US20020120273A1 - Anterior cervical plating system and method - Google Patents
Anterior cervical plating system and method Download PDFInfo
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- US20020120273A1 US20020120273A1 US10/134,463 US13446302A US2002120273A1 US 20020120273 A1 US20020120273 A1 US 20020120273A1 US 13446302 A US13446302 A US 13446302A US 2002120273 A1 US2002120273 A1 US 2002120273A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
- A61B17/8042—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being a cover over the screw head
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7059—Cortical plates
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
- A61B17/8014—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones the extension or compression force being caused by interaction of the plate hole and the screws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
- A61B17/8019—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones where the means are a separate tool rather than being part of the plate
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/808—Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
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Abstract
The present invention is directed to a system for anterior fixation of the spine that utilizes an elongated fixation plate. The plating system stabilizes the spine and promotes fusion and incorporation of a graft or implant in a portion of the spinal column. In one aspect of the invention, the fixation plate has a first end with a pair of holes. Bone screws extend through the holes to rigidly secure the plate to a first vertebra. The second end of the plate is provided with a pair of slots through which bone screws extend for engagement with a second vertebra. The screws extending through the slots are translatable in the slot to maintain compression of the spinal column portion. The plating system includes a retainer assembly that prevents screw back out. Methods and instruments relating to the plating system are also described.
Description
- The present invention relates generally to the field of instrumentation and systems for the spine, and more particularly to instrumentation and systems for use in treatment of various pathologies of the cervical spine.
- As with any bony structure, the spine is subject to various pathologies that compromise its load bearing and support capabilities. Such pathologies of the spine include, for example, degenerative diseases, the effects of tumors and, of course, fractures and dislocations attributable to physical trauma. Spinal surgeons have addressed these problems using a wide variety of instrumentation in a broad range of surgical techniques. The use of elongated rigid plates has been helpful in the stabilization and fixation of the lower spine, most particularly in the thoracic and lumbar spine. These same plating techniques have found some level of acceptance by surgeons specializing in the treatment of the cervical spine.
- The cervical spine can be approached either anteriorly or posteriorly, depending upon the spinal disorder or pathology to be treated. Many well-known surgical exposure and fusion techniques of the cervical spine are described in the publication entitledSpinal Instrumentation, edited by Drs. Howard An and Jerome Coter. This text also describes instrumentation that has been developed in recent years for the cervical spine. Plating systems have become predominant for providing internal instrumentation in techniques that achieve fusion of the cervical spinal from an anterior approach.
- During the development of cervical plating systems, particularly for the anterior approach, various needs have been recognized. For example, the system should provide strong mechanical fixation that can control movement of each vertebral segment. The system should be able to withstand axial loading and continuity with each of the three columns of the spine. The system should also be able to maintain stress levels below the endurance limits of the plate material, while at the same time exceeding the strength of the anatomic structures or vertebrae to which the plating system is engaged. The thickness of the system should be small to lower its prominence, particularly at the smaller spaces of the cervical spine. Also, the screws used to connect the plate to the vertebrae must not loosen over time or back out from the plate.
- While the plating system should satisfy certain mechanical requirements, the system should also satisfy certain anatomic and surgical considerations. For example, the cervical plating system should minimize the intrusion into the patient and reduce the trauma to the surrounding soft tissue. This is particularly important in such procedures that relate to the cervical spine because the complications can be very devastating, such as injury to the brain stem, spinal cord, or vertebral arteries. It has also been found that the optimum plating system permits placement of more than one screw in each of the instrumented vertebrae. Also, the system should be designed to contact the vertebrae for greater stability.
- Many spinal plating systems have been developed in the last couple of decades to address some of the needs and requirements for cervical fixation systems. However, even with the more refined plating system designs, there still remains a need for a system that effectively addresses the requirements for such a system.
- There is also a need for a plating system that addresses procedures designed to achieve fusion of the cervical spine. In cases where a graft or implant is implanted to maintain a disc space and/or replace one or more diseased vertebral bodies, it is desirable to increase the rate of fusion and incorporation of the graft or implant into the spine. A plating system that allows pre-loading of the graft or implant and/or provides continual loading thereafter is preferred.
- While the prior art plating systems relating to cervical plating systems are steps in the right direction, there remains a need for additional improvements. The present invention is directed to satisfying these needs, among others.
- The present invention contemplates a system for anterior fixation of the spine that utilizes an elongated fixation plate. In one aspect of the invention, the plating system promotes fusion and incorporation of a graft or implant in a spinal column portion. The plating system provides continual loading of the graft or interbody implant. In another aspect, the plating system allows a compressive load to be applied to the spinal column portion. This preloading and continual loading avoids stress-shielding and promotes fusion and incorporation of the graft or implant into the spinal column portion.
- In one aspect of the invention, the fixation plate has a first end with a pair of holes. Bone engaging fasteners extend through the holes to rigidly secure the plate to a first vertebra. A second end of the plate is provided with a pair of slots through which bone engaging fasteners extend for engagement with a second vertebra. The bone engaging fasteners extending through the slots are translatable in the slots to allow settlement and compression of the second vertebra with respect to the first vertebra. In a preferred embodiment, the plating system includes a retainer assembly that prevents fastener back out.
- According to another aspect of the invention, a bone fixation system for a spinal column segment is provided. The bone fixation system includes a plate with a central axis, a length between a first end and a second end, and top and bottom surfaces. The plate defines a plurality of first openings and a plurality of second openings between the top and bottom surfaces. At least one of the plurality of first openings is positioned adjacent the first end of the plate and defines a circular hole though the plate. At least one of the plurality of second openings is positioned adjacent the second end of the plate and defines a slotted hole having a first width and a first length adjacent the bottom surface. A number of bone engaging fasteners extend through the first and second openings. Each bone engaging fastener has a threaded shank and an enlarged head. The fastener has a substantially cylindrical portion with a third diameter that interfaces with the plate in the first opening such that the fastener inserted in the first opening assumes a fixed orientation with the plate. The head of said bone engaging fastener inserted into the second opening is translatable along the length of the second opening to maintain compression of the spinal column portion.
- In another aspect of the invention, a bone fixation system for a spinal column portion is provided. The bone fixation system includes a plate with a length along a central axis that extends between a first end and a second end. The plate has a top surface and a bottom surface and defines a plurality of first and second openings between the surfaces. At least a pair of the first openings is positioned adjacent the first end, and the first openings define a circular opening having a first diameter. At least a pair of the second openings is positioned adjacent the second end, and the second openings define a slot having a first width and a first length. A number of bone engaging fasteners with an elongated threaded shank and an enlarged head are provided. The bone engaging fasteners extend through the first and second holes from the top surface. A retainer assembly retains the bone engaging fasteners in the first and second openings. In one form, the retainer assembly includes a washer having a length that substantially corresponds to the length of the plate.
- In yet another aspect of the invention, a bone fixation system for a spinal column segment is provided. The system includes four bone engaging fasteners that have an enlarged head and a threaded shank. An elongated plate has a length extending between a first end and a second end sized to span between at least two vertebrae. The plate defines one pair of holes adjacent the first end and one pair of slots adjacent the second end. Each of the holes and the slots are configured to receive the threaded shank of a corresponding one of the bone engaging fasteners therethrough to engage the plate to the vertebrae. The bone engaging fasteners extend through the pair of holes to fix the plate to the first vertebra. Bone engaging fasteners extend through the pair of slots to secure the plate to the second vertebra. The bone engaging fasteners axially translate in the slots to maintain compression on the spinal column portion.
- In a further aspect of the invention, a bone fixation system for a spinal column portion is provided. The system includes six bone engaging fasteners that each have an enlarged head and a threaded shank. An elongated plate extending between a first end and a second end has a length sized to span between at least three vertebrae. The plate defines one pair of holes over a first vertebra, one pair of slots over a second vertebra, and one pair of intermediate slots over a third vertebra intermediate the first and second vertebrae. The holes and the slots are configured to receive the threaded shank of the bone engaging fasteners therethrough. The bone engaging fasteners extend through the pair of holes to fix the plate to the first vertebra The bone engaging fasteners extend through the slots to secure the plate to the second vertebra. The bone engaging fasteners axially translate in the slots to maintain compression on the spinal column portion. The surgeon can optionally place bone engaging fasteners in the intermediate slots to engage the plate to the third vertebra.
- In another aspect of the invention, there is provided a retainer assembly for an elongated plate that extends between at least two vertebrae. The retainer assembly includes a washer having at least one tapered aperture. The washer is translatable between a locked position and an unlocked position by threading a locking fastener into the tapered aperture.
- In another aspect of the invention, there is provided a retainer assembly for an elongated plate that extends between at least two vertebrae. The plate defines a number of openings for insertion of bone engaging fasteners to attach the plate to the at least two vertebrae. The plate further includes a first fastener bore in the plate adjacent at least one of the openings positioned over the first vertebra and a second fastener bore in the plate adjacent at least one of the openings positioned the second vertebra The retainer assembly includes a washer that defines at least a first aperture adjacent the at least one opening positioned over the first vertebra and a second aperture adjacent the at least one opening positioned over the second vertebra. A locking fastener for each of the apertures in the washer has an elongated shank extending through the aperture configured to engage the fastener bore of the plate. The washer is movable between a first position where the bone engaging fasteners are insertable into each of the at least one openings and a second position where the washer has a surface configured to contact the head of a bone engaging fastener extending through the at least one opening positioned over the first vertebra and overlap the head of a bone engaging fastener extending through the at least one opening positioned over the second vertebra.
- In another aspect of the invention, a retainer assembly for an elongated plate is provided. The plate extends between at least two vertebrae and defines a number of openings for insertion of bone engaging fasteners to secure the plate to the at least two vertebrae. The plate includes at least one first fastener bore. The retainer assembly includes a washer that defines at least a first aperture positioned in communication with the at least one fastener bore. A locking fastener extends through the first aperture and has an elongated shank to engage the fastener bore of the plate. The washer is movable along its central axis between a first position where the at least two bone engaging fasteners are inserted through the openings to engage the first and second vertebrae and a second position where a surface of the washer contacts at least the head of the bone engaging fasteners engaged to the first vertebra.
- In another aspect of the present invention, a method for applying a compressive load to a number of vertebrae including at least a first vertebra and a second vertebra is provided. The method includes: (a) providing a template having a guide surface and a notch; (b) positioning the template on the second vertebra with the guide surface on an endplate of the second vertebra to locate the template notch on the body of the second vertebra; (c) inserting a pin through the notch of the template into the body of the second vertebra; (d) removing the template; (e) placing a sleeve over the pin; (f) providing a plate having a length extending between a first end and a second end, the plate including a notch on the second end and a number of openings therethrough; (g) placing the plate on the vertebral segment with the sleeve nested in the notch of the plate; (h) fixing the first end of the plate to the first vertebra with bone engaging fasteners extending through the openings positioned over the first vertebra; (i) removing the sleeve from the pin to form a gap between the pin and the notch in the plate; (j) connecting a compression tool to the pin and the plate; and (k) applying a compression load to the vertebral segment with the compression tool until the pin contacts the notch. In one embodiment, the plate includes holes positioned over the first vertebra and slots positioned over the second vertebra. In another embodiment, the method further includes the step of retaining the bone engaging fasteners in the plate with a retainer assembly.
- In another aspect of the present invention, there is provided a method for maintaining compression of a spinal column portion. The method includes: (a) providing a plate having a length between a first end and a second end sized to span at least two vertebra, the plate having a pair of holes at the first end positioned over the fist vertebra and a pair of slots at the second end positioned over the second vertebra; (b) fixing the first end of the plate to the first vertebra with bone engaging fasteners extending through the pair of holes; (c) securing the second end of the plate to the second plate with bone engaging fasteners extending through the pair of slots; and (d) translating the bone engaging fasteners in the slots to allow settling of the spinal column segment. In one embodiment, the method further includes retaining the bone engaging fasteners in the plate with a retainer assembly.
- These and other forms, embodiments, aspects, features, objects of the present invention will be apparent from the following description.
- FIG. 1 is a top perspective view of an anterior plating system according to the present invention.
- FIG. 2 is a top perspective view of the anterior plating system of FIG. 1 with the bone screws locked in place.
- FIG. 3 is a top perspective view of the anterior plating system of FIG. 1 with bone screws translated in a slot of the plate.
- FIGS.4(a)-4(f) are top plan views of fixation plates of the present invention provided in different sizes and configurations.
- FIGS.5(a)-5(f) are top plan views of washers of the present invention provided in sizes and configurations corresponding to the plates in FIGS. 5(a)-5(f).
- FIG. 6 is a side elevational view of a bone screw according to one aspect of the present invention.
- FIG. 7 is a side elevational view of a locking fastener according to another aspect of the present invention.
- FIGS.8(a)-8(k) are various views and sections of washers according to the present invention.
- FIG. 9 is a top plan view of a first end of the fixation plate of the present invention.
- FIG. 10 is a cross-sectional view taken through line10-10 of FIG. 9.
- FIG. 11 is an end elevational view of the plate of FIG. 9.
- FIG. 12 is a top plan view of a second end of the fixation plate of the present invention.
- FIG. 13 is a cross-sectional view taken along line13-13 of FIG. 12.
- FIG. 14 is an enlarged cross-sectional view taken through line14-14 of FIG. 12.
- FIG. 15 is a top plan view of an intermediate portion of the fixation plate of the present invention.
- FIG. 16 is a cross-sectional view taken through line16-16 of FIG. 15.
- FIG. 17 is an enlarged cross-sectional view taken through line17-17 of FIG. 15.
- FIG. 18 is an enlarged cross-sectional view taken through line18-18 of FIG. 15.
- FIG. 19a is a partial sectional view of the anterior plate assembly of the present invention with the screws disposed through the holes at the first end of the plate and engaged in a vertebra.
- FIG. 19b is a partial sectional view of the anterior plate assembly of the present invention with the screws disposed through the slots of the plate and engaged in a vertebra.
- FIGS.20(a)-20(f) illustrate various instruments and steps of a method according to another aspect to the present invention.
- FIGS.21(a)-21 (c) are various perspective views of a compression tool according to yet another aspect of the present invention.
- FIGS.22(a)-22(b) are side elevational views of the arms of an alternate embodiment compression tool.
- For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended. Any alterations and further modifications in the illustrated devices, and any further applications of the principles of the invention as illustrated herein, are contemplated as would normally occur to one skilled in the art to which the invention relates.
- A
plating system 30 having application in an anterior approach to the cervical spine is depicted in FIGS. 1-3. The portion of the spine is shown schematically in FIG. 1 to include a first vertebra V1, a second vertebra V2, and intermediate vertebrae V3 and V4. Preferably, first vertebra V1 is the inferior or bottom vertebra in the portion of the spinal column and the second vertebra V2 is the superior or top vertebra of the portion of the spinal column. However, it is also contemplated herein that first vertebra V1 is the superior vertebra and that second vertebrae V2 is the inferior vertebra. It should also be understood that as described below, the present invention has application with spinal column portions that include vertebrae ranging in number from two to six vertebrae. One or more implants I may be placed into one or more of the disc spaces between adjacent vertebrae as needed. Implant I may be a bone graft, fusion device, or any other type of interbody device that is insertable into a disc space and promotes fusion between adjacent vertebrae. - In accordance with the present invention, the
plating system 30 includes anelongated plate 31 having a number of openings therethrough and a number of bone engaging fasteners, shown in the form of bone screws 50, that are insertable through the openings. In a preferred form, each bone engaging fastener is in the form of a bone screw.Plate 31 has a longitudinal axis L extending along the length of the plate at its centerline. Bone engaging fasteners or bone screws 50 are held inplate 31 by way of aretainer assembly 33 positioned along axis L. The openings ofelongated plate 31 include a pair ofholes 34 atfirst node 36 adjacent a first end ofplate 31.First node 36 is positioned over first vertebra V1.Plate 31 also includes a pair ofslots 35 at asecond node 37 adjacent a second end ofplate 31.Second node 37 is positioned over second vertebra V2. In some forms ofplate 31, severalintermediate nodes 38 are provided along the length of theplate 31 betweenfirst node 36 andsecond node 37. Eachintermediate node 38 includes a pair ofintermediate slots 32 positioned over a corresponding one of the intermediate vertebrae V3 and V4.Plating system 30 can be fabricated from any type of biocompatible material. - It is preferred that holes34 are paired with one of the holes of the pair on one side of the longitudinal axis L and the other hole of the pair on the opposite side of
axis L. Slots holes 34 are identical in shape and size, and are located symmetrically about the axis L. Pairedslots 35 are also identical in shape and size, and are located symmetrically about the axis L. The pairedslots 32 atintermediate nodes 38 are also identical in shape and size, and are located symmetrically about theaxis L. Plate 31 includes recesses between each ofnodes Plate 31 has a length selected by the surgeon withnodes nodes 38 to register with the patient vertebrae. -
Plate 31 preferably includes a roundedupper surface 41 that is in contact with the soft tissue surrounding the spine when the plate is engaged to the spine. Roundedsurface 41 reduces the amount of trauma that would be experienced by the surrounding soft tissue. Thebottom surface 42 ofplate 31 is preferably configured to contact the vertebral bodies of the spine at each of the instrumented levels. In one embodiment, at least a portion ofbottom surface 42 can be textured along the length of the plate to enhance its grip on a vertebral body. - Holes34 include a
recess 45 adjacent the top surface ofplate 31 that allow the head of the bone engaging fastener, such asbone screw 50, to be countersunk inplate 31. Similarly,intermediate slots 32 include arecess 46 around eachslot 32 adjacent top surface of the plate, andslots 35 include arecess 47 around eachslot 35 adjacent the top surface of the plate. Preferably,slots 35 include aramp 60 that, as described further below, allows a dynamic compression load to be applied to the spinal column portion upon insertion ofscrew 50 atsecond end 43 ofslot 35.Recesses screw 50 to be countersunk inplate 31 when inserted through a corresponding one of theslots groove 39 extends along axis L ofplate 31 and intersects with each ofrecesses groove 39. The end ofplate 31 atsecond node 37 includes anotch 40, which is preferably rounded with a radius R4 centered on axis L (FIG. 12.) -
Retainer assembly 33 includes awasher 90 having a length that substantially corresponds to the length ofplate 31.Washer 90 defines a plurality ofapertures 91. Eachaperture 91 is provided at abody portion vertebral nodes portion 98 extends between and connectsbody portions apertures 91 has acountersink 92 extending therearound adjacent to the top surface ofwasher 90. As described more fully below, countersink 92 is tapered from a first width at the first end ofaperture 91 to a second width at the second end ofaperture 91, the first width being greater than the second width. Locking fasteners, shown in the form ofscrews 85, are positionable, each through a corresponding one of theapertures 91, to engage a fastener bore 70 (see FIGS. 4(a)-4(f)) inplate 31 andcouple washer 90 to plate 31. - Consequently,
retainer assembly 33 retainsscrews 50 placed into the vertebral bodies at each of the instrumented levels.Washer 90 is translatable from an unlocked position (FIG. 1) for bone screw insertion to a locked position (FIG. 2) after screw insertion to contact the head of the bone screws inholes 34 and overlap the heads of bone screws inslots washer 90 does not contact the heads of bone screws inslots slots washer 90. Preferably,washer 90 resides almost entirely withingroove 39 ofplate 31 to minimize the overall height of the construct. - As shown in FIG. 1,
retainer assembly 33 is in an unlocked condition withscrews 85 at the second end ofapertures 90. In the unlocked condition,body portions washer 90 do not overlapholes 34 and a portion ofslots Narrowed portions 98 ofwasher 90 allowbone screws 50 to be placed throughholes 34 andslots 35 to secureplate 31 to the vertebrae V1 and V2. If desired, the surgeon can also place bone screws 50 inintermediate slots 32 to secureplate 31 to vertebrae V3 and V4 as deemed necessary.Plate 31 and bone screws 50 preferably interface inholes 34 such that rigid fixation ofplate 31 to the first vertebra V1 is achieved.Slots 35 are positioned over second vertebra V2, and include asecond end 43 and afirst end 44. As shown in FIG. 1, screw 50 is initially is inserted atsecond end 43 ofslot 35, allowing subsequent translation ofscrew 50 inslot 35 fromsecond end 43 tofirst end 44. For the purposes of clarity, only asingle screw 50 is shown inslot 35; however, it is contemplated that bone screws are inserted in bothslots 35. Bone screws 50 inserted inintermediate slots 32 also translate from thesecond end 48 to first end 49 (FIG. 15) ofslot 32. - Once
screws 50 are placed throughholes 34 and inslots washer 90 ofretainer assembly 33 may be translated to its locked condition shown in FIG. 2. In the locked condition,body portions washer 90 retain the heads of the inserted screws 50 inholes 34 andslots plate 31. In order to translate theretainer assembly 33 to its locked condition, lockingscrew 85 is threaded into a corresponding fastener bore 70 inplate 31. This downward threading of lockingscrew 85 causes the taperedcountersink 92 ofwasher 90 to ride along the head of lockingscrew 85 until lockingscrew 85 contacts the first end ofaperture 91. This translateswasher 90 along axis L to its locked condition, where thewasher 90 retains bone screws 50 inplate 31. - Bone screws50 are allowed to translate within
slots 35 andintermediate slots 32 from the second end of the slots to the first end of the slots whileretainer assembly 33 retains bone screws 50 inplate 31 and prevents screw backout. As shown in FIG. 3, the screw positioned inslot 35 has translated fromsecond end 43 tofirst end 44. The translation ofscrew 50 is limited by contact ofscrew 50 withfirst end 44. The amount of translation may also be controlled by providing bone screws inintermediate slots 32. Thus, the amount of translation of the spinal column segment can be limited by the length ofslots - Referring now to FIGS.4(a)-4(f) and FIGS. 5(a)-5(f), several embodiments of
elongated plate 31 andwasher 90 are depicted. It is understood that theanterior plating system 30 according to the present invention can be readily adapted for fixation to several vertebrae by modifying the length ofplate 31 and the number and arrangements ofholes 34,second slots 35, andintermediate slots 32. Pairedslots holes 34 at each of the vertebrae provide, at a minimum, for at least twobone screws 50 to be engaged into each respective vertebrae. The placement of two or more screws in each vertebral body improves the stability of the construct. It is one object of the present invention not only to provide for multiple screw placements in each vertebral body, but also to provide means for retaining the bone screws inplate 31 to prevent back out or loosening of the screws. The present invention contemplates various specific embodiments for aplate 31 that is provided in lengths that range from 19 millimeters (hereinafter “mm”) to 110 mm, and an overall width of about 17.8 mm. However, other dimensions for the length and width ofplate 31 are also contemplated herein. - The
plate 31 of FIGS. 1-3 is sized to span four vertebrae and includes afirst node 36, asecond node 37, and twointermediate nodes 38. In FIGS. 4(a) and 5(a), plate 31 a andwasher 90 a are sized span two vertebrae. Plate 31 a hasholes 34 a atfirst node 36 a and holes 34 a at second node 37 a Plate 31 a is provided withwasher 90 a that resides ingroove 39 a and is translatable to retain bone screws inholes 34 a. In this embodiment, plate 31 a provides rigid fixation at each vertebra. A modification of plate 31 a is depicted FIGS. 4(b) and 5(b). The holes at the second vertebral node are replaced withslots 35 b atsecond node 37 b. Awasher 90 b resides ingroove 39 b and is translatable to retain bone screws inholes 34 b andslots 35 b. -
Plate 31 c andwasher 90 c of FIGS. 4(c) and 5(c) similarly provide for instmentation at two vertebrae. Plate 30 c has a recess portion betweennodes Washer 90 c resides ingroove 39 c and is translatable to retain lock screws inholes 34 c andslots 35 c. It should be noted that the plates of FIGS. 4(a)-4(c) span two vertebrae, and preferably do not includenotch 40 on the second end of that plate as do the plates sized to span three or more vertebrae. -
Plate 31 d andwasher 90 d of FIGS. 4(d) and 5(d) are provided for instrumentation at three vertebrae.Plate 31 d has firstvertebral node 36 d, secondvertebral node 37 d, andintermediate node 38 d.Washer 90 d resides in groove 39 d and is translatable to retain bone screws inholes 34 d andslots Plate 31 e andwasher 90 e of FIGS. 4(e) and 5(e) are provided for instrumentation at five vertebrae.Plate 31 e has firstvertebral node 36 e, secondvertebral node 37 e, and threeintermediate nodes 38 e.Washer 90 e resides in groove 39 e and is translatable to retain bone screws inholes 34 e andslots Plate 31 f andwasher 90 f of FIGS. 4(f) and 5(f) are provided for instrumentation at six vertebrae, Plate 3 if has firstvertebral node 36 f, secondvertebral node 37 f, and fourintermediate nodes 38 f.Washer 90 f resides ingroove 39 f and is translatable to retain bone screws inholes 34 f andslots - Referring now to FIG. 6, the details of bone engaging fastener or screw50 are shown.
Bone screw 50 is preferably configured for engagement in the cervical spine, and includes threadedshank 51 that is configured to engage a cancellous bone of the vertebral body. The threaded shank may be provided with self-tapping threads, although it is also contemplated that the threads can require prior drilling and tapping of the vertebral body for insertion ofscrew 50. It is preferred that the threads onshank 51 define a constant outer diameter d2 along the length of the shank. It is also preferred thatshank 51 has a root diameter that is tapered along a portion of the length of the shank and increases from the tip ofshank 51 to a diameter d1 at an intermediate orcylindrical portion 52. -
Intermediate portion 52 extends betweenshank 51 and ahead 54 ofscrew 50. The threads onshank 51 extend intoportion 52 by a thread run out 53. According to standard machining practices,cylindrical portion 52 includes a short segment that does not bear any threads This segment ofcylindrical portion 52 interfaces or contacts with a plate thickness athole 34 orslot bone screw 50 extends. This short segment has an outer diameter d1. Thehead 54 ofscrew 50 includes atool recess 55 configured to receive a driving tool. In one specific embodiment,tool recess 55 is a hex recess, or in the alternative, any type of drive recess as would occur to those skilled in the art.Head 54 includes a truncated or flattenedtop surface 56 having a diameter d4. Aspherical surface 57 extends fromcylindrical portion 52 to ashoulder 59.Shoulder portion 59 has a diameter d5. Aninclined surface 58 extends betweenshoulder 59 and truncatedtop surface 56.Inclined surface 58 forms an angle A1 withtop surface 56. - It is contemplated that
screw 50 may be provided withshank 51 having a length that varies from about 10 mm to about 24 mm. In one specific embodiment ofscrew 50, the threads have diameter d2 of about 4.5 mm. In another specific embodiment, the diameter d2 is about 4.0 mm. In both specific embodiments,cylindrical portion 52 has a diameter d1 of about 4.05 mm.Cylindrical portion 52 has an unthreaded segment with a height h1 that is determined by standard machining practices for thread run-out between a shank and screw head. Height h1 and diameter d1 ofcylindrical portion 52 are sized to achieve a snug fit betweenscrew 50 andplate 31 inhole 34 orslot Head 54 is provided with height h2, outer diameter d5 atshoulder 59, diameter d4 attop surface 56, andinclined surface 54 angle A1 such that thehead 54 is nested within its correspondingslot hole 34 and recessed below the top surface of the plate. Although reference has been made to specific dimensions in this specific embodiment, it should be understood that the present invention also contemplates other dimensions and configurations forscrew 50. It should also be understood that bone screws used to secureplate 31 can each have a different length and diameters associated therewith, and need not correspond exactly to the other bone engaging fasteners used in the construct. - The details of locking
screw 85 are provided in FIG. 7. Lockingscrew 85 includes ashank 86 having machine threads thereon. In one specific embodiment, lockingscrew 85 terminates in asharp point 88 that permits penetration into the vertebral body when lockingscrew 85 is secured in threaded fastener bore 70.Head 87 includes a lowerconical surface 89 configured to mate withaperture 91 ofwasher 90.Head 87 further includes atool recess 87 a for receiving a driving tool therein. - Further details and embodiments of
washer 90 ofretainer assembly 33 are provided in FIGS. 8(a)-8(k).Washer 90 includessecond body portion 95,first body portion 93, and if necessary, one or moreintermediate body portions 94. A connectingportion 98 extends between and connects each of thebody portions Washer 90 has atop surface 100 a and abottom surface 100 b. Eachbody portion aperture 91 extending betweentop surface 100 a andbottom surface 100 b.Aperture 91 has a taperedcountersink portion 92 therearound adjacenttop surface 100 b.Aperture 91 allows passage ofshank 86 of lockingscrew 85 therethrough, and countersink 92 is preferably configured to mate withconical surface 89 andseat locking screw 85 at various positions along the length ofaperture 91. Preferably, countersinkportion 92 is sloped towardbottom surface 100 b fromsecond end 97 tofirst end 96. The mating conical features between lockingscrew 85 andaperture 91 provide a self-translating capability forwasher 90 relative to plate 31 as lockingscrew 85 is tightened into fastener bore 70 ofplate 31. -
Body portions portion 98. The width W1 and length ofbody portions recess 45 ofholes 34 and recesses 46, 47 ofslots body portions plate 31 whenwasher 90 resides ingroove 39 and is in the locked condition of FIG. 2. The width W2 and the length of the connectingportions 98 are configured to allow insertion of screws inholes 34 andslots washer 90 is in the unlocked condition of FIG. 1. - In FIGS.8(a) and 8(b) there is shown
second body portion 95 ofwasher 90.Aperture 91 has countersinkportion 92 that is tapered along the length ofaperture 91.Aperture 91 has a width W3 atbottom surface 100 b ofwasher 90.Countersink portion 92 has a width that varies along the length ofaperture 91 and is greater than width W3.Countersink portion 92 has a radius R1 atsecond end 97 and a radius R2 atfirst end 96 attop surface 100 a. It is preferred that R1 is less than R2 and the width ofcountersink portion 92 increases fromsecond end 97 towardsfirst end 96.Aperture 91 has a chord length S1 extending between the center of radius R1 and the center of radius R2.Body portion 95 further includes atransition portion 99 that extends between connectingportion 98 andbody portion 95. -
Intermediate body portion 94 of FIGS. 8(c) and 8(d) is similar in many respects tosecond body portion 95 of FIGS. 8(a) and 8(b), and also includes anaperture 91 having a taperedcountersink portion 92. However,intermediate body portion 94 has a connectingportion 98 extending in both directions therefrom. Asecond transition portion 98 a extends between second connectingportion 98 andbody portion 94.Body portion 94 has a chord length S1 between the center of radius R1 and the center of radius R2. - Tapered
countersink 92 ofaperture 91 provides a self-translating capability of thewasher 90. This is because thewasher 90 is translated relative to plate 31 as the lockingscrew 85 is threaded into threadedbore 70. The cammingconical surface 89 ofscrew 85 advances downward along the tapered portion of the wall ofcountersink portion 92 ofaperture 91. - FIGS.8(e) and 8(f) show
first body portion 93.First body portion 93 is also similar tosecond body portion 95. However, in one embodiment,first body portion 93 includes anaperture 91′ having acountersink portion 92′ that is not tapered along its length to provide a self-translating capability forwasher 90 like thecountersink portions 92 ofbody portions washer 90 is translated relative to plate 31 as described above, lockingscrew 85 will already be positioned atfirst end 96′, and may thereafter be threaded intobore 70 and seated withincountersink portion 92′. Alternatively, the surgeon may slide the washer by hand or with a tool to its translated position, and lock the washer in its translated position by seating lockingscrew 85 intocountersink 92′ atfirst end 96′.Countersink 92′ has a definite location atsecond end 96′ forseating locking screw 85, providing a reference for the surgeon to confirm thatwasher 90 has been translated to its locked position. It should be understood, however, that it is also contemplated herein thatbody portion 93 could also be provided withaperture 91 likebody portions - Referring now to FIG. 8(g), a cross-sectional view of
washer 90 is provided throughaperture 91 ofbody portion Washer 90 has anouter surface 104 configured to overlap bone screws 50 inslots inclined surface 58 ofscrews 50 whenretainer assembly 33 is in its locked condition.Outer surface 104 extends frombottom surface 100 b to ashoulder 103.Shoulder 103 extends betweeninclined surface 104 andtop surface 100 a.Inclined surface 104 forms an angle A2 with respect tobottom surface 100 b.Washer 90 defines a thickness t1 betweentop surface 100 a andbottom surface 100 b, and a shoulder height of t2 frombottom surface 100 b.Washer 90 has a width W7 alongbottom surface 100 b ataperture 91. - Referring now to FIG. 8(h), a cross-sectional view of
washer 90 is provided throughaperture body portion 93.Washer 90 hascontact surface 106 configured to contactinclined surface 58 ofscrews 50 whenretainer assembly 33 is in its locked condition.Contact surface 106 extends frombottom surface 100 b to a shoulder 105. Shoulder 105 extends betweencontact surface 106 andtop surface 100 a.Contact surface 106 forms an angle A3 with respect tobottom surface 100 b that is configured to mate with and provide surface contact withinclined surface 58 ofbone screw 50.Washer 90 defines a thickness t3 betweentop surface 100 a andbottom surface 100 b, and a shoulder height of t4 frombottom surface 100 b. - In one specific embodiment of the
washer 90, the body portions have a width W1 and connecting portion have width W2 that is based on the spacing between the centerlines of the paired slots and holes of the plates and the overall width of the plate. The width W3 ofaperture 91 in the specific embodiment is sized to accommodate theshank 86 of lockingscrew 85 withouthead 87 passing therethrough. The length ofbody portions slots plate 31. Preferably, thebody portions slot retainer assembly 33 is in its locked position. The taperedcountersink portion 92 ofaperture 91 has radius R1 that transitions to radius R2 along the chord length S1. Thickness t1 is less than thickness t3, and shoulder height t4 is less than shoulder height t2.Body portion 93 has a width W8 alongbottom surface 100 b that is greater than width W7 ofbody portions washer 90 are preferably arranged so thatbody portions slots slots Body portion 93 contacts the screw heads nested inholes 34 to further enhance the fixed orientation betweenscrews 50 andplate 31 inholes 34. Although reference has been made to the dimensional attributes of this specific embodiment, it should be understood that the present invention also contemplates other orientations and dimensional relationships forwasher 90. - The present invention also contemplates a retainer assembly in which individual washers are provided at each node for retaining screws in
holes 34 andslots plate 31. Referring now to FIGS. 8(i) and 8(j), aslot washer 195 and ahole washer 193 are provided.Slot washer 195 is similar tobody portion 95 ofwasher 90 andhole washer 193 is similar tobody portion 93 ofwasher 90, both of which are described above. Elements that are alike bear the same reference number as the corresponding element ofbody portions Slot washer 195 andhole washer 193 do not have a connectingportion 98 extending to another washer.Slot washer 195 has abody portion 198 with a length S2 that varies and is sized to correspond to the length of theadjacent slot washers 195 are positioned onplate 31.Slot washer 195 does not have a connectingportion 98 extending to another washer.Hole washer 193 has abody portion 199 with a length S3 that varies and is sized to correspond to the length of the plateadjacent hole 34 when washer is positioned onplate 31. - In FIG. 8(k) an alternate embodiment of
washers Washers 193′, 195′ are the same aswashers aperture 191.Aperture 191 does not have a tapered countersink, but rather has asemi-circular countersink portion 192 only atfirst end 196.Countersink portion 192 provides a single position for lockingscrew 85 to lock thewasher 193′, 195′ to plate 31 after thewasher 193′, 195′ has been translated relative to plate 31 by the surgeon.Washers 193′, 195′ havebody portion 198′, 199′ with length S4 that varies as described above with respect to length S2 and S3. - Referring now to FIGS.9-18, further details of
plate 31 will be discussed with reference to illustrations offirst node 36,second node 37, andintermediate node 38. In FIGS. 9-11,first node 36 ofplate 31 is depicted. It is preferred that holes 34 are identical and symmetrical aboutaxis L. Hole 34 includesrecess 45 adjacenttop surface 41.Holes 34 include acylindrical bore 77 having generally vertical sidewalls adjacentbottom surface 42. Cylindrical bore 77 extends betweenrecess 45 andbottom surface 42 ofplate 31, and has a diameter D1. Cylindrical bore 77 hasaxis 72 b that is offset at angle A5 from anaxis 72 a that extends normal to plate 31 as shown in FIG. 10.Recess 45 has a partialspherical portion 45 a defined about acentral axis 72 b.Axis 72 b is offset fromaxis 72 a by angle A5. Offset angle A5 directs bone screws inserted intoholes 34 toward the first end ofplate 31. Furthermore, as shown in FIG. 11, axes 72 a converge below thebottom surface 42 ofplate 31 at angle A4 with respect to anaxis 72 c that extends along the centerline ofplate 31 perpendicular toaxis L. Recess 45 intersectsgroove 39 at intersectingportion 45 c.Spherical portion 45 a is configured to mate withspherical surface 57 ofbone screw 50, allowing at least a portion ofhead 54 to be recessed belowtop surface 41 ofplate 31. - To facilitate insertion of drill guides, drills and the bone screws50,
recess 45 also includes a flaredportion 45 b that extends in a superior direction fromaxis 72 b. In one embodiment,recess 45 includes a wall that parallels bore 77 and extends between betweenspherical portion 45 a and flaredportion 45 b to further facilitate insertion and maintenance of a drill guide inrecess 45. - In one specific embodiment,
spherical portion 45 a has a diameter that mates with the diameter ofspherical surface 57 ofscrew 50, and is slightly larger than diameter d5 ofhead 54 ofbone screw 50. The cylindrical bore 77 ofhole 34 has a diameter D1 of 4.1 mm, which is slightly larger than the diameter d1 ofintermediate portion 52 ofscrew 50. This portion of the screw contacts bore 77 and assumes a fixed orientation with respect toplate 31. In this specific embodiment, offset angle A5 is about 12.6 degrees and convergence angle A4 is about 6 degrees relative toaxis 72 c. Although reference has been made to the dimensional attributes of this specific embodiment, it should be understood that the present invention also contemplates other dimensions. - Referring now to FIGS.12-14, second
vertebral node 37 is depicted.Vertebral node 37 includesslots 35 that are preferably identical and symmetrical aboutaxis L. Slot 35 includes slotted bore 78adjacent bottom surface 42 ofplate 31 having generally vertical sidewalls extending betweensecond end 43 andfirst end 44. Slotted bore 78 extends betweenbottom surface 42 andrecess 47 adjacenttop surface 42.Bore 78 has a width W5 and a chord length S4, and has acentral axis 75 b extending throughplate 31.Recess 47 has a spherical portion 47 a aboutcentral axis 75 b that extends aroundslot 35. As shown in FIG. 13,central axis 75 b is offset from axis 75 a that extends normal to plate 31 by angle A5. Offset angle A5directs bone screws inserted intoslot 35 towards the second end ofplate 31. It should be noted thatslot 35 allows insertion of a bone screw at angles less than A5 inslot 35, andbone screw 50 may be positioned withinslot 35 at any location between ends 43 and 44. However, retainingassembly 33 provides for insertion of bone screws 50 at second 43 as would be clinically desirable for settling. Furthermore, as shown in FIG. 14, axes 75 b converge below thebottom surface 42 ofplate 31 at angle A5 with respect toaxis 72 c. - Spherical portion47 a is configured to mate with
spherical surface 57 ofbone screw 50, allowing at least a portion ofhead 54 to be recessed belowtop surface 41 ofplate 31. To facilitate insertion of drill guides, drills and the bone screws 50,recess 47 also includes a flaredportion 47 b that extends around spherical portion 47 a. In one embodiment, it is contemplated thatrecess 47 include a wall that parallels bore 78 extending between spherical portion 47 a and flaredportion 47 b to further facilitate maintenance and insertion of a drill guide inrecess 47.Recess 47 intersectsgroove 39 atoverlap portion 47 c, as shown in FIG. 14. The second end ofsecond node 37 includesnotch 40 having radius R4 centered about axis L. It is also contemplated herein thatplate 31 is provided withoutnotch 40, as shown in FIGS. 4(a)-4(c). - In a preferred embodiment,
slot 35 includesramp 60 extending betweenbore 78 and flaredportion 47 b atsecond end 43.Ramp 60 is not configured to allowspherical surface 57 ofscrew 50 to seat therein, but has an orientation that causessecond end 43 ofslot 35 and screw 50 to separate asscrew 50 is threaded intoslot 35.Spherical surface 57 ofhead 54 provides camming action along theramp 60 untilhead 54 seats inrecess 47 at a position spaced a distance fromsecond end 43. This camming action applies a dynamic compression load to the spinal column portion. The amount of compression applied to the spinal column portion is controlled by the length oframp 60 from second 43 to the position inslot 35 wherescrew 50 seats inrecess 47. It should be understood thatslot 35 may also be provided withoutramp 60. - In one specific embodiment, spherical portion47 a has a diameter sized to mate with
spherical surface 57 ofscrew 50, and is slightly larger than diameter d5 ofhead 54 ofbone screw 50. Slotted bore 78 has a width W5 of about 4.1 mm, which is slightly larger than the diameter d1 ofintermediate portion 52 ofscrew 50. Thecylindrical portion 52 ofbone screw 50contacts plate 31 inbore 78 and prevents rotation ofscrew 50 transverse toaxis 72 c. The chord length S4 varies depending upon the length of theslot 35 needed for the particular application ofplate 31 and patient anatomy. In this specific embodiment, offset angle A5 is about 12.6 degrees and convergence angle A4 is about 6 degrees relative to anaxis 72 c. Although reference has been made to the dimensional attributes of this specific embodiment, it should be understood that the present invention also contemplates other dimensions. - Referring now to FIGS.15-17, various views of
intermediate node 38 are depicted.Vertebral node 38 includesslots 32 that are preferably identical and symmetrical aboutaxis L. Slot 32 includes slotted bore 79adjacent bottom surface 42 ofplate 31 having generally vertical sidewalls extending between asecond end 48 and afirst end 49. Slotted bore 79 extends betweenbottom surface 42 andrecess 46 adjacenttop surface 42.Bore 79 has a width W5 and a chord length S5, and has acentral axis 76 a extending throughplate 31.Recess 46 has a spherical portion 46 a that extends aroundslot 35. As shown in FIG. 16,central axis 76 a generally extends normal toplate 31. However, as shown in FIG. 17, theaxes 76 a converge below thebottom surface 42 ofplate 31 at angle A4 with respect toaxis 72 c. It should be noted thatslot 32 allows insertion of bone screws 50 at various angles with respect toaxis 76 a. - Spherical portion46 a is configured to mate with
spherical surface 57 ofbone screw 50, allowing at least a portion ofhead 54 to be recessed belowtop surface 41 ofplate 31. To facilitate insertion of drill guides, drills and bone screws 50,recess 46 also includes a flaredportion 46 b that extends around spherical portion 46 a. In one embodiment, a wall paralleling bore 79 extends between spherical portion 46 a and flaredportion 46 b to further facilitate insertion and maintenance of a drill guide inrecess 46.Screw 50 may be placed withinintermediate slot 32 between ends 48 and 49. However, it is preferred that the screw is inserted initially atsecond end 48, thus allowing compression loading of the spinal column segment.Recess 46 intersectsgroove 39 atoverlap portion 46 c, as shown in FIG. 17. - In one specific embodiment, spherical portion46 a has a diameter sized to mate with
spherical surface 57 ofscrew 50, and is slightly larger than diameter d5 ofhead 54 ofbone screw 50. The slotted bore 79 has a width W5 of about 4.1 mm, which is slightly larger than the diameter d1 ofintermediate portion 52 ofscrew 50.Cylindrical portion 52 ofbone screw 50 interfaces withplate 31 inbore 79 such that angular adjustment ofscrew 50 transverse toaxis 72 c is prevented. The chord length S5 varies depending upon the length ofslot 35 needed for the particular application ofplate 31 and patient anatomy. In this specific embodiment convergence angle A4 is about 6 degrees relative to anaxis 72 c. Although reference has been made to the dimensional attributes of this specific embodiment it should be understood that the present invention also contemplates other dimensions. - Referring now to FIG. 18, a cross-sectional view of
plate 31 is provided through line 18-18 of FIG. 15.Groove 39 has a width W6 attop surface 41 ofplate 31.Groove 39 hasbottom surface 73 extending betweeninclined sidewalls 74.Sidewalls 74 extend betweenbottom surface 73 ofgroove 39 andtop surface 41 ofplate 31. It is contemplated that thegroove 39 has a depth sufficient to accommodate thewasher 90 so as to minimize protrusion ofwasher 90 abovetop surface 41 ofplate 31. - To accommodate the anterior application of the
fixation plate assembly 30, the plate is curved in two degrees of freedom. Specifically, thebottom surface 42 of the plate can be curved along a large radius R, centered in a vertebral plane containing central axis L, as shown schematically in FIG. 16, to accommodate the lordotic curvature of the cervical spine. In addition,bottom surface 42 forms a medial/lateral curvature C, as shown in FIG. 18, to correspond to the curvature of the vertebral body. It is understood thatplate 31 can also be bent as needed to accommodate the particular spinal anatomy and vertebral pathology. - Referring now to FIG. 19a, a partial sectional view of
fixation plate assembly 30 atholes 34 is provided withscrews 50 engaged to vertebra V1 andretainer assembly 33 in the locked position. A pair ofscrews 50 are disposed within therespective holes 34 so that the threadedshanks 51 project beyond thelower surface 42 ofplate 31 into the vertebral body V1. Theintermediate portion 52 ofscrew 50 extends through thebore 77 of thehole 34.Spherical surface 57 ofhead 54contacts recess 45 ofhole 34 whenscrew 50 is seated therein. Theintermediate portion 52 provides a snug fit forscrew 50 in thebore 77 so thatscrew 50 is not able to pivot with respect toplate 31. - Referring to FIG. 19b, a partial sectional view of
fixation plate assembly 30 atslots screws 50 engaged to vertebra V1 andretainer assembly 33 in the locked position. A pair ofscrews 50 are disposed withinrespective slots shanks 51 project beyondlower surface 42 ofplate 31 into the corresponding vertebral body V2, V3, or V4.Cylindrical portion 52 ofscrew 50 extends throughbores slots Spherical surface 57 ofhead 54 contacts recesses 46, 47 ofslots screw 50 is seated therein.Cylindrical portion 52 provides a snug fit forscrew 50 inbores screw 50 is not able to pivot or translate with respect toaxis 72 c ofplate 31. Of course, screws 50 inserted intoslots slots plate 31 that use variable angle screws capable of assuming universal angular orientation with respect toplate 31 inslots - In order to ensure
screws 50 are retained withinplate 31,retainer assembly 33 is moved to its locked position where it contacts theheads 54 of bone screws 50 inholes 34. Lockingscrew 85 is threaded into threaded fastener bore 70 ofplate 31 to translatewasher 90 from its unlocked position to its locked position, as described above, and to drawcontact surface 106 into contact withinclined surface 58 ofscrew 50 as shown in FIG.19aContact surface 106 preferably applies a downward force ontohead 54 to firmly seat the screw heads within the plate recesses andfurther fix screw 50 inhole 34. In a preferred embodiment, this downward force is exacted bywasher 90 assurface 106 contacts inclinedsurface 58. As shown in FIG. 19b,outer surface 104 ofwasher 90 does not contact the heads of bone screws 50 inslots 32, 25.Outer surface 104 overlaps the bone screws 50 to retain bone screws inslots Outer surface 104 will contact the heads of the bone screws if the bone screws backout fromslots bottom surface 100 b ofwasher 90 does not contactbottom surface 73 ofgroove 39. - In a further aspect of the invention, the
retainer assembly 33 may be loosely fixed onplate 31 so the surgeon need not fiddle with applyingretainer assembly 33 to plate 31 during surgical procedures. The lockingfasteners 85 are pre-inserted throughapertures 91 ofwasher 90 and partially threaded into fastener bores 70.Washer 90 is initially positioned such that the second end of eachaperture 91 is positioned adjacent lockingscrew 85. After positioningscrews 50 through the holes and slots ofplate 31, lockingfasteners 85 are advanced further intobores 70 and along taperedportions 92 ofapertures 91 to translatewasher 90 to a locked condition and retainbone screws 50 inplate 31. - As previously mentioned,
sharp point 88 of lockingscrew 85 is preferably configured to penetrate the cortical bone. In one embodiment,sharp point 88 will penetrate the vertebra whenplate 31 is initially positioned on the bone. In this instance, lockingscrew 85 helps locate and temporarily stabilize the plate on the vertebra as the bone screws 50 are engaged to the vertebra. This temporary location feature provided by lockingscrew 85 can also be used to maintain the position ofplate 31 on the vertebra as a drill guide is used to drill and tap the vertebrae to receive bone screws 50. - According to another aspect of the invention, there are provided instruments and techniques for securing
plate 31 to vertebrae of a spinal column segment and for applying a compression load to a graft or implant placed in the spinal column segment. Referring to FIGS. 20(a)-20(f), aguide 150 includes ahandle 152, atemplate 154, andarm 153 extending therebetween. Preferably,arm 153 extends outward from the spine and is bent so that handle 152 parallels the spine, positioning handle 152 out of the way of the surgeon.Template 154 includes asecond end 155 that defines anotch 158.Template 154 also includesfirst end 156 having aprojection 156 a extending downward therefrom towards vertebral body V2.Template 154 further defines a pair ofslots 157 between second end 159 andfirst end 156. - The surgeon selects a
guide 150 with atemplate 154 sized to position notch 158 at the desired location on vertebra V2 and places guideinstrument 150 on vertebral body V2.Notch 158 is located on vertebra V2 by placingprojection 156 a in abutting contact with the endplate of vertebra V2 in discspace D. Slots 157 provide a visual indication to the surgeon of the range of positions available for screw insertion into the vertebral body throughslots 35 ofplate 31. If desired, the surgeon can obtain a desired position or location ofnotch 158 and the desired available range of bone screw positions on vertebra V2 by selecting a guide having a differentsized template 154. - Referring now to FIG. 20(b), after the notch is in the desired position on vertebra V2, a
compression pin 170 is placed into vertebra V2 guided bynotch 158.Pin 170 includes alower end 171 having a threaded portion (not shown) for attachingpin 170 to vertebra V2. The attachment portion is preferably threaded to screw into vertebra V2, but may also be smooth with a spiked tip for insertion into the vertebra. Pin 170 also includestool engagement portion 172 to facilitate installation ofpin 170 to the vertebral body. It is also contemplated that the surgeon can place pin 170 on the vertebral body spaced away fromnotch 158 if desired and the vertebral anatomy so allows. - After
pin 170 is engaged to vertebra V2, guide 150 is removed and asleeve 180 is placed overpin 170 as shown in FIG. 20(c).Sleeve 180 has ahollow body 181 extending between afirst end 186 adjacent vertebra V1 and asecond end 184. Asecond end 174 ofpin 170 preferably extends fromsecond end 184 ofsleeve 180, allowing access to pin 170.Sleeve 180 includesenlarged portion 184 to facilitate placement and removal ofsleeve 180. It is contemplated thatsleeve 180 has hollow interior and an internal configuration that provides secure attachment to pin 170.Body 181 includes cylindricalouter surface 182 with an outer diameter d6. - With
sleeve 180 in its proper position,plate 31 is positioned withnotch 40 in abutting contact withouter surface 182 ofsleeve 180, as shown in FIG. 20(d). The diameter d6 ofsleeve 180 slightly less than the twice the radius ofnotch 40 so thatnotch 40 is nested aroundsleeve 180.Plate 31 is then secured to vertebra V1 by insertingscrews 50 throughholes 34. - With
plate 31 secured to the vertebra V1,sleeve 180 is removed frompin 170, as shown in FIG. 20(e), forming agap 177 betweenpin 170 and notch 40. In a preferred embodiment, it is contemplated thatgap 177 is about 2 mm. However, other sizes forgap 177 are contemplated herein based on the desired compression to be applied. - Referring now to FIG. 20(f), a
compression tool 290 is secured to pin 170 and toslots 32 ofplate 31. It is also contemplated that the compression tool can be secured to plate 31 other than atslots 32 by, for example, engaging the sides ofplate 31.Compression tool 290 has afirst arm 291 with afirst foot 294 connected to pin 170.Second arm 292 is connected to the second end ofslots 32 viaextensions 297 extending fromsecond foot 296.First arm 291 andsecond arm 292 are manipulated by the surgeon to apply a compression load to the spinal column segment. The amount of applied load is limited bygap 177 betweenpin 170 and notch 40. For example, in the specific embodiment wheregap 177 is 2 mm, the spinal column portion is compressed 2 mm. - Bone screws50 are inserted into
slots 35 withcompression tool 290 maintaining the compression load. Withramp 60 at second 43 ofslot 35, an additional amount of dynamic compression is achieved with screw insertion inslots 35, as described above. Withscrews 50 seated atend 43 ofslots 35,compression tool 290 may be removed without release of the compression load. Additional bone screws may be inserted intointermediate slots 32.Washer 90 may then be translated as described above to retainbone screws 50 inplate 31. It should be note that it is contemplated herein thatcompression tool 290 and pin 170 are preferably only used with plates providing instrumentation at three or more vertebra. However, utilization of a compression tool configured to engage a plate for providing instrumentation at two vertebrae is not precluded. - Referring now to FIGS.21(a)-21(c), further details of
compression tool 290 are provided.Tool 290 hasfirst arm 291 havingfirst foot 294 extending therefrom.First foot 294 definesrecess 293 for receiving thepin 170.Second arm 292 hassecond foot 296 extending therefrom.Second foot 296 includesextensions 297 extending downward therefrom configured to engageintermediate slots 32 ofplate 31.Extensions 297 preferably includerecesses 307 that are configured contact the second ends ofintermediate slots 32. It is also contemplated thatextensions 297 have acurved bottom surface 308 that corresponds to the medial lateral curvature of the vertebral bodies. -
First arm 291 has a reducedthickness portion 299 extending through apassage 295 formed insecond arm 292, and is pivotally coupled tosecond arm 292 withpin 299.First arm 291 hascurved handle portion 306 having aprojection 303 extending therefrom.Second arm 292 has ahandle 305. Aratchet bar 301 is pivotally coupled tosecond arm 292 viacoupling 302. Preferably, ratchetbar 301 is spring-biased towardsprojection 303.Serrations 304 formed on the bottom side ofratchet mechanism 301 provide for selective engagement withprojection 303 onfirst arm 291. - The first and second arms are compressed towards one another to apply the compressive load to the vertebral segment.
Projection 303 engages the serrated bottom ofratchet bar 301 to prevent relaxation of the arms and allows the surgeon to maintain the compression load during insertion of bone screws 50 withinslots 35.Ratchet bar 301 may be lifted against its spring bias away fromarm 291 to disengageratchet bar 301 fromprojection 303.Arms compression tool 290 frompin 170 andplate 31. - While
compression tool 290 has been illustrated and described in detail, the present invention also contemplates other tools capable of being secured betweenpin 170 andplate 31 to provide a compression load to the spinal column segment. For example, referring now to FIGS. 22(a) and 22(b), it is contemplated that a compression tool may include one or more angular modifications tofirst arm 391 andsecond arm 392 to facilitate access toplate 31 andpin 170 at the surgical site.First arm 391 has alower portion 391 a forming angle B1 withfirst foot 396.First foot 396 hasextensions 397 extending therefrom that are similar toextensions 297 oftool 290. First arm has anupper portion 391 c that terminates withcurved handle 406.Curved handle 406 hasprojection 403 extending therefrom to engage a ratchet bar extending fromsecond arm 392.Arm 391 has avertical extension 391 b extending betweenlower portion 391 a andupper portion 391 c. Angle B2 is formed betweenlower portion 391 a andvertical portion 391 b. Angle B1 is formed betweenvertical portion 391 b andupper portion 391 c.Vertical portion 391 b as a region of reducedthickness 399 for connection withsecond arm 392. -
Second arm 392 has alower portion 392 a forming angle B1 withsecond foot 394.Second foot 394 has a recess (not shown) for receivingpin 170 and is similar to recess 293 oftool 290 described above.Second arm 392 has anupper portion 392 c that terminates withhandle 405.Upper portion 392 c hasratchet bar 401 withserrations 404.Ratchet bar 401 is pivotally coupled toarm 392 and spring-biased towardsprojection 403.Ratchet bar 401 is similar to ratchetbar 301, but is preferably curved along its length to accommodate the angular offsets inarms ratchet bar 401 andprojection 403.Arm 392 has avertical extension 392 b extending betweenlower portion 392 a andupper portion 392 c. Angle B2 is formed betweenlower portion 392 a andvertical portion 392 b. Angle B1 is formed betweenvertical portion 392 b andupper portion 392 c.Vertical portion 392 b as aslot 395 of receiving reducedthickness portion 399 ofvertical portion 391 b, where first and second arms are pivotally coupled via a pin (not shown.) - In one specific embodiment of
compression tool 290 and 390, angle B1 is about 120 degrees and angle B2 is about 150 degrees. However, other angular offsets in first and second arms ofcompression tools 190, 290 are also contemplated herein as would occur to those skilled in the art. - While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiment has been shown and described and that all changes and modifications the come within the spirit of the invention are desired to be protected.
Claims (51)
1. A bone fixation system for a portion of the spinal column, comprising:
a plate having a length along a central axis extending longitudinally between a first end and a second end, and a top surface and a bottom surface along said length, and said plate having a plurality of first openings and a plurality of second openings between said surfaces, wherein:
at least one of said plurality of first openings is positioned adjacent said first end, said one first opening defining a circular hole having a first diameter adjacent said bottom surface;
at least one of said plurality of second openings is positioned adjacent said second end, said one second opening defining a slot having a first width and a first length adjacent said bottom surface;
bone engaging fasteners extending through said first and second openings, each bone engaging fastener having an elongated shank defining bone engaging threads thereon and an enlarged head, said shank having a substantially cylindrical portion with a third diameter less than said first diameter so said bone engaging fastener can be inserted through said one first opening and said cylindrical portion contacts said plate in said one first opening so that said bone engaging fastener assumes a fixed orientation relative to said plate, said cylindrical portion third diameter also less than said second width so said bone engaging fastener can be inserted through said one second opening from said top surface of said plate and said head of said bone engaging fastener is translatable along the length of said at least one second opening to maintain compression of the spinal column portion.
2. The bone fixation system of claim 1 , wherein said second openings include a ramp that guides said bone engaging fastener as it is inserted into said one second opening to provide a dynamic compression load to the spinal column portion.
3. The bone fixation system of claim 1 , whereby each of said at least one first and second openings define a recess adjacent said top surface and said enlarged head defines a partially spherical surface complementary to said recess of said at least one first and second openings.
4. The bone fixation system of claim 3 , wherein said head of said fastener includes a truncated top surface.
5. The bone fixation system of claim 3 , further comprising a retainer assembly for retaining said heads of said number of bone engaging fasteners within said at least one first opening and said at least one second opening.
6. The bone fixation system of claim 5 , wherein said retainer assembly includes:
a first fastener bore defined in said plate adjacent said at least one first opening and a second fastener bore defined in said plate adjacent said at least one second opening;
a washer having at least a first aperture adjacent said at least one first opening and a second aperture adjacent said at least one second opening and a countersink portion communicating with each of said apertures, said washer further having a body with portions overlapping said at least one first and second opening when said washer is in a first position relative to said at least one first and second openings, said body portions being arranged so that bone engaging fasteners can be inserted through said at least one first opening and said at least one second opening when said washer is in a second position relative to said at least one first and second openings; and
a locking fastener for each of said apertures having a head configured to be at least partially recessed within said countersink portion of said washer and having an elongated shank extending through said aperture and configured to engage said fastener bore of said plate.
7. The bone fixation system of claim 6 , wherein said plate further defines a groove in said top surface extending longitudinally along said plate, said groove being overlapping said at least one first and second openings, said first and second fastener bores being positioned within said groove.
8. The bone fixation system of claim 5 , wherein said retainer assembly includes a washer having a contact surface for contacting said head of said bone engaging fastener in said one first opening and an outer surface for overlapping said heads of said bone engaging fasteners in said one second opening.
9. The bone fixation system of claim 1 , further comprising a retainer assembly including:
a first fastener bore defined in said plate adjacent said at least one first opening and a second fastener bore defined in said plate adjacent said at least one second opening;
a washer having at least a first aperture adjacent said at least one first opening and a second aperture adjacent said at least one second opening and a countersink communicating with each of said apertures, said washer further having a surface configured to contact said head of said bone engaging fastener extending through said at least one first opening; and
a locking fastener for each of said apertures having a head configured to be at least partially recessed within said countersink portion of said washer and an elongated shank extending through said aperture configured to engage said fastener bore of said plate.
10. The bone fixation system of claim 9 , wherein said washer has an outer surface that overlaps said head of said bone engaging fastener extending through said at least one second hole without contacting said head.
11. The bone fixation system of claim 9 , wherein said plate further defines a groove in said top surface extending longitudinally along said plate, said groove overlapping said at least one first and second openings, said first and second fastener bores being positioned within said groove.
12. The bone fixation system of claim 1 , wherein said elongated plated defines a plurality of vertebral nodes at longitudinally spaced location along the plate.
13. The bone fixation system of claim 12 , wherein there are provided a pair of said first openings at one said vertebral nodes adjacent said first end of said plate and a pair of said second openings at one of said vertebral nodes adjacent said second end of said plate.
14. The bone fixation system of claim 13 , wherein said openings of said pair of first openings are symmetrically positioned about said central axis and said openings of said pair of second openings are symmetrically positioned about said central axis.
15. A bone fixation system for a portion of the spinal column, comprising:
a plate having a length along a central axis extending longitudinally between a first end and a second end, a top surface and a bottom surface along said length, said plate further defining a plurality of first openings and a plurality of second openings between said surfaces, wherein:
at least two of said first openings are circular, having a first diameter, and are positioned adjacent said first end;
at least two of said second openings are slotted, having a first width and a first length, and are positioned adjacent said second end of said plate;
bone engaging fasteners extending through said first and second openings, each bone engaging fastener having an elongated shank having bone engaging threads thereon and an enlarged head, said bone engaging fasteners configured for insertion into said first and second openings from said top surface; and
means retaining said heads of said bone engaging fasteners in said first and second openings, said retaining means translatable from a first position allowing bone engaging fastener insertion into said first and second openings to a second position retaining said bone engaging fasteners in said first and second openings.
16. The bone fixation system of claim 15 , wherein said two first openings have a recess portion adjacent said top surface and said two second openings have a recess portion adjacent said top surface.
17. The bone fixation system of claim 16 , wherein said heads of said bone engaging fasteners are configured to be at least partially recessed in said two first and second openings.
18. The bone fixation system of claim 15 , wherein said two first and second openings each include a recess adjacent said top surface and said enlarged head has a partially spherical surface complementary to said recess of said two first and second openings.
19. The bone fixation system of claim 18 , wherein said plate further defines a groove in said top surface extending longitudinally along said plate for receiving said retaining means therein, said groove overlapping said recesses.
20. The bone fixation system of claim 15 , wherein said head of said bone engaging fastener has an inclined surface and said retaining means has a contact surface to contact said inclined surface of said bone engaging fasteners extending through said two first openings.
21. The bone fixation system of claim 15 , wherein retaining means includes:
a first fastener bore defined in said plate adjacent said two first openings and a second fastener bore defined in said plate adjacent said two second openings;
a washer having a body defining at least a first aperture adjacent said two first openings and a second aperture adjacent said two second openings and a countersink portion communicating with each of said apertures, said washer further having a contact surface configured to contact said head of said bone engaging fastener extending through said two first openings; and
a locking fastener for each of said apertures having a head configured to be at least partially recessed within said countersink portion of said washer and an elongated shank extending through said aperture and configured to engage said fastener bore of said plate.
22. The bone fixation system of claim 21 , wherein said apertures of said washer each form a slot having a length extending longitudinally with the plate.
23. The bone fixation system of claim 22 , wherein at least one of said aperture countersink portion is tapered along said length of said slot and has a width that increases along said length of said aperture from said second end towards said first end.
24. The bone fixation system of claim 22 , wherein said at least one aperture is positioned adjacent said two second openings.
25. The bone fixation system of claim 15 , wherein said retaining means includes:
a first fastener bore defined in said plate adjacent said two first openings and a second fastener bore defined in said plate adjacent said two second openings;
a washer having at least a first aperture adjacent said two first openings and a second aperture adjacent said two second openings and a countersink portion communicating with each of said apertures, said washer further having a body with portions overlapping said two first openings and said two second openings when said washer is in a first position relative to said two first and second openings, said body portions being arranged so that bone engaging fasteners can be extended through said two first openings and said two second openings when said washer is in a second position relative to said two first and second openings; and
a locking fastener for each of said apertures having a head configured to be at least partially recessed within said tapered portion of said washer and an elongated shank extending through said aperture and configured to engage said fastener bore of said plate.
26. The bone fixation system of claim 25 , wherein said apertures of said washer form slots having a length extending in the direction of the length of the plate.
27. The bone fixation system of claim 26 , where said countersink communicating with each of said apertures has a width that increases along the length of said aperture in a direction from said second end towards said first end.
28. A bone fixation system for a portion of the spinal column, comprising:
four bone engaging fasteners, each having an enlarged head and a threaded shank; and
an elongated plate having a length extending between a first end and a second end and sized to span between at least two vertebrae, said plate defining a one pair of adjacent holes adjacent said first end and one pair of adjacent slots adjacent said second, each of said holes and said slots configured to receive said threaded shank of a corresponding one of said bone engaging fasteners therethrough,
wherein said bone engaging fasteners extending through said pair of holes fix said plate to said first vertebra and said bone engaging fasteners extend through said slots to secure said plate to said second vertebra, and said bone engaging fasteners received in said slots are enabled to translate in said slots in a direction of the length of the plate to maintain compression on the spinal column portion.
29. The bone fixation system of claim 28 , wherein said plate has a top surface and a bottom surface and said holes and said slots each further include a recess adjacent said top surface.
30. The bone fixation system of claim 28 , further including a retainer assembly having a washer configured to overlap each of said holes and slots and retain said bone engaging fasteners extending through said holes and slots.
31. The bone fixation system of claim 30 , wherein said head of each of said bone engaging fasteners has an inclined surface and said washer has a contact surface configured to contact said inclined surface of said bone engaging fasteners extending through said pair of holes.
32. The bone fixation system of claim 30 , wherein said plate includes a first fastener bore defined in said plate between said pair of holes and a second fastener bore defined in said plate between said pair of slots, and said retainer assembly further includes:
said washer has at least a first aperture adjacent said holes and a second aperture adjacent said slots and a countersink portion communicating with each of said apertures; and
a locking fastener for each of said apertures, said locking fastener having a head configured to be recessed within said recess of said washer and an elongated shank extending through said aperture and configured to engage said fastener bore of said plate.
33. The bone fixation system of claim 32 , wherein said elongated shank of said locking fastener terminates in a sharp point for penetrating a vertebral body.
34. The bone fixation system of claim 33 , wherein said head of said locking fastener defines a lower conical surface for contacting said washer.
35. A bone fixation system for a portion of a spinal column, comprising:
six bone engaging fasteners, each having an enlarged head and a threaded shank; and
an elongated plate having a length extending between a first end and a second end and sized to span between at least three vertebrae, said plate defining one pair of holes over a first vertebra, one pair of intermediate slots over a second vertebra, and one pair of slots over a third vertebra, each of said holes and said slots configured to receive said threaded shank of a corresponding one of said bone engaging fasteners therethrough,
wherein said bone engaging fasteners extending through said pair of holes fix said plate to said first vertebra and said bone engaging fasteners extend through said slots to secure said plate to said second vertebra, and said bone engaging fasteners received in said slots are enabled to translate in said slots in a direction of the length of the plate to maintain compression on the spinal column portion.
36. The bone fixation system of claim 35 , further including a retainer assembly having a washer configured to overlap each of said holes and slots and retain said bone engaging fastener extending through said holes and slots in said plate.
37. A fastener retainer assembly for an elongated plate having a length extending between at least two vertebrae, the plate defining a number of openings therethrough for insertion of bone engaging fasteners to attach the plate to the at least two vertebrae, said retainer assembly comprising:
a first fastener bore defined in said plate adjacent at least one of the openings positioned over the first vertebra and a second fastener bore defined in said plate adjacent at least one the openings positioned over the second vertebra;
a washer defining at least a first aperture adjacent said at least one opening positioned over the first vertebra and a second aperture adjacent said at least one opening positioned over the second vertebra, said washer configured to retain said bone engaging fasteners extending through said openings in said plate; and
a locking fastener for each of said apertures, said locking fastener having an elongated shank extending through said aperture and configured to engage said fastener bore of said plate, said openings in said plate being positioned and configured wherein said washer is movable between a first position enabling insertion of said bone engaging fasteners into said at least one openings and a second position wherein said washer retains said inserted bone engaging fasteners in said plate.
38. The retainer assembly of claim 37 , wherein said apertures of said washer form slots having a length extending in the direction of the length of the plate.
39. The retainer assembly of claim 38 , wherein each of said apertures include a countersink portion communication with said slot.
40. The retainer assembly of claim 39 , wherein said countersink portion of at least one of said apertures is tapered and has a width that increases along the length of said aperture from a second end to a first end.
41. A fastener retainer assembly for an elongated plate extending between at least two vertebrae, the plate defining a number of openings for insertion of bone engaging fasteners therethrough to secure the plate to the at least two vertebrae, and the plate defining at least one fastener bore, said retainer assembly comprising:
a washer having a central axis and defining at least a firs aperture in communication with said at least one fastener bore, said washer further configured to retain said heads of at least two bone engaging fasteners extending through certain ones of said openings in said plate; and
a locking fastener for said first aperture having an elongated shank extending through said aperture and configured to engage said fastener bore of said plate, said washer being movable along said central axis between a first position whereby said at least two bone engaging fasteners are insertable into certain ones of said openings and a second position whereby washer retains said at least two bone engaging fasteners in said plate.
42. The retainer assembly of claim 41 , wherein said apertures of said washer form slots having a length extending in the direction of the length of the plate.
43. The retainer assembly of claim 42 , wherein each of said apertures include a countersink portion communication with said slot.
44. The retainer assembly of claim 42 , wherein said countersink portion of at least one of said apertures is tapered and has a width that increases along the length of said aperture from a second end to a first end.
45. A method for applying a compressive load to a portion of the spinal column, the spinal column portion including at least a first vertebra and a second vertebra, the method comprising:
engaging a pin to the second vertebra;
placing a sleeve over the pin;
providing a plate having a length extending between a first end and a second end, the plate including a notch on the second end, and a number of openings through the plate;
placing the plate on the spinal column portion with the sleeve nested in the radius of the plate;
fixing the first end of the plate to the first vertebra with bone engaging fasteners extending through the openings positioned over the first vertebra;
removing the sleeve from the pin to form a gap between the pin and the notch;
connecting a compression tool to the pin and the plate; and
applying a compression load to the spinal column portion with the compression tool until the pin contacts the notch.
46. The method according to claim 45 , wherein engaging a pin to the second vertebra includes:
providing a template having a guide surface and a notch;
positioning the template on the second vertebra with the guide surface on an endplate of the second vertebra to locate the notch on the body of the second vertebra;
inserting a pin through the notch of the template into the body of the second vertebra; and
removing the template;
47. The method according to claim 45 , further comprising providing a plate with holes positioned over the first vertebra and slots positioned over the second vertebra.
48. The method according to claim 45 , further comprising retaining the bone engaging fasteners in the plate with a retainer assembly.
49. A method for allowing graft settling in a portion of a spinal column, comprising:
providing a plate having a length between a first end and a second end sized to span at least two vertebra, the plate having a pair of holes at the first end positioned over the first vertebra and a pair of slots at the second end positioned over the second vertebra;
fixing the first end of the plate to the first vertebra with bone engaging fasteners extending through the pair of holes;
securing the second end of the plate to the second vertebra with bone engaging fasteners extending through the pair of slots; and
translating the bone engaging fasteners in the slots to allow settling of the spinal column portion.
50. The method according to claim 49 , further comprising retaining the bone engaging fasteners in the plate with a retainer assembly.
51. The method according to claim 50, wherein the retainer assembly includes a washer having a length substantially corresponding to the length of the plate.
Priority Applications (3)
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US10/771,284 US20040220571A1 (en) | 1998-04-30 | 2004-02-05 | Bone plate assembly |
US11/534,406 US20070203492A1 (en) | 1999-10-13 | 2006-09-22 | Anterior cervical plating system and method |
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CN1183877C (en) | 2005-01-12 |
CN1250172C (en) | 2006-04-12 |
CN1379642A (en) | 2002-11-13 |
US20070203492A1 (en) | 2007-08-30 |
DE60014127D1 (en) | 2004-10-28 |
CN1518960A (en) | 2004-08-11 |
JP2003530141A (en) | 2003-10-14 |
CA2386606C (en) | 2008-04-15 |
AU778601B2 (en) | 2004-12-09 |
CA2386606A1 (en) | 2001-04-19 |
AU7878400A (en) | 2001-04-23 |
JP4402330B2 (en) | 2010-01-20 |
ATE276706T1 (en) | 2004-10-15 |
ES2228616T3 (en) | 2005-04-16 |
EP1220645A1 (en) | 2002-07-10 |
US6533786B1 (en) | 2003-03-18 |
DE60014127T2 (en) | 2005-10-06 |
EP1220645B1 (en) | 2004-09-22 |
WO2001026566A1 (en) | 2001-04-19 |
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