion of the bone fixation elements 70 to limit back-out of the bone fixation elements 70.


Referring to FIGS. 4A and 4B, the intervertebral implant 300 of a fourth preferred embodiment includes the interbody spacer portion 320, the plate portion 350, first, second and third bone fixation elements 70 and the retention mechanism. In the fourth preferred embodiment, the retention mechanism includes a blocking plate 380 having a plurality of elastically deflectable spring fingers 384 extending distally therefrom for engaging corresponding recesses or indentations 386 formed in the plate portion 350. More preferably, the recesses or indentations 386 are formed within the bone fixation holes 40 formed in the plate portion 350. The blocking plate 380 is sized and configured to snap onto the trailing surface 62 of the plate portion 350 so that, in operation, the blocking plate 380 is operatively coupled to the plate portion 350 subsequent to the insertion of the bone fixation elements 70 to limit back-out of the bone fixation elements 70.


It should be understood that additional blocking plate geometries and securing mechanisms are envisioned. For example, referring to FIGS. 5A-5D, a variety of additional blocking plate geometries and securing mechanisms 380′, 380″, 380′″, 380″″ are provided for use with the preferred implant assemblies and their configuration and operation will be apparent to one having ordinary skill in the art from the above-listed descriptions of the implants, assemblies and blocking plates. The additional blocking plate configurations may be constructed of rigid or flexible materials and may be coupled to the plate portions before or after insertion of the bone fixation elements.


Referring to FIGS. 6A-6C, the intervertebral implant 400 of a fifth preferred embodiment includes the interbody spacer portion 420, the plate portion 450, first, second and third bone fixation holes 40 for receiving first, second and third bone fixation elements (not shown) and the retention mechanism. In the fifth preferred embodiment, the retention mechanism includes first, second and third unidirectional retaining clips 480 positioned inside the first, second and third bone fixation holes 40. The retaining clips 480 are preferably in the form of a wishbone clip formed of, for example, elgiloy, although other shapes and material are envisioned. The retaining clips 480 are mounted in the bone fixation holes 40 to assist in securing the bone fixation elements to the plate portion 450 by allowing insertion of the bone fixation elements into the holes 40 while preventing the bone fixation elements from backing-out of the holes 40. That is, the retaining clips 480 preferably permit unidirectional advancement of the head portion of the bone fixation elements distally into the bone fixation holes 40 and through the retaining clip 480 while limiting backing-out of the bone fixation elements by blocking its regression once the head portion has passed through the retaining clip 480.


In operation, the partially spherical head portion of the bone fixation elements passes distally into the bone fixation holes 40 and through the retaining clip 480 such that the tapered or partially spherical underside of the head portion of the bone fixation elements bear against the retaining clips 480 thereby urging the arms 481a, 481b of the retaining clips 480 to flex outwardly a slight amount to permit passage of the head portion therethrough.


Once the head portion of the bone fixation element has fully passed through the retaining clip 480, the arms 481a, 481b of the retaining clip 480 spring back to their original configuration, thereby covering and/or blocking the head portion of the bone fixation element. The bone fixation element is thereby prevented from backing-out due to the non-tapered (partially flat) aspect of the proximal surface of the head portion of the bone fixation element, which generally prevents the bone fixation element from passing back through the retaining clip 480. The retaining clip 480 may be manually flexed open by a tool to permit removal of the bone fixation elements from the implant 400, if desired.


Alternatively, the retention mechanism may take on any other form that facilitates unidirectional advancement of the bone fixation elements while limiting backing-out of the bone fixation elements. For example, the retention mechanism may be in the form of a blocking mechanism. For example, the plate portion 450 may be formed from a polymer such as PEEK and the retention mechanism may include one or more blocking mechanisms formed from a metal such as titanium. In use, the blocking mechanism is preferably disposed within the bone fixation hole 40 formed in the plate portion 450 and is configured in such a way as to enable deformation of the blocking mechanism to allow the head portion of the bone fixation element to pass beyond the blocking mechanism. Once the head portion of the bone fixation element passes beyond the blocking mechanism, the blocking mechanism elastically return to its original shape to block and/or cover the head portion of the bone fixation element from backing-out from the plate portion 450. The polymeric plate portion 450 can be injection molded onto or around the blocking mechanism(s). The blocking mechanism can be any one of a number of configurations so long as the blocking mechanism deforms to enable the bone fixation element to pass therethrough and then radially expands to block and/or cover at least a portion of the bone fixation element. The blocking mechanism can be configured to block and/or cover a single bone fixation element or a plurality of bone fixation elements.


Referring to FIG. 7, the intervertebral implant 500 of a sixth preferred embodiment includes the interbody spacer portion 520, the plate portion 550, first and second bone fixation elements 70 and the retention mechanism. In the sixth preferred embodiment, the retention mechanism includes an unidirectional retaining clip 580 disposed in a recess 582, such as a blind borehole, formed in the plate portion 550 between the bone fixation holes 40. In use, a portion of the retaining clip 580 protrudes from the recess 582 into each of the bone fixation holes 40 to cover and/or block the head portions 74 of the bone fixation elements 70 in an implanted position. The retaining clip 580 preferably permits unidirectional advancement of the head portions 74 of the first and second bone fixation elements 70 distally into the bone fixation holes 40 and past the retaining clip 580 to limit backing-out of the bone fixation elements 70 by covering and/or blocking their regression once the head portions 74 of the bone fixation elements 70 have advanced past the retaining clip 580. The retaining clip 580 is otherwise substantially identical in operation to the retaining clip 480 discussed above.


It should be noted that while the retaining clip 580 is shown as having an S-shape on its side and retaining clip 480 is shown as having a wishbone shape, it is envisioned that a range of applicable geometries can be used. For example, retaining clip 580 may have a wishbone shape wherein a portion of each arm protrudes into each bone fixation hole 40. Accordingly, the retaining clips 480, 580 may have nearly any shape and/or configuration that permits engagement with the plate portion 450, 550, flexure out of the bone fixation holes 40 as the head portion 74 of the bone fixation elements 70 passes therethrough and spring back at least partially into the bone fixation holes 40 once the head portion 74 passes the retaining clip 480, 580.


Referring to FIG. 7, the implant 500, and any other implant 10-2800 described herein, may also incorporate one or more stops 99 that are preferably integrally formed on the plate portion 550. The stops 99 are configured to abut the anterior (or lateral or antero-lateral) aspects of the vertebral bodies V during implantation. In operation, the stops 99 assist in preventing over-insertion of the implant 500 during insertion into the disc space D and assist in securing the position of the implant 500 during insertion of the bone fixation elements 70.


As shown in FIG. 7, the implant 500 may include first and second stops 99a, 99b. Incorporation of first and second stops 99a, 99b is desirable in circumstances where it is difficult to fully seat the implant 500 due to an irregular anatomy of the patient's spine, which often characterizes the anterior (or lateral or antero-lateral) aspects of the vertebral bodies V. Due to the disposition of the stops 99, the implant 500 generally has a zero-profile external to the disc space D at least along a cranial-caudal midline, because the trailing surface 62 of the plate portion 550 can be designed to be convex to match the disc space D. The distal surfaces of the stops 99 can be configured to embed at least partially into the vertebral bodies V during impaction to further reduce the profile of the plate portion 550 exterior to the disc space D, if so desired. For example, the distal surface of the stops 99 may include one or more pyramid shaped projections, teeth, blades, etc. extending therefrom for embedding at least partially into the vertebral bodies V during impaction. Alternatively, as shown in FIG. 8, the implant may include four stops 99a-99d disposed at or near the four corners of the plate portion. It is envisioned that the implant may include any number of stops 99 in any configuration.


Referring to FIGS. 9A-9C, the intervertebral implant 600 of a seventh preferred embodiment includes the interbody spacer portion 620, the plate portion 650, first and second bone fixation elements 70′ and the retention mechanism. In the seventh preferred embodiment, the retention mechanism includes forming scallop-shaped threaded regions 41′ on the inner surface of the bone fixation holes 40′ for engaging external threads 74a′ formed on the head portions 74′ of the bone fixation elements 70′. In operation, the partially threaded scallop-shaped bone fixation holes 40′ mate with the exterior threading 74a′ formed on the head portions 74′ of the bone fixation elements 70′ to permit variable angle orientation of the bone fixation elements 70′ with respect to the plate portion 650 as well as provide an interference fit between the head portions 74′ of the bone fixation elements 70′ and the interior of the bone fixation holes 40′ to reduce the likelihood of backing-out. The geometry of the bone fixation holes 40′ further enable a variety of different screw sizes and styles (variable angle screws, locking screws, locking variable angle screws, etc.) to be utilized in conjunction with the implant 600.


Referring to FIG. 10, the intervertebral implant 700 of an eighth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 750, a plurality of bone fixation elements 70 and the retention mechanism. In the eighth preferred embodiment, the retention mechanism includes a bushing 780 located within the bone fixation holes 40. More preferably, the bushing 780 is spring-loaded inside the bone fixation holes 40 formed in the plate portion 750. The bone fixation holes 40 preferably include an undercut or groove 782 for receiving and/or securing the bushing 780 therein. In use, the head portion 74 of the bone fixation element 70 bears against the bushing 780 during insertion of the bone fixation element 70, causing the bushing 780 to initially expand and then subsequently to collapse about the head portion 74 to thereby secure the bone fixation element 70 to the plate portion 750. The bushing 780 preferably includes a spherical or curvate outer surface 781 for mating with a corresponding spherical or curvate inner surface formed in the undercut or groove 782 so that the bushing 780, and hence the bone fixation element 70, can polyaxial rotate with respect to the plate portion 750.


Referring to FIG. 11, the intervertebral implant 800 of a ninth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 850, a plurality of bone fixation elements 70 and the retention mechanism. In the ninth preferred embodiment, the retention mechanism includes a bushing 880 circumferentially disposed around the head portion 74 or neck portion of the bone fixation element 70. More preferably, the bushing 880 is spring-loaded around the head portion 74 or neck portion of the bone fixation element 70. The bone fixation hole 40 formed in the plate portion 850 preferably includes one or more projections 882 protruding therein so that, as the bushing 880 and bone fixation element 70 are advanced into the bone fixation hole 40, the bushing 880 interacts with the one or more projections 882 to compress the bushing 880. Upon passing the projections 882, the bushing 880 radially expands such that the diameter of the bushing 880 is larger than the diameter of the bone fixation hole 40 as measured at the projections 882 thereby limiting back-out of the bone fixation element 70.


Referring to FIG. 12, the intervertebral implant 900 of a tenth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 950, a plurality of bone fixation elements 70 and the retention mechanism. In the tenth preferred embodiment, the retention mechanism includes one or more thin-walled projections 980 protruding into the bone fixation holes 40. The projections 980 being configured to deform as the bone fixation element 70 is advanced through the bone fixation hole 40. The bone fixation elements 70 preferably including a tapered flange 982 and a recess 984 formed on the head portion 74 or neck portion thereof. The flange 982 being configured to expand the projection 980 as the bone fixation element 70 is advanced through the bone fixation hole 40. Once the bone fixation element 70 is fully seated, the projection 980 contracts and is received within the recess 984 to thereby secure the bone fixation element 70 with respect to the plate portion 950.


Referring to FIG. 13, the intervertebral implant 1000 of an eleventh preferred embodiment includes the interbody spacer portion 1020, the plate portion 1050, first and second bone fixation elements 70 and the retention mechanism. In the eleventh preferred embodiment, the retention mechanism includes a plurality of deformable fingers, projections or thinned-walled lip members (collectively “fingers”) 1080 that are preferably machined into the plate portion 1050 circumferentially about the bone fixation holes 40. Once the bone fixation element 70 is inserted through the bone fixation hole 40, a forceps-like instrument 1090 may be used to deform the plurality of fingers 1080 to at least partially cover and/or block the head portion 74 of the bone fixation element 70. The fingers 1080 may be machined to stand proud or lie flush with respect to the trailing surface 62 of the plate portion 1050 prior to deformation.


Referring to FIGS. 14A and 14B, the intervertebral implant 1100 of a twelfth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 1150, a plurality of bone fixation elements 70 and the retention mechanism. In the twelfth preferred embodiment, the retention mechanism includes a spring clip 1180. The clip 1180 is preferably manufactured from an elastically deformable material so that the clip 1180 may be deformed to a reduced configuration. In use, the bone fixation element 70 is inserted into a bone fixation hole 40 formed in the plate portion 1150. The clip 1180 is then preferably deformed via a grasping or forceps-type instrument 1190 to the reduced configuration. After the bone fixation element 70 has been fully inserted, the instrument 1190 places the clip 1180 into the interior of the bone fixation hole 40 or a groove (not shown) formed on the trailing surface 62 of the plate portion 1150, and releases the spring clip 1180, at which point the spring clip 1180 expands and returns to its original shape, thereby locking to the groove or hole 40 and covering and/or blocking the head portion 74 of the bone fixation element 70.


Referring to FIG. 15, the intervertebral implant 1200 of a thirteenth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 1250, a plurality of bone fixation elements 70″ and the retention mechanism. In the thirteenth preferred embodiment, the bone fixation elements 70″ are in the form of an expansion-headed screw and the retention mechanism includes a locking screw 1280 couplable to and advanceable within the expansion-head screw 70″. That is, the head portion 74″ of the expansion-head screw 70″ preferably includes an internally threaded bore 1281 and optional slots (not shown) extending from a proximal end thereof. In use, the locking screw 1280 is actuated, e.g., rotated, into engagement with the internally threaded bore 1281 formed in the proximal end of the expansion-head screw 70″ to radially expand the head portion 74″ of the expansion-head screw 70″ to thereby lock the expansion-head screw 70″ within the bone fixation hole 40. The head portion 74″ may include a partially spherical outer surface for mating with a corresponding partially spherical inner surface formed in the bone fixation hole 40 to enable variable angular placement of the expansion-head screw 70″ with respect to the plate portion 1250″, as well as angulation of the screw shaft 72″ with respect to the plate portion 1250 after the screw 70″ is locked to the plate portion 1250. The spherical dimensions of the head portion 74″ of the expansion-head screw 70″ can be chosen to allow an interference or rigid fit or to allow for a clearance or toggling fit between the expansion-head screw 70″ and the plate portion 1250.


Many varieties of blocking plates are used in the art to limit back-out of bone fixation elements 70. Most of these blocking plates utilize an additional screw, rivet, or pin to secure the blocking plate in place. Referring to FIGS. 16A and 16B, the intervertebral implant of a fourteenth preferred embodiment includes the interbody spacer portion (not shown), the plate portion (not shown), a plurality of bone fixation elements (not shown) and the retention mechanism. In the fourteenth preferred embodiment, the retention mechanism includes a blocking plate 1380 formed from an elastic “spring-like” material that preferably enables the plate 1380 to be manufactured in a biased position. For example, the blocking plate 1380 may include a concave or convex trailing surface 1382 (as shown in FIG. 17A) that can be snapped or popped in the opposite direction by pushing on a center portion 1384 of the blocking plate 1380. This snapping movement forces the outside edges of the blocking plate 1380 to move inwardly or outwardly to increase or decrease the radius of the blocking plate 1380. The outside edges of the blocking plate 1380 can include fingers 1386 that are mateable with recesses (not shown) formed on the plate portion (not shown) such that a secure attachment between the blocking plate 1380 and the plate portion is achieved without the inclusion of additional components. Referring to FIG. 17B, applying a force to the center portion 1384 of the blocking plate 1380, when placed appropriately with respect to the plate portion, forces the blocking plate 1380 to pop inside out, increasing its radius and mating to the plate portion to at least partially cover the head portions 74 of the bone fixation elements 70.


Referring to FIG. 17, the intervertebral implant 1400 of a fifteenth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 1450, a plurality of bone fixation elements 70 and the retention mechanism. In the fifteenth preferred embodiment, the plate portion 1450 and the bone fixation elements 70 are manufactured from a polymer, such as PEEK, so that a welding process can be utilized to secure the bone fixation elements 70 to the plate portion 1450. That is, for example, the implant 1400 may include a ring 1480 or other protrusion inherent on the underside of the head portion 74 of the bone fixation elements 70. The plate portion 1450, the bone fixation elements 70 and the ring 1480 each being manufactured from PEEK or similar polymer. The ring 1480 creates a small surface area for heat or vibration to be transferred therethrough. In use, after the bone fixation elements 70 have been inserted through the plate portion 1450, an ultrasonic vibration or heat is applied to the head portion 74 of the bone fixation element 70 to thereby cause the ring 1480 and its interface with the plate portion 1450 to melt and fuse together, thereby locking the bone fixation element 70 to the plate portion 1450. The cross-sectional area of the ring 1480 adjacent to the plate portion 1450 is preferably relatively small to focus the vibrations and/or heat in these areas and to promote fusing of the ring 1480 to the plate portion 1450. Alternatively, the bone fixation element 70 can be a non-threaded pin so that the ultrasonic vibrations can be utilized to drive the pins into the bone before welding.


The most common bone fixation element for securing an implant to bone is a bone screw, as is apparent to one having ordinary skill in the art. The threads on the shaft of the bone screw provide purchase, which allows lagging and fixation. The bone screw is preferably threaded into the bone by torquing the head of the bone screw. This method of fixation may be altered by eliminating the threading step and saving surgical time and effort. For example, referring to FIG. 18, the intervertebral implant 1500 of a sixteenth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 1550, a plurality of bone fixation elements 70′″ and the retention mechanism. In the sixteenth preferred embodiment, the bone fixation elements 70′″ are in the form of non-threaded pins that include one or more projections 1580 extending from the neck or shaft portion of the pin 70′″. The projections 1580 preferably are biased to outwardly extend from the neck or shaft portion of the pin 70′″. The projections 1580 are preferably inwardly deflectable so that the projections 1580 can be advanced through the bone fixation holes 40 formed in the plate portion 1550. In use, once the non-threaded pins 70′″ have been fully inserted, the projections 1580 expand. The outward expansion of the projections 1580 occurs interior to the bone and/or adjacent to the leading surface 60 of the plate portion 1550 adjacent to the bone fixation hole 40 to secure the pin 70′″ into the bone and/or block the pin 70′″ from backing-out of the plate portion 1550.


Referring to FIGS. 19A and 19B, the intervertebral implant 1600 of a seventeenth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 1650, a plurality of bone fixation elements 70″″ and the retention mechanism. In the seventeenth preferred embodiment, the bone fixation elements 70″″ include a cannulated bore 1680 extending from a proximal end thereof. An instrument or mandrel 1682 is also provided for insertion into the cannulated bore 1680. In use, insertion of the mandrel or instrument 1682 into the cannulated bore 1680 expands one or more fingers or other expandable members 1684 on the shaft or neck portion of the bone fixation element 70″″. Alternatively, insertion of the mandrel or instrument 1682 into the cannulated bore 1680 creates a bulge 1686 along the shaft or near the neck of the bone fixation element 70″″. Alternatively, referring to FIG. 19C, the bone fixation elements 70″″ may be inserted into the patient's bone with the instrument or mandrel 1682 pre-inserted into the cannulated bore 1680. The instrument or mandrel 1682 including an enlarged distal end 1682a so that, in use, removal of the mandrel or instrument 1682 from the cannulated bore 1680 expands one or more fingers or other expandable members 1684 or creates a bulge 1686 along the shaft or near the neck of the bone fixation element 70″″. Alternatively, the bone fixation element 70′″ can be configured so that insertion of the mandrel or instrument 1682 expands a distal end of the bone fixation element 70″″, as shown in FIG. 19D.


Referring to FIGS. 20A-20C, the intervertebral implant 1700 of an eighteenth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 1750 and first and second bone fixation elements 70. In the eighteenth preferred embodiment, the trajectories of the bone fixation holes 40 formed in the plate portion 1750, and hence the trajectories of the first and second bone fixation elements 70, are configured so that the head portion 74 of the first bone fixation element 70 is blocked or covered by the head portion 74 of the second bone fixation element 70. Such a configuration limits the need to include additional retention mechanisms. Similarly, as shown in FIG. 20C, a third bone fixation element 70 can be utilized in a similar arrangement to at least partially cover the head portions 74 of the first and second bone fixation elements 70.


Referring to FIG. 21, the intervertebral implant 1800 of a nineteenth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 1850, a plurality of bone fixation elements 70 and the retention mechanism. In the nineteenth preferred embodiment, the head portion 74 of the bone fixation element 70 is preferably at least partially spherical and the bone fixation hole 40 formed in the plate portion 1850 is at least partially spherical. The maximum diameter of the head portion 74 is slightly larger than the entry diameter of the bone fixation hole 40. An interior diameter of the bone fixation hole 40 is enlarged so that the interior diameter of the hole 40 accommodates the head portion 74 of the bone fixation element 70. As the bone fixation element 70 is inserted into the bone fixation hole 40, the spherical head portion 74 of the bone fixation element 70 snaps into the bone fixation hole 40 where it is polyaxially captured due to the maximum spherical diameter of the head portion 74 being larger than the entry diameter of the bone fixation hole 40.


Referring to FIG. 22, the intervertebral implant 1900 of a twentieth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 1950, a plurality of bone fixation elements 70 and the retention mechanism. In the twentieth preferred embodiment, the bone fixation element 70 includes a cannulated bore 71 extending from a proximal end to an distal end of the bone fixation element 70 and one or more fenestrations 71a connecting the cannulated bore 71 to the exterior surface of the shaft portion 72 of the bone fixation element 70. In use, the bone fixation element 70 is inserted through the plate portion 1950 and into the patient's bone. Bone cement 1980 is then injected into the cannulated bore 71. The bone cement 1980 travels through the cannulated bore 71 and the fenestrations 71a and into the bone surrounding the shaft portion 72 of the bone fixation element 70. Upon curing, the bone cement 1980 secures the bone fixation elements 70 with respect to the bone. The fenestrations 71a may also be configured to direct cement outflow adjacent to the leading surface 60 of the plate portion 1950 to assist in securing the plate portion 1950 to the bone.


Alternatively, referring to FIG. 22A, a filament 1982 may be used in place of the bone cement 1980. In use, the filament 1982 is fed through the cannulated bore 71 after the bone fixation element 70 has been inserted into the patient's bone. The filament 1982 preferably is sized and configured to unwind after it is fed through the cannulated bore 71. The natural shape of the filament 1982 can be bent, spiral, or random, and an instrument can be used to unwind or straighten the filament 1982 as it is being fed through the cannulated bore 71. Once the filament 1982 is displaced out of the distal end of the bone fixation element 70, the filament 1982 returns to its original shape and forms a bulk of material 1984 which serves to enhance the anchoring of the bone fixation element 70 to the bone and a position of the cannulated bone fixation element 70 relative to the plate portion 1950.


Referring to FIGS. 23A and 23B, the intervertebral implant 2000 of a twenty-first preferred embodiment includes the interbody spacer portion (not shown), the plate portion (not shown), a plurality of bone fixation elements 70 and the retention mechanism. In the twenty-first preferred embodiment, the bone fixation element 70 includes a cannulated bore 71 and is configured to be at least partially flexible. The bone fixation element 70 can be manufactured from a shape memory alloy so that the shaft 72 assumes a geometry having at least one or more bends along its longitudinal axis. A mandrel 2080 is inserted into the cannulated bore 72. The mandrel 2080 serves to straighten the shaft 72 of the bone fixation element 70 so that the bone fixation element 70 can be inserted into the bone fixation hole formed in the plate portion and into the patient's bone (as shown in FIG. 23A). Thereafter, the mandrel 2080 is removed resulting in the bone fixation element 70 returning to its original, bent geometry, which acts to prevent the bone fixation element 70 from backing away from the bone and/or plate portion (as shown in FIG. 23B).


Referring to FIGS. 24A and 24B, the intervertebral implant 2100 of a twenty-second preferred embodiment includes the interbody spacer portion (not shown), the plate portion 2150, a plurality of bone fixation elements 70 and the retention mechanism. In the twenty-second preferred embodiment, the retention mechanism includes an eccentric ring 2180 that is rotatably coupled to the head portion 74 of the bone fixation element 70. In use, the bone fixation element 70 is inserted into the bone fixation hole formed in the plate portion 2150 and into the patient's bone. Thereafter, the eccentric ring 2180 is rotated, e.g. 90 degrees, into a mating slot 2182 formed in the plate portion 2150 to block the head portion 74 of the bone fixation element 70.


Referring to FIGS. 25A-25C, the intervertebral implant of a twenty-third preferred embodiment includes the interbody spacer portion (not shown), the plate portion (not shown) and a plurality of bone fixation elements 70. In the twenty-third preferred embodiment, the bone fixation elements 70 include one or more radial slots 2280 formed in the shaft 72 thereof. The plate portion includes an internal spring-loaded pin or spring tab 2282 that protrudes at least partially into the bone fixation holes 40. In use, advancement of the bone fixation elements 70 into the bone fixation holes 40 causes the spring-loaded tab 2282 to retract into an interior bore formed in the plate portion until the bone fixation element 70 is advanced a desirable amount with respect to the plate portion, at which point the spring-loaded tab 2282 expands into the bone fixation hole and engages the slot 2280 formed in the shaft portion 72 of the bone fixation element 70 to lock the bone fixation element 70 to the plate portion. The spring-loaded tab 2282 can extend along the interior of the plate portion and may be configured to protrude into a plurality of bone fixation holes so as to lock a plurality of bone fixation elements 70 simultaneously, as schematically represented in FIG. 25C.


Referring to FIG. 26, the intervertebral implant 2300 of a twenty-fourth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 2350 and a plurality of bone fixation elements 70. In the twenty-fourth preferred embodiment, the bone fixation elements 70 include a spring member 2380 radially coupled to the head portion 74 thereof. In use, after the bone fixation element 70 has been inserted into the bone fixation hole 40 formed in the plate portion 2350 and into the patient's bone, a locking or set screw 2382 is inserted into a bore 2381 formed in the head portion 74 of the bone fixation element 70. The locking or set screw 2382 interacts with the spring member 2380 causing the spring member 2380 to radially expand into engagement with a groove 2352 formed in the bone fixation hole 40 to thereby secure the bone fixation element 70 to the plate portion 2350.


Referring to FIG. 27, the intervertebral implant 2400 of a twenty-fifth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 2450 and a plurality of bone fixation elements 70. In the twenty-fifth preferred embodiment, the bone fixation elements 70 are preferably in the form of a spiral blade 2480. The bone fixation holes 40 formed in the plate portion 2450 include one or more guide slots 2482 to enable the spiral blade 2480 to past therethrough. Due to its contorted shape, the spiral blade 2480 rotates as it is being inserted, which can be done by inserting the distal end of the spiral blade 2480 through the guide slots 2482 and impacting the proximal end of the spiral blade 2480 with a mallet or alternative instrument. The spiral blade 2480 rotates as it passes through the guide slots 2482 and cuts its way into bone. Once fully inserted, the guide slots 2482 and the helical arrangement of the spiral blade 2480 prevent the spiral blade 2480 from backing-out of the plate portion 2450.


Referring to FIG. 28, the intervertebral implant 2500 of a twenty-sixth preferred embodiment includes the interbody spacer portion 2520, the plate portion 2550 and a plurality of bone fixation elements 70. In the twenty-sixth preferred embodiment, the bone fixation elements 70 include an elastically deformable ring 2580. The elastically deformable ring 2580 is preferably disposed around the head portion 74 of the bone fixation element 70. In use, as the bone fixation element 70 is advanced into the bone fixation hole 40 formed in the plate portion 2550, the elastically deformable ring 2580 advances and is compressed until the ring 2580 aligns and expands within a groove 2582 formed in the bone fixation hole 40 to thereby secure the bone fixation element 70 to the plate portion 2550. Alternatively, the elastically deformable ring 2580 can be disposed within the groove 2582 formed in the bone fixation hole 40 of the plate portion 2550. The ring 2580 compresses as the bone fixation element 70 is advanced into the bone fixation hole 40 until the ring 2580 aligns and expands within a groove formed on the shaft, neck, or head portions of the bone fixation element 70.


Referring to FIG. 29, the intervertebral implant 2600 of a twenty-seventh preferred embodiment includes the interbody spacer portion 2620, the plate portion 2650 and a plurality of bone fixation elements 70. In the twenty-seventh preferred embodiment, the bone fixation elements 70 include a compressible head portion 74. The head portion 74 can be made compressible by counter boring and cutting radial slots 74a to create spring fingers 74b. The bone fixation holes 40 preferably include one or more inwardly extending projections 2680 so that during advancement of the bone fixation elements 70 into the bone fixation holes 40, the spring fingers 74b are compressed by the projections 2680. Once the head portion 74 is inserted past the projections 2680, the head portion 74 radially expands to limit the bone fixation element 70 from backing-out relative to the plate portion 2650.


Referring to FIG. 30, the intervertebral implant 2700 of a twenty-eighth preferred embodiment includes the interbody spacer portion (not shown), the plate portion 2750, a plurality of bone fixation elements 70 and the retention mechanism. In the twenty-eighth preferred embodiment, the retention mechanism includes a rotational or torsional spring element 2780 rotatably coupled to the trailing surface 62 of the plate portion 2750. The rotational or torsional spring element 2780 includes one or more blocking pin portions 2782 attached thereto for at least partially covering the bone fixation holes 40. In use, as the bone fixation elements 70 are advanced into the bone fixation holes 40, the undersurface of the head portion 74 of the bone fixation 70 interacts with and pushes aside the blocking pins 2782 to allow the head portion 74 of the bone fixation element 70 to pass thereby. Once the head portion 74 is advanced past the blocking pin portions 2782, the rotational or torsional spring element 2780 returns the blocking pin portions 2782 to their original position at least partially covering the bone fixation holes 40. The rotational or torsional spring element 2780 is preferably configured to rotate out of the way to enable the bone fixation elements 70 to be inserted. The rotational or torsional spring element 2780 preferably snap back into place to at least partially cover the bone fixation holes 40 after the bone fixation elements 70 have been fully inserted. Alternatively, the retention mechanism may be in the form of a lead spring. Furthermore, linkages can be attached to the rotational or torsional spring element 2780 so that the linkages are pushed out of the way to enable the bone fixation element 70 to be inserted into the bone fixation holes 40 and return to at least partially cover the bone fixation holes 40. The rotational or torsional spring element 2780 can also be manually rotated to manipulate the linkages for locking and unlocking.


Referring to FIGS. 31A and 31B, the intervertebral implant 2800 of a twenty-ninth preferred embodiment includes the interbody spacer portion 2820, the plate portion 2850, a plurality of bone fixation elements 70 and the retention mechanism. In the twenty-ninth preferred embodiment, the retention mechanism includes a thin metallic web of material 2880. The metallic web of material 2880 having a hole 2882 and one or more slots or fingers 2884 radiating from the hole 2882. The metallic web of material 2880 being deformable so that in use, the metallic web of material 2880 deforms as the bone fixation element 70 is being advanced therethrough. The metallic web of material 2880 providing friction with the threaded shaft portion 72 of the bone fixation element 70 to prevent rotation and axial movement to thereby secure the bone fixation element 70 to the plate portion 2850. The metallic web of material 2880 can also be disposed interior to the spacer portion 2820 to interact with the threaded shaft portion 72 of the bone fixation element 70.


While the foregoing description and drawings represent the preferred embodiments of the present invention, it will be understood that various additions, modifications, combinations and/or substitutions may be made therein without departing from the spirit and scope of the present invention as defined in the accompanying claims. In particular, it will be clear to those skilled in the art that the present invention may be embodied in other specific forms, structures, arrangements, proportions, and with other elements, materials, and components, without departing from the spirit or essential characteristics thereof. One skilled in the art will appreciate that the invention may be used with many modifications of structure, arrangement, proportions, materials, and components and otherwise, used in the practice of the invention, which are particularly adapted to specific environments and operative requirements without departing from the principles of the present invention. In addition, features described herein may be used singularly or in combination with other features. The presently disclosed embodiments are therefore to be considered in all respects as illustrative and not restrictive, the scope of the invention being indicated by the appended claims, and not limited to the foregoing description.

Claims
  • 1. An intervertebral implant system comprising: an intervertebral implant defining a trailing end and a leading end opposite the trailing end along an insertion direction into an intervertebral disc space defined between first and second vertebrae, the intervertebral implant further defining a top surface configured to contact the first vertebra, and a bottom surface opposite the top surface with respect to a second direction that is perpendicular to the insertion direction, the bottom surface configured to contact the second vertebra, wherein the intervertebral implant further defines first and second bone fixation holes offset from each other along a third direction that is perpendicular to each of the insertion direction and the second direction;an implant inserter instrument configured to removably attach to the implant at a contact region that includes all locations at which the implant inserter instrument contacts the implant when the implant inserter instrument is attached to the implant, wherein 1) an entirety of the contact region is positioned between the first bone fixation hole and the second bone fixation hole with respect to the third direction, and 2) the contact region and the first bone fixation hole are each positioned such that a straight line drawn in the third direction intersects both the contact region and the first bone fixation hole; anda stop configured to abut at least one of the first and second vertebrae so as to prevent further insertion of the implant into the intervertebral disc space in the insertion direction,wherein the first bone fixation hole is configured to receive a first bone fixation element when the implant inserter instrument is attached to the implant, and the second bone fixation hole is configured to receive a second bone fixation element when the implant inserter instrument is attached to the implant, andwherein the contact region defines a maximum width measured in the third direction, the implant defines a minimum width measured from the first bone fixation hole to the second bone fixation hole in the third direction, and the minimum width is greater than the maximum width.
  • 2. The intervertebral implant system of claim 1, wherein the first and second bone fixation holes are configured to receive the first and second bone fixation elements, respectively, while 1) the implant inserter instrument is attached to the implant, and 2) the stop is in abutment with the at least one of the first and second vertebrae.
  • 3. The intervertebral implant system of claim 1, wherein the implant inserter instrument comprises a handle portion configured to be rotated so as to threadedly engage a threaded end of the implant inserter instrument with a threaded borehole of the implant.
  • 4. The intervertebral implant system of claim 3, further comprising a retention mechanism configured to cover at least a portion of the first bone fixation element, thereby preventing back out of the first bone fixation element from the first bone fixation hole.
  • 5. The intervertebral implant system of claim 4, wherein the retention mechanism is configured to be threadedly mate with the implant in the threaded borehole.
  • 6. The intervertebral implant system of claim 1, further comprising a retention mechanism configured to cover at least a portion of the first bone fixation element, thereby preventing back out of the first bone fixation element from the first bone fixation hole.
  • 7. The intervertebral implant system of claim 6, wherein the retention mechanism further covers at least a portion of the second bone fixation element, thereby preventing back out of the second bone fixation element from the second bone fixation hole.
  • 8. The intervertebral implant system of claim 1, wherein the implant inserter instrument comprises the stop, wherein the abutment of the stop with the one of the first and second vertebrae prevents further insertion of the implant into the intervertebral disc space in the insertion direction.
  • 9. The intervertebral implant system of claim 8, wherein the stop is further configured to abut the other of the first and second vertebrae, wherein abutment of the stop with the other of the first and second vertebrae prevents further insertion of the implant into the intervertebral disc space in the insertion direction.
  • 10. The intervertebral implant system of claim 1, wherein the stop is a first stop, and the system further comprises a second stop, wherein the first stop is configured to abut the first vertebra, and the second stop is configured to abut the second vertebra.
  • 11. The intervertebral implant system of claim 1, wherein the stop extends outboard of one of the top and bottom surfaces with respect to the second direction.
  • 12. The intervertebral implant system of claim 1, wherein the implant inserter instrument defines a first portion that is configured to abut the implant in a first recess of the implant, and a second portion that is configured to abut the implant in a second recess of the implant.
  • 13. The intervertebral implant system of claim 1, wherein 1) a trailing surface of the implant at the trailing end defines a first height measured in the second direction, 2) the implant inserter instrument defines a maximum instrument height measured in the second direction when the implant inserter instrument is attached to the implant, and 3) the maximum instrument height is greater than the first height.
CROSS REFERENCE TO RELATED APPLICATIONS

This is a continuation of U.S. patent application Ser. No. 15/205,173, filed Jul. 8, 2016, which is a divisional of U.S. patent application Ser. No. 13/901,002, filed May 23, 2013, which is a continuation of U.S. patent application Ser. No. 12/614,082, filed Nov. 6, 2009, which claims benefit of U.S. Provisional Patent Application No. 61/139,920, filed Dec. 22, 2008, and U.S. Provisional Patent Application No. 61/112,441, filed Nov. 7, 2008, the contents of which are hereby incorporated by reference in their entireties.

US Referenced Citations (887)
Number Name Date Kind
424836 Thompson Apr 1890 A
438892 Lippy Oct 1890 A
1105105 Sherman Jul 1914 A
1200797 Barbe Oct 1916 A
2151919 Jacobson Mar 1939 A
2372888 Duggan Apr 1945 A
2621145 Sano Dec 1952 A
2782827 Rosan Feb 1957 A
2906311 Boyd Sep 1959 A
2972367 Wootton Feb 1961 A
3062253 Miliheiser Nov 1962 A
3272249 Houston Sep 1966 A
3350103 Ahlstone Oct 1967 A
3426364 Lumb Feb 1969 A
3561075 Selinko Feb 1971 A
3579831 Stevens et al. May 1971 A
3707303 Petri Dec 1972 A
3810703 Pasbrig May 1974 A
3867728 Stubstad et al. Feb 1975 A
3899897 Boerger et al. Aug 1975 A
3945671 Gerlach Mar 1976 A
4017946 Soja Apr 1977 A
4056301 Norden Nov 1977 A
4123132 Hardy et al. Oct 1978 A
4135506 Ulrich Jan 1979 A
4278120 Hart et al. Jul 1981 A
4280875 Werres Jul 1981 A
4285377 Hart Aug 1981 A
4288902 Franz Sep 1981 A
4297063 Hart Oct 1981 A
4298993 Kovaleva et al. Nov 1981 A
4299902 Soma et al. Nov 1981 A
4349921 Kuntz Sep 1982 A
4388921 Sutter et al. Jun 1983 A
4394370 Jefferies Jul 1983 A
4450591 Rappaport May 1984 A
4484570 Sutter et al. Nov 1984 A
4488543 Tornier Dec 1984 A
4501269 Bagby Feb 1985 A
4503848 Caspar et al. Mar 1985 A
4512038 Alexander et al. Apr 1985 A
4545374 Jacobson Oct 1985 A
4553890 Gulistan Nov 1985 A
4599086 Doty Jul 1986 A
4627853 Campbell et al. Dec 1986 A
4640524 Sedlmair Feb 1987 A
4648768 Hambric Mar 1987 A
4678470 Nashef et al. Jul 1987 A
4708377 Hunting Nov 1987 A
4711760 Blaushild Dec 1987 A
4714469 Kenna Dec 1987 A
4717115 Schmitz et al. Jan 1988 A
4743256 Brantigan May 1988 A
4781721 Grundei Nov 1988 A
4793335 Frey et al. Dec 1988 A
4804290 Balsells Feb 1989 A
4812094 Grube Mar 1989 A
4829152 Rostoker et al. May 1989 A
4834757 Brantigan May 1989 A
4858603 Clemow et al. Aug 1989 A
4872452 Alexson Oct 1989 A
4878915 Brantigan Nov 1989 A
4904261 Dove et al. Feb 1990 A
4917704 Frey et al. Apr 1990 A
4932973 Gendler Jun 1990 A
4936851 Fox et al. Jun 1990 A
4946378 Hirayama et al. Aug 1990 A
4950296 McIntyre Aug 1990 A
4955908 Frey et al. Sep 1990 A
4961740 Ray et al. Oct 1990 A
4976576 Mahaney et al. Dec 1990 A
4978350 Wagenknecht Dec 1990 A
4994084 Brennan Feb 1991 A
4997432 Keller Mar 1991 A
5006120 Carter Apr 1991 A
5010783 Sparks et al. Apr 1991 A
5017069 Stencel May 1991 A
5020949 Davidson et al. Jun 1991 A
5026373 Ray et al. Jun 1991 A
5030220 Howland Jul 1991 A
5047058 Roberts et al. Sep 1991 A
5053049 Campbell Oct 1991 A
5062850 MacMillan et al. Nov 1991 A
5071437 Steffee Dec 1991 A
5084051 Toermaelae et al. Jan 1992 A
5085660 Lin Feb 1992 A
5096150 Westwood Mar 1992 A
5108438 Stone Apr 1992 A
5112354 Sires May 1992 A
5116374 Stone May 1992 A
5118235 Dill Jun 1992 A
5139424 Yli-Urpo Aug 1992 A
5147404 Downey Sep 1992 A
5163949 Bonutti Nov 1992 A
5163960 Bonutti Nov 1992 A
5180381 Aust et al. Jan 1993 A
5192327 Brantigan Mar 1993 A
5197971 Bonutti Mar 1993 A
5201736 Strauss Apr 1993 A
5207543 Kirma May 1993 A
5211664 Tepic et al. May 1993 A
5235034 Bobsein et al. Aug 1993 A
5238342 Stengel Aug 1993 A
5258031 Salib et al. Nov 1993 A
5269785 Bonutti Dec 1993 A
5275601 Gogolewski et al. Jan 1994 A
5281226 Davydov et al. Jan 1994 A
5282861 Kaplan Feb 1994 A
5284655 Bogdansky et al. Feb 1994 A
5290312 Kojimoto et al. Mar 1994 A
5295994 Bonutti Mar 1994 A
5298254 Prewett et al. Mar 1994 A
5304021 Oliver et al. Apr 1994 A
5306307 Senter et al. Apr 1994 A
5306308 Gross et al. Apr 1994 A
5306309 Wagner et al. Apr 1994 A
5314476 Prewett et al. May 1994 A
5314477 Marnay May 1994 A
5329846 Bonutti Jul 1994 A
5330535 Moser et al. Jul 1994 A
5331975 Bonutti Jul 1994 A
5345927 Bonutti Sep 1994 A
5348788 White Sep 1994 A
5368593 Stark Nov 1994 A
5380323 Howland Jan 1995 A
5385583 Cotrel Jan 1995 A
5397364 Kozak et al. Mar 1995 A
5403317 Bonutti Apr 1995 A
5403348 Bonutti Apr 1995 A
5405391 Henderson et al. Apr 1995 A
5411348 Balsells May 1995 A
5423817 Lin Jun 1995 A
5425772 Brantigan Jun 1995 A
5431658 Moskovich Jul 1995 A
5439684 Prewett et al. Aug 1995 A
5441538 Bonutti Aug 1995 A
5443514 Steffee Aug 1995 A
5443515 Cohen et al. Aug 1995 A
5454365 Bonutti Oct 1995 A
5458638 Kuslich et al. Oct 1995 A
5458641 Ramirez Jimenez Oct 1995 A
5458643 Oka et al. Oct 1995 A
5464426 Bonutti Nov 1995 A
5478342 Kohrs Dec 1995 A
5484437 Michelson Jan 1996 A
5487744 Howland Jan 1996 A
5489308 Kuslich et al. Feb 1996 A
5496348 Bonutti Mar 1996 A
5507818 McLaughlin Apr 1996 A
5514153 Bonutti May 1996 A
5514180 Heggeness et al. May 1996 A
5520690 Errico et al. May 1996 A
5522846 Bonutti Jun 1996 A
5522899 Michelson Jun 1996 A
5527343 Bonutti Jun 1996 A
5531746 Errico et al. Jul 1996 A
5534012 Bonutti Jul 1996 A
5534030 Navarro et al. Jul 1996 A
5534031 Matsuzaki et al. Jul 1996 A
5534032 Hodorek Jul 1996 A
5545222 Bonutti Aug 1996 A
5545842 Balsells Aug 1996 A
5549612 Yapp et al. Aug 1996 A
5549630 Bonutti Aug 1996 A
5549631 Bonutti Aug 1996 A
5549679 Kuslich Aug 1996 A
5550172 Regula et al. Aug 1996 A
5554191 Lahille et al. Sep 1996 A
5556430 Gendler Sep 1996 A
5556431 Buttner-Janz Sep 1996 A
5569305 Bonutti Oct 1996 A
5569308 Sottosanti Oct 1996 A
5570983 Hollander Nov 1996 A
5571109 Bertagnoli Nov 1996 A
5571190 Ulrich et al. Nov 1996 A
5571192 Schoenhoeffer Nov 1996 A
5577517 Bonutti Nov 1996 A
5578034 Estes Nov 1996 A
5584862 Bonutti Dec 1996 A
5593409 Michelson Jan 1997 A
5593425 Bonutti et al. Jan 1997 A
5597278 Peterkort Jan 1997 A
5601553 Trebing et al. Feb 1997 A
5601554 Howland et al. Feb 1997 A
5607428 Lin Mar 1997 A
5607474 Athanasiou et al. Mar 1997 A
5609635 Michelson Mar 1997 A
5609636 Kohrs et al. Mar 1997 A
5609637 Biedermann et al. Mar 1997 A
5616144 Yapp et al. Apr 1997 A
5620448 Puddu Apr 1997 A
5624462 Bonutti Apr 1997 A
5642960 Salice Jul 1997 A
5645596 Kim et al. Jul 1997 A
5645606 Oehy et al. Jul 1997 A
5653708 Howland Aug 1997 A
5662710 Bonutti Sep 1997 A
5667520 Bonutti Sep 1997 A
5669909 Zdeblick et al. Sep 1997 A
5674296 Bryan et al. Oct 1997 A
5676666 Oxland et al. Oct 1997 A
5676699 Gogolewski et al. Oct 1997 A
5681311 Foley et al. Oct 1997 A
5683216 Erbes Nov 1997 A
5683394 Rinner Nov 1997 A
5683463 Godefroy et al. Nov 1997 A
5685826 Bonutti Nov 1997 A
5694951 Bonutti Dec 1997 A
5702449 McKay Dec 1997 A
5702451 Biedermann et al. Dec 1997 A
5702453 Rabbe et al. Dec 1997 A
5702455 Saggar Dec 1997 A
5707390 Bonutti Jan 1998 A
5713899 Marnay et al. Feb 1998 A
5713900 Benzel et al. Feb 1998 A
5716325 Bonutti Feb 1998 A
5725531 Shapiro Mar 1998 A
5725588 Errico et al. Mar 1998 A
5728159 Stroever et al. Mar 1998 A
5733306 Bonutti Mar 1998 A
5735853 Olerud Apr 1998 A
5735875 Bonutti et al. Apr 1998 A
5735905 Parr Apr 1998 A
5755796 Ibo et al. May 1998 A
5755798 Papavero et al. May 1998 A
5766251 Koshino Jun 1998 A
5766252 Henry et al. Jun 1998 A
5766253 Brosnahan, III Jun 1998 A
5772661 Michelson Jun 1998 A
5776194 Mikol et al. Jul 1998 A
5776196 Matsuzaki et al. Jul 1998 A
5776197 Rabbe et al. Jul 1998 A
5776198 Rabbe et al. Jul 1998 A
5776199 Michelson Jul 1998 A
5778804 Read Jul 1998 A
5782915 Stone Jul 1998 A
5782919 Zdeblick et al. Jul 1998 A
5785710 Michelson Jul 1998 A
5800433 Benzel et al. Sep 1998 A
5827318 Bonutti Oct 1998 A
5836948 Zucherman et al. Nov 1998 A
5845645 Bonutti Dec 1998 A
5860973 Michelson Jan 1999 A
5860997 Bonutti Jan 1999 A
5861041 Tienboon Jan 1999 A
5865845 Thalgott Feb 1999 A
5865849 Stone Feb 1999 A
5872915 Dykes et al. Feb 1999 A
5876402 Errico et al. Mar 1999 A
5876452 Athanasiou et al. Mar 1999 A
5879389 Koshino Mar 1999 A
5885299 Winslow et al. Mar 1999 A
5888196 Bonutti Mar 1999 A
5888219 Bonutti Mar 1999 A
5888222 Coates et al. Mar 1999 A
5888223 Bray, Jr. Mar 1999 A
5888224 Beckers et al. Mar 1999 A
5888227 Cottle Mar 1999 A
5895426 Scarborough et al. Apr 1999 A
5899939 Boyce et al. May 1999 A
5902303 Eckhof et al. May 1999 A
5902338 Stone May 1999 A
5904683 Pohndorf et al. May 1999 A
5904719 Errico et al. May 1999 A
5906616 Pavlov et al. May 1999 A
5910315 Stevenson et al. Jun 1999 A
5911758 Oehy et al. Jun 1999 A
5920312 Wagner et al. Jul 1999 A
5922027 Stone Jul 1999 A
5928267 Bonutti et al. Jul 1999 A
5931838 Vito Aug 1999 A
5935131 Bonutti Aug 1999 A
5941900 Bonutti Aug 1999 A
5944755 Stone Aug 1999 A
5951558 Fiz Sep 1999 A
5954722 Bono Sep 1999 A
5954739 Bonutti Sep 1999 A
5958314 Draenert Sep 1999 A
5964807 Gan et al. Oct 1999 A
5968098 Winslow Oct 1999 A
5972031 Biedermann et al. Oct 1999 A
5972368 McKay Oct 1999 A
5976141 Haag et al. Nov 1999 A
5976187 Richelsoph Nov 1999 A
5980522 Koros et al. Nov 1999 A
5981828 Nelson et al. Nov 1999 A
5984967 Zdeblick et al. Nov 1999 A
5989289 Coates et al. Nov 1999 A
6001099 Huebner Dec 1999 A
6008433 Stone Dec 1999 A
6010525 Bonutti et al. Jan 2000 A
6013853 Athanasiou et al. Jan 2000 A
6017305 Bonutti Jan 2000 A
6017345 Richelsoph Jan 2000 A
6025538 Yaccarino et al. Feb 2000 A
6033405 Winslow et al. Mar 2000 A
6033438 Bianchi et al. Mar 2000 A
6039762 McKay Mar 2000 A
6042596 Bonutti Mar 2000 A
6045579 Hochschuler et al. Apr 2000 A
6045580 Scarborough et al. Apr 2000 A
6056749 Kuslich May 2000 A
6059817 Bonutti et al. May 2000 A
6066175 Henderson et al. May 2000 A
6077292 Bonutti Jun 2000 A
6080158 Lin Jun 2000 A
6080193 Hochschuler et al. Jun 2000 A
6086593 Bonutti Jul 2000 A
6086614 Mumme Jul 2000 A
6090998 Grooms et al. Jul 2000 A
6096080 Nicholson et al. Aug 2000 A
6096081 Grivas et al. Aug 2000 A
6099531 Bonutti Aug 2000 A
6102928 Bonutti Aug 2000 A
6110482 Khouri et al. Aug 2000 A
6113637 Gill et al. Sep 2000 A
6113638 Williams et al. Sep 2000 A
6120503 Michelson Sep 2000 A
6123731 Boyce et al. Sep 2000 A
6129763 Chauvin et al. Oct 2000 A
6132472 Bonutti Oct 2000 A
6136001 Michelson Oct 2000 A
6139550 Michelson Oct 2000 A
RE36974 Bonutti Nov 2000 E
6143030 Schroder Nov 2000 A
6143033 Paul et al. Nov 2000 A
6146421 Gordon et al. Nov 2000 A
6156070 Incavo et al. Dec 2000 A
6159215 Urbahns et al. Dec 2000 A
6159234 Bonutti et al. Dec 2000 A
6171236 Bonutti Jan 2001 B1
6171299 Bonutti Jan 2001 B1
6174313 Bonutti Jan 2001 B1
6187023 Bonutti Feb 2001 B1
6193721 Michelson Feb 2001 B1
6193756 Studer et al. Feb 2001 B1
6193757 Foley et al. Feb 2001 B1
6200347 Anderson et al. Mar 2001 B1
6203565 Bonutti et al. Mar 2001 B1
6206922 Zdeblick et al. Mar 2001 B1
6217617 Bonutti Apr 2001 B1
6224602 Hayes May 2001 B1
6231592 Bonutti et al. May 2001 B1
6231610 Geisler May 2001 B1
6235033 Brace et al. May 2001 B1
6235034 Bray May 2001 B1
6235059 Benezech et al. May 2001 B1
6241731 Fiz Jun 2001 B1
6241769 Nicholson et al. Jun 2001 B1
6245108 Biscup Jun 2001 B1
6258089 Campbell et al. Jul 2001 B1
6258125 Paul et al. Jul 2001 B1
6261291 Talaber et al. Jul 2001 B1
6261586 McKay Jul 2001 B1
6264695 Stoy Jul 2001 B1
6270528 McKay Aug 2001 B1
6277136 Bonutti Aug 2001 B1
6287325 Bonutti Sep 2001 B1
6306139 Fuentes Oct 2001 B1
6322562 Wolter Nov 2001 B1
6331179 Freid et al. Dec 2001 B1
6342074 Simpson Jan 2002 B1
6358266 Bonutti Mar 2002 B1
6361565 Bonutti Mar 2002 B1
6364880 Michelson Apr 2002 B1
6368343 Bonutti et al. Apr 2002 B1
6371986 Bagby Apr 2002 B1
6371987 Weiland et al. Apr 2002 B1
6371988 Pafford et al. Apr 2002 B1
6371989 Chauvin et al. Apr 2002 B1
6375681 Truscott Apr 2002 B1
6383186 Michelson May 2002 B1
6387130 Stone et al. May 2002 B1
6395031 Foley et al. May 2002 B1
6398811 McKay Jun 2002 B1
6413259 Lyons et al. Jul 2002 B1
6423063 Bonutti Jul 2002 B1
6432106 Fraser Aug 2002 B1
6443987 Bryan Sep 2002 B1
6447512 Landry et al. Sep 2002 B1
6447516 Bonutti Sep 2002 B1
6447546 Bramlet et al. Sep 2002 B1
6451042 Bonutti Sep 2002 B1
6454771 Michelson Sep 2002 B1
6458158 Anderson et al. Oct 2002 B1
6461359 Tribus et al. Oct 2002 B1
6464713 Bonutti Oct 2002 B2
6468289 Bonutti Oct 2002 B1
6468293 Bonutti et al. Oct 2002 B2
6468311 Boyd et al. Oct 2002 B2
6471724 Zdeblick et al. Oct 2002 B2
6475230 Bonutti et al. Nov 2002 B1
6482233 Aebi et al. Nov 2002 B1
6500195 Bonutti Dec 2002 B2
6503250 Paul Jan 2003 B2
6503267 Bonutti et al. Jan 2003 B2
6503277 Bonutti Jan 2003 B2
6511509 Ford et al. Jan 2003 B1
6524312 Landry et al. Feb 2003 B2
6543455 Bonutti Apr 2003 B2
6558387 Errico et al. May 2003 B2
6558423 Michelson May 2003 B1
6558424 Thalgott May 2003 B2
6562073 Foley May 2003 B2
6565605 Goble et al. May 2003 B2
6569187 Bonutti et al. May 2003 B1
6569201 Moumene et al. May 2003 B2
6575975 Brace et al. Jun 2003 B2
6575982 Bonutti Jun 2003 B1
6576017 Foley et al. Jun 2003 B2
6579290 Hardcastle et al. Jun 2003 B1
6585750 Bonutti et al. Jul 2003 B2
6592531 Bonutti Jul 2003 B2
6592609 Bonutti Jul 2003 B1
6592624 Fraser et al. Jul 2003 B1
6602291 Ray et al. Aug 2003 B1
6605090 Trieu et al. Aug 2003 B1
6607534 Bonutti Aug 2003 B2
6616671 Landry et al. Sep 2003 B2
6620163 Michelson Sep 2003 B1
6620181 Bonutti Sep 2003 B1
6623486 Weaver et al. Sep 2003 B1
6629998 Lin Oct 2003 B1
6630000 Bonutti Oct 2003 B1
6635073 Bonutti Oct 2003 B2
6638309 Bonutti Oct 2003 B2
6638310 Lin et al. Oct 2003 B2
6645212 Goldhahn et al. Nov 2003 B2
6652525 Assaker et al. Nov 2003 B1
6652532 Bonutti Nov 2003 B2
6656181 Dixon et al. Dec 2003 B2
6679887 Nicholson et al. Jan 2004 B2
6682561 Songer et al. Jan 2004 B2
6682563 Scharf Jan 2004 B2
6695846 Richelsoph et al. Feb 2004 B2
6695851 Zdeblick et al. Feb 2004 B2
6702821 Bonutti Mar 2004 B2
6702856 Bonutti Mar 2004 B2
6706067 Shimp et al. Mar 2004 B2
6709456 Langberg et al. Mar 2004 B2
6712818 Michelson Mar 2004 B1
6719803 Bonutti Apr 2004 B2
6730127 Michelson May 2004 B2
6736850 Davis May 2004 B2
6736853 Bonutti May 2004 B2
6743257 Castro Jun 2004 B2
6761738 Boyd Jul 2004 B1
6761739 Shepard Jul 2004 B2
6770078 Bonutti Aug 2004 B2
6770096 Bolger et al. Aug 2004 B2
6776938 Bonutti Aug 2004 B2
6786909 Dransfeld et al. Sep 2004 B1
6800092 Williams et al. Oct 2004 B1
6800093 Nicholson et al. Oct 2004 B2
6805714 Sutcliffe Oct 2004 B2
6808537 Michelson Oct 2004 B2
6824564 Crozet Nov 2004 B2
6833006 Foley et al. Dec 2004 B2
6835198 Bonutti Dec 2004 B2
6837905 Lieberman Jan 2005 B1
6849093 Michelson Feb 2005 B2
6855167 Shimp et al. Feb 2005 B2
6855168 Crozet Feb 2005 B2
6860885 Bonutti Mar 2005 B2
6860904 Bonutti Mar 2005 B2
6863673 Gerbec et al. Mar 2005 B2
6872915 Koga et al. Mar 2005 B2
6884242 Lehuec et al. Apr 2005 B2
6890334 Brace et al. May 2005 B2
6896701 Boyd et al. May 2005 B2
6899735 Coates et al. May 2005 B2
6902578 Anderson et al. Jun 2005 B1
6905517 Bonutti Jun 2005 B2
6908466 Bonutti et al. Jun 2005 B1
6916320 Michelson Jul 2005 B2
6923756 Sudakov et al. Aug 2005 B2
6932835 Bonutti et al. Aug 2005 B2
6953477 Berry Oct 2005 B2
6962606 Michelson Nov 2005 B2
6964664 Freid et al. Nov 2005 B2
6964687 Bernard et al. Nov 2005 B1
6972019 Michelson Dec 2005 B2
6972035 Michelson Dec 2005 B2
6974479 Trieu Dec 2005 B2
6984234 Bray Jan 2006 B2
6986788 Paul et al. Jan 2006 B2
6989029 Bonutti Jan 2006 B2
6990982 Bonutti Jan 2006 B1
7001385 Bonutti Feb 2006 B2
7001432 Keller et al. Feb 2006 B2
7018412 Ferreira et al. Mar 2006 B2
7018416 Hanson et al. Mar 2006 B2
7033394 Michelson Apr 2006 B2
7041135 Michelson May 2006 B2
7044968 Yaccarino et al. May 2006 B1
7044972 Mathys et al. May 2006 B2
7048755 Bonutti et al. May 2006 B2
7048765 Grooms et al. May 2006 B1
7060097 Fraser et al. Jun 2006 B2
7066961 Michelson Jun 2006 B2
7070557 Bonutti Jul 2006 B2
7077864 Byrd et al. Jul 2006 B2
7087073 Bonutti Aug 2006 B2
7094251 Bonutti et al. Aug 2006 B2
7104996 Bonutti Sep 2006 B2
7112223 Davis Sep 2006 B2
7119999 Fraser et al. Sep 2006 B2
7114500 Bonutti Oct 2006 B2
7128753 Bonutti et al. Oct 2006 B1
7134437 Bonutti Nov 2006 B2
7135024 Cook et al. Nov 2006 B2
7135043 Nakahara et al. Nov 2006 B2
7137984 Michelson Nov 2006 B2
7147652 Bonutti et al. Dec 2006 B2
7147665 Bryan et al. Dec 2006 B1
7163561 Michelson Jan 2007 B2
7172627 Fiere et al. Feb 2007 B2
7172672 Silverbrook Feb 2007 B2
7208013 Bonutti Apr 2007 B1
7217273 Bonutti May 2007 B2
7217290 Bonutti May 2007 B2
7226452 Zubok et al. Jun 2007 B2
7226482 Messerli et al. Jun 2007 B2
7232463 Falahee Jun 2007 B2
7232464 Mathieu et al. Jun 2007 B2
7238203 Bagga et al. Jul 2007 B2
7255698 Michelson Aug 2007 B2
7276082 Zdeblick et al. Oct 2007 B2
7311719 Bonutti Dec 2007 B2
7320708 Bernstein Jan 2008 B1
7323011 Shepard et al. Jan 2008 B2
7329263 Bonutti et al. Feb 2008 B2
7398623 Martel et al. Jul 2008 B2
7429266 Bonutti et al. Sep 2008 B2
7442209 Michelson Oct 2008 B2
7462200 Bonutti Dec 2008 B2
7481831 Bonutti Jan 2009 B2
7485145 Purcell Feb 2009 B2
7491237 Randall et al. Feb 2009 B2
7510557 Bonutti Mar 2009 B1
7534265 Boyd et al. May 2009 B1
7594932 Aferzon et al. Sep 2009 B2
7601173 Messerli et al. Oct 2009 B2
7608107 Michelson Oct 2009 B2
7615054 Bonutti Nov 2009 B1
7618456 Mathieu et al. Nov 2009 B2
7621960 Boyd et al. Nov 2009 B2
7625380 Drewry et al. Dec 2009 B2
7635390 Bonutti Dec 2009 B1
7637951 Michelson Dec 2009 B2
7655042 Foley et al. Feb 2010 B2
7704279 Moskowitz et al. Apr 2010 B2
7708740 Bonutti May 2010 B1
7708741 Bonutti May 2010 B1
7727283 Bonutti Jun 2010 B2
7749229 Bonutti Jul 2010 B1
7776067 Jackson Aug 2010 B2
7780670 Bonutti Aug 2010 B2
7806896 Bonutti Oct 2010 B1
7806897 Bonutti Oct 2010 B1
7828852 Bonutti Nov 2010 B2
7833271 Mitchell et al. Nov 2010 B2
7837736 Bonutti Nov 2010 B2
7846188 Moskowitz et al. Dec 2010 B2
7846207 Lechmann et al. Dec 2010 B2
7854750 Bonutti et al. Dec 2010 B2
7862616 Lechmann et al. Jan 2011 B2
7875076 Mathieu et al. Jan 2011 B2
7879072 Bonutti et al. Feb 2011 B2
7892236 Bonutti Feb 2011 B1
7892261 Bonutti Feb 2011 B2
7896880 Bonutti Mar 2011 B2
7931690 Bonutti Apr 2011 B1
7942903 Moskowitz et al. May 2011 B2
7959635 Bonutti Jun 2011 B1
7985255 Bray et al. Jul 2011 B2
7993403 Foley et al. Aug 2011 B2
8062303 Berry et al. Nov 2011 B2
8100976 Bray et al. Jan 2012 B2
8105383 Michelson Jan 2012 B2
8128669 Bonutti Mar 2012 B2
8128700 Delurio et al. Mar 2012 B2
8133229 Bonutti Mar 2012 B1
8162977 Bonutti et al. Apr 2012 B2
8182532 Anderson et al. May 2012 B2
8187329 Theofilos May 2012 B2
8211148 Zhang et al. Jul 2012 B2
8273127 Jones et al. Sep 2012 B2
8308804 Krueger Nov 2012 B2
8328872 Duffield et al. Dec 2012 B2
8343220 Michelson Jan 2013 B2
8343222 Cope Jan 2013 B2
8353913 Moskowitz et al. Jan 2013 B2
8382768 Berry et al. Feb 2013 B2
8425522 Bonutti Apr 2013 B2
8425607 Waugh et al. Apr 2013 B2
8444696 Michelson May 2013 B2
8465546 Jodaitis et al. Jun 2013 B2
8486066 Bonutti Jul 2013 B2
8540774 Kueenzi et al. Sep 2013 B2
8545567 Krueger Oct 2013 B1
8613772 Bray et al. Dec 2013 B2
8623030 Bonutti Jan 2014 B2
8632552 Bonutti Jan 2014 B2
8641726 Bonutti Feb 2014 B2
8641743 Michelson Feb 2014 B2
8641768 Duffield et al. Feb 2014 B2
8690944 Bonutti Apr 2014 B2
8739797 Bonutti Jun 2014 B2
8747439 Bonutti et al. Jun 2014 B2
8764831 Lechmann et al. Jul 2014 B2
8784495 Bonutti Jul 2014 B2
8795363 Bonutti Aug 2014 B2
8814902 Bonutti Aug 2014 B2
8834490 Bonutti Sep 2014 B2
8840629 Bonutti Sep 2014 B2
8845699 Bonutti Sep 2014 B2
8858557 Bonutti Oct 2014 B2
8956417 Bonutti Feb 2015 B2
9005295 Kueenzi et al. Apr 2015 B2
9044322 Bonutti Jun 2015 B2
9044341 Bonutti Jun 2015 B2
9050152 Bonutti Jun 2015 B2
9149365 Lawson et al. Oct 2015 B2
9192419 Mcdonough et al. Nov 2015 B2
9220604 Mcdonough et al. Dec 2015 B2
9241809 Mcdonough et al. Jan 2016 B2
9364340 Lawson et al. Jun 2016 B2
9402735 McDonough Aug 2016 B2
9414935 Mcdonough et al. Aug 2016 B2
9463097 Lechmann et al. Oct 2016 B2
9572681 Mathieu et al. Feb 2017 B2
9744049 Kueenzi et al. Aug 2017 B2
9848992 Mcdonough et al. Dec 2017 B2
9867718 Schmura et al. Jan 2018 B2
9883950 Bertagnoli et al. Feb 2018 B2
10010432 Schmura et al. Jul 2018 B2
10130492 Schmura et al. Nov 2018 B2
10492922 Mathieu et al. Dec 2019 B2
10507117 Mcdonough et al. Dec 2019 B2
10702394 Schmura et al. Jul 2020 B2
20010001129 McKay et al. May 2001 A1
20010005796 Zdeblick et al. Jun 2001 A1
20010010021 Boyd et al. Jul 2001 A1
20010016777 Biscup Aug 2001 A1
20010020186 Boyce et al. Sep 2001 A1
20010023371 Bonutti Sep 2001 A1
20010031254 Bianchi et al. Oct 2001 A1
20010039456 Boyer et al. Nov 2001 A1
20010041941 Boyer et al. Nov 2001 A1
20010049560 Paul et al. Dec 2001 A1
20020004683 Michelson Jan 2002 A1
20020010511 Michelson Jan 2002 A1
20020016595 Michelson Feb 2002 A1
20020022843 Michelson Feb 2002 A1
20020029055 Bonutti Mar 2002 A1
20020029084 Paul et al. Mar 2002 A1
20020040246 Bonutti Apr 2002 A1
20020049497 Mason Apr 2002 A1
20020065517 Paul May 2002 A1
20020077702 Castro Jun 2002 A1
20020082597 Fraser Jun 2002 A1
20020082603 Dixon et al. Jun 2002 A1
20020082803 Schiffbauer Jun 2002 A1
20020091447 Shimp et al. Jul 2002 A1
20020095155 Michelson Jul 2002 A1
20020095160 Bonutti Jul 2002 A1
20020099376 Michelson Jul 2002 A1
20020099378 Michelson Jul 2002 A1
20020099444 Boyd et al. Jul 2002 A1
20020106393 Bianchi et al. Aug 2002 A1
20020107571 Foley Aug 2002 A1
20020111680 Michelson Aug 2002 A1
20020128712 Michelson Sep 2002 A1
20020128717 Alfaro et al. Sep 2002 A1
20020147450 Lehuec et al. Oct 2002 A1
20020169508 Songer et al. Nov 2002 A1
20020161444 Choi Dec 2002 A1
20020193880 Fraser Dec 2002 A1
20030004576 Thalgott Jan 2003 A1
20030009147 Bonutti Jan 2003 A1
20030023260 Bonutti Jan 2003 A1
20030040798 Michelson Feb 2003 A1
20030045939 Casutt Mar 2003 A1
20030065396 Michelson Apr 2003 A1
20030078666 Ralph et al. Apr 2003 A1
20030078668 Michelson Apr 2003 A1
20030125739 Bagga et al. Jul 2003 A1
20030135277 Bryan et al. Jul 2003 A1
20030149484 Michelson Aug 2003 A1
20030153975 Byrd et al. Aug 2003 A1
20030167092 Foley Sep 2003 A1
20030181981 Lemaire Sep 2003 A1
20030195626 Huppert Oct 2003 A1
20030195632 Foley et al. Oct 2003 A1
20030199881 Bonutti Oct 2003 A1
20030199983 Michelson Oct 2003 A1
20040010287 Bonutti Jan 2004 A1
20040078078 Shepard Apr 2004 A1
20040078081 Ferree Apr 2004 A1
20040092929 Zindrick May 2004 A1
20040093084 Michelson May 2004 A1
20040097794 Bonutti May 2004 A1
20040098016 Bonutti May 2004 A1
20040102848 Michelson May 2004 A1
20040102850 Shepard May 2004 A1
20040126407 Falahee Jul 2004 A1
20040133278 Marino et al. Jul 2004 A1
20040138689 Bonutti Jul 2004 A1
20040138690 Bonutti Jul 2004 A1
20040143270 Zucherman et al. Jul 2004 A1
20040143285 Bonutti Jul 2004 A1
20040172033 Bonutti Sep 2004 A1
20040176853 Sennett et al. Sep 2004 A1
20040193181 Bonutti Sep 2004 A1
20040193269 Fraser et al. Sep 2004 A1
20040199254 Louis et al. Oct 2004 A1
20040210219 Bray Oct 2004 A1
20040210310 Trieu Oct 2004 A1
20040210314 Michelson Oct 2004 A1
20040220668 Eisermann et al. Nov 2004 A1
20040230223 Bonutti et al. Nov 2004 A1
20040249377 Kaes et al. Dec 2004 A1
20040254644 Taylor Dec 2004 A1
20040260427 Wimsatt Dec 2004 A1
20050015149 Michelson Jan 2005 A1
20050021042 Marnay et al. Jan 2005 A1
20050021143 Keller Jan 2005 A1
20050033433 Michelson Feb 2005 A1
20050049593 Duong et al. Mar 2005 A1
20050049595 Suh et al. Mar 2005 A1
20050065605 Jackson Mar 2005 A1
20050065607 Gross Mar 2005 A1
20050065608 Michelson Mar 2005 A1
20050071008 Louis Mar 2005 A1
20050085913 Fraser et al. Apr 2005 A1
20050101960 Fiere et al. May 2005 A1
20050113918 Messerli et al. May 2005 A1
20050113920 Foley et al. May 2005 A1
20050125029 Bernard et al. Jun 2005 A1
20050149193 Zucherman et al. Jul 2005 A1
20050154391 Doherty et al. Jul 2005 A1
20050159813 Molz, IV Jul 2005 A1
20050159818 Blain Jul 2005 A1
20050159819 McCormack et al. Jul 2005 A1
20050171606 Michelson Aug 2005 A1
20050171607 Michelson Aug 2005 A1
20050177236 Mathieu et al. Aug 2005 A1
20050216059 Bonutti et al. Sep 2005 A1
20050222683 Berry Oct 2005 A1
20050240267 Randall et al. Oct 2005 A1
20050240271 Zubok et al. Oct 2005 A1
20050261767 Anderson et al. Nov 2005 A1
20050267534 Bonutti et al. Dec 2005 A1
20050283236 Razian Dec 2005 A1
20060020342 Ferree et al. Jan 2006 A1
20060030851 Bray et al. Feb 2006 A1
20060079901 Ryan et al. Apr 2006 A1
20060079961 Michelson Apr 2006 A1
20060085071 Lechmann et al. Apr 2006 A1
20060089717 Krishna et al. Apr 2006 A1
20060129240 Lessar et al. Jun 2006 A1
20060136063 Zeegers Jun 2006 A1
20060142765 Dixon et al. Jun 2006 A9
20060167495 Bonutti et al. Jul 2006 A1
20060195189 Link et al. Aug 2006 A1
20060195193 Bloemer Aug 2006 A1
20060206208 Michelson Sep 2006 A1
20060229725 Lechmann et al. Oct 2006 A1
20060235470 Bonutti et al. Oct 2006 A1
20060265009 Bonutti Nov 2006 A1
20070088358 Yuan et al. Apr 2007 A1
20070088441 Duggal et al. Apr 2007 A1
20070093819 Albert Apr 2007 A1
20070106384 Bray et al. May 2007 A1
20070118125 Orbay et al. May 2007 A1
20070123987 Bernstein May 2007 A1
20070162130 Rashbaum et al. Jul 2007 A1
20070168032 Muhanna et al. Jul 2007 A1
20070177236 Kijima et al. Aug 2007 A1
20070208378 Bonutti et al. Sep 2007 A1
20070219365 Joyce et al. Sep 2007 A1
20070219635 Mathieu et al. Sep 2007 A1
20070225806 Squires et al. Sep 2007 A1
20070225812 Gill Sep 2007 A1
20070250167 Bray et al. Oct 2007 A1
20070270961 Ferguson Nov 2007 A1
20080033440 Moskowitz et al. Feb 2008 A1
20080039873 Bonutti et al. Feb 2008 A1
20080047567 Bonutti Feb 2008 A1
20080051890 Waugh et al. Feb 2008 A1
20080058822 Bonutti Mar 2008 A1
20080065140 Bonutti Mar 2008 A1
20080082169 Gittings et al. Apr 2008 A1
20080103519 Bonutti May 2008 A1
20080108916 Bonutti et al. May 2008 A1
20080114399 Bonutti May 2008 A1
20080119933 Aebi et al. May 2008 A1
20080132949 Aferzon et al. Jun 2008 A1
20080133013 Duggal et al. Jun 2008 A1
20080140116 Bonutti Jun 2008 A1
20080140117 Bonutti et al. Jun 2008 A1
20080161925 Brittan et al. Jul 2008 A1
20080177307 Moskowitz et al. Jul 2008 A1
20080188940 Cohen et al. Aug 2008 A1
20080200984 Jodaitis et al. Aug 2008 A1
20080206297 Roeder et al. Aug 2008 A1
20080234822 Govil et al. Sep 2008 A1
20080249569 Waugh et al. Oct 2008 A1
20080249575 Waugh et al. Oct 2008 A1
20080249622 Gray Oct 2008 A1
20080249625 Waugh et al. Oct 2008 A1
20080269806 Zhang et al. Oct 2008 A1
20080275455 Berry et al. Nov 2008 A1
20080281425 Thalgott et al. Nov 2008 A1
20080306596 Jones et al. Dec 2008 A1
20080312742 Abernathie Dec 2008 A1
20090076608 Gordon et al. Mar 2009 A1
20090088849 Armstrong et al. Apr 2009 A1
20090099601 Aferzon et al. Apr 2009 A1
20090099661 Bhattacharya et al. Apr 2009 A1
20090105830 Jones et al. Apr 2009 A1
20090132051 Moskowitz et al. May 2009 A1
20090192613 Wing et al. Jul 2009 A1
20090210062 Thalgott et al. Aug 2009 A1
20090210064 Lechmann et al. Aug 2009 A1
20090234455 Moskowitz et al. Sep 2009 A1
20090326580 Anderson et al. Dec 2009 A1
20100016901 Robinson Jan 2010 A1
20100125334 Krueger May 2010 A1
20100145459 Mcdonough et al. Jun 2010 A1
20100145460 Mcdonough et al. Jun 2010 A1
20100305704 Messerli et al. Dec 2010 A1
20100312346 Kueenzi et al. Dec 2010 A1
20110087327 Lechmann et al. Apr 2011 A1
20110118843 Mathieu et al. May 2011 A1
20110137417 Lee Jun 2011 A1
20110166660 Laurence Jul 2011 A1
20110230971 Donner et al. Sep 2011 A1
20110238184 Zdeblick et al. Sep 2011 A1
20110295371 Moskowitz et al. Dec 2011 A1
20120010623 Bonutti Jan 2012 A1
20120101581 Mathieu et al. Apr 2012 A1
20120109309 Mathieu et al. May 2012 A1
20120109310 Mathieu et al. May 2012 A1
20120109311 Mathieu et al. May 2012 A1
20120109312 Mathieu et al. May 2012 A1
20120109313 Mathieu et al. May 2012 A1
20120179259 Mcdonough et al. Jul 2012 A1
20120197401 Duncan et al. Aug 2012 A1
20120215226 Bonutti Aug 2012 A1
20120215233 Bonutti et al. Aug 2012 A1
20120221017 Bonutti Aug 2012 A1
20120323330 Kueenzi et al. Dec 2012 A1
20130073046 Zaveloff et al. Mar 2013 A1
20130073047 Laskowitz et al. Mar 2013 A1
20130166032 Mcdonough et al. Jun 2013 A1
20130173013 Anderson et al. Jul 2013 A1
20130226185 Bonutti Aug 2013 A1
20130237989 Bonutti Sep 2013 A1
20130268008 Mcdonough et al. Oct 2013 A1
20130289729 Bonutti Oct 2013 A1
20140018854 Bonutti et al. Jan 2014 A1
20140025110 Bonutti et al. Jan 2014 A1
20140025111 Bonutti et al. Jan 2014 A1
20140025112 Bonutti Jan 2014 A1
20140025168 Klimek et al. Jan 2014 A1
20140081406 Kellar et al. Mar 2014 A1
20140100663 Messerli et al. Apr 2014 A1
20140121777 Rosen et al. May 2014 A1
20140180422 Klimek et al. Jun 2014 A1
20140214166 Theofilos Jul 2014 A1
20140228963 Bonutti Aug 2014 A1
20140243985 Lechmann et al. Aug 2014 A1
20140257380 Bonutti Sep 2014 A1
20140257487 Lawson et al. Sep 2014 A1
20140277456 Kirschman Sep 2014 A1
20140309560 Bonutti Oct 2014 A1
20140336770 Petersheim et al. Nov 2014 A1
20140343573 Bonutti Nov 2014 A1
20140371859 Petersheim et al. Dec 2014 A1
20150257893 Mazzuca et al. Sep 2015 A1
20150320571 Lechmann et al. Nov 2015 A1
20160113774 Schmura et al. Apr 2016 A1
20180000607 Schmura et al. Jan 2018 A1
20180271672 Schmura et al. Sep 2018 A1
20200281740 Schmura et al. Sep 2020 A1
Foreign Referenced Citations (129)
Number Date Country
2004232317 Nov 2004 AU
2111598 Jun 1994 CA
2317791 Aug 1999 CA
1383790 Dec 2002 CN
1620271 May 2005 CN
1701772 Nov 2005 CN
1901853 Jan 2007 CN
2821678 Nov 1979 DE
3042003 Jul 1982 DE
3933459 Apr 1991 DE
4242889 Jun 1994 DE
4409392 Sep 1995 DE
4423257 Jan 1996 DE
19504867 Feb 1996 DE
29913200 Sep 1999 DE
202004020209 May 2006 DE
0179695 Apr 1986 EP
0298233 Jan 1989 EP
0302719 Feb 1989 EP
0505634 Sep 1992 EP
0577178 Jan 1994 EP
0639351 Feb 1995 EP
0425542 Mar 1995 EP
0504346 May 1995 EP
0517030 Sep 1996 EP
0897697 Feb 1999 EP
0605799 Apr 1999 EP
0641547 May 1999 EP
0966930 Dec 1999 EP
0968692 Jan 2000 EP
0974319 Jan 2000 EP
1124512 Aug 2001 EP
1194087 Apr 2002 EP
1393689 Mar 2004 EP
1402836 Mar 2004 EP
1033941 Aug 2004 EP
0906065 Sep 2004 EP
1051133 Oct 2004 EP
1103236 Aug 2006 EP
1459711 Jul 2007 EP
1847240 Oct 2007 EP
2552659 Apr 1985 FR
2697996 May 1994 FR
2700947 Aug 1994 FR
2703580 Oct 1994 FR
2727003 May 1996 FR
2747034 Oct 1997 FR
2753368 Mar 1998 FR
0157668 Jan 1921 GB
0265592 Aug 1927 GB
2148122 May 1985 GB
2207607 Feb 1989 GB
2239482 Jul 1991 GB
2266246 Oct 1993 GB
03-505416 Nov 1991 JP
09-280219 Oct 1997 JP
2006-513752 Apr 2006 JP
9601079 Jul 1997 MX
2229271 May 2004 RU
2244527 Jan 2005 RU
2307625 Oct 2007 RU
1465040 Mar 1989 SU
8803417 May 1988 WO
8810100 Dec 1988 WO
8909035 Oct 1989 WO
9000037 Jan 1990 WO
9201428 Feb 1992 WO
9206005 Apr 1992 WO
9301771 Feb 1993 WO
9508964 Apr 1995 WO
9515133 Jun 1995 WO
9520370 Aug 1995 WO
9521053 Aug 1995 WO
9526164 Oct 1995 WO
9639988 Dec 1996 WO
9640015 Dec 1996 WO
9720526 Jun 1997 WO
9723175 Jul 1997 WO
9725941 Jul 1997 WO
9725945 Jul 1997 WO
9737620 Oct 1997 WO
9739693 Oct 1997 WO
9817208 Apr 1998 WO
9817209 Apr 1998 WO
9855052 Dec 1998 WO
9856319 Dec 1998 WO
9856433 Dec 1998 WO
9909896 Mar 1999 WO
9909903 Mar 1999 WO
9927864 Jun 1999 WO
9929271 Jun 1999 WO
9932055 Jul 1999 WO
9938461 Aug 1999 WO
9938463 Aug 1999 WO
9956675 Nov 1999 WO
9963914 Dec 1999 WO
0007527 Feb 2000 WO
0007528 Feb 2000 WO
0025706 May 2000 WO
0030568 Jun 2000 WO
0040177 Jul 2000 WO
0041654 Jul 2000 WO
0059412 Oct 2000 WO
0066044 Nov 2000 WO
0066045 Nov 2000 WO
0074607 Dec 2000 WO
0103615 Jan 2001 WO
0108611 Feb 2001 WO
0156497 Aug 2001 WO
0162190 Aug 2001 WO
0180785 Nov 2001 WO
0193742 Dec 2001 WO
0195837 Dec 2001 WO
2004000177 Dec 2003 WO
2004069106 Aug 2004 WO
2005007040 Jan 2005 WO
2005020861 Mar 2005 WO
2006138500 Dec 2006 WO
0798288 Aug 2007 WO
2008014258 Jan 2008 WO
2008082473 Jul 2008 WO
2008102174 Aug 2008 WO
2008124355 Oct 2008 WO
2008154326 Dec 2008 WO
2009064644 May 2009 WO
2009158319 Dec 2009 WO
2010054181 May 2010 WO
2010054208 May 2010 WO
2012088238 Jun 2012 WO
Non-Patent Literature Citations (120)
Entry
AcroMed Carbon Fiber Interbody Fusion Devices; Jan. 1998, 8 pages.
Al-Sanabani, Application of Calcium Phosphate Materials in Dentistry, vol. 2013, Int. J. Biomaterials, 1-12, 2013.
Appendix 1 to Joint Claim Construction Brief,A—Synthes' Exhibits A-9, In the United States District Court for the District of Delaware Civil Action No. 1 :11-cv-00652-LPS, Jun. 8, 2012,192 pages.
Appendix 2 to Joint Claim Construction Brief, Globus' Exhibits A-F, In the United States District Court for the District of Delaware Civil Action No. 1 :11-cv-00652-LPS, Jun. 8, 2012, 146 pages.
Appendix 3 to Joint Claim Construction Brief, Exhibits A-C, In the United States District Court for the District of Delaware Civil Action No. 1: 11-cv-00652-LPS, Jun. 8, 2012, 38 pages.
Bailey, Stabilzation of the Cervical Spine by Anterior Fusion, 42-A(4), J. Bone Joint Surg., 565-594, Jun. 1960.
Banward, Iliac Crest Bone Graft Harvest Donor Site Morbidity, 20 (9) Spine 1055-1060, May 1995.
Benezech, L'arthrodese Cervicale ParVoie Anterieurea L'Aide de Plaque-Cage P.C.B., 3(1) Rach is 1,47,1997 (w/Translation).
Brantigan 1/F Cage for PLIF Surgical Technique Guide; Apr. 1991, 22 pages.
Brantigan, A Carbon Fiber Implant to Aid Interbody Lumbar Fusion, 16(6S) Spine S277-S282, Jul. 1991.
Brantigan, Compression Strength of Donor Bone for Posterior Lumbar Interbody Fusion, 18(9) Spine 1213-1221, 1993.
Brantigan, Interbody Lumbar Fusion Using a Carbon Fiber Cage Implant Versus Allograft Bone, 19(13) Spine 1436-1444, 1994.
Brantigan, Intervertebral Fusion,Chapter 27, posterior Lumbar Interbody Fusion Using the Lumber Interbody Fusion Cage , 437-466, Jul. 2006.
Brantigan, Pseudarthrosis Rate After Allograft Posterior Lumbar Interbody Fusion with Pedicle Screw and Plate Fixation , 19(11) Spine 1270-1280, Jun. 1994.
Bray, “InterPlate Spine Fusion Device: Subsidence Control Without Stress Shielding”, Orthopaedic Product News, Sep./Oct. 2006, pp. 22-25.
Bray, InterPlate Vertebral Body Replacement; website accessed May 4, 2017; http://rsbspine.com/Products.aspx, 2 pages.
Carbon Fiber Composite Ramps for Lumbar Interbody Fusion; Apr. 1997, 2 pages.
Chadwick et al., “Radiolucent Structural Materials for Medical Application”, www.mddionline.com/print/238 Jun. 2001, accessed Jul. 31, 2012, 9 pages.
Cloward, Gas-Sterilized Cadaver Bone Graffts for spinal Fusion Operation , 5(1) Spine 4-10 Jan./Feb. 1980.
Cloward, The Anterior Approach for Removal of Ruptured Cervical Disks, vol. 15, J. Neuro. 602-617, 1958.
Dabrowski, Highly Porous Titanium Scaffolds for Orthopaedic Applications, J. Biomed Mater. Res. B. Appl. Biomat. Oct.;95(1):53-61, 2010.
Delecrin, Morbidite du Prelevement de Greffons osseuz au Niveau des Cretes Iliaques dans la Chirurgie Du Rachis; Justification du recours aux substituts osseuz, 13(3) Rachis 167-174, 2001 (w/Translation).
DePuy Motech Surgical Titanium Mesh Brochure; 1998, 13 pages.
Dereymaeker, Nouvelle Cure neuro-Chirurgicale de discopathies Cervicales, 2 Neurochimrgie 226-234; 1956 (w/Translation).
Dickman, Internal Fixation and Fusion of the Lumbar Spine Using Threaded Interbody Cages, 13(3) Barrow Quarterly (1997); http://www.thebarrow.org/Education_And_Resources/Barrow_Quarterly/204837.
Enker, Interbody Fusion and Instrumentation, No. 300 Clin. Orth. Rel. Res. 90-101, Mar. 1994.
Expert Report of Dr. Domagoj Carie Regarding the Invalidity of U.S. Pat. Nos. 7,846,207, J ,862,616 and 7,875,076, In the United States District Court for the District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Nov. 5, 2012,149 pages.
Expert Report of John F. Hall, M.D., United States District Court for the District of Delaware,Civil Action No. 1:11-cv-00652-LPS, Dec. 14, 2012, 27 paqes.
Expert Report of Paul Ducheyne, Ph.D. Concerning Patent Validity, United States District Court District of Delaware, Civil Action No. 1 :11-cv-00652-LPS,Dec. 13, 2012,155 paqes.
Expert Report of Richard J. Gering, Ph.D., CLP In the United States District Court for the District of Delaware, Civil Action No. 1: 11-cv-00652-LPS, Dec. 14, 2012, 39 paqes.
Fassio, Use of Cervical Plate-Cage PCB and Results for Anterior Fusion in Cervical Disk Syndrome, 15(6) Rachis 355-361, Dec. 2003 Translation.
Fowler, Complications Associated with Harvesting Autogenous Iliac Bone Graft, 24(12) Am. J. Ortho. 895-904, Dec. 1995.
Fuentes, Les Complications de la Chirurgie Par Voie Anlerieure du Rachis Cervical, 8(1) Rachis 3-14, 1996 (w/translalion).
Germay, Resultats Cliniques de Ceramiques D'hydroxyapatite dans les arthrodeses Inter-somatiques du Rachis Cervical Par Voie Anterieure. Etude Retrospective a Propose de 67 cas. 13(3), Rachis 189-195, 2001 (w/Translation).
Graham, Lateral Extracavitary Approach to the Thoracic and Thoracolumbar Spine, 20(7) Orthopedics, 605-610, Jul. 1997.
Gunatillake, Biodegradable Synthetic Polymers for Tissue Engineering, vol. 5, Eur. Cells Materials, 1-16, 2003.
Huttner, Spinal Stenosis & Posterior Lumbar Interbody Fusion, No. 193, Clinical Ortho Rel. Res. 103-114, Mar. 1985.
International Patent Application No. PCT/CH2003/00089, International Search Report, dated Dec. 3, 2003, 3 pages.
International Patent Application No. PCT /US2011/066421; International Search Report and Written Opinion dated Jun. 14, 2012, 31 pages.
International Search Report, completed Aug. 16, 2007 for International Application No. PCT/US2007/005098, filed Feb. 27, 2007, 5 pgs.
International Search Report, dated Mar. 20, 2009, for PCT International Application No. PCT/US08/82473, filed Nov. 5, 2008.
Japanese Patent Application No. 2011-534926: Office Action dated Oct. 30, 2013, 7 pages.
Japanese Patent Application No. 2011-534928: Office Action dated Sep. 30, 2013, 11 pages.
Joint Claim Construction Brief, In the United States District Court for the District of Delaware, Civil Action No. 1:11-;v-00652-LPS, Jun. 14, 2012, 97 pages.
Jonbergen et al., “Anterior Cervical Interbody fusion with a titanium box cage: Early radiological assessment of fusion md subsidence”, The Spine Journal 5, Jul. 2005, 645-649.
Jost, Compressive Strength of Interbody Cages in the Lumbar Spine: the Effect of Cage Shape, Posterior Instrumentation and Bone Density, 7 Eur. Spine J. 132-141, 1998.
Jury Trial Demanded, In the United States District Court for the District of Delaware, Case No. 1:11-cv-00652-LPS, filed Jul. 22, 2011,8 pages.
Jury Verdict Form, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 14, 2013, 20 pages.
Kastner, Advanced X-Ray Tomographic Methods for Quantitative Charecterisation of Carbon Fibre Reinforced Polymers, 4th Annual Intern. Symposium on NDT in Aerospace, 2012, 9 pages.
Khan, Chapter 2—Implantable Medical Devices, Focal Controlled Drug Delivery, Advances in Delivery Science and Technology, A.J. Domb and W. Khan (eds.) 2014.
U.S Provisional Application filed Jan. 15, 1998 by David J. Urbahns, Entitled “Insertion Instruments and Method for Delivering a Vertebral Body Spacer”,, U.S. Appl. No. 60/071,527.
U.S. Appl. No. 11/199,599: Amendment/Request for Reconsideration after Non-Final Rejection, dated Sep. 29, 2009, 30 pages.
U.S. Appl. No. 11/199,599: Appeal Brief, dated Apr. 15, 2010, 51 pages.
U.S. Appl. No. 11/199,599: Final Rejection, dated Dec. 24, 2009, 21 pages.
U.S. Appl. No. 11/199,599: Interview Summary included Draft Amendments, dated Sep. 24, 2009, 16 pages.
U.S. Provisional Application filed Nov. 16, 2007 by Thomas Kueenzi et al., entitled “Low profile intervertebral implant”, U.S. Appl. No. 60/988,661.
U.S. Provisional Application filed Sep. 16, 2011 by Jillian Zaveloff et al., entitled “Multi-Piece Intervertebral Implants”, U.S. Appl. No. 61/535,726.
U.S. Appl. No. 11/199,599: Amendment dated Sep. 29, 2009, 30 pages.
U.S. Appl. No. 11/199,599: Non-Final Office Action dated Apr. 1, 2009, 20 pages.
U.S. Appl. No. 11/199,599: Preliminary Amendment dated Jan. 9, 2008, 11pages.
Verbiest H., La Chirurgie Anterieure et Laterale du Rachis Cervical,! 6(S2) Neurochirurgie 1-212; 1970 (w/Translation).
Wang, Determination of Cortical Bone Porosity and Pore Size Distribution using a Low Field Pulsed NMR Approach, J. Orthop Res., Mar.; 21(2):312-9 Mar. 2003.
Wang, Increased Fusion Rates with Cervical Plating for Two-Level Anterior Cervical Discectomy and Fusion, 25(1) Spine 41-45, Jan. 2000.
Watters, Anterior Cervical Discectomy with and without Fusion, 19(20) Spine 2343-2347 Oct. 1994.
Weiner, Spinde Update Lumbar Interbody Cages, 23(5) Spine, 634-640, Mar. 1998.
White, Relief of Pain by Anterior Cervical-Spine Fusion for Spondylosis, 55-A(3) J. Bone Joint Surg. 525-534, Apr. 1973.
Whitesides, Lateral Approach to the Upper Cervical Spine for Anterior Fusion, vol. 59, South Med J, 879-883, Aug. 1966.
Wilson, Anterior Cervical Discectomy without Bone Graft, 47(4) J. Neurosurg. 551-555, Oct. 1977.
Written Opinion, dated Mar. 20, 2009, for PCT International Application No. PCT/US08/82473, filed Nov. 5, 2008.
Younger, Morbidity at Bone Graft Donor Sites, 3(3) J. Orth. Trauma, 192-195, 1989.
Kozak, Anterior Lumbar Fusion Options, No. 300, Clin. Orth. Rel. Res., 45-51,1994.
Kroppenstedt, Radiological Comparison of Instrumented Posterior Lumbar Interbody Fusion with One or Two Closed-Box Plasmapore Coated Titanium Cages, 33(19) Spine, 2083-2088, Sep. 2008.
Lund, Interbody Cage Stabilisation in the Lumbar Spine, 80-B(2) J Bone Joint Surg., 351-359, Mar. 1998.
Lyu, Degradability of Polymers for Implantable Biomedical Devices, 10, Int. J. Mol. Sci., 4033-4065, 2009.
Malca, Cervical Interbody Xenografl with Plate Fixation, 21 (6) Spine, 685-690, Mar. 1996.
Marcolongo et al., “Trends in Materials for Spine Surgery”, Comprehensive Biomaterials, Biomaterials and Clinical Ise, 6.610, Oct. 2011, 21 pages.
McAfee, Minimally Invasive Anterior Retroperitoneal Approach to the Lumbar Spine, 21(13) Spine, 1476-1484, 1998.
Memorandum Opinion, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, May 7, 2013, 33 pages.
Nasca, Newer Lumbar Interbody Fusion Techniques, 22(2) J. Surg. Ortho. Advances, 113-117, 2013.
Order, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652- LPS, May 15, 2013, 4 pages.
Order, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, May 7, 2013, 7 pages.
Parlov et al., “Anterior Lumbar Interbody Fusion with Threaded Fusion Cages and Autologous Grafts”, Eur. Spine J., 1000, 9, 224-229.
PCB Evolution Surgical Technique Guide 2010.
PCT International Application No. PCT/US2009/063529: International Search Report and Written Opinion dated Apr. 14, 2010, 19 pages.
Plaintiffs' Responses and Objections to Defendant Globus Medical, Inc.'s First Set of Interrogatories {Nos. 1-11}, Jnited States District Court for the District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Nov. 14, 2011,18 pages.
Plaintiffs' Supplemental Responses and Objections to Defendant Globus Medical Inc. 's Interrogatories Nos. 6-10 and Second Supplemental Responses and Objections to Interrogatory No. 5, United States District Court for the District of Delaware, Civil Action No. 11-cv-652-LPS, Sep. 1, 2012, 12 pages.
Polysciences Inc. Info Sheet 2012.
Porex Website, http://www.porex.com/technologies/materials/porous-plastics, Porous Plastic Materials, accessed Aug. 21, 2015, 2 pages.
Redacted version of “Defendant Globus Medical, Inc.'s Answering Brief in Opposition to Plaintiff's Motion for Summary Judgment of No Anticipation by the Kozak and Michelson References”, Mar. 12, 2013, 233 pages.
Redacted version of “Opening Brief in Support of Plaintiffs' Motion for Summary Judgment of No Anticipation by the Kozak and Michelson References”, United States District Court District of Delaware, CivilAction No. 1:11-;v-00652-LPS, Feb. 13, 2013, 66 pages.
Redacted version of “Plaintiffs Reply Brief in Support of Plaintiffs Motion for Summary Judgment of No Anticipation by the Kozak and Michelson References”, Mar. 21, 2013,11 pages.
Reply Report of Dr. Domagoj Carie Regarding the Invalidity of U.S. Pat. Nos. 7,846,207,7,862,616 and 7,875,076, In the United States District Court for the District of Delaware,Civil Action No. 1 :11-cv-00652-LPS, Jan. 4, 2013, 81 pages.
Russian Patent Application No. 2011-1122797: Decision to Grant dated Oct. 9, 2013, 20 pages.
Samandouras, A New Anterior Cervical Instrumentation System Combining an Intradiscal Cage with an Integrated Plate, 26(10) Spine, 1188-1192, 2001.
Schleicher et al., “Biomechanical Comparison of Two Different Concepts for Stand alone anterior lumbar interbody fusion”, Eur. Spine J., Sep. 2008, 17, 1757-1765.
Scholz et al., “A New Stand-Alone Cervical Anterior Interbody Fusion Device”, Spine, Jan. 2009, 34(2), 6 pages.
Second Expert Report of Wilson C. Hayes, Ph.D., United States District Court for the District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Dec. 14, 2012, 22 pages.
Sonntag, Controversy in Spine Care, Is Fusion Necessary After Anterior Cervical Discectomy 21(9) Spine, 1111-1113, May 1996.
Spruit et al., “The in Vitro Stabilizing Effect of Polyether-etherketone Cages Versus a Titanium Cage of similar design for anterior lumbar interbody fusion”, Eur. Spine J., Aug. 2005, 14 752-758.
Synthes History and Evolution of LBIF Brochure; Nov. 2015, 30 pages.
Synthes Spine Cervical Stand-Alone Devices Presentation Brochure; 2010, 40 pages.
Synthes Spine, “CorticoCancellous ACF Spacer. An allograft space or anterior fusion of the cervical spine,” brochure, Musculoskeletal Transplant Foundationm, 2003, 6 pages.
Synthes Spine, “SynFix-LR System, Instruments and Implants for Stand-Alone Anterior Lumbar Interbody Fusion(ALIF)”, Technique Guide dated 2008, pp. 2-40, Published by Synthes Spine (USA).
Synthes Spine, “Zero-P Instruments and Implants. Zero-Profile Anterior Cervical Interbody Fusion (ACIF) device”, Technique Guide dated 2008, pp. 2-32, Published by Synthes Spine (USA).
Synthes SynFix-LR System Technique Guide dated 2008.
Synthes Zero-P Instruments and Implants Technique Guide dated 2008.
Takahama, A New Improved Biodegradable Tracheal Prosthesis Using Hydroxy Apatite and Carbon Fiber 35(3) ASAIO Trans, 291-293, Jul.-Sep. 1989.
Tamariz, Biodegradation of Medical Purpose Polymeric Materials and Their Impacton Biocompatibility, Chapter 1, Intech-bio degradation Life of Science, 2013; 28 pages.
Tan, A Modified Technique of Anterior Lumbar Fusion with Femoral Cortical Allograft, 5(3) J. Ortho. Surg. Tech., 83-93, 1990.
Trial Transcript, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 10, 2013, 114 pages.
Trial Transcript, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 11, 2013, 98 pages.
Trial Transcript, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 12, 2013, 75 pages.
Trial Transcript, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 13, 2013, 94 pages.
Trial Transcript, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 14, 2013, 26 pages.
Trial Transcript, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 3, 2013, 38 pages.
Trial Transcript, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 4, 2013, 110 pages.
Trial Transcript, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 5, 2013, 39 pages.
Trial Transcript, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 6, 2013, 80 pages.
Trial Transcript, United States District Court District of Delaware, Civil Action No. 1:11-cv-00652-LPS, Jun. 7, 2013, 37 pages.
U.S Provisional Application filed Dec. 19, 1999 by David J. Urbahns, Entitled “Insertion Instruments and Method for Delivering a Vertebral Body Spacer”,, U.S. Appl. No. 60/068,205.
Related Publications (1)
Number Date Country
20200138596 A1 May 2020 US
Provisional Applications (2)
Number Date Country
61139920 Dec 2008 US
61112441 Nov 2008 US
Divisions (1)
Number Date Country
Parent 13901002 May 2013 US
Child 15205173 US
Continuations (2)
Number Date Country
Parent 15205173 Jul 2016 US
Child 16737676 US
Parent 12614082 Nov 2009 US
Child 13901002 US